Diabetes – An overview
It is a multi-systemic, chronic disorder that has been rising in prevalence in the last couple of decades. According to the WHO, the prevalence of this among adults worldwide has been estimated at 8.5% in 2014. According to the Centers for Disease Control and Prevention reports of 2017, the prevalence of diabetes in the United States was estimated at 9.4% while prevalence among the adult population was estimated at 12.2%.
What is diabetes?
Diabetes mellitus, commonly known as diabetes, is an endocrine disorder where the patient develops a functional or absolute deficiency of a hormone known as Insulin. Insulin is secreted following a meal and its actions reduce blood glucose in order to regulate blood glucose levels. Its counterpart, Glucagon hormone is involved in increasing the blood glucose level. The balance of these two hormones maintains the blood glucose level within the normal range (120 mg/l – 70 mg/l in practice). Reduction in insulin level leads to over-activity of glucagon and subsequent high blood glucose level. This high blood glucose level is what drives all the complications of diabetes.
Types of diabetes
Diabetes is categorized into two main types based on its pathophysiology, type I diabetes and type II diabetes.
Type I diabetes occurs due to the destruction of Pancreatic endocrine cells which are responsible for insulin secretion. Usually, this is an abnormal effect of own immune system. Chronic pancreatitis and rarely infections also can give rise to a similar presentation. Type I diabetes usually occurs in children and has a good response to treatment.
Type II occurs due to tissues being resistant to insulin. Despite having adequate insulin, their blood glucose levels do not reduce as usual. In the early stages, the insulin level rises as a compensatory mechanism. But later on, the insulin level falls due to pancreatic exhaustion.
Both type I and type II diabetes ultimately lead to very high glucose levels. Their effects and disease outcomes are more or less the same.
There are no specific symptoms of diabetes. Yet, having one or several of following may suggest of one having diabetes
- Family history of diabetes
- Increased thrust and urination
- Extreme hunger and increased appetite
- Unexplained weight loss
- Long-standing sores and wounds
- Frequent atypical infections
- Blurred vision
Risk factors of Diabetes
It is considered a disease that has a multifactorial inheritance in which both genetics and environment play a role. Obesity (BMI value over 27-30 kg/ m2) is one of the main factors which results in diabetes. Obese people develop insulin resistance with a later acquisition of it. Consumption of fast foods, fatty and sugary foods are also add-ons to that. A sedentary lifestyle and lack of exercise further increase the risk of developing this disease.
It leads to several debilitating complications. Usually, these compilations develop very slowing over a long period of time. Diabetes affects your eyes, which is called retinopathy. It affects your kidneys which is called nephropathy. It affects your nerves which is called neuropathy. These 3 manifestations occur partly due to diabetes’ effects on the vasculature.
People with uncontrolled diabetes tend to develop permanent blindness, chronic kidney failure, and multiple nerve impairments after about 10 – 15 years of time. This can virtually affect all the nerves in the body including the brain. Nerve damages manifest as numbness of limbs, urinary retention, constipation, difficulty in swallowing, erectile dysfunction, muscle weaknesses, etc.
High blood glucose
The high blood glucose level stimulates the liver to excessively produce fats and cholesterol. So diabetes is usually followed up by hyperlipidemia. Glucose in blood binds with the blood vessel walls and increases their permeability. Lipids, protein, and other blood contents accumulate inside the blood vessels forming atherosclerotic plaques. Narrowing of the lumen of the blood vessels produces hypertension. Impaired blood flow to the heart leads to myocardial infarctions. The obstruction of blood vessels supplying the brain leads to strokes.
These are quite common with uncontrolled and long-standing diabetic patients. Those people tend to miss injuries as they do not feel pain (due to neuropathy). The vascular disease diminishes the blood supply to the wound which interrupts the healing process. On the other hand, tissue glucose provides an excellent medium for bacterial growth. Therefore, diabetic patients develop frequent foot ulcers which can even progress till amputations.
It has an immunosuppressive action. High blood glucose level downgrades the immune responses. Chronic diabetes patients develop recurrent severe infections as a result.
Treatments of diabetes
It still doesn’t have a proper cure. But Many medications are available to maintain the blood glucose within the optimal level. If a diabetic person can control his blood glucose level within the normal range, he’s expected to have a completely normal life.
Blood glucose control in this is achieved mainly by lifestyle modifications and medications.
“Do” s in diabetes –
- Have a healthy meal with low fats and sugar
- Include fruits and vegetables in meals
- Regular exercise at least half an hour a day for most of the days of the week
- Take care of your feet
- Regular blood glucose monitoring
- Eye checkups and renal function tests
“Don’t” s in diabetes –
- Eating fast foods and high-fat foods
- Alcohol and tobacco use
- Sedentary lifestyle
- Special foods are currently not indicated
Medical management is by synthetic insulin hormone and by oral hypoglycemic drugs. A diabetic person should not self-medicate his condition. Instead, he should be treated and followed up by a proper medical clinic.
If the control of blood glucose level is optimal with regards to following criteria, a diabetic person is expected to have a good outcome
- HbA1C level less than 6.5%
- Fasting blood glucose level less than 126 mg/l
- BMI of less than 25 kg/ m2 (Asians less than 23 kg/m2)
Regular exercises of at least half an hour a day, healthy food habits, proper body weight and abstinence of alcohol and smoking are thought to prevent or at least delay the onset of diabetes.
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