Diabetes Facts
What is diabetes? It is a chronic condition, characterized by excessive amounts of blood sugar or glucose. Its full name is diabetes mellitus, although for the remainder of this paper the commonly used name diabetes will be used. When there is too much glucose in the blood – a condition known as hyperglycemia – glucose finds its way into the urine, which gave rise to the term “sweet urine.” (Stöppler and Shiel (Ed.), 2012).
Glucose – in addition to being a simple sugar contained in various foods – is also a nutrient essential to the normal functioning of cells in the body. Carbohydrates in food are broken down by the digestive process in the small intestine and the glucose in the food is absorbed into the bloodstream and conveyed to the cells. However, insulin is also necessary to help the glucose enter those cells. Hence, insufficient insulin causes the cells to be starved of energy, even though the bloodstream contains ample glucose. The unused glucose is then excreted in the urine (Stöppler and Shiel (Ed.), 2012).
Causes of diabetes. In normal (healthy) people, the pancreas produces insulin that lowers the level of blood glucose, adjusting it to the level needed. When that process is not working properly, there is either insufficient insulin produced, or the insulin produced is in some way defective, or the cells fail to use the insulin properly or efficiently, which can then lead to an excess of insulin (hyperglycemia) and diabetes. That third cause primarily affects muscle cells and fat tissue, leading to an effect called insulin resistance, which is the main problem in type 2 diabetes. In type 1 diabetes, the insulin-producing cells in the pancreas experience a process that destroys them, leading to a lack of insulin. There is also a progressive decline in those insulin-producing cells in type 2 diabetes. For those with insulin resistance, the body can partially compensate by producing more insulin. However, if that decline continues, hyperglycemia can eventually occur (Stöppler and Shiel (Ed.), 2012).
Insulin is a hormone produced by special pancreas cells known as beta cells. After consuming food, the blood glucose level rises, causing the pancreas to release more insulin, lowering the glucose level and allowing more glucose to enter the cells. As soon as the level drops to normal, insulin release is reduced. In healthy people, that process regulates the blood glucose levels to maintain them within a controlled range (Stöppler and Shiel (Ed.), 2012).
The different types of diabetes. As previously mentioned, there are two principal types of diabetes, known as type 1 and type 2 respectively. Around 10 percent of all patients have type 1 and the other 90 percent have type 2 (Stöppler and Shiel (Ed.), 2012).
Type 1 diabetes. In the type 1 variety of diabetes, the pancreas becomes the target of an autoimmune attack by the host body and cannot then manufacture insulin, meaning that patients with type 1 diabetes are dependent upon insulin medication for their continued survival. Antibodies – proteins in the blood and part of the body’s immune system – with abnormalities present, are found in type 1 diabetes patients. The pancreas beta cells are attacked by the body’s own immune system, which mistakenly creates and directs antibodies against the patient’s own body. Genetic inheritance is believed to be a factor in this process, though the exact mechanism is not fully understood (Stöppler and Shiel (Ed.), 2012).
Additionally, certain infections of a viral nature may be a cause of abnormal antibodies that damage those pancreatic beta cells. There are certain antibodies most likely to trigger type 1 diabetes, and they can be identified in patients, in order to determine those most at risk of acquiring type 1 diabetes. This type of diabetes tends to occur in younger people (usually under 30), as well as the occasional older individual. However, general screening for the condition is not recommended by the American Diabetes Association, unless the individuals are considered to be in the high risk category, e.g. those having a close relative (usually sibling or parent) already having type 1 diabetes (Stöppler and Shiel (Ed.), 2012).
Type 2 diabetes. Formerly known as “non-insulin dependent diabetes mellitus (NIDDM), or adult onset diabetes mellitus (AODM),” type 2 diabetes is characterized by an inappropriate amount of insulin produced, especially in patients with insulin resistance. Many individuals produce too much insulin. Also, apart from the excess of insulin production, there are cases where the insulin production is either insufficient or in some way defective. Indeed worsening control of glucose levels is known to be affected by a steady decline in insulin production by the beta cells of the pancreas, and is a major reason for type 2 diabetes patients ultimately needing insulin therapy. Eventually, for these patients, their liver produces glucose (a process known as gluconeogenesis) even though their glucose levels may already be high (Stöppler and Shiel (Ed.), 2012).
Although most type 2 diabetes patients are over 30 and the condition is more likely with increasing age, some very young patients are appearing, mostly directly resulting from a bad diet, being overweight, and having insufficient exercise. In fact obesity is one of the most significant risk factors for type 2 diabetes. It has been shown that the greater the obesity, the higher is the risk of type 2 diabetes (for children as well as adults). The estimate is that for every 20 percent increase in excess body weight, the risk of type 2 diabetes doubles. However, irrespective of weight, for people older than 40, the risk of type 2 diabetes increases with every decade, rising to around 27 percent for those aged 65 or more. It has also been found that certain ethnic groups are more prone. With the non-Hispanic Caucasians as the lowest at 7 percent, other percentages are as follows: Asian-Americans 8 percent, Hispanics 12 percent, Blacks 13 percent, Native American from 20 to 50 percent. Women developing it during pregnancy are also a significant group (Stöppler and Shiel (Ed.), 2012).
Other types. As mentioned above, diabetes can occur while woman is pregnant, due to hormonal changes in individuals genetically predisposed to it. Estimates are that between 2 and 10 percent of all pregnancies are affected in this way. That form of diabetes is known as gestational diabetes. Although it usually clears up after the baby is born, between 35 and 60 percent of women affected go on to develop type 2 diabetes in the following one or two decades, particularly where the woman needed insulin during the pregnancy and in the case of those who did not lose excess weight after the birth. It is normal procedure for gestational diabetes patients to be asked to take an “oral glucose tolerance test” about six weeks after the delivery to check if the gestational diabetes has persisted, and to check for susceptibility of developing type 2 diabetes (Stöppler and Shiel (Ed.), 2012).
Another form of diabetes is known as secondary diabetes, where the patient has heightened blood glucose levels caused by another condition. A prime example is when the insulin-producing cells in the pancreas are destroyed by “chronic pancreatitis” caused by trauma or excessive alcohol consumption or even removal of the pancreas by surgery. Further forms of diabetes can be caused by hormone-related problems such as excessive production of growth hormone caused by a pituitary gland tumor, or due to Cushings syndrome which is a disorder of the adrenal glands (Stöppler and Shiel (Ed.), 2012).
Further, some medications may disturb the control of diabetes, or “unmask” diabetes that was present but in a latent state. This is most common when taking steroid medications (like prednisone) and medications used to treat HIV/AIDS (Stöppler and Shiel (Ed.), 2012).
Diabetes symptoms. Early symptoms result from high glucose levels in the urine causing increased output of urine and dehydration, which manifests itself as increased thirst and the need to drink more water. If there is insufficient insulin production, there is likely to be a loss of weight even though appetite may increase. In some instances, patients with untreated diabetes also experience fatigue and possibly nausea and vomiting. Diabetes patients are also more likely to develop bladder and skin infections and infections of the vaginal areas. When the blood glucose levels fluctuate, the vision can become blurred. Very high glucose levels can cause lethargy and even coma (Stöppler and Shiel (Ed.), 2012).
Diagnosis of diabetes. The simplest and preferred method of diagnosis is to take a blood sample after the subject has fasted for eight hours, then to analyze it. This is called the “fasting blood glucose (sugar) test.” Results from this test should be below100 mg/dl. Levels above 126 mg/dl found on two or more days indicate diabetes. Alternatively, it can also be diagnosed using a random (non-fasting) blood glucose test producing a result of 200 mg/dl or more. If successive fasting tests results are all in the range between 100 and 126 mg/dl, the condition is called impaired fasting glucose (IFG), which is not diabetes but is a cause for concern. There is also an “oral glucose tolerance test” which is still used in diagnosing gestational diabetes, for example. The patient fasts for at least 8 hours and takes the fasting glucose test. The patient is then given 75 grams of glucose, usually in liquid form, then tested by taking blood samples at intervals (say 5 times over a 3 hour period). If the person has diabetes, the glucose levels stay more elevated for longer (Stöppler and Shiel (Ed.), 2012).
Diabetes and nutrition. Anyone with diabetes has to ensure that their diet is balanced; i.e. that they control their blood sugar (glucose) level by balancing the carbohydrate content of the food they eat with insulin, any prescribed oral medications, and physical exercise. For that reason, one of the most important ways to help manage diabetes is to have a proper nutrition plan (“Nutrition and Diabetes” n.d.).
Importance of diet planning. With diabetes, eating healthy, satisfying meals is important. Various foods and quantities affect the blood glucose level, so choose healthier foods wherever possible and eat meals at times matching the diabetes treatment. These are all factors that will help keep blood glucose within limits. Your Body Mass Index (BMI) and the amount of exercise are key to a diet plan, and eating meals at the right times helps you maintain your weight whilst getting the nutrition you need (“Nutrition and Diabetes” n.d.).
How food affects blood sugar. Carbohydrates are an import element of your diet. They have the greatest effect on blood glucose level and are contained in starchy foods and in fruit, in milk and yoghourt, and in sweets, too. Controlling the amount of carbohydrates to avoid excess is key to managing blood glucose level. In contrast, protein has only a small effect on blood glucose, though the body needs it to function effectively. Protein is found in nuts, animal products, beans and some dairy produce. Fat in food slows down the digestive process, which can lower blood sugar shortly after eating, but raise it later. Choosing healthier fat types and restricting the amount of high-fat food combats heart disease – a major threat for those with type 2 diabetes (“Nutrition and Diabetes” n.d.).
Diabetes Complications
Acute complications. One is a seriously elevated level of blood sugar, due to a lack of insulin. Another is very low blood sugar level due either to an excess of insulin or to glucose-lowering medication. In severe cases a heightened blood sugar level can lead to a coma, especially in older patients with type 2 diabetes, and requires immediate emergency medical intervention with insulin and intravenous fluid. The second acute complication, hypoglycemia (excessively low blood sugar), is usually the result of too much insulin given, especially when a meal is missed or delayed. Very low blood sugar can also result in other problems such as dizziness, confusion, weakness and tremors. If untreated, the result can be a coma, or seizures, or even irreversible brain damage. The recommended treatment is an immediate soft drink or orange juice, for example (Stöppler and Shiel (Ed.), 2012).
Chronic complications. These are usually complications affecting blood vessels, either the smaller ones (affecting organs like the eyes and kidneys or the nerves), or the larger ones, including the heart and arteries. The main complication affecting the eyes is called diabetic retinopathy, which can occur in patients who have been diabetic for five years or more. It can cause bleeding in the retina and retinal scarring, which can be treated by laser. Cataracts and glaucoma are also prevalent conditions for diabetics. Also wide variations in blood sugar cause blurry vision, so good control is important. Kidney disease can also occur (diabetic nephropathy), but the likelihood and progression of it can be mitigated by tight control of blood pressure and blood sugar levels. Nerve damage due to diabetes (diabetic neuropathy) is caused by restricted blood flow to the nerves, which can cause numbness or aching. Treatment by certain medications can be helpful, as can better blood sugar control (Stöppler and Shiel (Ed.), 2012).
Diabetes Treatments
All treatments are geared to stabilizing blood sugar levels Insulin is used to treat type 1 diabetes, plus exercise and a dietary regime. Type 2 diabetes is treated by controlling weight and diet, and exercise too. If these methods provide insufficient control of high blood sugar levels, then oral medications are prescribed. If they fail to resolve the issues, insulin treatment may be used. A balanced diet is important. It should be “low in fat, cholesterol and simple sugars” and of three meals daily (Stöppler, Shiel (Ed.) and Marks (Ed.), 2012).
Type 2 diabetes medications. These are designed to increase the pancreas insulin output, decrease glucose released by the liver, increase the insulin sensitivity of cells, decrease the amount of carbohydrates absorbed from the intestine, and to retard the stomach emptying in order to delay carbohydrates entering the small intestine. Medications need to be tailored to the patient as individual needs vary (Stöppler, Shiel (Ed.) and Marks (Ed.), 2012).
Conclusions
The research has shown that diabetes can be controlled by a combination of methods including weight control, exercise, a balanced healthy diet, and careful overall management of blood sugar (glucose) levels. If necessary, treatment by medications (and insulin if needed for type 2 diabetes) can be effective in management of the condition, though complications can arise, particularly for older patients with a long term history of diabetes.
References:
“Nutrition and Diabetes.” (n.d.). Lilly Diabetes. Retrieved from http://www.lillydiabetes.com/Pages/nutrition-and-diabetes.aspx
Stöppler, Melissa, Conrad and Shiel, William, C. (Ed.). (2012). “Diabetes Mellitus.” MedicineNet.com. Retrieved from http://www.medicinenet.com/diabetes_mellitus/article.htm
Stöppler, Melissa, Conrad, Shiel, William, C. (Ed.) and Marks, Jay, W. (Ed.). (2012). “Diabetes Treatment.” MedicineNet.com. Retrieved from http://www.medicinenet.com/diabetes_treatment/article.htm
