What is Diabetes?
Diabetes happens when your body isn't able to take up sugar (glucose) into its cells and use it for energy. This results in a build-up of extra sugar in your bloodstream.
Poorly controlled diabetes can lead to serious consequences, causing damage to a wide range of your body's organs and tissues – including your heart, kidneys, eyes, and nerves.
Why is my blood glucose level high? How does this happen?
The process of digestion includes breaking down the food you eat into various different nutrient sources. When you eat carbohydrates (for example, bread, rice, pasta), your body breaks this down into sugar (glucose). When glucose is in your bloodstream, it needs help – a "key" – to get into its final destination where it's used, which is inside your body's cells (cells make up your body's tissues and organs). This help or "key" is insulin.
Insulin is a hormone made by your pancreas, an organ located behind your stomach. Your pancreas releases insulin into your bloodstream. Insulin acts as the “key” that unlocks the cell wall “door,” which allows glucose to enter your body’s cells. Glucose provides the “fuel” or energy tissues and organs need to properly function.
If you have diabetes:
Your pancreas doesn’t make any insulin or enough insulin.
Or
Your pancreas makes insulin but your body’s cells don’t respond to it and can’t use it as they normally should.
If glucose can’t get into your body’s cells, it stays in your bloodstream, and your blood glucose level rises.
What are the different types of diabetes?
The types of diabetes are:
Type 1 diabetes.
This type is an autoimmune disease, meaning your body attacks itself. In this case, the insulin-producing cells in your pancreas are destroyed. Up to 10% of people have diabetes have Type 1.
It’s usually diagnosed in children and young adults (but can develop at any age). It was once better known as “juvenile” diabetes. People with Type 1 diabetes need to take insulin every day. This is why it is also called insulin-dependent diabetes.
Type 2 diabetes.
With this type, your body either doesn’t make enough insulin, or your body’s cells don’t respond normally to the insulin. This is the most common type of diabetes. Up to 95% of people with diabetes have Type 2. It usually occurs in middle-aged and older people. Other common names for Type 2 include adult-onset diabetes and insulin-resistant diabetes. Your parents or grandparents may have called it “having a touch of sugar.”
Prediabetes: This type is the stage before Type 2 diabetes. Your blood glucose levels are higher than normal but not high enough to be officially diagnosed with Type 2 diabetes.
Gestational diabetes: This type develops in some women during their pregnancy. Gestational diabetes usually goes away after pregnancy. However, if you have gestational diabetes you're at higher risk of developing Type 2 diabetes later on in life.
Less common types of diabetes include:
Monogenic diabetes syndromes: These are rare inherited forms of diabetes accounting for up to 4% of all cases. Examples are neonatal diabetes and maturity-onset diabetes of the young.
Cystic fibrosis-related diabetes: This is a form of diabetes-specific to people with this disease.
Drug or chemical induced diabetes: Examples of this type happen after organ transplant, following HIV/AIDS treatment, or are associated with glucocorticoid steroid use.
Diabetes insipidus is a distinct rare condition that causes your kidneys to produce a large amount of urine.
Who gets diabetes? What are the risk factors?
Factors that increase your risk differ depending on the type of diabetes you ultimately develop.
Risk factors for Type 1 diabetes include:
- Having a family history (parent or sibling) of Type 1 diabetes.
- Injury to the pancreas (such as by infection, tumor, surgery, or accident).
- Presence of autoantibodies (antibodies that mistakenly attack your own body’s tissues or organs).
- Physical stress (such as surgery or illness).
- Exposure to illnesses caused by viruses.
Risk factors for prediabetes and Type 2 diabetes include:
- Family history (parent or sibling) of prediabetes or Type 2 diabetes.
- Being African-American, Hispanic, Native American, Asian-American race, or Pacific Islander.
- Being overweight.
- Having high blood pressure.
- Having low HDL cholesterol (the “good” cholesterol) and high triglyceride level.
- Being physically inactive.
- Being age 45 or older.
- Having gestational diabetes or giving birth to a baby weighing more than 9 pounds.
- Having polycystic ovary syndrome.
- Having a history of heart disease or stroke.
- Being a smoker.
Risk factors for gestational diabetes include:
- Family history (parent or sibling) of prediabetes or Type 2 diabetes.
- Being African-American, Hispanic, Native American, or Asian-American.
- Being overweight before your pregnancy.
- Being over 25 years of age.
SYMPTOMS AND CAUSES
What causes diabetes?
The cause of diabetes, regardless of the type, is having too much glucose circulating in your bloodstream. However, the reason why your blood glucose levels are high differs depending on the type of diabetes.
Causes of Type 1 diabetes
This is an immune system disease; Your body attacks and destroys insulin-producing cells in your pancreas. Without insulin to allow glucose to enter your cells, glucose builds up in your bloodstream. Genes may also play a role in some patients. Also, a virus may trigger an immune system attack.
Cause of Type 2 diabetes and prediabetes
Your body’s cells don't allow insulin to work as it should to let glucose into its cells. Your body's cells have become resistant to insulin. Your pancreas can’t keep up and make enough insulin to overcome this resistance. Glucose levels rise in your bloodstream.
Gestational Diabetes: Hormones produced by the placenta during your pregnancy make your body’s cells more resistant to insulin. Your pancreas can’t make enough insulin to overcome this resistance. Too much glucose remains in your bloodstream.
What are the symptoms of diabetes?
Symptoms of diabetes include:
- Increased thirst.
- Weak, tired feeling.
- Blurred vision.
- Numbness or tingling in the hands or feet.
- Slow-healing sores or cuts.
- Unplanned weight loss.
- Frequent urination.
- Frequent unexplained infections.
- Dry mouth.
Other symptoms
In women
Dry and itchy skin, and frequent yeast infections or urinary tract infections.
In men
Decreased sex drive, erectile dysfunction, decreased muscle strength.
Type 1 diabetes symptoms
Symptoms can develop quickly – over a few weeks or months. Symptoms begin when you’re young – as a child, teen, or young adult. Additional symptoms include nausea, vomiting or stomach pains and yeast infections, or urinary tract infections.
Type 2 diabetes and prediabetes symptoms
You may not have any symptoms at all or may not notice them since they develop slowly over several years. Symptoms usually begin to develop when you’re an adult, but prediabetes and Type 2 diabetes is on the rise in all age groups.
Gestational diabetes: You typically will not notice symptoms. Your obstetrician will test you for gestational diabetes between 24 and 28 weeks of your pregnancy.
What are the complications of diabetes?
If your blood glucose level remains high over a long period of time, your body’s tissues and organs can be seriously damaged. Some complications can be life-threatening over time.
Complications include:
- Cardiovascular issues include; coronary artery disease, chest pain, heart attack, stroke, high blood pressure, high cholesterol, atherosclerosis (narrowing of the arteries).
- Nerve damage (neuropathy) causes numbing and tingling that starts at toes or fingers then spreads.
- Kidney damage (nephropathy) can lead to kidney failure or the need for dialysis or transplant.
- Eye damage (retinopathy) can lead to blindness; cataracts, glaucoma.
- Foot damage includes nerve damage, poor blood flow, and poor healing of cuts and sores.
- Skin infections.
- Erectile dysfunction.
- Hearing loss.
- Depression.
- Dementia.
- Dental problems.
Complications of gestational diabetes.
In the mother: Preeclampsia (high blood pressure, excess protein in the urine, leg/feet swelling), risk of gestational diabetes during future pregnancies, and risk of diabetes later in life.
In the newborn: usually, High birth weights more than the normal are realized, low blood sugar (hypoglycemia), higher risk of developing Type 2 diabetes over time, and death shortly after birth occurs.
DIAGNOSIS AND TESTS
How is diabetes diagnosed?
Diabetes is diagnosed and managed by checking your glucose level in a blood test. There are three tests that can measure your blood glucose level: fasting glucose test, random glucose test, and A1C Test
Fasting plasma glucose test: This test is best done in the morning after an eight-hour fast (nothing to eat or drink except sips of water).
Random plasma glucose test: This test can be done any time without the need to fast.
A1c test: This test, also called HbA1C or glycated hemoglobin test, provides your average blood glucose level over the past two to three months.
This test measures the amount of glucose attached to hemoglobin, the protein in your red blood cells that carries oxygen. You don’t need to fast before this test.
Oral glucose tolerance test: In this test, the blood glucose level is first measured after an overnight fast. Then you drink a sugary drink. Your blood glucose level is then checked at hours one, two, and three.
Gestational diabetes tests: There are two blood glucose tests if you are pregnant. With a glucose challenge test, you drink a sugary liquid and your glucose level is checked one hour later. You don’t need to fast before this test. If this test shows a higher than normal level of glucose (over 140 ml/dL), an oral glucose tolerance test will follow (as described above).
Type 1 diabetes: If your healthcare provider suspects Type 1 diabetes, blood and urine samples will be collected and tested. The blood is checked for autoantibodies (an autoimmune sign that your body is attacking itself). The urine is checked for the presence of ketones (a sign your body is burning fat as its energy supply). These signs indicate Type 1 diabetes.
Who should be tested for diabetes?
If you have symptoms or risk factors for diabetes, you should get tested. The earlier diabetes is found, the earlier management can begin and complications can be lessened or prevented. If a blood test determines you have prediabetes, you and your healthcare professional can work together to make lifestyle changes (e.g. weight loss, exercise, healthy diet) to prevent or delay developing type 2 diabetes.
Additional specific testing advice based on risk factors:
Testing for Type 1 diabetes: Test in children and young adults who have a family history of diabetes. Less commonly, older adults may also develop Type 1 diabetes. Therefore, testing in adults who come to the hospital and are found to be in diabetic ketoacidosis is important. Ketoacidosis is a dangerous complication that can occur in people with Type 1 diabetes.
Testing for type 2 diabetes: Test adults age 45 or older, those between 19 and 44 who are overweight and have one or more risk factors, women who have had gestational diabetes, children between 10 and 18 who are overweight and have at least two risk factors for type 2 diabetes.
Gestational diabetes: Test all pregnant women who have had a diagnosis of diabetes. Test all pregnant women between weeks 24 and 28 of their pregnancy. If you have other risk factors for gestational diabetes, your obstetrician may test you earlier.
MANAGEMENT AND TREATMENT
Managing Diabetes
How is diabetes managed?
Diabetes affects your whole body. To best manage diabetes, you’ll need to take steps to keep your risk factors under control and within the normal range, including:
- Keep your blood glucose levels as near to normal as possible by following a diet plan, taking prescribed medication, and increasing your activity level.
- Maintain your blood cholesterol (HDL and LDL levels) and triglyceride levels as near the normal ranges as possible.
- Control your blood pressure. Your blood pressure should not be over 140/90 mmHg.
- You hold the keys to managing your diabetes by:
- Planning what you eat and following a healthy meal plan. Follow a Mediterranean diet (vegetables, whole grains, beans, fruits, healthy fats, low sugar) or Dash diet. These diets are high in nutrition and fiber and low in fats and calories. See a registered dietitian for help understanding nutrition and meal planning.
- Exercising regularly. Try to exercise for at least 30 minutes most days of the week. Walk, swim or find some activity you enjoy.
- Losing weight if you are overweight. Work with your healthcare team to develop a weight-loss plan.
- Taking medication and insulin, if prescribed, and closely following recommendations on how and when to take it.
- Monitor your blood glucose and blood pressure levels at home.
- Keeping your appointments with your healthcare providers and having laboratory tests completed as ordered by your doctor.
- Quitting smoking (if you smoke).
- You have a lot of control – on a day-to-day basis – in managing your diabetes!
PREVENTION
Can prediabetes, Type 2 diabetes, and gestational diabetes be prevented?
Although diabetes risk factors like family history and race can’t be changed, there are other risk factors that you do have some control over. Adopting some of the healthy lifestyle habits listed below can improve these modifiable risk factors and help to decrease your chances of getting diabetes:
- Eat a healthy diet, such as the Mediterranean or Dash diet. Keep a food diary and calorie count of everything you eat. Cutting 250 calories per day can help you lose ½ pound per week.
- Get physically active. Aim for 30 minutes a day at least five days a week. Start slow and work up to this amount or break up these minutes into more doable 10 minute segments. Walking is great exercise.
- Lose weight if you are overweight. Don’t lose weight if you are pregnant, but check with your obstetrician about healthy weight gain during your pregnancy.
- Lower your stress. Learn relaxation techniques, deep breathing exercises, mindful meditation, yoga and other helpful strategies.
- Limit alcohol intake. Men should drink no more than two alcoholic beverages a day; women should drink no more than one.
- Get an adequate amount of sleep (typically 7 to 9 hours).
- Quit smoking.
- Take medications – to manage existing risk factors for heart disease (e.g., high blood pressure, cholesterol) or to reduce the risk of developing Type 2 diabetes – as directed by your healthcare provider.
Can Type 1 diabetes be prevented?
No. Type 1 diabetes is an autoimmune disease, meaning your body attacks itself. Scientists aren’t sure why someone’s body would attack itself. Other factors may be involved too, such as genetic changes.
Can the long-term complications of diabetes be prevented?
Chronic complications are responsible for most illnesses and death associated with diabetes. Chronic complications usually appear after several years of elevated blood sugars (hyperglycaemia). Since patients with Type 2 diabetes may have elevated blood sugars for several years before being diagnosed, these patients may have signs of complications at the time of diagnosis.
The Author is Anasia Knight Daniella, a Critical Care Nurse/Registered Midwife in Arua Regional Referral Hospital.
For more information reach out on anasianight@gmail.com or on WhatsApp or telegram
