What is diabetes?
Diabetes mellitus is a type of metabolic
disease which results in high blood sugar (glucose) levels due to defects in
insulin secretion, or its action, or both. Diabetes mellitus, commonly referred
to as diabetes was first identified as a disease associated with "sweet
urine," and excessive muscle loss in the ancient world. Extremely high
levels of blood glucose (hyperglycaemia) leads to spillage of glucose into the urine, hence the term sweet
urine.
Normally, a hormone produced by the
pancreas called insulin controls the blood glucose level by lowering the blood
glucose level as needed. When the blood glucose elevates (for example, after eating
food), the pancreas releases insulin in order to normalize the glucose level in
the body by increasing the uptake of glucose into the body’s cells. The absence
of or insufficient production of or lack of response to insulin causes
hyperglycaemia, which in turn, causes diabetes. Diabetes is a chronic medical
condition, meaning that although it can be controlled, it lasts a lifetime.
The two types of diabetes are referred to
as type 1 and type 2. Former names for these conditions were insulin-dependent and
non-insulin-dependent diabetes, or juvenile onset and adult onset diabetes.
What is glucose?
The simple sugar found in our food are
called glucose. Glucose is an essential nutrient that is essential for the
functioning of the body cells as it provides energy. By breaking down carbohydrates
in the small intestine, the glucose in the digested food is then absorbed by
the intestinal cells into the bloodstream and is carried by the bloodstream to
all the cells in the body where it is utilized. However, glucose is unable
enter the cells without the aid of insulin. Without insulin, the cells become
starved of glucose energy despite the high levels of glucose in the
bloodstream. In certain types of diabetes, the cells' inability to utilize
glucose gives rise to the ironic situation of "starvation in the midst of
plenty". The abundant, unutilized glucose is wastefully excreted in the
urine.
What is insulin?
Insulin is a hormone that is produced by
beta cells, which are found in the pancreas. The pancreas is a deep-seated
organ in the abdomen located behind the stomach. In addition to helping glucose
enter the cells, insulin also plays the important role of regulating glucose
levels in the blood. After a meal, the blood glucose level rises, in response, the
pancreas normally releases more insulin into the bloodstream to help glucose
enter the cells and lowering the glucose levels in the blood after a meal. When
the blood glucose levels are lowered, the amount of insulin release from the
pancreas is reduced. It is important to note that even in a fasting state,
there is still steady release of insulin which helps to maintain a steady blood
sugar level during fasting. In normal individuals, such a regulatory system
helps to keep blood glucose levels in a tightly controlled range. As outlined
above, in patients with diabetes, the insulin is either absent, relatively
insufficient for the body's needs, or not used properly by the body. All these
factors cause elevated levels of blood glucose (hyperglycaemia).
What is type 1 diabetes?
Type 1 diabetes is an autoimmune disease
in which the immune system mistakenly manufactures antibodies and inflammatory cells that are
directed against and cause damage to patients' own body
tissues. In the case of type 1 diabetes,
the beta cells of the pancreas, which are responsible for insulin production,
are attacked by the misdirected immune system. It is believed that the tendency
to develop abnormal antibodies in type 1 diabetes is, in part, genetically
inherited, though the details are not fully understood.
What is type 2 diabetes
Type 2 diabetes was also previously
referred to as non-insulin dependent diabetes mellitus (NIDDM), or adult-onset
diabetes mellitus (AODM). In type 2 diabetes, the pancreas can still produce
insulin but is inadequate for their bodies need. In many cases this means the
pancreas produces larger than normal quantities of insulin. A major feature of
type 2 diabetes is a lack of sensitivity to insulin by the cells of the body, particularly
fat and muscle cells.
In addition to the problems caused by the
increase the resistance of insulin, the insulin released by the pancreas may
also be defective and suboptimal. There is also a chance that the production of
insulin by the beta cells may decline over a period of time, which contributes
to worsening glucose control. This is plays a major part for many patients with
type 2 diabetes who may end up requiring insulin therapy. Finally, the liver in these patients will continue to produce glucose through a
process called gluconeogenesis despite the elevated levels of glucose. The
control of gluconeogenesis also becomes compromised.
While it is believed that type 2 diabetes
occurs mostly to individuals over the age of 30 and the incidence increases
with age. In recent years, an alarming number of patients with type 2 diabetes
are barely in their teen years. Most of these cases are a direct result of poor
eating habits, higher body weight, and lack of exercise.
While genetics do play a large role in developing
this form of diabetes, there are other risk factors - the most significant of
which is obesity. There is a direct relationship between the degree of obesity and the
risk of developing type 2 diabetes, and this holds true for both children and
adults. It is estimated that the chance to develop diabetes doubles for every
20% increase over desirable body weight.
Regarding age, data shows that for each
decade after 40 years of age, regardless of weight, there is an increase in the
number of incidences of diabetes. The prevalence of diabetes in persons 65
years of age and older is around 25%. Finally, diabetes occurs much more
frequently in women with a prior history of diabetes that develops during
pregnancy (gestational
diabetes).
Gestational diabetes
Diabetes can also occur temporarily
during pregnancy, and reports suggest that it occurs in 2% to 10% of all
pregnancies. Due to significant hormonal changes during pregnancy, there may be
an increase in the blood sugar levels in genetically predisposed individuals. This
is called gestational diabetes. Gestational diabetes will usually resolve once
the baby is born. However, 35% to 60% of women who had gestational diabetes may
eventually develop type 2 diabetes over the next 1 to 2 decades, especially
those who require insulin therapy during pregnancy and those who remain overweight after their delivery.
Symptoms of Diabetes
The early symptoms of untreated diabetes
are elevated blood sugar levels, and loss of glucose via urination. High
amounts of glucose in the urine can cause increased urine output (frequent
urination) and may lead to dehydration. The dehydration also
causes increased thirst and water consumption.
Insulin deficiency will also eventually
lead to weight loss. This occurs despite having an increase in appetite.
Feeling nausea or fatigue and vomiting can also occur if diabetes was left untreated.
Frequent infections in areas such as the bladder,
skin, and vaginal areas are also more likely to occur in people with untreated
or poorly-controlled diabetes.
Fluctuations in blood glucose levels can
lead to blurred vision, extremely elevated glucose levels can lead to lethargy
and even coma.
Possible causes of Diabetes
Insufficient production of insulin,
production of defective insulin, or the inability of cells to use insulin
properly and efficiently leads to hyperglycaemia and diabetes. This latter
condition tends to mainly affect muscle cells and fat tissues; thus it is known
as insulin resistance. This is the primary problem in type 2 diabetes. In type
2 diabetes, there is also a decline in the production of beta cells which
causes the body to be unable to properly control the elevated blood sugar level.
Essentially, if someone is resistant to insulin, the body initially can, to
some degree, increase production of insulin and overcome the level of
resistance. However, after a period of time, due to the steady decrease in the
production of insulin, hyperglycaemia develops.
The absolute lack of insulin, usually
secondary to a destructive process affecting the insulin-producing beta cells
in the pancreas, is the main disorder in type 1 diabetes.
Below is a list of possible complications that could be caused by
badly controlled or untreated diabetes:
Eye complications - glaucoma, cataracts, diabetic retinopathy, and some others.
Foot complications - neuropathy,
ulcers, and sometimes gangrene which may require that the foot be amputated
Skin complications - people with
diabetes are more susceptible to skin infections and skin disorders
Heart problems - such as ischemic
heart disease, when the blood supply to the heart muscle is diminished
Hypertension - common in people with
diabetes, which can raise the risk of kidney disease, eye problems, heart attack and stroke
Mental health - uncontrolled
diabetes raises the risk of suffering from depression, anxiety and some other
mental disorders
Hearing loss - diabetes patients
have a higher risk of developing hearing problems
Gum disease - there is a much higher
prevalence of gum disease among diabetes patients
Gastroparesis - the muscles of the
stomach stop working properly
Ketoacidosis - a combination of
ketosis and acidosis; accumulation of ketone bodies and acidity in the blood.
Neuropathy - diabetic neuropathy is
a type of nerve damage which can lead to several different problems.
HHNS (Hyperosmolar Hyperglycaemic
Nonketotic Syndrome) - blood glucose levels shoot up too high, and there
are no ketones present in the blood or urine. It is an emergency condition.
Nephropathy - uncontrolled blood
pressure can lead to kidney disease
PAD (peripheral arterial disease) -
symptoms may include pain in the leg, tingling and sometimes problems walking
properly
Stroke - if blood pressure,
cholesterol levels, and blood glucose levels are not controlled, the risk
of stroke increases significantly
Erectile dysfunction - male
impotence.
Infections - people with badly
controlled diabetes are much more susceptible to infections
Healing of wounds - cuts and lesions
take much longer to heal
The dos and don’ts to help better manage Diabetes
A healthy Diet
Having diabetes does not require a strict or
difficult diet, and while food with high sugar content does affect blood
glucose levels, it does not have to be completely removed from the daily diet.
Dietary concerns is dependent on which type of
diabetes the person has. For type 1 diabetes, diet is about managing
fluctuations in blood glucose levels while for type 2 diabetes, it is about
losing weight and restricting calorie intake.
For people with type 1 diabetes, the timing of
meals is particularly important in terms of glycaemic control and in relation
to the effects of insulin injection.
In general, however, a healthy, balanced diet is
all that is needed, and the benefits are not just confined to being able to
better control diabetes, it also helps to maintain overall health. A
healthy diet typically includes a variety of fruits and vegetables, whole
grains, low-fat dairy products, skinless poultry and fish, nuts and legumes and
non-tropical vegetable oils.
The
following are some general dietary tips for a healthy lifestyle:
·
Eat regularly -
avoid the effects that skipping meals or having delayed meals has on your on
glucose levels due to work or long journeys, take a healthy snack with you
·
Eat vegetables and
fruits in place of high-calorie foods such as potato chips - a variety of fresh
and frozen is good but avoid high-calorie sauces and food containing high
amounts of salt or sugar
·
Whole grains which
are high in fibre are recommended as a healthy source of carbohydrates
·
Eat pulses, a
low-fat starchy source of protein and fibre, such as beans, lentils,
chickpeas and garden peas
·
Reduce intake of
saturated and trans fats by having poultry and fish without the skin and
cooked, for example, under the grill or steamed, rather than fried
·
Take a similar
approach to cooking red meat while reducing intake and looking for the leanest
cuts
·
Eat fish twice a
week or more, but avoid batters and frying, instead go for steaming or grilling
and choose fish that are high in omega-3 such as salmon, mackerel, sardine,
trout and herring
·
Avoid partially
hydrogenated vegetable oils and limit saturated fat and trans-fat - replace
them with monounsaturated and polyunsaturated fats
·
Dairy awareness
helps reduce fat intake - select skim (fat-free) milk and low-fat (1%) dairy
products, reduce consumption of cheese and butter and swap out creamy sauces
for tomato-based ones
·
Cut back on sugar
by avoiding added sugars in drinks and foods - have tea and coffee without
sugar, avoid fruit that is canned in syrup, avoid sweet or carbonated drinks
and pay attention to food labels
·
Cut back on salt -
prepare food at home with little or no salt and avoid foods with high sodium
such as processed foods
·
Cut back on portion
sizes - be wary of amounts consumed when eating out
·
Be wary of
"diabetic" foods - they usually are of no particular benefit and can
be expensive
·
Drink alcohol only
in moderation - as a guide, n o more
than one drink a day for women and no more than two for men.
Exercise
Exercising is a proven method in which to help people prevent the
onset of diabetes, manage symptoms for those with diabetes and also plays a
crucial role in maintaining overall health and prevent complications.
According to a joint
position statement by The
American College of Sports Medicine and the American Diabetes Association,
exercise:
·
plays a key role in
preventing and controlling blood sugar levels
·
can prevent or
delay type 2 diabetes
·
can prevent
diabetes during pregnancy (gestational diabetes)
·
Staying physically
active also helps prevent diabetes-related health complications and improves
overall quality of life.
·
Exercise is useful
for those with diabetes because it improves insulin sensitivity by helping the
cells of the body use available insulin . Physical activity also stimulates a
separate mechanism, unrelated to insulin, to allow the cells to use glucose for
energy, thereby regulating blood glucose levels.
There are 2 main types
of exercise that are recommended
Aerobic exercise
Also known as cardiovascular exercise, aerobic activity helps the body
use insulin more effectively. It brings other benefits too, including:
·
stress relief
·
improved
circulation
·
reduced risk of
heart disease
·
lower blood
pressure
·
improved
cholesterol levels
·
strong bones
·
weight management
·
better mood
Examples of aerobic exercises include:
·
brisk walking or
hiking
·
low-impact aerobic
exercise classes
·
swimming
·
rowing
·
cycling
·
basketball
·
dancing
·
skating
·
tennis
·
jogging
·
Tai Chi
Strength
training
Strength training, or resistance training, helps
lower blood sugar levels and increases insulin sensitivity. In addition, it
increases resting metabolism and builds stronger bones and muscles, reducing
the risk of osteoporosis
Examples of strength training include:
·
lifting free
weights
·
lifting heavy
objects, such as bottles of water or canned food
·
weight machines
·
resistance bands
·
exercises that use
body weight such as sit-ups, squats, planks, and push-ups
·
strength training classes
It can be useful to consider incidental physical
activity - everyday activities that aren't classed as exercise but involve
movement. Some research suggests that such activities can contribute to improved
fitness.
Types of incidental physical activities include:
·
taking the stairs
instead of the elevator
·
walking to the bus
stop
·
vacuuming
·
moderate intensity
gardening
·
walking around the
shopping mall
·
washing the car
Other considerations
Beginning an exercise plan can be daunting. It is
important to:
·
Set realistic goals - start slowly - with just 5-10 minutes of exercise daily - and
gradually increase the frequency and intensity of the activity.
·
Include aerobic and
strength-based activities - an exercise
plan for diabetes management should include both aerobic exercise and strength
training - research indicates
undertaking both forms of physical activity is more effective than doing just
one of the two.
·
Take precautions - always keep fast-acting carbohydrates on-hand in case of hypoglycaemia.
Consider wearing a medical alert bracelet in case of emergency.
·
Choose footwear
wisely - many people with diabetes have
problems with their feet, due to poor circulation and nerve damage. Wear
comfortable and supportive running shoes.
·
Be consistent - to reap the benefits of exercise for diabetes, it should be
undertaken regularly.
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