Diabetes (Diabetes Mellitus) Overview
Diabetes (diabetes mellitus) is characterised by a group of metabolic health conditions that influence how the body uses glucose (sugar) and the hormone, insulin. Glucose is a vital energy source for the body’s cells which make up tissues and muscles. It is also the brain’s primary fuel source and is thus vital for your health.
An excess amount of glucose in the bloodstream can mean that you have diabetes (any type). Causes of this may differ with the various types, but in all instances of diabetes, the presence of excess glucose can cause severe health concerns.
The pancreas (the organ behind the stomach) normally releases insulin to assist the body with storing and using glucose and fat from the food we eat (insulin allows sugar to travel from the bloodstream into the cells of the body). Diabetes can develop when the pancreas produces little or no insulin, or in other cases, when the body does not respond appropriately to insulin produced.
Typical signs that this is happening include excessive thirst, hunger and urination, as well as fatigue, sores or cuts that are slow-healing, and blurry vision. Diabetes can develop quickly (typically only type 1), but it’s not uncommon for diabetes to develop slowly too and only be diagnosed when symptoms of longer-term health concerns arise, such as heart conditions, numbness and tingling sensations in the feet.
Diabetes is a chronic condition (type 1 and type 2 – see below for a full explanation of these), for which there is, as yet, no cure. Reversible diabetes include prediabetes (blood sugar levels appear higher than normal, but not enough to be diagnosed as diabetes) and gestational diabetes (may arise during pregnancy but typically resolves once the baby is born and the body returns to normal).
Long-term health concerns commonly linked to diabetes include kidney failure, blindness and nerve damage.
A person diagnosed with diabetes needs to manage their condition on a continuous (daily) basis to lead a healthy lifestyle.
What to expect
Symptoms of diabetes do vary depending on the type that is diagnosed. Typically, those diagnosed with type 1 experience symptoms quite quickly (within a matter of days or weeks) and the nature of negative effects can be more severe.
In the case of type 2 (or even prediabetes) symptoms are generally mild and may not be noticed at first. One of the main reasons type 2 diabetes is so frequently diagnosed is due to other health problems whereby long-term damage brings about noticeable symptoms.
Common symptoms and signs of diabetes (type 1 and type 2) are:
- A dry mouth and itchy skin: When the body requires more fluids to produce urine, a reduction in moisture needed in other areas of the body occurs too. Along with becoming thirstier, dehydration occurs and with that, a dry mouth. Skin also loses moisture and becomes dry, resulting in itchiness.
- Increased thirst and frequent urination: The average individual will need to urinate between 4 and 7 times during a 24-hour period. Normally, the body reabsorbs glucose as it passes through the kidneys. Those with diabetes have higher blood sugar levels, and the body struggles or is unable to allow this. Instead the body will ‘react’ and try and get rid of the extra glucose by producing more urine. To do this, the body requires more fluids. A person with diabetes will feel thirstier, drink more and therefore experience an increased need to urinate more often than is normal.
- Extreme hunger, irritability, fatigue and lack of energy: Normally the body converts the food we eat into glucose for sustained energy. Our body’s cells require insulin to absorb or use glucose. When not enough insulin is produced or there is a resistance in the body’s cells, glucose cannot be absorbed (used) and thus causes a lack of energy or fatigue (this can range from a general ‘worn out’ feeling to complete exhaustion), which in turn results in a person feeling hungrier than usual. Muscles and tissues in the body ‘raise the hunger flag’ making an individual feel less satisfied and desire more food, even if they’ve already eaten.
- Unexplained weight loss: The primary source of energy is food and if there is a lack in the body, it will start burning muscle, protein or fat stores instead. This can lead to weight loss even though eating habits have not undergone a change for the intended purpose of weight loss.
- Presence of ketones in the urine: When there is not enough available insulin in the body, ketones develop as a by-product of the breakdown of muscle and fat (in place of energy). Ketones can build-up in the blood to dangerous levels and cause diabetic ketoacidosis, which can be life-threatening. The presence of ketones causes symptoms of nausea and vomiting.
- Blurry vision: With the changes in fluid levels (shifting into the eye duct), lenses in the eyes begin to swell up. This can lead to a change in shape and a decreased ability to focus. Blurry vision can be resolved when sugar levels normalise. Chronically high blood pressure can cause diabetic retinopathy (which is the leading cause of blindness). The risk for cataracts and glaucoma is higher in diabetic individuals.
- Slow-healing sores or cuts: Over time, increased blood-sugar levels negatively affect the impact on white blood cells (responsible for healing wounds) and thus the overall blood flow in the body. This leads to nerve damage, making it more difficult for the natural process of healing wounds. Other causes of nerve damage can be pain or numbness in the feet or legs.
- Frequent infections: Yeast infections in both men and women are common problems. Yeast feeds on glucose, and the higher than normal levels of blood-sugar in body of a diabetic person thus allows it to thrive. Infections then grow in the warm, moist folds of skin and are most common in the areas between fingers and toes, underneath breasts, as well as in and around sex organs. Women can also experience frequent bladder infections.
Factors to consider
Although diabetes is categorised into different types, they all have something in common, and that is how the body breaks down and uses sugars and carbohydrates from food consumed. The body either doesn’t produce enough insulin, is unable to sufficiently use the insulin it does produce, or a combination of both.
Cells in the body are unable to absorb glucose, and so its presence builds up in the bloodstream. High levels of glucose cause damage to the tiny blood vessels in the kidneys, heart, eyes and nervous system. Eventually this can lead to heart disease, stroke, kidney disease, blindness and nerve damage to the nerves in the feet.
The major types of diabetes are:
- Type 1 diabetes: This form of diabetes is typically categorised as an autoimmune disease. With this type, the body’s immune system malfunctions and destroys (attacks) insulin-producing beta cells with antibodies in the pancreas. The reason this happens is often attributed to genetic (a genetic predisposition or faulty beta cells in the pancreas) or environmental triggers, but the exact cause is not entirely clear. Type 1 diabetes can occur at any age, with many being diagnosed as children or young adults. Managing the condition, which is also known as insulin-dependent diabetes, involves the taking of insulin on a daily basis.
- Type 2 diabetes: This form of diabetes most often develops gradually with age (also commonly referred to as adult-onset diabetes or non-insulin-dependent diabetes). Typically, type 2 diabetes is because of insulin resistance. It is also not yet fully understood why this happens in the body. The cells in the body become unable to use insulin effectively and a resistance develops. The body’s fat, liver and muscle cells cannot take in and store glucose. The abnormal build-up of blood sugar (hyperglycemia) impairs functions in the body. This form of diabetes accounts for up to 95% of adult cases and is by far the most commonly diagnosed of the two. More teenagers are now being diagnosed with this type due to a growing number of younger people becoming overweight or obese earlier in life. Type 2 diabetes is most often diagnosed in individuals who are overweight and sedentary (inactive and remain in a seated position for extended periods of time). Genetics and family history can also play a major role in the development of type 2 diabetes. Often a milder form of diabetes, it can still lead to major health complications, especially in the smallest blood vessels that nourish the kidneys, nerves and eyes.
Other types of diabetes are:
- Prediabetes: Technically, this is not clinically recognised as a type of diabetes, but is often a condition considered as the first stage that leads to a type 2 diabetes diagnosis. The condition is thus characterised by blood-sugar levels that are higher than normal, but not enough to be in the range of a typical diabetes diagnosis. As such, the condition merely places an individual at higher risk of a diabetes diagnosis, as well as other health concerns such as stroke and heart disease.
- Gestational diabetes: Blood-sugar elevation during pregnancy can lead to this form of diabetes. A state of pregnancy, where multiple changes occur in the body, can to some degree, lead to insulin resistance. Gestational diabetes affects between 3 and 8% of women at any stage during pregnancy. Although it does tend to subside after the baby’s birth, it should never be left undiagnosed or treated as it can cause problems such as a high birth weight or breathing problems for the baby. Blood-sugar levels increase and circulate through the placenta to the unborn baby. Generally, expectant moms are tested for gestational diabetes between 24 and 28 weeks of pregnancy. Gestational diabetes commonly develops during these weeks and must be controlled to protect the little one’s growth and development. If it develops, a woman does have an increased risk of developing type 2 diabetes within a few weeks post birth or up to five to ten years later.
- It is rare and highly irregular, but sometimes a type of diabetes can result from specific conditions, such as pancreatic disease. Surgeries, medications or infections can elevate blood sugar levels and thus have also been linked as causes of diabetes.
Causes and risk factors
Exact causes of the malfunction that occurs in the body is not specifically known, but is largely attributed to both genetic and environmental factors. These include:
- A lack of insulin production (Type 1 diabetes)
- Insulin resistance (Type 2 diabetes)
- Pregnancy (Gestational diabetes)
- Polycystic ovary syndrome / PCOS (A condition where a woman experiences irregular menstrual periods, excess hair growth and obesity.)
- Genetics and family history (Odds do appear to increase if a parent or sibling has diabetes)
- Age (The risk of type 2 diabetes does appear to increase as a person ages, particularly after 45. Younger adults or children with decreased muscle mass and reduced amounts of exercise are also at risk. Typically type 1 diabetes is diagnosed before age 30).
- Obesity (Excess body fat causes inflammation and leads to insulin resistance. Not all obese or overweight individuals develop diabetes. The link between the two is still be researched).
- Poor diet (An increased resistance to insulin occurs in diets high in calories, fat and cholesterol)
- Lack of exercise (Regular aerobic exercise and resistance training help muscle tissue respond better to insulin)
- Ethnicity (Some ethnic groups have been noted to have a higher diagnosis rate of diabetes – although research is not 100% conclusive. These include African-Americans, Native Americans, Hispanic/Latino-Americans, Asians, Alaska Natives, Pacific Islanders and people of Indian origin.
- Exposure to a viral illness (This can play a role in type 1 diabetes)
- Abnormal cholesterol and triglyceride (fat carried in the blood) levels (Low levels of high-density lipoprotein / ‘good cholesterol’, you may be high risk for type 2 diabetes)
- The presence of autoantibodies (Damaging immune system cells)
- High blood pressure (More than 140/90 millimetres of mercury is linked to an increased risk of type 2 diabetes)
Complications and health concerns
Long-term health concerns because of diabetes lead to a higher risk of other complications. The less your blood-sugar is controlled, the higher the risk of other health problems, many of which are disabling or even life-threatening. These include:
- Heart problems and cardiovascular disease
- Neuropathy (nerve damage)
- Nephropathy (kidney damage)
- Retinopathy (eye damage)
- Skin infections (bacterial and fungal)
- Hearing impairment
- Alzheimer’s disease
Gestational diabetes complications for a baby include excess growth, low blood sugar (hypoglycaemia), type 2 diabetes in later life stages and even death (before or shortly after birth). A mother can experience complications such as preeclampsia, needing a caesarean due to the large size of the baby, damage to the heart, kidneys, nerves and the eye, as well as subsequent gestational diabetes in another pregnancy.
When should you see a doctor?
Signs and symptoms for diabetes could point to a number of other conditions. If you experience one or more of the below, as a general rule, it is highly recommended that you see your physician.
- Feeling weak and / or sick to your stomach (nausea)
- Are very thirsty (even when drinking a lot of fluids) and urinating a lot on an ongoing basis
- Abdominal pain (a bad stomach ache)
- Find that you are breathing more deeply and faster than usual
- Have sweet breath (sometimes the smell can resemble nail polish remover) which can be a sign of very high ketones in the body
If you notice any other symptoms of diabetes, and especially if you are older than 45, it is highly recommended that you see your doctor and get tested. Early detection can help avoid serious complications and health problems.
Signs of serious trouble in any type of diabetes that will require immediate medical care include:
- Hyperglycemia (high blood sugar)
- Diabetic ketoacidosis (increased ketones in urine) - This is life-threatening
- Hyperglycemic hyperosmolar nonketotic syndrome (a sky-high blood sugar level that turns blood thick and syrupy)
- Hypoglycemia (low blood sugar)
Diagnosis and tests
Your doctor may use one of more tests to screen for diabetes if suspected during your consultation. He or she will follow recommended guidelines of screening tests to carefully make the correct diagnosis.
These guidelines include:
- Anyone with a body mass index (BMI) greater than 25, irrespective of age, and especially where additional risk factors are noted.
- Anyone 45 years of age and older.
Tests commonly done for diagnosis (type 1 and type 2 diabetes) are:
- Fasting blood sugar test: After an overnight fast, a blood sample will be taken. A level that is less than 100 mg/Dl is considered normal. If around the 6.1 – 6.9 mmol/L or 100 to 125 mg/Dl mark, it prediabetes will be diagnosed. If the level is 7.0 mmol/L or 126 mg/Dl or higher on two separate tests, a diabetes diagnosis will be made.
- A random blood sugar test: At a random time of day a blood test may be requested, irrespective of when you last ate. The random blood sugar level will be assessed and used to help make a diagnosis. A level of 200 milligrams per decilitre (mg/Dl), or 11.1 mmol/L (millimole) or higher will indicate diabetes.
- Oral glucose tolerance test: An individual will be requested to fast overnight, after which the blood sugar level will be measured. Then the person will be given a sugary liquid to drink, and the blood sugar levels measured again periodically for the following two hours by means of blood samples. After the two-hour period, a reading of more than 200 mg/Dl or 11.1mmol/L will indicate diabetes. A less than 140 mg/dL or 7.8mmol/L is considered normal, and anything in between 140 and 199 mg/Dl or 7.8-11mmol/L will fall into the prediabetes category.
- Urine sample tests: If your doctor suspects type 1 diabetes after any of the above blood tests are performed, a urine sample may be requested to check for the presence of ketones. A test for autoantibodies (harmful immune system cells) linked with type 1 diabetes may also be performed.
- Glycated haemoglobin test (A1C): A blood test that indicates a person’s average blood sugar level for the past 2 to 3 months. The average is measured as a percentage of blood sugar attached to haemoglobin (the oxygen-carrying protein in red blood cells). The higher the level, the more haemoglobin with sugar attached (an A1C level of 6.5% higher on two separate tests will indicate diabetes). A percentage level lower than 5.7 is considered normal. An in between level (around 5.7 and 6.4%) can indicate prediabetes.
Results may not be consistent and can be inaccurate. Common reasons for this may be that you are pregnant, or have other conditions such as a haemoglobin variant (an uncommon form of haemoglobin). If it is suspected that any other known conditions could cause inconsistencies, your doctor may not use this test to diagnose diabetes which he or she can foresee would render your results inaccurately. A diagnosis may not be made entirely based on this test. Your doctor may also screen for diabetes using any of the aforementioned tests as well
Should you be pregnant, your doctor will assess your risk, and the level of risk for gestational diabetes before recommending the below screening tests.
- Initial glucose challenge test: A women will be given a syrupy glucose solution to drink and after an hour blood will be taken to measure her blood sugar level. A normal level is usually below the 140 mg/dL mark (or 7mmol/L). A level higher than normal may only mean that you have an increased risk of gestational diabetes, and doesn’t necessarily confirm a diabetes diagnosis. The doctor will do a follow-up test to check for gestational diabetes if the level is higher than normal.
- Follow-up glucose tolerance test: An expectant mom will be requested to fast overnight. From there a blood sample will be taken and the fasting blood sugar level measured. She will be given another sweet solution to drink, which will have a higher glucose concentration. The blood sugar level will then be measured every hour for the next 3 hours. If it is found that at least two of the readings are higher than normal for each of the three ours o the test, gestational diabetes will be diagnosed.
Treatments and medications
The type of diabetes diagnosed will determine the most effective treatment plan which may involve blood sugar monitoring, oral medications and insulin. Lifestyle changes are also an integral part of managing the condition. Maintaining a healthy weight, a nutritious diet and regular activity are a vital way of life for a person with diabetes.
Typically, treatment for type 1 diabetes involves insulin injections or the use of an insulin pump. Frequent blood sugar checks and carbohydrate counting are also important for managing the condition.
Treatment for type 2 diabetes also involves monitoring blood sugar levels, as well as the taking of medications, insulin, or both.
Treatments which apply to all types of diabetes are:
- Healthy eating: There is no distinct ‘diabetes diet’. However, a diabetic person can benefit greatly from nutritious foods that are high in fibre (fruits, vegetables and whole grains). Refined carbohydrates, animal products and sweets should be kept to a minimum. What and how much a diabetic person eats can be something of a challenge. Working closely with a registered dietician who can help devise a meal plan that best fits your overall health goals, lifestyle and preferences can be enormously beneficial.
- Physical activity: Frequent aerobic exercise is essential for a diabetic individual. Exercise increases a person’s sensitivity to insulin, resulting in the body needing less to transport sugar to the cells. Exercise also helps to lower blood sugar levels by aiding movement of sugar into the cells where it is needed for energy. It is a good idea to discuss physical activity and exercise with your doctor before attempting anything and everything. Generally, activities such as biking, swimming or walking are good means of exercise. These types of activities are easily incorporated in your daily routine. If you enjoy a specific activity, aminimum of 30 minutes (or more) most days of the week will do you the world of good. If you haven’t been active for some time, start at a slow pace and gradually build up your fitness levels.
Treatment specific to type 1 and type 2 diabetes:
- Monitoring blood sugar levels: Monitoring frequency (often with a glucose monitor) will depend on the necessary treatment plan. A diabetic can check their blood sugar levels numerous times a week or as many as 4 to 8 times a day. Monitoring is the best way to ensure that levels remain within a person’s target range. As such, it is necessary for monitoring to be done with great care, even though levels can sometimes be erratic. A diabetic will soon learn how their body responds to medication, physical activity, food, other types of illnesses, alcohol, stress, and hormone fluctuations (particularly for women), and how this affects blood sugar level changes. Your doctor may also recommend regular A1C testing every 2 to 3 months to measure average blood sugar levels, which can then be compared with daily sugar test readings. An A1C test is more effective for assessing how well your overall treatment plan is working.
- Insulin: Insulin therapy for individuals with type 1 diabetes is essential for survival. Types of insulin include long-acting insulin, rapid-acting insulin and other intermediate options. A mixture of types may be prescribed to be used during the day and night. Insulin is not taken orally as stomach enzymes can interfere with its action. Instead, insulin is injected through the skin and into fatty tissue below by using syringe and fine needle (or a pump or an insulin pen).
- Oral and other medications: Medications may be prescribed as a means to help stimulate the production and release of more insulin in the pancreas. Other medications may be prescribed to suppress the production and release of glucose from the liver because less insulin is needed to assist with transferring sugar into the body’s cells. Some medications also block the action of intestinal or stomach enzymes that break down carbohydrates or make tissues more sensitive to insulin.
- Transplantation: A pancreas transplant will sometimes be a treatment option for those with type 1 diabetes. If successful, insulin therapy will no longer be needed. There are serious risks with this option, and a lifetime of immune-suppressing medications to prevent organ rejection will be necessary. Severe side effects such as an increased risk of organ injury, infection and cancer can occur. Transplants may only be considered if diabetes can’t be controlled or if an individual also needs a kidney transplant.
- Bariatric surgery: Individuals who also have a BMI (body mass index) higher than 35 and type 2 diabetes can benefit from bariatric surgery. Significant improvements in blood sugar levels have been noted in those who have had a gastric bypass procedure. For this reason, this procedure can be considered.
What happens if diabetes goes undetected?
Any type of diabetes undiagnosed or left untreated is extremely dangerous due to the nature of complications and other serious illnesses which can occur. Complications can be acute or severe, but can happen quickly. When this happens, it is often considered a medical emergency requiring immediate medical care.
Complications can cause deep and rapid breathing, nausea or vomiting, abdominal pain, a flushed complexion, confusion, sweet or fruity smelling breath, coma and loss of consciousness, fainting, sweating, dizziness and trembling. Any of these symptoms can become life-threatening if not treated quickly or effectively enough.
More long-term complications due to chronically high blood sugar levels can also cause other serious health concerns, which can only be treated by medical means.
Can diabetes be cured?
As there is still much about the condition that isn’t known with 100% surety, there is no known cure for diabetes. It can only be treated by medical professionals and managed through effective lifestyle changes.
Daily treatment reduces the risk of further complications, but all plans must be supervised or developed by a physician. Individuals with type 1 and type 2 diabetes can lead long and active lives if they adhere to a strict treatment plan that involves necessary lifestyle changes, taking medications and careful monitoring of their glucose levels.