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What Is Diabetes?

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What Is Diabetes?

What Are the Causes, Risk Factors, Symptoms and Treatment Methods of Diabetes?

Diabetes, which is one of the leading diseases among today's diseases, is very common and plays a key role in the formation of many fatal diseases.

Diabetes is a disease that occurs as a result of the deficiency of the insulin hormone, which balances glucose level in blood, or despite its adequate secretion, it cannot be functionally used in body. It is accompanied by high blood glucose called hyperglycemia and is a chronic, progressive and lifelong disease.

 

In a healthy individual, fasting blood glucose level does not exceed 70-100 mg/dl. On the hand, postprandial blood glucose level (2 hours after a meal) does not exceed 140 mg/dl. A fasting or postprandial blood glucose level above these limits indicates the presence of diabetes.

What Is Blood Glucose? What Causes Hyperglycemia?

Glucose is the body's main source of energy and obtained in two ways:

  • Foods containing carbohydrates (external),
  • Stored in the liver and, when necessary, released to blood (internal).
  • It can also be produced continuously by liver and kidney.

In particular, most of the foods containing carbohydrates are turned into glucose to be used for energy in the body. The pancreas, an organ located in the upper part of the spleen, produces the insulin hormone, which allows muscles and other tissues to receive glucose from blood and use it as energy. Insulin regulates the energy balance and blood glucose level in the body and is one of the hormones secreted by the pancreas. Glucose released into the blood with food reaches to stomach, and from there to intestines. Then, it is absorbed and mixed with blood. Lastly, it advances to the cells through the insulin hormone. Being used as a “fuel” by the cells, the glucose is stored in liver and adipose tissues if its amount is more than the body needs.

If the pancreas cannot produce enough insulin hormone or the produced hormone cannot be used effectively (due to insulin resistance), glucose that needs to be turned into energy accumulates in the blood and eventually causes high blood glucose level. This condition manifests itself with symptoms such as dry mouth, weight loss, drinking a lot of water and eating a lot.

Which Symptoms Develop If Blood Glucose Is Always High?

Urinary frequency: If the pancreas cannot produce insulin or the already produced insulin is not processed for energy by the cells due to insulin resistance, the glucose builds up in blood and begins to be removed from body through kidneys with urination after a certain level. The excessive glucose is excreted into urine and also drags along fluids from tissues, and the patients therefore begin to urinate frequently.

Frequent water consumption: Patients need to drink water frequently due to dehydration caused by urinary frequency.

Weight loss: The cells in body, which cannot use the consumed foods, begin to use the stored fats as an energy source. Therefore, patients become weak.

The time required for these symptoms to appear depends on the amount of damage to beta cells of pancreatic gland and ratio of destruction. Damage may last weeks, months or even years. When the destruction is completed quickly in a short time, the body has to use its own proteins and fats for its energy needs. Ketones, which are made due to excessive breaking down of fats, are harmful wastes for the body. Ketones build up in the body create a medical emergency called Diabetic Ketoacidosis (DKA). Although it is frequently seen in people with Type 1 diabetes, DKA can also develop in every patient with diabetes under special circumstances. Symptoms of ketoacidosis are abdominal pain, rapid breathing, severe malaise and fatigue. In case of appearance of these symptoms, patients are advised to urgently apply to a hospital.

Link Between High Blood Glucose and Diabetes

Not every person with high blood glucose has diabetes; however, hyperglycemia must be detected for the diagnosis of diabetes.  If fasting blood glucose is above 100 mg/dl, it is evaluated as hyperglycemia whereas if it is over 126 mg/dl, it is considered as diabetes.

Types of Diabetes

Although there are several types of diabetes, its most common types are as follows;

 

Despite being rare, there are also subtypes such as Gestational Diabetes, Prediabetes (Borderline Diabetes), and Latent Autoimmune Diabetes in Adults (LADA) and Maturity-Onset Diabetes of the Young (MODY) that can occur with some genetic disorders.

Differences Between Type 1 and Type 2 Diabetes

Type 1 Diabetes

Type 2 Diabetes

It is usually seen in children and adolescents.

It is usually seen in adults. In recent years, it is seen together with obesity in children and adolescents (most commonly after adolescence).

They are slim or normal-weight.

Most of them are obese.

Due to absence of insulin production, they have to get insulin injections.

They take tablets or get insulin injections.

Type 1 Diabetes

Being an autoimmune disease, type 1 diabetes is a diabetes disease that usually develops in childhood, resulting from insufficient or no insulin production in the pancreas. It also requires external insulin intake.  Patients with type 1 diabetes usually do not produce insulin at all. Their blood glucose levels are generally observed to be at high levels due to lack of insulin.

Type 1 diabetes is a disease that develops rapidly and can lead to serious consequences if treatment with insulin is not immediately initiated.

Type 1 diabetes, previously called insulin-dependent, genetically directed or early-onset diabetes, is also called Juvenile Diabetes because it usually occurs in childhood or young adults.

Type 2 Diabetes

Being also called non-insulin dependent or late-onset diabetes, patients with type 2 diabetes usually do not need external insulin intake.  They can manage their glucose level with regular diet, exercise, medication or insulin intake.

Type 2 diabetes is more common in patients with obesity aged over 45. However, it is also becoming common in children and young adults due to increasing obesity. It is the most common type of diabetes and constitute 90-95% of all patients with diabetes.

If not diagnosed or treated at early stage, serious conditions that can even lead to death can develop in patients with type 2 diabetes. Millions of people around the world live with type 2 diabetes without even knowing they have the disease or without adequate medical care.

Gestational Diabetes - Diabetes During Pregnancy

Gestational diabetes is the condition of high blood glucose that occurs after the week 24 of pregnancy. A pregnant woman's blood glucose rises due to a hormone (human placental lactogen) secreted from the placenta. For this reason, pregnant women may be diabetic during pregnancy even though there is no previous sign of diabetes. It usually normalizes after the pregnancy. However, its treatment is very important, particularly for healthy development of the baby. If not treated, the baby develops and borns prematurely.

All pregnant women between week 24 and 28 of pregnancy should have a 3-hour glucose tolerance test (75 grams) for early detection of gestational diabetes.

Complications Caused by Diabetes

When treatment principles are not followed in diabetes disease, blood glucose level cannot be controlled, which results in health problems in the short or long term. Diabetes can damage to nerves as well as vessels, which are called complications.  Acute and chronic complications can be seen in patients with both type 1 and type 2 diabetes.

Chronic diseases that can develop due to diabetes include:

  • Cardiovascular Diseases (Circulatory System Diseases): It is the most common cause of death among patients with diabetes. People with diabetes have a 2 to 5 times greater risk of heart disease or stroke. Veins in legs are also affected and amputation (loss of limb) can occur with neuropathy.
  • Diabetic Retinopathy (Eye Damage): Diabetes is the leading cause of visual loss and visual impairment in adults. While 2% of patients with diabetes and uncontrolled blood glucose go blind, 10% of them develop severe visual impairment.
  • Nephropathy (Kidney Damage): It can develop in 40% of people with uncontrolled type 1 diabetes by the age of 50. It is threatening enough to require dialysis and/or kidney transplant or cause severe kidney disease.
  • Neuropathy (Nerve Damage): Diabetic neuropathy affecting at least half of people with diabetes can lead to loss of sensation in the legs and feet. This can also result in foot injury and amputation of the leg.
  • Diabetic Foot Ulcer
  • Impotency: Diabetic neuropathy can cause impotency, as well.

Although diabetes is a serious disease, it is possible to maintain a healthy and long life with appropriate nutrition therapy, medical treatment, regular exercise and diabetes training.

What Are Symptoms of Diabetes?

Both Type 1 Diabetes and Type 2 Diabetes show the same symptoms. Among these are the feeling of hunger and fatigue despite the consumption of normal amount of meals. The most common early symptoms are excessive thirst and urinary frequency. These initial symptoms are often linked to hyperglycemia, the scientific term for high blood glucose.

In general, the symptoms of diabetes are as follows:

  • Excessive hunger
  • Excessive thirst
  • Weight loss.
  • Urinary frequency
  • Blurry vision
  • Excessive fatigue
  • Non-healing wounds

Also, man can experience some symptoms such as loss of libido and erectile dysfunction. On the other hand, symptoms such as urinary tract infections, yeast infection and dry-itchy skin lesions can be seen in women.

Symptoms of Diabetes in Children - Diabetes in Babies

Diabetes caused by the deterioration in the processes associated with insulin hormone in infants and children manifests itself with some obvious symptoms:

  • Increase in amount of urine, bedwetting
  • Excessive thirst and fluid consumption
  • Dry mouth
  • Excessive feel of hunger
  • Fatigue
  • Weight loss
  • Bad temper and depression

In addition to these, it is possible to see some findings such as the following, which can be caused by diabetic ketoacidosis in children with diabetes who are not treated or whose treatment is disrupted:

  • Mental fog or loss of consciousness
  • Deep and rapid breathing
  • Dry skin
  • Abdominal pain
  • Vomiting
  • Fruit or acetone smell in breath

If symptoms of diabetic ketoacidosis occur, a healthcare institution should be consulted immediately.

What Causes Diabetes?

As a result of many studies, it has been concluded that genetic and environmental factors play a key role in diabetes. In diabetes, which basically has two types as Type 1 and Type 2, the factors causing the disease vary based on these types.

Genetic factors play a vital role among the causes of type 1 Diabetes. The pancreas produces insulin hormone, which regulates blood glucose. However, some viruses targeting the pancreas and conditions disrupting functional of body's immune system are among the other factors causing this disease.

Also, the causes of type 2 diabetes, which is the more common type of diabetes, can be listed as follows:

  • Obesity
  • Family history of diabetes
  • Aging
  • Sedentary lifestyle
  • Stress
  • Gestational diabetes development during pregnancy and delivering a baby weighing more than normal

Diagnosis of Diabetes

Whether a person has diabetes is detected by means of Fasting Blood Glucose (FBG) or Oral Glucose Tolerance Test (OGTT). If FBG is measured as 100-125 mg/dl, it is an indication of prediabetes. On the other hand, if the FBG is measured as 126 mg/dl or above, it indicates the presence of diabetes.

In OGTT, it is important to evaluate blood glucose value 2 hours after taking liquid rich in glucose. If blood glucose measurement is 140-199 mg/dl at hour 2, it is the indication of prediabetes. On the other hand, if it is 200 mg/dl or above, diagnosis of diabetes is made.

Apart from all these, if the HbA1C test measuring your average blood glucose levels over the past 3 months is above 7%, it means that you have diabetes.

Treatment of Diabetes

The positive side of diabetes is that it responds very well to treatment. It is possible for patients to lead a normal and productive life after being diagnosed with diabetes provided that they comply with the requirements of their treatment, have regular check-ups, receive diabetes training and adapt their lifestyle to their disease.

The aim of diabetes treatment is to keep your blood glucose level and other risk factors (such as cholesterol and blood pressure) under control and prevent developing chronic diseases in the long term. How successful treatment will be depends on your age, weight, diet and exercise habits, work schedule, previous health problems, type of diabetes, and your patience and determination. This means that you should constantly monitor your blood glucose levels, restrict certain foods, lose weight and receive insulin by medication and/or injection.

Treatment methods of diabetes differ according to the type of it.

The unchanging principle in the treatment of type 1 diabetes is insulin therapy. Taking insulin is a necessity and life-saving method for patients with type 1 diabetes. Other fundamentals of treatment are healthy diet, regular exercise and diabetes training. Patients should take good care of their diseases all day long for keeping blood glucose at a favorable level in order for them to feel good themselves and lead a healthy life. Diet program of patients is planned by a dietitian in line with the insulin dose and plan recommended by the physician. The life of patients with type 1 diabetes becomes much easier thanks to carbohydrate counting application, with which dose of insulin can be adjusted according to the amount of carbohydrates in the food, and diabetes technologies (insulin pump, continuous glucose monitoring systems, artificial pancreas).

Treatment for type 2 diabetes includes medical nutrition therapy (regulation of eating habits), lifestyle changes and exercise. In addition to these, oral antidiabetic medications are also part of the treatment, which aim at increasing the sensitivity of cells to insulin hormone or directly increasing the secretion of insulin hormone. However, some patients with type 2 diabetes may need external insulin intake to keep their blood glucose levels within normal limits. In these cases, the treatment is supported with insulin injections at appropriate doses.