Understanding Diabetes

Introduction

Diabetes mellitus is a chronic condition that develops when the body cannot properly regulate blood sugar (glucose). Glucose is essential for fueling cells and maintaining brain function, but without adequate insulin production or action, glucose builds up in the bloodstream. Over time, this can damage multiple organs and increase the risk of life-threatening complications.

What is Diabetes?

Diabetes refers to a group of metabolic disorders characterized by high blood sugar levels. Insulin, a hormone produced by the pancreas, allows glucose to enter cells. In diabetes, this process is impaired due to either insufficient insulin, resistance to insulin, or both.

Types of Diabetes

Type 1 Diabetes

• An autoimmune condition in which the immune system destroys pancreatic beta cells.
• Patients produce little to no insulin and require lifelong insulin therapy.
• Typically diagnosed in childhood or adolescence but can occur at any age.
• Symptoms often develop suddenly and include excessive thirst, frequent urination, unexplained weight loss, and fatigue.

Type 2 Diabetes

• The most common form of diabetes, associated with insulin resistance and declining insulin production.
• Risk factors: obesity, sedentary lifestyle, age over 45, family history, and high blood pressure or cholesterol.
• Symptoms may develop gradually and include hunger, thirst, frequent urination, blurred vision, slow-healing wounds, and numbness in extremities.
• Some individuals may have no symptoms until complications appear.

Gestational Diabetes

• Develops during pregnancy when hormones interfere with insulin sensitivity.
• Usually resolves after delivery but increases risk of type 2 diabetes for both mother and child.
• Most women have no symptoms and are diagnosed through routine screening between weeks 24–28 of pregnancy.

Other Forms

• Monogenic diabetes (caused by a single gene defect).
• Secondary diabetes related to conditions such as cystic fibrosis, pancreatitis, or certain medications.

Prediabetes

• Blood glucose levels are higher than normal but not yet diabetic.
• Fasting glucose: 100–125 mg/dL (5.6–6.9 mmol/L).
• Strong risk factor for type 2 diabetes and cardiovascular disease.
• Lifestyle changes—healthy diet, weight management, and exercise—can prevent progression.

Symptoms of Diabetes

• Persistent hunger and thirst
• Frequent urination
• Unexplained weight loss
• Extreme fatigue
• Blurred vision
• Slow-healing sores or infections

Additional in men: reduced libido, erectile dysfunction, muscle weakness.
Additional in women: recurrent urinary tract infections, yeast infections, dry or itchy skin.

Type 1 Diabetes Symptoms

• Sudden onset of severe thirst, frequent urination, weight loss, mood changes, and fatigue.

Type 2 Diabetes Symptoms

• Develop slowly and may remain unnoticed for years.
• Typical signs include blurred vision, tingling in hands or feet, recurrent infections, or wounds that heal poorly.

Gestational Diabetes Symptoms

• Usually asymptomatic.
• Detected during screening in mid-pregnancy.

Causes and Mechanism

Role of Insulin

Insulin allows glucose to move from the bloodstream into cells for energy. In diabetes, this mechanism fails.

• Type 1: Autoimmune destruction of insulin-producing cells in the pancreas.
• Type 2: Cells become resistant to insulin, and the pancreas cannot keep up with demand.
• Gestational: Pregnancy hormones induce insulin resistance that the pancreas cannot fully compensate for.

Risk factors include genetics, obesity, age, sedentary lifestyle, history of gestational diabetes, and certain medical conditions such as polycystic ovary syndrome (PCOS).

Complications of Diabetes

Uncontrolled blood sugar damages blood vessels and nerves, leading to:

• Cardiovascular disease (heart attack, stroke)
• Neuropathy (nerve damage causing numbness and pain)
• Nephropathy (chronic kidney disease)
• Retinopathy (vision loss, blindness)
• Poor circulation and foot ulcers, which may lead to amputation
• Skin infections (bacterial, fungal)
• Mental health issues, including depression

Complications in Gestational Diabetes

• For the baby: excessive growth, birth trauma, low blood sugar at birth, higher risk of type 2 diabetes later in life.
• For the mother: preeclampsia, higher chance of gestational diabetes in future pregnancies.

Diagnosis

Common tests include:

• A1C test: Average blood glucose over 2–3 months.
• Fasting plasma glucose (FPG): Blood sugar after at least 8 hours of fasting.
• Oral glucose tolerance test (OGTT): Measures blood sugar before and two hours after consuming glucose.
• Random plasma glucose test: Blood sugar at any time of the day.

Gestational diabetes is diagnosed through glucose screening between weeks 24–28 of pregnancy.

Treatment and Management

Although diabetes cannot be cured, it can be effectively controlled. Treatment depends on the type:

Type 1 Diabetes

• Requires daily insulin therapy (rapid, short, intermediate, or long-acting insulin).
• Balanced diet and regular monitoring of blood glucose.

Type 2 Diabetes

• Lifestyle modification (diet, exercise, weight management).
• Oral medications: metformin, sulfonylureas, DPP-4 inhibitors, GLP-1 agonists, SGLT2 inhibitors, and more.
• Insulin therapy may be needed as the disease progresses.

Gestational Diabetes

• Frequent monitoring of blood glucose.
• Diet and exercise adjustments.
• Insulin may be prescribed if blood sugar remains uncontrolled.

Self-Care and Home Management

• Diet: Emphasize fruits, vegetables, whole grains, and lean protein. Avoid refined carbohydrates and saturated fats.
• Exercise: At least 150 minutes of moderate activity per week.
• Weight management: Achieving a healthy weight reduces insulin resistance.
• Smoking cessation: Improves overall cardiovascular and metabolic health.

Prevention

Type 1 diabetes cannot be prevented. However, type 2 and gestational diabetes may be delayed or avoided with:

• Healthy diet rich in fiber, low in fat and calories.
• Regular physical activity.
• Maintaining a healthy weight.
• Routine check-ups for those at risk.

Conclusion

Diabetes is a lifelong condition that requires ongoing management. While it cannot yet be cured, proper treatment, lifestyle adjustments, and regular monitoring can help individuals live healthy, active lives and reduce the risk of serious complications.

This article is for educational purposes only and should not replace professional medical advice. Always consult your physician for diagnosis and treatment.

Source: Adapted and restructured by Everwell Magazine