Diabetes Mellitus

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Diabetes Symptoms

Diabetes is a chronic condition associated with abnormally high levels of glucose (glucose) in the blood. Insulin produced by the pancreas lowers blood sugar. Insufficient insulin production or inability to properly use insulin causes diabetes.
Two types of type 1 and type 2 diabetes are referred to. The above names for these diabetes cases are insulin dependent and non-insulin dependent, or the onset of juvenile diabetes and the onset of adults.
Symptoms include type I and type 2 diabetes

  • Increase the amount of urine.
  • Be extreme,
  • Weight loss.
  • Hunger.
  • Fatigue.
  • Skin Problems.
  • Slow healing of wounds.
  • Fungal infections and.
  • Tingling or numbness in feet or feet.

Among the risk factors that affect patients with diabetes, overweight or obesity, leading to a stable standard of living and family history of diabetes, high blood pressure (hypertension), low levels of “good” cholesterol, and high levels of triglycerides in the blood .

If you think you may have diabetes or diabetes, contact health professionals.

What is diabetes? 

Diabetes is a group of metabolic diseases characterized by high blood sugar (glucose) that result from defects in insulin secretion, its function or both. It has been identified with diabetes, which is commonly referred to as diabetes disease (as it will be in this article) for the first time as a disease associated with “sweet urine” and excessive muscle loss in the ancient world. High levels of glucose in the blood (hyperglycemia) cause glucose to leak into the urine, hence the term sweet urine.

Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers blood sugar. When glucose increases in the blood (eg after eating), the release of insulin from the pancreas to normalize the glucose level, improving the absorption of glucose in the cells of the body. In patients with diabetes, lack of inadequate production or lack of response to insulin causes hyperglycemia. Diabetes is a chronic medical condition, which means that although it can be controlled, it lasts a lifetime.

How many people in the United States have diabetes? 

Diabetes affects nearly 29.1 million people (9.3% of the population) in the United States, while another 86 million have diabetes before and do not know it.


It is estimated that 8.1 million people in the United States have diabetes and do not even know them.
Over time, diabetes can lead to blindness, kidney failure and nerve damage. These types of damages are the result of damage to small vessels, known as micro vascular disease.


Diabetes is also a key factor in accelerating hardening and narrowing of arteries (atherosclerosis), leading to strokes, cardiovascular disease and other major vascular diseases. This is known as vascular disease.


Economically, the total annual cost of diabetes in 2012 was estimated at $ 245 billion in the United States. This included 116 billion direct medical costs (health care costs) for people with diabetes and another $ 69 billion in other costs due to disability, premature death or job loss.

Medical expenses for diabetics are more than double that for people who do not have diabetes. Remember that these figures only reflect the population of the United States. Overall, the statistics are awesome.

Diabetes is the seventh leading cause of death in the United States listed in death certificates in recent years.

9 early signs and symptoms of diabetes

  1. Early symptoms of untreated diabetes are associated with elevated blood sugar levels, and glucose loss in the urine. High amounts of glucose in the urine may increase the amount of urine (frequent urination) and lead to dehydration.
  2. Drought also causes increased thirst and water consumption.
  3. A lack of relative or absolute insulin eventually leads to weight loss.
  4. The weight loss of diabetes occurs despite an increase in appetite.
  5. Some diabetics also complain of fatigue.
  6. Nausea and vomiting can also occur in patients with untreated diabetes.
  7. It is likely to occur in patients with untreated or poorly controlled diabetes – frequent infections (such as bladder, skin, and vaginal infections).
  8. Fluctuations in blood glucose levels can lead to blurred vision.
  9. Extremely high glucose levels can lead to inactivity and coma.

How do I know if I have diabetes?

  • Many people are unaware that they have diabetes, especially in its early stages when symptoms may not be present.
  • There is no definite way to know if you have diabetes without undergoing blood tests to determine your blood glucose levels (see section on Diagnosis of diabetes).
  • See your doctor if you have symptoms of diabetes or if you are concerned about your diabetes risk.

 

What causes diabetes?
Insufficient insulin production (both absolute and relative to body needs), defective insulin production (which is unusual), or inability of cells to use insulin properly and effectively leads to high blood sugar and diabetes.
  • This latter condition affects mostly the cells of muscle and fat tissues, and results in a condition known as insulin resistance. This is the primary problem in type 2 diabetes.
  • The absolute lack of insulin, usually secondary to a destructive process affecting the insulin-producing beta cells in the pancreas, is the main disorder in type 1 diabetes.

In type 2 diabetes, there is also a steady decrease in beta cells that add to the high blood sugar process. Basically, if someone is insulin resistant, the body can, to some extent, increase insulin production and overcome the resistance level. After the time, if production is decreased and insulin can not be released strongly, high blood sugar develops.

 

What is glucose?

Glucose is a simple sugar found in food. Glucose is an essential nutrient that provides energy for the smooth functioning of the body’s cells. Carbohydrates are broken down into the small intestine, then glucose is absorbed into the digested food by intestinal cells in the bloodstream, and is transferred through the blood stream to all cells in the body where it is used. However, glucose can not enter cells alone, and insulin needs to help transport in cells. Without insulin, cells become starved of glucose energy despite the abundance of glucose in the bloodstream. In certain types of diabetes, the inability of cells to use glucose raises the irony of “starvation in the midst of a lot”. Excreted abundant, and unused glucose from extravagance in the urine.

 

What is insulin?

Insulin is a hormone produced by specialized cells (beta cells) of the pancreas. (The pancreas is a deeply localized organ in the abdomen located behind the stomach.) In addition to helping glucose enter the cells, insulin is also important to strictly regulate the level of glucose in the blood. After a meal, the blood glucose level increases. In response to increased glucose levels, the pancreas normally releases more insulin into the bloodstream to help glucose enter the cells and lower blood glucose levels after a meal. When blood glucose levels decrease, the release of insulin from the pancreas is rejected. It is important to keep in mind that even in fasting there is a constant low release of insulin that fluctuates a bit and helps maintain a constant level of blood sugar during fasting. In normal individuals, such a regulatory system helps maintain blood glucose levels in a strictly controlled range. As described above, in patients with diabetes, insulin is absent, is relatively insufficient for the needs of the body or is not used properly by the body. All these factors cause high blood glucose levels (hyperglycemia).

What are the risk factors for diabetes?

Risk factors for type 1 diabetes are not as well understood as those for type 2 diabetes. Family history is a known risk factor for type 1 diabetes. Other risk factors can include infections or diseases Having Certain of the pancreas.

Risk factors for type 2 diabetes and prediabetes are many. The following can raise your risk of developing type 2 diabetes:

  • Being obese or overweight.
  • High blood pressure.
  • Elevated levels of triglycerides and low levels of “good” cholesterol (HDL) .
  • Sedentary lifestyle.
  • Family history.
  • Increasing age.
  • Polycystic ovary syndrome.
  • Impaired glucose tolerance.
  • Insulin resistance.
  • Gestational diabetes during a pregnancy.
  • Ethnic background: Hispanic/Latino Americans, African-Americans, Native Americans, Asian-Americans, Pacific Islanders, and Alaska natives are at greater risk.

 

What are the different types of diabetes?

There are two major types of diabetes, called type 1 and type 2. Type 1 diabetes was also formerly called insulin dependent diabetes mellitus (IDDM), or juvenile-onset diabetes mellitus. In type 1 diabetes, the pancreas undergoes an autoimmune attack by the body itself, and is rendered incapable of making insulin. Abnormal antibodies have been found in the majority of patients with type 1 diabetes. Antibodies are proteins in the blood that are part of the body’s immune system. The patient with type 1 diabetes must rely on insulin medication for survival.

What is type 1 diabetes

In autoimmune diseases, such as type 1 diabetes, the immune system mistakenly manufactures antibodies and inflammatory cells that are directed against and cause damage to patients’ own body tissues. In persons with type 1 diabetes, the beta cells of the pancreas, which are responsible for insulin production, are attacked by the misdirected immune system. It is believed that the tendency to develop abnormal antibodies in type 1 diabetes is, in part, genetically inherited, though the details are not fully understood.

Exposure to certain viral infections (mumps and Coxsackie viruses) or other environmental toxins may serve to trigger abnormal antibody responses that cause damage to the pancreas cells where insulin is made. Some of the antibodies seen in type 1 diabetes include anti-islet cell antibodies, anti-insulin antibodies and anti-glutamic decarboxylase antibodies. These antibodies can be detected in the majority of patients, and may help determine which individuals are at risk for developing type 1 diabetes.

At present, the American Diabetes Association does not recommend general screening of the population for type 1 diabetes, though screening of high risk individuals, such as those with a first degree relative (sibling or parent) with type 1 diabetes should be encouraged. Type 1 diabetes tends to occur in young, lean individuals, usually before 30 years of age; however, older patients do present with this form of diabetes on occasion. This subgroup is referred to as latent autoimmune diabetes in adults (LADA). LADA is a slow, progressive form of type 1 diabetes. Of all the people with diabetes, only approximately 10% have type 1 diabetes and the remaining 90% have type 2 diabetes.

 

What is type 2 diabetes

Type 2 diabetes was also previously referred to as non-insulin dependent diabetes mellitus (NIDDM), or adult-onset diabetes mellitus (AODM). In type 2 diabetes, patients can still produce insulin, but do so relatively inadequately for their body’s needs, particularly in the face of insulin resistance as discussed above. In many cases this actually means the pancreas produces larger than normal quantities of insulin. A major feature of type 2 diabetes is a lack of sensitivity to insulin by the cells of the body (particularly fat and muscle cells).

In addition to the problems with an increase in insulin resistance, the release of insulin by the pancreas may also be defective and suboptimal. In fact, there is a steady decline in beta cell production of insulin in type 2 diabetes that contributes to worsening glucose control. (This is a major factor for many patients with type 2 diabetes who ultimately require insulin therapy.) Finally, the liver in these patients continues to produce glucose through a process called gluconeogenesis despite elevated glucose levels. The control of gluconeogenesis becomes compromised.
While it is said that type 2 diabetes occurs mostly in individuals over 30 years old and the incidence increases with age, an alarming number of patients with type 2 diabetes are barely in their teen years. Most of these cases are a direct result of poor eating habits, higher body weight, and lack of exercise.

While there is a strong genetic component to developing this form of diabetes, there are other risk factors – the most significant of which is obesity. There is a direct relationship between the degree of obesity and the risk of developing type 2 diabetes, and this holds true in children as well as adults. It is estimated that the chance to develop diabetes doubles for every 20% increase over desirable body weight.

Regarding age, data shows that for each decade after 40 years of age regardless of weight there is an increase in incidence of diabetes. The prevalence of diabetes in persons 65 years of age and older is around 26%. Type 2 diabetes is also more common in certain ethnic groups. Compared with a 7% prevalence in non-Hispanic Caucasians, the prevalence in Asian Americans is estimated to be 9%, in Hispanics 13%, in blacks around 13%, and in certain Native American communities 20% to 50%. Finally, diabetes occurs much more frequently in women with a prior history of diabetes that develops during pregnancy (gestational diabetes).

 

What are the other types of diabetes?

Gestational diabetes

Diabetes can occur temporarily during pregnancy, and reports suggest that it occurs in 2% to 10% of all pregnancies. Significant hormonal changes during pregnancy can lead to blood sugar elevation in genetically predisposed individuals. Blood sugar elevation during pregnancy is called gestational diabetes. Gestational diabetes usually resolves once the baby is born. However, 35% to 60% of women with gestational diabetes will eventually develop type 2 diabetes over the next 10 to 20 years, especially in those who require insulin during pregnancy and those who remain overweight after their delivery. Women with gestational diabetes are usually asked to undergo an oral glucose tolerance test about six weeks after giving birth to determine if their diabetes has persisted beyond the pregnancy, or if any evidence (such as impaired glucose tolerance) is present that may be a clue to a risk for developing diabetes.

Secondary diabetes

“Secondary” diabetes refers to elevated blood sugar levels from another medical condition. Secondary diabetes May Develop When the pancreatic tissue responsible for the production of insulin is destroyed by disease, chronic pancreatitis: such as (inflammation of the pancreas by toxins like excessive alcohol), trauma, or surgical removal of the pancreas.

Hormonal disturbances

Diabetes can also result from other hormonal disturbances, such as excessive growth hormone production (acromegaly) and Cushing’s syndrome. In acromegaly, a pituitary gland tumor at the basis of the brain causes excessive production of growth hormone, leading to hyperglycemia. In Cushing’s syndrome, adrenal glands produce the an excess of cortisol, Which Promotes blood sugar elevation.

Medications

Certain medications may worsen diabetes control, or “unmask” latent diabetes. This is commonly seen MOST When steroid medications (prednisone Such as) are taken and medications used With Also in the treatment of HIV infection (AIDS).

 

What kind of doctor treats diabetes?

Endocrinology is the specialty of medicine that deals with hormone disturbances, and both endocrinologists and pediatric endocrinologists manage patients with diabetes. People with diabetes may also be treated by family medicine or internal medicine specialists. When complications arise, people with diabetes may be treated by other specialists, including neurologists, gastroenterologists, ophthalmologists, surgeons, cardiologists, or others.

 

How is diabetes diagnosed?

The fasting blood glucose (sugar) test is the preferred way to diagnose diabetes. It is easy to perform and convenient. After the person has fasted overnight (at least 8 hours), a single sample of blood is drawn and sent to the laboratory for analysis. This can also be done accurately in a doctor’s office using a glucose meter.

Normal fasting plasma glucose levels are less than 100 milligrams per deciliter (mg/dl).
Fasting plasma glucose levels of more than 126 mg/dl on two or more tests on different days indicate diabetes.
A random blood glucose test can also be used to diagnose diabetes. A blood glucose level of 200 mg/dl or higher indicates diabetes.

When fasting blood glucose stays above 100mg/dl, but in the range of 100-126mg/dl, this is known as impaired fasting glucose (IFG). While patients with IFG or prediabetes do not have the diagnosis of diabetes, this condition carries with it its own risks and concerns, and is addressed elsewhere.

 

The oral glucose tolerance test

Though not routinely used any longer, the oral glucose tolerance test (OGTT) is a gold standard for making the diagnosis of type 2 diabetes. It is still commonly used for diagnosing gestational diabetes and in conditions of pre-diabetes, such as polycystic ovary syndrome. With an oral glucose tolerance test, the person fasts overnight (at least eight but not more than 16 hours). Then first, the fasting plasma glucose is tested. After this test, the person receives an oral dose (75 grams) of glucose. There are several methods employed by obstetricians to do this test, but the one described here is standard. Usually, the glucose is in a sweet-tasting liquid that the person drinks. Blood samples are taken at specific intervals to measure the blood glucose.

For the test to give reliable results:

  • The person must be in good health (not have any other illnesses, not even a cold).
  • The person should be normally active (not lying down, for example, as an inpatient in a hospital), and
  • The person should not be taking medicines that could affect the blood glucose.
  • The morning of the test, the person should not smoke or drink coffee.
The classic oral glucose tolerance test blood glucose levels Measures five times over a period of three hours. Some physicians simply get a baseline blood sample followed by a sample two hours after drinking the glucose solution. In a person without diabetes, the glucose levels rise and then fall quickly. In someone with Diabetes, glucose levels rise higher than the normal and fail to come back down as fast.
People with glucose levels between normal and diabetic have impaired glucose tolerance (IGT) or insulin resistance. People with impaired glucose tolerance do not have diabetes, but are at high risk for progressing to diabetes. Each year, 1% to 5% of people whose test results show impaired glucose tolerance actually eventually develop diabetes. Weight loss and exercise may help people with impaired glucose tolerance return their glucose levels to normal. In addition, some physicians advocate the use of medications, such as metformin (Glucophage), to help prevent/delay the onset of overt diabetes.
Research has shown that glucose intolerance itself can be a risk factor for the development of heart disease. In the medical community, most doctors now understand that glucose intolerance is not simply a precursor to diabetes, but it is their own clinical entity of the disease that requires treatment and follow-up.

Evaluating the results of the oral glucose tolerance test

Glucose tolerance tests may lead to one of the following diagnoses :

  • Normal response: A person is said to have a normal response when the 2-hour glucose level is less than 140 mg/dl, and all values between 0 and 2 hours are less than 200 mg/dl.
  • Impaired glucose tolerance (prediabetes): A person is said to have impaired glucose tolerance when the fasting plasma glucose is less than 126 mg/dl and the 2-hour glucose level is between 140 and 199 mg/dl.
  • Diabetes: A person has diabetes when two diagnostic tests done on different days show that the blood glucose level is high.
  • Gestational diabetes: A pregnant woman has gestational diabetes when she has any two of the following:, a fasting plasma glucose of 92 mg/dl or more, a 1-hour glucose level of 180 mg/dl or more, or a 2-hour glucose level of 153 mg/dl, or more.

Why is blood sugar checked at home?

Home tests of blood sugar (glucose) are an important part of controlling blood sugar. An important goal of diabetes treatment is to maintain blood glucose levels near the normal range of 70 to 120 mg / dl before meals and below 140 mg / dl at two hours after eating. Blood glucose levels are usually tested before and after meals, and before bedtime. The level of sugar in the blood is usually determined by pricking the fingertip with a puncture device and applying the blood to a glucose meter, which reads the value. There are many meters in the market, for example, Accu-Check Advantage, One Touch Ultra, Sure Step and Freestyle. Each meter has its own advantages and disadvantages (some use less blood, some have a larger digital reading, some take a shorter time to give results, etc.). The results of the test are used to help patients make adjustments in medications, diets, and physical activities.

Here are some interesting developments in blood glucose monitoring that include continuous glucose sensors. The new continuous glucose sensor systems involve an implantable cannula placed just below the skin in the abdomen or arm. This cannula allows for frequent sampling of blood glucose levels. Attached to this is a transmitter that sends the data to a device similar to a pager. This device has a visual screen that allows the user to see, not only the current glucose reading, but also the graphic tendencies. In some devices, the rate of blood sugar change is also shown.

There are alarms for low and high sugar levels. Certain models will sound an alarm if the rate of change indicates that the user is at risk of falling or the blood glucose rise too fast. One version is designed specifically to interact with your insulin pumps. In most cases, the patient must still manually approve any insulin dose (the pump can not respond blindly to the glucose information it receives, it can only give a calculated guess as to whether the user should administer insulin and, if so , how much).

However, in 2013 the United States FDA approved the first artificial pancreas type device, which means an implanted sensor and pump combination that stops the insulin delivery when glucose levels reach a certain low point. All these devices must be correlated with the measurements of the digital clamps for a few hours before they can work independently. The devices can then provide readings of 3 to 5 days.

Diabetes experts feel that these blood glucose monitoring devices give patients a significant amount of independence to manage their disease process; and they are a great tool for education as well. It is also important to remember that these devices can be used intermittently with fingerstick measurements. For example, a well-controlled patient with diabetes can rely on fingerstick glucose checks a few times a day and do well. If they become ill, if they decide to embark on a new exercise regimen, if they change their diet  IQ and so on, they can use the sensor to supplement their fingerstick regimen, providing more information on how they are responding to new lifestyle changes or stressors. This kind of system takes us one step closer to closing the loop, and to the development of an artificial pancreas that senses insulin requirements based on glucose levels and the body’s needs and releases insulin accordingly – the ultimate goal.

 

Hemoglobin A1c (HBA1c)

To explain what hemoglobin A1c is, think in simple terms. sugar sticks, and when it’s around for a long time, it’s harder to get it out. In the body, sugar also adheres, particularly to proteins. The red blood cells that circulate in the body live for about three months before dying. When sugar sticks to these hemoglobin proteins in these cells, it is known as glycosylated hemoglobin or hemoglobin A1c (HbA1c). The measurement of HBA1c gives us an idea of the amount of sugar present in the bloodstream during the last three months. In most laboratories, the normal range is 4% -5.9%. In poorly controlled diabetes, its 8.0% or more, and in well-controlled patients, it is less than 7.0% (optimal is <6.5%).
The benefits of measuring A1c is that is gives a more reasonable and stable view of what’s happening over the course of time (three months), and the value does not vary as much as finger stick blood sugar measurements. There is a direct correlation between A1c levels and average blood sugar levels as follows.
While there are no guidelines to use A1c as a screening tool, it gives a physician a good idea that someone is diabetic if the value is elevated. Right now, it is used as a standard tool to determine blood sugar control in patients known to have diabetes.

The American Diabetes Association currently recommends an A1c goal of less than 7.0% with the A1C goal for selected individuals as close to normal as possible (<6%) without significant hypoglycemia. Other groups, such as the American Association of Clinical Endocrinologists, feel that an A1c of <6.5% should be the goal.

Of interest, studies have shown that there is a 35% decrease in the relative risk of micro vascular disease for each 1% reduction in A1c. The closer to the normal A1c, the lower the absolute risk of micro vascular complications.

It should be mentioned here that there are a number of conditions in which an A1c value may not be accurate. For example, with significant anemia, the red blood cell count is low, and thus the A1c is altered. This may also be the case in sickle cell disease and other hemoglobinopathies.

What are the acute complications of diabetes?

  1. Severely elevated blood sugar levels due to an actual lack of insulin or a relative deficiency of insulin.
  2. Abnormally low blood sugar levels due to too much insulin or other glucose-lowering medications.

    REFERENCES:

    American Diabetes Association. Diabetes Basics.
    <http://www.diabetes.org/diabetes-basics>

    CDC.gov. Diabetes Public Health Resource.
    <http://www.cdc.gov/diabetes>

    CDC.gov. “2014 National Diabetes Statistics Report. 2012.
    <http://www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html>

    Khardori, R., MD. “Type 2 Diabetes Mellitus.” Medscape. Oct 08, 2015.
    <http://emedicine.medscape.com/article/117853-overview>

 

 

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