Table of Content

• What is the role of insulin?

• Why does our body need glucose?

• What happens in diabetes mellitus?

• 5 Different types of diabetes

• Risk factors for diabetes

• 8 Symptoms and signs of diabetes mellitus

• How to diagnose diabetes mellitus?

• Diabetes mellitus treatment

• 10 complications of diabetes mellitus

• Can diabetes be prevented? Yes!

• Take home message

Introduction

• Diabetes mellitus is considered a ‘silent epidemic’ especially in developing countries. The prevalence of the diseases has dramatically increased in the recent decades because of an increase in the rate of fast food intake, sedentary lifestyle and rising rates of obesity.

• Diabetic patients, if undiagnosed or inadequately treated, can develop multiple life-threatening complications.

• Before starting with the details of the disease diabetes mellitus, it is important to understand the basics of the hormone called Insulin and its role in diabetes. Also, we shall discuss the importance of glucose in our bodies. 

What is the role of insulin?

Insulin is a hormone produced by the cells called Islets of Langerhans or Beta cells in our pancreas. The main role of this hormone is to maintain an appropriate amount of blood sugar in our body at all times and also help store the surplus amount of glucose in the cells for future use. So naturally whenever there is an issue with Insulin, the blood sugar levels get affected correspondingly thereby causing diabetes symptoms and complications.

How insulin maintains blood sugar levels?

• Whenever we take food (glucose), the glucose enters the bloodstream from the digestive tract.

• Once glucose enters the blood, a signal is sent to the pancreas to start the production of Insulin and release it into the blood.

• The insulin, once released into the circulation, causes the glucose to enter into the target cells of liver, muscle and heart, thereby reducing the amount of glucose in the bloodstream.

• Now, as the blood sugar levels drop , the secretion of insulin from the pancreas also drops.

Why does our body need glucose?

• Glucose is a sugar (that is, a carbohydrate structure) that can be supplied to our body by eating food. It is the main source of energy in our body, especially for cells of your muscles, brain, heart and liver. To be useful as a source of energy, glucose has to enter into the cells. Glucose is helped by insulin to enter into these cells.

• Glucose is mainly supplied to these cells via food, but if the person hasn’t eaten in a while, the glucose can be released from its stores in the liver. Liver, with the help of insulin, stores the glucose in the form of a structure called Glycogen. When you haven’t eaten for some time, the blood glucose levels start falling. In such a case, the liver breaks down the stored glycogen to form glucose thereby maintaining an appropriate blood sugar level.

What happens in diabetes mellitus?

• In diabetes, due to various reasons, insulin is either not produced in the body or even if produced in adequate amounts, it is not able to function effectively. Because of this, glucose is not able to enter into the cells to act as an energy source and it stays in the blood itself. This is the reason behind an increased blood sugar level in diabetes mellitus.

• In short, the body is unable to use the glucose given to it via food without the presence of insulin.

• The presence of excess glucose in your blood starts causing diabetes symptoms and complications over a period of time. Diabetes has no cure, but can certainly be controlled by lifestyle modifications and medications if necessary, to lead a healthy life.

5 Different types of diabetes

There are multiple types of diabetes. These include:

1. Type 1 diabetes mellitus.

2. Type 2 diabetes mellitus.

3. Pre-diabetes.

4. Gestational diabetes mellitus.

5. Maturity Onset Diabetes of the Young (MODY).

 We’ll see about each of the types in brief:

1. What is type-1 diabetes mellitus?

• Type 1 diabetes mellitus, also known as juvenile diabetes or insulin-dependent diabetes, is a type of immune-mediated diabetes mellitus. This condition usually starts at a very young age, typically around adolescence.

• In type 1 diabetes, the body’s own immune system mistakenly destroys the insulin-producing cells (called the Islets of Langerhans) in the pancreas, thereby severely affecting the production of Insulin (the hormone necessary for maintaining appropriate blood sugar levels).

• This destruction of the insulin-producing cells can also happen because of genetic causes or because of certain environmental insults to the pancreas.

• Ultimately, because of the very less amount of insulin available, the blood sugar levels rise to dangerous levels in the body and end up causing complications if not diagnosed and treated early.

2. What is type-2 diabetes mellitus?

• It is another chronic type of diabetes where even though the production of insulin is fine, the body doesn’t utilize the available insulin properly, thereby leading to high blood sugar levels.

• This is the most common type of diabetes mellitus and Indians are very prone to developing this because of consuming high carbohydrate food items on a daily basis.

• In contrast to type 1 diabetes which has an immune basis, type 2 diabetes is a metabolism based disorder. That’s why obesity is a major risk factor for developing type 2 diabetes. This type is mostly adult in onset, however with the increasing prevalence of obesity among children, there has been a rise in the number of younger people developing type 2 diabetes.

3. Pre-diabetes

• This is a stage where the blood sugar levels are higher than normal, but not high enough to be diagnosed as type 2 diabetes mellitus. The complications of type 2 diabetes like blood vessel damage or kidney damage could already have started at this stage.

• If diagnosed at this stage itself, it’s favourable because, if the person undergoes lifestyle modifications like taking a healthy diet and regular physical exercise, they can escape from developing type 2 diabetes mellitus.

4. Gestational diabetes mellitus (GDM)

• This is a type of diabetes that develops exclusively during pregnancy, especially in the second trimester. This mainly happens because there are certain hormones produced by the placenta. These hormones interfere with the proper functioning of the insulin in the mother, thereby leading to raised blood sugar in the mother’s blood.

• Pregnant women who develop GDM are at a risk of plenty of complications both to the mother and the baby.

• Also, the women who develop GDM during pregnancy are at a high risk of developing GDM in the subsequent pregnancies and full blown type 2 diabetes mellitus later in life.

5. Maturity onset diabetes of the young

• MODY is a group of diabetic conditions which are inherited through generations.

• This is a genetic condition, where the genes involved in the production of insulin from the pancreas are defective. Based on the gene involved, there are multiple types of MODY.

• This disease is commonly confused with type 1 diabetes mellitus because MODY also occurs at a younger age, typically before the age of 30. Rarely, it can also begin at a later age.

Risk factors for diabetes

Most risk factors are common between type 1 and type 2 diabetes. However there are some factors that are exclusive to each of them:

5 Risk factors for type 1 diabetes

1. Positive family history increases of risk of developing type 1 DM.

2. Genetics.

3. Environmental risk factors.

4. Presence of auto-antibodies (the antibodies produced by our own immune system that destroys our own insulin-secreting cells).

5. Age - as already seen, type 1 diabetes occurs usually at a much younger age.

13 Risk factors for type 2 diabetes

Since this is the most common type of diabetes, knowing the risk factors for it helps in early prevention.

1. Obesity.

2. Age more than 40 years.

3. Family history of type 2 diabetes.

4. History of GDM during pregnancy.

5. Racial factors like - Indian, African-American, Hispanics etc.

6. Sedentary lifestyle / very less physical activity.

7. Frequent fast food and soft drinks intake.

8. Raised blood lipid and cholesterol levels.

9. Is currently in pre-diabetes stage.

10. Smoking, alcohol intake.

11. High blood pressure.

12. Persistently disturbed sleep.

13. Mental health disorders like schizophrenia, bipolar disorder etc. are some of the risk factors for developing type 2 diabetes mellitus.

4 Risk factors for GDM

1. If the woman has a history of GDM during her previous pregnancy.

2. If she gave birth to a heavy baby in the previous pregnancy (weighing > 4kg). Is overweight or obese during pregnancy.

3. Has a positive family history of type 2 diabetes.

4. Has PCOS (polycystic ovarian syndrome).

Now that we are aware of the various risk factors leading to diabetes mellitus, we shall now talk about the diabetes symptoms and signs.

8 Symptoms and signs of diabetes mellitus

Both type 1 diabetes and type 2 diabetes have some common symptoms such as:

1. Frequent urination

2. Increased thirst and hunger.

3. Dry and itchy skin.

4. Dry mouth.

5. Fatigue.

6. Blurring of vision.

7. Unexplained weight loss.

8. Tingling or numbness of hands and feet.

• These are some of the commonly noticed diabetes symptoms, irrespective of the type.

• In addition to the above, some diabetes mellitus symptoms and warning signs can be seen specifically in either type of diabetes mellitus.

Specific type 1 diabetes symptoms 

• Bedwetting in affected children who were previously normal.

• Fruity odor in the breath.

• Nausea and vomiting.

The clinical picture of MODY closely resembles that of type 1 diabetes.

Specific type 2 diabetes symptoms 

Some diabetes symptoms and complications are seen more commonly in type 2, especially in long-standing cases:

• Delayed wound healing.

• Fungal infections in the skin folds.

• Blackening of the nape of the neck or underarms called Acanthosis nigricans.

Symptoms of gestational diabetes mellitus

In most cases of GDM, the woman doesn’t experience the common signs and symptoms seen in other types of diabetes. However rarely intense thirst and an increased frequency of urination can be seen.

How to diagnose diabetes mellitus?

• There are several ways to diagnose diabetes mellitus. Based on your complaints and clinical picture, the physician may advise blood and urine tests to diagnose whether you are diabetic or not.

• The guidelines for the different blood tests are formulated by the American Diabetes Association (ADA).

• The different tests that may be needed include:

1. Fasting blood sugar (FBS) level

This is measured after a standard fasting period of 8 hours overnight. If your FBS values are more than or equal to 126 mg/dl, you are diabetic. (the normal value of FBS is less than 100 mg/dl).

2. PostPrandial blood sugar (PPBS) levels

This is measured two hours after a standard meal. If your PPBS values are more than or equal to 200 mg/dl, you are diabetic. (the normal value is less than 200 mg/dl)

3. OGTT- Oral glucose tolerance Test

This is a 2 step test in which first the fasting values are taken, then the patient is made to drink a glucose + water solution containing about 75 grams of glucose and then a second reading will be taken 2 hours after the drink.

4. Random blood sugar (RBS) levels

• This is a test when the blood sugar levels are measured during any time of the day, irrespective of the previous meal.

• Values above 200 mg/dl are diabetic.

• This test however is not very reliable, as it can vary depending on the meals taken before the test. However this test is taken into consideration if the patient also has other symptoms of diabetes mellitus like increased thirst, increased urination and increased hunger.

5. HBA1C

• This test measures your average blood sugar levels for the past 3 months. This is considered as the most accurate method of diagnosis and staging of  diabetes mellitus.

• BA1C levels of more than 6.5% is considered diabetic (Normal value is less than 5.7%) .

6. Urine glucose levels

• Your physician may advise you to undergo an urine glucose level test to estimate whether the excess glucose in the blood is being lost via urine. Normally the kidneys filter back all the glucose and do not excrete it in the urine. However when the blood sugar levels are very high, as in uncontrolled diabetes, it overcomes the kidneys’ ability to filter back the glucose and starts appearing in the urine.

• Over time, this glucose getting excreted into the urine can damage the kidneys. So the amount of urine excreted in the urine (usually indicated as +, ++, +++ based on amount) can be taken as an indirect Indicator of the kidney’s functioning.

7. In addition to the above laboratory investigations, your physician may measure your blood pressure readings during every visit.

8. You could be advised to do Kidney function tests to monitor the functioning of the kidneys.

9. You could be referred to an ophthalmologist after being diagnosed with diabetes to check the health of your retina and optic nerve.

Diabetes mellitus treatment

1. Lifestyle modifications

This is the most important part of treating diabetes. Since type 2 diabetes is a metabolic disorder, it is important to adapt healthy habits to keep the blood sugar levels in control.

Healthy diet

• Your physician may guide you to a dietitian to tailor your diet plan according to you.

• The most important nutrients advised in diabetes are complex carbohydrates, dietary fibre, proteins, vitamins, and minerals. Getting the right balance of proteins, carbohydrates, and fats from a specially designed diet plan is important .

•  A diabetic person should eat low glycemic index foods.

•  Foods such as green leafy vegetables, lemon water, homemade soup, karela (juice or other preparation), sprouted methi seeds, onion, garlic, ginger, amla, flax seeds, methi dana, soybean, etc are advised for diabetic patients.

•  Foods to be avoided include sweet and sweet products, soft drinks, alcohol, and juices, excess of potato and beetroot, and fruits like mango, cheeku, banana, and grapes.

Exercise

• Regular physical activity is important to maintain an ideal weight for your height. This could include walking, jogging, swimming or aerobic exercises. Aim for at least 30 minutes of exercise every day.

2. Blood sugar monitoring

If your treating physician finds it necessary, he may prescribe you at-home monitoring of blood sugar using a glucometer. You should keep a track of your blood sugar readings before and after every meal. This may be necessary especially if you are taking Insulin injections.

3. Oral anti-diabetic medications

• If your blood sugar levels cannot be controlled by lifestyle modifications alone, you may be prescribed oral drugs. These drugs may either stimulate your insulin production or may mimic the action of insulin in the body. 

• If you are at a risk of heart diseases or high blood pressure, your physician may add drugs to lower your blood pressure levels and blood cholesterol levels.

4. Insulin injections

• Earlier insulin injections were considered as the last solution if the patient did not respond to the oral drugs or lifestyle modifications. Nowadays, if your blood sugar levels are too high, you could be directly started on insulin injections.

• There are different types of insulin, classified based on their duration of action like long acting, intermediate acting, short acting, rapid acting insulin etc. For example, long acting insulin can act throughout the day whereas the short acting variant is used at every meal.

• Based on your blood sugar fluctuations throughout the day, you may either be prescribed a single variant or a combination of different types of insulin.

10 complications of diabetes mellitus

• Long-standing type 2 diabetes mellitus could lead to multiple complications like:

1. Cardiovascular disease.

2. Nerve damage.

3. Erectile dysfunction is men due to nerve damage.

4. Kidney damage.

5. Reduced vision and cataracts.

6. Hearing impairment.

7. Foot damage due to nerve damage and delayed healing of wounds.

8. Increased incidence of skin infections, especially fungal infections.

9. Depression.

10. Alzheimer’s disease.

• Other severe complications like diabetic ketoacidosis and hyper osmotic hyperglycaemic syndromes (extremely high blood sugar levels causing shock) are more common in type 1 diabetes mellitus and in very old, debilitated patients.

Can diabetes be prevented? Yes!

• Type 1 diabetes cannot be prevented even since it’s a genetic disorder. But type 2 diabetes can be prevented beforehand.

• If you have parents or a sibling who’s diabetic, there’s a risk that you too may develop the disease.

• You could try the following ways to prevent becoming diabetic:

1. Cut down refined sugar in your diet.

2. Exercise regularly.

3. Maintain an appropriate BMI.

4. Drink plenty of water everyday.

5. Quit smoking and alcohol.

6. Track your calories.

7. Take a healthy balanced diet and do not fall prey to fad diets that promise instant weight loss.

8. Get adequate sleep.

9. If you at risk of developing diabetes (eg. positive family history ,had gestational diabetes etc) regularly visit your physician for screening your blood sugar levels. 

Take home message

Diabetes is a slow killer but fortunately it can be prevented and controlled by following a healthy, organic lifestyle. So, follow a healthy diet, exercise regularly to keep diabetes at bay.

Wishes for a happy and healthy life !