Diabetes is a lifestyle disease that affects millions of Americans and is the 7th leading cause of death in the United States. According to the 2014 National Diabetes Statistics Report prepared by the Centers for Disease Control and Prevention (CDC), approximately 29.1 million people in the country have diabetes. The CDC further estimates that about 8.1 million people have diabetes but are undiagnosed or unaware of their condition.
Though not immediately life-threatening, the disease increases the risk for developing complicated medical conditions including cardiac disease, hypertension, and kidney disease. More severe cases can cause kidney failure, blindness, and loss of limbs to amputation.
However, diabetes can be managed and prevented by making healthy lifestyle choices.
Types of Diabetes
Diabetes mellitus (DM) is a metabolic disease characterized by elevated blood sugar levels. Glucose builds up in the blood when the hormone called insulin cannot metabolize the sugar from the food that has been ingested. This occurs in either of three ways: when the pancreas cannot produce sufficient insulin, when it overproduces insulin, or when the insulin released cannot be utilized properly by the body because the cells have developed a condition called insulin resistance. Here is a brief discussion of the types of diabetes.
Type 1 Diabetes
In type 1 diabetes, there is underproduction of insulin. The disorder is commonly diagnosed among children and young adults. The disease was previously called “juvenile diabetes.” The American Diabetes Association (ADA) estimates that only about 5 percent of diabetic patients have this form of diabetes.
Insulin is the hormone responsible for breaking down the sugar components, carrying the glucose from the bloodstream to be distributed throughout the cells of the body, and converting it into energy. Because those with Type 1 Diabetes do not produce sufficient amounts of the hormone, they need “insulin therapy” to survive. Thus, type 1 diabetes is also referred to as the “insulin dependent diabetes mellitus.”
Type 2 Diabetes
Type 2 diabetes is more common compared to Type 1. It is estimated that about 90 to 95 percent of all diabetes cases are of this form.
The disorder occurs when the pancreas produces insulin but the body cannot effectively use it. This condition is called insulin resistance. This causes the pancreas to overproduce the hormone in order to keep up with the demands to metabolize the sugar in the food ingested by the body. Over time, the pancreas will simply be unable to produce sufficient amounts to break down the glucose components, causing it to build up in the blood.
Gestational diabetes is the type that affects women during pregnancy. Most pregnant women develop the condition around the 24th week or after the baby’s body has been formed.
This does not indicate that the woman had diabetes prior to conceiving. It only means that she has high blood sugar levels during her pregnancy. However, she may be at risk for developing type 2 diabetes later on in life. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), women who are diagnosed with gestational diabetes have about 35 to 60 percent chances of acquiring type 2 diabetes within 20 years.
Gestational diabetes can be harmful to the fetus. The glucose in the mother’s bloodstream can cross over the placenta which in turn, causes the baby to have high blood sugar levels. The extra sugar is stored as fat. As a result, the fetus may develop “fetal macrosomia,” a term used to describe a baby who is born with a significantly higher birth weight than normal.
Prediabetes is a condition where a person has blood sugar levels that are higher than normal and yet are not high enough to be considered diabetes. Those with prediabetes are at a higher risk for developing type 2 diabetes compared to those with healthy blood glucose levels.
According to the CDC, about 15 to 30% of those diagnosed with the condition are likely to develop type 2 diabetes within 5 years. However, prediabetes is potentially reversible. Those who maintain a healthy diet and active lifestyle can prevent the onset of diabetes or reduce the chances of progression by as much as 50 percent.
Signs and Symptoms
The symptoms of diabetes vary according to the elevation level of the blood sugar. Some patients may not notice any signs in the early stages and may not detect the disease unless some blood tests are conducted. The symptoms common to both Type 1 and Type 2 diabetes include: increased thirst, frequent urination, food cravings despite having eaten, fatigue, inexplicable weight loss, tingling sensation in the feet, numbness in the feet, blurred eyesight, dry and itchy skin, irritability, slow-healing sores, and infections in the gums or mouth.
Tests and Diagnosis
Early detection and diagnosis are critical to an effective management and treatment of diabetes. A person who suspects that he may be manifesting some of the symptoms should get himself checked immediately. Parents who notice some signs of type 1 diabetes in their children should promptly discuss these with the child’s pediatrician.
Since symptoms of diabetes may not become immediately evident, the American Diabetes Association (ADA) recommends that people with risk factors or genetic predispositions be regularly screened. These include people with a body mass index higher than 25 regardless of age, those aged 45 years and older, and those with additional risk factors such as hypertension. The risk factors are expounded on in the later part of this article.
Here are the tests to determine if a person has the following types of diabetes:
Type 1, Type 2, or Prediabetes
When either prediabetes or any of the types of diabetes is suspected by the doctor, he may order that the patient undergoes one of the following tests, as reported by Mayo Clinic:
Glycated hemoglobin (A1C) test
This blood test is used to ascertain the average blood sugar level for the past two or three months. It works by measuring the percentage of blood sugar that has attached to the hemoglobin, a protein that carries the oxygen in the red blood cells.
An A1C level of 6.5 percent or higher on two separate tests indicates diabetes. A level between 5.7 and 6.4 percent indicates prediabetes. A reading belong 5.7 percent is considered a normal or healthy blood sugar level.
Random Blood Sugar
This is performed by taking blood samples at random without regard to the time of the last meal or drink taken. A random blood sugar level of 200 milligrams decilitre (mg/dL) or of 11.1 millimoles per liter (mmol/L) and higher is suggestive of diabetes.
Fasting Blood Sugar (FBS)
In FBS, a patient is first required to fast for at least 8 hours. During the fasting period, even water intake is prohibited. A result that shows an FBS level between 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is indicative of prediabetes. An FBS level of 126 mg/dL (7 mmol/L) on two separate occasions suggests that the patient has diabetes. A reading below 100 is considered normal.
2 Hour Glucose Tolerance Test (GTT)
To conduct a GTT, a patient must first undergo an FBS test. Afterward, he is asked to drink a glucose liquid and more blood is drawn to test glucose levels two hours after the drink is taken.
A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A GTT reading of more than 200 mg/dL (11.1 mmol/L) indicates diabetes. A GTT reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.
Additional Tests for Type 1 Diabetes
To confirm a diagnosis of Type 1 diabetes, other tests specifically designed to establish the presence of certain antibodies that would indicate the condition are performed. These are:
The test measures C-peptide levels in the blood. A low level suggests that a person has type 1 diabetes because C-peptide levels correlate to the amount of insulin being produced by the pancreas.
Glutamic Acid Decarboxylase Autoantibodies (GADA)
The GADA test is used to verify the presence of autoantibodies directed against beta cells in the pancreas which produce insulin.
Insulin Autoantibodies (IAA)
In type 1 diabetes, the immune system produces antibodies that attack the insulin produced by the body. The IAA test is used to ascertain whether such antibodies are present.
Insulinoma-Associated-2 Autoantibodies (IA-2A)
This is similar to GADA the sense that the test aims to locate antibodies. What makes IA-2A different is that it searches for the presence of antibodies that attack specific enzymes in the beta cells.
Gestational Diabetes Tests
A pregnant woman may be asked to undergo some blood tests to check for gestational diabetes. These are:
Initial Glucose Tolerance Test (GTT)
To perform a GTT, the patient is asked to drink a glucose solution. After an hour, blood is drawn to check the blood sugar level. A blood sugar level below 140 mg/dL (7.2 to 7.8 mmol/L) is considered normal. A higher reading indicates a potential risk for gestational diabetes. A follow-up test needs to be done to conclude the diagnosis.
Follow-up Glucose Tolerance Test
This is done if the initial GTT result is suggestive of gestational diabetes. The pregnant woman is asked to fast overnight and then the FBS is measured. Afterward, she is asked to consume a syrupy sweet solution of higher glucose concentrations. The blood sugar levels will be checked every hour for a period of three hours. When at least two out of the three test results show a blood sugar level reading that is higher than normal, she is conclusively diagnosed to have gestational diabetes.
Treatment and Management
Diabetes is a lifelong condition that requires effective management. The goal of treatment is to lower and stabilize the patient’s blood sugar levels. To accomplish this, doctors advise patients to religiously take the prescribed medications and to incorporate changes in lifestyle.
A healthy diet is a major component in the management of diabetes. Meals should consist mainly of foods that are high in fiber and nutrition such as whole grains, white or lean meat, vegetables, and fruits with a low glycemic index. Foods consisting of refined or processed sugars and starch should be avoided. It is recommended that a dietitian is consulted to help the patient draw the proper meal plans.
Patients diagnosed with type 1, type2, and prediabetes could significantly benefit from incorporating some form of physical exercise in their daily routines. Aerobic exercises lower the blood sugar levels and improve the cells sensitivity to insulin.
Medications for type 2 diabetes aim to increase insulin output, reduce the amount of glucose released from the liver, and increase the cells’ insulin sensitivity. A drug called Metformin is usually prescribed for this disorder. In some cases, insulin therapy is prescribed in addition to oral medications.
Those who have type 1 diabetes need insulin therapy. Insulin is injected with a needle and syringe or an insulin pen. An insulin pump may also be used. A doctor may prescribe a combination of insulin types, depending on the patient’s needs and lifestyle.
The treatment for gestational diabetes and prediabetes are similar to the therapies prescribed for type 2 diabetes. Those diagnosed with prediabetic conditions must observe a healthy diet and aim to have at least 150 minutes of aerobic activities per week to delay or prevent progression to type 2 diabetes.
Regardless of the form of diabetes, patients should monitor their blood glucose levels several times a day to make sure they maintain the target blood sugar level.
The cause of type 1 diabetes is unknown and it is difficult to prevent. Among the diabetes risk factors are family history, race, the presence of autoantibodies, and a diet low in vitamin D.
Some people are more predisposed to type 2 diabetes than others. Certain factors elevate the chances of developing the disorder. These include family history, race, age, weight, high body mass index, physical inactivity, and a diet rich in sugar and carbohydrates. Those with health conditions such as hypertension, polycystic ovary syndrome (PCOS), and high levels of triglyceride and cholesterol are also predisposed to the disease.
Various researches and clinical studies are being undertaken to find more remedies for the treatment of diabetes. In the meantime, patients can delay the onset of complications and manage their symptoms. The disease is controllable for as long as those diagnosed are committed to change their lifestyle and cooperate with their physicians.