Diabetes Mellitus

Overview

Metabolism is a term that we must understand.It means the sum of physical and chemical changes taking place in living cells. It includes all reactions by which the body obtains energy from food and spends it. So, when we say metabolic diseases, these diseases refer to those disorders in which the various reactions in the cells are affected (population of energy or utilization of energy) due to abnormal production of one or more hormones, or a deficiency of an enzyme.

Diabetes mellitus is a metabolic disorder characterized by high blood glucose levels due to a decreased ability or complete inability of the tissues to utilize carbohydrates, accompanied by changes in the metabolism of fat, protein, water and electrolytes.

The disorder is due to a deficiency or diminished effectiveness of the hormone insulin, produced by the beta cells of the Islet of Langerhans of pancreas. Themetabolicderangementin long standing cases is frequently associated with permanent and irreversible, functional and structural changes in the vascular system of the body characteristically affecting the eye, kidney and nervous system.

Insulin is a hormone produced by the pancreas that regulates the amount of glucose sugar in the blood it allows glucose to enter the body cells where it can be used for energy insulin is produced by beta cells in the islets of Langerhans which are located in the pancreas.

According to WHO

According to World Health Organization (WHO), as of 2021, as estimated 422 million adults worldwide are living with diabetes. This presents approximately 6.5% of the global adult population.

The prevalence of diabetes is increasing rapidly worldwide, particularly in low-and middle-income countries, where urbanization and lifestyle changes are leading to a rise in diabetes cases.In fact, the WHO predicts that diabetes will be the 7th leading cause of death worldwide by 2030.

It is important to note that these estimates are based on reported cases of diabetes, and there may be many more people living with undiagnosed diabetes. Additionally, diabetes disproportionately affects certain populations, such as older adults, indigenous peoples, and people with low income or education levels.

Prevention and management of diabetes require a multi-faceted approach including promoting healthy lifestyles, improving access to healthcare, and raising awareness about the disease and its complications. The WHO recommends that people with diabetes receive regular medical care to manage their blood sugar levels, monitor for complications, and receive education and support to help them manage their condition.

name="Facts">Facts

Diabetes is a chronic metabolic disorder that affects millions of people worldwide

There are several types of diabetes including type one diabetes type 2 diabetes and gestational diabetes.

Type 1 diabetes is an autoimmune disorder that typically develops in children and young adults while type 2 diabetes is the most common form of diabetes and is often caused by lifestyle factors such as obesity physical inactivity and poor diet.

Gestational diabetes occurs during pregnancy and usually resolves after childbirth.

Symptoms of diabetes may include increased thirst and hunger frequent urination fatigue blurred vision and slow healing of wounds or infections.

Diabetes can lead to serious complications such as cardiovascular disease kidney damage nerve damage and blindness if left untreated

Treatment for diabetes typically involves lifestyle modifications such as a healthy diet and regular exercise and medication such as oral hypoglycemic agents or insulin injections

Prevention of diabetes involves maintaining a healthy weight eating a balanced diet engaging in regular physical activity and avoiding smoking and excessive alcohol consumption

Regular monitoring of blood sugar levels is important for people with diabetes to prevent or manage complications

Diabetes is a major public health concern and research is ongoing to better understand the causes and develop more effective treatments for the condition

Types

Several forms of diabetes have been identified as a result of research and survey conducted worldwide. These forms of diabetes include:

Type I –Insulin Dependent Diabetes Mellitus (IDDM)

Type II – Non-insulin Dependent Diabetes Mellitus (NIDDM)

Type III –Malnutrition Related Diabetes Mellitus (MRDM)

Impaired Glucose Intolerance (IGT)

Gestational Diabetes

Others

Type 1:- Mostly children and adolescents suffer from this type of diabetes.However, it may appear in adults and elderly too. In this, there is little or no production of insulin by beta cells of the pancreas. Hence the young individuals require daily insulin injections. If daily injection is not taken, there could be life threatening metabolic complications and the symptoms could be very severe. More people are underweighting in this type of diabetes.

Type 2:- Overweight and obese adults are generally afflicted by these types of diabetes. The insulin produced by the pancreas is normal or even high. The symptoms of the disease are gradual.The problem is caused by insulin resistance. Obesity is the main cause of insulin resistance; weight reduction diet and exercise can be helpful to decrease the insulin resistance.Antidiabetic drugs can also be useful.

Type 3:- This type of diabetes has been categorised as a separate entity. It is often seen commonly in developing countries, India being one of them.It occurs in the young mostly between the ages of 15-30 years.People look thin, lean and malnourished. The reason for this type of diabetes is that the pancreas does not produce enough insulin (necrotic tissues on the pancreas) and hence these individuals require insulin. Very often hormonal disorders may occur.It has also been seen that when insulin is discontinued, the complication is lesser than type 1 diabetes.

Impaired Glucose Intolerance:- Patient suffering from impaired glucose tolerance is regarded as ‘at risk’.Risk factors should, therefore, be minimized in such patients to prevent development of diabetes.

Gestational diabetes:- This type of diabetes occurs during pregnancy and usually resolves after childbirth.It is caused by hormonal changes that can lead to insulin resistance. Women who develop gestational diabetes are at increased risk of developing type 2 diabetes later in life.

Other types of diabetes:-There are several other less common types of diabetes, including monogenic diabetes (caused by mutations in a single gene), cystic fibrosis-related diabetes (associated with cystic fibrosis), and steroid-induced diabetes (caused by the use of certain medications).

Symptoms

The symptoms of diabetes can vary depending on the type of diabetes and the severity of the condition. some common symptoms of diabetes include:

Polyurea:-High levels of glucose in the blood can cause the kidney to work harder to filter the blood leading to more frequent urination.

Polydipsia:- Excessive thirst due to loss of water from the body.

Polyphagia:- Increased appetite, urge for sweat items of food due to heavy loss of sugar in urine.

Pruritis Vulvae:- Irritation in the genitalia caused by local deposition of sugar from urine. It can be also caused disrupted sleep.

Fatigue:-Diabetes can cause feelings of fatigue or weakness due to the body's inability to use glucose for energy.

Blurred vision:- High level ofglucose in the blood can cause swelling in the lenses of the eyes, leading to blurred vision.

Slow healing of wounds or infections:- High level of glucose in the blood can impair the body's inability to heal wounds or fight infections.

Para esthesia:- Overtime, high level of glucose in the blood can damage nerves, leading to a condition called diabetic neuropathy that can cause tingling or numbness in the feet or hands.

Nausea and vomiting:- People with type 1 diabetes may experience nausea and vomiting due to high level of ketones in the blood.

Unintentional weight loss:-Without enough insulin, the body may start to break down fat and muscle for energy, leading to weight loss.

Dark patches of skin:- People with type 2 diabetes may develop dark patches of skin, usually on the neck, armpits, or groin.

Erectile dysfunction:-Men with type 2 diabetes may experience erectile dysfunction, a condition that makes it difficult to achieve or maintain an erection.

Causes

The causes of diabetes vary depending on the type of diabetes

Type 1 diabetes is caused by an autoimmune response in which the body’s immune system attacks and destroys the cells in the pancreas that produce insulin. the exact cause of this autoimmune response is unknown, but it may be triggered by genetic and environmental factors such as exposure to certain viruses or chemicals.

Type 2 diabetes is caused by a combination of genetic and lifestyle factors. In this type of diabetes, the body becomes resistant to insulin, and the pancreas may not be able to produce enough insulin to keep blood sugar levels within a normal range. Risk factors for type 2 diabetes include being overweight or obese, having a sedentary lifestyle, having a family history of diabetes, and being over the age of 45.

Gestational diabetes is caused by the hormonal changes and insulin resistance that occur during pregnancy. women who are overweight or obese before pregnancy, have a family history of diabetes, or have had gestational diabetes in a previous pregnancy are at higher risk of developing gestational diabetes.

Other types of diabetes such as monogenic diabetes and secondary Diabetes, can be caused by genetic factors or underlying medical conditions.

Risks

Diabetes as we know is a lifelong disease,i have said earlier also that it can be controlled but not cured control of diabetes by ensuring normal blood level it is important for preventing the complications to develop but sometimes they do develop as acute or chronic complications

Acute Complications of Diabetes

Hypoglycemia or low blood sugar: Hypoglycemia refers to a medical condition where the level of glucose (sugar) in the blood is lower than normal this can occur when a person with diabetes takes too much insulin or other glucose-lowering medications, skips meals or eats too little, or engages in excessive physical activity. It can also be caused by certain medications alcohol consumption and medical conditions such as liver disease, kidney disease, and insulin-producing tumors.

Symptoms of hypoglycemia can include shakiness, sweating, rapid heartbeat, headache, confusion, irritability, weakness, dizziness, and fainting. In severe cases, hypoglycemia can lead to seizures, coma or even death.

Hyperglycemia or High Blood Sugar

hyperglycemia refers to a medical condition where the level of glucose (sugar) in the blood is higher than normal.It is most commonly associated with diabetes but can also be caused by other medical conditions, medications, or lifestyle factors.

In diabetes, hyperglycemia occurs when the body either doesn't produce enough insulin(type 1diabetes) or becomes resistant to insulin (type 2 diabetes), leading to high blood sugar levels.Symptoms of hyperglycemia can include increased thrust, frequent urination, blurred vision, fatigue, and slow healing of wounds.

Untreated or uncontrolled hyperglycemia can lead to long term complications such as nerve damage, kidney damage, cardiovascular disease, and blindness

Diagnosis

Timely and proper diagnosis plays a key role not only in identifying new cases but also in managing old cases with or without diabetic complications certain diagnostic tests help in understanding the previous history of a diabetic and also in preventing the onset of future complications let us review some of these.

The oral glucose tolerance test (OGTT)

Urinary sugar test(Benedict'sTest)

Glycosylated hemoglobin test

Oral Glucose Tolerance Test (OGTT):- An oral glucose tolerance test is a medical test used to diagnose diabetes, impaired glucose tolerance, and other conditions related to blood glucose levels. It involves drinking a glucose solution, then having blood sugar levels measured at specific intervals.

The test typically involves the following steps:-

Fasting:- The patient is asked to fast for 8 to 12 hours prior to the test.

Blood test:-A fasting blood sugar level is measured to establish a baseline.

Glucose solution:- The patient drinks a glucose solution containing a measured amount of glucose (usually 75 grams for adults).

Blood tests:- Blood sugar levels are measured at specific intervals after the glucose solution is consumed, typically at 30 minutes,1 hour, 2 hour and sometimes three hours after ingestion.

Results interpretation:-The test results are then used to diagnose diabetes, impaired glucose tolerance, or other conditions related to blood sugar levels.

Normal blood sugar levels after an OG T are as follows:

Fasting blood sugar level:- less than 100mg/dl

1 hour after drinking glucose solution:- less than 200mg/dl

2 hours after drinking glucose solution:- less than 140mg/dl

Urinary sugar (Uristix Benedict’s test):- Urinary sugar testing using Uristix Benedict’s test is a Diagnostic tool used to detect the presence of sugar in urine. This test is often used to monitor blood sugar control in people with diabetes, as well as to screen for diagnose diabetes.

The uristix benedicts test involves using a urine test strip that changes color in the presence of sugar.The test strip contains a reagent that reacts with glucose or other reducing sugars to produce a color change. The degree of color change corresponds to the amount of sugar present in the urine.

To perform the test, a urine sample is collected in a clean, dry container. A Uristix test strip is then dipped into the urine sample and allowed to react for a specified amount of urine time. The test strip is then compared to a color chart to determine the amount of sugar present in the urine.

While urinary sugar testing can provide valuable information about blood sugar control, it is important to note that glucose may not appear in urine until blood glucose levels are quite high. Therefore, a negative result does not always rule out diabetes or other conditions related to blood sugar levels

Glycosylated hemoglobin:- Glycosylated hemoglobin (HBA1c) is a blood test that measures the average blood sugar level over a period of 2-3 months.It is used to monitor blood sugar control in people with diabetes and to diagnose diabetes.

When glucose in the blood binds with hemoglobin in red blood cells, a glycosylated hemoglobin molecule is formed.The level of glycosylated hemoglobin in the blood is directly proportional to the average blood sugar level over the past 2-3 months.This makes (HBA1c) a useful indicator of long-term blood sugar control in people with diabetes.

The HBA 1C test is performed by taking a blood sample, usually from a vein in the arm. The test results are reported as a percentage of total hemoglobin that is glycosylated.The American Diabetes Association recommends an HBA1c target of less than 7% for most people with diabetes.

Treatment and Precautions

The treatment of diabetes depends on the type of diabetes and the severity of the condition. The main goals of diabetes treatment are to manage blood sugar levels, prevent complications, and Improve quality of life. Here are some common treatment options for diabetes:-

Type 1 diabetestreatment:-Insulin therapyis the primary treatment of type 1 diabetes. This involves taking regular insulin injections or using an insulin pump to deliver insulin throughout the day.It is important to monitor blood sugar levels regularly to adjust the insulin doses as needed.

Type 2 diabetestreatment:-Treatment for type 2 diabetes may involve lifestyle changes, such as a healthy diet, regular exercise, and weight loss.In some cases, medications may be prescribed to lower blood sugar levels to improve insulin sensitivity. For people with severe or advanced type 2 diabetes, insulin therapy may be necessary.

Continuous glucose monitoring:-Continuous glucose monitoring (CGM) involves wearing a small sensor that measures glucose levels in the tissue fluid under the skin. This can help people with diabetes monitor their blood sugar levels more frequently and make adjustments to their treatment plan as needed.

Medications:- There are several medications available to help manage blood sugar levels in people with diabetes. These medications may include oral medications or injectable medications such as GLP-1 agonists or SGLT 2 inhibitors.

Blood sugar monitoring:- Regular blood sugar monitoring is an essential part of diabetes management.This can be done with a blood glucose meter or a continuous glucose monitoring device.

Lifestyle changes:- In addition to medical treatments, lifestyle changes such as a healthy diet, regular exercise, and weight loss can also help manage diabetes.tes">As a dietician, our key objective involves bringing about lifelong adoptable quantitative and qualitative changes in the nutrient intake dietary habits and food choices of the patients as per their insulin drug doses and lifestyle the dietician should work in close coordination with the doctor and other members of the patient care team.

Diet plays a very important role in management of diabetes as it exerts a direct influence on the blood glucose levels. The goals of diet therapy are to maintain and prolong a healthy, productive, and a happy life. This means nutritional assessment is important for setting practical and acceptable goals for the patient. The goal that the patient can comprehend, relate to, and can be followed easily.

Insulin:-

Short-acting:-

Works hardest 2-3 hours after injection but is completely gone after 4-6 hours.

It is also called regular insulin

Zinc is added because it prolongs its action

Intermediate Acting:

Works hardest 8-12 hours after injection and gives some effect upto 24 hours.

One type of this insulin is known as neutral protamine hagedorn.

Long Acting:

Does not work until 4-8 hours after the injection

Its peak activity occurs 18-24 hours after injection

 and continues to work after 36 hours

less commonly used

doctors use combination of salt and intermediate insulin

Oral drugs:

 Oral antidiabetic drugs act by different mechanisms: increasing insulin secretion (sulfonylureas and glinides), decreasinginsulin resistance (thiazolidinedione andmetformin), or delaying the absorption of glucose from the intestine (alpha-glucosidase inhibitors)

How to reverse Diabetes through diet?

Diabetes is a chronic disease that occurs when the body can no longer produce or properly use insulin which is needed to regulate blood sugar levels while diet alone may not be able to completely reverse diabetes it can be a very important component of an overall treatment plan here are some dietary changes that can help manage and potentially reverse diabetes

Increase fiber intake:- Eating foods high in fibre, such as whole grains, fruits and vegetables can help regulate blood sugar levels and improve insulin sensitivity.

Reduce consumption of processed and sugary foods:-Food high in sugar and refined carbohydrates can cause blood sugar spikes and worsen insulin resistance so it's important to limit or avoid these types of foods.

Choose healthy fats:-Replacing saturated and trans fats with unsaturated fats, such as those found in nuts, seeds and fatty fish can help reduce inflammation and improve insulin sensitivity.

Eat smaller more frequent meals:-Eating smaller meals throughout the day can help regulate blood sugar levels and prevent large spikes and drops

Limit alcohol consumption:-Drinking alcohol can cause blood sugar spikes and worsen insulin resistance so it's important to limit or avoid alcohol.

Stay hydrated:-Drinking plenty of water can help regulate blood sugar levels and prevent dehydration which can worsen diabetes symptoms.

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