Diabetes

What is Diabetes?

According to the American Diabetes Association, as of 2018, nearly 34.2 million Americans have diabetes mellitus. Of those, 1.6 million have type 1 diabetes, with type 2 being the predominant presentation.

Type 1 Diabetes Mellitus (T1DM)

This form of the disease is due to decreased insulin secretion by the pancreas. The cause and mechanism that causes this lack of insulin are unknown. It may be due to autoimmune or environmental factors, such as an infection.

Type 2 Diabetes Mellitus (T2DM)

This form is primarily due to insulin resistance, where the body is unable to use insulin properly. T2DM causes 80% of diabetes cases worldwide. At least some cases of this type of the disease result from obesity or lack of physical activity and exercise. Type 2 diabetes is often known as adult-onset or noninsulin-dependent diabetes.

Gestational Diabetes

There is also another type of diabetes named gestational diabetes, which occurs during pregnancy. Diagnosis is usually via a glucose intolerance test administered as a routine part of prenatal care. 

Gestational diabetes can produce short- and long-term risks for both mother and baby. It is most common to face complications during delivery, such as needing an emergency cesarean section or having trouble delivering a large baby. Many times, this condition resolves spontaneously following birth. However, women who have experienced this condition should continue to monitor for the development of high blood sugar later in life.

The Importance of Care

People with any of the above types of diabetes have high glucose levels in their bodily fluids. This is from carbohydrates in foods that the body cannot metabolize due to lack of or intolerance to insulin. This increased sugar can be harmful to many body systems and puts you at a higher risk of developing many health issues, including:

  • Cardiovascular disease
  • High blood pressure
  • Low blood sugar levels
  • Kidney disease or kidney failure
  • Diabetic retinopathy and blindness
  • Nerve damage in the limbs can cause pain, sores, or gangrene
  • Skin breakdown, with an increased risk for infection

Given these potentially serious complications, type 1, type 2, and gestational diabetes require appropriate care.

Pathophysiology and Risk Factors

Diabetes occurs from inadequate insulin production by the pancreas or deficiency in insulin processing. In the latter case, insulin resistance may begin years before diabetes develops. Often, it is present before the onset of any symptoms of hyperglycemia.

Risk factors include:

  • A family history of high or irregular blood sugar
  • Age (over 45 years old)
  • Obesity or weight gain
  • Lack of physical activity and exercise
  • Race/ethnic background (African-American, Native American, Asian American/Pacific Islander, Latino, and multi-racial individuals have increased risk)
  • A history of gestational diabetes for women

If you have one or more of these risk factors, you may want to monitor your blood sugar and watch for any signs or symptoms of diabetes.

Signs and Symptoms

There are three classic symptoms associated with increased blood glucose. These are:

  • Polyuria (urinating six or more times per day)
  • Polydipsia (increased thirst)
  • Polyphagia (increased hunger)

Substantial weight loss may also occur in some patients. Diabetes can lead to several other complications, such as vision difficulties, pain or loss of feeling in extremities, high blood pressure, and changes in kidney function. If you experience any of these or the three telltale symptoms above, speak with one of our online doctors for further evaluation.

Diagnosis

Diagnosis of diabetes usually involves measuring your blood sugar. This is accomplished via a fingerstick test where a drop of blood is drawn from your fingertip and read by a small meter. 

What blood sugar level is normal depends on whether or not you have fasted before the test. A fasting blood glucose of less than 100 mg/dL is considered normal. If you have eaten before the test, blood glucose under 140 mg/dL is generally acceptable.

If your blood sugar is above these readings, you'll most likely undergo one or more of the following tests:

  • Hemoglobin A1C - This lab test provides an average reading of your blood sugar over three months. Your result is expressed as a percent. Less than 5.7% is normal, while above 6.5% classifies as diabetes.
  • Oral Glucose Tolerance Test - This is a test where you will drink a sweet liquid. Your blood glucose level is taken at various time points to see how well your body can metabolize the sugar.
  • Antibody test - This tests for antibodies usually found in people with type 1 diabetes but not usually those with type 2 diabetes.

Treatment

Lifestyle Modifications

Regardless of your blood sugar reading, there are several lifestyle changes you can make to improve your overall health, and potentially, your glucose level:

  • Don't smoke or use tobacco products as they are bad for your health in general and can make diabetes worse.
  • Be physically active, as exercise can help maintain a healthy lifestyle and improve insulin sensitivity (if you have this condition).
  • Try to control your blood pressure as hypertension increases your risk of developing diabetes. If you need to take medication for high blood pressure, take it properly to avoid further complications.
  • Avoid a high-salt diet, as it can lead to heart disease and diabetes.
  • Eat a healthy diet rich in foods with a low glycemic index (GI), which is beneficial in maintaining healthy blood glucose levels in diabetic patients. Low GI foods include most fruits, legumes, popcorn, whole grains, and vegetables such as carrots and spinach.
  • Avoid exposure to secondhand smoke and other environmental toxins.
  • Track your blood sugar levels regularly and keep track of your readings to share with your doctor.

Medical Management 

Currently, there isn't a cure for diabetes. Type 1 disease is treated with insulin injections that replace the insulin your body cannot produce so you can metabolize sugars and carbohydrates. Type 2 disease may be treated with a combination of diet, weight loss, and exercise, and, in some cases, medicine and insulin. 

For some patients, oral medication such as metformin is enough to increase their bodies' sensitivity to insulin. If these are not effective, other oral or injectable drugs may be a treatment option. In some cases, when people fail to respond to these medications, it may be necessary to use insulin injections. If you have difficulty controlling your blood sugar, your doctor may refer you to an endocrinologist for specialized care.

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Prognosis

The prognosis for diabetes depends on several factors, including the type of diabetes and whether you can maintain a healthy lifestyle. If diagnosed and treated promptly, you can lead a long and healthy life. Nevertheless, diabetes is a chronic condition. If left uncontrolled for an extended period, it can lead to complications that can affect many different organs and body systems. 

If you would like to learn more about diabetes, the risk factors, and how you can continue living a fulfilling life with this condition, see one of our doctors available online now and start feeling better today!

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