I chose the title ‘what is diabetes?” because I wanted to discuss broad aspects of this condition.
Diabetes is overwhelming and straining our society’s resources. It can cause a great deal of hardship on affected people and on entire communities.
To be able to prevent and treat a condition, such as diabetes mellitus, in an effective way, you need to know as much as possible about this condition.
Before we go any further, it’s necessary to distinguish between type 1 and type 2 diabetes.
Understanding the difference between these two types of diabetes mellitus is essential, because their causes are completely different.
What is Diabetes Type 1?
Diabetes mellitus type 1 is a chronic condition that results in elevated blood sugar levels, due to the lack of production of insulin.
Only 5% of the diabetic population has type 1 diabetes mellitus.
Causes of diabetes mellitus
Destruction of insulin-producing pancreatic beta cells can cause type 1 diabetes.
A combination of environmental, genetic and immunologic factors might be contributing to the new development of type 1 diabetes mellitus.
This condition affects mostly children and younger adults.
Treatment of type 1 diabetes
The population diagnosed with type 1 diabetes is entirely dependent on insulin. That’s why another name for this condition is insulin-dependent diabetes mellitus.
Rarely, an infection or damage to pancreas can be the cause of beta cell destruction followed by the cessation of insulin production.
The major difference between type 1 and type 2 diabetes is that type 1 diabetes is usually not preventable.
However, type 2 diabetes can be prevented with early intervention and lifestyle changes.
Because the most common cause of type 1 diabetes is an over- functioning immune system, it’s recommended to evaluate every patient who has type 1 diabetes for thyroid and celiac disease.
Because over-functioning immune system can cause both of the above conditions as well.
Gestational diabetes mellitus
Gestational diabetes is usually diagnosed in women in their second to third trimester of pregnancy, who didn’t have any history of elevated blood sugar in the past.
To learn more about this condition, I suggest reading my article about gestational diabetes mellitus.
What is Diabetes Type 2?
Diabetes mellitus type 2 accounts for almost 95% of all patients diagnosed with diabetes.
In this article, I’m primarily going to discuss topics affecting the prevention, diagnosis and treatment of type 2 diabetes.
As previously mentioned, the management of type 2 diabetes is clearly different than type 1 diabetes.
Therefore, we’re going to concentrate on the most common form of diabetes, which is type 2 diabetes.
The number of patients with type 2 diabetes mellitus is growing exponentially, especially in Asian Americans, American Indians, Hispanics and Non-Hispanic Blacks.
Diabetes and obesity
There is an association between the growth of the diabetic population and the increased incidence of obesity throughout the world.
Obesity shown to increase insulin resistance or lazy metabolism, which results in high blood sugar levels.
Type 2 diabetes mellitus process is a chronic and slow path. Before an individual develops diabetes, he has to develop pre-diabetes.
Unfortunately, undiagnosed pre-diabetes and diabetes is a major problem in our society. Especially, knowing that early intervention and well-planned lifestyle changes can often prevent type 2 diabetes mellitus.
Symptoms of high blood sugar
Individuals with slightly elevated blood sugar level are usually asymptomatic.
However, patients with significantly elevated blood sugar levels have symptoms such as increased urinary frequency, fatigue, and thirst.
How to lower blood sugar levels in the pre-diabetic population
Weight loss: as previously mentioned, weight gain and obesity can cause or worsen elevated blood sugar levels. By contrast, weight loss can help to prevent and manage diabetes mellitus.
Studies have shown that a 5 to 7% weight loss can decrease the risk of developing type 2 diabetes by 41- 58%.
Two common healthy ways to lose weight are dietary modifications and increased physical exercise.
Metformin: if patients with pre-diabetes are recognized early, they could be started on Metformin. This medication can reduce blood sugar levels and lessen the risk of developing diabetes.
Diabetes definition and diagnosis
Different criteria for diagnosing diabetes.
A1c: one way to diagnose a person with diabetes is using hemoglobin A1c. According to the guidelines, if A1c ≥ 6.5%, then this person can be diagnosed with diabetes mellitus.
Fasting blood sugar: If the fasting blood sugar of a person is ≥ 126 mg/dl, then this person can be diagnosed with diabetes.
For a fasting blood work you’ll need to avoid eating food for at least 8 hours.
Random blood sugar of 200 ml/dl and more: If a person has a random high blood sugar level more than 200 mg/dl, then there is a higher chance of that person having diabetes.
Fasting and 2-Hour Plasma Glucose: This is the most complex method for diagnosing diabetes mellitus. The steps are as follow.
Patient will have a blood work to check the fasting blood sugar (after avoiding caloric foods for at least 8 hours)
Ingest a 75 g load of sugar
Patient will have a blood work after the ingestion of 75 grams of sugar
Diabetes is diagnosed, if the blood sugar level two hours after ingestion is ≥200 mg/dl.
As previously mentioned, this method of diagnosing diabetes is complex and not used very often.
How does A1c work?
This is a blood test that provides you with an average of your blood sugar over the past three months.
Other names of this tests are, Hemoglobin A1c, HbA1c or the glyco-hemoglobin test.
The A1c blood work doesn’t require fasting and often preferred over obtaining fasting blood sugar.
Diagnosis of diabetes and A1c
A1c can help to diagnose diabetes and pre-diabetes.
Normal: 5.6% and below
Pre-diabetes: 5.7% to 6.4%
Diabetes: 6.5% and above
What are the causes of a false A1c result?
The A1c blood test doesn’t always deliver accurate results.
For instance, the following conditions could interfere with A1C blood test:
Anemia
Dehydration
Kidney failure
Liver disease
Thalassemia
Sickle cell disease
Diabetes mellitus and heart disease
Patients with diabetes mellitus are at a higher risk of suffering from cardiovascular complications, including heart attack and stroke.
The rate of diabetic patients who suffer from sudden death, is also much higher than the population without diabetes mellitus.
According to statistics, 37–42% of all ischemic (blood clot induced) strokes in both African Americans and whites are attributable to the effects of diabetes alone or in combination with high blood pressure.
Because of the higher risk of dying from heart and vascular disease in diabetic patients, it’s vital to treat diabetes and its risk factors aggressively.
To prevent major complications in the future, it’s important to recognize and diagnose patients who are at risk for diabetes, as early as possible
Screening for diabetes mellitus
The American Diabetes Association recommends to screen all adults beginning at age 45 years, regardless of their weight, and all other individuals who are overweight or obese at any age (BMI 25 kg/m2 or 23 kg/m2 in Asian Americans).
Definition of overweight and obesity
The BMI or body mass index is calculated by dividing a person’s weight in kilograms by the square of their height in meters.
An individual is classified as overweight or obese based on his body mass index. The categories are as follow,
BMI less than 18.5 is defined as underweight.
BMI 18.5 to <25 is normal.
BMI 25 to <30 is within the overweight range.
BMI 30 or higher is within the obese range.
What is your risk for type 2 diabetes mellitus?
Please answer following seven questions to determine your future risk for developing diabetes mellitus. If you have yes answers to at least five questions, then you are at a higher risk of having diabetes.
Are you older than 40?
Are you a man?
Are you a female and diagnosed with gestational diabetes in the past?
Are your parents or siblings diagnosed with diabetes?
Have you ever been diagnosed with high blood pressure?
Do you have a regular exercise routine?
Are you overweight?
Vaccinations for patients diagnosed with diabetes mellitus
Every diabetic patient should have the following vaccinations.
Flu vaccination for every diabetic patient older than six months.
Pneumococcal vaccination– PPSV23 type– for diabetic patients between two to 64 years of age.
At age 65 years, patient should receive a pneumococcal vaccine–PCV13 type–at least 1 year after vaccination with PPSV23 type.
After age 65, patient should also receive another pneumonia vaccine–PPSV23 type.
Every diabetic patient must have two types of pneumococcal vaccines – one PPSV23 type and one PCV13 type.
Hepatitis B vaccination: every diabetic patient should be vaccinated for hepatitis B.
Common diseases that affect diabetic patients
Diabetes is associated with several serious medical conditions. I’ve already discussed the association between diabetes and heart and vascular disease.
Conditions associated with diabetes.
Dementia
Diabetic retinopathy
Polyneuropathy (nerve damage)
Kidney failure
Cancer
Fatty liver
Hearing impairment
HIV
Fractures
Sleep apnea
Depression/anxiety
Low testosterone in men
Eating disorders
Medications
There are two groups of sugar lowering medications.
For treatment of type 2 diabetes, oral medications are the first-line treatment in most patients.
Patients with uncontrolled blood sugar levels on oral medications might benefit from insulin or newer blood sugar lowering injections.
Commonly used oral medications you might be familiar with.
Oral medications
Sulfonylurea
Glipizide
Glyburide
This group of medications include some of the older blood glucose lowering drugs available in the market. Sulfonylureas shown to reduce blood sugar level in an effective way.
However, there are some drawbacks to these drugs, such as weight gain and a higher rate of hypoglycemic (low blood sugar) incidents.
Biguanides
Metformin
Metformin is another drug that can help managing type 2 diabetes. The major side effects of this medication are diarrhea, vitamin B12 deficiency and rarely, an elevated blood lactic acid level.
DPP-4 inhibitors
Sitagliptin (Januvia)
Linagliptin (Trajenta)
DPP-4 Inhibitors are a newer class of medications and usually well- tolerated. They can cause a rash and swelling of the lips and might worsen heart failure symptoms.
This class of medications is more expensive than metformin and sulfonylureas.
SGLT2 inhibitors
Canagliflozin
Empagliflozin
These medications work by inhibiting the reabsorption of the sugar molecules in the kidneys. This causes the excretion of sugar in the urine.
In addition to lowering blood sugar, these medications can also lower blood pressure levels and weight.
Unfortunately, these medications could cause urinary tract infections, kidney failure, increase urinary frequency, increased blood cholesterol levels and dehydration.
Injections
Insulin
Doctors use insulin to treat diabetes mellitus for many decades. One of the side effects of insulin is weight gain.
GLP-1 receptor agonists
Exenatide
Liraglutide
This class of medications increases insulin production of the body and reduces the blood sugar level. This medication can cause weight loss.
The adverse effects are possible pancreatitis, diarrhea, vomiting, nausea and reports of thyroid tumors in animals.
One last thing…
I hope that you’ve learned few new things by reading this article.
Please share it with your followers and friends.
This information might help them to rethink and modify a few things in their lives and you might end up being the reason for this change.
Why not?
Sharing is caring.
Keep on reading and learning.
H. Leon Daneschvar, MD
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