DIABETES MELLITUS: BASIC FACTS
Diabetes mellitus is a condition characterized by high levels of blood sugar (referring to glucose), wherein the body lacks insulin (a hormone produced by the pancreas that controls the blood sugar level) or the body cells are insensitive to insulin, or both.
Glucose is a simple sugar resulting from digestion of food. While the body cells need glucose as primary energy source, insulin moves glucose from the blood into the liver, muscle, and fat cells that use glucose as fuel. When there is inability of the pancreas to secrete any or sufficient insulin, or pancreas overload due to too much sugar ingested over a long period of time, or overcompensatory mechanism (when there is insulin resistance, the pancreas tends to produce more insulin to get the same result, which leads to exhaustion of insulin-producing cells), or a combination of these, there will be resulting deficiency of insulin.
On the other hand, predisposition to insulin resistance has been observed to be an inherited factor. Insulin resistance is also associated with blood lipid imbalances which cause atherosclerosis (fatty buildups in the arteries). Obesity and lack of physical activity are also important risk factors for development of insulin resistance.
When there is not enough insulin or when the body cells are resistant to insulin, over time, glucose builds up in the blood.
TYPES OF DIABETES MELLITUS
The major types of diabetes mellitus are:
1. Type I – which occurs most commonly in childhood or adolescence, thus, also called “juvenile-onset diabetes.” There is destruction of the beta cells of the pancreas (the pancreas is attacked by misdirected abnormal antibodies), which leads to little or no insulin. This is also called “insulin-dependent diabetes” because people with this condition must rely on regular injections of insulin.
2. Type II – which has onset during adulthood, occurring mostly in individuals over 40 years old, thus, also termed “adult-onset diabetes.” The defect may range from predominantly insulin resistant with relative insulin deficiency to a predominantly secretory defect with insulin resistance. This type of diabetes tends to develop more slowly, that is why many people with type 2 diabetes do not know they have it even if it has become a serious condition. This condition is controlled by diet and oral medications, however, insulin is sometimes necessary when treatment with diet and glucose-lowering oral medications are not enough.
3. Gestational diabetes – which develops temporarily during pregnancy, and generally resolves after the baby is delivered. Significant hormonal changes during pregnancy may cause the mother to be less sensitive to the effect of insulin in the body, leading to blood sugar elevation. This requires careful medical supervision during pregnancy because the condition may pose risks to the fetus or mother. Women who have diabetes during their pregnancy also are at a high risk for developing type 2 diabetes later in life.
It is not clear how diabetes mellitus is acquired. But it seems that genetics, diet and age are predisposing factors.
SYMPTOMS
The symptoms of diabetes mellitus are related to elevated blood glucose, and thereby excretion of glucose in the urine.
Classic symptoms are :
1. Frequent urination (polyuria) – more glucose in the blood leads to its excretion in the urine and an increase in the urine output.
2. Excessive thirst (polydipsia) – increased urine output leads to dehydration, and therefore the body compensates by increasing water consumption.
3. Excessive hunger (polyphagia) – increased food cravings because there is a defect in the utilization of glucose in the body.
Other symptoms may include fatigue, nausea, vomiting and weight loss. People who are diabetic are also prone to developing infections of the urinary bladder, skin, or vaginal areas. A patient may also experience blurred vision, numbness in the feet or legs, or slow healing of wounds. However, people with mildly elevated blood sugar may experience no symptoms at all.
Symptoms of ketoacidosis (which is common in type 1 diabetes and is a serious condition) include rapid breathing, abdominal pain, vomiting, extreme lethargy, and drowsiness; also there is a smell of acetone on the patient’s breath.
TESTS TO CONFIRM DIAGNOSIS
The diagnosis of diabetes mellitus is based on the symptoms.
Tests to confirm the diagnosis are :
1. Blood glucose -
a) Fasting blood glucose – testing for fasting blood glucose taken after eight hours of fasting overnight.
The normal fasting plasma glucose levels are less than 100 mg/dL. Fasting plasma glucose greater than 126 mg/dL indicates diabetes. Levels between 100 mg/dL and 126 mg/dL are considered to be risk factors for type 2 diabetes.
b) Random (non-fasting) blood glucose – testing for blood glucose at any time of the day.
Random plasma glucose levels at 200 mg/dL or higher indicate diabetes. Diabetes is suspected if high level is accompanied by the classic symptoms of diabetes. This must be confirmed with fasting blood glucose testing.
c) Oral glucose tolerance test – testing for blood glucose taken before and after two hours following ingestion of thick, sweet syrup of glucose.
The plasma glucose level of 200 mg/dL or higher at two hours confirms the diagnosis of diabetes.
2. Urine test – The test shows the amount of glucose in the urine. This also detects ketones and protein in the urine that may assist in the early diagnosis of ketoacidosis and assess how well the kidneys are functioning, respectively. Urine test is not as accurate as blood testing for the diagnosis of diabetes, however, it is easily performed.
COMPLICATIONS OF DIABETES
Diabetes can cause diseases of small vessels, which can damage the eyes, nerves, kidneys and heart.
The long-term complications of diabetes are:
1. Eye complications – such as retinopathy, cataracts and glaucoma.
2. Nerve damage – can contribute to foot ulcer, impotence in men, diarrhea, etc., depending on the nerves affected.
3. Kidney failure – which, over time, can lead to kidney damage.
4. Heart disease and stroke
MANAGEMENT OF DIABETES
There is no cure for diabetes. However, it can be treated or controlled using medications, exercise and a healthy diet to keep blood glucose within normal range; and preventing long-term complications.
It is important to consult the doctor regarding diabetic treatment.
Oral medications and Insulin
Persons with type 1 diabetes require daily injections of insulin.
Oral medications that lower blood glucose in type 2 diabetes perform any of the following functions: increasing insulin production by the pancreas; helping increase the body cell’s responsiveness to insulin; or delaying absorption of glucose from the gut. When oral medications are insufficient, insulin injection may be required.
Weight
It is important to maintain a reasonable weight by eating the right amount of calories the body needs according to size, age and activity level.
Diet
1. Eat less sugar. Avoid foods high in sugar such as frosted cake, soft drink, sugary foods, etc.
2. Eat less fat. Too much fat will lead to heart and blood vessel disease.
3. Use less salt. This can cause the body to retain water and may also raise blood pressure.
4. Eat fruits and vegetables (especially green, leafy vegetables). They are rich sources of vitamins (vitamins C and E are especially helpful to diabetic patients), antioxidants, and fiber which is vital to diabetic health.
5. Eat high-fiber foods. Whole grains are also important sources of fiber.
Lipid Levels
People with diabetes should also have their cholesterol and triglyceride levels checked regularly. The goal is to keep the low-density-lipoprotein (LDL) cholesterol (“bad cholesterol”) below 100 mg/dL; the high-density-lipoprotein (HDL) cholesterol (“good cholesterol”) not below 40 mg/dL; and the triglycerides (blood fats) ideally maintained below 150 mg/dL.
Blood Pressure
It is recommended that blood pressure for people with diabetes should be lower than 130/80 mm Hg. This lowers the risk of kidney damage, coronary disease and vascular disease.
Foot Care
It is important for people with diabetes to adopt a daily check and care for their feet to avoid development of infections. Feet care includes washing the feet daily with lukewarm water and mild soap, then drying them thoroughly (especially between the toes); softening dry skin with thin coat of skin lotion or petroleum jelly; and cutting toenails straight across to avoid ingrown toenails. Promoting blood circulation in the legs and feet is also important.
Stop Smoking
Cessation of smoking is recommended as this leads to many complications especially for diabetic patients, such as poor blood circulation and increased blood pressure.
(References: Medicinenet.com, HealthAtoZ.com, Americanheart.org, DrLam.com, Medline Plus Medical Encyclopedia, Wikipedia.org, The Diabetes Sourcebook)