Diabetes

Diabetes: Symptoms, Causes, Diagnosis, Treatment, and Prevention

What is Diabetes?

Diabetes is the most common chronic disorder of the human metabolism. It is an endocrinal disorder, which results either due to faulty insulin production or its complete absence.

Diabetes: Causes

The etiological factors of diabetes include the agent factors, the host factors and the environmental factors. They may include genetic influences, pancreatic disorders, associated infections, obesity, age, etc.

The important causative factors include the following:

Agent Factors: Few significant host factors are:

  • Pancreatic Disorders: such as neoplasm, inflammatory diseases, etc.
  • Genetic Defects: insulin gene mutation
  • Infections: viral infection may damage the beta cells of pancreas.


Host
 Factors: It includes the following aspects:

  • Age: usually middle aged individuals are more frequently affected.
  • Obesity: Generally obese people are more prone to develop diabetes.
  • Maternal Influences: The children born to diabetic mother are overweight and are susceptible to diabetes type 2 development.

Environmental Factors: Environment plays a pivotal role in the occurrence of diabetes.

  • Sedentary Lifestyle: lack of exercises and a dull inactive life increases the chances of diabetes.
  • Diet: Food rich in cholesterol and less fiber is a leading cause of diabetes.
  • Malnutrition: PEM in childhood may result in the damage of beta cells of pancreas and may precipitate diabetes.
  • Alcohol: Excessive alcohol may damage the pancreas and cause diabetes.
  • Chemicals: such as alloxan, streptozotacin, etc are known to be toxic to beta cells of pancreas.
  • Stress: Stress is the most common feature of today’s fast and demanding life; is also an important factor in the development of diabetes. Stress causes diabeticketoacidosis. The obvious symptoms of ketoacidosis are nausea, vomiting dehydration, etc.

Diabetes: Types

Primarily diabetes is of three types, namely diabetes type 1, type 2 and gestational diabetes. The classification is important as it determines the medications required for its treatment.

There are mainly three types of diabetes:

  • Diabetes Type 1: No production of insulin at all.
  • Diabetes Type 2: Insufficient insulin production or the insulin produced is not working adequately.
  • Gestational Diabetes: Development of diabetes during pregnancy. It generally disappears on its own soon after child-birth.

Pre-diabetes


It is a condition which is characterized by insufficient insulin production by the pancreas or the resistance of the cells to utilize insulin. The blood glucose levels are more than normal but the situation is not enough to be called as diabetes. It is also known as “impaired fasting glucose” or “impaired glucose tolerance”.


Metabolic Syndrome

Also known as Syndrome X. It is condition characterized by presence of type 2 diabetes with hypertension, high cholesterol levels in blood particularly LDL cholesterol; abnormalities in clotting of blood and high incidences of cardiovascular diseases.

Diabetes: Symptoms

The signs and symptoms of diabetes involve polyuria, polyphagia, polydipsia, dryness of mouth, etc. These symptoms may vary  with types.

Diabetes Type 1

The symptoms are generally severe and occur abruptly. The common ones are listed as:

  • Dryness of mouth
  • Excessive thirst (polydipsia)
  • Excessive appetite  (Polyphagia- especially after eating)
  • Polyuria( excessive urination)
  • Weight loss
  • Heavy labored breathing (Kussmaul respirations)
  • Blurring of vision
  • Excessive fatigue (unexplained weakness and tiredness)
  • Sometimes loss of consciousness

Diabetes Type 2

The symptoms of diabetes type 2 are mostly similar to type 1 with few additions. They are:

  • Itchy skin
  • Yeast infections
  • Weight gain
  • Cuts or sores- slow healing
  • Numbness or tingling sensation in hands and feet
  • Impotence
  • Erectile dysfunction

Gestational Diabetes

Often there are no symptoms of pregnancy induced diabetes, but sometimes the individuals may experience the following:

  • Excessive thirst
  • Blurring of vision 
  • Excessive micturition
  •  Excessive hunger

Diabetes: Diagnosis and Prevention

Diagnosis of diabetes is highly important, as most of the times it is undiagnosed until some complication sets in. Here are mentioned some of the commonly used diagnostic aids. 

For Example, Urine examination, Blood Glucose Fasting Test,  Glycosylated Hemoglobin Test, etc. The main preventive aspect for diabetes is discouragement of sedentary lifestyle and following regular exercise routine.

Various laboratory diagnostic tests are available for the detection of diabetes. Some of the commonly used are;

Urine Examination

Test of urine for diabetes at two hours after a meal is generally employed in routine clinical practice.

Blood Glucose Finger Stick Test

This test can be performed easily anywhere even in community screening. The results however are not very accurate.

Blood Glucose Fasting

The blood sample is taken after 8-10 hours of fasting. If the blood glucose levels are 125mg/dL without prior eating, the individuals are termed as diabetic.

Glycosylated Hemoglobin Test or Hemoglobin A1c

It is best available measurement for the level of blood glucose over the past 120 days (which is actually the life span of RBCs – the basis of the test).

The surplus glucose attaches to the hemoglobin of the RBCs for its entire life span. The test involves the measurement of the RBCs having the excess glucose attached.


Glucose Tolerance Oral Test

This test comprises of two steps. First step consist of drawing a blood sample in fasting mode and the second step is taking a blood sample around two hours after a sweet drink with 75 grams of glucose.  If the value of blood sugar in the second sample is 200mg/dL, then the person is a diabetic.

Diabetes: Prevention

The commonly suggested preventive measures for diabetes are as:

  • Follow regular exercise regime.
  • Avoid sedentary lifestyle.
  • Follow a balanced diet and plan what you should eat and what to avoid.
  • Regular monitoring of blood glucose levels and cholesterol levels should be done.
  • Keep your blood pressure regularly checked. In case of hypertension immediately consult a physician. Blood pressure has important role in diabetes development.

Diabetes: Treatment and Prognosis

The treatment of diabeteschiefly depends on the type and varies from one type to the other. However following an improvised lifestyle and adopting behavioral changes can control blood sugar levels to a great extent. Prognosis of diabetes is dependent upon the early diagnosis of the disease.

Treatment

Diabetes treatment is highly individualized and varies from person to person. It chiefly depends upon age, accompanied medical ailment, any associated complication etc.,

Diabetes Type 1:

It includes daily injection of insulin generally a combination of long acting insulin ( eg. NPH, Lente, glargine (Lantus), detemir, or ultralente) and a short acting insulin ( eg. lispro (Humalog) or aspart (NovoLog). The injections are taken around mealtime.

Insulin has to be taken as an injectable and not via oral route as the stomach destroys it before reaching the blood circulation where it is so badly needed.

Diabetes Type 2:


Patients are advised to follow a daily exercise routine and lose weight.

However medicines like sulfonylurea or biguanide [ metformin Glucophage) can be given to control plasma sugar levels.

Following a healthy diet plan is very important otherwise they will require insulin injections to control blood glucose levels.

A number of drugs are available for controlling glucose levels. The most commonly used are:

Sulfonylureas

The increase insulin production by stimulating the pancreas.

Biguanides

They lower the glucose production by the liver.

Alpha-glucosidase inhibitors

They reduce the absorption of polysaccharides in the meals we eat, so the glucose production is automatically reduced.

Thiazolidinediones

They enhance insulin sensitivity.

Meglitinides

They act upon the pancreas.

Commercial Insulins

the common available insulins are:

A. Rapid-acting insulins: for example:

  • Regular insulin (Humulin R, Novolin R)
  • Insulin lispro (Humalog)
  • Insulin aspart (Novolog)
  • Insulin glulisine (Apidra)
  • Prompt insulin zinc (Semilente, slightly slower acting)

B. Intermediate-acting insulins: for example:

  • Isophane insulin,
  • neutral protamine
  • Hagedorn (NPH) (Humulin N, Novolin N)
  • Insulin zinc (Lente)

C. Long-acting insulins: for example:

  • Extended insulin zinc insulin Ultralente)
  • Insulin glargine (Lantus)
  • Insulin detemir (Levemir)

Diabetes: Prognosis

The prognosis of diabetes is good only if diagnosed and treated well otherwise complication is obvious.

DiabetesGlossary 

  • Polydipsia – Excessive thirst 
  • Polyuria – Excessive urination
  • Insulin – A hormone secreted by beta cells of islets of Langerhans in pancreas regulates carbohydrate metabolism. 
  • Kussmaul Respirations – Laboured heavy breathing
  • Metabolic Syndrome – It is a combination of related symptoms like hypertension, increased glucose levels, high LDL cholesterol levels. It is also known as Syndrome