Diabetes

Overview

Diabetes Mellitus commonly known as Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.

Over time, having too much glucose in your blood can cause health problems. Although diabetes has no cure, you can take steps to manage your diabetes and stay healthy.

Sometimes people call diabetes “a touch of sugar” or “borderline diabetes.” These terms suggest that someone doesn’t really have diabetes or has a less serious case, but every case of diabetes is serious.

What are the different types of diabetes?

The most common types of diabetes are type 1  (previously known as insulin-dependent, juvenile or childhood-onset) , type 2 (formerly called non-insulin-dependent, or adult-onset), and gestational diabetes.

Type 1 diabetes

If you have type 1 diabetes, your body does not make insulin. Your immune system attacks and destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. People with type 1 diabetes need to take insulin every day to stay alive. Type 1 diabetes is an autoimmune condition. It’s caused by the body attacking its own pancreas with antibodies. In people with type 1 diabetes, the damaged pancreas doesn’t make insulin. This type of diabetes may be caused by a genetic predisposition. It could also be the result of faulty beta cells in the pancreas that normally produce insulin.

Exposure to certain viral infections (mumps and Coxsackie viruses) or other environmental toxins may serve to trigger abnormal antibody responses that cause damage to the pancreas cells where insulin is made. Some of the antibodies seen in type 1 diabetes include anti-islet cell antibodies, anti-insulin antibodies and anti-glutamic decarboxylase antibodies. These antibodies can be detected in the majority of patients, and may help determine which individuals are at risk for developing type 1 diabetes.

Type 2 diabetes

If you have type 2 diabetes, your body does not make or use insulin well. You can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people. Type 2 is the most common type of diabetes. Type 2 diabetes comprises the majority of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity.

In addition to the problems with an increase in insulin resistance, the release of insulin by the pancreas may also be defective and suboptimal. In fact, there is a known steady decline in beta cell production of insulin in type 2 diabetes that contributes to worsening glucose control. (This is a major factor for many patients with type 2 diabetes who ultimately require insulin therapy.) Finally, the liver in these patients continues to produce glucose through a process called gluconeogenesis despite elevated glucose levels. The control of gluconeogenesis becomes compromised.

Gestational diabetes

Gestational diabetes is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes, occurring during pregnancy. However, if you’ve had gestational diabetes, you have a greater chance of developing type 2 diabetes later in life. Sometimes diabetes diagnosed during pregnancy is actually type 2 diabetes.  Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. They and their children are also at increased risk of type 2 diabetes in the future. Gestational diabetes is diagnosed through prenatal screening, rather than through reported symptoms.

Other types of diabetes

Less common types include monogenic diabetes (Neonatal Diabetes Mellitus & MODY), which is an inherited form of diabetes that result from mutations or changes in a single gene. Neonatal diabetes mellitus (NDM) and maturity-onset diabetes of the young (MODY) are the two main forms of monogenic diabetes. NDM occurs in newborns and young infants. MODY is much more common than NDM and usually first occurs in adolescence or early adulthood. Another rare and less common form is cystic fibrosis-related diabetes; which is a unique type of diabetes that is common in people with cystic fibrosis CF.

Impaired Glucose Tolerance and Impaired Fasting Glycaemia

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at high risk of progressing to type 2 diabetes, although this is not inevitable.

Prevalence of Diabetes

Globally, an estimated 422 million adults were living with diabetes in 2014, compared to 108 million in 1980. The global prevalence (age-standardized) of diabetes has nearly doubled since 1980, rising from 4.7% to 8.5% in the adult population. There are 30.3 million people with diabetes (9.4% of the US population) including 23.1 million people who are diagnosed and 7.2 million people (23.8%) undiagnosed. The numbers for prediabetes indicate that 84.1 million adults (33.9% of the adult U.S. population) have prediabetes, including 23.1 million adults aged 65 years or older (the age group with highest rate). The estimated percentage of individuals with type 1 diabetes remains at 5% among those with diabetes.
Diabetes caused 1.5 million deaths in 2012. Higher-than-optimal blood glucose caused an additional 2.2 million deaths, by increasing the risks of cardiovascular and other diseases. Forty-three percent of these 3.7 million deaths occur before the age of 70 years.

Symptoms

Early signs and symptoms of diabetes

  1. The early symptoms of untreated diabetes are related to elevated blood sugar levels, and loss of glucose in the urine. High amounts of glucose in the urine can cause increased urine output (frequent urination) and lead to dehydration.
  2. The dehydration also causes increased thirst and water consumption.
  3. A relative or absolute insulin deficiency eventually leads to weight loss.
  4. The weight loss of diabetes occurs despite an increase in appetite.
  5. Some untreated diabetes patients also complain of fatigue.
  6. Nausea and vomiting can also occur in patients with untreated diabetes.
  7. Frequent infections (such as infections of the bladder, skin, and vaginal areas) are more likely to occur in people with untreated or poorly-controlled diabetes.
  8. Fluctuations in blood glucose levels can lead to blurred vision.
  9. Extremely elevated glucose levels can lead to lethargy and coma.

Symptoms of Type 1 Diabetes

Symptoms of Type 2 Diabetes

Symptoms may be similar to those of type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen.

Treatment for Diabetes

Prevention

Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. To help prevent type 2 diabetes and its complications, people should:

Diagnosis and treatment

Early diagnosis can be accomplished through relatively inexpensive testing of blood sugar.

Treatment of diabetes involves diet and physical activity along with lowering blood glucose and the levels of other known risk factors that damage blood vessels. Tobacco use cessation is also important to avoid complications.

Interventions that are both cost-saving and feasible in developing countries include:

Other cost saving interventions include:

Medications for Nerve Pain due to Diabetes:
The pain of diabetic nerve damage may respond to traditional treatments with certain medications such as gabapentin (Neurontin), phenytoin (Dilantin), and carbamazepine (Tegretol) that are traditionally used in the treatment of seizure disorders. Amitriptyline (Elavil, Endep) and desipramine (Norpraminine) are medications that are traditionally used for depression. The pain of diabetic nerve damage may also improve with better blood sugar control, though unfortunately blood glucose control and the course of neuropathy do not always go hand in hand. Newer medications for nerve pain include Pregabalin (Lyrica) and duloxetine (Cymbalta).

Risk Factors

Risk factors for type 1 diabetes are not as well understood as those for type 2 diabetes. Family history is a known risk factor for type 1 diabetes. Other risk factors can include having certain infections or diseases of the pancreas.

Risk factors for type 2 diabetes and prediabetes are many. The following can raise your risk of developing type 2 diabetes:

Complications

When diabetes is not well managed, complications develop that threaten health and endanger life. Acute complications are a significant contributor to mortality, costs and poor quality of life. Abnormally high blood glucose can have a life-threatening impact if it triggers conditions such as diabetic ketoacidosis (DKA) in types 1 and 2, and hyperosmolar coma in type 2. Abnormally low blood glucose can occur in all types of diabetes and may result in seizures or loss of consciousness. It may happen after skipping a meal or exercising more than usual, or if the dosage of anti-diabetic medication is too high.

Over time, high blood glucose leads to complications such as:

Economic Impact

Diabetes and its complications bring about substantial economic loss to people with diabetes and their families, and to health systems and national economies through direct medical costs and loss of work and wages. While the major cost drivers are hospital and outpatient care, a contributing factor is the rise in cost for analogue insulins which are increasingly prescribed despite little evidence that they provide significant advantages over cheaper human insulins.

Managing Diabetes

The starting point for living well with diabetes is an early diagnosis – the longer a person lives with undiagnosed and untreated diabetes, the worse their health outcomes are likely to be. Easy access to basic diagnostics, such as blood glucose testing, should therefore be available in primary health-care settings. Established systems for referral and back-referral are needed, as patients will need periodic specialist assessment or treatment for complications. For those who are diagnosed with diabetes, a series of cost-effective interventions can improve their outcomes, regardless of what type of diabetes they may have. These interventions include blood glucose control, through a combination of diet, physical activity and, if necessary, medication; control of blood pressure and lipids to reduce cardiovascular risk and other complications; and regular screening for damage to the eyes, kidneys and feet, to facilitate early treatment. Diabetes management can be strengthened through the use of standards and protocols.
Efforts to improve capacity for diagnosis and treatment of diabetes should occur in the context of integrated noncommunicable disease (NCD) management to yield better outcomes. At a minimum, diabetes and cardiovascular disease management can be combined. Integrated management of diabetes and tuberculosis and/or HIV/AIDS can be considered where there is high prevalence of these diseases.

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