Diabetes Mellitus

Diabetes mellitus is a prevalent chronic disease that affects millions of people worldwide. It is a metabolic disorder that occurs when the body cannot produce enough insulin or effectively use the insulin it produces, leading to high blood glucose levels. Over time, uncontrolled diabetes can cause serious damage to various organs, including the heart, blood vessels, eyes, kidneys, and nerves. Understanding the causes, symptoms, and management of diabetes is crucial for maintaining optimal health and preventing complications.

What is Diabetes Mellitus?

Diabetes mellitus is a disorder of carbohydrate metabolism characterised by abnormally high blood sugar (glucose) levels. In a healthy individual, the pancreas produces insulin, a hormone that helps glucose enter cells to be used for energy. However, in people with diabetes, either the pancreas does not produce enough insulin, or the body's cells do not respond normally to insulin, leading to a buildup of glucose in the blood. This results in symptoms such as increased urination, thirst, weight loss, and potential damage to nerves and blood vessels.

Here are the different types of the condition:

Type 1 Diabetes Mellitus

Type 1 Diabetes, also known as insulin-dependent diabetes, is an autoimmune disease in which the body's immune system attacks and destroys the insulin-producing beta cells in the pancreas. As a result, little or no insulin is produced, leading to high blood sugar levels. Type 1 diabetes usually develops in childhood or adolescence but can also occur in adults. People with type 1 diabetes require daily insulin injections or the use of an insulin pump to manage their blood sugar levels.

Type 2 Diabetes Mellitus

Type 2 Diabetes is the most common form of diabetes, accounting for around 90% of all cases. In type 2 diabetes, the body's cells become less responsive to insulin, a condition known as insulin resistance. As a result, glucose builds up in the blood, and the pancreas produces more insulin to compensate. Over time, the pancreas may not be able to produce enough insulin to maintain normal blood sugar levels. Type 2 diabetes typically develops in middle or late adulthood but is increasingly being diagnosed in children and adolescents due to rising obesity rates. Risk factors for type 2 diabetes include obesity, physical inactivity, family history, and certain ethnicities.

Gestational Diabetes Mellitus

Gestational Diabetes is a type of diabetes that develops during pregnancy, usually in the second or third trimester. It occurs when hormonal changes and insulin resistance during pregnancy affect the body's ability to process glucose effectively. While gestational diabetes typically resolves after childbirth, women who experience it are at a higher risk of developing type 2 diabetes later in life. Proper management of gestational diabetes through diet, exercise, and sometimes medication is essential for the health of both the mother and the baby.

Being aware of the following early signs can help in the timely diagnosis and management of diabetes mellitus:

• Frequent urination

• Excessive thirst and dry mouth

• Increased hunger

• Fatigue and tiredness

• Unexplained weight loss

• Blurry vision

• Slow healing cuts and wounds

• Tingling or numbness in hands and feet

• Dark, velvety skin patches, particularly in the folds of the neck, armpits, or groin

• Frequent yeast infections

• Dry skin

Recognising the following symptoms is crucial for the early detection and treatment of diabetes mellitus:

Common Symptoms

The symptoms of diabetes mellitus can be subtle and may develop gradually, making them easy to overlook. The most common symptoms include increased thirst, frequent urination, excessive hunger, fatigue, and unexplained weight loss. High blood sugar levels can cause the kidneys to work harder to remove excess sugar from the blood, leading to frequent urination and dehydration. This, in turn, can cause excessive thirst. Since the body's cells cannot absorb glucose properly, individuals may feel constantly hungry despite eating regularly.

Vision and Healing Issues

High blood sugar can damage blood vessels in the eyes, leading to blurry vision. Additionally, it can impair blood circulation and nerve function, causing slow healing of cuts and wounds, as well as tingling or numbness in the hands and feet.

Skin and Infection Problems

Excess sugar in the urine can lead to frequent yeast infections, particularly in warm, moist areas of the skin. Dark, velvety skin patches called acanthosis nigricans can form in the folds of the neck, armpits, or groin due to an excess of insulin in the blood.

Diabetes mellitus has the following stages:

Prediabetes

Prediabetes is a condition in which blood sugar levels are higher than normal but not high enough to be classified as diabetes. People with prediabetes are at increased risk of developing type 2 diabetes if left untreated. Making lifestyle changes, such as adopting a healthy diet and increasing physical activity, can help prevent or delay the progression to type 2 diabetes.

Diabetes

When blood sugar levels remain consistently elevated, a person is diagnosed with diabetes. At this stage, proper management through lifestyle modifications, medication, and regular monitoring is essential to control blood sugar levels and prevent complications.

Complications of Diabetes

Uncontrolled diabetes can lead to serious complications over time. These include cardiovascular disease, such as heart attack and stroke, chronic kidney disease, vision loss due to diabetic retinopathy, and nerve damage (neuropathy). Regular check-ups and adherence to treatment plans can help minimise the risk of developing these complications.

Diabetes mellitus might have different causes:

Type 1 and Type 2 Diabetes

Diabetes mellitus is primarily caused by issues with insulin production or usage. Type 1 diabetes occurs when the body does not produce enough insulin, while Type 2 diabetes happens when the body does not respond properly to insulin (insulin resistance). Both types lead to high blood sugar levels.

Gestational Diabetes

Gestational diabetes is a form of diabetes that develops during pregnancy, often due to hormonal changes and increased insulin resistance.

There are different risk factors for diabetes mellitus:

• Family history of diabetes

• Being overweight or obese

• Physical inactivity

• High blood pressure

• High cholesterol levels

• Prediabetes (elevated blood sugar levels, but not high enough for a diabetes diagnosis)

• Polycystic ovary syndrome (PCOS)

• Age (risk increases with age, particularly after 45 years)

• Ethnicity (higher risk among African Americans, Hispanics, Native Americans, and Asian Americans)

Who's at Risk?

Lifestyle factors such as being overweight, having a sedentary lifestyle, and consuming a diet high in processed foods and added sugars can increase the risk of developing type 2 diabetes mellitus. If you identify with any of these risk factors and develop any symptoms associated with diabetes mellitus, please check with your doctor for a diagnosis.

People with diabetes mellitus may develop the following complications:

Heart and Blood Vessel Complications

Diabetes mellitus significantly increases the risk of developing cardiovascular diseases, such as coronary artery disease, heart attacks, strokes, and atherosclerosis. These conditions can lead to angina, heart failure, and narrowing of arteries, which can have severe consequences for an individual's health and quality of life.

Nerve Damage (Diabetic Neuropathy)

Persistently high blood sugar levels can damage nerves, causing symptoms like numbness, tingling, burning, or pain in the hands, feet, or legs. This nerve damage, known as diabetic neuropathy, can also affect digestive nerves, leading to nausea, vomiting, diarrhoea, or constipation. In some cases, it may even result in erectile dysfunction.

Kidney Damage (Diabetic Nephropathy)

Over time, diabetes can damage the kidneys' filtering system, causing a condition called diabetic nephropathy. If left untreated, this can progress to chronic kidney disease, potentially requiring dialysis or a kidney transplant.

Eye Damage (Diabetic Retinopathy)

Elevated blood sugar levels can damage the blood vessels in the eyes, increasing the risk of developing eye diseases such as glaucoma, cataracts, and diabetic retinopathy. If not properly managed, these conditions can lead to vision loss or even blindness.

Foot Damage

The combination of nerve and blood vessel damage caused by diabetes can result in numbness, tingling, pain, or loss of feeling in the feet. This makes it more difficult for individuals to notice minor cuts and blisters, which can develop into ulcers, infections, and, in severe cases, may require amputations.

Other Complications

Diabetes mellitus can also lead to various other complications, including skin and mouth conditions, hearing impairment, Alzheimer's disease, dementia, digestion problems, increased susceptibility to infections, dental problems, osteoporosis, myopathy, and depression. Managing blood sugar levels effectively is crucial in preventing or delaying the onset of these complications.

Here are some preventative measures you can follow, especially if you have diabetes mellitus risk:

Maintain a Healthy Weight

One of the most important steps in preventing diabetes is maintaining a healthy weight. Being overweight or obese is a significant risk factor for developing type 2 diabetes. Aim to achieve and maintain a body mass index (BMI) within the healthy range by following a balanced diet and engaging in regular physical activity.

Engage in Regular Physical Activity

Regular exercise helps control weight, lower blood sugar levels, and increase insulin sensitivity. Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, along with strength training exercises at least twice a week.

Follow a Balanced Diet

Eat a variety of nutrient-dense foods, such as fruits, vegetables, whole grains, lean proteins, and healthy fats. Limit your intake of saturated and trans fats, added sugars, and processed foods. Focus on consuming foods with a low glycemic index to help maintain stable blood sugar levels.

Manage Stress

Chronic stress can lead to elevated blood sugar levels. Engage in stress-reducing activities like meditation, deep breathing exercises, yoga, or hobbies you enjoy to help manage stress effectively.

Avoid Smoking and Limit Alcohol Consumption

Smoking and excessive alcohol consumption can increase the risk of developing diabetes and its complications. If you smoke, seek help to quit, and limit your alcohol intake to moderate levels, if at all.

Regular Check-ups

Schedule regular check-ups with your healthcare provider to monitor your blood sugar, blood pressure, and cholesterol levels. Early detection and management of pre-diabetes or diabetes can help prevent or delay the onset of complications.

To diagnose diabetes mellitus, your doctor might perform several steps, including:

Fasting Plasma Glucose (FPG) Test

The fasting plasma glucose test measures blood sugar levels after an 8-hour fast. A result of 126 mg/dL (7.0 mmol/L) or higher on two separate tests indicates diabetes.

Oral Glucose Tolerance Test (OGTT)

The oral glucose tolerance test involves measuring blood sugar levels before and 2 hours after drinking a glucose-containing liquid. A result of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes.

Random Plasma Glucose (RPG) Test

The random plasma glucose test measures blood sugar levels at any time, regardless of when you last ate. A result of 200 mg/dL (11.1 mmol/L) or higher, along with symptoms of diabetes, indicates diabetes.

Glycated Hemoglobin (HbA1c) Test

The HbA1c test measures your average blood sugar levels over the past 2-3 months. An HbA1c level of 6.5% or higher on two separate tests indicates diabetes. Normal HbA1c levels are below 5.7%, while levels between 5.7% and 6.4% suggest pre-diabetes.

Here are some treatment options for the condition:

Lifestyle Changes

The first line of treatment for diabetes mellitus is adopting healthy lifestyle changes. This includes following a balanced diet, engaging in regular physical activity, maintaining a healthy weight, managing stress, and avoiding smoking and excessive alcohol consumption.

Oral Medications

If lifestyle changes alone are not sufficient to manage blood sugar levels, oral medications may be prescribed. These include:

• Biguanides: The primary medication in this class is metformin. It works by decreasing glucose production by the liver and increasing muscle tissue sensitivity to insulin.

• Alpha-glucosidase inhibitors: Examples include acarbose and miglitol. They block the breakdown of starches and sugars in the intestines, slowing carbohydrate absorption.

• Sulfonylureas: Examples include glimepiride, glipizide, and glyburide. These medications stimulate the pancreas to produce more insulin.

• Thiazolidinediones (TZDs): Examples include pioglitazone and rosiglitazone. They increase insulin sensitivity in muscle and fat tissues and reduce glucose production in the liver.

• DPP-4 inhibitors: Medicines like sitagliptin, saxagliptin, and linagliptin help the body produce more insulin and reduce glucose production.

• SGLT2 inhibitors: Medicines like canagliflozin, dapagliflozin, and empagliflozin will cause the kidneys to remove excess glucose through urine.

Insulin Therapy

For individuals with type 1 diabetes and some with type 2 diabetes, insulin therapy is necessary to manage blood sugar levels. Insulin can be administered through injections or an insulin pump, and the type and dosage will be determined by a healthcare provider based on individual needs.

Monitoring and Education

Regular blood sugar monitoring, either through self-monitoring or continuous glucose monitoring (CGM) devices, is essential for effective diabetes management. Diabetes education programmes can help individuals learn how to manage their condition, make healthy lifestyle choices, and prevent complications.

By adopting a comprehensive approach to diabetes management, including lifestyle changes, medication, monitoring, and education, individuals with diabetes can effectively control their blood sugar levels and reduce the risk of developing complications associated with the condition.

If you experience any symptoms of diabetes mellitus, such as frequent urination, excessive thirst, unexplained weight loss, blurred vision, or slow-healing wounds, it's essential to consult with a doctor promptly. Early diagnosis and treatment can help prevent or delay the onset of complications associated with diabetes mellitus.

Additionally, if you have been diagnosed with diabetes mellitus and are experiencing difficulty managing your blood sugar levels or are concerned about potential complications, it's crucial to maintain regular check-ups with your healthcare provider. They can help adjust your treatment plan, monitor your condition, and provide guidance on lifestyle changes to optimise your health.

• Diabetes mellitus is a chronic condition characterised by elevated blood sugar levels due to either a lack of insulin production (Type 1) or insulin resistance (Type 2).

• Common symptoms of diabetes mellitus include frequent urination, excessive thirst, unexplained weight loss, blurred vision, and slow-healing wounds.

• Risk factors for developing diabetes mellitus include family history, obesity, physical inactivity, and age.

• Diagnosis of diabetes mellitus involves blood tests such as the fasting plasma glucose test, oral glucose tolerance test, and glycated haemoglobin (A1C) test.

• Treatment for diabetes mellitus includes lifestyle changes (diet and exercise), blood sugar monitoring, and medications such as metformin, sulfonylureas, and insulin therapy.

• Regular check-ups with a healthcare provider are essential for managing diabetes mellitus and preventing complications.