We often hear about Diabetes or one of our family member has it and we tend to understand that it has something to do with the sugar level in our body.
Often times, we will hear somebody say that we should be mindful of our sugar intake if we have a family history of Diabetes or that we should cut down on sugar or carbohydrates to correct and treat Diabetes.
It is in this article that we will talk about more about Diabetes, how do we get it and, if we have it, how do we manage it. To know more about treatment and management, we should understand why we have it and the precipitating factors why we are predisposed to having it.
What is Diabetes Mellitus?
Diabetes is a chronic disease that is characterised by increased level of sugar in the bloodstream. When we consume food, it is broken down to macronutrients like carbohydrates, fats and proteins.
Carbohydrates are then broken down to simple sugars, proteins into amino acids and fats into fatty acids. This will signal the pancreas to produce insulin.
Insulin serves as the key to transport the glucose into the cell and this will be used up as a form of energy necessary for the cell to perform its function.
If you are diabetic, you either have impaired insulin production or you can’t utilise the insulin that is being produced by your pancreas. This will lead to an increased level of glucose in the blood which can cause serious health damage to the body.
Types of Diabetes
There are several types of Diabetes
Type 1 Diabetes
This is an auto immune disease. In an auto immune disease, our body typically develops an auto immune response to a virus that enters our body.
In Type 1 Diabetes, our immune response to the virus is inappropriate because of the presence of susceptibility genes (these are not limited to Type 1 Diabetes but also present in other auto-immune diseases such as Systemic Lupus Erythematosus, Rheumatoid Arthritis, Ciliac Disease).
Antibodies produced in the body attack the beta cells of the pancreas which are responsible for the production of insulin.
There is a general decrease of the beta cells because of the antibodies and the level of insulin decreases significantly and this will lead to an increase in the glucose level in the blood.
This increase of glucose in the blood is known as Type 1 Diabetes.
Type 2 Diabetes
Unlike Type 1 Diabetes, this is not an auto-immune disease but is caused by Metabolic Syndrome.
You may wonder what Metabolic Syndrome is. It is generally characterised by the following criteria:
- Fasting Glucose level greater than or equal to 100mg/dL
- HDL level – for female less than or equal 50mg/dL and for male less than or equal to 40mg/dL
- Triglycerides level greater than or equal to 150mg/dL
- High Basal Metabolic Rate – for female higher or equal to 35 and for male higher or equal to 40
- Blood pressure of higher or equal to 130/80
The person who has these criteria is known to be suffering from Insulin Resistance. It has been studied that Metabolic Syndrome can be influenced by genetics and ethnicity.
Due to a high amount of glucose in the blood, the beta cells capacity to produce insulin is diminished resulting to very limited amount of insulin that can transport glucose into the cell.
When glucose level rise in the blood stream this is known as Type 2 Diabetes.
Gestational Diabetes
This type of Diabetes is associated with pregnancy. There is a high glucose level during the pregnancy but normally disappears after giving birth.
Pregnant women who are obese or with high BMI might have developed insulin resistance that cause increased level of glucose in the blood
What are the symptoms of Diabetes?
These are the cardinal signs of Diabetes:
Weight Loss
In Diabetes, there is a low level of insulin causing the transport of glucose into the cell to be inefficient. The cell does not get enough fuel and will not be able to synthesise ATP (energy of the cell). This will make the body utilise other forms of fuel such as body fats and proteins and muscles causing tissue wasting and unexplained weight loss.
Polyphagia
Term used to describe excessive eating or hunger.
When the body utilises body fats, muscles and proteins as the source of fuel, because there’s not enough glucose going inside the cell, the brain is stimulated and the hunger centre is activated. This will send a signal to the body that it needs to eat to compensate for the caloric loss the body is undergoing from burning fats and proteins.
Polyuria
Due to high glucose level in the body, glucose gets filtered in the kidney tubules and are present in high amount.
Reabsorption of water is diminished and more glucose will be excreted in the urine (glycosuria). Glucose will attract more water because it is osmotically active and will then result to more urine being excreted from the kidneys.
Polydipsia
Medical term used to describe excessive thirst.
Since there is a large amount of urine being excreted and high amount of glucose in the blood stream, your blood volume starts to decrease. This will cause a hyperosmolar blood and will then stimulate the brain to think that the body needs to replenish the water lost and will cause increased thirst.
How do you diagnose Diabetes?
Diagnosing Diabetes requires blood tests that can be carried out by your GP. These are tests that measure blood sugar and will help your doctor diagnose if you are Diabetic.
Fasting Blood Tests
This is widely used to diagnose Diabetes. This will require you to fast for at least eight hours before the blood test is carried out.
You are not allowed to eat nor drink, except for water. This is easiest done if you fast overnight and have the blood test early in the morning.
2 Hour Glucose Tolerance Test
This blood test is mainly used to diagnose Gestational Diabetes.
This test involves giving a sweetened drink to stimulate insulin response of the body. In Diabetic people, since they have developed Insulin Resistance, glucose level will still be high on two tests after a sweetened drink.
Hemoglobin A1C
This is the main test used to diagnose Diabetes. No preparation is needed for this and they will have to take blood samples to check blood sugar levels for the last two or three months.
Risk Factors for Type 2 Diabetes
It is important to familiarise ourselves with the risk factors for Type 2 Diabetes to be able to know what we can do to avoid having it.
Here is a list of the Risk Factors for Type 2 Diabetes:
- Ethnicity – 2 to 4 times more likely to develop in Black African, African-Caribbean and South Asian descent
- Age – Over 40 are more pre-disposed to having Type 2 Diabetes
- Family History – you are 2 to 6 times more likely to get it if you have a family history of Diabetes
- Obesity – More likely to develop Diabetes if you are overweight or with truncal or abdominal obesity
- Hypertension – if you consistently have high blood pressure, your chance of developing Diabetes is higher
- Sedentary Lifestyle – lacking of regular exercise will pre-dispose you to having Diabetes
- Alcohol – since alcohol contains calories and can cause insulin resistance, increased consumption will increase the chance of you getting this disease
Treatment for Diabetes
Diabetes Mellitus is a disorder showing high amount of blood glucose that can be the result of impaired insulin production (Type 1 Diabetes) or development of insulin resistance (Type 2 Diabetes).
Here are several treatment for Diabetes:
Insulin Therapy
Insulin, being a polypeptide, can be used for both Type 1 and Type 2 to manage blood glucose level. This is administered through sub-cutaneous injections.
There are several types of insulin: Rapid or Fast Acting, Intermediate Acting and Long Acting Insulin.
Oral Medications
Tablets and medications that stimulates the pancreas to produce insulin. Common medications are Metformin and Sitagliptin
Islet Cell Transplant
This surgical intervention is done for Type 1 Diabetic patients. This will prevent the diabetic person from suffering from hypoglycaemic episodes.
Lifestyle Change
Having a healthy lifestyle meaning eating healthy food and regular exercise can lead to weight loss and decrease insulin resistance.
If you are experiencing the symptoms mentioned above, it is important to contact your GP to be able to carry out the tests necessary to diagnose Diabetes.
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