Diabetes is a chronic metabolic disorder characterized by hyperglycemia, the presence of high sugar (glucose) levels in the blood. The level of glucose in the blood is regulated by insulin hormone. The normal level of glucose in the blood should be between 70 and 100 mg/dL (fasting) and <140 mg/dL (random). (There are different views about the normal range of blood glucose. Please discuss the same with your healthcare team.) Impaired production or function of insulin increases glucose levels in the blood.
There are 3 types of diabetes:
- Type 1 diabetes is an autoimmune disease, in which the insulin producing cells are mistakenly killed by the body’s defense system; hence, decreasing the production of insulin and increasing the accumulation of blood sugar.
- Type 2 diabetes occurs either due to the reduced production of insulin or the inadequate use of the hormone produced by the various cells of the body. This is termed as insulin insensitivity and is the most common type of diabetes.
- Gestational diabetes is a temporary condition, which occurs during pregnancy. Gestational diabetes resolves after childbirth but poses a future risk for the development of type 2 diabetes in the mother.
The various causes of diabetes include:
- Sedentary lifestyle
- Viral infection or nutritional factor in childhood
- Old age
- High blood triglyceride levels
- Autoimmunity, when the body’s defense system attacks and destroys pancreatic cells
The common symptoms of diabetes mellitus are increased thirst, frequent urination, extreme hunger, unexplained weight loss, fatigue, blurred vision, delayed wound healing, dehydration, altered mental status and frequent infections.
When you present to your doctor with the above symptoms, your doctor will order a few tests to diagnose diabetes:
- Fasting blood glucose test: The fasting blood glucose test is the preferred test for diagnosing diabetes. A sample of blood is drawn after fasting overnight and tested for levels of glucose. Levels of 100 to 125 mg/dL is inferred as prediabetes, while levels more than 125 mg/dL on two or more separate tests on different days indicates diabetes.
- Random blood glucose test: A blood sample is taken randomly, at any time of day (regardless of whether you have eaten or not). Blood glucose levels of 200 mg/dL or higher indicates diabetes.
- Oral glucose tolerance test: It is commonly performed for diagnosing gestational diabetes, diabetes and pre-diabetes. In this test, a sample of blood is taken to determine fasting blood sugar level. Following this, a standard amount of sugar is provided orally, and blood samples are taken at specific intervals within 2 hours to measure the blood glucose. Levels more than 200 mg/dL indicates diabetes, and levels 140 to 199 mg/dL indicates prediabetes.
When left untreated, diabetes can damage various parts of the body:
- Eyes: Diabetic retinopathy, cataracts and glaucoma
- Kidney: diabetic nephropathy, progressive renal failure
- Nerves: diabetic neuropathy and erectile dysfunction
- Cardiovascular diseases: Early coronary artery disease, peripheral vascular disease, hypertension and ischemia
- Feet: Increased risk of infections and foot ulcers
- Slow wound healing, many times necessitating amputation
Treatment of diabetes involves diet, exercise, medications and other lifestyle improvements. These will help to maintain normal blood sugar levels and prevent or minimize complications of diabetes.
- Diet: Eat a consistent well-balanced diet that is high in fiber, and low in saturated fats and concentrated sweets. Meals should be taken on a regular schedule and long periods between eating should be avoided.
- Exercise: Regular exercise in any form can help maintain a healthy weight and blood sugar levels within the normal range.
- Smoking and alcohol use: Stop smoking and limit consumption of alcohol.
- Medical treatment: Medicines are prescribed based on the type of diabetes, presence of associated medical problems, complications of diabetes, age and general health. The treatment usually involves daily injection of a combination of insulin. It is given in two or three injections per day, generally around mealtimes. There are other drugs that can be taken orally.
- Treating comorbidities: Your doctor will also include medications and treatments to prevent, control and treat other associated conditions.
Regular monitoring of blood glucose is necessary to prevent long-term complications of the disease.
Some other treatments that are suggested to control diabetes include:
- Pancreatic transplantation: This method can be indicated for type 1 diabetes. If the pancreas transplant is successful, you would no longer require insulin. However, the treatment may have major side effects like organ rejection, which can be more fatal than diabetes itself. Hence, this treatment is suggested only in severe cases where diabetes cannot be controlled through any other means.
- Bariatric surgery: This is a weight loss surgery. Though it is not a direct treatment for diabetes, weight loss surgeries may help to reduce blood sugar in patients with a BMI of 35 and above.