The Basics of Diabetes

What is Diabetes?

Diabetes is a disease where your blood sugar levels are above normal because your cells are unable to absorb glucose, hence the sugar stays in your blood. Most people do not even know they have diabetes. This disease causes serious complications in your health including heart disease, blindness, kidney failure, and lower extremity amputations. Diabetes is the 6th leading cause of death in the US and majority of the patients developed heart disease.

There is always an underlying cause why your body is not able to utilize glucose for energy making the glucose levels in your blood to increase above normal. You have to remember that the cells in your body that use glucose must be able to absorb glucose from your blood effectively and use it to give them energy. Another thing is that the insulin made by your pancreas are very important as they are used as a vessel to let the sugar enter the cell. Last thing is that glucose is broken down by food or from muscle and liver from a storage called glycogen.

In one form of diabetes, the body stops making insulin so your cells won’t be able to get glucose from your blood. Sometimes, your body does not make enough insulin as much as your body needs. Other times, the cells won’t open up. So even if you have enough insulin, you can’t get the cells to open, so the cells won’t be able to receive glucose for energy. This is called insulin resistance.

Type of Diabetes

Type I diabetes is usually diagnosed in children and young adults. In type 1 diabetes, the pancreas doesn’t make any insulin at all.

Type II diabetes is the most common form of the disease. It accounts for 90-95% of all the cases of diabetes. In type 2 diabetes, either your body doesn’t make enough insulin or the cells in your body ignore the insulin so they can’t utilize glucose like they are supposed to. When your cells ignore the insulin, it is often referred to as insulin resistance.

Other types of diabetes which only account for a small number of the cases of diabetes include gestational diabetes, which is a type of diabetes that only pregnant women get. If not treated, it can cause problems for mothers and babies and usually disappears when the pregnancy is over. Other types of diabetes resulting from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses may account for 1% to 2% of all cases of diabetes.

How do you get diabetes?

Risk factors for Diabetes II:

  • older age
  • obesity
  • family history
  • prior history of gestational diabetes
  • impaired glucose tolerance
  • physical inactivity
  • race/ethnicity

Risk factors for Diabetes I:

  • autoimmune
  • genetic
  • environmental factors

Symptoms

People who think they might have diabetes must visit a physician for a diagnosis.

Symptoms include:

  • frequent urination
  • excessive thirst
  • unexplained weight loss
  • extreme hunger
  • sudden vision changes
  • tingling or numbness in hands or feet
  • feeling very tired much of the time
  • very dry skin
  • sores that are slow to heal
  • more infections than usual

Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of type 1 diabetes.

Glucose is sugar, so do all I just have to avoid sweets?

Most food, and all of the carbohydrates, are broken down into its simplest structure, which is glucose. The acid in your stomach breaks down the food as soon as it enters the stomach. Proteins are broken down into their amino acids and carbohydrates are broken down to glucose. The blood then picks it up and carries it to your cells for energy. In healthy people, the blood picks up the glucose absorbed from the GI tract, and sends a signal to your pancreas to make and release insulin. Remember, in Type 2 diabetes your body doesn’t make enough insulin, or some of your cells ignoring the insulin that is there. In both situations, your cells don’t get the glucose they need for energy and they are starving while all the extra glucose is just floating around in your blood and can’t be used. The worst part is, when all that extra glucose is floating around in your blood, it is causing damage to your blood vessels and organs and that damage increase your risk of heart disease. That is why it is very important to keep your blood glucose levels as close to normal as possible. When the glucose levels get really high, the glucose starts to leak out into your urine.

Treatment

Diabetes I: Healthy eating, physical activity, and insulin injections are the basic therapies. The amount of insulin taken must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose testing.

Diabetes II: Healthy eating, physical activity, and blood glucose testing are the basic therapies. Many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels. Some of the oral medications work by stimulating your pancreas to make more insulin. Other oral medicines work to make your cells open up again.

How to keep blood sugar level under control?

Frequent blood tests are used to monitor your blood sugar. Most patients with diabetes should have a home blood monitoring kit. Some doctors ask their patients to check their blood sugar as frequently at 6 times a day, though this is an extreme. The more information you have about your blood sugar levels, the easier it will be for you to control it. People with diabetes must take responsibility for their day-to-day care, and keep blood glucose levels from going too low or too high.

When your blood sugar is too high, your doctor refers to it as hyperglycemia. You may not experience any symptoms, but the high levels of glucose in your blood is causing damage to your blood vessels and organs. That is why it is important to have your body utilize the sugar properly and get it out of your bloodstream.

When your blood sugar is too low, your doctor refers to it as hypoglycemia. Having low blood sugar can be very dangerous and patients taking medication for diabetes should watch for symptoms of low blood sugar.

It is important that you monitor your blood sugar regularly to avoid both low as well as high blood sugar.

Some patients are may not follow the proper diet and exercise except for the days leading up to a blood test in the doctor’s office. They want to look like they are doing a good job controlling their blood sugar. This way their fasting blood glucose test results will be good for the doctor. But, there is a test that will show your doctor the real picture over the past 3 months or so. It is called the hemoglobin A1C (HbA1C) test. Hemoglobin is the part of your blood, or red cells, that carries oxygen to your cells. Glucose sticks to the hemoglobin in your red cells of the blood as they emerge from the bone marrow where they are made.

The amount of sugar on the red cell is proportionate to the blood sugar level at the moment the red cell goes into circulation, and remains at that level for the life of the red cell. So if there has been a lot of extra glucose in your blood, there will be a lot of glucose stuck all over your hemoglobin. Since the average lifespan of the hemoglobin in your blood is 90-100 days, a HbA1C test shows a doctor how well you have been controlling your blood sugar over the last 3 months. This test is a check on the overall sugar control, not just the fasting blood sugar. So it is important to control your blood sugar at all times, and not just before visiting the doctor. The most important reason to control your blood sugar is so that you can live a longer, healthier life without complications that can be caused by not controlling your diabetes.

Complications

The complications of diabetes can be devastating. Both forms of diabetes ultimately lead to high blood sugar levels, a condition called hyperglycemia. The damage that hyperglycemia causes to your body is extensive and includes:

  • Damage to the retina from diabetes (diabetic retinopathy) is a leading cause of blindness.
  • High blood pressure and high cholesterol and triglyceride levels. These independently and together with hyperglycemia increase the risk of heart disease, kidney disease, and other blood vessel complications.
  • Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach (gastroparesis), chronic diarrhea, and an inability to control heart rate and blood pressure with posture changes.
  • Damage to the kidneys from diabetes (diabetic nephropathy) is a leading cause of kidney failure.
  • Damage to the nerves from diabetes (diabetic neuropathy) is a leading cause of lack of normal sensation in the foot, which can lead to wounds and ulcers, and all too frequently to foot and leg amputations.
  • Diabetes accelerates atherosclerosis or “hardening of the arteries”, and the formation of fatty plaques inside the arteries, which can lead to blockages or a clot (thrombus), which can then lead to heart attack, stroke, and decreased circulation in the arms and legs (peripheral vascular disease).

Hypoglycemia, or low blood sugar, occurs from time to time in most people with diabetes. It results from taking too much diabetes medication or insulin, missing a meal, doing more exercise than usual, drinking too much alcohol, or taking certain medications for other conditions. It is very important to recognize hypoglycemia and be prepared to treat it at all times.

Symptoms:

  • Headache
  • dizziness
  • poor concentration
  • tremors of hands
  • sweating
  • faint
  • seizure

Diabetic ketoacidosis is a serious condition in which uncontrolled hyperglycemia (usually due to complete lack of insulin or a relative deficiency of insulin) over time creates a buildup in the blood of acidic waste products called ketones. High levels of ketones can be very harmful. This typically happens to people with type 1 diabetes who do not have good blood glucose control. Diabetic ketoacidosis can be precipitated by infection, stress, trauma, missing medications like insulin, or medical emergencies like stroke and heart attack.

Hyperosmolar hyperglycemic nonketotic syndrome is a serious condition in which the blood sugar level gets very high. The body tries to get rid of the excess blood sugar by eliminating it in the urine. This increases the amount of urine significantly and often leads to dehydration so severe that it can cause seizures, coma, even death. This syndrome typically occurs in people with type 2 diabetes who are not controlling their blood sugar levels or have become dehydrated or have stress, injury, stroke, or medications like steroids.

Pre-Diabetes

Pre-diabetes is a common condition related to diabetes. In people with pre-diabetes, the blood sugar level is higher than normal but not high enough to be considered diabetes. Pre-diabetes increases your risk of getting type 2 diabetes and of having heart disease or a stroke. Pre-diabetes can be reversed without insulin or medication by losing a modest amount of weight and increasing your physical activity. This can prevent, or at least delay, onset of type 2 diabetes. When associated with certain other abnormalities, it is also called the metabolic syndrome.

Diagnosis

  • Fasting blood glucose test. This test is performed after you have fasted (no food or liquids other than water) for eight hours. A normal fasting blood glucose level is less than 100 mg/dl. A diagnosis of diabetes is made if your blood glucose reading is 126 mg/dl or higher. (In 1997, the American Diabetes Association lowered the level at which diabetes is diagnosed to 126 mg/dl from 140 mg/dl.)
  • “Random” blood glucose test. A normal blood glucose range is in the low to mid 100s. A diagnosis of diabetes is made if your blood glucose reading is 200 mg/dl or higher and you have symptoms of disease such as fatigue, excessive urination, excessive thirst or unplanned weight loss.
  • Oral glucose tolerance test. For this test, you will be asked, after fasting overnight, to drink a sugar-water solution. Your blood glucose levels will then be tested over several hours. In a person without diabetes, glucose levels rise and then fall quickly after drinking the solution. In a person with diabetes, blood glucose levels rise higher than normal and do not fall as quickly.

A normal blood glucose reading two hours after drinking the solution is less than 140 mg/dl, and all readings between the start of the test until two hours after the start are less than 200 mg/dl. Diabetes is diagnosed if your blood glucose levels are 200 mg/dl or higher.