Overview

Diabetes is a chronic disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces. Insulin is a hormone made by the pancreas that acts like a key to let glucose from the food we eat pass from the blood stream into the cells in the body to produce energy. All carbohydrate foods are broken down into glucose in the blood. Insulin helps glucose get into the cells. There are three main types of diabetes
type 1, type 2 and gestational.

A. Type 1 diabetes can develop at any age, but occurs most frequently in children and adolescents. When you have type 1 diabetes, your body produces very little or no insulin, which means that you need daily insulin injections to maintain blood glucose levels under control.

B. Type 2 diabetes is more common in adults and accounts for around 90% of all diabetes cases. When you have type 2 diabetes, your body does not make good use of the insulin that it produces. The cornerstone of type 2 diabetes treatment is healthy lifestyle, including increased physical activity and healthy diet. However, over time most people with type 2 diabetes will require oral drugs and/or insulin to keep their blood glucose levels under control.

C. Gestational diabetes (GDM) is a type of diabetes that consists of high blood glucose during pregnancy and is associated with complications to both mother and child. GDM usually disappears after pregnancy but women affected and their children are at increased risk of developing type 2 diabetes later in life. Learn more.

Symptoms

The symptoms of type 2 diabetes include :

• Excessive thirst and dry mouth
• Frequent urination
• Lack of energy, tiredness
• Slow healing wounds
• Recurrent infections in the skin
• Blurred vision
• Tingling or numbness in hands and feet.
• These symptoms can be mild or absent and so people with type 2 diabetes may live several years with the condition before being diagnosed.

Causes

Several risk factors have been associated with type 2 diabetes and include:

• Family history of diabetes
• Overweight
• Unhealthy diet
• Physical inactivity
• Increasing age
• High blood pressure
• Ethnicity
• Impaired glucose tolerance (IGT)*
• History of gestational diabetes
• Poor nutrition during pregnancy

Diagnosis

Diabetes may be diagnosed based on plasma glucose criteria, either the fasting plasma glucose (FPG) or the 2-h plasma glucose (2-h PG) value during a 75-g oral glucose tolerance test (OGTT), or A1C criteria. FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 h.*
OR
2-h PG ≥200 mg/dL (11.1 mmol/L) during OGTT. The test should be performed as described by the WHO, using a glucose load containing the equivalent of 75-g anhydrous glucose dissolved in water.*
OR
A1C ≥6.5% (48 mmol/mol). The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay.*
OR
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L).
* In the absence of unequivocal hyperglycemia, results should be confirmed by repeat testing.

Prevention

There is no cure for diabetes, but it can be treated and controlled. The goals of managing diabetes are to:

• Keep your blood glucose levels as near to normal as possible by balancing food intake with medication and activity.
• Maintain your blood cholesterol and triglyceride (lipid) levels as near the normal ranges as possible.
• Control your blood pressure. Your blood pressure should not go over 140/90.
• Decrease or possibly prevent the development of diabetes-related health problems.
• You hold the keys to managing your diabetes by:
• Planning what you eat and following a balanced meal plan
• Exercising regularly
• Taking medication, if prescribed, and closely following the guidelines on how and when to take it
Monitoring your blood glucose and blood pressure levels at home

The treatment of diabetes includes managing with help of insulin and oral anti-diabetic drugs. Oral anti-diabetes medicines includes 2 major classes of drugs o Insulin sensitizers (helps to increase insulin utilization in body) o Insulin Secretagogue (Improve insulin production)

Treatment

Various medicines are available to manage diabetes and international bodies like American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) suggests the use of medicine or combination of drugs based on patient condition.

Different classes of drugs are as below:

• Sulphonyulureas Improve insulin production.eg,. Glimepiride, Gliclazide
• Biguanides Reduce hepatic glucose production and increase uptake of glucose by periphery muscles. e.g. Metformin
• Meglitinide Improve insulin production e.g. Repaglinide, Nateglinide
• Thiazolidinediones Improve insulin Sensitization e.g. Pioglitazone, Rosiglitazone
• DPP4 inhibitors Inhibition of DPP4 enzyme and enhances activity of incretins that play important role in insulin secretion and blood glucose control regulation e.g.Evogliptin, Teneligliptin, Sitagliptin, Vildagliptin, Linagliptin
• Alpha Glucosidase inhibitors Inhibits glucose absorption from GIT e.g.Voglibose, acarbose
• SGLT2 inhibitors Block the re-uptake of glucose in the renal tubules, promoting loss of glucose in the urine. Oral preparations may be used alone or in combination with other agents e.g.Dapagliflozin, Canagliflozin, Empagliflozin

Complications Of Diabetes

Diabetes complications are divided into microvascular (due to damage to small blood vessels) and macrovascular (due to damage to larger blood vessels).

Microvascular complications include damage to eyes (retinopathy) leading to blindness, to kidneys (nephropathy) leading to renal failure and to nerves (neuropathy) leading to impotence and diabetic foot disorders (which include severe infections leading to amputation).

Macrovascular complications include cardiovascular diseases such as heart attacks, strokes and insufficiency in blood flow to legs.

There is evidence from large randomized-controlled trials that good metabolic control in both type 1 and 2 diabetes can delay the onset and progression of these complications.

Diabetic retinopathy (eye disease)

Cause

Diabetic retinopathy is a leading cause of blindness and visual disability. It is caused by small blood vessel damage to the back layer of the eye, the retina, leading to progressive loss of vision, even blindness.

Symptoms

Usually the patient complains of blurred vision, although other visual symptoms may also be present.

Diagnosis

Diagnosis of early changes in the blood vessels of the retina can be made through regular eye examinations.

Treatment

Good metabolic control can delay the onset and progression of diabetic retinopathy. As well, early detection and treatment of vision-threatening retinopathy can prevent or delay blindness. This involves regular eye examinations and timely intervention

Nephropathy (kidney disease)

Cause

Diabetic kidney disease is also caused by damage to small blood vessels in the kidneys. This can cause kidney failure, and eventually lead to death. In developed countries, this is a leading cause of dialysis and kidney transplant.

Symptoms

Patients usually have no symptoms early on, but as the disease progresses, they may feel tired, become anemic, not think clearly, and even develop dangerous electrolyte imbalances.

Diagnosis

Early diagnosis can be made by a simple urine test for protein as well as a blood test for kidney function.

Treatment

If diagnosed at an early stage, several measures can retard the progression to kidney failure. These include control of high blood glucose, control of high blood pressure, intervention with medication in the early stage of kidney damage, and restriction of dietary protein.

Neuropathy (nerve disease)

Cause

Diabetes causes nerve damage through different mechanisms, including direct damage by the hyperglycemia and decreased blood flow to nerves by damaging small blood vessels. This nerve damage can lead to sensory loss, damage to limbs, and impotence in diabetic men. It is the most common complication of diabetes.

Symptoms

The symptoms are many, depending on which nerves are affected: for example, numbness in extremities, pain in extremities, and impotence. Decreased sensation to feet can lead to patients not recognizing cuts and developing foot infections. If not treated early, these can lead to amputation (more about diabetic foot disease below).

Diagnosis

Early diagnosis is made by early recognition of symptoms by patients and health care providers as well as by careful examination by health care providers at regular intervals.

Treatment

If detected early, and blood glucose brought under control, these complications can also be prevented or delayed.

Diabetic foot disease:

Due to changes in blood vessels and nerves, it often leads to ulceration and subsequent limb amputation. It is one of the most costly complications of diabetes, especially in communities with inadequate footwear. It results from both vascular and neurological disease processes. Regular inspection and good care of the foot can prevent amputations. Comprehensive foot programs can reduce amputation rates by 45-85%.

Cardiovascular disease

Cause

Hyperglycemia damages blood vessels through a process called “atherosclerosis”, or clogging of arteries. This narrowing of arteries can lead to decreased blood flow to heart muscle (causing a heart attack), or to brain (leading to stroke), or to extremities (leading to pain and decreased healing of infections).

Symptoms

The symptoms of these different conditions are varied: ranging from chest pain to leg pain, to confusion and paralysis.

Diagnosis

While early detection of these complications can delay progression, early detection of other risk factors such as smoking, high blood pressure, high serum cholesterol and obesity is even more important.

Treatment

Controlling these other risk factors along with blood glucose can prevent or delay cardiovascular complications.

Reference:

https://www.who.int/diabetes/action_online/basics/en/index3.html

Resources

https://www.idf.org/aboutdiabetes/what-is-diabetes American

https://www.unitypoint.org/livewell/article.aspx?id=4e39b5e1-ab20-4770-8be0-29564e8d7a97 www.mayoiclinic.org