Definition :

Diabetes mellitus (DM) is a set of related diseases in which the body cannot regulate the amount of sugar (specifically, glucose) in the blood.

The blood delivers glucose to provide the body with energy to perform all of a person’s daily activities.

 

  • The liver converts the food a person eats into glucose. The glucose is then released into the bloodstream.

 

  • In a healthy person, the blood glucose level is regulated by several hormones, primarily insulin. Insulin is produced by the pancreas, a small organ between the stomach and liver. The pancreas also makes other important enzymes released directly into the gut that helps digest food.
  • Insulin allows glucose to move out of the blood into cells throughout the body where it is used for fuel.
  • People with diabetes either do not produce enough insulin (type 1 diabetes) or cannot use insulin properly (type 2 diabetes), or both (which occurs with several forms of diabetes).
  • Several forms of diabetes involve the inability to both produce or use insulin properly. Persons with diabetes are unable to move glucose from their blood into their cells. The result is that the glucose remains in their blood, and damage occurs to the cells that need glucose for energy to perform activities, as well as harming tissues and organs that are exposed to increased amounts of glucose that has not been sent to the cells it should have gone to.

Type 1 Diabetes:

Type 1 Diabetes occurs when the body produces insufficient amounts of insulin, or stops producing insulin altogether; the body does not produce enough insulin to regulate the amount of glucose in the person’s blood. Approximately ten-percent of persons with diabetes in America have Type 1 Diabetes, and it is commonly recognized in people when they are in childhood or during their teenage years. Former names for Type 1 Diabetes include, ‘Juvenile-Onset Diabetes,’ and, ‘Insulin-Dependent Diabetes Mellitus.’ Persons who are older can develop Type 1 Diabetes due to destruction of their pancreas. Things such as damage caused by disease or alcohol, or having the pancreas removed during surgery, or a progressive failure of pancreatic beta cells that produce insulin can cause Type 1 Diabetes. Persons with this form of diabetes need insulin treatment on a daily basis in order to remain alive.

Type 2 Diabetes:

Type 2 Diabetes occurs when a person’s body becomes either partially, or completely, unable to use insulin. Their pancreas may still secrete insulin, but they have become what the medical field refers to as, ‘Insulin-Resistant.’ Their body attempts to fight this resistance by producing even more insulin. A person who is insulin-resistance develops Type 2 Diabetes once they cannot continue to secrete enough insulin to meet the body’s demands.

Approximately ninety-percent of persons with diabetes have Type 2 diabetes, which is usually recognized when the person is an adult; commonly when they are over forty-five years of age. Other names this form of diabetes has been known by include, ‘Non-Insulin Dependent Diabetes Mellitus,’ or, ‘Adult-Onset Diabetes Mellitus.’ These other names are no longer appropriate because persons who are younger have this form of diabetes, and persons with Type 2 diabetes may also need to use insulin. Control of Type 2 Diabetes usually involves weight loss, diet, oral medications, and exercise.

Gestational Diabetes:

Gestational Diabetes occurs when a woman is approximately halfway through pregnancy. Women who have this form of diabetes are more likely to have larger babies than women who do not have Gestational Diabetes. Women who experience Gestational Diabetes often find that it simply goes away, once they have delivered the baby, although women who have this form of diabetes are more likely to develop Type 2 Diabetes at a later point in their life.

Metabolic Syndrome:

Metabolic Syndrome involves a series of abnormalities, of which Type 2 Diabetes is a part. The syndrome involves not only Type 2 Diabetes, but high fat levels in the person’s blood, hypertension, decreased HDL cholesterol, elevated LDL cholesterol, blood clotting, inflammatory responses, and central obesity. Metabolic Syndrome has a high rate of Cardiovascular Disease associated with it, and is also referred to as, ‘Syndrome X.’

Pre-Diabetes:

Pre-Diabetes is a condition that is related to Diabetes that has the potential to be reversed through both weight loss and exercise, which can prevent Type 2 Diabetes from occurring. Pre-Diabetes increases a person’s risk of not only developing Type 2 Diabetes, but their risk of either a stroke, or heart disease. Persons with Pre-Diabetes experience blood sugar levels which are higher than they should be, yet are not high enough to be considered either Type 1 or Type 2 Diabetes.

Approximately one-third of the adults in North America who have diabetes are unaware that they have it. Around seventeen million adults in North America are aware that they have Diabetes, and one-million people each year are diagnosed with diabetes. Diabetes is found to be either the direct cause or a contributing factor in two-hundred thousand deaths each year, and the numbers of persons being diagnosed with diabetes is increasing rapidly. Obesity and sedentary lifestyles are among many reasons why diabetes is increasing.

Causes:

To understand the causes we must know how glucose is normally processed in the body.
How Glucose normally works:

Glucose is a main source of energy for the cells that make up your muscles and other tissues. Glucose comes from two major sources: the food you eat and your liver. During digestion, sugar is absorbed into the bloodstream. Normally, sugar then enters cells, with the help of insulin.The hormone insulin comes from the pancreas, a gland located just behind the stomach. When you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a key, unlocking microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.

Your liver acts as a glucose storage and manufacturing center. When you haven’t eaten in a while your liver releases stored glucose to keep your glucose level within a normal range.

 

Causes of Type 1 Diabetes:

In type 1 diabetes, your immune system — which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream. Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what those factors are is still unclear.

Causes of PreDiabetes and  Type 2 Diabetes:

In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells, sugar builds up in your bloodstream. Exactly why this happens is uncertain, although as in type 1 diabetes, it’s believed that genetic and environmental factors play a role in the development of type 2. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight.

Causes of  Gestational Diabetes:

During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin. As your placenta grows larger in the second and third trimesters, it secretes more of these hormones — making it even harder for insulin to do its job.Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can’t keep up. When this happens, too little glucose gets into your cells and too much stays in your blood. This is gestational diabetes.

Symptoms:


 

Diabetes symptoms vary depending on how high your blood sugar is elevated. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. In type 1 diabetes, however, symptoms tend to come on quickly and be more severe. Some of the signs and symptoms of type 1 and type 2 diabetes include:

  • Increased thirst

 

  • Frequent urination

 

  • Extreme hunger

 

  • Unexplained weight loss

 

  • Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there’s not enough insulin)

 

  • Fatigue

 

  • Blurred vision

 

  • Slow-healing sores

 

  • Mild high blood pressure

 

  • Frequent infections, such as gum or skin infections and vaginal or bladder infections

Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence. Type 2 diabetes, the most common type, can develop at any age and is often preventable.

 

Diagnosis:

Tests to diagnose diabetes include:

  • Fasting blood glucose testblood glucose levels are checked after fasting for between 12 and 14 hours. You can drink water during this time, but should strictly avoid any other beverage. Patients with diabetes may be asked to delay their diabetes medication or insulin dose until the test is completed.

 

  • Random blood glucose test – blood glucose levels are checked at various times during the day, and it doesn’t matter when you last ate. Blood glucose levels tend to stay constant in a person who doesn’t have diabetes.

 

  • Oral glucose tolerance testa high-glucose drink is given. Blood samples are checked at regular intervals for two hours.

 

The most common test for diagnosis of diabetes is the fasting blood glucose test. Glucose tolerance tests are used when the results of the fasting blood glucose are borderline. They are also used to diagnose diabetes in pregnancy (gestational diabetes). A blood sugar test can also be required for some other diagnostics.

 

Complications:

Persons with diabetes should have regular checkups to check for signs of complications caused by diabetes. Their regular health care provider can do many of these checks, others may need to be done by a specialist. The checks that need to be done include having their eyes checked at least once a year by an eye specialist to look for Diabetic Retinopathy. The persons urine needs to be checked on a regular basis; at least two or three times a year, because protein in their urine may be a sign of Nephropathy.

Health care providers can check the sensation in a person with diabetes legs using a tuning fork or monofilament device to check for Diabetic Neuropathy. They can also check the person’s lower legs and feet for things like blisters, cuts, scrapes or other lesions that may become infected. Persons with diabetes need regular screening for high cholesterol and high blood pressure, which can contribute to heart disease.

 

Diabetes  Self  Care  at  Home:

Diet:

A healthy diet is the key to control of blood sugar levels in persons with diabetes, and in the prevention of complications of diabetes. Persons who are overweight and having difficulty losing weight can work with their health care provider to find a dietician, or a weight modification program to help them reach their goal weight. Eating a consistent and well-balanced diet which is low in saturated fat and concentrated sweets, as well as high in fiber, in about the same number of calories at the same times each day is the best thing. Doing so helps the person’s health care provider to prescribe appropriate doses of either insulin or medication, and helps to keep blood sugar levels fairly even – as well as helping to avoid dangerously high or low blood sugar levels.

Exercise:

Regular exercise, in any form, can help reduce the risk of developing diabetes. Activity can also reduce the risk of developing complications of diabetes such as heart disease, stroke, kidney failure, blindness, and leg ulcers.

  • As little as 20 minutes of walking three times a week has a proven beneficial effect. Any exercise is beneficial; no matter how easy or how long, some exercise is better than no exercise.

 

  • If the patient has complications of diabetes (such as eye, kidney, or nerve problems), they may be limited both in type of exercise, and amount of exercise they can safely do without worsening their condition. Consult with your health care professional before starting any exercise program.

 

Alcohol use:

Moderate or eliminate consumption of alcohol. Try to have no more than seven alcoholic drinks in a week, and never more than one or two drinks in an evening. One drink is considered 1.5 ounces of liquor, 6 ounces of wine, or 12 ounces of beer. Excessive alcohol use is a known risk factor for type 2 diabetes. Alcohol consumption can cause low or high blood sugar levels, nerve pain (neuritis), and an increase in triglycerides.

 

Smoking:

If the patient has diabetes, and smokes cigarettes or use any other form of tobacco, they are raising the risks markedly for nearly all of the complications of diabetes. Smoking damages blood vessels and contributes to heart disease, stroke, and poor circulation in the limbs. If a person needs help to quit tobacco use, talk to a health care professional.

 

Blood Sugar Monitoring:

Persons with diabetes need to check their blood sugar levels often. It is recommended that they check their blood sugar before meals, and before going to bed. They should record their blood sugar levels in a logbook, which also includes either insulin or medication doses and the times they were taken, what they have eaten and at what times, the exercise they have done, and any issues related to diabetes that were significant. A logbook provides highly useful information that a health care provider can use to see how the person is responding to treatment and other planning.

Medical Treatment of Diabetes:

People are treated for diabetes individually depending on the type of diabetes they have. The form of treatment a health care worker provides also depends on whether or not the person has additional complications from diabetes and their general health at the time they are diagnosed. Treatment of diabetes involves lifestyle changes and blood sugar control, and creation of a plan to meet treatment goals.

Persons who have just been diagnosed with diabetes will often times find a care team spending a great deal of time educating them about the condition and its treatment, along with everything the person needs to know in regards to caring for themselves daily. The team includes not only a health care provider and their staff members; but specialists involved with eye care, foot care, Neurology, Diabetes Education, and a Professional Dietician. The team interacts with the person who has diabetes at appropriate intervals to check on their progress and goals. Education is essential for persons with all types of diabetes.

 

Treatment for type 1 Diabetes:

 

Treatment of Type 1 Diabetes nearly always involves daily injections of insulin, usually in the form of a combination of short acting insulin. Insulin cannot be taken orally; if it were, the insulin would be destroyed in the person’s stomach before it would be distributed in their bloodstream, which is where it is needed. The majority of persons with Type 1 Diabetes administer insulin injections to themselves. If someone else gives the person with diabetes their insulin injections, it is still important that the person with diabetes know how to administer the injection themselves in the event that another person is unavailable.

Persons with diabetes learn how to inject insulin from a trained professional, who will also show them how to store insulin; usually a Nurse who works with their health care provider, or diabetes educator. People with Type 1 Diabetes commonly inject insulin two or three times daily, usually around meal times. The amount of insulin they use depends on their individual needs as determined by their health care provider. There are some longer acting forms of insulin that are usually injected once or twice a day. Some persons with Type 1 Diabetes have the insulin they take administered continuously through an infusion pump in order to receive adequate control of their blood glucose levels.

If a person has taken insulin it is important that they eat because insulin will lower their blood sugar level whether they have eaten or not. If the person has taken insulin and not eaten, they risk hypoglycemia, also referred to as an, ‘Insulin Reaction.’ While persons with Type 1 Diabetes are learning how insulin affects them there is a period of time where they are adjusting. The adjustment period includes how different meals and exercise, as well as insulin affect them and their blood sugar levels.

It is important to learn to keep blood sugar levels as even as possible. Equally important is maintaining an accurate record of the person’s insulin dosages and blood sugar levels; health care providers will need this information in order to provide treatment and management of diabetes for them. Pursuing a consistently healthy diet that is right for their weight and size is just as important in the effort to control the person’s blood sugar levels.

 

Treatment of Type 2 Diabetes:

 

Persons with Type 2 Diabetes may have the opportunity to lower their blood sugar levels without the need for medication, if their HbA1c test results warrant this opportunity. Losing weight and exercising are the best ways to lower blood sugar levels in persons with Type 2 Diabetes. If a person with this type of diabetes is presented with this opportunity, they may have from three to six months before their blood sugar and HbA1c test is checked again. If the blood sugar levels are still high in the results, the person will start taking oral diabetes medication to control blood sugar levels.

While on oral medication for Type 2 Diabetes, it is important to lose weight if the person is overweight, eat a healthy diet, and pursue appropriate exercise. The person’s health care provider will monitor their progress while they are taking oral medication closely after they have started taking it to ensure that the proper dose is being administered, and to make sure that side-effects are at a minimum.

The person’s health care provider may choose to combine two forms of medication in order to achieve blood sugar levels that are within an appropriate range. Over time, persons with Type 2 Diabetes may need insulin injections in order to achieve control of blood sugar levels. It is now becoming more common for persons with Type 2 Diabetes to use a combination of insulin injections and medication to control their blood sugar levels.

Diabetes Medication for Type 2 Diabetes:

 

There are several types of medication commonly used to treat type 2 diabetes:

  • Sulfonylureas: Stimulate your pancreas to make more insulin.

 

  • Biguanides :Decrease the amount of glucose made by your liver.

 

  • Alpha-glucosidase inhibitors: Slow the absorption of the starches you eat.

 

  • Thiazolidinediones: Make you more sensitive to insulin.

 

  • Meglitinides: Stimulate your pancreas to make more insulin.

 

  • D-phenylalanine :Help your pancreas make more insulin quickly.

 

  • Combination oral medicines: A combination of different types of pills.