Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

All rights reserved with siahmsr digital healthcare[siahmsr wellness]

Reviewed by SIAHMSR medical team.

Diabetes

   Diabetes is a condition that occurs when your blood glucose level rises beyond the normal limit. Glucose is a sugar that your body can produce and it also comes from the food you eat. Your body breaks down most of the food you eat into sugar (glucose) and releases it into your bloodstream.

 Glucose metabolism is controlled by hormone insulin that your pancreas makes. Diabetes is a disease state where either insulin production is low or insulin produced cannot remove glucose from blood.

Diabetes is a condition that occurs when your blood glucose level rises beyond the normal limit. Prediabetes  is a state or condition in which blood glucose levels are higher than normal but not high enough to be diagnosed with type 2 diabetes.  Prediabetes enhances the risk of developing type 2 diabetes later.  It also enhances the risk for infections and cardiovascular diseases

Causes

Diabetes [diabetes mellitus] has various causes.

·       It has a strong genetic link.  Diabetes has strong family history with presence of diabetes in either or both of the parents.

Gene mutations also cause diabetes as in MODY [Maturity-onset diabetes of the young] and neonatal diabetes. 

·       Environment & lifestyle

The sugar you eat may not produce diabetes directly. However it can cause obesity and eventually hormonal imbalances leading to diabetes. Stress and environmental factors also play some role.

·       Autoimmunity [ a condition in which body’s immune system works against pancreatic cells producing insulin and destroys them].Type 1 diabetes and LADA happen when your immune system attacks the insulin-producing cells in your pancreas.

·       Pregnancy

Diabetes is associated with pregnancy in some women- gestational diabetes.

·       Infections 

Certain infections raise blood sugar level and it persists lifelong in some group of people.

·       Injury to pancreas

Surgery or injury to pancreas may adversely affect its capacity to make insulin, resulting in Type 3c diabetes.

Types of Diabetes

·       Type 1 diabetes 

     Type 1 diabetes is a state in which no insulin is produced by your body. The immune system of your body attacks and destroys the cells in your pancreatic islet cells which is the producer of insulin. Therefore type 1 diabetes is a condition of raised blood sugar as no insulin is produced. Type 1 diabetes usually occurs in children and young adults, although it can appear at any age. It is important for type 1 diabetes patients to take insulin every day to stay alive. The most common complication of type 1 diabetes is diabetic ketoacidosis (DKA) which is life threatening complication if not addressed in time.

·       Type 2 diabetes

This is the most common type found in majority of people. In this type either insulin production by the pancreas is not enough or the insulin inaction happens. The insulin cannot take up glucose into cells and clear it from blood. This state is known as insulin resistance.

Overweight, obesity, particularly central obesity of trunk predispose to type 2 diabetes and insulin resistance.  As a consequence of obesity and high body mass index (BMI), there is resistance of the peripheral tissues to the action of insulin. The beta-cell in the pancreas continues to produce insulin, but the amount is not enough  to oppose the resistance from cells and tissues. 

 Family history of diabetes is another risk factor. However you can modify your lifestyle through dietary modification, exercise programs to prevent and manage type 2 diabetes. 

·       Prediabetes

Prediabetes  is a state or condition in which blood glucose levels are higher than normal but not high enough to be diagnosed with type 2 diabetes.  Prediabetes enhances the risk of developing type 2 diabetes later.  It also enhances the risk for infections and cardiovascular diseases [ diseases of  heart and blood vessels]in future. In the United States, 96 million adults—more than 1 in 3—have prediabetes. 

·       Gestational diabetes 

This is persistently raised blood sugar level during pregnancy. After childbirth the blood sugar may become normal. However, some women become diabetic later in life. This is type2 kind of diabetes 

 Other uncommon types of diabetes

·       Type 3c diabetes:  Any damage to pancreas (other than autoimmune attack), impairs the capacity of pancreas to produce insulin. Pancreatitis, pancreatic cancer, cystic fibrosis and hemochromatosis can cause pancreatic damage and may lead to diabetes. Pancreatectomy or surgical removal of pancreas also results in Type 3c.

·       Latent autoimmune diabetes in adults (LADA):  Type 1 diabetes happens from autoimmune attack on pancreas; LADA also results from an autoimmune reaction, but the progression to diabetes is not as fast as in type 1 diabetes. Its course is progressive and occurs mainly in young populations above 30.

·       Maturity-onset diabetes of the young (MODY):

  This type of diabetes results from an inherited genetic mutation that impairs production and usage of insulin by the body. There are around over 10 different types of MODY. This type of diabetes runs in families. 

·       Neonatal diabetes:

Diabetes that occurs within the first six months of life is called neonatal diabetes. The high sugar level may disappear within a few months of onset of diabetes [transient form].However it may reappear later in life. In about 50% of babies diabetes persists lifelong and it is called permanent neonatal diabetes mellitus. 

·       Brittle diabetes:

It is a rare form of Type 1 diabetes with frequent and severe episodes of high and low blood sugar levels  necessitating hospitalization. 

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Type 2 diabetes

  It is the most common type of diabetes found in majority of people across the globe. In this type either insulin production by the pancreas is not enough or the insulin inaction happens. The insulin cannot help take up of glucose into  the cells and clear it from blood. This state is known as insulin resistance.

    Overweight, obesity, particularly central obesity of trunk predispose to type 2 diabetes and insulin resistance.  As a consequence of obesity and high body mass index (BMI), there is resistance of the peripheral tissue to the action of insulin. The beta-cells in the pancreas continue to produce insulin, but the amount is not sufficient to oppose the resistance from cells.

Over time, type 2 diabetes can cause serious damage to the body, especially nerves and blood vessels. Therefore early diagnosis is important to prevent the complications of type 2 diabetes.

More than 95% of people with diabetes have type 2 diabetes. Type 2 diabetes was formerly called non-insulin dependent, or adult onset. Of late, this type of diabetes is also occurring increasingly and frequently in children also.

Symptoms 

·       Increased thirst

·       Increased frequency of urination

·       Blurred vision

·       Tiredness or fatigue

·       Unintentional weight loss

Over time, diabetes can damage blood vessels in the heart, eyes, kidneys and nerves and may cause various complications. 

Complications

Acute complications

These are acute in onset and sometimes life threatening also if proper treatment is not given  in time.

·       Diabetic ketoacidosis [DKA]

DKA happens when your body doesn’t produce sufficient insulin. So your blood glucose remains high. Insulin is needed for glucose to be taken up by cells and converted into energy. If there’s no insulin or not enough insulin, your body starts breaking down fat for energy instead of glucose. Fat breakdown causes release of ketones into your bloodstream and urine. Ketones cause your blood to become acidic, which is a life-threatening condition mostly associated with type 1 diabetes[ blood sugar above 250 mg/dl].

·       Hyperosmolar hyperglycaemic state [HHS]  

HHS happens when very high blood sugar leads to severe dehydration and highly concentrated blood (high osmolality), which are life-threatening. Commonly seen in people with type 2 diabetes with very high blood sugar levels[ higher than 600 mg/dl]

There is lack of insulin or insufficiency in HHS also, but the production of insulin is still enough to prevent the production of ketones in blood and urine. So it is a different condition, which is life threatening due to dehydration and highly concentrated blood.

 Intense thirst, frequent urination and mental status changes - delirium, loss consciousness are the symptoms presenting in both conditions. 

About 50% to 60% of HHS cases are triggered by infections such as  pneumonia, urinary tract infections and sepsis . Stroke ,heart attack  and myocardial infarction can also trigger a stress response which can also leads to HHS.  Certain medications for other diseases such as thiazide diuretics, beta-blockers, glucocorticoids, and some atypical antipsychotics may trigger HHS.

The death rate in HHS can be as high as 20%, which is about 10 times higher than the mortality seen in diabetic ketoacidosis. Therefore manage diabetes right from the very beginning with proper medications to prevent these grave complications.

         Chronic complications

·       heart attack

·       stroke

·       chronic kidney disease or nephropathy

·       nerve damage  or neuropathy

·       eye problems or diabetic retinopathy

·       cancer  – chronic inflammatory state associated with high blood sugar predisposes to cancer.

·       Infections

·       gum diseases

·       sexual problems – The nerve and blood vessel damages may cause decreased arousal and erection problems .

Diagnosis and treatment

Diagnosis

·       Random blood sugar test [RBS]

 A blood sample will be taken at a random time [no fasting needed]

 a blood sugar level of 200 milligrams per deciliter (mg/dL) means diabetes.

·       Fasting blood sugar [FBS]

A blood sample will be taken after fasting the previous night [ at least 8 hrs of fasting]. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two different tests means you have diabetes.

·       Glucose tolerance test

 After fasting overnight  the fasting blood sugar level is measured in the morning. Then you drink a sugary liquid, and blood sugar levels are tested after the next two hours.

A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A value of more than 200 mg/dL (11.1 mmol/L) after two hours means you have diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) means you have prediabetes.

·       A1C test

It measures average blood sugar level for the past 2 to 3 months. That is, the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. It's also called a glycated hemoglobin test.

If  A1C level of 6.5% or higher on two  different tests reports are found that means  you have diabetes. An A1C between 5.7% and 6.4% means that you have prediabetes. Below 5.7% is considered normal. 

Treatment

Your health care provider or doctor may prescribe medications of the following category for managing diabetes.

·       metformin

·       sulfonylureas

·       sodium-glucose co-transporters type 2 (SGLT-2) inhibitors

·       insulin injections or other medicines 

Complementary and alternative medicine (CAM)

Homeopathy for diabetes

Only Type 2 diabetes may be managed by homeopathic medications.

A few medications are listed below:

Lycopodium

Phosphorus

Phosphoric acid

Uranium nitricum

Cephalandra Indica

Gymnema  Sylvestre