Diabetes

Symptoms: Frequent urination (primarily at night), dehydration, sudden weight loss, increased appetite, blurred vision, numbness in limbs, fatigue, dry skin, slow healing sores, highly prone to infections of the gum, skin, and vagina, nausea, stomach ache, vomiting, high level of ketone in urine, weakness, irritability, mood swings 
Causes: sugar build-up in the blood, the pancreas failing to produce sufficient insulin, and other genetic and environmental factors 
Risk Factors: Age, family history, ethnicity, prediabetic conditions, obesity, inactive or sedentary lifestyle

Prevalence: The global diabetes prevalence in 2019 is expected to be 9.3% (463 million people), rising to 10.2% (578 million) by 2030 and 10.9% (700 million) by 2045. The prevalence is higher in urban (10.8%) than rural (7.2%) areas, as well as in high-income (10.4%) than low-income countries (4.0%).
Severity: Mild, moderate, and severe 
Which doctor to consult: Endocrinologist, Diabetologist

Overview

Diabetes mellitus is a disease collection that affects how the body processes blood sugar (glucose). Glucose is an important energy source for muscle and tissue cells. It is also the brain's primary source of fuel.

The primary cause of diabetes varies by type. However, regardless of the type of diabetes, it can cause excess sugar in the bloodstream. Too much sugar in the blood can cause serious health issues.
 

Types of diabetes:

Here’s an overview of the different types of diabetes:

Type 1 Diabetes: This type occurs when the pancreas produces little or no insulin, a hormone that allows glucose to enter cells for energy. It’s often diagnosed in children and young adults and requires daily insulin administration.
Type 2 Diabetes: The most common form of type 2 diabetes arises when the body doesn’t use insulin properly. It can develop at any age and is often associated with obesity and a family history of diabetes.
Gestational Diabetes: This type develops during pregnancy and usually resolves after childbirth. However, it increases the risk of developing type 2 diabetes later in life.
Prediabetes: Characterized by blood sugar levels that are higher than normal but not yet high enough to be classified as diabetes. It raises the risk of developing type 2 diabetes and heart disease.
Secondary Diabetes: This can occur due to other medical conditions, such as pancreatic disease, or as a side effect of certain medications.
Monogenic Diabetes: A rare form caused by mutations in a single gene, affecting insulin production or function.
Each type of diabetes has specific management and treatment approaches, including lifestyle changes, medication, and regular monitoring of blood sugar levels to prevent complications.

Symptoms:

• Increased thirst and urination

• Feeling tired

• Unexplained weight loss

• Blurred vision

• Increased hunger

• Frequent urination

• Sores that don’t heal

• Extreme fatigue

Causes of Diabetes:

Type 1 Diabetes is an autoimmune response in which the body attacks its own insulin-producing cells in the pancreas. The exact cause of this immune response is unclear.
Type 2 Diabetes: This occurs when the body becomes resistant to insulin, leading to sugar buildup in the blood. It’s often linked to obesity, physical inactivity, and genetic factors.
Gestational Diabetes: Caused by insulin-blocking hormones produced by the placenta during pregnancy.
It’s important to note that many people may have no symptoms and remain unaware of their condition. Early diagnosis and management are crucial to prevent complications.

Risk factors:

Diabetes is a complex condition with several risk factors, some of which can be modified through lifestyle changes, while others are non-modifiable. Here’s a breakdown of the risk factors:

Non-modifiable Risk Factors:

• Family history: Having a parent or sibling with diabetes increases your risk.

• Gestational diabetes: If you had diabetes during pregnancy.

• Race or ethnic background: Certain groups, including African Americans, Hispanic Americans, Native Americans, and Asian Americans, are at higher risk.

• Age: The risk increases as you get older, particularly after age 45.

Modifiable Risk Factors:

• Physical activity: Lack of regular exercise can increase your risk.

• Blood pressure: High blood pressure can contribute to the risk of developing diabetes.

• Smoking: Tobacco use can increase blood sugar levels and lead to insulin resistance.

• Diet: A diet high in fat, calories, and cholesterol increases the risk of diabetes.

• Alcohol: Excessive alcohol intake can lead to chronic pancreatitis, which can cause diabetes.

• Sleep: Poor sleep patterns and insufficient sleep can affect blood sugar levels and insulin sensitivity.

• Weight: Being overweight or obese is a significant risk factor.

• Cholesterol levels: High triglyceride levels and low HDL (good) cholesterol contribute to risk.

• Stress and well-being: Long-term stress can affect blood sugar levels.
  Managing these factors, especially the modifiable ones, can help prevent or delay the onset of diabetes. It’s important to consult with healthcare professionals for personalized advice and management strategies. For more detailed information, you can visit the provided sources.

Possible Complications:

• Cardiovascular Complications

If left untreated, diabetes can increase the risk of atherosclerosis. This is a condition where the blood vessels become narrow, causing chest angina, heart attack, and even stroke.

• Retinopathy

Atherosclerosis is also associated with multiple complications, such as diabetic retinopathy. This can cause permanent blindness.

• Neuropathy

Diabetic neuropathy or nerve damage is common in diabetes patients. Due to the high glucose level in the blood, nerves throughout the body can be damaged. But the most prominent outcome is seen in the lower limbs, such as the feet and legs.

• Nephropathy

Shrinking of the blood vessels also impacts the kidneys, which have tiny glomeruli to filter waste from the blood. Since people with diabetes have a fragile filtering system, the high level of ketone can cause further problems, damaging the kidneys permanently.

• Alzheimer’s Disease

Cognitive decline is highly prevalent in diabetes patients. Adult patients with type 2 diabetes are most susceptible to Alzheimer’s, while type 1 patients are likely to develop dementia.

Prevention:

There is no way to prevent type 1 diabetes. However, the same healthy lifestyle choices that help treat prediabetes, type 2 diabetes, and gestational diabetes can also help prevent them.

Consume healthy foods: Choose foods with less fat and calories and more fibre. Prioritize fruits, vegetables, and whole grains. Avoid boredom by eating a variety of foods.
Get more physical activity: On most days of the week, aim for 30 minutes of moderate aerobic activity. Alternatively, aim to get at least 150 minutes of moderate aerobic activity each week. For example, go for a brisk walk every day. If you can't fit in a long workout, split it into smaller sessions throughout the day.

Lose the extra pounds: If you are overweight, losing even 7% of your body weight can reduce your risk of diabetes. For instance, if you weigh 200 pounds (90.7 kilograms), losing 14 pounds (6.4 kilograms) can reduce your risk of diabetes. However, don't try to lose weight while pregnant. Consult your healthcare provider about how much weight you can safely gain during pregnancy.

Make long-term changes to your eating and exercise habits to keep your weight in a healthy range. Remember the advantages of losing weight, such as a healthier heart, increased energy, and higher self-esteem.

When to Consult a Doctor?

You must seek medical help in case of the following conditions:

• On symptoms

When experiencing sudden weight loss, tiredness, and the urge to urinate frequently, it is advised to seek medical consultation. Women, during their pregnancy, must undergo diabetes screening as a routine check-up to ensure the safety of their baby and themselves.

• Urge to vomit

One of the many complications of diabetes is diabetic ketoacidosis. It causes an acid build-up in your bloodstream, known as ketones. The complication can occur very quickly, within 24 hours. You can conduct home blood screening with kits to check the higher sugar and ketone levels in blood and urine. If the ketone level is even moderately high, and there is an urge to vomit, especially while eating or drinking, consult your endocrinologist immediately.

• Regular screening

Regular screening for diabetes is essential, especially after 45 years of age, for both men and women. Procedures include eye exams, foot exams, kidney function tests, dental examinations, and screening for heart diseases. Getting blood pressure checked every three to six months is also essential. Moreover, any sudden change in skin colour, numbness, or swelling can also be a sign of diabetes. One must keep the endocrinologist updated about these changes.

Diagnosis:

• Physical Examination

An endocrinologist can diagnose diabetes type 1 and type 2 by observing the signs and symptoms. However, a physical check-up ensures proper further detection of the type. Also, anyone over the age of 35 must undergo regular blood sugar screening to ensure normal results.

Diagnostic Tests

1. Blood Tests

A blood glucose test is the preliminary and most effective diagnosis for detecting diabetes. It can be done in two ways. A random blood sugar test is done by collecting blood samples at any time. The individual does not need to fast for this test. Ideally, detecting a sugar level of 200mg/dL or higher confirms diabetes.

2. Fasting Blood Sugar Test

The other type is a fasting blood sugar test, where an individual must fast for at least 8-10 hours before the sample collection. Fasting blood sugar levels lower than 100mg/dL is the normal standard. If the sugar level falls between 100 and 125mg/dL, one can be considered prediabetic. A level of more than 126mg/dL on two different tests confirms diabetes.

• Oral Test

There is also an oral test for glucose tolerance for testing diabetes. It measures the body’s response to glucose and is a more effective method of diagnosing type 2 diabetes. The test is also used for screening gestational diabetes during pregnancy. The test helps the endocrinologist understand how the body breaks down glucose after a meal. For testing for type 2 diabetes, one must drink 237ml or eight ounces of a syrupy glucose solution. The blood sugar level will then be measured after two hours.

• Advanced Tests

1. Glycated Haemoglobin (HbA1C) Test

The glycated haemoglobin or HbA1C test is an advanced form of diagnosis which does not require an individual to fast. This test finds the average blood sugar in the last two to three months. This test detects the blood sugar attached to the haemoglobin particles, which carry oxygen to the red blood corpuscles (RBCs). A higher number in this test confirms more haemoglobin molecules are attached to the blood glucose. Ideally, an HbA1C level of 6.5% or higher confirms diabetes, while a range of 5.7%-6.4% is seen in prediabetic people. Anything below 5.7% confirms normalcy.

Treatment:

• Home Care

There are plenty of ways to manage diabetes at home if an individual is not too keen on medication. 

1. Healthy Diet: One of the primary things to do in case of diabetes is to control diet. Eating more fruits and vegetables and eating a high-protein diet is a good start. It is better to avoid refined carbohydrates altogether. Also, one should try consuming whole fruit instead of packaged juice and always check the labels on food packaging to avoid hidden sugar. 

2. Weight Loss: You would be surprised to know that losing just about five to 10% of body weight can produce remarkable results in controlling diabetes. Losing unnecessary weight and fat would also help an individual better manage cholesterol levels and blood pressure. This, in turn, will help avoid further heart complications. 

3. Exercise: Being inactive is a primary cause of diabetes. So, the first thing one needs to do is include at least 30 minutes of exercise every day. It can be a brisk walk, jogging, cycling, swimming, or going to the gym. 

4. Regular Blood Sugar Test: Whether an individual takes medication or not, the doctor will always advise him/her to monitor the blood sugar levels. Regular testing with home kits can give a better idea about the patterns. For instance, it would be easier for the individual to track which activities lower his/her blood sugar level or which food raises it. This can further help in chalking out a clear guideline. 

5. Better Sleep Cycle: A damaged circadian rhythm can aggravate diabetes. Restful sleep is the best way to ensure insulin and blood sugar levels stay normal. Also, it is better to avoid alcohol, caffeine, and spicy foods, as these consumables jeopardise healthy sleep. If a person suffers from sleep apnea, he/she can consult a doctor. Usually, it can be a side effect of type 2 diabetes and can be improved using a CPAP machine.

Medication

Depending on the severity of the condition, it is usually better to opt for medication. Home remedies for diabetes are more of a lifestyle choice and should be included in addition to controlling or avoiding the development of diabetes. But once the condition is developed and severe, insulin therapy is the only feasible solution to keep it under control.

1. Intensive Insulin Therapy: In the case of type 1 diabetes, the human body cannot produce insulin on its own.

Fortunately, insulin is an easily available medication for people affected with type 1 diabetes. Insulin is injected under the skin or directly injected into the bloodstream. There are many types of insulin also. Only an endocrinologist can confirm which type of insulin will work best for the diabetic person. However, insulins can be categorised into the following types:

• Short-acting insulin 

• Rapid-acting insulin

• Combination or premixed insulin

• Ultra-long-acting insulin

2. Amylinomimetic Injectables: The drug category amylinomimetics (Pramlintide) treats type 1 and type 2 diabetes. It is given to patients in whom insulin is ineffective. The medication slows the time taken by the stomach to empty itself and reduces the secretion of glucagon post-meal. The medicine is also known to curb appetite.

3. Alpha-glucosidase Inhibitors: Alpha-glucosidase inhibitors (Acarbose, Miglitol, Voglibose) inhibit the carbohydrate-digesting enzymes in the small intestine, reducing carbohydrate absorption. This includes controlling enzymes like sucrase, glucoamylase, isomaltase, and maltase. It is best to consume alpha-glucosidase before meals.

4. Biguanides: Biguanides (Metformin, Phenformin) reduce the production rate of glucose and the absorption of glucose in the intestine. Instead, they help in the absorption of glucose by the muscles, making the body more reactive to insulin medication.

• Surgical Treatment

In case of severe diabetes and other diabetic complications arising, there are a few treatment options available.

1. Bariatric Surgery: Bariatric or weight-loss surgery is an effective treatment method for diabetes type 2 patients. It helps obese people with a higher BMI by controlling the sugar level in the blood. The most common type of bariatric surgery is the duodenal switch, which can help reduce the risk of diabetes from worsening or causing severe complications.

2. Pancreas Transplant: For severe insulin-dependent diabetic patients, a pancreas transplant is often the only solution. Since the pancreas fails to produce insulin in type 1 diabetes, this can help patients, as their body once again can produce its own insulin.

3. Islet Transplant: The islet cell transplant most effectively treats type 1 diabetes patients. The treatment helps reduce the occurrence of hypoglycaemia, where the glucose level reduces significantly in the blood.

Additional Information

• Stages of Type-1 Diabetes

Both Type 1 and Type 2 diabetes have been known to develop in the following stages:

1. Stage 1 defines the presence of β-cell autoimmunity with two or more islet antibodies with normoglycemia

2. Stage 2 develops with dysglycemia 

3. Stage 3 confirms the onset of symptomatic diabetes

• Effect of Smoking on Diabetes

Controlling diabetes can become even more challenging if an individual has a smoking habit. This is due to nicotine, which can raise the level of blood sugar. Smokers tend to require a higher insulin dose to check their blood sugar levels.