Breaking Down Diabetes Mellitus
Diabetes Mellitus, commonly referred to as “Diabetes, Sugar-Diabetes” is a disease characterised by abnormally high levels of circulating blood sugar. Blood sugar is often measured via a finger prick test and less often via blood drawn into a test tube and processed at the lab. Normal blood sugar levels are determined by the time and state when measurements are taken:
|Prediabetes||Type 2 diabetes|
|Fasting glucose||>= 5.6 to 6.9 mM||> = 7 mM|
|Two-hour OGTT glucose||>= 7.8 to 11 mM||> = 11.1 mM|
|HbA1c||>= 5.7 to 6.4% (39-47 mmol/mol)||>= 6.5% (48 mmol/mol)|
|Random blood glucose||–||>= 11.1 mM|
While the most common type of Diabetes is Type II, there are various other types and they are classified according to the cause at a genetic, cellular and biochemical level. The lioad classifications also correlate with when Diabetes would be suspected, how it manifests and the treatment used.
Pre-Diabetes State refers to a period preceding full-blown Type II Diabetes and is characterised by 2 phenomena; high-fasting glucose (abnormally elevated sugar levels during a prolonged period of no sugar intake when blood sugar should otherwise be normal to low) and impaired glucose tolerance (inability of the body to deal with a sudden surge in blood sugar following a meal).
Type I diabetes generally occurs in children and teenagers. It is characterised by absolute lack of Insulin due to the destruction of insulin-producing cells in an organ called the pancreas. This destruction is triggered by the body’s own immune system systematically attacking and wiping out all the cells (Pancreatic Beta Cells). This phenomenon is termed “autoimmune”.
Children who present with symptoms often complain of increased thirst and frequent urination, sometimes even bed wetting. They may also have unexplained weight loss, weakness, blurred vision and episodes of severe hunger. Children may also present with an acute medical emergency called DKA (Diabetic Ketoacidosis) characterised by vomiting, abdominal pain, confusion and abnormally rapid and shallow lieathing.
- The diagnosis often rests on measuring and confirming elevated blood sugar levels. The doctor will, however, perform more tests including presence of sugar in the urine, presence of any complications relating to Diabetes itself causing damage to organs like the kidneys, eyes, blood vessels, liain, heart, etc. Treatment for Type I Diabetes is insulin. Insulin is only available in a self-administered injectable format. The dosage is measured in “units” and these are initially calculated and prescribed by the clinician at which time further fine-tuning “titration” will be made in accordance with the patient’s response, complications, diet, level of physical activity, presence of other medical illnesses, etc.
- Intrinsic and vital to successful treatment is a multi-disciplinary team (MDT) headed by a physician/endocrinologist and including a diabetic nurse, diabetic educator, dietician and often a psychologist to assist with adapting to and coping with a lifelong illness.
- Monitoring for how well controlled one’s sugar is done via measurement of blood glucose at various times (fasting, after eating, before a meal) and via a test called HbA1c (which provides a window into the average blood glucose levels over the preceding 3-month period).
Type II Diabetes is the most common form of Diabetes. In South Africa, 15% of people over the age of 25 have type II Diabetes. It’s characterised by a gradual process of Insulin Resistance, a period during which the body has insulin, but the cells do not respond with the normal sensitivity. Instead, the body produces large amounts of Insulin to overcome this defect resulting in High Blood Insulin levels (Hyperinsulinemia). As the disease progresses, the Insulin producing cells go through a burnout phase from all the overcompensation and start to decline, ultimately resulting in absolute Insulin deficiency. This process can take place over a prolonged period of time – 5 to 8 years and sometimes even up to 12 years.
- Type II Diabetes has a significant genetic corelation, i.e., there is often a family history of the disease but the rapidity of onset, severity, response to treatment and ultimately development of complications is related to intake of sugar, body weight, physical activity, alcohol consumption, presence of other metabolic diseases such as hypertension and high cholesterol.
- Type II Diabetes often presents relatively later than Type I Diabetes, i.e., often between the 40s and 60s but can also present and is increasingly being diagnosed in younger patients (teenagers). It is being diagnosed in old age, too.
- Presenting symptoms can range from vague and non-specific to an acute medical emergency. There can be increased thirst and frequent urination, unexplained weight loss, fatigue, blurred vision, frequent infections (boils, urinary tract infections, nail fungal infections, poor wound healing, etc). The patient may also present with a medical emergency called diabetic ketoacidosis (more common in Type I Diabetes), hyperglycaemic hyperosmolar state or for those undiagnosed for a long time, complications of Diabetes may be their presenting symptoms, for example, kidney failure, stroke, gangrene, etc.
- The diagnosis will be made by a clinician and centres around demonstrating the presence of an abnormally high blood sugar and the clinician will further investigate any presence of complications and or associated diseases.
- Treatment for Type II Diabetes, at least in the early disease stage, centres around improving the body’s insulin secretion and optimal usage, improving the body’s sensitivity to it and later will include insulin. These treatments are often oral-based and they work in a variety of mechanisms, meaning they can often be used together.
- The key to successful treatment, avoidance of complications and prolonging the life of those living with Type II Diabetes is adherence not just to medical treatment but weight management through diet and physical activity, skin and nail care. This is where a multi-disciplinary team (MDT) is important headed by a physician/endocrinologist and including a diabetic nurse, diabetic educator, dietician, podiatrist, physiotherapist, biokineticist, etc.
Other types of Diabetes include:
- Diabetes (Type III) which is associated with other genetic and or metabolic diseases, diseases of the pancreas (trauma, surgery, infection, cancer), drugs, alcohol, etc.
- Gestational Diabetes (Type IV) which occurs during pregnancy and resolves post-delivery.
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Disclaimer: Any information contained here is merely a guideline. Always visit your healthcare practitioner for any health-related advice or diagnosis.