Diabetes mellitus often simply referred to as diabetes is a disease in which your blood glucose, or sugar, levels are too high, as a result of the body either not producing enough insulin, or because body cells do not properly respond to the insulin that is produced. Insulin is a hormone produced in the pancreas which enables body cells to absorb glucose, to turn into energy. If the body cells do not absorb the glucose, the glucose accumulates in the blood (hyperglycemia), leading to various potential medical complications.
Diabetes Causes
Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.
To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested:
* A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
* An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.
People with diabetes have high blood sugar. This is because:
* Their pancreas does not make enough insulin
* Their muscle, fat, and liver cells do not respond to insulin normally
* Both of the above
Diabetes Types
There are many types of diabetes, the most common of which are:
* Type 1 diabetes: results from the body's failure to produce insulin, and presently requires the person to inject insulin.
* Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency.
* Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM.
Type 1 diabetes
Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas leading to insulin deficiency. This type of diabetes can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, where beta cell loss is a T-cell mediated autoimmune attack.
Type 1 diabetes is usually diagnosed in childhood. Many patients are diagnosed when they are older than age 20.Daily injections of insulin are needed. The exact cause is unknown. Genetics, viruses, and autoimmune problems may play a role.
Type 2 diabetes
Type 2 diabetes mellitus is characterized by insulin resistance which may be combined with relatively reduced insulin secretion. Type 2 diabetes is the most common type.
It usually occurs in adulthood, but young people are increasingly being diagnosed with this disease. The pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to insulin.
In the early stage of type 2 diabetes, the predominant abnormality is reduced insulin sensitivity. At this stage hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver. As the disease progresses, the impairment of insulin secretion occurs, and therapeutic replacement of insulin may sometimes become necessary in certain patients.
Gestational diabetes
Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2%–5% of all pregnancies and may improve or disappear after delivery. Gestational diabetes is fully treatable but requires careful medical supervision throughout the pregnancy. About 20%–50% of affected women develop type 2 diabetes later in life.
Even though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations. Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. Hyperbilirubinemia may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A cesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.
Other types
Pre-diabetes indicates a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. Many people destined to develop type 2 diabetes spend many years in a state of pre-diabetes which has been termed "America's largest healthcare epidemic,"
Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization when the current taxonomy was introduced in 1999.
Diabetes Symptoms
High blood levels of glucose can cause several problems, including:
* Blurry vision
* Excessive thirst
* Fatigue
* Frequent urination
* Hunger
* Weight loss
However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.
Symptoms of type 1 diabetes:
* Fatigue
* Increased thirst
* Increased urination
* Nausea
* Vomiting
* Weight loss in spite of increased appetite
Patients with type 1 diabetes usually develop symptoms over a short period of time. The condition is often diagnosed in an emergency setting.
Symptoms of type 2 diabetes:
* Blurred vision
* Fatigue
* Increased appetite
* Increased thirst
* Increased urination
Diabetes Treatment
The immediate goals are to treat diabetic ketoacidosis and high blood glucose levels. Because type 1 diabetes can start suddenly and have severe symptoms, people who are newly diagnosed may need to go to the hospital.
The long-term goals of treatment are to:
* Prolong life
* Reduce symptoms
* Prevent diabetes-related complications such as blindness, heart disease, kidney failure, and amputation of limbs
These goals are accomplished through:
* Blood pressure and cholesterol control
* Careful self testing of blood glucose levels
* Education
* Exercise
* Foot care
* Meal planning and weight control
* Medication or insulin use
There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms.
LEARN THESE SKILLS
Basic diabetes management skills will help prevent the need for emergency care. These skills include:
* How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)
* What to eat and when
* How to take insulin or oral medication
* How to test and record blood glucose
* How to test urine for ketones (type 1 diabetes only)
* How to adjust insulin or food intake when changing exercise and eating habits
* How to handle sick days
* Where to buy diabetes supplies and how to store them
After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems. Review and update your knowledge, because new research and improved ways to treat diabetes are constantly being developed.
SELF-TESTING
If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a number of devices available, and they use only a drop of blood. Self-monitoring tells you how well diet, medication, and exercise are working together to control your diabetes. It can help your doctor prevent complications.
The American Diabetes Association recommends keeping blood sugar levels in the range of:
* 80 - 120 mg/dL before meals
* 100 - 140 mg/dL at bedtime
Your doctor may adjust this depending on your circumstances.
WHAT TO EAT
You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. A registered dietician can help you plan your dietary needs.
People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugar from becoming extremely high or low.
People with type 2 diabetes should follow a well-balanced and low-fat diet.
HOW TO TAKE MEDICATION
Medications to treat diabetes include insulin and glucose-lowering pills called oral hypoglycemic drugs.
People with type 1 diabetes cannot make their own insulin. They need daily insulin injections. Insulin does not come in pill form. Injections are generally needed one to four times per day. Some people use an insulin pump. It is worn at all times and delivers a steady flow of insulin throughout the day. Other people may use inhaled insulin. See also: Type 1 diabetes
Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth. There are several types of medicines used to lower blood glucose in type 2 diabetes. See also: Type 2 diabetes
Medications may be switched to insulin during pregnancy and while breastfeeding.
Gestational diabetes may be treated with exercise and changes in diet.
EXERCISE
Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than those who do not exercise regularly.
Here are some exercise considerations:
* Always check with your doctor before starting a new exercise program.
* Ask your doctor or nurse if you have the right footwear.
* Choose an enjoyable physical activity that is appropriate for your current fitness level.
* Exercise every day, and at the same time of day, if possible.
* Monitor blood glucose levels before and after exercise.
* Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise.
* Carry a diabetes identification card and a cell phone in case of emergency.
* Drink extra fluids that do not contain sugar before, during, and after exercise.
You may need to change your diet or medication dose if you change your exercise intensity or duration to keep blood sugar levels from going too high or low.
FOOT CARE
People with diabetes are more likely to have foot problems. Diabetes can damage blood vessels and nerves and decrease the body's ability to fight infection. You may not notice a foot injury until an infection develops. Death of skin and other tissue can occur.
If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations.
To prevent injury to the feet, check and care for your feet every day.
Possible Complications
Emergency complications include:
* Diabetic hyperglycemic hyperosmolar coma
* Diabetic ketoacidosis
Long-term complications include:
* Atherosclerosis
* Coronary artery disease
* Diabetic nephropathy
* Diabetic neuropathy
* Diabetic retinopathy
* Erection problems
* Hyperlipidemia
* Hypertension
* Infections of the skin, female urinary tract, and urinary tract
* Peripheral vascular disease
* Stroke
Source:health.nytimes
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