Diabetes

Inflammatory and Immune System

Diabetesmellitus is a group of metabolic diseases that occurs when your blood glucose, or “sugar”, is too high (hyperglycemia). Blood glucose is found in your blood and is the primary source of energy in the human body. In healthy people, the body uses insulin, a hormone made in the pancreas, to uptake glucose into the body’s cells. There are two major forms of diabetes, type 1 and type 2. With type 1 diabetes, the pancreas does not produce insulin and the cause is usually genetic. In type 2 diabetes, the body produces insulin but the gates that open up and allow glucose into the cells are defective. Persistently high blood sugar levels damage the blood vessels and prevent blood flow to organs and tissues. High blood sugar levels over time reduce energy and nutrients into your body’s cells and damage delicate organ tissue. Severe complications of diabetes are stroke, heart disease, kidney damage, blindness, and limb amputations due to poor circulation and nerve damage. Diabetes, especially type 2, is one of the leading causes of death in the world and the number of new cases is growing exponentially worldwide.

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Symptoms

The three most common symptoms of undiagnosed diabetes are the need to urinate often, feeling extremely thirsty, and increased hunger. Symptoms vary for each individual and include:

  • Excessive thirst
  • Frequent urination
  • Extreme hunger
  • Chronic fatigue
  • Weight loss (sudden or unexplained)
  • Irritability
  • Blurred vision
  • Sores or wounds that heal slowly
  • Dry, itchy skin
  • Frequent infections (i.e., skin, gum, and vaginal)
  • Fruity-smelling breath or urine
  • Numbness and tingling of the hands and feet

Types

There are several types of diabetes in this family of metabolic diseases, however, the majority of cases fall under two categories, type 1 and type 2. Type 1 is an auto-immune type and Type 2 is acquired, but both have a genetic link. Gestational diabetes is also discussed due to its occurrence in pregnant women.

Type 1 diabetes (T1D).Accounts for 5-10% of all cases of diabetes. Also called juvenile diabetes or insulin-dependent,T1D symptoms usually appear in childhood, but can appear anytime into early adulthood. In type 1 diabetes, the pancreas no longer produces insulin and the body is unable to process any glucose without taking daily insulin injections. This is thought to be an auto-immune disorder that is triggered by either a virus or environmental factors. There is no cure and this type is not reversible, but it is manageable requiring lifelong treatment with insulin injections.

Type 2 diabetes (T2D).Also called non-insulin-dependent diabetes mellitus, or NIDDM. This type of diabetes accounts for 90-95% of all known cases of diabetes. T2D usually occurs in the adult years, but the age of onset is decreasing. The pancreas decreases or stops the production of insulin and the body has reduced sensitivity to any insulin present. There is usually a cause linked to the following: obesity, family history, history of gestational diabetes, and ethnic background (Native American, African American, Hispanic). The good news is this type is highly treatable and even reversible if the pancreas is still functioning. You may or may not require insulin injections and it is often manageable with diet and/or oral medications.

Gestational diabetes. This sub-type of type 2 diabetes only occurs during pregnancy. It is more common in women who are obese and have a history of Polycystic Ovarian Syndrome (PCOS). Babies born to mothers with GD have a risk of being higher birthweight and low blood sugar at birth. This condition is easily managed during pregnancy with good medical care and diet.

Risk Factors

The risk factors associated with type 1 diabetes are unknown, but genetics and some viruses may contribute to a higher risk of developing this form of diabetes. Risk factors associated with type 2 diabetes are:

  • Age (45 or older)
  • Obesity
  • Low physical activity
  • Family history of diabetes
  • Ethnicity (African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander)
  • High blood pressure
  • Depression
  • History of heart disease or stroke
  • History of gestational diabetes
  • Polycystic ovary syndrome
  • Have acanthosis nigricans (dark, thick, and velvety skin around neck or armpits)

Diagnosis

Diabetes can be very silent for years, without any outward symptoms until the disease progresses. If you do not have symptoms, the disease is often found during a routine physical. It is highly recommended that anyone age 45 and older be screened routinely for diabetes every three years. If you do have any of the above symptoms, see your doctor as soon as possible. The following tests are used to diagnose diabetes:

Random blood sugar test. During a routine office visit, your doctor can just take a small sample of blood from your finger and test it for blood sugar. Whether you have eaten or not, if your blood sugar is 200 mg/dL or higher you may have diabetes.

Fasting blood sugar test. You will fast after bedtime the night before and have nothing to eat or drink the morning before your test. They will take a blood sample and test it for blood sugar. It should be lower than 100 mg/dL and if it is between 100 mg/dL and 125 mg/dL you may have prediabetes. Over 125 mg/dL two times means you have diabetes.

Glucose tolerance test. This blood test requires fasting the night before the test and the morning of the test. When you first get to the lab they will draw a blood sample and then have you drink a very sweet glucose drink. After drinking the solution, they will draw your blood every two hours to see how your body processes glucose. If your blood sugar drops to 140 mg/dL or less after two hours, your body handles glucose normally. If your blood sugar stays above 200 mg/dL then you may have diabetes. If your blood sugar stays between 140 mg/dL and 100 mg/dL then you may have prediabetes.

The A1C test. The glycated hemoglobin A1C test checks the average of your blood sugar levels over three months. When your blood sugar rises, it sticks to the hemoglobin in your blood and stays there. Even if you have normal blood sugar levels during random testing, this test will pick up that you may have had high blood sugars over the three months. The test levels that indicate your blood sugars work like this:

  • A1C 5.7 or lower – Normal
  • A1C 5.7 to 6.4 – Prediabetes
  • A1C 6.5 or higher – Diabetes if this number comes up on two different occasions
    If you are diagnosed with diabetes, it is recommended that you have the A1C test done 2 to 4 times yearly. It is recommended that you try to keep your A1C less than 7, but your doctor will tell you the best numbers for your age and other health conditions you may have.

You will also keep track of your daily blood sugar levels either twice daily or before each meal if you take insulin.

Other tests. To check for any complications your doctor may test:

  • Liver function tests
  • Thyroid function tests
  • Kidney function tests
  • Cholesterol testing
  • Blood pressure
  • Eye examinations
  • Foot examinations

Treatments

The treatments for diabetes include:

  • Eating a healthy balanced diet
  • Exercise
  • Diabetic medications (oral antidiabetics and/or insulin injections)
  • Daily blood sugar monitoring

Eating a healthy balanced diet. A diabetic diet consists of balanced low-calorie, low-fat, and healthy carb foods. It is also important to eat foods that are high in fiber such as fresh vegetables, fresh fruits, and whole grains. Try to avoid processed foods, high-fat foods, and desserts.

The good news is that diabetics can have carbohydrates if they are low on the “glycemic index.” Recent studies have shown that certain carbohydrates break down slower than refined carbohydrates and benefit a diabetic diet. Adding protein foods to carbohydrates also slows down blood sugar spikes. A diabetic educator can help you with your meal plans that will keep your blood sugar in a good range.

Exercise. Diabetics need to get 30 minutes of exercise at least 5 days a week. This includes; swimming, walking quickly, and riding a bike. Aerobic exercise at least 3 days a week can help lower blood sugar levels and improve circulation.
Exercise brings down the blood sugar levels so it is important to check your blood sugar before and after exercise, eat a light carb snack before you start and after you finish and stop physical activity if you have symptoms of low blood sugar including; dizziness, sweating, confusion, or shakiness.

Diabetic medications. If you have Type 1 diabetes you will need insulin injections since your pancreas no longer makes insulin. You may also need other medications to prevent complications.If you have Type 2 diabetes, you may be able to control your blood sugar levels with dietary management alone. You may also need oral antidiabetics to help your body process glucose and increase insulin production from the pancreas. In more advanced Type 2 diabetes, some people need to also take oral insulin medications or insulin injections.

Blood sugar monitoring. Diabetes checking your blood sugar at least twice a day. Type 1 diabetics need to check before each meal to know how much insulin to take. The traditional method is using a standard glucose meter which requires at least two finger pricks each day to check the sugar level. However, the FDA has approved continuous glucose-monitoring devices that do not require a finger prick. These devices monitor your glucose level throughout the day using a variety of different sensor methods, including a patch worn on your stomach or a device around your upper arm. It is vitally important to monitor so you know when your blood sugar is either too low or too high. Symptoms of these include:

Low Blood Sugar

  • Weakness
  • Fatigue
  • Shakiness
  • Sweating
  • Confusion
  • Hunger
  • Headache
  • Irritability
  • Anxiety
  • Blurred vision
  • Fast heartbeat
  • Fainting
  • Seizures

High Blood Sugar

  • Excessive urination
  • Excessive thirst
  • Blurred vision
  • Dry skin
  • Weakness
  • Fatigue

Prevention

Type 1 diabetes may not be preventable because it is a genetic and autoimmune condition. Type 2 diabetes is preventable and reversible in the early stages of the disease. Prevention tips include:

  • Keep your weight in a healthy range
  • Get plenty of exercises
  • Eat healthily
  • Get your blood sugar checked at your yearly physical
  • Avoid stress

Lifestyle Changes

Learn the glycemic index. The glycemic index is based on how high carbohydrates will raise your blood sugar. There are low glycemic carbs, moderate glycemic carbs, and high glycemic carbs. This will help you include healthy carbs in your diet.

Increase fluid intake. Increased sugar-free fluids can help flush excess sugar from your body and protect your health.

Check restaurant menu options. Before you go out to eat, check ahead to make sure there are menu options that are “diabetic friendly.” If you are in a pinch and don’t have time, opt for the “heart-healthy” choices.

Let people know about your condition. People around you need to know that you are diabetic. Teach them about symptoms of low or high blood sugar and how to help you if you become unconscious or unable to care for yourself.

Keep blood sugar rescue on hand. If you do have a drop in blood sugar, you will need to have some kind of blood sugar rescue available. If you can manage yourself, keep things like orange juice, hard candies, or glucose rescue tablets on hand. You will also need a glucose pen injection and the people around you will need to know how to use it.

References

American Diabetes Association. (2013, January). Diagnosis and classification of diabetes mellitus. Diabetes Care, 36(Supp. 1), S67-S74. Retrieved from:https://care.diabetesjournals.org/content/diacare/36/Supplement_1/S67.full.pdf

Centers for Disease Control and Prevention. (2020, March 11). Type 1 diabetes. Retrieved fromCenters for Disease Control and Prevention:https://www.cdc.gov/diabetes/basics/type1.html

Centers for Disease Control and Prevention. (2020, March 11) Type 2 diabetes. Retrieved fromCenters for Disease Control and Prevention:https://www.cdc.gov/diabetes/basics/type2.html

Food and Drug Administration Writing Staff. (2016, December 20). FDA expands indication for continuous glucose monitoring system, first to replace fingerstick testing for diabetes treatment decisions. Retrieved from:https://www.fda.gov/news-events/press-announcements/fda-expands-indication-continuous-glucose-monitoring-system-first-replace-fingerstick-testing

Fowler, M. J. Microvascular and macrovascular complications of diabetes. Clinical Diabetes, 29(3), 116-122. Retrieved from:https://clinical.diabetesjournals.org/content/diaclin/29/3/116.full.pdf

Mayo Clinic Staff. (2020, January 30). Type 1 diabetes in children. Retrieved from Mayo Clinic:https://www.mayoclinic.org/diseases-conditions/type-1-diabetes-in-children/symptoms-causes/syc-20355306

National Institute of Diabetes and Digestive and Kidney Diseases. (2016, November). Risk factors for type 2 diabetes. Retrieved from:https://www.niddk.nih.gov/health-information/diabetes/overview/risk-factors-type-2-diabetes

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