About diabetes
Diabetes is an acute or chronic, hereditary or acquired condition characterized by abnormal or excess urine formation that passes through the kidneys. Depending on the presence or absence of glucose in the urine, diabetes is classified into diabetes mellitus and diabetes insipidus. Diabetes mellitus, often known simply as diabetes, is a group of common endocrine disease characterized by sustained high blood sugar levels.Diabetes is due to either the pancreas not producing enough insulin.Diabetes mellitus (DM) is a metabolic disease, involving inappropriately elevated blood glucose levels.A group of diseases that result in too much sugar in the blood (high blood glucose). It develops when your pancreas does not make enough insulin or any at all, or when your body is not responding to the effects of insulin properly. Diabetes affects people of all ages. Most forms of diabetes are chronic (lifelong), and all forms are manageable with medications and/or lifestyle changes.Glucose (sugar) mainly comes from carbohydrates in your food and drinks.Your blood carries glucose to all your body’s cells to use for energy.
When glucose is in your bloodstream.The insulin is a hormone. If your pancreas is not making enough insulin or your body is not using it properly, glucose builds up in your bloodstream, causing high blood sugar (hyperglycemia). Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood glucose. Hyperglycaemia, also called raised blood glucose or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.
Types of diabetes
Based on the presence of glucose in the urine, they are classified into two types, namely:-
- Diabetes insipidus
- Diabetes mellitus
There are several types of diabetes insipidus :-
The types of diabetes insipidus are based on the decrease in antidiuretic hormone (ADH) concentration or its binding abnormality to the kidney cells, they are classified into four types:-
Central diabetes insipidus
Nephrogenic diabetes insipidus
Gestational diabetes insipidus
Dipsogenic diabetes insipidus or psychogenic polydipsia
There are several types of diabetes mellitus. The most common forms include:-
Type 2 diabetes:- A chronic condition that affects the way the body processes blood sugar (glucose).With type 2 diabetes, the body either does not produce enough insulin, or it resists insulin / your body’s cells do not respond normally to the insulin. This is the most common type of diabetes. It mainly affects adults, but children can have it as well.
Type 1 diabetes:– This type is an autoimmune disease, in which your immune system attacks and destroys insulin-producing cells in your pancreas for unknown reasons. A chronic condition in which the pancreas produces little or no insulin.It typically appears in adolescence. It can also occur in children and adolescents depending on how many B-cells of the pancreas are non-functioning.Up to 10% of people who have diabetes have Type 1. It’s usually diagnosed in children and young adults, but it can develop at any age.
Prediabetes:- This type is the stage before type 2 diabetes. Prediabetes means you have a higher than normal blood sugar level. It is not high enough to be considered type 2 diabetes yet. But without lifestyle changes, adults and children with prediabetes are at high risk to develop type 2 diabetes.Your blood glucose levels are higher than normal but not high enough to be officially diagnosed with type 2 diabetes.
Gestational diabetes:- This type develops in some people during pregnancy. It is diabetes diagnosed for the first time during pregnancy (gestation). Like other types of diabetes, gestational diabetes affects how your cells use sugar (glucose). Gestational diabetes causes high blood sugar that can affect your pregnancy and your baby’s health.Gestational diabetes usually goes away after pregnancy. However, if you have gestational diabetes, you are at a higher risk of developing type 2 diabetes later in life.
Other types of diabetes include:
Type 3c diabetes :-This form of diabetes happens when your pancreas experiences damage (other than autoimmune damage), which affects its ability to produce insulin.Pancreatitis, pancreatic cancer, cystic fibrosis and hemochromatosis can all lead to pancreas damage that causes diabetes. Having your pancreas removed(pancreatectomy) also results in type 3c.
Latent autoimmune diabetes in adults (LADA):- Like type 1 diabetes, LADA also results from an autoimmune reaction, but it develops much more slowly than type 1. People diagnosed with LADA are usually over the age of 30.
Maturity-onset diabetes of the young (MODY):- It, also called monogenic diabetes, happens due to an inherited genetic mutation that affects how your body makes and uses insulin. There are currently over 10 different types of MODY. It affects up to 5% of people with diabetes and commonly runs in families.
Neonatal diabetes:– This is a rare form of diabetes that occurs within the first six months of life. It is also a form of monogenic diabetes. About 50% of babies with neonatal diabetes have the lifelong form called permanent neonatal diabetes mellitus. For the other half, the condition disappears within a few months from onset, but it can come back later in life. This is called transient neonatal diabetes mellitus.
Brittle diabetes:- It is a form of type 1 diabetes that’s marked by frequent and severe episodes of high and low blood sugar levels. This instability often leads to hospitalization. In rare cases, a pancreas transplant may be necessary to permanently treat brittle diabetes.
Causes
Causes of diabetes mellitus include:-
Insulin resistance:- Type 2 diabetes mainly results from insulin resistance. Insulin resistance happens when cells in your muscles, fat and liver do not respond as they should to insulin. Several factors and conditions contribute to varying degrees of insulin resistance, including obesity, lack of physical activity, diet, hormonal imbalances, genetics and certain medications.
Autoimmune disease:- Type 1 diabetes and LADA happen when your immune system attacks the insulin-producing cells in your pancreas.
Hormonal imbalances:- During pregnancy, the placenta releases hormones that cause insulin resistance. You may develop gestational diabetes if your pancreas can’t produce enough insulin to overcome the insulin resistance. Other hormone-related conditions like acromegaly and cushing syndrome can also cause type 2 diabetes.
Pancreatic damage:- Physical damage to your pancreas, from a condition, surgery or injury, can impact its ability to make insulin, resulting in Type 3c diabetes.
Genetic mutations:- Certain genetic mutations can cause MODY and neonatal diabetes.
Long-term use of certain medications can also lead to Type 2 diabetes, including corticosteroids and HIV/AIDS medications.
Symptoms
Symptoms of diabetes mellitus include:-
Polyphagia– frequent hunger, especially pronounced hunger
Polydipsia– frequent thirst, especially excessive thirst
Dry mouth
Polyuria– increased volume of urination (not an increased frequency, although it is a common consequence),frequent urination
Fatigue.
Unexplained weight loss
Numbness or tingling in your hands or feet.
Frequent skin and/or vaginal yeast infection
Blurred vision
Restlessness
Poor wound healing (cuts, scrapes, sores etc.)
Dry or itchy skin
Tingling in feet or heels
Erectile dysfunction
Recurrent infection, external ear infections (swimmers ear)
Seizures
Additional details about symptoms per type of diabetes include:
Type 1 diabetes:- Symptoms of T1D can develop quickly – over a few weeks or months. You may develop additional symptoms that are signs of a severe complication called diabetes related ketoacidosis (DKA). DKA is life-threatening and requires immediate medical treatment. DKA symptoms include vomiting, stomach pains, fruity-smelling breath and labored breathing.
Type 2 diabetes and prediabetes:- You may not have any symptoms at all, or you may not notice them since they develop slowly. Routine blood work may show a high blood sugar level before you recognize symptoms. Another possible sign of prediabetes is darkened skin on certain parts of your body (acanthosis nigricans).
Gestational diabetes:- You typically won’t notice symptoms of gestational diabetes. Your healthcare provider will test you for gestational diabetes between 24 and 28 weeks of pregnancy.
Diagnosis
Three tests can measure your blood glucose level:
Fasting blood glucose test:-For this test, you do not eat or drink anything except water (fast) for at least eight hours before the test. As food can greatly affect blood sugar, this test allows you to see your baseline blood sugar.
Random blood glucose test: “Random” means that you can get this test at any time, regardless of if you’ve fasted.
HbA1c:- This test, also called HbA1C or glycated hemoglobin test, provides your average blood glucose level over the past two to three months.
To screen for and diagnose gestational diabetes, providers order an oral glucose tolerance test.
Diabetes diagnostic criteria-
Differential Diagnosis
In addition to T1DM, T2DM, and MODY, any disorder that damages the pancreas can result in DM. There are several diseases of the exocrine pancreas, including:-
Cystic fibrosis
Hereditary hemochromatosis
Pancreatic cancer
Chronic pancreatitis
Hormonal syndromes that can lead to impaired insulin secretion include:-
Pheochromocytoma
Acromegaly
Cushing syndrome
Drug-induced insulin resistance is also in the differential of classical diabetes. These drugs include:-
Phenytoin
Glucocorticoids
Estrogen
Other diseases in the differential of diabetes mellitus include:-
- Gestational diabetes
- Thyroid disorders
Comparison of type 1 and 2 diabetes :-
Management and Treatment
The four main aspects of managing diabetes include:-
Blood sugar monitoring:- Monitoring your blood sugar (glucose) is key to determining how well your current treatment plan is working. It gives you information on how to manage your diabetes on a daily and sometimes even hourly basis. You can monitor your levels with frequent checks with a glucometer and finger stick and/or with a continuous glucose monitor (CGM). You and your healthcare provider will determine the best blood sugar range for you.
Oral diabetes medications:- Oral diabetes medications (taken by mouth) help manage blood sugar levels in people who have diabetes but still produce some insulin, mainly people with Type 2 diabetes and prediabetes. People with gestational diabetes may also need oral medication.
Insulin:- People with type 1 diabetes need to inject synthetic insulin to live and manage diabetes. Some people with type 2 diabetes also require insulin. There are several different types of synthetic insulin. They each start to work at different speeds and last in your body for different lengths of time. The four main ways you can take insulin include injectable insulin with a syringe (shot),insulin pens, insulin pump and rapid acting inhaled insulin.
Diet:- Meal planning and choosing a healthy diet for you are key aspects of diabetes management, as food greatly impacts blood sugar. If you take insulin, counting carbs in the food and drinks you consume is a large part of management. The amount of carbs you eat determines how much insulin you need at meals. Healthy eating habits can also help you manage your weight and reduce your heart disease risk.
Exercise:– Physical activity increases insulin sensitivity (and helps reduce insulin resistance), so regular exercise is an important part of management for all people with diabetes.
Prevention
You can not prevent autoimmune and genetic forms of diabetes.There is no known preventive measure for type 1 diabetes.However, islet autoimmunity and multiple antibodies can be a strong predictor of the onset of type 1 diabetes.Type 2 diabetes,which accounts for 85–90% of all cases worldwide,can often be prevented or delayed by maintaining a normal body weight, engaging in physical activity, and eating a healthy diet.Higher levels of physical activity (more than 90 minutes per day) reduce the risk of diabetes by 28%. Dietary changes known to be effective in helping to prevent diabetes include maintaining a diet rich in whole grains and fiber, and choosing good fats. The relationship between type 2 diabetes and the main modifiable risk factors (excess weight, unhealthy diet, physical inactivity and tobacco use) is similar in all regions of the world. But there are some steps you can take to lower your risk for developing prediabetes, Type 2 diabetes and gestational diabetes including:-
Eat a healthy diet,
Get physically active. Aim for 30 minutes a day at least five days a week.
Work to achieve a weight that’s healthy for you.
Manage your stress
Limit alcohol intake.
Get adequate sleep (typically 7 to 9 hours) and seek treatment for sleep disorders.
Quit smoking
Take medications as directed by your healthcare provider to manage existing risk factors for heart disease.
It is important to note that there are some diabetes risk factors you can not change, such as your genetics/family history, age and race.
Prognosis
The prognosis for diabetes varies greatly depending on several factors, including:-
The type of diabetes.
How well you manage the condition over time and your access to diabetes care.
Your age at diagnosis/how long you’ve had diabetes.
If you have other health conditions.
If you develop diabetes complications.
The prognosis of DM gets significantly influenced by the degree of glucose management. Chronic hyperglycemia significantly increases the risk of DM complications. The diabetes control and complications trial and the united kingdom prospective diabetes study found that individuals with T1DM and T2DM respectively had increased microvascular complications with chronic hyperglycemia. Patients who can revert to normal glucose during the progression from pre-diabetes to frank DM had a good prognosis and may be able to slow disease progression. Chronic high blood sugar can cause severe complications, which are usually irreversible. Several studies have shown that untreated chronic high blood sugar shortens your lifespan and worsens your quality of life.
Diabetes mellitus was the seventh leading cause of death in the United States in 2015. A large number of people with diabetes will die from a heart attack or stroke.
However, it is important to know that you can live a healthy life with diabetes. The following are key to a better prognosis:-
Lifestyle changes.
Regular exercise.
Dietary changes.
Regular blood sugar monitoring.
Studies show that people with diabetes may be able to reduce their risk of complications by consistently keeping their A1c levels below 7%.
Complications
The most acute complication of DM is diabetic ketoacidosis (DKA), which typically presents in T1DM. This condition is usually either due to inadequate dosing, missed doses, or ongoing infection. In this condition, the lack of insulin means that tissues are unable to obtain glucose from the bloodstream. Compensation for this causes the metabolism of lipids into ketones as a substitute energy source, which causes systemic acidosis, and can be calculated as a high anion-gap metabolic acidosis. The combination of hyperglycemia and ketosis causes diuresis, acidemia, and vomiting leading to dehydration and electrolyte abnormalities, which can be life-threatening. In T2DM, hyperosmolar hyperglycemic syndrome (HHS) is an emergent concern. It presents similarly to DKA with excessive thirst, elevated blood glucose, dry mouth, polyuria, tachypnea, and tachycardia. However, unlike DKA, HHS typically does not present with excessive urinary ketones since insulin still gets produced by pancreatic beta cells. Microvascular and macrovascular complications vary according to the degree and the duration of poorly controlled diabetes and include nephropathy, retinopathy, neuropathy, and ASCVD events, especially if it is associated with other comorbidities like dyslipidemia and hypertension. DM is also a common cause of blindness in adults aged 20 to 74 years in the United States. Diabetic retinopathy contributes to 12000 to 24000 new cases of blindness annually, and treatments generally consist of laser surgery and glucose control. Renal disease is another significant cause of morbidity and mortality in DM patients. It is the leading contributor to end-stage renal disease (ESRD) in the United States, and many patients with ESRD will need to start dialysis or receive a kidney transplant.
Long-term diabetes complications :-
Blood glucose levels that remain high for too long can damage your body’s tissues and organs. This is mainly due to damage to your blood vessels and nerves, which support your body’s tissues.
Cardiovascular (heart and blood vessel) issues are the most common type of long-term diabetes complication. They include:-
Coronary artery disease
Heart attack
Stroke
Atherosclerosis
Other diabetes complications include:-
Nerve damage (neuropathy), which can cause numbness, tingling and/or pain.
Nephropathy which can lead to kidney failure or the need for dialysis or transplant.
Retinopathy which can lead to blindness.
Diabetes-related foot conditions.
Skin infections.
Amputations
Sexual dysfunction due to nerve and blood vessel damage, such as erectile dysfunction or vaginal dryness.
Gastroparesis and hearing loss
Oral health issues, such as periodontal.
Living with diabetes can also affect your mental health. People with diabetes are two to three times more likely to have depression than people without diabetes.
Incidence
The incidence of diabetes has been rising significantly worldwide, affecting millions of people. According to the World Health Organization (WHO), approximately 537 million adults were living with diabetes in 2021, and this number is projected to rise to 643 million by 2030. The prevalence of type 2 diabetes, in particular, has been increasing due to factors such as poor diet, lack of physical activity, obesity, and an aging population. Developing countries are witnessing a rapid surge in diabetes cases due to urbanization and lifestyle changes. Diabetes is a serious health condition that can lead to complications like heart disease, kidney failure, nerve damage, and blindness if not managed properly. Public health measures and awareness programs are crucial to controlling this epidemic and promoting early diagnosis and management.
Conclusion
In conclusion, diabetes is a chronic condition that requires lifelong management and awareness. With proper care, including maintaining a balanced diet, regular exercise, blood sugar monitoring, and adherence to prescribed medications, individuals can effectively manage their diabetes and prevent complications. Early diagnosis and proactive management are crucial in minimizing the risks associated with diabetes, such as heart disease, kidney failure, and vision loss. By staying informed, making healthy lifestyle choices, and working closely with healthcare professionals, people with diabetes can lead healthy and fulfilling lives.