Diabetes Mellitus

Diabetes Mellitus, commonly known as diabetes, is a chronic metabolic disease characterized by high blood sugar (glucose) levels. Glucose is vital to your health because it’s an important source of energy for the cells that make up your muscles and tissues, and it’s your brain’s primary fuel. The body’s ability to produce or use insulin, a hormone produced by the pancreas that allows glucose to enter cells for energy, is impaired in people with diabetes. This leads to glucose building up in the bloodstream. Over time, high blood sugar can lead to serious health problems, including heart disease, kidney disease, nerve damage, and vision problems.

There are several main types of diabetes:

• Type 1 Diabetes: An autoimmune condition where the body’s immune system attacks and destroys the insulin-producing beta cells in the pancreas. It typically develops in childhood or adolescence but can occur at any age. People with Type 1 diabetes require daily insulin injections to survive.
• Type 2 Diabetes: The most common type, occurring when the body either doesn’t produce enough insulin or doesn’t use insulin effectively (insulin resistance). It is often linked to genetics, lifestyle factors such as obesity and physical inactivity, and typically develops in adults, though it’s increasingly seen in younger individuals.
• Gestational Diabetes: Develops during pregnancy in women who haven’t previously had diabetes. It usually resolves after childbirth but increases the mother’s and child’s risk of developing Type 2 diabetes later in life.

Causes:

The causes of diabetes vary depending on the type, but all involve problems with insulin production or utilization, leading to elevated blood glucose.

• Type 1 Diabetes:
  • Autoimmune Reaction: The immune system mistakenly attacks and destroys pancreatic beta cells.
  • Genetics: A family history of Type 1 diabetes increases risk.
  • Environmental Factors: Possible viral infections or other environmental triggers may play a role.
• Type 2 Diabetes:
  • Insulin Resistance: Cells in muscles, fat, and liver become resistant to insulin, so they don’t absorb enough glucose.
  • Insufficient Insulin Production: The pancreas cannot produce enough insulin to overcome resistance.
  • Genetics: Strong family history component.
  • Obesity and Overweight: A major risk factor; excess fat tissue can lead to insulin resistance.
  • Physical Inactivity: Lack of exercise contributes to insulin resistance and weight gain.
  • Age: Risk increases with age, especially after 45.
  • Ethnicity: Certain ethnic groups have a higher risk.
  • Polycystic Ovary Syndrome (PCOS): Increases insulin resistance in women.
• Gestational Diabetes:
  • Hormonal Changes During Pregnancy: Placental hormones can make cells more resistant to insulin.
  • Genetic Predisposition: Family history of diabetes.
  • Obesity before Pregnancy.
  • Previous Gestational Diabetes.

Symptoms:

The symptoms of diabetes can develop slowly and may be subtle, especially in Type 2 diabetes. Type 1 diabetes symptoms tend to appear more suddenly and severely.

• Increased Thirst (Polydipsia).
• Frequent Urination (Polyuria).
• Increased Hunger (Polyphagia).
• Unexplained Weight Loss: More common in Type 1.
• Fatigue.
• Blurred Vision.
• Slow-Healing Sores.
• Frequent Infections: Such as gum, skin, or vaginal infections.
• Numbness or Tingling: In the hands or feet (peripheral neuropathy).
• Dry Skin.
• Irritability or Mood Changes.

Diagnosis:

Diabetes is diagnosed through blood tests that measure blood glucose levels. Early diagnosis is important to prevent complications.

• Fasting Plasma Glucose (FPG) Test: Measures blood glucose after an overnight fast (at least 8 hours).
  • Normal: Less than 100 mg/dL (5.6 mmol/L)
  • Prediabetes: 100 to 125 mg/dL (5.6 to 6.9 mmol/L)
  • Diabetes: 126 mg/dL (7.0 mmol/L) or higher on two separate tests
• Oral Glucose Tolerance Test (OGTT): Measures blood glucose before and 2 hours after drinking a glucose-containing beverage.
  • Normal: Less than 140 mg/dL (7.8 mmol/L) after 2 hours
  • Prediabetes: 140 to 199 mg/dL (7.8 to 11.0 mmol/L) after 2 hours
  • Diabetes: 200 mg/dL (11.1 mmol/L) or higher after 2 hours
• Random Plasma Glucose Test: Measures blood glucose at any time, regardless of when you last ate.
  • Diabetes: 200 mg/dL (11.1 mmol/L) or higher, along with symptoms of diabetes.
• A1C Test (Glycated Hemoglobin Test): Measures your average blood sugar level over the past 2-3 months.
  • Normal: Below 5.7%
  • Prediabetes: 5.7% to 6.4%
  • Diabetes: 6.5% or higher on two separate tests
• Antibody Tests: For Type 1 diabetes, blood tests can detect autoantibodies that are present in Type 1 but not typically in Type 2.

Treatment:

Diabetes management focuses on keeping blood glucose levels within a target range to prevent complications. Treatment plans are highly individualized.

• For All Types of Diabetes:
  • Healthy Eating: Emphasize fruits, vegetables, whole grains; limit processed foods, sugary drinks, and unhealthy fats. Carbohydrate counting may be used.
  • Regular Physical Activity: At least 150 minutes of moderate-intensity aerobic activity per week, plus strength training.
  • Weight Management: Especially for Type 2 diabetes, even modest weight loss can significantly improve blood glucose control.
  • Blood Glucose Monitoring: Regular self-monitoring (SMBG) or continuous glucose monitoring (CGM) to track levels and adjust treatment.
  • Regular Check-ups: With healthcare providers, including ophthalmologists, podiatrists, and nephrologists, to monitor for complications.
• Specific Treatments by Type:
  • Type 1 Diabetes:
    • Insulin Therapy: All individuals with Type 1 diabetes require lifelong insulin replacement, administered via injections (syringes, pens) or an insulin pump. Different types of insulin (rapid-acting, short-acting, intermediate-acting, long-acting) are used.
  • Type 2 Diabetes:
    • Oral Medications:
      • Metformin: Often first-line; reduces glucose production by the liver and improves insulin sensitivity.
      • Sulfonylureas: Stimulate the pancreas to produce more insulin.
      • DPP-4 Inhibitors: Improve insulin secretion and reduce glucagon.
      • SGLT2 Inhibitors: Cause the kidneys to excrete more glucose in the urine.
      • GLP-1 Receptor Agonists: Injectable medications that slow digestion, reduce glucose production, and stimulate insulin release.
    • Injectable Non-Insulin Medications: (e.g., GLP-1 receptor agonists).
    • Insulin Therapy: May be required if oral medications and lifestyle changes are not sufficient to control blood glucose.
  • Gestational Diabetes:
    • Diet and Exercise: Often the first approach.
    • Blood Glucose Monitoring: Frequent monitoring is essential.
    • Medication: Insulin or oral medications (e.g., metformin) may be prescribed if blood glucose targets are not met with lifestyle changes.

Living with diabetes requires ongoing self-management and collaboration with a healthcare team to maintain good health and prevent long-term complications.