Diabetes

                                              Diabetes Mellitus

Diabetes is a chronic disease which is characterized by high blood sugar level due to defects in insulin action, insulin secretion or both. Insulin is a hormone secreted by pancreas and helps in the regulation of body blood sugar. A person become diabetic either when the pancreas does not produce sufficient amount of insulin or when the body cells not responding properly to insulin. The increase level of blood sugar can cause many serious health problems. 

Types

Diabetes are classified into three main types;

  1. Type 1 diabetes (formerly referred as insulin dependent diabetes mellitus/juvenile diabetes) is a type of diabetes in which very little or no insulin produced by pancreas due to pancreatic beta cells destruction. This type of diabetes affects people at any age but mostly appears during childhood and adolescence.
  2. Type 2 diabetes (formerly called insulin independent diabetes mellitus) is occur when the body cells not responding properly to insulin secreted by pancreas. Type 2 diabetes is the most common type of diabetes and it is estimated about 90% of all diabetes cases worldwide. Among many causes of type 2 diabetes the most important ones are genetics and life style (like lack of exercise, unhealthy diet and obesity) The combine effect of these two factors can trigger insulin resistance in type 2 diabetes.  
  3. Gestational diabetes is another type in which hyperglycemia (high blood sugar) occurs in pregnant without previous history of diabetes. The hormone secreted by placenta during pregnancy causes body cells resistance to insulin.

Symptoms

The symptoms of diabetes are differed and depending on how much your blood sugar is raised. In the beginning of the prediabetes and type 2 diabetes some people may not experience any diabetes symptom. The people affected by type 1 diabetes shows the symptoms very quickly and be more severe. The following sign and symptoms are occurred in type 1 and 2 diabetes:

  • Polydipsia (increase thirst)
  • Polyuria (frequent urination)
  • Increase in appetite
  • Fatigue
  • Irritability 
  • Unexplained weight loss
  • Blurred vision
  • Slow-healing sores
  • Presence of ketones in urine
  • Gums and skin infections


Risk factors 

The diabetes risk factors depend on the type of diabetes.

Type 1 diabetes risk factors

The exact reason of type 1 diabetes is unknown, but some factors may signal a high risk including;

  • Family history
  • Environmental factors
  • Autoantibodies
  • Geography 

Type 2 diabetes

It is difficult to understand for the researcher that why some people develop diabetes and other don´t but following factors high the risk of type 2 diabetes:

  • Excessive body weight
  • Physical inactivity
  • Family history
  • Polycystic ovary syndrome
  • Abnormal level of triglyceride and cholesterol 
  • Older age
  • Race (like blacks, American Indian, Hispanics and Asian-Americans. 

Gestational diabetes

Risk factor are:

  • Family history
  • Age 
  • Weight (overweight before pregnancy)
  • Race (the reason is unknown but gestational diabetes develop in black, Asian and Hispanic women are more likely to)

Diagnosis

The diagnosis of diabetes is based on patient symptoms along with laboratory investigation which consists on;

Glucose measurement 

  • Fasting (a person is considered diabetic if fasting blood sugar is 7 mmol/L (126mg/dl) or higher) 
  • Random (when blood sugar level is 11.1 mmol/L (200mg/dl) or higher indicate diabetes)
  • Oral glucose tolerance test (in this test a patient drinking sugary liquid and then measuring of sugar levels periodically for next 2 hours. When the blood sugar level is higher than 11.1mmol/L (200mg /dl) after 2 hours suggest diabetes)
  • Hb1Ac (when the values of HbA1c test is 6.5 % or higher indicated diabetes)

Other laboratory tests including 

  • Insulin measurement
  • Fructosamine
  • Glycated albumin 
  • Microalbumin 
  • C-peptide.

Treatment and management

  • Healthy diet (fresh fruits, vegetables, food with more fiber, whole grains, low-fat dairy products and legumes (lentils, peas and beans)
  • Regular physical activity (everyone needs to do at least 30 – 60 minutes of moderate (15 to 30 minutes of energetic) aerobic exercise. It is good to move around a bit every 30 minutes)
  • Weight loss 
  • Monitoring blood sugar level 
  • Insulin therapy (type 1 diabetes and many type 2 and gestational diabetic patient need insulin for survive)
  • Oral or other medication (such as Metformin, sulfonylureas, Meglitinides, DPP-4 inhibitors, GAL-1receptor agonists, GLP-1 receptor agonists and SGLT2 inhibitors)
  • Bariatric surgery (people with BMI more than 35 may get benefit from this kind of surgery)

Complications

With over time the uncontrol diabetes causes many serious complications such as cardiovascular disease (atherosclerosis, stroke, heart attack and coronary artery disease with angina), Neuropathy (the nerve damage occur because of the increase amount of sugar in the blood can damage the walls of capillaries that nourish nerves). Nephropathy (kidney damage), retinopathy (eye damage), skin problems (susceptible to fungal and bacterial infections), foot damage, depression and increase risk of dementia (like Alzheimer´s disease), vitiligo, edema and limited joint mobility.   

Prevention

By changing lifestyle may help in diabetes prevention. Some of the following tips are given by American diabetes association 

  • More physical activity
  • Take plenty of fiber
  • Go for whole grains
  • Loss of extra weight
  • Avoid fad diets and make healthier choices
  • Avoid tobacco use (smoking increases the risk of cardiovascular and diabetes disease)

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