Doc Fio

What is Diabetes Mellitus ?

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Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose).

Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues.

It's also your brain's main source of fuel.

If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the causes may differ.

Too much glucose can lead to serious health problems.

Chronic diabetes conditions include type 1 diabetes and type 2 diabetes.

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Potentially reversible diabetes conditions include:

1. prediabetes — when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes

2. gestational diabetes, which occurs during pregnancy but may resolve after the baby is delivered.

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What are the Symptoms?

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Diabetes symptoms vary depending on how much your blood sugar is elevated.

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Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially.

In type 1 diabetes, symptoms tend to come on quickly and be more severe.

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Some of the signs and symptoms of type 1 and type 2 diabetes are:

• Increased thirst

• Frequent urination

• Extreme hunger

• Unexplained weight loss

• Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin)

• Fatigue

• Irritability

• Blurred vision

• Slow-healing sores

• Frequent infections, such as gums or skin infections and vaginal infections

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Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age, though it's more common in people older than 40.

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What Causes Diabetes Mellitus?

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To understand diabetes, first you must understand how glucose is normally processed in the body.

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How insulin works

Insulin is a hormone that comes from a gland situated behind and below the stomach (pancreas).

• The pancreas secretes insulin into the bloodstream.

• The insulin circulates, enabling sugar to enter your cells.

• Insulin lowers the amount of sugar in your bloodstream.

• As your blood sugar level drops, so does the secretion of insulin from your pancreas.

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The role of glucose

Glucose — a sugar — is a source of energy for the cells that make up muscles and other tissues.

• Glucose comes from two major sources: food and your liver.

• Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.

• Your liver stores and makes glucose.

• When your glucose levels are low, such as when you haven't eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range.

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Causes of type 1 diabetes.

The exact cause of type 1 diabetes is unknown.

What is known is that your immune system — which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing cells in the pancreas.

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This leaves you with little or no insulin.

Instead of being transported into your cells, sugar builds up in your bloodstream.

Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what many of those factors are is still unclear.

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Causes of prediabetes and type 2 diabetes

In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance.

Instead of moving into your cells where it's needed for energy, sugar builds up in your bloodstream

Exactly why this happens is uncertain, although it's believed that genetic and environmental factors play a role in the development of type 2 diabetes.

Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight.

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Causes of gestational diabetes

During pregnancy, the placenta produces hormones to sustain your pregnancy.

These hormones make your cells more resistant to insulin.

Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can't keep up.

When this happens, too little glucose gets into your cells and too much stays in your blood, resulting in gestational diabetes.

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What are the Risk factors?

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Risk factors for diabetes depend on the type of diabetes.

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Risk factors for type 1 diabetes

Although the exact cause of type 1 diabetes is unknown, factors that may signal an increased risk include:

•  Family history.

      Your risk increases if a parent or sibling has type 1 diabetes.

•  Environmental factors. 

      Circumstances such as exposure to a viral illness likely play some role in type 1 diabetes.

•  The presence of damaging immune system cells (autoantibodies). 

      Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes                    autoantibodies. 

•  Dietary factors. 

      These include low vitamin D consumption, early exposure to cow's milk or cow's milk        formula, and              exposure to cereals before 4 months of age.

      None of these factors has been shown to directly cause type 1 diabetes.

•  Geography. 

      Certain countries, such as Finland and Sweden, have higher rates of type 1 diabetes.

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Risk factors for prediabetes and type 2 diabetes

Researchers don't fully understand why some people develop prediabetes and type 2 diabetes and others don't.

It's clear that certain factors increase the risk, however, including:

• Weight. 

The more fatty tissue you have, the more resistant your cells become to insulin.

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•  Inactivity. 

The less active you are, the greater your risk.

Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.

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• Family history.

Your risk increases if a parent or sibling has type 2 diabetes.

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•  Race. 

Although it's unclear why, people of certain races — including blacks, Hispanics, American Indians and Asian-Americans — are at higher risk.

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• Age. 

Your risk increases as you get older.

This may be because you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults.

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• Gestational diabetes. 

If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes later increases.

If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes.

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• Polycystic ovary syndrome. 

For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.

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• High blood pressure. 

Having blood pressure over 140/90 millimeters of mercury (mm Hg) is linked to an increased risk of type 2 diabetes.

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• Abnormal cholesterol and triglyceride levels. 

If you have low levels of high-density lipoprotein (HDL), or "good," cholesterol, your risk of type 2 diabetes is higher. People with high levels of triglycerides have an increased risk of type 2 diabetes. 

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Risk factors for gestational diabetes

Any pregnant woman can develop gestational diabetes, but some women are at greater risk than are others.

Risk factors for gestational diabetes include:

• Age. 

Women older than age 25 are at increased risk.

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• Family or personal history. 

Your risk increases if you have prediabetes — a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You're also at greater risk if you had gestational diabetes during a previous pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth.

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• Weight. 

Being overweight before pregnancy increases your risk.

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What are Diabetes Complications?

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Log-term complications of diabetes develop gradually.

The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications.

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Eventually, diabetes complications may be disabling or even life-threatening.

Possible complications include:

• Cardiovascular disease. 

Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you are more likely to have heart disease or stroke.

• Nerve damage (neuropathy). 

Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.

• Kidney damage (nephropathy). 

The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.

• Eye damage (retinopathy). 

Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.

• Foot damage. 

Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.

• Skin conditions. 

Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.

• Hearing impairment. 

Hearing problems are more common in people with diabetes.

• Alzheimer's disease. 

Type 2 diabetes may increase the risk of Alzheimer's disease. 

• Prediabetes may develop into type 2 diabetes.

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How is Diabetes  Diagnosed?​

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Tests for type 1 and type 2 diabetes and prediabetes

• Glycated hemoglobin (A1C) test. 

This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells.

The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached.

- A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes.

- A1C level 5.7 -  6.4 percent indicates prediabetes.

- A1C below 5.7 is considered normal. 

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Some conditions that make A1C test results aren't consistent or inaccurate : if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — your doctor may use

 

Other Important tests to diagnose diabetes:

• Random blood sugar test. 

A blood sample will be taken at a random time.

Regardless of when you last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or higher suggests diabetes.

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• Fasting blood sugar test. 

A blood sample will be taken after an overnight fast.

A fasting blood sugar level :

- less than 100 mg/dL (5.6 mmol/L) is normal.

- 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes.

- 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.

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• Oral glucose tolerance test. 

For this test, you fast overnight, and the fasting blood sugar level is measured.

Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours.

A blood sugar level two hours after meal :

- less than 140 mg/dL (7.8 mmol/L) is normal.

- between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.

- above 200 mg/dL (11.1 mmol/L)  indicates diabetes. 

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• Urine Test.

If type 1 diabetes is suspected, your urine will be tested to look for the presence of a byproduct produced when muscle and fat tissue are used for energy when the body doesn't have enough insulin to use the available glucose (ketones). 

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How is Diabetes Mellitus treated?

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What ever your type of Diabetes is, you need to be very informed and educated about your condition. Make a commitment to managing your diabetes. Learn all you can about diabetes. Establish a relationship with a diabetes educator, and ask your diabetes treatment team for help when you need it.

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The successfull management of Diabetes rely on your adherence to the whole therapy; lifestyle changes  and medication.

In general, ​​​treatments for all types of diabetes include :

1. Lifestyle changes :

•       Healthy eating. 

Contrary to popular perception, there's no specific diabetes diet.

You'll need to center your diet on more fruits, vegetables and whole grains — foods that are high in nutrition and fiber and low in fat and calories — and cut down on animal products, refined carbohydrates and sweets.

In fact, it's the best eating plan for the entire family.

Sugary foods are OK once in a while, as long as they're counted as part of your meal plan.

A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle.

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•       Physical activity.

Exercise lowers your blood sugar level by moving sugar into your cells, where it's used for energy.

Exercise also increases your sensitivity to insulin, which means your body needs less insulin to transport sugar to your cells.

Get your doctor's OK to exercise. Then choose activities you enjoy, such as walking, swimming or biking. What's most important is making physical activity part of your daily routine.

Aim for at least 30 minutes or more of aerobic exercise most days of the week. If you haven't been active for a while, start slowly and build up gradually.

If yo are overweight, losing just 7 percent of your body weight if you're overweight can make a significant difference in your blood sugar control. 

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2. Medication

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• Insulin. People with type 1 diabetes need insulin therapy to survive. Many people with type 2 diabetes or gestational diabetes also need insulin therapy

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• Oral or other medications. Sometimes other oral or injected medications are prescribed as well. Some diabetes medications stimulate your pancreas to produce and release more insulin. Others inhibit the production and release of glucose from your liver, which means you need less insulin to transport sugar into your cells. Still others block the action of stomach or intestinal enzymes that break down carbohydrates or make your tissues more sensitive to insulin. Metformin (Glucophage, Glumetza, others) is generally the first medication prescribed for type 2 diabetes

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• Transplantation. In some people who have type 1 diabetes, a pancreas transplant may be an option. With a successful pancreas transplant, you would no longer need insulin therapy. But transplants aren't always successful — and these procedures pose serious risks. You need a lifetime of immune-suppressing drugs to prevent organ rejection. These drugs can have serious side effects, including a high risk of infection, organ injury and cancer. 

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• Bariatric surgery. Although it is not specifically considered a treatment for type 2 diabetes, people with type 2 diabetes who also have a body mass index higher than 35 may benefit from this type of surgery. People who've undergone gastric bypass have seen significant improvements in their blood sugar levels. However, this procedure's long-term risks and benefits for type 2 diabetes aren't yet known.

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Treatment for gestational diabetes

• Controlling your blood sugar level is essential to keeping your baby healthy and avoiding complications during delivery. In addition to maintaining a healthy diet and exercising, in some cases, using insulin or oral medications.

• Monitoring your blood sugar level during labor. If your blood sugar rises, your baby may release high levels of insulin — which can lead to low blood sugar right after birth.

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Treatment for prediabetes

• If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back to normal . 

• Sometimes medications — such as metformin (Glucophage, Glumetza, others) — also are an option if you're at high risk of diabetes, including when your prediabetes is worsening or if you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome.

• In other cases, medications to control cholesterol — statins, in particular — and high blood pressure medications are needed.

 

Healthy lifestyle choices remain key, however.​

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Low blood sugar (hypoglycemia). If your blood sugar level drops below your target range, it's known as low blood sugar (hypoglycemia). Your blood sugar level can drop for many reasons, including skipping a meal and getting more physical activity than normal. However, low blood sugar is most likely if you take glucose-lowering medications that promote the secretion of insulin by your pancreas or if you're receiving insulin therapy.

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Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar — sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, irritability, slurred speech, drowsiness, confusion, fainting and seizures. Low blood sugar is treated with quickly absorbed carbohydrates, such as fruit juice or glucose tablets.

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For all types of Diabetes Mellitus, below are key steps to maintain your Diabetes Mellitus management:

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• Schedule a yearly physical and regular eye exams. Your regular diabetes checkups aren't meant to replace yearly physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications and screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.

• Keep your vaccinations up to date. High blood sugar can weaken your immune system. Get a flu shot every year, and your doctor may recommend the pneumonia vaccine, as well.

• Pay attention to your feet. Wash your feet daily in lukewarm water. Dry them gently, especially between the toes. Moisturize with lotion, but not between the toes. Check your feet every day for blisters, cuts, sores, redness or swelling. 

• Keep your blood pressure and cholesterol under control. Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Medication may be needed, too.

• Take care of your teeth. Diabetes may leave you prone to more-serious gum infections. Brush and floss your teeth at least twice a day. And if you have type 1 or type 2 diabetes, schedule regular dental exams. Consult your dentist right away if your gums bleed or look red or swollen.

• If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications. Smokers who have diabetes are more likely to die of cardiovascular disease than are nonsmokers who have diabetes, 

• If you drink alcohol, do so responsibly. Alcohol can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, do so only in moderation.

• Take stress seriously. The hormones your body may produce in response to prolonged stress may prevent insulin from working properly, which will raise your blood sugar and stress you even more. Set limits for yourself and prioritize your tasks. Learn relaxation techniques. And get plenty of sleep.

• Identify yourself. Wear a tag or bracelet that says you have diabetes. Keep a glucagon kit nearby in case of a low blood sugar emergency — and make sure your friends and loved ones know how to use it.

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What are the Prevention?

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Type 1 diabetes can't be prevented.

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However, the same healthy lifestyle choices that help treat prediabetes, type 2 diabetes and gestational diabetes can also help prevent them:

• Eat healthy diet. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom.

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• Increase physical activity. Aim for 30 minutes of moderate physical activity a day. Take a brisk daily walk. Ride your bike. Swim laps. If you can't fit in a long workout, break it up into smaller sessions spread throughout the day.

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• Reduce weight, If you're overweight, losing even 7 percent of your body weight — for example, 14 pounds (6.4 kilograms) if you weigh 200 pounds (90.9 kilograms) — can reduce the risk of diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

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• Sometimes medication is an option as well. Oral diabetes drugs such as metformin (Glucophage, Glumetza, others) may reduce the risk of type 2 diabetes — but healthy lifestyle choices remain essential.

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• Regular health screening, especially Blood sugar test. Have your blood sugar checked at least once a year to check that you haven't developed type 2 diabetes.

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