Diabetes

What is Diabetes?

Diabetes, also known as Diabetes mellitus (DM), is a medical condition that results in high levels of sugar in the blood. The food an individual consumes is turned into glucose, which is used as energy making glucose an important source of energy for the body. Insulin is a hormone produced by a gland called the pancreas and it helps glucose to be delivered to the cells of the body such as muscles and other tissues. This function of insulin does not take place in Diabetes. Thus, instead of getting absorbed in the body, glucose piles up in the bloodstream leading to high blood sugar levels.

Is Diabetes a Medical emergency?

Diabetes is a chronic condition and is not a medical emergency but it can lead to various serious health problems.

Types

There are two types of Diabetes. They are:

Type 1 Diabetes: A condition in which the immune system destroys insulin-making cells in the body. This type occurs in children and adolescents, and the body does not produce insulin.

Type 2 Diabetes: A chronic condition that causes high blood sugar levels, insulin resistance, and inadequate production of insulin. In this type, the body does not respond to insulin as the way it should, and also it does not make enough insulin.

PreDiabetes: This is a condition when the blood sugar level is higher than it should be, but not high enough to be diagnosed as Diabetes. In other words, it is an initial stage before turning into Diabetes.

Causes

The exact cause of Diabetes is not known. In type 1, the immune system attacks and destroys insulin-making cells. The reason behind this is not exactly known. In type 2, the cells become resistant to insulin and the pancreas does not produce enough insulin. The reason behind this is also not exactly clear. Nevertheless, genetics and environmental factors contribute to the development of the condition.

Risk factors

Factors that increase the probability of developing Diabetes include:

• Obesity
• High blood pressure
• Abnormal cholesterol and triglyceride levels
• Advanced age
• Sedentary lifestyle or lack of physical activity
• Prior family history of Diabetes
• Unhealthy diet and eating a lot of junk foods
• Stress
• Excess body fat
• Smoking
• Preterm birth and low birth weight during birth
• Presence of certain viruses that trigger autoimmune destruction of the islet cells
• Gestational Diabetes: Women who acquire Diabetes during pregnancy have an increased risk of developing Diabetes later in life
• Medical conditions: Other medical conditions like acromegaly, Cushing's syndrome, hyperthyroidism, polycystic ovarian syndrome, etc., can contribute to its development
• Medications: Medications like glucocorticoids, thiazides, beta-blockers, atypical antipsychotics, and statins can increase the risk of its development

Symptoms & signs

Signs and symptoms of Diabetes are not recognized immediately. The symptoms develop slowly and they include:

• Increased thirst
• Frequent urination
• Fatigue and tiredness
• Increased appetite
• Unexplained weight loss
• Non-healing sores
• Frequent infections
• Vision changes
• Irritability

Investigations

Investigation tests for Diabetes are:

Glycated hemoglobin (A1C) test: This test measures the average blood sugar level for the past two to three months.

• Normal A1C level is below 5.7 percent
• An A1C level between 5.7 and 6.4 percent is considered prediabetes
• An A1C level of 6.5 percent or higher on two separate tests indicates Diabetes

Random blood sugar test: A blood sample is collected irrespective of the food consumed. The blood sugar level of 200 mg/dL (11.1 mmol/L) or above suggests Diabetes.

Fasting blood sugar test: A blood sample is collected after an overnight fast.

• Blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal
• Blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes
• Blood sugar level of 126 mg/dL (7 mmol/L) or higher on two separate tests is considered as Diabetes
• Oral glucose tolerance test: Following an overnight fast, a sugary liquid drink is consumed. Blood sugar levels for the next two hours are checked.
• Blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal.
• Blood sugar level between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.
• Blood sugar level of 200 mg/dL (11.1 mmol/L) or higher after two hours indicates Diabetes.

Urinary glucose testing: High glucose levels in the urine during pregnancy also suggest gestational Diabetes. Increased glomerular filtration rates during pregnancy contribute to high glucose levels in the urine.

After the diagnosis of Diabetes is confirmed, additional tests such as blood tests and urine tests are also done to distinguish between type 1 and type 2 Diabetes as the treatment differs for both types.

After being diagnosed positive for Diabetes, the A1C level is checked every few months. The change of the A1C level indicates a change in medication and diet plans. Blood and urine tests are also performed periodically to check cholesterol, thyroid, liver, and kidney functions. Eye checkup is also recommended to identify any Diabetes-induced eye disorders.

Diagnosis

Diagnosis of Diabetes is done considering the results of the investigation tests.

Treatment options

There is no cure for Diabetes. Treatment focuses on keeping the sugar levels in control and taking steps to avoid further complications. Steps required to control sugar levels include:

• Healthy Diet: Eating a healthy diet which includes fruits, vegetables, whole grains, lean protein, low-calorie, high fiber, and low-fat foods can control blood sugar levels. Saturated fats, refined carbohydrates, and sweets should be avoided.
• Physical Activity: Physical activity plays an important role in controlling the condition. Physical exercise lowers blood sugar levels and moves sugar into the cells so that they could be used as energy. Regular aerobic exercise, walking, swimming, or biking all help to regulate sugar levels in the blood.

Medical treatment

Diabetes can be controlled with diet and exercise; however, in a few cases, blood sugar levels could not be controlled with diet and exercise alone. They require medications to keep blood sugar levels in control. The following medications may be used

• Metformin
• Sulfonylureas
• Meglitinides
• Thiazolidinediones
• DPP-4 inhibitors
• GLP-1 receptor agonists
• SGLT2 inhibitors

Insulin Therapy: Individuals with type 1 diabetes need insulin therapy to survive. Individuals with type 2 diabetes or gestational diabetes also need insulin therapy. Insulin is available in different forms.

• Rapid-acting insulin.
• Short-acting insulin.
• Intermediate-acting insulin.

Depending upon the requirement, dosage and mixture of insulin types are prescribed by the physician. Insulin can be taken through different methods. They include:

• Fine needle and syringe
• Insulin pen with a fine needle
• Insulin pump

Interventional treatment including surgery and indications for surgery/ Surgical treatment

Surgical interventions for the treatment of high blood sugar include:

Pancreas Transplantation: Some individuals may benefit from pancreas transplantation. Insulin therapy may not be required if pancreas transplantation is successful. However, immune-suppressing drugs may be needed to prevent organ rejection.

Bariatric Surgery: High blood sugar that is caused due to obesity may need a weight loss reduction procedure called Bariatric surgery. This surgery improves blood sugar levels.

Role of diet/ Exercise/ Lifestyle changes/ Preventive measures

Preventive measures and lifestyle modifications for type 2 Diabetes include:

• Maintaining adequate weight.
• Healthy diet. Consuming more green leafy vegetables and limiting sugary drinks should be followed
• Regular exercise
• Avoiding a sedentary lifestyle
• Quitting smoking or other tobacco products
• Limiting alcohol intake
• Keeping blood pressure and cholesterol under control
• Scheduling regular eye exams

Complications

In Diabetes, glucose builds up in the blood instead of being absorbed by cells. Thus, cells get starved for energy. This leads to various complications affecting many major organs like the heart, kidneys, eyes, blood vessels, and nerves. Some of them are listed below.

• Heart disorders: Heart abnormalities like cardiovascular disease, ischemic heart disease, and stroke
• Nerve damage: Excessive sugar levels in the blood can cause tingling, numbness, and pain at the tips of the toes and fingers. Gradually it leads to sensory loss in the affected limbs. Erectile dysfunction can occur in a few men.
• Kidney Damage: Kidney failure that requires kidney transplantation
• Eye Damage: Like cataracts and glaucoma. It can damage the blood vessels in the retina leading to complete blindness
• Non-healing sores: Untreated sores or injuries can progress into serious infections that can eventually lead to amputation
• Hearing loss: Diabetes can cause impairments in hearing
• Infections: Individuals with Diabetes are more vulnerable to develop bacterial and fungal infections
• Obstructive sleep apnea: Sleep apnea is a common condition that develops in people with high blood sugar
• Dementia: Type 2 Diabetes increases the risk of dementia and cognitive dysfunction. It can cause Alzheimer's or vascular dementia.
• Depression: Depression is sometimes seen in individuals with high blood sugar
• Pregnancy complications: Diabetes during pregnancy can cause preeclampsia, too large size of baby, and a higher risk of the baby developing Diabetes in future. Untreated gestational Diabetes can also lead to the baby’s death.

Prognosis

The prognosis of Diabetes varies between individuals. It depends upon how well the sugar levels are maintained. Regardless, Diabetes can lead to complications of other organs and could be life-threatening.

When to contact the doctor? / How to identify the complications?

Medical consultation is recommended after noticing any signs and symptoms of Diabetes such as frequent urination, excessive thirst, and unexplained weight loss.

Indications for hospitalization

Hospitalization is required in individuals with uncontrolled sugar levels and for any vascular complications that may arise.

Screening methods

Screening is recommended in the following instances:

• Individuals who are having a body mass index of 25 or greater regardless of age
• Individuals who are above 45 years of age
• Women who have a history of gestational Diabetes
• Individuals who were diagnosed with preDiabetes
• Children who are overweight and have at least one risk factor for acquiring Diabetes, such as a family history of Diabetes

Suggested clinical specialists/ Department to consult for this condition

• Endocrinology