All you need to know about Diabetes Mellitus

Diabetes mellitus

Diabetes mellitus is a disease that affects the way the body uses blood glucose levels. Glucose is important for the cells that make up the body tissues and muscles. Glucose is broken down to give energy to the body to do various activities.

The cause of Diabetes can vary. Whatever the type, it may lead to an increase in blood glucose levels. When blood glucose level increases, it can lead to significant health conditions.

There are two types of Diabetes that can affect the blood glucose level of a person. The mechanism which affects and the types of Diabetes are discussed in this blog.

Types of Diabetes

The two types of Diabetes are

• Type 1 Diabetes
• Type 2 Diabetes

Type 1 Diabetes

Type 1 Diabetes is an autoimmune disease. The body attacks its own cells, which leads to this disease called type 1 Diabetes.

The pancreas of the person affected with type 1 Diabetes will not be able to make insulin or produce very less insulin. Type 1 Diabetes is also called insulin-dependent or juvenile Diabetes. Type 1 Diabetes is usually seen in young children and teenagers. However, it can occur at any age.

According to CDC, type 1 Diabetes is less common when compared to type 2, and about 5-10% of people with Diabetes have type 1.

Type 1 Diabetes is caused due to autoimmune reactions. The cells attack their own pancreas, which can destroy the beta cells in the pancreas. This reduces the ability of the pancreas to make insulin. This destruction of beta cells can continue for months without any symptoms.

In some cases, type 1 Diabetes can run in families. A virus can also be a triggering factor for the development of type 1 Diabetes. CDC states that diet and lifestyle habits will not cause type 1 Diabetes.

The symptoms of type 1 Diabetes can be similar to other health conditions. If you think you have type 1 Diabetes, it is recommended to check with your healthcare professional.

To check for type 1 Diabetes, a blood test will be required. The collected blood sample will be tested for autoantibodies. These antibodies can indicate that a person has type 1 Diabetes and not type 2.

A person affected with type 1 Diabetes should take insulin shots every day to manage the imbalance in the blood glucose level. Insulin cannot be taken as a pill as the digestive juices in the stomach can degrade the enzyme.

Type 2 Diabetes

The body of a person affected with type 2 Diabetes will not respond to insulin. This condition is called insulin resistance. This leads the pancreas to make more insulin to make the cells respond to the production of the insulin.

Eventually, this leads to an increase in blood glucose levels. This sets as prediabetes and later leads to type 2 Diabetes. High blood glucose levels, irrespective of the type, can be damaging to the body and can cause major health problems like heart and kidney diseases.

The symptoms of type 2 Diabetes can develop for years, and they will remain unnoticed. These symptoms can be hard to notice, and only a blood test will help identify the condition.

Type 2 Diabetes can be managed with certain lifestyle changes and certain alterations in the diet plan. Being physically active can also help manage type 2 Diabetes.

Prediabetes

Prediabetes can be a significant health condition. This condition causes a rise in blood glucose levels. However, the rise in blood glucose level will not be high enough to indicate or diagnose as type 2 Diabetes. According to CDC, one in 3 people has prediabetes.

Additionally, more than 80% of the population will not know they have prediabetes, which can increase the risk of heart disease and stroke.

When the body does not respond to insulin production, it can lead to prediabetes. The occurrence of prediabetes can increase if a person is

• Overweight
• Aged above 45
• Having a family history of type 2 Diabetes
• Physical inactive
• Gestational Diabetes
• Affected with polycystic ovary syndrome

Prediabetes can be prevented with physical activity and a healthy lifestyle. Changes in eating habits can also help prevent prediabetes. Being overweight can increase the risk. So, a healthy body weight can reduce the risk of prediabetes.

Gestational Diabetes

Gestational Diabetes is the occurrence of Diabetes for the first-time during pregnancy. Gestational Diabetes can occur when the body cannot make insulin during pregnancy.

During pregnancy, a woman goes through a lot of physical and mental changes. A prominent physical change is weight gain. Such changes can lead to a deficiency in the body to use insulin less effectively. This can lead to gestational Diabetes.

In most cases, pregnant women affected with gestational Diabetes will not have any symptoms. A proper medical test will be required to confirm the disease.

If a woman has gestational Diabetes, it can affect their baby. And the baby has an increased risk of

• Premature birth
• Low blood sugar
• Developing type 2 Diabetes later in life and
• Being overweight which can make labour more difficult.

Usually, the blood glucose level will return to normal after delivery. However, both the mother and the baby can develop type 2 Diabetes later in life. The development of type 2 Diabetes can be prevented with a healthy lifestyle and food habits.

Monogenic Diabetes syndromes

Monogenic Diabetes syndrome accounts for about 4% of the total cases. It results when a mutation occurs in a single gene, whereas type 1 and type 2 Diabetes are caused due to multiple gene mutations.

It is a rare condition, and in most cases, they are inherited from parents. According to the Endocrine Society, of all Diabetes mellitus cases, monogenic Diabetes syndrome accounts for 2-5%.

The syndrome occurs in different forms, and it usually affects young people. The disease makes it difficult for the body to make insulin. The specific form of the syndrome is called MODY (maturity-onset Diabetes of the young) or neonatal Diabetes.

Genes play an important role in making proteins. If there is a mutation in the genes, it can affect the way the protein function and can lead to diseases like Diabetes.

The common mutations occur in the genes of GCK, HNF1A, MODY3 and MODY2. The treatment for MODY will depend on the conditions. Some people will not require any treatment apart from diet and certain lifestyle changes. In severe cases, insulin might be required to treat the disease.

Cystic fibrosis-related Diabetes

Cystic fibrosis-related Diabetes is caused due to complications of cystic fibrosis. The symptoms may differ from both types; however, the cause can be the same. The cause of fibrosis-related Diabetes is insulin deficiency, which leads to the destruction of pancreatic islet cells.

Insulin resistance can play an important role in exacerbating pulmonary diseases. Abnormal glucose metabolism leads to cystic fibrosis-related Diabetes.

According to NCBI, the occurrence of cystic fibrosis-related Diabetes is present in about 2% of children and 19% of adolescents and 45–50 % occurrence is seen in people aged above 30 years.

The cause of the disease is still unknown and is predicted to be a multifactorial problem that includes both structural and functional components.

Research data suggested that there were no clinical symptoms observed during the time of diagnosis. According to NCBI, gaining weight and difficulty maintaining weight despite taking good nutrition can also indicate the symptoms of cystic fibrosis-related Diabetes.

Since there are no major symptoms exhibited by the patients, it is advised to take a regular screening test for people affected with cystic fibrosis.

Screening methods like urine glucose tests, random plasma glucose measurements, fructosamine testing and haemoglobin monitoring are not recommended due to their low sensitivity.

Insulin is the preferred treatment for patients affected with cystic fibrosis-related Diabetes. Additionally, insulin therapy can give better glycaemic control and improved pulmonary function in patients affected with cystic fibrosis-related Diabetes.

Like Diabetes, cystic fibrosis-related Diabetes has no cure and will require lifetime treatment. Insulin therapy is preferred, and the condition also responds well to the treatment.

Drug or chemical-induced Diabetes

Drug-induced Diabetes can be induced by drugs, and certain medications can have an adverse effect on health. These drugs can also lead to high blood glucose.

Some of the common medications that can induce hyperglycaemia and Diabetes are

• Alpelisib,
• Antipsychotics
• Steroids
• Transplant immuno-suppressants
• Thiazide diuretics
• Lipid-lowering agents
• Beta-blockers and
• Antiretrovirals

If the high blood glucose levels are not controlled, it can increase the risk of macrovascular and microvascular complications.

In certain cases, hyperglycaemia can be controlled when the drugs are paused or with alternative therapy.

The multiple mechanisms that cause drug-induced Diabetes or hyperglycaemia are

• Insulin resistance
• Increased hepatic glucose production
• Decreased insulin secretion
• Glucose intolerance
• Autoimmune destruction of beta cells.

How common is Diabetes?

According to NCBI, about 25.2 million people have impaired glucose tolerance and the affected population between the age of 20-79 years may be 77.0 million.

Additionally, people with Diabetes above 65 years may be 12.1 million, and the undiagnosed cases maybe 57 per cent. The total number of deaths in 2019 related to Diabetes can be about 1 million.

Symptoms of Diabetes

Some of the common symptoms of Diabetes, irrespective of the type, include

• Weakness
• Tiredness without doing any activity
• Fatigue
• Morning sickness
• Dry mouth
• Delayed healing
• Frequent infections
• Dry mouth
• Blurred vision
• Increased thirst
• Decreased sex drive
• Erectile dysfunction
• Decreased muscle strength.

Causes of Diabetes mellitus

Type 1 Diabetes can occur when the immune cells attack the beta cells in the pancreas. They destroy the beta cells, and scientists think environmental factors can also trigger type 1 Diabetes. However, scientists are studying the exact cause of type 1 Diabetes.

Type 2 Diabetes is caused due to various reasons like genetic factors and lifestyle changes.

If a person is overweight, the chances of developing type 2 Diabetes are high. Additionally, physical inactivity can also trigger type 2 Diabetes. The complications of type 2 Diabetes can be heart and blood vessel diseases.

Suppose a person has a sedentary lifestyle and consumes fatty foods, it can trigger insulin resistance and pave the way for type 2 Diabetes.

You can check the risk factor of type 2 Diabetes by Body Mass Index (BMI). Gestational Diabetes can also be an important factor for developing type 2 Diabetes later in life for both baby and mother.

Risk factors of Diabetes mellitus

The risk factors of Diabetes mellitus increase with these traits.

• Family history of Diabetes (both type 1 and type 2 Diabetes).
• Pancreatic injuries like infection, accident, surgery and tumour).
• Physical stress.
• Being obese or overweight.
• Having hormonal diseases like Cushing’s syndrome and Acromegaly.
• Medications that can harm the beta cells.
• Affected with polycystic ovary syndrome.
• Chain smoking.

Diagnosis of Diabetes Mellitus

The diagnosis of Diabetes can be carried out by a blood test. The blood test will assess the glucose or sugar levels in the blood. Each test has its own sensitivity and accuracy.

Fasting plasma glucose test

The fasting blood glucose test will be taken after a night fast. You should not drink or eat anything before the test. However, some sips of water can be taken. If a person has a blood glucose level of 100 mg/dL, it is considered normal.

A fasting blood sugar level of 100 to 125 mg/dL is considered prediabetes, and above 126 mg/dL, it is considered Diabetes.

Random plasma glucose test

Random plasma glucose tests, as the name suggests, can be taken at a random time. The time of food consumption will not be considered. The blood will be drawn and tested for a blood glucose level. A glucose level higher than 200 mg/dL is considered diabetic.

A1c test

The A1c is also called haemoglobin A1c or HbA1c. The test measures the blood glucose level for the average of the past three months.

The blood will be drawn and tested for a blood glucose level. The sugar, after entering the bloodstream, will attach itself to the haemoglobin. A person having a blood glucose level will have high sugar-coated haemoglobin levels.

Gestational Diabetes tests

Screening for gestational Diabetes is also called an oral glucose tolerance test. The test will be carried out on an empty stomach. And then, a glucose drink will be given. The blood will be drawn again after two hours. The test is usually prescribed during the 24 and 28 weeks of pregnancy.

Management of Diabetes mellitus

Diabetes can be managed with food and a healthy lifestyle. If you follow a healthy lifestyle, it can be managed without any medication. However, in some cases, when the glucose level is too high or low, proper treatment will be required.

If the body is not producing any insulin, then people will require insulin shots. Additionally, a proper healthy diet with low GI fruits and vegetables will be required. There will be certain restrictions to fruits, as fruits can lead to a sudden sugar rush.

People with Diabetes should check their blood glucose levels regularly. If it is not treated or managed properly, it can lead to significant health issues like heart disease and stroke.

Stress can have a negative impact on a person’s life. It can elevate blood glucose levels. The stress in daily life should be managed properly.

Regular physical activity, healthy food habits and a proper sleep cycle will be required to manage blood glucose levels. Regular check-ups with your doctor will be crucial for the management.

If there are any unusual symptoms or any wounds that have not healed, consult your doctor. If left untreated, it can lead to amputation of legs or hands with unhealed wounds.

Some of the quick tips to manage blood glucose levels are listed below.

• A healthy diet and physical activity
• Regular blood glucose level check-ups and record the results.
• Maintaining proper sleep cycle
• Manage stress
• Monitor any abnormal symptoms.
• Always check your hands and feet for any unhealed wounds.
• Wash your feet and hands after returning from home.
• Hydrate yourself and avoid sugary beverages.

Treatment of Diabetes Mellitus

The treatment will depend on the type of Diabetes. The usual treatments include blood sugar level monitoring, oral drugs and insulin shots.

Insulin

Insulin therapy is usually prescribed for people with type 1 and 2 Diabetes. The types of insulin available are short-acting insulin, rapid-acting insulin and other intermediate options.

Usually, insulin is not prescribed through oral administration as the enzyme will degenerate in the stomach’s strong acidic environment.

Insulin is usually prescribed through a needle and syringe. A glucose monitor will measure the blood glucose level every few minutes. This insulin pump will deliver a specific amount of insulin continuously.

Medications

There are medications that can help the pancreas to release more insulin, whereas other medications can prevent the release of glucose from the liver.

There are medications that can block the action of stomach or intestinal enzymes that help break the nutrients like carbohydrates. Drugs are also used to prevent the kidneys from reabsorbing filtered sugar. The sugar will be eliminated through urine.

Bariatric surgery

Bariatric surgery is suggested for people with type 2 Diabetes and who are obese. The surgery is suggested for people with a BMI of 35 and higher. However, the doctor will decide whether the surgery is required or not.

Prevention of Diabetes Mellitus

Diabetes mellitus can be prevented with certain lifestyle changes and eating habits.

Lose extra weight

Being obese can increase the risk of Diabetes. So, try to lose the extra calories you have gained. Cut down on fatty foods and munch on healthy snacks.

Physical activity

People who lead a sedentary lifestyle can also get affected by Diabetes mellitus. Try to have some physical activity like walking or jogging. Physical activity can boost your metabolism and keep your blood glucose level under check.

When to consult a doctor?

Consult a doctor when you have symptoms like

• Extreme thirst
• Frequent urination
• Sweet craving that cannot be controlled
• Family history of Diabetes and
• Babies born to mothers who had gestational Diabetes.

However, the symptoms can differ from one person to another. So, it is recommended to test your blood glucose levels twice a year.

Conclusion

Living with Diabetes can be stressful. However, people with Diabetes can lead a happy life. High blood glucose levels can be harmful to health and increase the risk of other diseases and conditions.

Suppose you have any symptoms. Consult your doctor, and do not ignore any discomfort caused. Also, remember to check the blood glucose levels once in a while.

If you have Diabetes, do not panic. It can be managed with medications and proper physical activity. However, physical activity and certain lifestyle changes can keep your blood glucose levels in check without the use of medications.

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