Diabetes is a medical term referring to any disease that produces excessive elimination of a substance in your urine. Depending on their symptoms, diabetes is grouped in four main categories:
Diabetes insipidus (DI), excretion of large amounts of urine due to decreased secretion of antidiuretic hormone (vasopressin) by the pituitary gland;
Diabetes mellitus, high levels of sugar in the urine due to abnormal elevation of blood glucose concentrations in the blood plasma (hyperglycemia);
Renal glycosuria (or renal glucosuria), characterized by presence of sugar in the urine without hyperglycemia;
Gestational diabetes, a form of diabetes that occurs during pregnancy.
Among those forms of diabetes, diabetes mellitus is the most common. It is grouped in three categories: type 1 diabetes (insulin dependent diabetes), type 2 diabetes (non-insulin dependent diabetes) and gestational diabetes.
What are the types and causes of diabetes mellitus?
Type 1 diabetes (insulin-dependent diabetes) – Type 1 diabetes, also known as juvenile diabetes,is characterized by an inadequate insulin secretion by particular cells of the pancreas, Beta cells or Langerhans cells. The causes of this loss of insulin production are not well unknown. However, scientists believe that the organism of type 1 diabetics reject, by the formation of antibodies, cells which are capable of producing insulin. This disorder can be caused by genetic, viral and autoimmune factors. Type 1 diabetes accounts for 5 to 10 percent of people with diabetes.
Type 2 Diabetes (non-insulin dependent diabetes) – It is a form of diabetes mellitus characterized by high levels of sugar in the blood. This type of diabetes results from lack of insulin secretion by the pancreas and its ineffectiveness to keep the blood sugar within normal levels. Type 2 Diabetes tends to occur most often in obese people, or those have been obese, and usually after age 40. In addition, the disease can be caused by genetic factors or unhealthy lifestyle such as lack of exercise, alcohol abuse and high-fat diet. However, the causes of diabetes in the vast majority have not yet any logical explanation. Type 2 diabetes accounts for up to 90 to 95 percent of all people with diabetes.
Gestational diabetes mellitus is a specific type of diabetes that occurs in pregnant women only. It is due to blocking effects of certain hormones (secreted during the pregnancy) on the insulin. No specific cause of this disorder has been identified yet, but it is believed that during pregnancy, the body of the mother produces hormones to support the fetus as he/she grows. In some women, these hormones work against their bodies, making their muscle, fat and liver cells unable to use enough insulin needed. Without this insulin, the level of sugar in the mother’s blood starts to build up, which can do harm to both mother and fetus, if left untreated.
Gestational diabetes occurs in nearly 7 percent of all pregnancies during the second half (of pregnancy). Unlike type 1 and type 2 diabetes, Gestational diabetes is often curable. However, to avoid risks to the fetus (malformation, development too fast), the pregnancy must be regularly monitored and treated, if necessary. Diet and treatment for gestational diabetes are the same as those of diabetes mellitus type 1 and type 2, with the exception of certain drugs which increase the risk of foetal malformation.
Diabetes Warning Signs and Symptoms
Symptoms of diabetes may develop in a gradually, and take different characteristic depending on the type. In general, signs and symptoms of Type 1 Diabetes, Type 2 Diabetes and Gestational diabetes include:
- Fatigue
- Difficulty concentrating
- Blurred vision
- Intense thirst (polydipsia)
- Frequent urination (polyuria)
- Insatiable hunger (polyphagia)
- Weight loss
- Skin infection (dry, itchy skin, ulcers, etc.)
- Loss of feeling in the feet
- Muscle weakness (lack of strength)
- Accumulation in the blood of organic acids and toxic substances called ketones (ketoacidosis)
- Neuropathy (damage to the peripheral nerves) – type 2
- Nausea and vomiting
- Decreased perspiration
- Sweet–smelling fruity acetone breath
Diabetes Diagnosis
The diagnosis is primarily based on the analysis of blood glucose (sugar in the blood). The existence of diabetes is established when a fasting plasma glucose test reveals a blood sugar of 126 mg/dL (126 milligrams per deciliter) or above. If the fasting plasma glucose is 100 to 125 mg/dL, your physician can reccomend oral glucose tolerance test. A 2-hour glucose level of 200 mg/dL (200 milligrams per deciliter) or above reveals a diabetic state. The disease will be confirmed by repeating the test on another day. Your doctor can also suggest Casual Plasma Glucose test (Random plasma glucose test) to measure your plasma, or blood glucose levels.
See the tables below:
Table 1
| Fasting Plasma Glucose Test | Diagnosis |
| 99 and below | Normal |
| 100 to 125 | Pre-diabetes |
| 126 and above | Diabetes |
Table 2
| Oral Glucose Tolerance Test | Diagnosis |
| 139 and below | Normal |
| 140 to 199 | Pre-diabetes |
| 200 and above | Diabetes |
Diabetes Treatment
There is no cure for diabetes; however, there are steps (treatments) you can take to keep it under control, and prevent complications. Treatment is based on healthy life style (physical exercise, balanced diet, healthy environment), regular self-monitored blood glucose and insulin injection.
Exercise – As for cardiovascular, cancer and stress, regular physical exercise has beneficial effects on diabetes. It helps all types of diabetic patients have normal blood sugar levels. However, all diabetic patients should be cautious in exercise. You should not wake up one day and engage in heavy workout, the exercise must be gradual. It is also important to warm up before exercise, and drink lots of fluids during of periods of exercise. In addition, it is recommended that people with diabetes regularly Control their blood sugar during exercise.
Balanced diet – To have normal blood sugar levels and prevent diabetic complications, it crucial for all diabetic patients to have a healthy diet. 10 to 15% of your diet should be protein especially from lentils, fish and lean meats. Carbohydrates should constitute 50% to 60% of the calorie intake. Most of them should come from slow sugars and fibers, because they reduce the rise in blood glucose level. Consumption of fruit should reach between 10% and 15% of carbohydrates. (Healthy) fats should represent 25 to 30% of calories intake. If you are obese, losing weight is also necessary.
In addition, you should:
- Avoid bad stress
- Eliminate sugar in all its forms, white/brown sugar, simple Sugar (candy, cereal, cakes, cookies, pies, soft drinks, etc.)
- Avoid fatty foods (peanuts, ice cream, desserts and chocolate, eggs, meats, cheese, butter, etc.)
- Avoid Tobacco (including second hand smoke)
- Alcoholic beverages (cocktail, beer, wine, liquor)
Self-Monitoring Of Blood Glucose (SMBG) – Diabetes mellitus requires regular and consistent monitoring. Thanks to scientific Progress, if you have diabetes mellitus you are able to easily measure your blood sugar several times a day from drops of blood from your finger. There are devices for reading blood glucose automatically. Patients can write their blood glucose levels and insulin doses on notebook to facilitate them to reach and keep a normal blood sugar level.
Some patients need daily injections of insulin. If you are one of them, using a syringe, you can administer insulin by subcutaneous or intramuscular injection 1-to 3 times daily.
Diabetes Complications
Diabetes Complications occur in both insulin-dependent diabetes and non insulin-dependent diabetes, but complications are more frequent and severe in insulin-dependent diabetes.
Complications of diabetes are mainly due to the alteration of either small vessels (microangiopathy), or large vessels (macroangiopathy). Complications can lead to:
Diabetic macroangiopathy – this is an affection of large and medium size blood vessels responsible for arthritis of lower limbs and coronary heart disease. It is aggravated by smoking, hyperlipidemia (elevation of fats in the bloodstream), high blood pressure and physical inactivity.
Diabetic nephropathy – this complication is very common in diabetic patients affecting almost 45% of diabetics. This condition is characterized by the appearance of abnormally elevated amount of protein in the urine (proteinuria). if left untreated, diabetic nephropathy can lead to kidney failure.
Diabetic neuropathy – this condition is less common than Diabetic nephropathy. It is characterized by quasi-insensitivity (loss of feeling) in the lower limbs due to infectious complications, mainly of ulcers in the feet or nutritional problems.
Ketoacidosis is a serious condition where the body has excessive accumulation of ketones or acids that build up in the blood. It is mostly the result of untreated diabetes mellitus. It causes Sweet–smelling fruity acetone breath, extreme tiredness, constant urination, extreme weight loss, agitation, Irritation, Confusion, etc. without a proper treatment, ketoacidosis can lead to hyperosmolar coma, also called Hyperosmolar Nonketotic state (HNS).
Hyperosmolar Nonketotic State (HNS) – this is a serious medical condition in which the diabetic is unconscious. This condition affects mostly people with type 2 diabetes. It is characterized by hyperglycemia (High Blood Sugar), diabetic hyperosmolar syndrome (blood sugar level tops 600 milligrams per deciliter) and dehydration without significant ketoacidosis.
Diabetic Retinopathy is a group of eye problems caused by complications of diabetes mellitus. This condition is very serious and required immediate medical attention. If left untreated, Diabetic retinopathy can eventually lead to blindness.
Hypoglycemia – to function properly, your body needs enough blood glucose. Hypoglycemia happens when blood glucose level is too low to provide enough energy for the fnctions of your body.
This can be a result of the treatment itself, excess of diet or exercise. Symptoms consist of sudden fatigue, feeling of hunger, dizziness and sweating.
Chronic Infections – complications of diabetes can easily lead to microbial or mycotic (caused by a fungus) infection. Those infections can develop in the urinary system and feet when there is injury. Diabetic foot ulcers are at high risk of becoming irreversibly infected. Those types of infections require immediate medical care to prevent Amputation. Diabetes remains the leading cause of amputation of the lower limbs. It may sound frightening, but in case of uncontrollable infection or gangrene, amputation is necessary.
References:
Simon C, Everitt H, Birtwistle J, Kendrick T. Oxford Handbook of General Practice. 2nd edition. Oxford University Press: 2006
http://www.diabetes.org/for-parents-and-kids/what-is-diabetes/skin-complications.jsp
Resolving granuloma annulare with etanercept. Shupack and Siu
Arch Dermatol 2006;142:394-39
