DIABETES

When the level of blood glucose or blood sugar is too high, this condition is referred to as Diabetes. Blood glucose is the main source of your energy; it comes from the food you consume. After you food intake, normally glucose from the food reaches your cells with the help of Insulin, a hormone produced by pancreas. However, glucose may not get into your cells and stay back in your blood when your body

  • does not produce adequate quantities of insulin or
  • is unable to produce insulin at all or
  • does not use insulin effectively

Over a period, high glucose levels in blood may cause serious health conditions. Diabetes does not have a cure, however the condition shall be effectively managed and one shall stay healthy with preventive measures.

Types Of Diabetes

The most common types of diabetes are:

  • Type 1 Diabetes
  • Type 2 Diabetes
  • Gestational Diabetes

Type 1 Diabetes

Type 1 diabetes is diagnosed when insulin producing cells in pancreas are attacked and destroyed by your immune system and your body does not make insulin and hence, it is also referred to as insulin-dependent diabetes.

Type 1 diabetes is diagnosed at a young age. Mostly, it affects children and young adults; hence, it is also called as juvenile diabetes or early-onset diabetes. In rare instances, it may affect adults as well.

Though type 1 diabetes is not so common as type 2, approximately 10% of all diabetes cases are of type 1.

Type 2 Diabetes

Type 2 diabetes is diagnosed when your body does not produce adequate insulin or does not use insulin effectively. Though people of all age groups can develop type 2 diabetes, often the middle-aged and the older people are more susceptible. It is the most common diabetes type; approximately 90% of diabetes cases are of type 2.

Losing excess weight, followin a healthy diet, monitoring blood glucose levels, and regularly doing exercises may help some patients control their type 2 diabetes, especially when diabetes has just been diagnosed. As type 2 diabetes is a progressive disease, patients will have to take insulin (normally in tablet form) when the disease gets worse.

Gestational Diabetes

During pregnancy, some women develop gestational diabetes. In most cases, after childbirth, this diabetes goes away. If it is left undiagnosed or uncontrolled, it causes complications to the mother and/or the baby.

Having diagnosed with gestational diabetes:

  • Is an indication that you are at a high risk of developing type 2
  • May actually turn out to be a type 2 diabetes

Other Types Of Diabetes

The diabetes listed below are less commonly occuring:

  • Monogenic diabetes, an inherited form of diabetes
  • Cystic fibrosis-related diabetes

Pre-Diabetes

Pre-diabetes is diagnosed when your blood sugar levels are on the higher side of the permissible range but not high enough to be diagnosed as diabetes. Nowadays, it is becoming more common; it also increases the risk of type 2 diabetes to a greater extent.

Symptoms Of Diabetes

The more common symptoms of diabetes are shown in the image below:

Diabetes symptoms are plenty in number and they vary from person to person. Common symptoms of diabetes include:

  • Increased thirst, hunger, and urination
  • Nausea or vomiting
  • Fatigue and drowsiness
  • Breathing deeper and faster
  • Blurred vision
  • Numbness and/or tingling in the feet and/or hands
  • Decreased healing of wounds, sores or bruises
  • Dry and itchy skin
  • Unexplained weight loss
  • Frequent or recurring infections of skin, gum, bladder and vagina (yeast infections)

As diabetes progresses, it may damage internal organs such as eyes, kidneys, respiratory system, and cardiovascular system. The image below shows the diabetes symptoms that one may observe when it is already progressing.

Type 1 diabetes symptoms develop within weeks.  Whereas type 2 diabetes symptoms takes several years to develop and are so mild that one may not even notice them. Type 2 diabetes patients also develop insulin resistance symptoms such as high blood pressure, fluctuations in cholestrol levels, skin darkening around neck and in armpits, irregular menstruation among teens and adults.

When diabetes is left untreated, the blood sugar levels may shoot up so high and a condition known as Diabetic Ketoacidosis may develop. In such circumstances, one may develop symptoms such as abdominal pain, vomiting, shortness of breath, dehydration, and even coma; if left untreated, it could be fatal.

Causes And Risk Factors Of Diabetes

Type 1 Diabetes

When your immune system attacks and destroys beta cells of pancreas that produce insuline, sugar in your bloodstream is not transported to individual cells. As a result, sugar level increases in blood causing type 1 diabetes.

It is unclear which factors cause type 1 diabetes. Researchers believe it to be a combination of genetic and environmental factors.

Risk factors of type 1 diabetes include family medical history, pancreatic diseases, and in general, infections and illnesses.

Type 2 Diabetes

In Type 2 diabetes and in some cases of the pre-diabetes that can lead to type 2 diabetes, your body cells become resistant to insulin. When the produced insulin is inadequate, instead of moving to body cells, sugar builds up in bloodstream.

Though the exact cause is unknown, it is thought that both genetic factors and environmental factors play major role. The most common, known causes and risk factors of Type 2 diabetes is shown in the image below.

The risk factors of type 2 diabetes are:

  • Weight: Being obese or overweight or having lots of belly fat, which may cause your body to release chemicals that can destabilize the cardiovascular and metabolic systems
  • Age: being 45 years old or more
  • Family history: Having close relatives with a history of diabetes
  • Ethnicity: Being an asian american, african american, american indian, alaska native, native hawaiian, hispanic/latino, or pacific islander
  • Blood pressure: Having high blood pressure
  • Cholesterol level: Having low levels of HDL cholesterol and high levels of triglycerides
  • Gestational diabetes: Having a history of gestational diabetes
  • Medical conditions: Having heart disease, stroke, mental depression, PCOS (polycystic ovaries syndrome), or acanthosis nigricans; men with low testosterone levels
  • Lifestyle: Being physically inactive and not following a healthy diet

Gestational Diabetes

To sustain pregnancy, placenta produces certain hormones that increases insulin resistance of body cells. Occasionally, extra insulin produced by pancreas become inadequate and as result too little glucose only reaches cells leaving behind a lot in bloodstream causing gestational diabetes.

The risk factors of gestational diabetes are excess weight, glucose intolerance, ethnicity, family history, and age.

Other Causes Of Diabetes

Genetic Mutations

Mutations or changes in gene cause Monogenic Diabetes. These changes can be passed by inheritance or caused on its own. These genetic changes reduce insulin production in pancreas. The most common monogenic diabetes are maturity-onset diabetes and neonatal diabetes.

Damage To Pancreas

Cystic fibrosis cause scarring in pancreas. As a result, pancreas produce inadequate insulin.

Hemochromatosis is a disease where the body stores too much iron. Such iron buildup damages pancreas.

Trauma and diseases such as pancreatitis and pancreatic cancer can harm the beta cells of pancreas and drastically reduce insulin production causing diabetes. If there is severe damage, pancreas may be removed and as a result diabetes will onset due to lack of insulin.

Hormonal Diseases

Certain hormonal diseases cause insulin resistance and diabetes. They are:

  • Cushing’s syndrome: excessive cortisol production
  • Acromegaly: excessive growth hormone production
  • Hyperthyroidism: excessive thyroid hormone production

Medicines

Certain medications such as anti-seizure drugs, certain types of diuretics, and psychiatric drugs, can harm beta cells of pancreas or disrupt the functioning of insulin.

Diagnosis Of Diabetes

Your health care provider can diagnose diabetes, pre-diabetes, and gestational diabetes through blood tests. These tests show if your blood sugar is too high.

Do not try to diagnose yourself if you think you might have diabetes. Over-the-counter testing equipments such as, a blood glucose meter, cannot diagnose diabetes.

To check for diabetes, your doctor may request one or more of these tests:

Test Name

Test Description

Fasting Plasma Glucose (FPG) or

Fasting blood sugar test

This test is done after 8 hours of fasting. Usually, this test is done in the morning and blood sugar is measured.

100mg/dL to 125.99mg/dL – Pre Diabetic

126mg/dL or higher              – Diabetic 

Oral Glucose Tolerance Test (OGTT)

During this test, you’re asked to drink a glass of water with 75 gms of glucose dissolved in it. After two hours, blood sugar is measured.

200mg/dL or higher              – Diabetic

Random blood sugar test

This test helps to findout your average blood sugar levels in the past 3 months. Your doctor shall consider your age and verify for any other conditions in your blood before prescribing the test.

5.7% to 5.9 %                          – Pre Diabetic

6.5% or higher                        – Diabetic

A1C test

This test helps to findout your average blood sugar levels in the past 3 months. Your doctor shall consider your age and verify for any other conditions in your blood before prescribing the test.

5.7% to 5.9 %                          – Pre Diabetic

6.5% or higher                        – Diabetic

Glucose challenge test

Mostly this test is prescribed for pregnant women. No fasting is required. You are asked to drink a sweet beverage containing glucose. After 1 hour blood sugar levels are measured. If the levels are too high (135mg/dL to 140mg/dL), you are prescribed an OGTT with fasting.

The image below illustrates the blood sugar levels that indicate different types of diabetes:

Additional Diagnosis for Diabetes

Certain conditions require additional testing or repetitive testing:

  • Type 1 Diabetes: You may be prescribed to test for certain auto-antibodies that may be attacking your cells and tissues.
  • Gestational diabetes: Having gestational diabetes means that you are at greater risk of having type 2 diabetes later in your life. In some cases, it eventually is a type 2 diabetes that got diagnosed during the pregnancy. Hence, 6-12 weeks after the childbirth, you may be prescribed to get your blood glucose levels tested.

Complications of Diabetes

Diabetes is a progressive disease. The longer you have diabetes, higher are the risks of complications. Complications could be either disabling or fatal. The image below illustrates some of the complications that one may expect to have with prolonged diabetes.

Most common diabetic complications include:

  • Cardiovascular Diseases: Heart attack, coronary artery disease with chest pain, stroke, and narrowing of arteries.
  • Nerve Damage (neuropathy): Injury to capillary walls, that supply the nerves, especially in legs
  • Kidney Damage (nephropathy): Damage to glomeruli, blood vessel clutter that purifies blood
  • Eye Damage (retinopathy): Cataract, glaucoma, damage to retinal blood vessels, diabetic retinopathy, and blindness
  • Foot Damage. Nerve damage in the feet (poor blood flow to the feet often lead to further complications) and untreated cuts and blisters develop infections, does not heal fully, and may lead to amputation
  • Skin Conditions: More susceptible to skin problems such as, bacterial and/or fungal infections
  • Hearing Impairment
  • Alzheimer’s Disease: Increased risk of Alzheimer’s disease due to type 2 diabetes

Complications of Gestational Diabetes

Complications in Babies

Your baby is at a greater risk of having the complications listed below:

  • Excess growth: When you have gestational diabetes, exess glucose in your blood may reach your baby across the placenta. This shall trigger baby’s pancreas to produce excess insulin and the baby shall grow too large.
  • Low blood sugar: As your baby’s pancreas produce more insulin, occasionally these babies develop hypoglycemia (low blood sugar) soon after they are born.
  • Diabetes: Babies of mothers with gestational diabetes may develop type 2 diabetes later in their life.
  • Death: Gestational diabetes, if left untreated, could be fatal for babies either before or immediately after they are born.

Complications in Mothers

Having gestational diabetes may increase the risk of complications listed below in mothers:

  • Preeclampsia. A condition with high blood pressure, excess protein in urine, and swelling in the legs, especially in feet.
  • Subsequent gestational diabetes: Having had gestational diabetes in one pregnancy, increases the risk of having it again during subsequent pregnancies.

Treatment of Diabetes

Preventive lifestyle modifications, constant monitoring, and medications play major role in diabetes treatment. The treatment plan differs for different types of diabetes.

Altering your Lifestyle

Making few changes in your current lifestyle and strictly following certain healthy habbits are mandatory when you are diagnosed with diabetes.

  • Healthy weight: You may need to understand what and how much to eat in order to maintain a healthy weight. A dietitian can help you reach your health goals while considering your food preferences.
  • Physical activity: Exercise helps sugar to move into your cells and lowers the blood sugar. It also increases your body’s insulin sensitivity and your insulin requirement also comes down. Hence it is of great importance that you make physical activity as part of your daily routine. However, it is advisable to get your doctor’s approval before choosing your exercise routine.

Medical Treatment

Your treatment plan changes according to the type of diabetes. The image below explains the outline of treatment plans for type 1 and type 2 diabetes.

Monitoring Your Blood Sugar

Carefully monitoring blood sugar is the key to maintain good health. Based on your treatment plan:

  • The number of times you may need to check your blood sugar level varies from few times a week to multiple times a day
  • If you are receiving insulin therapy, you may be asked to use a continuous glucose monitor.

Even with careful monitoring, the blood sugar levels may exceed your target range. Consult your doctor and learn how food, illness, medications, hormone levels, physical activity, or alcohol can impact your blood sugar levels.

Your doctor may recommend regular A1C testing to measure your average blood sugar level in order to evaluate your diabetes treatment plan.

Insulin

For type 1 diabetes, insulin therapy is mandatory. For type 2 and gestational diabetes, your doctor may recommend insulin therapy, if needed.

For insulin therapy:

  • Your doctor may recommend one or more insulin types, such as rapid-acting insulin and long-acting insulin
  • You may need to inject insulin throughout day and night
  • You need to inject insulin by using a fine needle, syringe, or insulin pen device
  • You may need to use a insulin pump, which you can wear and inject insulin through a catheter. You can also use tubeless and wireless insulin pump.

Oral Or Other Medications

Other oral or injectable medications for diabetes help you by:

  • Stimulating your pancreas to release more insulin
  • Inhibiting the release of glucose from liver
  • Blocking activity of stomach and intestine enzymes, which break down carbohydrates and increase insulin sensitivity.

Transplantation

In rare occasions, for type 1 diabetic patients whose blood sugar levels are beyond control and who also need a kidney transplant, a pancreas transplant is recommended.

Treatment Procedure

Though the treatment plan for different types of diabetes differs largely, the treatment procedure remains the same across. The image below explains the general treatment procedure for diabetes:

It is mandatory to monitor your blood glucose level, if it is adviced by your doctor. Our specialists at Shanghai SKY Clinic recommend  OneTouch UltraEasy Glucometer to monitor the blood glucose. The details are given in the image below:

Please contact us to refill you test strips and medications.