Overview of Diabetes

Insulin regulates the breakdown of carbohydrates, fats, and proteins in the body to produce energy. They are mostly broken down into glucose which is released into the blood stream. When the blood glucose level increases the pancreas releases insulin.

Insulin works by:

• causing the cells to absorb the glucose from the blood
• causing the liver to absorb glucose to be stored for later use
• reducing the production of glucose
• causing the cells to convert glucose into energy

Once the blood glucose level drops, the production of insulin decreases.

Diabetes results when the body does not make enough insulin, or when the insulin produced does not function properly or when the cells don’t respond to the insulin properly (insulin resistance) or all the above. As a result, an increase in blood sugar known as hyperglycemia occurs.

Some symptoms of diabetes

• Frequently feeling thirsty
• Frequent urination
• Feeling tired
• Weight loss
• Dry skin
• Blurred vision
• Frequent infections: yeast and urinary tract infections in women
• Poor wound healing
• Numbness of tingling of hand and/or feet
• Headaches

In addition, Type 1 diabetics may have stomach pain, nausea, and vomiting. Gestational diabetes usually doesn’t have any symptoms.

Chronic hyperglycemia (high blood glucose levels) can lead to damage and potentially failure of various organs, including the eyes, heart, kidneys, blood vessels, and nerves causing a lot of diabetic complications some of which are listed below:

• Heart disease
• Chronic kidney disease
• Nerve damage
• Vision loss
• Hearing loss
• Erectile disfunction
• Diabetic Ketoacidosis

Diabetic Ketoacidosis

This is a serious and life-threatening condition that is common in people with Type 1 diabetes and can be found in people with Type 2 diabetes. It usually occurs due to illness, inadequate use of insulin, alcohol or drug use, heart attack, stroke, or the use of certain medicines like diuretics and corticosteroids, pregnancy, etc.

When the body does not have enough insulin for energy production the liver breaks down fat to produce energy. This process also produces acids called ketones which are very dangerous when they are at high levels in the body.

Symptoms of Diabetic Ketoacidosis

• Thirst
• Headache
• Frequent urination
• Headache
• Fruity scented breath
• Nausea and vomiting
• Fatigue
• Stomach pain
• High blood glucose level
• High levels of ketones in the urine

It is important to check your ketone levels when you are ill or when your blood glucose is 240 mg/dL. Call your doctor immediately or go to the emergency room if you are having symptoms of Diabetic Ketoacidosis.

Types of Diabetes

Type 1 Diabetes: This is thought to be caused by the complete destruction of cells that produce insulin due to an auto immune reaction. In this type, the patient is unable to produce insulin. It can be diagnosed at any age. Symptoms occur relatively quickly in weeks to months. Type 1 diabetes is treated with daily insulin.

Type 2 Diabetes: The insulin in these patients is ineffective and the body is unable to regulate the blood sugar level. It takes years to develop, and you may not notice any symptoms at first. It is therefore very important to get your blood glucose tested if you have risk factors.

Gestational Diabetes: This develops in some pregnant women who have no history of diabetes. The body can’t make enough insulin during the pregnancy and the cells don’t respond to the insulin properly. Generally, there are no symptoms present, which is why it is important to be tested by the doctor around weeks 24 to 28 of the pregnancy. Gestational diabetes can cause high blood pressure during pregnancy.

It usually goes away once the baby is born but increases your risk for type 2 diabetes.

Gestational diabetes can cause health problems for the baby like being born early, being very large, having Type 2 diabetes and obesity in later life, etc.

Prediabetes

This is a condition where the blood sugar is higher than it should be but is not high enough to be classed as Type 2 diabetes. Prediabetes increases the risk for Type 2 diabetes, heart disease and stroke. In this condition the insulin is ineffective, and the body is unable to regulate the blood sugar level. The pancreas makes more and more insulin to try to keep up but ultimately it can’t, and the blood glucose begins to get higher. It takes years to develop, and you may not notice any symptoms at first.

Some people may not be aware that they have prediabetes until it becomes Type 2 diabetes. This makes it very important to have your blood sugar tested by your doctor if you have the risk factors of prediabetes some of which are listed below:

• Age 45 and over
• Family History of diabetes
• Overweight
• Low physical activity
• History of gestational diabetes
• African American, American Indian, Alaska Native, Hispanic, or Latino, American Indian, or Alaska Native, Asian American, Pacific Islander
• If you have Polycystic Ovary Syndrome (PCOS)
  • The cause of PCOS is unknown but women with this condition usually have insulin resistance.

You can take a prediabetes risk test by the CDC (Center for disease control and prevention) here.

Prediabetes may be prevented or reversed by increasing activity level, losing weight if overweight, and by starting a healthy diet following the directions of your healthcare provider.

Prevention of Diabetes

Currently there is no known way to prevent Type 1 diabetes and prevention of type 2 diabetes is a long-term lifestyle change. A few things you can do are:

• Increase activity level
• Weight loss if overweight
• Start a healthy diet following the directions of your healthcare provider

Management and Treatment

There is no cure for diabetes, but it can be managed with lifestyle modifications like a healthy diet and exercise and with medications. It is important to see your doctor routinely so that your health and wellbeing can be monitored.

• Daily Insulin, or other injectable medication (will be covered in a future article)
• Oral tablets (will be covered in a future article)
• Check blood glucose regularly (will be covered in a future article)
• Monitor blood pressure and cholesterol with your doctor’s guidance
• Exercise and physical activity
• Keeping a healthy diet
• Weight loss if overweight
• Stress reduction
• Learn to recognize symptoms of low and high blood sugar
• Monitor eyes, feet and skin as directed by your doctor to prevent problems in the future
• Keep up to date with immunization

It is very important to keep your doctor’s appointments and get all the tests required by your doctor like, eye tests, dental tests, cholesterol tests, kidney tests, foot check, etc. This is so that they can monitor your heart, nerves, vision, mental health, hearing and so on to make sure that everything is in order and to prevent deterioration.

Risk Factors

Type 1 Diabetes:

• Family History: More likely if you have a parent or sibling with Type 1 diabetes
• Young age, although it can occur at any age, it is more commonly diagnosed in children, teenagers, or young adults
• White people are more likely to develop type 1 diabetes

Type 2 Diabetes:

• Prediabetes
• Age 45 and over
• Family History
• Overweight
• Low physical activity
• History of gestational diabetes
• Family History: More likely if you have a parent or sibling with Type 2 diabetes
• African American, American Indian, Alaska Native, Hispanic, or Latino, American Indian, or Alaska Native, Asian American, Pacific Islander

Gestational Diabetes

• Overweight
• Aged 25 and over
• Had gestational diabetes previously
• Family history of Type 2 diabetes
• Have a hormone disorder known as Polycystic ovary syndrome (PCOS)
• African American, American Indian, Alaska Native, Hispanic, or Latino, American Indian, or Alaska Native, Asian American, Pacific Islander

Testing for Diabetes

• Fasting blood sugar test: This blood test is conducted after fasting overnight.
  • Normal result: A fasting blood sugar level of 99 mg/dL or lower
  • Prediabetes: A fasting blood sugar level of 100 to 125 mg/dL
  • Diabetes: A fasting blood sugar level of 126 mg/dL or higher

• Glucose tolerance test: This blood test consists of two parts. The first test is conducted after fasting overnight to get the initial blood sugar level. Then you will be given a set amount of glucose liquid of known concentration.
  • For Type 2 diabetes testing your blood will be taken 2 hours after the drink.
    • Normal result: At 2 hours, a blood sugar level of 140 mg/dL
    • Prediabetes: At 2 hours, a blood sugar level of 140 to 199 mg/dL
    • Diabetes: At 2 hours, a blood sugar level of 200 mg/dL or higher
  • For Gestational diabetes testing your blood will be taken 1, 2 and 3 hours after the drink.
    • Normal fasting result: A blood glucose level is lower than 95 mg/dL
    • Normal result after 1 hour: A blood glucose level is lower than 180 mg/dL
    • Normal result after 2 hours: A blood glucose level is lower than 155 mg/dL
    • Normal result after 3 hours: A blood glucose level is lower than 140 mg/dL

If your blood glucose level is higher than 190 mg/dL after the 1-hour test, you’ll be diagnosed with gestational diabetes. If any of the results are higher than normal at either stage but not as high as 190 mg/dL, you will be tested again at a later date.

• Hemoglobin A1C test: This test measures your average blood sugar level over 2 or 3 months. It measures the percentage of your red blood cells that have sugar-coated hemoglobin. People with higher blood sugar levels have more sugar attached to their hemoglobin, which is a protein in your red blood cells, than people with normal blood sugar levels.
  • Normal is an A1C below 5.7%
  • Prediabetes is an A1C between 5.7 and 6.4%
  • Diabetes is an A1C 6.5% or higher

For most people with diabetes the goal is 7% or less, the exact number will depend on other things like age and any other medical conditions. Your doctor will work with you to set your ideal A1C goal.

Managing diabetes when you are sick

It is often challenging to control blood sugar when you are sick because of the inability to eat or drink adequately and because of possible processes that are occurring in the body to fight the illness.

It is important to try minimizing the effect of your illness by:

• Following the directions of your doctor
• Continue to take insulin or oral medication as directed by your doctor
• Test your blood glucose more often as directed by your doctor
• Monitor your temperature to make sure you do not have a fever which may indicate an infection
• Weigh yourself daily to monitor for severe weight loss
• Drink enough to prevent dehydration
• Eat as normally as you can. If you cannot get enough carbohydrates from food, then you may need to have some drinks with sugar as directed by your doctor but monitor so that blood glucose does not get too high
• Monitor for symptoms of diabetic ketoacidosis

Note: Call your doctor immediately or go to the emergency room if your symptoms persist.