Diabetes is a disease that occurs when your blood sugar (glucose) is too high. Blood sugar is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.
Over time, having too much glucose in your blood can cause health problems. Although diabetes has no cure, you can take steps to manage your diabetes and stay healthy.
The most common types of diabetes are type 1, type 2, and gestational diabetes; every case of diabetes is serious.
Type 1 diabetes: your body doesn’t make insulin. Your immune system attacks and destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. People with type 1 diabetes need to take insulin every day to stay alive.
Type 2 diabetes: your body does not make or use insulin well. You can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people. Type 2 is the most common type of diabetes.
Gestational diabetes: this develops in some women when they are pregnant. Most of the time, this type of diabetes goes away after the baby is born. However, if you’ve had gestational diabetes, you have a greater chance of developing type 2 diabetes later in life.
Other types of diabetes : Less common types include monogenic diabetes, which is an inherited form of diabetes, and cystic fibrosis-related diabetes .
Why sugar (glucose) is important in our body
The mammalian brain depends on glucose as its main source of energy. In the adult brain, neurons have the highest energy demand, requiring continuous delivery of glucose from blood. In humans, the brain accounts for ~2% of the body weight, but it consumes ~20% of glucose-derived energy making it the main consumer of glucose (~5.6 mg glucose per 100 g human brain tissue per minute).
Glucose metabolism provides the fuel for physiological brain function through the generation of ATP, the foundation for neuronal and non-neuronal cellular maintenance, as well as the generation of neurotransmitters. Our body uses it for energy too.
How the Body Controls Blood Sugar (Glucose)
When the blood sugar levels rise after a meal, the pancreas releases the hormone insulin. Insulin enters the bloodstream and ensures that the sugar in the food and drinks we consume is transported from our blood to our cells, where it is transformed into energy for the body.
When blood sugar levels are low, the pancreas releases glucagon into the bloodstream. This hormone causes the cells of the liver to release stored sugar. Glucagon also ensures that the cells of the liver produce new sugar from other substances in the body. When the blood sugar level has risen, the release of glucagon is stopped once again. (Institute for Quality and Efficiency in Health Care).
Insulin resistance
Type 2 diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin well. As a result, your body needs more insulin to help glucose enter cells. At first, the pancreas makes more insulin to keep up with the added demand. Over time, the pancreas can’t make enough insulin, and blood glucose levels rise.
You are more likely to develop type 2 diabetes if you are age 45 or older, have a family history of diabetes, or are overweight. Physical inactivity, race, and certain health problems such as high blood pressure also affect your chance of developing type 2 diabetes. You are also more likely to develop type 2 diabetes if you have prediabetes or had gestational diabetes when you were pregnant.
Obesity: first cause of diabetes
Energy imbalance between calories consumed and expended, sedentary lifestyles and excessive consumption of sweet foods and fats, especially saturated fats, is leading the Indian population to obesity more than other people. Obesity, being a primary factor behind type II diabetes, is leading India towards becoming a diabetic capital of the world by 2030. Obesity is rapidly rising in the Western world where substantial weight gain seems to be the norm. When compared to previous decades, young children today seem to be especially affected by this obesity epidemic, with 41 million children from birth to age 5 years classified as overweight or obese. About 80% of children continue to be adolescents with excess weight and are predicted to be adults with obesity. The cycle of increasing obesity continues, with parents with obesity having a strong influence on their children’s inclination toward obesity; when both parents are obese, the children have around an 80% chance of becoming obese as well. While genes certainly play a role in every person’s metabolism and appetite, the environment is one of the main contributors to the obesity epidemic.
Like their parents who choose foods that are loaded in calories but deficient in nutrients and do not participate in enough physical activity, children learn to live in the same manner.
Diabetes Problems
- Diabetes can damage blood vessels and lead to heart disease and stroke. You can do a lot to prevent heart disease and stroke by managing your blood glucose, blood pressure, and cholesterol levels; and by not smoking.
- Hypoglycemia: certain diabetes medicines make low blood glucose more likely. You can prevent by following your meal plan and balancing your physical activity, food, and medicines. Testing your blood glucose regularly can also help prevent hypoglycemia.
- Nerve Damage (Diabetic Neuropathy): Diabetic neuropathy is nerve damage that can result from diabetes. Different types of nerve damage affect different parts of your body. Managing your diabetes can help prevent nerve damage that affects your feet and limbs, and organs such as your heart.
- Kidney Disease: also called diabetic nephropathy, is kidney disease caused by diabetes.
- Foot Problems: Common foot problems, such as a callus, can lead to pain or an infection that makes it hard to walk.
- Eye Disease: Diabetes can damage your eyes and lead to low vision and blindness. The best way to prevent eye disease is to manage your blood glucose, blood pressure, and cholesterol; and to not smoke. Also, have a dilated eye exam at least once a year.
- Gum Disease and Other Dental Problems such as infection, gum disease, or dry mouth. To help keep your mouth healthy, manage your blood glucose, brush your teeth twice a day, see your dentist at least once a year, and don’t smoke.
- Sexual and Bladder Problems: Sexual and bladder problems are more common in people with diabetes. Problems like erectile dysfunction, loss of interest in sex, bladder leaks, and retained urine can happen if diabetes damages your blood vessels and nerves. Treatments are available to help control symptoms and restore intimacy.
- Depression: is common among people with a chronic, or long-term, illness such as diabetes.
- Cancer: diabetes is linked to some types of cancer. Not smoking and getting recommended cancer screenings can help prevent cancer.
- Dementia
- Sleep Apnea: People who have sleep apnea —when you stop breathing for short periods during sleep—are more likely to develop type 2 diabetes.
Diabetes Tests & Diagnosis
Your health care professional can diagnose diabetes, prediabetes, and gestational diabetes through blood tests. The blood tests show if your blood glucose, also called blood sugar, is too high.
What tests are used to diagnose diabetes and prediabetes? Health care professionals most often use the fasting plasma glucose (FPG) test or the A1C test to diagnose diabetes. In some cases, they may use a random plasma glucose (RPG) test.
Fasting plasma glucose (FPG) test
The FPG blood test measures your blood glucose level at a single point in time. For the most reliable results, it is best to have this test in the morning, after you fast for at least 8 hours. Fasting means having nothing to eat or drink except sips of water.
A1C test
The A1C test is a blood test that provides your average levels of blood glucose over the past 3 months. Other names for the A1C test are hemoglobin A1C, HbA1C, glycated hemoglobin, and glycosylated hemoglobin test. You can eat and drink before this test. When it comes to using the A1C to diagnose diabetes, your doctor will consider factors such as your age and whether you have anemia or another problem with your blood.The A1C test is not accurate in people with anemia.
If you’re of African, Mediterranean, or Southeast Asian descent, your A1C test results may be falsely high or low. Your health care professional may need to order a different type of A1C test.
What test numbers tell me if I have diabetes or prediabetes?
Each test to detect diabetes and prediabetes uses a different measurement. Usually, the same test method needs to be repeated on a second day to diagnose diabetes. Your doctor may also use a second test method to confirm that you have diabetes.
The tests can’t identify what type you have. Sometimes the doctor are unsure if diabetes is type 1 or type 2. Treatment depends on the type of diabetes, so knowing which type you have is important.
To find out if your diabetes is type 1, your health care professional may look for certain autoantibodies. Autoantibodies are antibodies that mistakenly attack your healthy tissues and cells. The presence of one or more of several types of autoantibodies specific to diabetes is common in type 1 diabetes, but not in type 2 or monogenic diabetes. A health care professional will have to draw your blood for this test.
Your doctor may want you to check your urine for ketones if you have symptoms of diabetic ketoacidosis . When ketone levels get too high, you can develop this life-threatening condition. Symptoms include
- trouble breathing
- nausea or vomiting
- pain in your abdomen
- confusion
- feeling very tired or sleepy
Ketoacidosis most often is a problem for people with type 1 diabetes.
Talk with your doctor about what vaccines you should get to keep from getting sick, such as a flu shot and pneumonia shot. Preventing illness is an important part of taking care of your diabetes. Your blood glucose levels are more likely to go up when you’re sick or have an infection.
When medicines and lifestyle changes are not enough to manage your diabetes, other treatments include bariatric surgery for certain people with type 1 or type 2 diabetes, and an “artificial pancreas” and pancreatic islet transplantation for some people with type 1 diabetes.
Also called weight-loss surgery or metabolic surgery, bariatric surgery may help some people with obesity and type 2 diabetes lose a large amount of weight and regain normal blood glucose levels. Some people with diabetes may no longer need their diabetes medicine after bariatric surgery. Whether and for how long blood glucose levels improve seems to vary by the patient, type of weight-loss surgery, and amount of weight the person loses.
Medicines that can cause diabete
Sometimes certain medicines can harm beta cells or disrupt the way insulin works. These include
- niacin, a type of vitamin B3
- certain types of diuretics, also called water pills
- anti-seizure drugs
- psychiatric drugs
- drugs to treat human immunodeficiency virus (HIV )
- pentamidine, a drug used to treat a type of pneumonia
- glucocorticoids—medicines used to treat inflammatory illnesses such as rheumatoid arthritis , asthma , lupus , and ulcerative colitis
- anti-rejection medicines, used to help stop the body from rejecting a transplanted organ
statins, which are medicines to reduce LDL (“bad”) cholesterol levels, can slightly increase the chance that you’ll develop diabetes. However, statins help protect you rom heart disease and stroke. For this reason, the strong benefits of taking statins outweigh the small chance that you could develop diabetes.
If you take any of these medicines and are concerned about their side effects, talk with your doctor.
Meal plan and sport
To manage diabetes follow your diabetes meal plan: choose fruits and vegetables, beans, whole grains, chicken or turkey without the skin, fish, lean meats, and non fat or low-fat milk and cheese. Drink water instead of sugar-sweetened beverages. Choose foods that are lower in calories, saturated fat, trans fat, sugar, and salt.
Choose a balanced diet with an health care professional, small portions at regular intervals.
Make physical activity part of your daily routine
Sugar substitutes
Sugar substitutes in various food and beverages are very popular in most of the countries. Extensive scientific research has demonstrated the safety of the six low-calorie sweeteners currently approved for use in foods in the U.S. and Europe (stevia, acesulfame-K, aspartame, neotame, saccharin and sucralose) each with an acceptable daily intake. A number of studies have been carried out to confirm the safety of artificial sweeteners. A number of studies have also shown the adverse effects of the same. But most of the studies have limitations such as effects shown only in animals not in human, small sample size, high doses, statistically non-significant or borderline significant, etc.
References
- Calories Eva V.
Osilla; Sandeep Sharma. Last Update: April 17, 2018.
- Sugar for the brain: the role of glucose in physiological and pathological brain function. Philipp Mergenthaler, Ute Lindauer,Gerald A. Dienel, and Andreas MeiselTrends Neurosci. 2013 Oct; 36(10): 587–597.
- Sugar substitutes: Health controversy over perceived benefits Kirtida R. Tandel. J Pharmacol Pharmacother. 2011 Oct-Dec; 2(4): 236–243.
- Sugar consumption, metabolic disease and obesity: The state of the controversy. Stanhope KL. Crit Rev Clin Lab Sci. 2016;53(1):52-67. doi: 10.3109/10408363.2015.1084990. Epub 2015 Sep 17.
- Centers for Disease Control and Prevention website. www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf (PDF, 1.3 MB) . Updated July, 18 2017. Accessed August 1, 2017.
- American Diabetes Association. Foundations of care and comprehensive medical evaluation. Diabetes Care. 2016;39(suppl 1):S26
- National Institutes of Health, Office of Dietary Supplements. Dietary supplements: what you need to know. ods.od.nih.gov/HealthInformation/DS_WhatYouNeedToKnow.aspx . Reviewed June 17, 2011. Accessed June 21, 2016
- Yardley JE, Sigal RJ. Exercise strategies for hypoglycemia prevention in individuals with type 1 diabetes. Diabetes Spectrum. 2015;28(1):32–38.
- Colberg SR, Sigal RJ, Yardley JE, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065–2079.
- Cordera R, Adami GF. From bariatric to metabolic surgery: looking for a “disease modifier” surgery for type 2 diabetes. World Journal of Diabetes. 2016;7(2):27–33.
- Kirwan JP, Aminian A, Kashyap SR, Burguera B, Brethauer SA, Schauer PR. Bariatric surgery in obese patients with type 1 diabetes. Diabetes Care. 2016;39(6):941–948.
