Diabetes

Diabetes mellitus refers to a collection of conditions marked by increased blood sugar levels. This spike is often due to issues related to insulin production or functionality. While diabetes can lead to severe health challenges and early mortality, proactive steps can help manage and mitigate these risks.

Distinguishing the Four Main Types of Diabetes

1. Type 1 Diabetes:
   • Formerly known as insulin-dependent diabetes mellitus or juvenile-onset diabetes.
   • Contributes to 5-10% of diagnosed diabetes cases.
   • The causes intertwine with autoimmune reactions, genetic predispositions, and environmental triggers.
2. Type 2 Diabetes:
   • Previously termed non-insulin dependent diabetes mellitus or adult-onset diabetes.
   • Makes up roughly 90-95% of diagnosed diabetes instances.
   • Risk elements include advanced age, obesity, diabetes in the family, past experiences with gestational diabetes, imbalanced glucose tolerance, lack of physical activity, and certain racial or ethnic backgrounds.
3. Gestational Diabetes:
   • Appears in 2-5% of pregnancies and typically vanishes post-pregnancy.
   • Higher prevalence among obese individuals.
   • Past sufferers of gestational diabetes might have an increased probability of type 2 diabetes onset.
4. Other Specific Diabetes Types:
   • Emerges from unique genetic conditions, surgeries, medications, malnutrition, infections, or other diseases.
   • These account for 1-2% of total diabetes diagnoses.

Potential Complications of Diabetes

• Cardiovascular Concerns:

  • Diabetes raises the risk of heart diseases, with sufferers facing 2-4 times the mortality risk from heart-related conditions than non-diabetics.

• Stroke:

  • Diabetic individuals have a 2-4 times heightened stroke risk.

• Elevated Blood Pressure:

  • Approximately 60-65% of diabetics grapple with high blood pressure issues.

• Vision Impairments:

  • Leading cause of blindness in adults aged between 20 and 74.
  • Causes 12,000-24,000 new blindness cases annually due to diabetic retinopathy.

• Renal Issues:

  • Major contributor to end-stage kidney diseases.

• Nervous System Ailments:

  • 60-70% experience varying nerve damage degrees, leading to sensations in extremities, digestion issues, and more.

• Amputations:

  • Over half of the lower limb amputations in the U.S. involve diabetes patients.

• Dental Health:

  • Increased gum diseases leading to potential tooth loss, especially in type 1 diabetics.

• Pregnancy Complications:

  • Varies based on the care received during the preconception phase.

• Other Risks:

  • Conditions like diabetic ketoacidosis and hyperosmolar nonketotic coma can be life-threatening.
  • Diabetics may also face a heightened risk from other illnesses, including respiratory ones like pneumonia and flu.

New Diagnostic Criteria for Diabetes

The latest diagnostic approach for diabetes has been updated:

• The primary test for diabetes diagnosis is the fasting plasma glucose test, but physicians might opt for the oral glucose tolerance test in specific situations.
• A confirmed fasting plasma glucose level ≥ 126 mg/dL denotes diabetes.
• When diabetes symptoms are evident, a confirmed nonfasting plasma glucose level ≥ 200 mg/dL also denotes diabetes.
• If the oral glucose tolerance test is selected (involving 75 grams of glucose dissolved in water), a plasma glucose concentration ≥ 200 mg/dL after 2 hours confirms diabetes.
• The criteria for diagnosing gestational diabetes in pregnant women differ.
• Abnormal test results must be reconfirmed on a separate day, except in particular situations.

Diabetes Treatment

Every day brings advancements in diabetes understanding, treatment, and prevention. The primary goal is to maintain near-normal blood glucose levels. Self-management training is crucial. Each treatment is tailored to the individual, addressing medical, psychosocial, and lifestyle concerns.

• Type 1 Diabetes Treatment: As the pancreas doesn't produce insulin due to the destruction of beta cells, this form can be challenging. Treatment includes a meticulous diet, planned exercise, home blood glucose monitoring, and multiple insulin shots daily.
• Type 2 Diabetes Treatment: The mainstays of treatment are diet, exercise, home blood glucose testing, oral medication, or insulin. Roughly 40% of type 2 diabetes patients need insulin injections.

Impaired Fasting Glucose

This is a new diagnostic category for those with fasting plasma glucose levels between 110-125 mg/dL. These levels are higher than normal but not enough to diagnose diabetes. Efforts are on to identify those at risk of developing diabetes from this group.

Insulin Explained

Insulin, produced by pancreatic beta cells, helps the body process glucose from meals. Those with type 1 diabetes lack this production, necessitating insulin injections. Individuals with type 2 diabetes produce insulin, but their bodies don't utilise it effectively, leading to the need for diabetes pills or insulin injections. Insulin injections are necessary as oral intake would degrade it, rendering it ineffective. Over 20 insulin types are available, differing in onset, peak time, duration, and cost.

Pills for Type 2 Diabetes

The primary treatment is meal planning, weight management, and exercise. When these measures fall short, medicines that reduce blood sugar levels become necessary, either in pill form or as insulin injections.

How Diabetes Pills Work?

While type 1 diabetes patients don't produce insulin, those with type 2 diabetes either don't produce enough or their cells resist it. Current diabetes pills fall into three categories:

1. Insulin Release Stimulators: Sulfonylurea drugs, in use since the 1950s, are taken before meals to stimulate insulin release. Repaglinide, a short-acting variant, is taken before meals and might cause hypoglysemia.
2. Insulin Sensitisers: Metformin aids insulin function, mostly in the liver. Glitazones like rosiglitazone and pioglitazone improve insulin function in muscles and fat. Be wary of fluid retention with litazones.
3. Starch & Sugar Breakdown Blockers: Acarbose and meglitol are alpha-glucosidase inhibitors, which slow down the blood sugar level rise after meals by inhibiting starch and some sugar breakdowns. They might cause gas and diarrhoea.