➵ Dr Duley on the silent killer
DIABETES: THREE VARIANTS About a million new cases are diagnosed worldwide every year.
It has been estimated that about 66% of adults with diabetes don’t know they have it. And 5% of South Africans are diabetic – that is 2.5 million people.
About a million new cases of diabetes are diagnosed worldwide each year 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 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, 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.
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 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 the age of 45.
It was once called adult-onset diabetes mellitus, or non-insulin-dependent lin-dependent diabetes mellitus.
These hese names are no longer used because Type 2 diabetes does occur in young people, 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 ational diabetes is more likely than other women to develop Type 2 diabetes later in life.
Women with th gestational diabe-tes are more likely to have big 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 a stroke.
Prediabetes can typically be reversed (without insulin or medication) by lifestyle changes, such as losing 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 and maintaining a healthy weight.
Symptoms and signs
► Fatigue
► Unexplained weight loss
► Excessive thirst (polydipsia)
► Excessive urination (polyuria)
► Excessive eating (polyphagia)
► Poor wound healing
► Infections
► Altered mental status
► Blurry vision