Diabetes

Diabetes mellitus is a metabolic disease that is caused by excess glucose (a type of sugar) in your bloodstream, either because your body can’t produce enough insulin or can’t use the insulin it does produce.

Insulin is a hormone produced by a healthy pancreas that helps the body break down the sugar in the blood and store it elsewhere in the body to be used later as energy. It is vitally important to the body because high blood sugar damages the body’s blood vessels, nerves, organs, tissues and much more.

Diabetes has been around for thousands of years but is now one of the leading chronic diseases of modern life. It currently affects some eleven million Canadians, which is more than 25% of the population of this country.

Diabetes occurs in two primary forms – types 1 and 2. The type 1 form is caused by the inability of the body to produce enough insulin to meet its needs. Type 2 diabetes is the result of the body losing its ability to break down blood sugar despite producing enough insulin.

This disease has many symptoms but some of the most typical ones are chronic hunger and thirst, a need to urinate frequently, blurred vision and chronic fatigue. Others are a tendency to lose weight ( with type 1 diabetes) and skin sores (especially with type 2 diabetes).

Complications of diabetes include blindness, deafness, foot ulcers, amputation, nerve damage (sciatica, for example), organ damage (kidney disease, for example) and even dementia. When it occurs together with conditions such as obesity, heart disease, high cholesterol  and hypertension, it can produce a life threatening medical condition known as metabolic syndrome.

Doctors can use a range of drugs to treat either the type 1 or 2 forms of the disease. In addition, the type 2 form can be managed by changes to dietary intake and exercise levels

Types Of Diabetes

As mentioned above, there are two main forms of the disease – type 1 and type 2.

Type 1

This is an auto immune condition and is the result of the body’s immune system, beginning to attack and destroy the cells of the pancreas, the organ responsible for production of insulin. As a result of these attacks, the body begins to produce decreasing amounts of insulin, which in turn causes the buildup of excess blood sugar.

This form of diabetes causes frequent thirst, hunger and urination as well as weight loss.

Type 2

Type 2 diabetics produce enough insulin to break down their excess blood sugar. However, their body’s cells have become resistant to insulin and require always increasing amounts of the hormone to keep blood glucose at healthy levels.

Once the body’s ability to produce insulin has reached its limit, blood sugar levels starts to increase.

People with type 2 diabetes will show similar symptoms to those seen with type 1 but will also suffer from bodily sores and chronic tiredness.

Other Types Of Diabetes

There are two other forms of diabetes:

• Gestational, which tends to occur among certain expectant women as a result of the placenta they carry during childbearing;
• Prediabetes, which is characterised by elevated levels of blood sugar, but not high enough to produce full blown diabetes.

Risk Factors

The factors that can increase your risk of developing diabetes differ between types 1 and 2.

Type 1 Risk Factors

These are:

• Family history;
• Exposure to certain viruses is believed by some researchers to influence the risk of developing type 1 ;
• Having certain damaging immune system cells;
• The geographical location in which you live. The incidence of the type 1 form of the disease  appears to vary with location.

Type 2 Risk Factors

The factors that increase the risk that you might develop type 2 diabetes are:

• Excess body weight appears to increase type 2 risk;
• Sedentary lifestyle;
• Having a family member with type 2 diabetes;
• Ethnicity – rates of type 2 are higher among Blacks, Hispanics, South Asian and other ethnic groups;
• Increasing age;
• Having developed gestational diabetes in the past;
• High blood pressure or cholesterol  / triglyceride levels

Gestational diabetes has its own set of risk factors, including being over age 25, family history, being overweight and belonging to the ethnic groups identified above.

Symptoms Of Diabetes

As mentioned above, the key symptoms of diabetes include extreme thirst and hunger, frequent urination, unexpected weight loss, bodily sores and fatigue.

Diabetics may also experience the following:

• Irritability;
• Blurred vision;
• Frequent infections (e.g. in the gums, skin or genitals).

Diagnosis

Diabetes is mainly diagnosed by testing blood sugar levels.

Traditionally, doctors would ask the patient to fast for around 8 hours and then take a blood sample to measure blood glucose levels.

However, more recently, the A1C (or glycated hemoglobin) test has come into widespread use. It does not require fasting and provides an indication of average blood sugar levels over the 2-3 month period prior to the test.

The A1C test may be supplemented by random blood sugar tests (no fasting required), a fasting blood sugar test or an oral glucose tolerance test. This last option involves having the patient fast overnight and then testing the blood sugar level in the morning. The patient then drinks a sugary liquid and has his blood sugar measured over the next two hours.

Doctors may also take urine samples to look for evidence that muscle and fat tissue are being used to provide energy. If this is present, it could indicate that there is inadequate insulin to utilize the glucose available in the body – a sign of possible type 1 diabetes.

Diabetes Treatment

Treatment for diabetes involves some or all of the following, depending on the type of diabetes you have:

• Eating a healthy diet and, in particular, avoiding  sweets, sugary foods and refined carbohydrates. Focus more on lean proteins, health fats and fruits and vegetables.
• Increased physical activity such as swimming, walking and biking. This will help to burn up your excess blood sugar levels so that you rely less on the use of insulin for its removal.
• If you have type 1 diabetes, doctors can prescribe insulin therapy to make up for the shortfall in the insulin your body is producing. You can get insulin in many forms (e.g. rapid acting, long lasting, etc.). Your doctor can suggest which type of insulin is best for your particular circumstances;
• Oral medications can be taken for a variety of purposes. Some may stimulate your pancreas to increase its production of insulin. Other medications can reduce the production and release of glucose from the liver. The result of having less glucose in the bloodstream is less insulin being required to remove excess sugar.

Yet another class of medication can be taken to increase your tissues’ sensitivity to insulin so that you need less of the hormone to control your blood sugar.

Doctors can also prescribe SGLT2 inhibitors – a class of medication that prevents the kidneys from absorbing sugar into the blood and instead force it into the urine for excretion.

• For type 1 diabetics, a pancreas transplant may be an option worth considering but may not be successful unless immune suppressant drugs (with their own set of risks) are also taken.
• For type 2 diabetics, bariatric surgery may be considered. Although the long term effects are uncertain, this procedure can produce significant reductions in blood sugar levels.