Learning About Diabetes

The incidence of diabetes is rising rapidly. It is estimated that one out of every three people born today will get diabetes in their lifetime. This is thought to be due to the increase in obesity due to overeating and a sedentary lifestyle.

What is diabetes?
Diabetes is a condition where the blood sugar levels are higher than normal. Blood sugar level is normally controlled by a hormone called insulin, produced by the pancreas. Diabetes occurs when there is a defective production of insulin or a defective response to insulin, known as insulin resistance.

2 types of diabetes.
Type 1 diabetes is an autoimmune disease, where the cells producing insulin in the pancreas are destroyed by the body’s immune system. Type 1 diabetes usually occurs in young people.

Type 2 diabetes is usually due to a defective response to insulin, and is commonly associated with obesity. Type 2 diabetes usually occurs in adults, however, it has become increasingly common in young people, as obesity in young people is increasing rapidly.

Symptoms of diabetes
The symptoms of diabetes are (1) increased thirst (2) increased frequency of urination (3) weight loss. People with diabetes are also prone to infections.

Diagnosis of diabetes.
The diagnosis of diabetes is made by measuring the levels of glucose in your blood. A random blood glucose higher than 11.1 mmol/l or fasting blood glucose higher than 7.0 mmol/l on 2 separate occasions indicates that you have diabetes.

Treatment of diabetes.
There are three treatment options, depending on the severity of your diabetes.

(1) For those with mild diabetes, the first option is to reduce the amount you eat and increase your exercise so as to lose weight. For some overweight people, simply losing weight can reverse diabetes. Watching your diet is important in diabetes. The obvious thing is to avoid eating too much sugars, however, counting the amount of carbohydrates you eat is also important as carbohydrates are broken down into sugars in your body. Foods high in cholesterol and saturated fat are also best avoided as having diabetes greatly increases your risk of cardiovascular disesase.

(2) The next option for those with moderate diabetes is oral antidiabetic medicines. You may be prescribed with sulphonylureas that help increase the production of insulin by your pancreas. A major side effect of sulphonylureas is the risk of hypoglycemia, or low blood sugar. An alternative is thiazolidinediones, which increase your body’s sensitivity to insulin. A major side effect of thiazolidindiones is water retention and heart failure. Other drugs are metformin which also increases insulin sensitivity, and acarbose which reduces the absorption of sugar. These drugs are less well tolerated as they have the side effects of nausea and gastrointestinal discomfort.

(3) The last resort for those with severe diabetes is insulin. There are several formulations of insulin, rapid acting, short acting and slow acting. You can chose to inject yourself after every meal or have an insulin pump inserted. Inhaled preparations of insulins are currently being tested. Hypoglycemia awareness is very important for diabetics on insulin. Recognising the early warning signs of low blood sugar such as numbness and tingling, sweating and anxiety, may save your life.

Complications of diabetes.
The complications of diabetes can be divided into acute complications and long-term complications.

The acute complications resulting from high blood sugar are ketoacidosis and hyperosmolality. Ketoacidosis occurs when the body’s tissues are starved because they cannot take up the sugar in the blood due to a lack of insulin. They make ketones which are acidic and result in pH imbalances in the body. Hyperosmolality is due to dehydration and usually occurs in the elderly. Both result in loss of consciousness and can be fatal. The other acute complication is hypoglycemia or low blood sugar, due to overdosage of insulin or sulphonylureas. Hypoglycemia results in mental impairment and loss of consciousness.

If diabetes is not well controlled, it can lead to many debilitating long-term complications. Control of diabetes is usually measured using glycated haemoglobin or HbA1c. HbA1c levels below 7% indicate good control.

(1) Diabetic retinopathy. Uncontrolled diabetes can result in blindness, therefore diabetics need to go for an eye examination every year.

(2) Diabetic neuropathy. Diabetes can result in nerve damage. A common complication is impotence. Another common complication is the development of diabetic foot ulcers. Maintaining clean healthy feet is important for diabetics

(3) Kidney disease. Kidney disease due to diabetes is the most common reason for requiring dialysis. Diabetics need to have their urine checked yearly for microalbumin.

(4) Increased risk of stroke and heart attack. Diabetics need to have their weight and blood pressure monitored regularly.

(5) Increased infections

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