Diabetes

Overview of diabetes

Old age is associated with numerous pathological complications and diseases that disrupt the normal functioning of the body. Most of these diseases are apparently chronic and can be regulated through expert medications and diet recommendations. In recent years, Diabetes has been identified as the primary cause of digestive complications within the body. It not only affects an individual’s overall health but also poses a socio-economic threat. The prevalence of diabetic disorders can be traced back to 2004 when more than 220 million people worldwide were reported with Diabetes. WHO has also projected the doubling of diabetes rates between 2005 to 2030. Global standards of healthcare must be raised to address the impending issues related to Diabetic conditions.

What is Diabetes?

Diabetes refers to a group of pathological conditions in which the concentration of blood glucose increases due to shortage of insulin within the body due to pancreatic dysfunctions. In this condition, the body cannot convert glucose from food into energy, leading to excess accumulation of unused glucose within the body. According to recent findings by WHO, death due to diabetic diseases occurs mostly under the age of 70. Although Diabetes is usually a disease of old age, children in their growing years have also been diagnosed with diabetes in some cases.

What are the main causes of Diabetes?

Diabetes is more prominent in low and middle income countries and might arise due to multiple factors. The primary cause of Diabetes is the scarcity of insulin within the body that absorbs blood glucose and utilizes it to produce energy. This occurs under two circumstances:

• The pancreas cannot produce enough insulin to control blood glucose level
• The insulin produced cannot be efficiently utilized to regulate blood glucose

Both these conditions are attributed to functional abnormalities of the pancreas.

What are the causes of Type 1 Diabetes?

These causes mainly belong to the category of genetic factors or past infections:

• Auto-immune destruction of beta cells of pancreas (responsible for storage and release of insulin)
• Presence of antibodies to islet cells (responsible for insulin production) in the blood
• Gradual decline in the secretion of insulin

What are the causes of Type 2 Diabetes?

These causes are mainly related to factors such as :

• Obesity
• Age (increased insulin resistance)
• Insufficient physical activities
• Heredity
• Ethnicity (African Americans, Native Americans, Hispanics)
• Polycystic Ovary conditions

The above factors combine to give rise to the following conditions :

• Insulin resistance in the liver and skeletal muscles occurs, causing increased glucose production from the liver.
• Excessive generation of free fatty acids by fat cells leading to insulin deficiency
• Beta cell damage causes reduced insulin production

What are the main warning signs and symptoms?

The symptoms of diabetes vary according to the type of Diabetes. The generalized symptoms are stated below:

• Excessive thirst and urination
• Extreme fatigue and headache
• Delayed recovery from injuries
• Abnormal weight loss/gain
• Pain in limbs
• Unclear vision
• Itchy and reddish skin (at times with rashes)
• Abnormal loss/increase of appetite
• Irritability and frequent mood swings

What are the different types of diabetic diseases?

Two major categories are Diabetes has been studied so far, that cause 80% of death in low and middle-income countries. These are – Diabetes Mellitus and Diabetes Insipidus. These are discussed below:

Diabetes Mellitus (DM): It refers to a group of metabolic conditions that lead to hyperglycemia (abnormal increase in blood glucose level). This condition is caused by insufficient production or utilization of insulin. It can be further classified into two types: (a) Type 1 Diabetes and (b) Type 2 Diabetes

• Type 1: It occurs due to insufficient insulin production. It is also called Juvenile Onset Diabetes and contributes to 5-10 % of diabetes cases (according to CDC reports). In this case, the pancreas cannot generate sufficient insulin needed to control blood glucose level due to destruction of beta cells. Patients belonging to this category undergo artificial intake of insulin to make up for insulin deficiency in the body.
• Type 2: It is also called Adult-onset Diabetes and occurs due toan insufficient utilization of insulin. WHO reports claim that Type 2 Diabetes affects more than 90% of Diabetic patients worldwide. The primary risk factors of this type of Diabetes are excessive body weight, and limited physical activities.

Diabetes Insipidus (DI): It is characterized by excessive thirst and production of large volumes of urine. In extreme cases, it might result in frequent bedwetting or dehydration. Children suffering from Diabetes Insipidus exhibit symptoms nausea, irritability, disturbed sleep and diarrhoea. Diabetes Insipidus has the following subtypes-

• Central DI: It is caused due to damage of pituitary gland (due to head injuries, genetic disorders or neurosurgery) resulting in disturbed storage and release of ADH (Antidiuretic hormone).
• Nephrogenic DI: This disease is caused due to the impaired response of the kidney to ADH due to certain medications or chronic diseases (Polycystic Kidney).
• Dipsogenic DI: This type of diabetic disease occurs due to the damage of the thirst center located at the hypothalamus. It causes excessive thirst and urination, leading to sodium imbalance in body fluids.
• Gestational DI: Gestational diabetic condition is observed in 2-5 % of women during the pre-natal stage, but it does not persist after the pregnancy period. It is caused due to the destruction of ADH in mother by an enzyme produced by the placenta.

Are there some long-term systemic complications?

Diabetic diseases in any form might leave long-lasting detrimental impacts on the patient’s body. The important ones are listed below-

• Permanent renal failure
• Cardio-vascular diseases
• Foot ulcers
• Diabetic retinopathy

Treatment & Prevention

The treatment chiefly depends on the type of diabetes. However, certain measures such as intake of a healthy diet, maintaining a healthy weight, a regular physical activity can help in managing the condition well.

Type 1 – Regular blood sugar checks, calorie counting and use of insulin injections or pumps are required.

Type 2 – Diabetes medication and/or insulin are administered in this case. Regular monitoring and the evaluation of the blood sugar levels are required. Certain lifestyle changes can help in controlling the spike in the blood sugar levels.

• Blood sugar level monitoring: Based on the treatment plan, the blood sugar level is usually checked 1 to 4 times in a day. The A1C levels are usually checked in order to evaluate the average blood sugar levels in the past 2 to 3 months. As compared to the regular blood sugar level tests, the A1C test is considered as better indicators of the effect of the diabetes management plan. An elevated A1C level indicates changes should be made in the oral medications, insulin dose, diet etc.
• Insulin therapy: Insulin is essential for survival for individuals with type 1 diabetes. However, insulin administration may also be required in cases of type 2 diabetes or gestational diabetes.
• Medications: Medications prescribed for diabetes have a different mechanism of action. They can help to stimulate the pancreas to produce more insulin; they can block the intestinal or stomach enzymes that metabolize carbohydrates or make tissues more sensitive to insulin. For instance, oral medication metformin is prescribed in cases of type 2 diabetes.

A pancreas transplant is performed in some cases as an alternative to insulin therapy. Transplants are not successful in all the cases and have grave risks involved. Bariatric surgery is an option considered for patients with type 2 diabetes having a body mass index (BMI) higher than 35. Gestational diabetes and prediabetes are managed by lifestyle changes and by keeping the blood sugar levels under check. In some cases, medications or insulin might be prescribed.

Management of weight, intake of appropriate diet, and regular physical activities are methods to reverse prediabetes and prevent the occurrence of type 2 diabetes.

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