A to Z of diabetes mellitus
VARIETY: THERE ARE THREE MAJOR FORMS OF THE DISEASE, TYPE 1, TYPE 2 AND GESTATIONAL
About one million new cases are diagnosed each year worldwide.
It has been estimated that about 66% of adults with diabetes do not know they have diabetes. Currently, 5% of South Africans are diabetic. That is 2.5 million people. About one million new cases of diabetes are diagnosed each year worldwide and diabetes is the direct or indirect cause of at least 200 000 deaths each year.
The incidences of type 1 diabetes and type 2 diabetes are increasing rapidly.
This is due to many factors, but the most significant reasons for type 2 diabetes are the increasing incidence of obesity associated with sedentary lifestyles.
Diabetes mellitus is a chronic or lifelong condition that affects your body’s ability to use the energy found in food.
There are three major types of diabetes: type 1 diabetes, type 2, and gestational diabetes.
All types of diabetes mellitus have something in common. Normally, your body breaks down the sugars and carbohydrates you eat into a special sugar called glucose. Glucose fuels the cells in your body. But the cells need insulin, a hormone, in your bloodstream in order to take in the glucose and use it for energy.
With diabetes mellitus, either your body doesn’t make enough insulin or it can’t use the insulin it does produce, or a combination of both.
Since the cells can’t take in the glucose, it builds up in your blood. High levels of blood glucose can damage the tiny blood vessels in your kidneys, heart, eyes, or nervous system. That’s why diabetes, especially if left untreated, can eventually cause heart disease, stroke, kidney disease, blindness, and nerve damage in the feet.
Types of diabetes Type 1 diabetes
The body stops producing insulin or produces too little insulin to regulate blood glucose level. This type affects about 5% of all people with diabetes. It is typically diagnosed during childhood or adolescence. It used to be referred to as juvenile-onset diabetes or insulin-dependent diabetes mellitus. This insulin deficiency can also occur in adulthood due to destruction of the pancreas by alcohol, disease, or removal by surgery. Type 1 diabetes also results from progressive failure of the pancreatic beta cells, the only cell type that produces significant amounts of insulin. People with type 1 diabetes require daily insulin injections to sustain life.
Type 2 diabetes
Although the pancreas still secretes insulin, the body of someone with type 2 diabetes is partially or completely incapable of responding to insulin. This is often referred to as insulin resistance.
The pancreas tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they fail to secrete enough insulin to cope with their body’s demands.
It is typically diagnosed during adulthood, usually after age 45. It was once called adult-onset diabetes mellitus, or non insulin dependent diabetes mellitus.
These names are no longer used because type 2 diabetes does occur in young people and even children, and some people with type 2 diabetes require insulin therapy.
Type 2 diabetes is usually controlled with diet, weight loss, exercise, and/or oral medications.
However, more than half of all people with type 2 diabetes will require insulin to control their blood sugar levels at some point during the course of their illness if they do not respond to lifestyle changes and/or oral medication.
Gestational diabetes
This form of diabetes occurs during the second half of pregnancy.
Although gestational diabetes typically resolves after delivery of a baby, a woman who develops gestational diabetes is more likely than other women to develop type 2 diabetes later in life.
Women with gestational diabetes are more likely to have large babies.
Prediabetes
This is quite a common condition related to diabetes. In people with prediabetes, the blood sugar level is higher than normal but not yet high enough to be considered diagnostic of diabetes.
Prediabetes increases a person’s risk of developing type 2 diabetes, heart disease, or stroke.
Prediabetes can typically be reversed (without insulin or medication) by lifestyle changes, such as losing a modest amount of weight and increasing physical activity levels.
Weight loss can prevent, or at least delay, the onset of type 2 diabetes.
Approximately 20% more adults are now believed to have this condition and may develop diabetes within 10 years unless they change to healthier lifestyles, such as exercising more and maintaining a healthy weight.
Causes of type 1 diabetes
Type 1 diabetes is an autoimmune disease. The body’s immune system specifically attacks the cells in the pancreas that produce insulin.
A predisposition to develop type 1 diabetes may run in families, but genetic causes (a positive family history) are much more common for type 2 diabetes.
Environmental factors, including common and unavoidable viral infections, may also contribute to type 1 diabetes. Type 1 diabetes is slightly more common in men than in women.
Causes of type 2 diabetes
Type 2 diabetes has strong genetic links, so type 2 diabetes tends to run in families.
Several genes have been linked to type 2 diabetes, and many are under study related to type 2 diabetes.
However, lifestyle plays a major role in type 2 diabetes and the following are the risk factors: High blood pressure. High triglyceride (fat) levels in the blood.
Gestational diabetes or giving birth to a baby weighing more than 4kg.
High sugar and carbohydrate diet. High alcohol intake. Sedentary lifestyle. Obesity or being overweight.
Family history, particularly when a close relative had type 2 diabetes or gestational diabetes.
Aging: Increasing age is a significant risk factor for type 2 diabetes.
Risk begins to rise significantly at about age 45 and rises considerably after age 65.
Symptoms and signs
Type 1 diabetes is usually recognised in childhood or early adolescence, often in association with an injury or illness (such as a virus or urinary tract infection).
The extra stress can cause diabetic ketoacidosis. Symptoms of ketoacidosis include nausea and vomiting. Dehydration and often serious disturbances in blood levels of potassium and other factors follow. Without treatment, ketoacidosis can lead to coma and death.
Symptoms of type 2 diabetes are often subtle and may be attributed to aging or obesity. A person may have type 2 diabetes for many years without knowing it. Type 2 diabetes can be precipitated by steroids and stress. If not properly treated, type 2 diabetes can lead to complications such as blindness, kidney failure, heart disease and nerve damage.
Common symptoms of both type 1 and type 2 diabetes include:
Fatigue, or feeling constantly tired: In diabetes, the body is inefficient and sometimes unable to use glucose for fuel. The body switches over to metabolising fat, partially or completely, as a fuel source. This process requires the body to use more energy.
Weight loss: People with diabetes are unable to process many of the calories in the foods they eat.
Thus, they may lose weight even though they eat an apparently appropriate or even an excessive amount of food.
Losing sugar and water in the urine and the accompanying dehydration also contributes to weight loss.
Excessive thirst (polydipsia): A person with diabetes develops high blood sugar levels, which overwhelms the kidney’s ability to reabsorb the sugar as the blood is filtered to make urine.
Excessive urine is made as the kidney spills the excess sugar. The body tries to counteract this by sending a signal to the brain to dilute the blood, which translates into thirst.
The body encourages more water consumption to dilute the high blood sugar back to normal levels and to compensate for the water lost by excessive urination.
Excessive urination (polyuria): Another way the body tries to rid the body of the extra sugar in the blood is to excrete it in the urine.
This can lead to dehydration because a large amount of water is necessary to excrete the sugar.
Excessive eating (polyphagia): If the body can, it will secrete more insulin in order to try to manage the excessive blood sugar levels.
With type 2 diabetes, the body resists the action of insulin.
One function of insulin is to stimulate hunger. Therefore, higher insulin levels lead to increased hunger.
Poor wound healing: High blood sugar levels prevent white blood cells, which are important in defending the body against bacteria and also in cleaning up dead tissue and cells, from functioning normally.
When these cells do not function properly, wounds take much longer to heal and become infected more frequently.
Long-standing diabetes also is associated with thickening of blood vessels, which prevents good circulation, including the delivery of enough oxygen and other nutrients to body tissues.
Infections: Certain infections such as frequent yeast infections of the genitals, dental infections, skin infections, and frequent urinary tract infections may result from suppression of the immune system by diabetes and by the presence of glucose in the tissues, which allows bacteria to grow.
Altered mental status: Agitation, unexplained irritability, inattention, extreme lethargy, or confusion can all be signs of very high blood sugar, ketoacidosis or hypoglycemia (low sugar). Any of these in a diabetic patient merits the immediate assessment of blood glucose.
Blurry vision: Blurry vision is not specific for diabetes but is frequently present with high blood sugar levels.
Diabetes mellitus is a chronic or lifelong condition.