What is diabetes?
Diabetes is a chronic disease that can be fatal. It occurs when the body is unable to make insulin, or when the body is unable to use insulin properly.
Insulin is a hormone that is produced by the body to use sugar (or glucose) as energy and to control blood sugar levels.
The pancreas, an organ located behind and under the stomach, regulates blood sugar levels by secreting insulin into the bloodstream for circulation throughout the body. Insulin is secreted when blood sugar levels are high and causes cells in the body to take in sugar.
Cells either use sugar as energy or store it in the form of fat.
The uptake of sugar by cells results in a decrease in blood sugar levels, which also signals the pancreas to stop producing insulin.
Those with diabetes have chronically high levels of sugar in the blood, which is harmful and damaging to nerves, blood vessels, and organs.
Prediabetes is diagnosed when blood sugar levels are found to be above normal levels, but not above the diabetes diagnosis threshold.
50% of those diagnosed with prediabetes will develop type 2 diabetes in the future.
It is important to be tested often for prediabetes as some harmful diabetes complications may already begin during the prediabetic state, including nerve damage and heart disease.
Prediabetes arises when cells in the body become unresponsive or resistant to insulin and the pancreas cannot produce enough insulin to compensate for the resistance.
Because of this insulin resistance, sugar builds up in the bloodstream instead of being absorbed by cells.
Types and causes of diabetes
There are three types of diabetes: type 1, type 2, and gestational.
Type 1 diabetes
Of those living with diabetes, 5-10% live with type 1, which usually starts during childhood or adolescence.
Type 1 diabetes is caused when the body’s own immune system, which normally protects the body against bacteria and viruses, destroys the beta cells in the pancreas that secrete insulin.
In type 1 diabetes, there is almost a complete lack of insulin production.
Without insulin production, sugar is not taken up by cells for energy and builds up in the bloodstream.
The development of type 1 diabetes is believed to be influenced by both genetic and environmental factors, although it is still unclear what the specific factors are.
Type 2 diabetes
Around 90% of those with diabetes have type 2 diabetes.
Type 2 diabetes is caused by the inability of the body to respond to insulin production, or insufficient insulin production, both of which result in high blood sugar levels.
Both genetic and environmental factors are believed to play a role in the development of type 2 diabetes.
Gestational diabetes occurs temporarily during 2-4% of pregnancies due to hormones released by the placenta that make cells more insulin resistant.
The pancreas must produce more insulin to compensate for the placental hormones.
When it is unable to produce enough insulin, sugar will build up in the bloodstream. Having gestational diabetes can cause both the mother and child to have an increased risk of developing diabetes in their lifetime.
Symptoms of diabetes
Some symptoms of diabetes include:
- Having blurred vision
- Feeling unusually hungry and/or thirsty
- Needing to urinate often
- Gaining or losing weight inexplicably
- Experiencing numbness or tingling in hands and/or feet
- Feeling very fatigued
- Having infections (eg. skin, gum, and vaginal infections) that frequently recur
- Having injuries and sores that take a long time to heal
- Erectile dysfunction (in men)
- Ketones in the urine, which occur when muscles and fats break down due to insufficient insulin production
Those that experience these symptoms should speak to their healthcare provider.
It is also important to note that there are sometimes no symptoms of type 2 diabetes. Therefore, those who are over 40 years old should be checked at least once every three years.
Complications of diabetes
Some complications of diabetes include nerve damage, eye disease, hearing impairment, kidney damage, stroke, and foot problems.
Complications from gestational diabetes
For the baby
Excess size. If too much glucose crosses the placenta, extra insulin is made by the baby’s pancreas and causes the baby to grow too large. This condition (called macrosomia) increases the likelihood of a mother requiring a C-section delivery.
Low blood sugar. Babies of mothers with gestational diabetes may have low blood sugar shortly after being born because of their increased production of insulin. Immediate feedings or administering intravenous glucose can be used to raise blood sugar levels in these babies.
Increased risk of type 2 diabetes. Babies have a higher risk of becoming obese and having type 2 diabetes if their mothers had gestational diabetes.
Death. If gestational diabetes is left untreated, this can cause stillbirth or death of the baby a short time after birth.
For the mother
Preeclampsia. This is a serious and potentially life-threatening condition (for both the mother and baby) in which the mother experiences high levels of protein in the urine, high blood pressure, and swollen legs and feet.
Increased risk of gestational diabetes in future pregnancies.
Increased risk of type 2 diabetes.
Risk factors for diabetes
Risk factors for type 1 diabetes are not currently clear and are being researched. The only known risk factors at this time include:
- Having an immediate family member with type 1 diabetes.
- Having previously been exposed to a virus that led to beta cell death and diabetes autoantibodies in the immune system
- A diet that included early consumption of cow milk and/or cereal, and/or low consumption of vitamin D
- Being from Finland or Sweden (which have higher type 1 diabetes rates)
For type 2 diabetes, risk factors include:
- Age (the risk of type 2 diabetes increases with age)
- Having an immediate family member with diabetes
- Being of Hispanic, African, Aboriginal, South Asian, or Asian descent
- Previous diagnosis of prediabetes, polycystic ovary syndrome, psychiatric disorders, Acanthosis nigricans (having areas of darkened skin), and/or obstructive sleep apnea
- Having had a baby weighing over 9 pounds (or 4 kilograms) at birth
- Having had gestational diabetes (30% of women with gestational diabetes develop type 2 diabetes in 15 years)
- Having high cholesterol and/or triglyceride levels
- Having high blood pressure
- Being overweight, with weight primarily carried in the stomach area (fat tissue increases the body’s resistance to insulin)
- Having taken glucocorticoid medication
Having these risk factors means more regular testing for diabetes is needed. Earlier detection and diagnosis result in more effective treatment and reduce the risk of debilitating or chronic complications.
- Being over 25 years of age
- Having prediabetes
- Having an immediate family member with type II diabetes
- Having had gestational diabetes during a previous pregnancy
- Having had a baby weighing over 9 pounds (or 4 kilograms) at birth
- Being overweight
- Being of African, Asian, Hispanic, or Aboriginal descent
Diagnosis of diabetes
Diabetes can be diagnosed in several ways, all of which involve measuring blood sugar levels, either directly or indirectly.
Blood glucose in the fasting state, at random time points, or after ingesting a drink with a specific amount of glucose can be measured to diagnose diabetes.
Blood sugar levels of 7.0 mmol/L or greater in the fasting state, 11.0 mmol/L or greater at any point, or 11.0 mmol/L or greater after drinking the measured sugar drink indicate diabetes.
Another diagnostic test for diabetes is the A1C or HbA1C test, which measures the percentage of a protein called hemoglobin, which carries oxygen in red blood cells, that have sugar molecules attached to them.
A higher percentage reflects a higher blood sugar level and a higher risk for diabetes. A result of 6.5% or greater indicates diabetes.
Treatment of diabetes includes monitoring blood sugar levels and using insulin treatment to keep blood sugar levels in a normal range.
Medications and surgery are also used in the treatment of diabetes.
Blood sugar monitoring. Blood sugar levels must be frequently monitored each day to ensure it is in a normal range.
Blood sugar is monitored using glucose meters or continuous glucose monitors.
Regular A1C or HbA1C testing is also recommended as it gives an indication of blood sugar levels over the past two or three months and is a measure of the effectiveness of the prescribed treatment plan.
Insulin. Treatment with insulin is required for those with type 1 diabetes, and may also help those with type 2 diabetes to control blood sugar levels.
There are different kinds of insulin that can be prescribed in mixtures to be used throughout the day.
The types of insulin available include rapid-, short-, intermediate- and long-acting, which differ in the times that they take to begin to work, when they peak, and how long they continue to work.
Because insulin is broken down by the stomach, it cannot be taken orally and is often injected using either a syringe or an insulin pen.
There are also insulin pumps, which are small devices that contain insulin and are connected to the body with a catheter. Tubeless pumps are also available.
Insulin pumps are programmed to provide the body with insulin as needed, depending on diet, exercise, and other lifestyle factors.
Medications. Oral or injected medications are available that can increase the production and secretion of insulin by the pancreas, inhibit the release of glucose from the liver (decreasing the need for insulin), inhibit the breakdown of carbohydrates in the digestive system, or make cells more sensitive to insulin.
Metformin is usually the medication that is first prescribed for type 2 diabetes.
Surgery. Pancreas transplants can be an option for those with type 1 diabetes.
Because of the high risk of the procedure, and the harmful side effects of the immune-suppression drugs required to prevent organ rejection, transplants are not usually done except when other treatment options have failed.
There are several components to the effective management of diabetes.
Education. It is most important for those with diabetes to be educated about the cause of the disease so that they can take appropriate steps to treat it and prevent it from getting worse.
Exercise. Exercise lowers blood sugar levels, in addition to contributing to maintaining a healthy weight and lowering stress levels. It also improves cells’ ability to respond to insulin.
At least 30 minutes of aerobic exercise each day, combined with resistance training twice a week, is recommended.
Diet. Diet is a major determinant of blood sugar levels. Not only what is eaten, but also when and how much, is important to monitor.
It is recommended to plan meals appropriately and maintain a diet high in fruits, vegetables, legumes, and whole grains, and low in saturated fats, refined carbohydrates, sweets, and animal products.
This high-nutrition, high-fiber, low-fat, low-calorie diet helps maintain a healthy weight.
Stress. Prolonged stress may cause the body to produce hormones that hinder the effects of insulin, raising blood sugar levels.
Stress should be managed by relaxation techniques and getting an appropriate amount of sleep.
Blood pressure. For those with diabetes, high blood pressure increases the risk of eye, heart, and kidney disease, as well as stroke.
Therefore, blood pressure should be managed with exercise, diet, and, if needed, medication.