Diabetes Mellitus: All You Need To Know
Diabetes Mellitus (DM), commonly referred to as diabetes is not just a disease anymore; rather, it has graduated to the level of an epidemic. In fact, many people who are waiting for Apple to release an ‘iPump’, or a glucometer that plays iTunes, might not have to wait that long either.
According to the National Diabetes Statics Report 2014, more than 9% of Americans suffer from diabetes with the figure expected to rise in future. With more than 21 million people diagnosed and about 8 million undiagnosed cases, it is costing the country more than 245 billion dollars in healthcare and even more so in terms of productivity.
What Is Diabetes Mellitus?
When diabetics say, “I’m not ill, my pancreas is just lazy”, they have the basic concept of the disease right. Diabetes mellitus is a disease where the pancreas either produces no insulin (commonly called type I diabetes) or insufficient amounts of insulin (type II diabetes).
All the food that we eat is digested and eventually broken down by the digestive system into the simplest sugar called glucose, which when collected in the bloodstream, is absorbed by cells in the muscles and organs for energy with the help of insulin. If there are insufficient levels of insulin in the body, the glucose would not be absorbed, resulting in persistently high levels of blood sugar, a state called hyperglycemia.
To understand the ill effects of hyperglycemia, imagine the sugar molecules as tiny soldiers wielding swords. As the blood moves through various organs, these soldiers use their weapon on these organs and wreak havoc, giving diabetes mellitus the title of a multi-organ disease.
In type I diabetes, there is almost complete deficiency of insulin because the insulin-producing cells of the pancreas, called the beta cells are damaged by an autoimmune or an unknown mechanism of action. Due to this, type I diabetes is more common in childhood with peak incidence occurring during puberty.
About 10% of all diagnosed diabetics in the US suffer from this type of diabetes. Due to an absolute deficiency of insulin, type I diabetes patients need to be given exogenous insulin, inserted either with the help of a pump or an injection, to survive.
In type II diabetes, there is a decreased production of insulin, or resistance to insulin due to obesity. This type of diabetes presents itself later in life (mostly between the ages of 25-55 years) and is by far the more common of the two. In fact, 90% of diabetics have type I diabetes. Obesity, poor lifestyle, family history, are just some of the factors associated with type II diabetes.
It is said that diabetes mellitus is a disease of the rich in poor countries; however in rich countries, diabetes is considered the disease of the poor — with obesity being the main culprit. In subclinical form, also known as the pre-diabetic state or glucose intolerant, diabetes may be present for years before diagnosis.
Because of this, many people have some evidence of vascular damage (affecting the eyes most commonly) at the time of diagnosis. Of particular note is that the risk of this disease is increased 80-100 fold by unhealthy lifestyles and obesity. Type II diabetics can mostly control their blood sugar with the help of dietary modification, exercise and medication alone; but sometimes, they may also need insulin injections or pumps.
Why Is Diabetes Mellitus So Common And What Are Its Associations?
As mentioned before, diabetes is on the rise throughout the world, being more common in people with an affluent lifestyle and positive family history. Four factors that majorly affect this disease include, family history, increasing age, obesity and ethnicity.
Type II diabetes is most commonly caused by lifestyle, but ethnicity also plays a major role; for example, populations having South Asian, Caribbean and African ancestry have a lifetime risk exceeding more than 30%, and as such, the disease is 2-4 times more prevalent in these groups.
The chances of developing type II diabetes are increased in some diseases. We will discuss some of these.
- Polycystic Ovarian Syndrome (PCOS) is a common condition for women, especially in young adulthood, that is characterized by a triad of irregular menstruation, excessive facial hair and obesity. Insulin resistance is a common feature seen in PCOS and such patients subsequently develop type II diabetes.
- Gestational Diabetes is a type of diabetes you contract when you are pregnant; women who have gestational diabetes almost always go on to develop type II diabetes later in life. Gestational diabetes occurs because of increased insulin resistance due to pregnancy hormones. One sign of gestational diabetes is a high birth weight of the baby (>9lbs).
- Central Obesity means that fat is concentrated around the trunk, is a risk factor for type II diabetes. Having a high waist circumference or a high BMI (equal or more than 30) puts you at risk. Some other diseases associated with type II diabetes include; hypertension, hypertriglyceridemia, decreased HDL levels (increased cholesterol and fat content in the body) and disturbed hemostatic variables.
Collectively, this group of risk factors is known as metabolic syndrome. These disorders cause not only insulin resistance and consequently type II diabetes, but also increase the overall risk of cardiovascular disorders and increased atherosclerosis. Obesity not only overburdens the heart, but also slowly smothers it, eventually resulting in a myocardial infarction (heart attack) or heart failure.
The answer to why diabetes is so common, lies in our eating habits and lifestyle. The incidence of diabetes was much lower a few centuries ago because there was a lack of availability of processed food, pre-packaged food, fast food, food full of preservatives, excessive sugar and salt and most important of all, there was abundant adequate physical activity. Being a couch potato and binge-watching television is literally sucking the life out of people; there is a resultant increase in morbidity as well as mortality.
The statistical data for the US is astonishing. According to the Centers for Disease Control and Prevention (CDC), the number of diabetics have increased from 5.5 million in 1980 to 22 million in 2014, showing a fourfold increase.
Robert E Ratner, MD, Chief Scientific and MO of the American Diabetes Association (ADA) calls these recent trends ‘frightening’ and recognizes that early age diabetes is a ‘harbinger of adult health problems.’ As predicted by Dr Ratner, we are seeing an epidemic of diseases like MI, kidney failure and strokes at relatively younger ages like 30-35 years.
Diabetes mellitus is not just an issue with the American population, it is on the rise in the European and Asian populations too. Baroness Barbara Young, the chief executive of Diabetes UK, calls diabetes ‘the crisis’ which could threaten health services. An estimated 5 million people in the UK would develop diabetes by the year 2025.
Indian and Chinese populations account for 40% of diabetic people. Genetic predisposition, along with westernization of diet and physical inactivity are likely responsible for the statistics in these regions.
How Does Diabetes Mellitus Develop?
We already know that insulin is a hormone produced by the beta cells of the pancreas, and its role is to manage the high levels of glucose in our bloodstream after a meal while helping it get absorbed into cells and tissue to provide energy. Insulin not only promotes cellular uptake of glucose, but also helps store glucose in the form of glycogen in cells and liver.
Moreover, insulin promotes the process whereby amino acids (building blocks of proteins), fats and proteins are absorbed and stored. During the period of insulin secretion, fat and protein breakdown for producing glucose (energy) is reduced. Now, we know that diabetes is a disease of insulin insufficiency, but let us see exactly how the process happens.
Type I Diabetes
This type of diabetes is a part of immune-mediated, organ-specific diseases. There is predominant genetic involvement in this disease, particularly the HLA gene on chromosome 6. In this disease, the defense mechanism of the body (immune system) is directed against its own organs, hence the term ‘auto-immune’.
There are organ-specific antibodies that attack the beta cells of the pancreas and destroy them, thus curtailing their ability to produce insulin. This results in absolute deficiency of insulin which is why insulin therapy is needed. Although the destruction of the beta cells may take time, the onset of the disease is sudden and symptoms may present over a few days or weeks.
Type I diabetes can occur with other auto-immune diseases like vitiligo, thyroid disease, celiac disease, and pernicious anemia.
Type II Diabetes
Unlike type I diabetes, this type does not involve complete insulin deficiency. Rather, it is characterized by gradual beta cell dysfunction, coupled with impaired insulin action through peripheral insulin resistance. There is insulin present in such individuals, but it is unable to produce its effect in cells.
When insulin is unable to act on the cells, the beta cells respond by increasing their production of insulin and a vicious circle of increased production to overcome resistance begins, which results in exhaustion of the beta cells.
Although the mechanism of insulin resistance is poorly understood, it has been found that it is related to central obesity and the amount of triglycerides in the cells of the muscles and liver. More than 50% of beta cells are present in type II diabetes at the time of diagnosis, which is why there is no absolute deficiency of insulin.
However, the amount of insulin produced by this depleted beta cell mass is unable to maintain glucose homeostasis, and the effects of hyperglycemia start becoming evident.
During the early stage of type II, the patient is in a state of pre-diabetes, or impaired glucose tolerance. In this state, the insulin is working partially to reduce blood glucose level, however this level of glucose is still higher than in normal individuals.
In type II diabetes, the patient can manage hyperglycemia with the help of dietary modification and exercise. This is because exercise reduces insulin resistance and thus the body uses even this measly amount of insulin efficiently.
Here is what a type II flow chart looks like:
Early form of diabetes may persist for years before the actual diagnosis. This state, also called Impaired Glucose Tolerance, may be responsible for causing vascular complications later on.
The classic symptoms of diabetes include:
- Excessive Urination occurs because of high amounts of glucose in the blood, which the kidney is unable to filter out and when released in the urine, attract a large quantity of water and hence a large amount of urine is produced.
- Excessive Thirst occurs due to excessive urination and electrolyte imbalance.
- Weight Loss occurs because the body is unable to utilize glucose (due to deficiency of insulin which facilitates the uptake of glucose by muscles), it breaks down protein and fat to fulfil energy requirements.
- Dry Mouth occurs due to water and electrolyte depletion.
Some of the other symptoms that are likely present for years but the patient is likely to ignore include:
- Lack of energy and lethargy
- Blurring of vision (as a side effect of high blood glucose)
- Fungal infections like vaginal candida or balanitis, due to decreased immunity
- Tingling of hands and feet
- Excessive hunger: this occurs when the muscles are unable to utilize the glucose in the blood and thus signal the body that more food is needed
- Slow healing wound: not only do diabetics have recurrent infections due to decreased immunity, but they also have delayed healing
- Darkened skin: dark lines called acanthosis nigricans, in the skin folds like neck or the armpits, are indicative of insulin resistance
Sometimes the disease process is very advanced and presents a lot of complications. These can include:
- Diabetic ketoacidosis (in type I diabetes)
- Hyperosmolar hyperglycemic state (in type II diabetes)
- Skin infections like recurrent boils
- Retinopathy occurs, which means that persistent hyperglycemia has damaged the retina in the eye and is affecting the vision of the patient. Usually this process occurs in more advanced diseases and is a common cause of blindness
- Erectile dysfunction is the inability to achieve an erection
- Arterial disease affects the blood supply of the limbs or even the heart. If the limbs are affected, the patient is likely to contract gangrene and may need amputation. If the arteries supplying blood to the heart are affected, then a myocardial infarction (heart attack) results
Can You Save Yourself From Diabetes?
If you are someone with a strong family history of diabetes, and yet rule the kingdom of couch potatoes, and have a stressful job to boot, then you are a train wreck just waiting to happen. However, it is never too late to make a change in your life.
Even in people with newly diagnosed type II diabetes, lifestyle and dietary modifications go a long way in disease management. Furthermore, just because either or both of your parents had diabetes, does not mean that you would develop it, instead it just increases your chances of developing diabetes.
It is important to remember that healthy living is the key to preventing diabetes, because there is no single magical drug available that can help in the primary prevention of type II diabetes.
According to Kopleman et al, high body fat is the cause of 64% diabetic cases in men and 77% of cases in women. However, people who exercise regularly, have better eating habits, and do not smoke, have an 80-90% lower rate of developing diabetes.
Eating healthy and living healthy are two things that are easier said than done, but these are the two determinants of a happier and healthier living. Taking a few minutes out of your hectic schedule for a run or an aerobics session might seem difficult in the beginning, but they are a far safer choice than living with diabetes.
Dietary Association Of Diabetes Mellitus
It is no secret that unhealthy eating habits are responsible for such a high incidence of diabetes, but let us see how exactly it does that.
Increased intake of carbohydrates leads to an increased requirement of insulin, (to maintain the balance between blood sugar and insulin secretion) and over a period of time, this results in a decline of insulin secretion and eventual development of diabetes. It is like exhausting the pancreas with high insulin requirements, which subsequently stops producing enough insulin to maintain normal blood glucose levels.
Unhealthy eating habits combined with a sedentary lifestyle and stress are most likely to fry your pancreas. Urbanization, eating foods with high glycemic index, mental or physical stress and excessive sugar intake are the culprits in the American population.
Not only does exercise help lower the blood glucose level through energy expenditure, but it also helps facilitate the entry of glucose into muscles and cells, thus requiring lower levels of insulin.
Moreover, exercise also releases endorphins—the ‘happy’ hormones that help decrease mental stress and elevate mood. On the other hand, obesity and lack of physical activity induce a state of insulin resistance, whereby higher levels of insulin are needed to mobilize blood glucose into muscles and cells. Insulin resistance, secondary to obesity, also exhausts the pancreas and results in diabetes.
It has been found that small frequent meals are healthier than having two to three large meals a day. Not only do frequent small meals help maintain a steady blood sugar level, but they also reduce the insulin requirement of the body. Large meals, on the other hand, produce a lot of glucose, thus needing a larger amount of insulin to process.
We talked a little about this syndrome before; this is a group of risk factors which include hypertension, hyperlipidemia, diabetes and low level of HDL in the body. People who fall in this category should not only double their efforts to make lifestyle changes, but should also seek professional help to do so.
According to a research paper published in the Archives of Internal Medicine, a healthy diet is defined as one having a high fiber content, lower trans fat component, higher ratio of unsaturated fat and an overall lower glycemic index. A healthier diet would not only decrease the risk of diabetes, but would also help deal with chronic conditions like hypertension and hyperlipidemias—both of which will reduce the risk of cardiovascular disorders.
A Diabetic’s Lifestyle
A dysfunction in carbohydrate metabolism can make a person diabetic, which in turn forces a person to make efforts to correct it as long as he or she lives. This correction can involve use of an insulin pump, insulin injections, or blood sugar level controlling anti-diabetic tablets. However, a major lifestyle haul is often involved. The goal is to control blood sugar levels, with continuous and periodic monitoring along with this lifestyle modification.
A diabetic may often be advised to de-stress, incorporate exercise into his routine, or increase his level of everyday care. Stress is a state of despair or tension that occurs when a person is unable to cope with pressure. Stress can lead to secretion of hormones often associated with ‘fight or flight’ responses seen in humans. Over time this can lead to depression, among other mental health issues.
Diabetes needs a high level of decision-making activity and maintenance by a patient, which can be adversely affected if a person is not fully equipped to handle this responsibility. Depression and stress are often common among people with diabetes type 1 and type 2. According to the American Diabetes Association (ADA), a person suffering from a chronic illness is three times more likely to be diagnosed with depression.
Commonly associated depression and stress in diabetics has been termed “Diabetes burnout”. Diabetes burnout can lead to a person completely disregarding the maintenance of moderate blood sugar levels. A patient suffering from burn out may miss appointments, avoid or forget taking medications and may have unhealthy eating habits.
ADA suggests several distressing activities that can help a diabetic patient like avoiding self-medication with nicotine and consuming too much coffee or alcohol, taking time out to relax, getting enough sleep, resting if you are sick, managing your time better, learning to recognize that you are tired, learning to say no, and most importantly increasing your physical activity.
Physical activity can help alleviate your mood as the endorphins associated with exercise increase in the body. Diabetics with type 2 disease are especially advised to exercise because when you are physically active , the cells in your body become more sensitive to insulin and consume up more sugar from the blood stream. This can also help improve your A1C, which when lowered, can help you decrease the number of diabetes pills or insulin injections you take.
A diabetic is advised to consult with a doctor before they start any kind of physical activity to adjust their medication or diet. Planning your routine, tracking your progress, evaluating your blood sugar levels, and befriending someone with the same goal and activities can help you remain consistent in your workout routine. A 30-60 minute, moderate intensity workout session is advised for diabetics, which they should perform most days of the week.
Cardio workouts like running, swimming, walking, and cycling can also help you lower your weight. High intensity interval training (HIIT) can help lower your weight, fat mass, and control your blood sugar levels if you have type 2 diabetes. Strength training and stretching exercises can also provide multiple benefits.
Diabetes And Food Planning
It has been noted that the rate and extent of diabetes differ from person to person and diabetics therefore require specially planned meals according to their condition, adjusted by a registered dietitian. But there are a few general techniques are same for every type of diabetic meal planning. The planning process involves taking help from the three major concepts including ‘The Healthy Plate Method’, ‘Carb Counting’ and knowing the glycemic index of foods.
According to the ADA, the gist of the plate method is to include 50% non-starchy vegetables, 20% proteins, 25% grains and other starchy foods and collecting the rest of your energy from healthy fruits in addition to drinks.
The second, very crucial concept regarding diabetic meal planning is carb counting. Since carbs can directly increase blood glucose levels therefore it is advised to take them in moderation i.e. 45-60g of carbs per meal but that varies from person to person.
Furthermore, an amalgamation of moderate carb diet with foods having low glycemic Index (GI) can help prevent sudden spikes in the blood sugar levels. Some of the foods having low GI are non-starchy vegetables, oat meals and lentils etc.
Another vital point regarding food planning of diabetics that should be kept in mind is to use low salt and fat content to prevent other problems associated with diabetes such as hypertension and cardiac problems.
Effects Of Diabetes Mellitus
We have said throughout this article that diabetes is a multi-organ disease; let us now discuss this in detail.
Persistent hyperglycemic states are dangerous not only for the heart, but they also damage the kidneys, nerves, brain, eyes, blood vessels, limbs, skin and even the teeth—oww!
- Cardiovascular System: the damage to the heart and blood vessels is extensive in diabetes. This is because diabetes speeds up the process of atherosclerosis (deposition of fat plaques in the blood vessels). This damage can occur both in the coronary vasculature (blood vessels of the heart)—thus causing angina or even heart attack, and the blood vessels of the brain—causing stroke. Moreover, a diabetic state is a fertile ground for the development of hypertension, again due to narrowing of blood vessels, and hypertension itself is a risk factor for diseases like stroke and coronary artery disease. Therefore, diabetic individuals have more than two times the risk of developing cardiovascular diseases as compared to a normal individual.
- Kidney Damage (diabetic nephropathy): this is a common side effect of diabetes. Diabetes damages the kidney in two ways, either directly through hyperglycemic states or indirectly through the development of hypertension. Kidneys contain millions of small blood vessels through which waste can be filtered, and this waste is then passed out of the body through urine. Excessive blood sugar damages this filter, causing small molecules of protein—called albumin, to pass through. This condition, called microalbuminuria is an early sign of kidney damage. Eventually, the filtering system of the kidney fails, leading to end stage renal disease and the need for dialysis ensues.
- Eye Damage (retinopathy): when light enters the eye, it is refracted through the cornea and lens and falls on the retina where an image is formed and this image is transmitted from the retina to the brain through the optic nerve. The tiny blood vessels on the retina are also affected in diabetes. Persistent hyperglycemic states, either make the blood vessels on the retina very leaky, or causes them to become excessively narrow. Eventually, this results in retinal damage and even blindness. Diabetics are also likely to develop other problems like cataracts at an earlier age and even glaucoma.
- Recurrent Skin Infections: in this case there is a reduced immunity (due to poor blood supply), which causes patients to develop recurrent skin infections, including both fungal and bacterial infections. Such people could also go on to develop oral fungal infections (oral candida). Digital sclerosis, is another condition associated with unmanaged diabetes; it causes thickening of skin, usually on the hands or feet. Diabetics also experience excessive dryness of skin, but this can be effectively dealt with by using petroleum jelly or moisturizers.
- Brain Damage: as we learned before, the chances of stroke are increased in diabetic individuals through the narrowing of blood vessels, but it seems that brain damage is not limited just to strokes. Diabetics also have an increased risk of developing Alzheimer’s disease, whose risk grows exponentially with increasing blood sugar levels. The exact relation between these diseases, however, remains unclear.
- Foot/Leg Amputation: poor healing is a common feature of diabetes and when combined with a decreased blood supply to the limbs, it can mean an increased risk of developing gangrene and peripheral arterial disease. Leg or foot ulcers and gangrene development are common side effects of diabetes. Needless to say, both indicate a poor diabetic control and long-term disease. With the development of gangrene, amputation of foot or below-knee amputation can become a necessity. This is why diabetics are given special instructions to take care of their feet, and to properly manage any cut, blister or boil, which could fester if left untreated.
- Hearing Disabilities: such disabilities are common in diabetics, likely and are secondary to nerve damage.
- Tingling Or Hand And Feet (neuropathy): this occurs when the blood supply to the peripheral nerves is compromised. The blood supply of said nerves is damaged by persistent hyperglycemia, causing symptoms like tingling, burning, lack of sensation or even pain. If the nerves of the digestive system are damaged, it can cause delays in stomach empting, nausea, vomiting, diarrhoea or constipation. In men, erectile dysfunction is another common side effect of diabetes.
Why Controlling Normal Blood Glucose Level Is Important?
A strict glycemic control is necessary for all diabetics, both type I and type II patients. A chart with healthy glycemic range is shown below:
Short Term Effects Of High BSLIt is necessary to maintain the BSL (blood sugar level) between these ranges to prevent long-term and short-term complications. Long-term complications of hyperglycemia are those that are mentioned above. We already know how persistently high BSL damages multiple organs. Now, we will discuss the short term effects of both high and low BSL.
Hyperglycemia is defined as having BSL of more than 180mg/dl. When the glucose level in the bloodstream exceeds this limit, then certain symptoms are seen, which include:
- Excessive urination
- Excessive thirst as well as hunger
- Weight loss (if the condition persists for longer)
- Blurring of vision
- Dryness of skin
- Drowsiness or headache
- Recurrent skin infections like boils or blisters
- Slow healing wounds
Such symptoms have an acute onset, and are an indication that strict glycemic control is needed. High BSL can be caused by a missed insulin dose, missed medication, increased stress on the body, interaction with some other medication, decreased physical activity or increased diet. Another common reason may be your body requirement of insulin has increased and your current medication is no longer sufficient to meet this demand.
There are two diabetic emergencies associated with very high BSL — Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS). Both these conditions have a different mechanism of action and are seen in different types of diabetes.
DKA is a hallmark of type I diabetes, and is seen in either previously undiagnosed cases, an ongoing infection or illness, or in an interruption of insulin therapy. When there is severe insulin deficiency, the body cannot utilize glucose for energy and for this reason it catabolizes (breaks down) fat. When fat is catabolized, a by-product called ketone is produced and this molecule greatly disturbs the internal environment of the body, a state called ketosis.
In DKA, ketones can be detected in the blood as well as the urine, and the pH of blood is also disturbed (becomes more acidotic). The patient experiences shortness of breath, dry mouth, fruity breath, abdominal pain, confusion, marked dehydration, and subnormal body temperatures. DKA is a medical emergency that should be treated promptly with insulin and fluid administration. HHS is commonly seen in type II diabetics.
The BSL of these patients can be very high, in the range of >300mg/dl which can be a consequence of eating glucose-rich food, any infection or illness that increases the insulin requirement of the body, steroid medication or being previously undiagnosed. In HHS there is not much catabolism of fat, but there is marked dehydration, a stupor-like state or even unconsciousness. This is also a diabetic emergency that needs to be promptly treated, as the mortality of HHS is as high as 20-30%.
The other end of the spectrum is low BSL, which is called hypoglycemia. Hypoglycemia is defined as a blood sugar level of below 70mg/dl. The reason for this can be skipped meals, too much medication, eating less or exercising more. Low BSL presents itself with the following symptoms:
- Blurred vision
- Palpitations and sweating
- Pallor of skin
- Shaking and tingling of skin
- Trouble concentrating on anything
- Mood swings
- Loss of consciousness
This state, just like hyperglycemia, is also a dangerous state. In an acute attack of hypoglycemia, the patient may lose consciousness so suddenly that, he or she has no warning symptoms. For this reason, it is important for the patient, as well as, those around him to recognize the symptoms and treat them promptly by giving:
- A cup of soda
- A tablespoon of sugar
- Anything sweet like candy
It is also recommended to wear a medical ID bracelet stating your condition, so that medics can treat you promptly and properly in case of an emergency.
How To Check Blood Sugar Level?
Monitoring and regularly checking BSL is not only important, but it can also be life-saving. Knowing about the dangers of hypoglycemia or hyperglycemia can help you take care of yourself or your loved one in a crisis.
With the recent advances in technology, it has become very easy to check blood sugar at home. All you need is a glucometer and a test strip. A good and reliable kit is a necessity for a diabetic patient; one should have it available all the time.
Wash your hands and dry them; prepare your device, as instructed by the manual and put in the test strip. Now, prick your fingertip using your personal lancing device and put the drop of blood on the test strip. Wait a couple of seconds, and view your result on the device. Now proceed as necessary according to your BSL. Don’t forget to properly dispose the lancet.
Not only do user-friendly glucometers allow you to monitor your BSL, but they also help you know the efficacy of your medication. Using a log book, you can record your readings so that your healthcare provider can adjust your medication according to your body requirement.
ADA recommends checking BSL at least three times a day, especially for people taking insulin. For people taking oral medication, they should check it as often as their healthcare professional recommends. Recommended times are usually:
- Before a meal
- Two hours after meal
- In the middle of the night
- In times of stress or illness
Diabetes that develops only during pregnancy, and continues thereafter, is called gestational diabetes. The high levels of blood glucose seen during gestational diabetes are not only dangerous for the mother but for the baby as well. The disease develops during the middle or towards the end of pregnancy with expectant mothers tested for it between the 24th and 28th weeks of pregnancy.
The disease pattern for gestational diabetes is the same as for diabetes mellitus, i.e., insulin resistance which subsequently causes inadequate absorption of glucose by the cells and thus high blood glucose levels. Although the exact cause for insulin resistance is not known, ADA speculates that it could be caused by placental hormones that block the action of insulin on the cells and hence cause insulin resistance.
According to the CDC, the overall prevalence of gestational diabetes was as high as 9.2% in2014, however, it was found to be more prevalent in Native American, Hispanic, Black and Asian women as compared to white women.
Some of the risk factors for gestational diabetes are:
- Family history of type II diabetes
- History of pre-diabetes
- History of PCOS (Polycystic Ovary Syndrome)
- Being overweight
- Previous gestational diabetes
- Previous pregnancy with a large baby (delivery of a baby weighing more than 9lbs)
- Mother being more than 25 years of age
- Mother being treated for AIDS/HIV
Risk To The Baby
Not only is gestational diabetes dangerous for the mother, but it also poses risks to the baby. According to ADA, some of these risks are:
- Large baby: mothers with gestational diabetes have large babies, because the excess glucose crosses the placenta and reaches the baby. Not only does this cause the baby’s pancreas to work overtime to produce insulin, but it also causes storage of this extra glucose as fat
- Risk of hypoglycemia: due to the excessive insulin produced by the pancreas, such babies are at risk of hypoglycemia right after birth
- Respiratory distress syndrome: babies born to mothers with gestational diabetes also are at risk of having breathing condition called respiratory distress syndrome
- Babies are also at risk of dying soon after birth
- Shoulder dystocia at birth due to large bodies
- Risk of diabetes later in life: such babies can also have a high risk of developing diabetes later in life, along with an increased chance of being obese
Risk To The Mother
Some of the problems that the mother faces are:
- Difficult delivery: may occur due to a large baby
- Increased chances of a C-section: a large baby may mean that a cesarean section is needed to deliver the baby
- High blood pressure and preeclampsia: swollen ankles, high blood pressure and protein in the urine is called preeclampsia that may be dangerous for both the mother and the baby and may need constant monitoring to prevent complications. Mothers with gestational diabetes are at an increased risk of developing preeclampsia
What To Do If You Have Gestational Diabetes?
Gestational diabetes can be managed easily if one heeds the advice of their doctor. Some of the precautions that need to be taken include:
- Monitor your blood glucose properly
- Prenatal visits
- Make healthy food choices and consult a dietitian or doctor to make a meal plan and adhere to it to manage adequate blood glucose levels
- Stay physically active as exercise and activity naturally control high blood glucose
- Take insulin or oral hypoglycemic as advised by your physician. Some doctors prescribe medication to control the blood glucose.
Some people with diabetes can manage their condition with healthy eating and exercise. However, most of the patients will ultimately need pharmacotherapy to meet their target blood glucose levels. Diabetes medications vary, depending upon the disease severity, duration and complications associated with it. For instance, individuals with type 1 diabetes need insulin (injections) right from the outset.
In people with type 2 diabetes, the following oral medications, called hypglycemics, are prescribed:
- Biguanides: such as Metformin (Glucophage, Metformin Hydrochloride ER, Riomet, Fortamet, Glumetza). Metformin is considered the safest and most effective diabetes drug. It reduces insulin resistance and increases glucose uptake by the cells.
- Sulfonylureas or Insulin Secretagogues: include tolbutamide (Orinase, Tol-Tab), chlorpropamide (Diabenese) and tolazamide (Tolinase), glipizide (Glucotrol), and glimepiride (Amaryl). These drugs enhance insulin secretion from pancreatic beta cells and sometimes cause hyperinsulinemia.
- Glinides: include rapaglinide (Prandin) and nateglinide (Starlix). They have the same action as sulfonylureas.
- Thiazolidinediones or Glitazones: include pioglitazone (Actos), rosiglitazone (Avandia). These drugs bind to receptors in fat cells and enhance insulin sensitivity.
- Alpha-glucosidase Inhibitors: include acarbose (Precose) and miglitol (Glyset). These drugs are taken before meals and delay glucose digestion.
- Incretin mimetics: include exenatide (Byetta), dulaglutide (Trulicity), and liraglutide (Victoza). These drugs are analogues of incretin hormones (GLP-1 and glucose-dependent insulinotropic polypeptide – GIP) that secrete insulin in response to meals.
- Synthetic Amylin Analogue: includes pramlinitide (SymlinPen 120, SymlinPen 60) that is used for both type 1 and type 2 diabetes. It delays gastric emptying, giving a feeling of satiety.
- DPP-4 Inhibitors or Gliptins: include saxagliptin (Onglyza), alogliptin (Nesina), sitagliptin (Januvia), and linagliptin (Tradjenta). These drugs inhibit dipeptidyl-peptidase-4 (DPP-4) – an enzyme that cleaves incretins.
- Sodium-glucose co-transporter 2 (SGLT2) Inhibitors: A relatively new class of drug, SGLT-2 inhibitors include canagliflozin (Invokana), empagliflozin (Jardiance), and dapagliflozin (Farxiga). These drugs enhance sugar excretion by blocking the reabsorption of glucose from the kidneys.
Most individuals with type 2 diabetes will ultimately need insulin.
Diabetes Mellitus And Insulin Use
Usually provided through injections, insulin is a peptide hormone that regulates carbohydrate metabolism in the body. It forces cells in the liver, muscles, and fat tissues absorb glucose.
Insulin Comes In Different Types
- Short-acting insulin: regular insulin (Humulin and Novolin)
- Rapid-acting insulin: insulin aspart (Novolog, FlexPen), insulin glulisine (Apidra), and insulin lispro (Humalog)
- Intermediate-acting insulin: insulin isophane (Humulin N, Novolin N)
- Long-acting insulin: insulin glargine (Lantus), insulin determir (Levemir), and insulin degludec (Tresiba)
- Combination insulin: Novolog Mix 70/30, Humalog Mix 75/25, Humulin 70/30, Novolin 70/30.
Innovations In Diabetes
The 21st century promises new advances in the treatment, diagnosis, monitoring, and management of diabetes.
Modes Of Insulin Administration
Insulin administration in diabetes besides injections is now possible. Insulin pens are a very popular alternative. These pens have replaceable cartridges of insulin, a replaceable needle, and often a dial to choose insulin dose you want to administer. They are helpful for patients that are in need of multiple doses, are blind (often a side effect of diabetes), or visually impaired.
Insulin pumps or Continuous Subcutaneous Insulin Infusion (CSII) devices are the most advanced form of insulin delivery. These pumps are small, computerized devices that are programmed to periodically deliver insulin directly into the fatty tissue under the skin. These pumps can last for years, however insulin can be replaced once a previous supply has been used up.
Insulin patches are an experimental form of insulin delivery system. The aim behind the patches is to deliver insulin painlessly to the patient without any hassle. The proposed mechanism of delivery is to use transdermal patches much like nicotine patches, to provide the body with the insulin it needs.
Stem cell research has been hailed as a potential cure for diabetes. Theoretically, stem cells may help re-growth of Islet cells. A team of Brazilian and American researchers was first to demonstrate this in human diabetes disease. Based on the principle of “immunologic reset”, the stem cell therapy holds great promise in treating the disease altogether.
Gene therapy can also be potentially used to manufacture insulin, help limit the beta cell destruction, and help other cells to be differentiated into beta cells.
Monitoring And Management
New advances in electronics have led to the development of glucose meters. These meters are medical devices that can help measure approximate blood sugar levels in levels in diabetics. A small drop of blood can help you reveal your sugar levels in the comfort of your own home.
In the long-term, people can manage their conditions more effectively if they can track and chart these levels over the course of time. Hyperglycemia and hypoglycemia in diabetes patient can also be controlled with the help of these meters.
The technological boom of this century in the form of software and apps can help a diabetic patient to monitor, track, and keep a record of his or her sugar levels at all times. Some of these phone apps include BG monitor diabetes, Blue Loop and Calorie Counter PRO.
Myths About Diabetes
There are many myths about diabetes which may make it hard to understand. To cut through the confusion, we’ve broken down some of the common misconceptions:
Eating Too Much Sugar Causes Diabetes
While sugar itself has nothing to do with type I diabetes, its role in type II diabetes is rather indirect. Increased intake of sugar, or rather, sugar-sweetened beverages, increases the tendency to being overweight, which increases the risk of type II diabetes.
According to ADA, the intake of beverages like fruit punch, sports drinks, regular soda and energy drinks should be avoided. Just one can of soda has the same amount of carbs as ten tablespoons of sugar. The real culprit in type II diabetes is unhealthy eating, rather than eating too much sugar.
Diabetes Is Not A Serious Disease
Diabetes is the seventh-leading cause of deaths in the world; it has a higher mortality than both AIDS and breast cancer combined. Diabetics die either by complications caused by diabetes, or by the disease itself. Diabetes should be taken seriously by the patient, with regular follow-ups, annual checkups and most importantly, compliance to medication.
Being Overweight Means You Are A Diabetic In The Making
If someone tells you that you being overweight could mean that you are a diabetic in the making, then tell them two things:
- There are risk factors other than being overweight that contribute to diabetes, e.g., genetic makeup, age and ethnicity
- You are not fat, it’s your awesomeness swelling up inside you. (….and then hit the gym)
Diabetics Cannot Eat Chocolates Or Sweets
Diabetics who are regularly monitoring their BSL and taking their medication can certainly enjoy a few chocolates or sweets, as part of a healthy diet plan. If combined with regular exercise and medication, they should not be harmful at all.
All types of diabetes are the same
Fact- There are many different types of diabetes. The main types of diabetes are type 1, type 2 and gestational diabetes. There are also other forms of diabetes but they are less common. Each type of diabetes has different causes and may be managed in different ways but once someone has diabetes, it will need to be managed every day, except gestational diabetes which goes away once the baby is born. All types of diabetes are complex and serious.
People with diabetes can’t eat dessert
Fact- Because diabetes is a condition where your blood glucose level is too high, many people think they need to avoid sugars and foods containing sugar. However, if eaten as part of a healthy meal plan, or combined with exercise, sweets and desserts can be eaten by people with diabetes.
The key is to eat everything in moderation. That doesn’t mean you can eat all the sugar you may want. Most sweets contain a large amount of carbohydrate in a very small serving. So you need to be sure to have a small serving.