Contents
What is diabetes? How many types of diabetes are there?
Diabetes is a condition when the level of glucose in the blood is higher than normal.
Many people think that diabetes results when there is excess glucose in the urine as that is how diabetes was first diagnosed thousands of years ago. Excess glucose in the urine is actually a consequence of diabetes.
Diabetes can be divided into 2 main types: Type 1 Diabetes and Type 2 Diabetes.
Type 1 Diabetes
This was previously known as Insulin Dependent Diabetes (IDDM) or juvenile onset diabetes. About 5-10% of people who suffer from diabetes have Type 1 diabetes. It usually occurs in younger patients and can occur very suddenly with thirst, frequent urination, loss of weight and vomiting. The glucose level is very high and there is excess acid in the blood. This is a serious condition known as diabetic ketoacidosis. Patients with Type 1 diabetes hardly produce any insulin of their own and need insulin injections for survival.
Type 2 Diabetes
This was previously known as Non Insulin Dependent Diabetes (NIDDM) or adult onset diabetes. About 90-95% of people with diabetes have Type 2 diabetes. It typically occurs in older patients who are overweight or who have a family history of diabetes. Patients with Type 2 diabetes may not often have any symptoms. The initial treatment includes diet control and medication but a lot of patients with Type 2 diabetes may require some insulin to control their diabetes eventually.
What are the main causes of diabetes? Is it inherited? What about lifestyle contributors?
Type 1 Diabetes is caused by near total destruction of the insulin producing cells of the pancreas by the body’s immune system. If one or both parents have Type 1 diabetes, the risk of their children getting diabetes is slightly higher.
Type 2 Diabetes is more complex and is caused by a combination of insufficient insulin production by the pancreas, together with the body’s inability to use the insulin effectively (insulin resistance). The chance of developing Type 2 diabetes increases with age and commonly runs in families. If one or both parents have Type 2 diabetes, the risk of the children developing diabetes is greatly increased. Becoming overweight or obese also significantly increases the likelihood of getting diabetes.
How do we detect someone who is suffering from diabetes? Are there any signs and symptoms? When is diabetes diagnosed?
Typical symptoms of diabetes include the following:
• Increased thirst
• Increased frequency of urination during both day time and night time
• Weight loss despite increased food intake
• Tiredness
• Blurring of vision
Sometimes patients may notice ants crawling around their toilet as the urine is sweet.
Very often, patients who have diabetes have absolutely no symptoms and they can only be diagnosed on a blood test.
There are three ways to diagnose diabetes using blood tests
- Fasting blood glucose level (after at least 8 hours of fasting)
A fasting glucose of ≥ 7.0 mmol/L (126 mg/dl) is diagnostic of diabetes
- Random blood glucose level
A random glucose of ≥ 11.1 mmol/L (200 mg/dl) with typical symptoms of diabetes is diagnostic of diabetes
- An oral glucose tolerance test
This is a test which consists of a drinking a solution containing 75 g of glucose.
A blood glucose level of ≥ 11.1 mmol/L (200 mg/dl) 2 hours after drinking the solution is diagnostic of diabetes.
Ideally, to confirm the diagnosis of diabetes, any of the tests should be repeated on a separate day unless the glucose level is very high, in which case, the diagnosis is certain.
What are the treatments available?
For Type 2 diabetes, a combination of lifestyle changes and tablets are commonly used initially. With time, the pancreas function deteriorates for all patients and eventually many patients with type 2 diabetes will also require insulin to control their diabetes.
Lifestyle Changes
Many patients with Type 2 diabetes are overweight. Diet and exercise are very important to the management of diabetes. Weight loss in overweight patients helps to make the body more sensitive to insulin and thus lowers the glucose level. Exercise also has a similar effect in increasing insulin sensitivity. In the very early stages of diabetes, lifestyle changes alone may be sufficient to maintain good glucose control. Even in later stages of diabetes, lifestyle modification is still an important component of overall management.
Oral Diabetic Drugs
In addition to lifestyle modification, most diabetic patients will also need oral diabetic medication. There are five different classes of diabetic drugs and they work via different mechanisms. They are often used in combination as a single class of drug may not be sufficient to keep the glucose level normal.
- Sulphonylureas stimulate the pancreas to produce insulin.
- Metformin decreases the amount of glucose produced by the liver.
- Alpha glucosidase inhibitor in the intestines inhibits the digestion of complex starches into simple sugars.
Thiazolidinediones increase the sensitivity of the body’s tissues to insulin. In this manner, the insulin that is produced by the pancreas is able to work more effectively.
- Prandial regulators act similarly to the sulphonylureas by stimulating insulin secretion by the pancreas.
- Incretin enhancers increase the amount of incretin hormone that is produced by the intestines. These incretin hormones are able to increase insulin production by the pancreas. They also reduce the amount of another hormone called glucagon. The overall effect of incretin enhancers is a lower glucose level.
Insulin
Insulin is used to treat all patients with Type 1 diabetes as well as many patients with Type 2 diabetes. Insulin will be injected into the layer of fat just beneath the skin, either in the abdomen, arms or legs. Insulin injections are given 1-4 times a day and are sometimes combined with diabetes tablets. For certain patients with Type 1 diabetes, they wear an insulin pump, which gives a continuous infusion of insulin into the body.
Inhaled insulin is a newly developed method of administering insulin. Insulin is formulated as a very fine power that can be absorbed by the lungs. It is administered using an insulin inhaler and can be substituted for short acting insulin given before meals.
How can we prevent diabetes?
To help prevent or delay the onset of diabetes, it is important to stay fit and healthy and keep your weight down. It is also important to go for regular screening for diabetes or prediabetes. Patients who have diabetes will all go through a stage of prediabetes before they become diabetic. Prediabetes is a condition where the glucose level in the blood is higher than ‘normal’ but does not reach the level which would constitute diabetes. Even at this stage, exercise and dieting will help to delay the onset of diabetes.
Which particular group of people will prone to have diabetes?
Certain groups of people are more prone to diabetes:
• Those with a family history of diabetes
• Patients who are overweight
• Patients who have a history of diabetes in pregnancy
• Patients who have hypertension or high triglycerides
• Older patients
Contributed by:
Dr. Peter Eng
- Consultant Endocrinologist, Mount Elizabeth Medical Centre
A Member of eMenders (
www.emenders.com)
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