If you have been bothered by the question, “what is diabetes”, perhaps you have been wondering if you already have the condition or not. If this is the case, the following are a few typical symptoms of this metabolic disorder:
• a gradual change in vision, usually characterized by blurriness
• an incessant feeling of hunger or thirst, or excessive appetite
• a feeling of lightheadedness (typically after consuming meals)
• a recurring numbness of the extremities, usually of the hands and feet
Sometimes, these symptoms might also be attributed to other types of diseases, but it is still best to check your condition to get a prior diagnosis of your state.
When there is a lack of insulin produced in the body, the possible reasons include the body being unresponsive to the insulin (insulin resistance), or the body is incapable of producing insulin due to the damaged cells of the pancreas. In these two instances, type 2 diabetes is in the first case, wherein the body does not respond to insulin or the body has a really low insulin level.
Both diabetes type 1 and type 2 share one central feature: elevated blood sugar (glucose) levels due to absolute or relative insufficiencies of insulin, a hormone produced by the pancreas. Insulin is a key regulator of the body’s metabolism. It normally works in the following way:
During and immediately after a meal, the process of digestion breaks carbohydrates down into sugar molecules (of which glucose is one) and proteins into amino acids.
Right after the meal, glucose and amino acids are absorbed directly into the bloodstream, and blood glucose levels rise sharply. (Glucose levels after a meal are called postprandial levels.)
The rise in blood glucose levels signals important cells in the pancreas, called beta cells, to secrete insulin, which pours into the bloodstream. Within ten minutes after eating, insulin rises to its peak level.
Insulin then enables glucose, atorvastatine, and amino acids to enter cells in the body, particularly muscle and liver cells. Here, insulin and other hormones direct whether these nutrients will be burned for energy or stored for future use. (It should be noted that the brain and nervous system are not dependent on insulin; they regulate their glucose needs through other mechanisms.)
When insulin levels are high, the liver stops producing glucose and stores it in other forms until the body needs it again.
As blood glucose levels reach their peak, the pancreas reduces the production of insulin.
About two to four hours after a meal both blood glucose and insulin are at low levels, with insulin being slightly higher. The blood glucose levels are then referred to as fasting blood glucose concentrations.
In type 1 diabetes, the disease process is more severe and onset is usually in childhood: Beta-cells in the pancreas that produces insulin are gradually destroyed.
The main characteristics of type 1 diabetes are dysfunctional. The pancreas, a large gland under the stomach, stops the production of insulin. In shortage of insulin, the body’s cells could not turn glucose (sugar), into energy. Without insulin, the body prickles its own fats as a substitute. Except treated with daily doses of insulin, people with type 1 diabetes gather hazardous chemical substances in their blood from the usage of fat. This can affect a condition known as ketoacidosis. This is life-threatening if not preserved. To be in a good shape, people with type 1 diabetes depend on insulin injections every day of their lives. If this is an insulin pen or insulin pump. Type 1 diabetics must measure blood glucose levels several times a day – to prevent any serious fluctuations. The beginning of type 1 diabetes typically happens in people under 30 years but can happen at any age. About 12 percent of diabetics could be considered as type 1.
The exact origin of type 1 diabetes is officially proven by any scientific source, but we do know it has a strong family link and cannot be prevented. We for sure identify that it has nothing to do with the regime, although maintaining a healthy regime is essential in helping to manage type 1 diabetes. At this point, nothing can be done to prevent or cure type 1 diabetes.
Symptoms possibly will arise suddenly. If this happens, visit a doctor. Through a simple test, a doctor can find out if they’re the result of type 1 diabetes.
Here is a short list of symptoms. The following are type 1 diabetes symptoms:
Although there is no cure for type 1 diabetes at present, the disease can be managed through maintaining a healthy lifestyle, regular blood glucose testing, and insulin. Type 1 diabetes is managed with insulin replacement injections for the rest of one’s life, a healthy diet and eating plan, frequent exercise, and regular blood glucose monitoring (up to 6 times per day or as advised by a doctor). The aim of treating your diabetes is to keep blood glucose levels as close to ‘normal’ as possible, that is between 4.6 to 6.4 mmol/L. Keeping blood sugar levels in good physical shape to prevent both short-term and long-term complications.
Type 2 Diabetes, or Non-Insulin Dependent Diabetes Mellitus (NIDDM), is the most common form of Diabetes. While Type 1 or Insulin-Dependent Diabetes typically becomes evident in childhood and is due to an inborn lack or complete absence of insulin production, Type 2 Diabetes typically becomes evident in adulthood and is significantly due to the patient’s lifestyle. Of all diabetics, 85% to 90% are Type 2. In many countries, the incidence of Type 2 Diabetes has been rising sharply in recent decades, while the average age of onset has been declining. Type 2 Diabetes affects more than 17 million people in North America, over 20 million in Latin America, and over 150 million worldwide.
Type 2 diabetes is the most common form of diabetes, accounting for 90% of cases. An estimated 17 million Americans have type 2 diabetes and half are unaware they have it. The disease mechanisms in type 2 diabetes are not known, but some experts suggest that it may involve the following three stages in most patients:
The first stage in type 2 diabetes is the condition called insulin resistance; although insulin can attach normally to receptors on the liver and muscle cells, certain mechanisms prevent insulin from moving glucose (blood sugar) into these cells where it can be used. Most type 2 diabetics produce variable, even normal or high, amounts of insulin, and in the beginning, this amount is usually sufficient to overcome such resistance.
Over time, the pancreas becomes unable to produce enough insulin to overcome resistance. In type 2 diabetes the initial effect of this stage is usually an abnormal rise in blood sugar right after a meal (called postprandial hyperglycemia). This effect is now believed to be particularly damaging to the body.
Eventually, the cycle of elevated glucose further impairs and possibly destroys beta ce2s, thereby stopping insulin production completely and causing full-blown diabetes. This is made evident by fasting hyperglycemia, in which elevated glucose levels are present most of the time.
Type 2 Diabetes is caused by a complicated interplay of genes, environment, insulin abnormalities (reduced insulin secretion in the beta cells and insulin resistance in muscle cells), increased glucose production in the liver, increased fat breakdown, and possibly defective hormonal secretions in the intestine. The recent dramatic increase indicates that lifestyle factors (obesity and sedentary lifestyle) may be particularly strong levitra in releasing the genetic elements that cause this type of Diabetes.
Type 2 Diabetes, also known as Non-Insulin Dependent Diabetes Mellitus or NIDDM, affects at least 17 million Americans, and the incidence is sharply rising. A major 2020 US study reported that the prevalence of type 2 diabetes increased by one-third between 2010 and 2020 and the biggest increase (70%) was among young adults in their 30s. Type 2 diabetes typically has developed after the age of 40. In 2011 alone it rose by 6% overall with an increase of 10% in African Americans. Data indicate that African Americans and Hispanic Americans are particularly susceptible to developing Type 2 Diabetes.
The characteristic feature of diabetes type 2 is the body’s resistance to the actions of insulin. In many people, before diabetes develops, normal or even excessive levels of insulin compensate for this resistance. Over time however, insulin production often drops and resistance worsens. Researchers are trying to determine why these events occur.
Elevated levels of free fatty acids and the hormones resistin and leptin have been associated with insulin resistance at different phases. Such factors are also present in obesity. It is not known yet if elevated levels are simply a product of obesity or play some causal role in diabetes.
Some researchers suggest that proteins called calpains may play an important role in both insulin secretion and insulin action.
Elevated growth hormone during puberty appears to increase the risk for insulin resistance in overweight adolescents.
Some experts theorize that abnormal regulation of certain important peptides (amylin and CGRP) may occur, thus affecting both the nervous and circulatory systems. One effect is to alter blood flow, which may contribute to insulin resistance. How each of these factors contributes to type ll diabetes is under investigation.
One 2020 study found high levels of interleukin 6 (IL-6) and C-reactive protein (CRP) in people with diabetes. Both of these substances are markers for inflammation and damage caused by an over-active immune response. Some researchers believe such inflammation may contribute to the disease process leading to diabetes.
Some research is now investigating genes that may be responsible for inherited cases of type 2 diabetes in middle-aged Caucasians.
A defective fatty-acid binding protein 2 (FABP2) gene may result in higher levels of unhealthy fat molecules (particularly triglycerides), which may be critical in the link between obesity and insulin resistance in some people with diabetes type ll.
A defective lipoprotein lipase (LpL) gene may pose a risk for coronary artery disease and type ll diabetes in people who have it.
Variations in a gene that regulates a protein called calpain-10 is proving to affect insulin secretion and action and may play a role in diabetes type 2. There is some disagreement, however, about its significance.
Defective genes that regulate a molecule called peroxisome proliferator-activated receptor (PPAR) gamma may contribute to both type ll diabetes and high blood pressure in some patients.
A defective gene has been detected that reduces the activity of a protective substance called a beta 3-adrenergic receptor, which is found in visceral fat cells (those occurring around the abdominal region). The result is a slow-down in metabolism and an increase in obesity. The defective gene has been found in Pima Indians and other populations with a very high incidence of type 2 diabetes and obesity.
The Thrifty Gene. One theory suggests that some cases of type ll diabetes and obesity are derived from normal genetic actions that were once important for survival. Some experts postulate the existence of a so-called “thrifty” gene, which regulates hormonal fluctuations to accommodate seasonal changes. In certain nomadic populations, hormones are released during seasons when food supplies have traditionally been low, which results in resistance to insulin and efficient fat storage. The process is reversed in seasons when food is readily available. Because modern industrialization has made high-carbohydrate and fatty foods available all year long, the gene no longer serves a useful function and is now harmful because fat, originally stored for famine situations, is not used up. Such a theory could help explain the high incidence of type 2 diabetes and obesity found in Pima tribes and other Native American tribes with nomadic histories and Western dietary habits. It is also used to explain the relationship between low birth weight and future diabetes in Pima tribes: poor nutrition in fetuses or infants cause changes that reduce insulin sensitivity so that fat storage increases, leading to later obesity and diabetes.
Until recently, diabetes in children was almost always typed 1 (an autoimmune disease). Of major concern, however, are estimates that between 8% and 45% of new diabetes cases in children are type 2. (The significant differences in estimates are due to the difficulties in detecting the disease in children.) It is evident that diabetes is on the increase, not only in the US but also in other nations, including Europe and Japan. Diabetes is usually recognized in children who are in middle to late puberty. It most often occurs in girls and children who are overweight.
Research now indicates that low birth weight is a risk factor for type 2 diabetes. Some research indicates that malnutrition in a pregnant woman may be responsible for causing metabolic abnormalities in the developing fetus that eventually lead to diabetes.
In a 2020 study of nearly 85,000 nurses, obesity was the number one risk factor for diabetes type 2. It is estimated that 80% to 95% of the current dramatic increases in type 2 diabetes is due to obesity and having excess fat in the abdominal region. Excess body fat appears to play a strong role in insulin resistance, but the way the fat is distributed is also significant. Weight concentrated around the abdomen and in the upper part of the body (apple-shaped) is associated with insulin resistance and diabetes, heart disease, high blood pressure, stroke, and unhealthy cholesterol levels. Fat that settles in a “pear-shape” around the hips and flank appears to have a lower association with these conditions. One study suggested that waist circumferences greater than 35 inches in women and 40 inches in men signify an increased risk for heart disease and diabetes.
Between 25% to 33% of all type 2 patients have family members with diabetes. Having a first-degree relative with the disease poses a 40% risk of developing diabetes. One study reported that people with positive family histories have a higher risk for developing the disease at an earlier stage with more severe features.
The risk for type 2 diabetes varies among population groups. Diabetes also seems to pose higher or lower risks for specific complications among ethnic groups. Genetic, socioeconomic factors, or both seem to be involved in ethnic differences.
African Americans. A 2020 study reported that African American men have one and a half times the risk of developing type 2 diabetes and African American women have twice the risk as their Caucasian peers. An earlier 2010 study also found that African Americans with diabetes are also at higher risk for amputations than diabetic Caucasians, which is most likely due to a higher incidence of high blood pressure and smoking as well as poorer health care. Genetic factors also play a role. For example, there is some evidence that African Americans have insulin abnormalities unrelated to dietary or other factors.
Native Americans. The Pima tribe in Arizona has an incidence of type 2 diabetes that is 19 times higher than that of the white population. The risk for diabetic complications among young Pima adults is also very high. Other Native American tribes in North America are also at high risk for type 2 diabetes. The association between diet and diabetes among this population remains critical, however, in assessing these ethnic differences. In one study, Pimas who lived in Mexico exercised more and ate less fat (but consumed more calories) than Pima tribes in Arizona. The incidence of diabetes in their Arizona Pima relatives was about 50%, while it was only 6% in the Mexican Pima tribes (about the same as their non-Pima neighbors).
Hispanic Americans. The rate of type 2 diabetes is also very high among Mexican Americans, approximately double that for Caucasians.
Maturity-Onset Diabetes in Caucasian Youth. Maturity-onset diabetes in youth (MODY) is a rare genetic form of type 2 diabetes that develops only in Caucasian teenagers. It accounts for 2% to 5% of type 2 cases. (It should be noted that this is not diabetes associated with obesity that is now being seen increasingly in young people, including Caucasians.)
An estimated 5% of pregnant women develop a form of type 2 diabetes, usually temporary, in their third trimester called gestational diabetes.
Conditions that damage or destroy the pancreas, such as pancreatitis, pancreatic surgery, or certain industrial chemicals can cause diabetes. Polycystic ovaries are highly associated with diabetes. Certain drugs can also cause temporary diabetes, including corticosteroids, beta-blockers, and phenytoin. Rare genetic disorders (Klinefelter’s syndrome, Huntington’s chorea, Wolfram’s syndrome, leprechaunism, Rabson-Mendenha2 syndrome, lipoatrophic diabetes, and others) and hormonal disorders (acromegaly, Cushing’s syndrome, pheochromocytoma, hyperthyroidism, somatostatinoma, aldosteronoma) are associated with or increase the risk for diabetes.
Type 2 diabetes usually begins gradually and progresses slowly. Symptoms in adults include the following:
Symptoms in children are often different:
Hypoglycemia
People with diabetes who need to intensively control glucose levels are at risk for hypoglycemia (also called insulin shock). The condition develops if blood glucose levels fall below normal and may also be caused by insufficient intake of food, excess exercise, or alcohol intake. Usually, the condition is manageable, but occasionally, it can be severe or even life-threatening, particularly if the patient fails to recognize the symptoms. Mild hypoglycemia is common among people with type 2 diabetes, but severe episodes are rare, even among those who are taking insulin. Still, all patients who are intensively controlling glucose levels should be aware of warning symptoms.
Risk Factors for Severe Hypoglycemia. People at highest risk for severe hypoglycemia are those who intensively control blood glucose and also have one or more of the following conditions:
Symptoms. Mild symptoms usually occur at moderately low and easily correctable levels of blood glucose. They include the following:
Severely low blood glucose levels can precipitate neurologic symptoms:
Preventive Measures. The following tips may help avoid hypoglycemia or prepare for attacks.
Family and friends should be aware of the symptoms and be prepared:
Diabetic ketoacidosis (DKA) is a life-threatening complication that is caused by insulin depletion. Until recently, it has been a complication almost exclusively of type 1 diabetes. In such cases, it is nearly always due to noncompliance with insulin treatments. However, DKA is being reported increasingly in type 2 diabetes, especially among Hispanic and African Americans. It is not clear, however, what causes total insulin depletion in these patients. Research is needed to find which individuals are at particular risk.
Diabetic ketoacidosis often develop as follows:
Symptoms and complications include the following:
Life-saving treatment employs rapid rehydration using a saline solution followed by low-dose insulin and potassium replacement.
Diagnosing Diabetes
Experts now recommend that everyone over age 45 be tested regularly for diabetes. Younger adults should be tested who have the following conditions:
Some experts recommend that any child over 10 should be tested for type ll diabetes (even if they have no symptoms), if they are overweight and have at least two of the above mentioned risk factors. It should be noted that children who have symptoms of diabetes are usually diagnosed with type 1. This is of particular concern given the rise in childhood type 2 diabetes, and some centers report a misdiagnosis in 25% of cases.
Testing for Diabetes
Fasting Plasma Glucose. In order to simplify the diagnosis of diabetes, the American Diabetes Association has recommended the sole use of the fasting plasma glucose (FPG)(Fasting Plasma Glucose) test. It is a simple blood test taken after eight hours of fasting. In general results indicate the following:
The FPG (Fasting Plasma Glucose) test is not always reliable and there is considerable controversy about using it as the sole basis for diagnosing diabetes. Arguments against its sole use are the following:
At this time, even if a person has normal FPG (Fasting Plasma Glucose) levels but still has symptoms of diabetes and a family history or other risk factors, then diabetes should not be ruled out and a glucose tolerance test should also be performed.
Glucose Tolerance Test. A glucose tolerance test uses the following procedures:
The following results suggest different conditions:
Test for Glycated Hemoglobin. Another test examines blood levels glycated hemoglobin , also known as hemoglobin A1c (HbA1c). Measuring glycated hemoglobin is not currently used for an initial diagnosis, but it may be useful for determining the severity of diabetes. Some experts think it should be used to help predict complications in people who have FPG levels between 110 and 139, which are above normal but do not indicate full-blown diabetes.
The basis for its use as a diagnostic measurement in diabetes is as follows:
The test is not affected by food intake so it can be taken at any time. A home test has been developed that might make it easier to measure HbA1c. In general, measurements suggest the following:
Screening Tests for Complications
Screening for Heart Disease. All patients should be tested for hypertension and unhealthy cholesterol and lipid levels and given an electrocardiogram. Other tests may be warranted in patients with signs of heart disease.
Screening for Kidney Damage. The earliest manifestation of kidney damage is microalbuminuria, in which tiny amounts (30 to 299 mg per day) of protein called albumin are found in the urine. About 20% of type ll patients show evidence of microalbuminuria upon diagnosis of diabetes. It should be noted, however, that only a small percentage of type ll diabetics eventually develop kidney disease. Microalbuminuria is also a marker for other complications involving blood vessel abnormalities, including heart attack and stroke.
Screening for Thyroid Abnormalities. Thyroid function tests should be administered.
General Guidelines for Treatments
Treatment for type 2 diabetes generally follows certain stages that depend on the amount of residual insulin and ability to control blood glucose levels:
Treatment Goals and Intensive Control of Blood Glucose Levels
Major studies have now reported that, as in type 1 patients, rigorous control of blood glucose levels can help reduce the risk for complications in type 2 diabetics, including retinopathy, kidney and nerve damage. Even short-term control of blood glucose may improve their quality of life. (It may also help prevent impotence in men. )
It is not clear, however, if controlling blood glucose has any major benefits on the heart, and heart disease is the most serious complication in type ll diabetes. Studies are mixed on the effects of intensive glucose control, with some even reporting some harm. Of particular concern is weight gain from insulin therapies, a major problem and health risk in most patients with type 2 diabetes. Newer insulin-sensitizing medications may pose less of a risk for weight gain, however, and new weight loss drugs are also proving to be helpful in offsetting weight gain from other drugs.
Until more is known, at this time patients should still aim for the following test results:
Patients should discuss all options with their physicians.
Healthy lifestyle habits are the cornerstone of diabetes treatment. Lifestyle changes are difficult to initiate and sustain, however. Patients should be certain to surround themselves with a solid network of doctors, dietitians, family, and friends who understand both their condition and their needs. At least one study has found that family involvement plays a large role in adhering to lifestyle and medical regimens.
A Diabetic Diet and Weight Loss
The Diabetic Diet. The current state of the diabetic diet is in flux, and at this time, there is no single diet that meets all the needs of everyone with diabetes. Patients should meet with a professional dietitian to plan an individualized diet that takes into consideration all health needs. There are some constants, however:
Weight Loss. Being overweight is the number one risk factor for diabetes type ll. A number of studies have suggested that healthy habits might prevent diabetes, but they have had significant flaws. Now, an important well-conducted 2020 study in Finland has added very strong evidence on the value of weight loss and exercise. In the study, individuals at risk for developing type ll diabetes were put on a weight loss and exercise program. Although the average weight loss was relatively small (about 10 pounds), the risk for diabetes in this group was 58% lower than the comparison group who were given no intervention. Health benefits are highest with the first pounds lost, and losing only 10% of body weight can control progression of diabetes.
Unfortunately, not only is weight loss difficult to sustain, but many of the oral medications used in type ll diabetes cause weight gain as a side effect. For obese patients who cannot control weight using dietary measures alone, weight-loss drugs, such as orlistat (Xenical) or sibutramine (Meridia), may be beneficial. In some studies, for example, orlistat not only helped subjects to reduce weight but also improved glucose, cholesterol, and lipid levels. Surgical procedures are proving to be extremely beneficial in selected cases.
Exercise
Regular exercise, even of moderate intensity (such as brisk walking), improves insulin sensitivity and can even prevent type 2 diabetes. In fact, studies of older people who engage in regular to moderate aerobic exercise (eg, brisk walking, biking) lower their risk for diabetes even if they don’t lose weight. Exercise also helps lower blood pressure, improve cholesterol levels, and decrease body fat. All in all, even moderate exercise reduces the risk of heart disease in people with type 2 diabetes, even if they have no cardiac risk factors other than diabetes. Low-impact aerobic exercise is best. Resistance or high impact exercises can strain weakened blood vessels in the eyes of patients with retinopathy. High-impact exercise may also injure blood vessels in the feet.
In general, experts recommend the following:
Monitoring Blood Glucose
In patients being treated with insulin or insulin-producing or sensitizing drugs, it is important to monitor blood glucose levels carefully to avoid hypoglycemia. Patients should aim for the following measurements:
Different goals may be required for specific individuals, including pregnant women, very old and very young people, and those with accompanying serious medical conditions.
Blood glucose levels are generally more stable in type ll diabetes than in type 1, so experts usually recommend measuring blood levels only once or twice a day. Usually, a drop of blood obtained by pricking the finger is applied to a chemically treated strip. The glucose level is read on a standard meter or a small, portable digital display device. A noninvasive device called the GlucoWatch, measures glucose by sending tiny electric currents through the skin and is showing promise for detecting hypoglycemia.
Improving Sleep
Some research suggests that not getting enough sleep may impair insulin use and increase the risk for obesity. More research is needed, but it is always wise to improve sleep habits.
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