DIABETES

Diabetes Mellitus (commonly called Diabetes) is a serious condition that causes a person’s blood glucose (or blood sugar) to become abnormally high over a prolonged period. Glucose is vital to our health because it is an important source of energy for the cells in the body. Insulin is a hormone that is produced by the Pancreas, which is a large gland located behind the stomach. Insulin is responsible for controlling blood glucose; it moves glucose from the blood into the cells. 

There are two main types of diabetes. In Type 1 Diabetes the body's immune system attacks and destroys the cells in the pancreas that produce insulin. Roughly 10% of persons with diabetes have Type 1, and they require insulin daily. In Type 2 Diabetes the cells in the body become resistant to the action of insulin, and the pancreas is unable to make enough to overcome this resistance. This is the most common type of diabetes (roughly 90%).

Normal blood glucose levels are between 4.4 and 7.2 mmol/l  (80 and 130 mg/dl) before meals, and less than 10.0 mmol/l (180 mg/dl) two hours after meals. (To convert mg/dl to mmol/l you can divide by 18.)

WHO Facts:

• The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014.
• In 2015, an estimated 1.6 million deaths were directly caused by diabetes. Another 2.2 million deaths were attributable to high blood glucose in 2012.
• Almost half of all deaths attributable to high blood glucose occur before the age of 70 years. WHO projects that diabetes will be the seventh leading cause of death in 2030.

Risk Factors

Although the exact cause of Diabetes is unknown, there are several risk factors. You are at higher risk of getting diabetes if:

1.     You have a parent or sibling with diabetes
2.     You are overweight or obese
3.     You are physically inactive
4.     You are black or Asian
5.     You are older, especially over 45 years
6.     You have Hypertension

SYMPTOMS
 
The symptoms of diabetes vary depending on how much sugar is in the blood. Also, some persons do not have any symptoms, and can have the disease for years before being diagnosed. The more common symptoms are:
 

• Frequent urination
• Increased thirst
• Extreme hunger
• Fatigue
• Weight loss
• Blurred vision
• Frequent infections (such as gums, skin or vaginal infections)
• Cuts or wounds that heal slowly
• Tingling, pain or numbness in the hands and feet

 
DIAGNOSIS

A blood test is done in order to confirm the diagnosis. Your doctor may or may not choose to repeat the blood test, depending on your symptoms. There are four possible ways of diagnosing diabetes.

• A fasting blood glucose test result of 7.0 mmol/l (126mg/dl) or higher. (This test checks your blood sugar after you have gone at least 8 hours of no food or drink (except for water).
• A random blood glucose test result of 11.1 mmol/l (200mg/dl) or higher. (This test is done at any time, whether you had food/ drink or not).
• Two Hour Oral Glucose Tolerance Test (OGTT) result of 11.1 mmol/l (200 mg/dl) or higher. (This test checks your blood sugar before and after having a glucose drink.)
• An A1C blood test result of 6.5% or higher. (The A1C test measures your average blood sugar for the past 2 to 3 months.)

 
COMPLICATIONS of Diabetes
 
SHORT-TERM COMPLICATIONS
(These are normally emergencies)
 
Diabetic Ketoacidosis (DKA)

DKA is a serious condition that occurs when the blood glucose is very high (usually above 15mmol/l). When the cells cannot get energy from glucose, the body begins to burn fat, and this process produces ketones. Ketones are poisonous chemical that make the body more acidic. Symptoms of DKA include, frequent urination, increased thirst, fatigue, abdominal pain, nausea and vomiting, blurred vision, changes in breathing, fruity smelling breath and confusion. Persons should be taken to a hospital IMMEDIATELY.

Hyperosmolar Hyperglycemia Syndrome (HHS)

HHS is a serious condition that also happens with extremely high blood glucose levels (often over 40mmol/l). Some symptoms include excessive urination, increased thirst, disorientation and drowsiness; HHS can lead to severe dehydration, coma and even death. Persons with extremely high blood glucose levels must be treated in the hospital.

Hypoglycemia

This occurs when the blood glucose levels are too low (usually below 4 mmol/l). It can happen suddenly, and occurs when someone misses/ delays a meal, or take more medication or insulin than needed. Some signs include trembling, feeling shaky, sweating, being anxious, palpitations, tiredness, headache and lack of concentration. Having something sweet to eat/drink can improve symptoms, if not you should go to the hospital.

LONG-TERM COMPLICATIONS
(These occur in persons who have had diabetes for several years)

Excess sugar in the blood can lead to atherosclerosis. This is a condition where the arteries become narrowed and hardened due to a buildup of plaque around the artery wall. These plaques disrupt the flow of blood in the blood vessels. Below are some examples of the complications that can be caused by atherosclerosis.

Heart
Plaques in the coronary arteries (that supply the heart) can block blood flow resulting in a HEART ATTACK.

Brain
A blockage in the blood vessels of the brain can lead to a STROKE.

Kidney
Decreased blood flow to the kidneys can lead to KIDNEY FAILURE. If severe, this may require dialysis or a kidney transplant.

Eyes
Diabetes, can lead to CATARACTS, GLAUCOMA, RETINOPATHY (disease of the retina in the eye) and BLINDNESS.  

Nerves
Damage to the nerves can lead to many complications. If the nerves that innervate the bladder, sex organs, intestines and stomach are damaged, then this could result in frequent URINARY TRACT INFECTIONS, DECREASED AROUSAL, CONSTIPATION and GASTROPARESIS. (In gastroparesis, the stomach looses its ability to move food through the digestive tract, and this leads to bloating and vomiting.)

Lower Limbs
Damage to the nerves in the legs or feet can lead to symptoms such as: decreased sensation, numbness, weakness, tingling (pins and needles) and Pain (burning, shooting or stabbing). Because of the reduced sensation in the feet, persons often get injuries that go unnoticed. This can lead to ulcers, infections, deformed feet and amputations.

Plaques may develop in the arteries of the legs, which may disrupt blood flow. Persons may begin to notice pain/ cramping in the calves when walking or exercising (claudication). Additionally, they may suffer with leg pain especially at night that is only relieved by hanging the legs over the bed. At more severe stages, the skin of the toes or other parts of the feet may turn black. Theses are all symptoms of Peripheral Arterial Disease, which may require surgery to treat.

TREATMENT

Lifestyle Modification
The first line treatment for most persons with Type 2 Diabetes is Lifestyle Modification. A healthy diet and regular exercise can help some persons maintain normal blood sugar levels.

Medication
If a healthy diet and increased physical activity fails to control blood sugar, then you may have to be started on medication. Metformin is usually the first medication prescribed for persons with diabetes. Most medications work by stimulating the pancreas to produce more insulin or by reducing insulin resistance.

Insulin
Persons with Type 1 disease may have to be started on insulin immediately. Persons with Type 2 disease may be started on insulin immediately or after oral medication fails to control blood sugar.

Tip#1:

Healthy diet

A healthy diet is key to prevent and treat Diabetes. Your diet should contain mostly fruits, vegetables, whole grains, nuts, legumes, and some meat. Avoid processed foods and foods high in sugar as much as possible. There is no such thing as a “Diabetic Diet”; eating healthy would lead to improvement in overall health. (See a nutritionist if you would like further advice and a detailed meal plan prepared for you.)

Tip#2:

Weight loss

Weight loss for persons who are overweight/obese, could lead to a significant improvement in blood sugar control. It would also reduce the risk of developing other diseases.

Tip#3:

Regular exercise

Exercise not only helps to control blood sugar, but it is also good for overall health. It is recommended that you do a minimum of 150 minutes, of moderate intensity exercise per week, and this should be spread over 3 to 5 days. Walking, running, bicycling and swimming, are all good examples.

Tip#4:

Reduce stress

Some persons notice an increase in blood sugar whenever they are in stressful situations. Reducing “stress” is very important for blood sugar control and overall health.

Tip#5:

Cigarette smoking and Alcohol

Quit smoking cigarettes; they contribute to the formation of plaques in the arteries that can lead to heart attack, stroke, peripheral arterial disease, and other conditions.

Alcohol should also be avoided as much as possible. Limit your intake to no more than 14 units per week. Visit the link below to show you how to calculate your alcohol units. https://www.nhs.uk/live-well/alcohol-support/calculating-alcohol-units/   

Tip#6:

Self-glucose Monitoring

Persons with diabetes would benefit from attaining a blood glucose meter. This is a simple test system for use at home to measure the amount of sugar (glucose) in the blood.

Checking your blood sugar can help you to monitor how well the medication is working.  It can also help you to know if you have dangerously high or low levels of glucose and can also help you to understand how diet, exercise, stress and illness affect your blood sugar levels.

Tip#7:

If you have Type 1 Diabetes, it would be best to monitor your blood sugar everyday and keep a diary of the results. If you have Type 2 Diabetes, your doctor can advise you on how often your blood sugar should be monitored. These “blood glucose meter” tests can also be done at a health clinic or at a pharmacy.

Tip#8:

Medication

Taking your medication every day will allow you to achieve optimal blood sugar control. Some medications have side effects such as weight gain, weight loss, hypoglycemia, etc. Talk to your doctor if you are uncomfortable with any side effects, as there are other kinds of medications available.

Tip#9:

Insulin

Whether you use a syringe or an insulin pen, do not inject insulin in exactly the same place each time, otherwise hard lumps may develop. The lower part of the stomach, the upper buttocks and the front and side of the thighs are good areas, (You should rotate your injection sites often.)

 Tip#10:

Manage hypertension and other illnesses

If you have other illnesses such as Hypertension and High Cholesterol, you should ensure that these are properly controlled, since this would decrease your chance of developing complications.

Tip#11:

Doctor visits/ Medical checkup

All persons with Diabetes must have regular medical check ups (at least twice a year). Your doctor will need to have several tests done in order to ensure that you are not developing complications from the disease. This is also when your medication may be adjusted based on how well your blood sugar has been controlled.

Tip#12:

Eye Screening

Persons with Diabetes should have their eyes checked by an ophthalmologist  (eye doctor) at least once a year. Identifying and treating any conditions of the eyes early can prevent blindness.

 
I hope these tips on DIABETES were helpful; Remember YOUR HEALTH IS INVALUABLE!

By Dr. J. Lawarna Matthew
 
Acknowledgements
American Diabetes Association
Diabetes UK
Visit http://www.diabetes.org/diabetes-basics/ and https://www.diabetes.org.uk/ for more information.