Diabetes

Diabetes mellitus is life-long condition that results from the inability of the body cells to take in glucose. In normal individuals, the carbohydrate in the food that we eat is digested and broken down into smaller components like glucose. Glucose should enter the cells to be metabolized further to provide energy for the body. The entry of glucose into the cells is facilitated by the hormone insulin, which is produced by the pancreas. Insulin is detected by the receptors on the cells and is interpreted by the cells as the signal to take up glucose. In diabetes, a metabolic derangement prevents this entry of glucose into the cells.

There are two types of diabetes mellitus: type 1 and type 2. In Type 1 Diabetes Mellitus, the pancreas produces little or no insulin so that there is nothing that signals the cells to take in glucose. This condition is usually detected early in life and may be auto-immune or inherited. In Type 2 Diabetes Mellitus, there is insulin, but the cell receptors are not sensitive to that insulin; therefore, even if there is a signal, the signal is just ignored by the cells. In both instances, glucose cannot enter the cells and accumulates in the blood, leading to hyperglycemia or high levels of glucose in the blood. The irony of diabetes is that there is too much glucose in the blood, yet the cells are still “hungry” because they cannot take up that glucose. The high level of glucose in the blood damages other organs and leads to long-term, often life threatening, complications.

Signs and symptoms

The most common symptoms of diabetes are known as the 3Ps:

• Polyuria—the need to urinate frequently and, often times, even at night
• Polydipsia—the need to drink frequently as if the person is always thirsty
• Polyphagia—the need to eat frequently as if the person is always hungry

Other signs and symptoms of diabetes are:

• Weight loss
• fatigue
• Delayed wound healing
• Blurring of vision
• Numbness on the fingers tips and toes
• Extreme complication of type 1 diabetics is an emergency state known as diabetic ketoacidosis. The symptoms of this include stomachache, vomiting and hyperventilation and even coma and death.

Diagnosis

A consult to the doctor is advisable if any of the above-mentioned signs and symptoms is present. If a doctor suspects a patient to have diabetes, a fasting blood sugar (FBS) test will be requested. An FBS is just like an ordinary blood test except that it is preceded by 8-12 hours of fasting. An elevated FBS is indicative of diabetes.

Treatment

Type 1 Diabetes is a non-curable condition, but it can be controlled. Mild Type 2 diabetics can be “cured” with weight loss and appropriate diet. The cornerstone in the management of diabetes is the control of blood sugar. This is can be done by giving various medications that address the problems in glucose uptake. These medications include:

• Oral anti-hyperglycemic agents, which lower the levels of glucose in the blood
• Insulin sensitizers, which make the cells sensitive to insulin
• Insulin injections, which are absolutely necessary for Type 1 diabetes and may be necessary for Type 2

Along with the administration of these medications, dieting and monitoring of blood sugar are also important. Diabetics are encouraged to monitor blood sugar at home to make sure that it does not go too high or too low. Monitoring of blood sugar ensures that the medications are being given at optimal dosages and in a proper schedule.

Monitoring and Prevention of complications

Diabetes is known to cause many long-term complications because the elevated levels of sugar in the blood can destroy many organs. It can damage the:

• Blood vessels, which can lead to heart attack, stroke, and poor wound healing
• Nerves (diabetic neuropathy), which can lead to numbness of the toes, making it possible for some wounds in the foot to go unnoticed for several days, become gangrenous and eventually end up in amputation
• Eyes (diabetic retinopathy), which can lead to blurring of vision and blindness
• Kidneys (diabetic nephropathy), which can lead to kidney failure and the need for dialysis
• Pregnancy – blood sugar levels are even more difficult to maintain in pregnancy and can lead to problems in both mother and child

To prevent these complications, monitoring and control of “ABC” is encouraged:

• A stands for HbA1C. HbA1C is a hemoglobin blood test that measures the control of blood sugar over the past three months. For doctors, this can give a clue as to the adequacy of treatment or compliance of patients to their diabetic medications. The goal for A1C level is 7.0% or below.
• B stands for blood pressure. Because hypertension can damage the very same organs that are damaged in diabetes (heart, brain, kidneys, and eyes), controlling blood pressure can help minimize the insults to the said organs. Diabetics should maintain blood pressure that is lower than 140/90 but not lower than 90/60.
• C stands for cholesterol. Hypercholesterolemia or elevated levels of cholesterol in the blood can cause deposition of fatty plaques in the blood vessels, thus increasing the risk for stroke and heart attack. Keeping cholesterol levels in check can help minimize the long-term complications of diabetes.

Patients with diabetes will need monitoring of the blood sugar and HbA1C with a doctor every few months, or more often if it is not at a stable level., Medications or insulin injection protocol will be adjusted according to the results of this.  The patient may also be checked for blood pressure readings and cholesterol levels.

The following are steps that can help control the ABCs:

• Be compliant with your maintenance medications, be it for your hypertension, cholesterolemia, heart disease, or kidney problem.
• Have a healthy diet and avoid sweets or fatty meals.
• Exercise regularly and aim for target weight loss to your ideal weight for your age and height.
• Stress management
• Quit smoking.
• Limit alcohol intake which has many calories as well as metabolic effects.
• If you are obese, aim to lose weight.
• Visit your doctor regularly.