What is Diabetes?
Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).
Fast facts on diabetes
Here are some key points about diabetes. More detail and
supporting information is in the main article.
• Diabetes
is a long-term condition that causes high blood sugar levels.
• In 2013
it was estimated that over 382 million people throughout the world had diabetes
(Williams textbook of endocrinology).
• Type 1
Diabetes - the body does not produce insulin. Approximately 10% of all diabetes
cases are type 1.
• Type 2
Diabetes - the body does not produce enough insulin for proper function.
Approximately 90% of all cases of diabetes worldwide are of this type.
• Gestational
Diabetes - this type affects females during pregnancy.
• The most
common diabetes symptoms include frequent urination, intense thirst and hunger,
weight gain, unusual weight loss, fatigue, cuts and bruises that do not heal
male sexual dysfunction, numbness and tingling in hands and feet.
• If you
have Type 1 and follow a healthy eating plan, do adequate exercise, and take
insulin, you can lead a normal life.
• Type 2
patients need to eat healthily, be physically active, and test their blood
glucose. They may also need to take oral medication, and/or insulin to control
blood glucose levels.
• As the
risk of cardiovascular disease is much higher for a diabetic, it is crucial
that blood pressure and cholesterol levels are monitored regularly.
• As
smoking might have a serious effect on cardiovascular health, diabetics should
stop smoking.
• Hypoglycemia
- low blood glucose - can have a bad effect on the patient. Hyperglycemia -
when blood glucose is too high - can also have a bad effect on the patient.
Common symptoms of diabetes
The most common signs and symptoms of diabetes are:
Frequent urination
Have you been going to the bathroom to urinate more often
recently? Do you notice that you spend most of the day going to the toilet?
When there is too much glucose (sugar) in your blood you will urinate more
often.
If your insulin is ineffective, or not there at all, your
kidneys cannot filter the glucose back into the blood. The kidneys will take
water from your blood in order to dilute the glucose - which in turn fills up
your bladder.
Disproportionate thirst
If you are urinating more than usual, you will need to
replace that lost liquid. You will be drinking more than usual. Have you been
drinking more than usual lately?
Intense hunger
As the insulin in your blood is not working properly, or is not
there at all, and your cells are not getting their energy, your body may react
by trying to find more energy - food. You will become hungry.
Weight gain
This might be the result of the above symptom (intense
hunger).
Unusual weight loss
This is more common among people with Diabetes Type 1. As
your body is not making insulin it will seek out another energy source (the
cells aren't getting glucose). Muscle tissue and fat will be broken down for
energy. As Type 1 is of a more sudden onset and Type 2 is much more gradual,
weight loss is more noticeable with Type 1.
Increased fatigue
If your insulin is not working properly, or is not there at
all, glucose will not be entering your cells and providing them with energy.
This will make you feel tired and listless.
Irritability
Irritability can be due to your lack of energy.
Blurred vision
This can be caused by tissue being pulled from your eye
lenses. This affects your eyes' ability to focus. With proper treatment this
can be treated. There are severe cases where blindness or prolonged vision
problems can occur.
Cuts and bruises don't heal properly or quickly
Do you find cuts and bruises take a much longer time than
usual to heal? When there is more sugar (glucose) in your body, its ability to
heal can be undermined.
More skin and/or yeast infections
When there is more sugar in your body, its ability to
recover from infections is affected. Women with diabetes find it especially
difficult to recover from bladder and vaginal infections.
Itchy skin
A feeling of itchiness on your skin is sometimes a symptom
of diabetes.
Gums are red and/or swollen - Gums pull away from teeth
If your gums are tender, red and/or swollen this could be a
sign of diabetes. Your teeth could become loose as the gums pull away from
them.
Frequent gum disease/infection
As well as the previous gum symptoms, you may experience
more frequent gum disease and/or gum infections.
Sexual dysfunction among men
If you are over 50 and experience frequent or constant
sexual dysfunction (erectile dysfunction), it could be a symptom of diabetes.
Numbness or tingling, especially in your feet and hands
If there is too much sugar in your body your nerves could
become damaged, as could the tiny blood vessels that feed those nerves. You may
experience tingling and/or numbness in your hands and feet.
Some facts and myths about diabetes
Many presumed "facts" are thrown about in the
paper press, magazines and on the internet regarding diabetes; some of them
are, in fact, myths. It is important that people with diabetes, pre-diabetes,
their loved ones, employers and schools have an accurate picture of the
disease. Below are some diabetes myths:
People with diabetes should not exercise - NOT TRUE!!
Exercise is important for people with diabetes, as it is for everybody else.
Exercise helps manage body weight, improves cardiovascular health, improves
mood, helps blood sugar control, and relieves stress. Patients should discuss
exercise with their doctor first.
Fat people always develop type 2 diabetes eventually - this
is not true. Being overweight or obese raises the risk of becoming diabetic,
they are risk factors, but do not mean that an obese person will definitely
become diabetic. Many people with type 2 diabetes were never overweight. The
majority of overweight people do not develop type 2 diabetes.
Diabetes is a nuisance, but not serious - two thirds of
diabetes patients die prematurely from stroke or heart disease. The life
expectancy of a person with diabetes is from five to ten years shorter than
other people's. Diabetes is a serious disease.
Children can outgrow diabetes - this is not true. Nearly all
children with diabetes have type 1; insulin-producing beta cells in the
pancreas have been destroyed. These never come back. Children with type 1
diabetes will need to take insulin for the rest of their lives, unless a cure
is found one day.
Don't eat too much sugar, you will become diabetic - this is
not true. A person with diabetes type 1 developed the disease because their
immune system destroyed the insulin-producing beta cells. A diet high in
calories, which can make people overweight/obese, raises the risk of developing
type 2 diabetes, especially if there is a history of this disease in the
family.
I know when my blood sugar levels are high or low - very
high or low blood sugar levels may cause some symptoms, such as weakness,
fatigue and extreme thirst. However, levels need to be fluctuating a lot for
symptoms to be felt. The only way to be sure about your blood sugar levels is
to test them regularly. Researchers from the University of Copenhagen, Denmark
showed that even very slight rises in blood-glucose levels significantly raise
the risk of ischemic heart disease.
Diabetes diets are different from other people's - the diet
doctors and specialized nutritionists recommend for diabetes patients are
healthy ones; healthy for everybody, including people without the disease.
Meals should contain plenty of vegetables, fruit, whole grains, and they should
be low in salt and sugar, and saturated or trans fat. Experts say that there is
no need to buy special diabetic foods because they offer no special benefit,
compared to the healthy things we can buy in most shops.
High blood sugar levels are fine for some, while for others
they are a sign of diabetes - high blood-sugar levels are never normal for
anybody. Some illnesses, mental stress and steroids can cause temporary hikes
in blood sugar levels in people without diabetes. Anybody with
higher-than-normal blood sugar levels or sugar in their urine should be checked
for diabetes by a health care professional.
Diabetics cannot eat bread, potatoes or pasta - people with
diabetes can eat starchy foods. However, they must keep an eye on the size of
the portions. Whole grain starchy foods are better, as is the case for people
without diabetes.
One person can transmit diabetes to another person - NOT
TRUE. Just like a broken leg is not infectious or contagious. A parent may pass
on, through their genes to their offspring, a higher susceptibility to
developing the disease.
Only older people develop type 2 diabetes - things are
changing. A growing number of children and teenagers are developing type 2
diabetes. Experts say that this is linked to the explosion in childhood obesity
rates, poor diet, and physical inactivity.
I have to go on insulin, this must mean my diabetes is
severe - people take insulin when diet alone or diet with oral or non-insulin
inject-able diabetes drugs do not provide good-enough diabetes control, that's
all. Insulin helps diabetes control. It does not usually have anything to do
with the severity of the disease.
If you have diabetes you cannot eat chocolates or sweets -
people with diabetes can eat chocolates and sweets if they combine them with
exercise or eat them as part of a healthy meal.
Diabetes patients are more susceptible to colds and illnesses
in general - a person with diabetes with good diabetes control is no more
likely to become ill with a cold or something else than other people. However,
when a diabetic catches a cold, their diabetes becomes harder to control, so
they have a higher risk of complications.
Accurate tests are available to doctors to definitively
confirm a diagnosis of diabetes.
Before tests are conducted, a diagnosis may be suspected
when patients report certain symptoms. Doctors will evaluate these symptoms by
asking questions about the patient's medical history.
Doctors may also carry out a physical examination, including
checks for complications that could have already developed - examining the feet
for changes in sensation, for example.
Testing can be part of routine screening for people at risk
of the disease, who may show up as having prediabetes. The US Department of
Health and Human Services recommends diabetes testing for anyone overweight at
the age of 45 years and over, alongside anyone under the age of 45 with one or
more of the following risk factors
Hypertension (high blood pressure)
High cholesterol
History of diabetes in the family
African-American, Asian-American, Latino/Hispanic-American,
Native American or Pacific Islander background
History of gestational diabetes (diabetes during pregnancy)
or delivering a baby over 9 lbs.
Blood tests for diabetes diagnosis
One of three blood tests can be used to confirm a diagnosis
of diabetes:
Fasting plasma glucose (FPG) levels - a blood test after 8
hours of no eating
Glycosylated hemoglobin (HbA1c) - to measure a marker of the
average blood glucose level over the past 2-3 months
Oral glucose tolerance testing (OGTT) - a test used less
frequently that measures levels before and 2 hours after consuming a sweet
drink (concentrated glucose solution).
Glycosylated hemoglobin is often abbreviated to A1C, and
this blood test is also used in the monitoring of diabetes management.
To make an initial diagnosis, an HbA1c reading must be 6.5%
or higher. An A1C result between 5.7% and 6.4% indicates prediabetes and a risk
of type 2 diabetes.
The HbA1c is the preferred blood test for diagnosis because
- while it is more expensive than the FPG test - it has advantages, including:
Greater convenience (no need for fasting)
Less day-to-day variation during stress and illness.
When the fasting plasma glucose test is used to confirm
symptoms, diabetes is diagnosed at levels equal to or above 126 mg/dL (7.0
mmol/L).
For oral glucose tolerance testing, the plasma glucose
levels after 2 hours need to be equal to or above 200 mg/dL (11.1 mmol/L) for a
diabetes diagnosis.
Another blood test is the random plasma glucose test - taken
regardless of time and eating - which diagnoses diabetes if the level is at
least 200 mg/dL (11.1 mmol/L).
Unless the clinical picture is clear, a positive blood test
should also be repeated to rule out laboratory error.
Urine tests for diabetes diagnosis
Urine tests are no longer used to make a diagnosis of
diabetes, although they were once common. Blood tests are used instead because
urine tests are not sensitive or specific enough and offer only a crude
indication of high blood sugar levels.
A urine sample may be used, however, to test for ketones,
particularly in people with type 1 diabetes who exhibit certain symptoms. Here,
the test can pick up ketoacidosis, a complication of diabetes.
Treatments For Diabetes
Type 2 diabetes has a number of drug treatment options to be
taken by mouth known as oral antihyperglycemic drugs or oral hypoglycemic
drugs.
Oral diabetes drugs are usually reserved for use only after
lifestyle measures have been unsuccessful in lowering glucose levels to the
target of an HbA1c below 7.0%, achieved through an average glucose reading of
around 8.3-8.9 mmol/L (around 150-160 mg/dL).
The lifestyle measures that are critical to type 2 diabetes
management are diet and exercise, and these remain an important part of
treatment when pills are added.
People with type 1 diabetes cannot use oral pills for
treatment, and must instead take insulin.
What oral drugs are available for type 2 diabetes?
No one particular choice of oral hypoglycemic is considered
the most effective form of treatment - the decision over which drug to use is
instead based on:
Consideration of the adverse side effects
Convenience and overall tolerability
Personal preference.
In reality, weighing up each drug is something to do in
partnership with a prescriber - guidelines partly drawn up by the American
Diabetes Association list a great number of advantages and disadvantages for
each of the available drug treatments, including the consideration of cost.
The use of a single drug can be escalated to combination
therapy with a second drug in an effort to improve glycemic control.
Metformin is usually the first treatment offered, however,
and it is the most widely used oral antihyperglycemic. Metformin is a sensitizer
in the class known as biguanides; it works by reducing the amount of glucose
released by the liver into the bloodstream and increasing cellular response to
insulin. A metformin pill is usually taken twice a day.
This drug is a low-cost antihyperglycemic with mild side
effects that can include diarrhea and abdominal cramping. Metformin is not
associated with weight gain or hypoglycemia.2-4
Sulphonylureas are secretagogues that increase pancreatic
insulin secretion. There are several drug names in this class, including
Chlorpropamide
Glimepiride
Glipizide
Glyburide.
Again, the choice of drug is an individual one. In the case
of sulphonylureas, the choice depends on daily dosing and the level of side
effects. These drugs are associated with weight gain and hypoglycemia.
Glitazones (also known as thiazolidinediones) are
sensitizers - they increase the effect of insulin in the muscle and fat and
reduce glucose production by the liver.
Two glitazones are available: pioglitazone and
rosiglitazone. These drugs can have the side effects of weight gain or swelling
and are associated with increased risks of heart disease and stroke, bladder
cancer and fractures.
In the UK, rosiglitazone was withdrawn from the market over
concerns about adverse events.4 In 2015, it remains available in the US, with
information on its safety provided by the US Food and Drug Administration
(FDA).
Alpha-glucosidase inhibitors are intestinal enzyme
inhibitors that block the breakdown of carbohydrates into glucose, reducing the
amount absorbed in the gut.
Available as acarbose and miglitol, they are not usually
tried as first-line drugs because of common side effects of flatulence,
diarrhea and bloating, although these may reduce over time.
Dipeptidyl peptidase-4 (DPP4) inhibitors include alogliptin,
linagliptin, saxagliptin and sitagliptin.
Also known as gliptins, DPP4 inhibitors have a number of
effects, including stimulating pancreatic insulin (by preventing the breakdown
of the hormone GLP-1). They may also help with weight loss through an effect on
appetite.
These drugs do not increase the risk of hypoglycemia. Mild
possible side effects are nausea and vomiting.
Sodium-glucose co-transporter 2 (SGLT2) inhibitors include
canagliflozin and dapagliflozin. They work by inhibiting the reabsorption of
glucose in the kidneys, causing glucose to be excreted in the urine
(glycosuria).
SGLT2s may also cause modest weight loss. Side effects include
urinary infection.
Meglitinides include repaglinide and nateglinide. They
stimulate the release of insulin by the pancreas. Meglitinides are associated
with a higher chance of hypoglycemia and must be taken with meals three times a
day. As a result, these drugs are less commonly used.
When you have diabetes, your daily to-do list can seem like a lot. You track your blood sugar, take medicine, watch your diet, and exercise.
It can make you feel overwhelmed and burned out. If you’re there:
Know that no one is perfect.
There are no vacations from diabetes. Even the most diligent people can’t keep their blood sugar or diet or physical activity on target all the time.
“Diabetes is unique because [you’re] actually making medical decisions, day-to-day, minute-to-minute,” says Alicia McAuliffe-Fogarty, PhD, a clinical health psychologist.
This can be stressful, says David Nathan, MD, director of the Diabetes Center at Massachusetts General Hospital.
“If people are always stressed out about diabetes, they’re miserable,” Nathan says.
He says people need to forgive themselves if they miss their goals for a day, a week, or even more.
“Chill a little bit,” Nathan says. “We’re going to do the best we can. We need to recognize no one is perfect.”
Pay attention to what stresses you out.
Living with diabetes can cause fear, anger, worry, and sadness.
Lawrence Fisher, PhD, director of the Behavioral Diabetes Research Group at UCSF School of Medicine, has studied what doctors call “diabetes distress” in people with type 1 and those with type 2 diabetes. He learned that during any 18-month period, from a third to a half of people with diabetes will feel a good bit of it.
He cites seven common sources of diabetes distress among people with type 1 diabetes. The most common is a feeling of helplessness.
“The [blood sugar] numbers have a life of their own. They go up. They go down. You’re constantly making adjustments,” Fisher says. “There’s a feeling of powerlessness that is really hard to tolerate.”
Other common sources of diabetes distress among people with type 1 diabetes include:
Worry about what those around them assume
Concern about access to good health care
Perceived lack of support from family or friends, or feeling like they’re the “diabetes police”
Fear of dangerously low blood sugar
Stress over managing blood sugar levels
Bother over what to eat and when
Tell your doctor all about it.
See him regularly. When you go, make sure to share your physical symptoms, and how you’re feeling about things. Your diabetes can make it more likely for you to be depressed or anxious. What’s more, how you feel plays a big role in your ability to control your diabetes.
“That’s a component that’s often forgotten or left out,” McAuliffe-Fogarty says of mental well-being. “It’s equally important as eating right and exercising.”
It’s important that you take an active role in communicating with your doctor. He’s trained in managing diabetes. But he may not be as knowledgeable about the emotional toll the disease can take, McAuliffe-Fogarty says.
