Diabetes

Symptoms: Frequent urination (primarily at night), dehydration, sudden weight loss, increased appetite, blurred vision, numbness in limbs, fatigue, dry skin, slow healing sores, highly prone to infections of the gum, skin, and vagina, nausea, stomach ache, vomiting, high level of ketone in urine, weakness, irritability, mood swings 
Causes: sugar build-up in the blood, the pancreas failing to produce sufficient insulin, and other genetic and environmental factors 
Risk Factors: Age, family history, ethnicity, prediabetic conditions, obesity, inactive or sedentary lifestyle
Severity: Mild, moderate, and severe 
Which doctor to consult: Endocrinologist, Diabetologist

Overview

Often, diabetes mellitus or type 1 diabetes is referred to as diabetes. It occurs when the body cannot produce sufficient insulin, causing an increase in the blood glucose level. There is also type 2 diabetes, also known as diabetes insipidus, but it is rare.

Glucose is essential for fuelling the brain, muscles, and aerobic and anaerobic cellular respiration. So, diabetes can mess up cognitive function and increase lung inflammation. It is known to have some connection with acute respiratory distress syndrome in a small way. Moreover, the disease also disrupts the antimicrobial defence mechanism in the body, making it prone to infections and higher mortality risk.

Diabetes is often mistaken for stomach flu, viral infections, strep throat, or urinary tract infection. The disease has similar symptoms to anaphylaxis (bladder control), bulimia nervosa, anorexia nervosa, amyloidosis, anaemia, etc.

There is a third type of diabetes, apart from type 1 and type 2. It is called gestational diabetes and can occur in pregnant women. This form of diabetes can impact the cellular use of glucose, causing high blood sugar levels or hyperglycaemia. This can be damaging to the mother and baby’s health.

There is no permanent cure yet developed for diabetes. However, treatments are available for controlling and monitoring the sugar level in the blood. Changes in diet and lifestyle are also proven to show positive results in managing complications.

When to Consult a Doctor?

You must seek medical help in case of the following conditions:

• On symptoms

When experiencing sudden weight loss, tiredness, and the urge to urinate frequently, it is advised to seek medical consultation. Women, during their pregnancy, must undergo the diabetes screening as a routine check-up to ensure the safety of their baby and themselves.

• Urge to vomit

One of the many complications of diabetes is diabetic ketoacidosis. It causes an acid build-up in your bloodstream, known as ketones. The complication can occur very quickly, within 24 hours. You can conduct home blood screening with kits to check the higher sugar and ketone levels in blood and urine. If the ketone level is even moderately high, and there is an urge to vomit, especially while eating or drinking, consult your endocrinologist immediately.

• Regular screening

Regular screening for diabetes is essential, especially after 45 years of age, for both men and women. Procedures include eye exams, foot exams, kidney function tests, dental examinations, and screening for heart diseases. Getting blood pressure checked every three to six months is also essential. Moreover, any sudden change in skin colour, numbness, or swelling can also be a sign of diabetes. One must keep the endocrinologist updated about these changes.

Diagnosis

• Physical Examination

Typically, an endocrinologist can diagnose diabetes type 1 and type 2 by observing the signs and symptoms. However, a physical check-up ensures further detection of the type properly. Also, anyone over the age of 35 must undergo regular blood sugar screening to ensure normal results.

Diagnostic Tests

1. Blood Tests

Blood glucose test is the preliminary and most effective diagnosis for detecting diabetes. It can be done in two ways. A random blood sugar test is done by collecting blood samples at any random time. The individual does not need to fast for this test. Ideally, detecting a sugar level of 200mg/dL or higher confirms diabetes.

2. Fasting Blood Sugar Test

The other type is a fasting blood sugar test, where an individual must fast for at least 8-10 hours before the sample collection. Fasting blood sugar levels lower than 100mg/dL is the normal standard. If the sugar level falls between 100 and 125mg/dL, one can be considered prediabetic. A level of more than 126mg/dL on two different tests confirms diabetes.

• Oral Test

There is also an oral test for glucose tolerance for testing diabetes. It measures the body’s response to glucose and is a more effective method of diagnosing type 2 diabetes. The test is also used for screening gestational diabetes during pregnancy. In simple terms, the test helps the endocrinologist understand how the body breaks down the glucose after a meal. For testing for type 2 diabetes, one is required to drink 237ml or eight ounces of a syrupy glucose solution. The blood sugar level will then be measured after two hours.

• Advanced Tests

1. Glycated Haemoglobin (HbA1C) Test

The glycated haemoglobin or HbA1C test is an advanced form of diagnosis which does not require an individual to fast. This test finds the average blood sugar in the last two to three months. This test detects the blood sugar attached to the haemoglobin particles, which carry oxygen to the red blood corpuscles (RBCs). A higher number in this test confirms more haemoglobin molecules are attached to the blood glucose. Ideally, an HbA1C level of 6.5% or higher confirms diabetes, while a range of 5.7%-6.4% is seen in prediabetic people. Anything below 5.7% confirms normalcy.

Treatment

• Home Care

There are plenty of ways to manage diabetes at home if an individual is not too keen on medication. 

1. Healthy Diet: One of the primary things to do in case of diabetes is to control diet. Eating more fruits and vegetables and eating a high-protein diet is a good start. It is better to avoid refined carbohydrates altogether. Also, one should try consuming whole fruit instead of packaged juice and always check the labels on food packaging to avoid hidden sugar. 
2. Weight Loss: You would be surprised to know that losing just about five to 10% of body weight can produce remarkable results in controlling diabetes. Losing unnecessary weight and fat would also help an individual better manage the cholesterol levels and blood pressure. This, in turn, will help avoid further heart complications. 
3. Exercise: Being inactive is a primary cause of diabetes. So, the first thing one needs to do is include at least 30 minutes of exercise every day. It can be a brisk walk, jogging, cycling, swimming, or going to the gym. 
4. Regular Blood Sugar Test: Whether and individual takes medication or not, the doctor will always advise him/her to keep a tab on the blood sugar levels. Regular testing with home kits can give a better idea about the patterns. For instance, it would be easier for the individual to tract which activities lower his/her blood sugar level or which food raises it. This can further help in chalking out a clear guideline. 
5. Better Sleep Cycle: A damaged circadian rhythm can aggravate diabetes. Restful sleep is the best way to ensure the insulin and blood sugar levels stay normal. Also, it is better to avoid alcohol, caffeine, and spicy foods for these consumables jeopardise a healthy sleep. If a person suffers from sleep apnoea, he/she can consult a doctor. Usually, it can be a side-effect of type 2 diabetes and can be improved using a CPAP machine.

Medication

Depending on the severity of the condition, it is usually better to opt for medication. Home remedies for diabetes are more of a lifestyle choice and should be included in addition to controlling or avoiding the development of diabetes. But once the condition is developed and severe, insulin therapy is the only feasible solution to keep it under control.

1. Intensive Insulin Therapy: The human body cannot produce insulin on its own, in the case of type 1 diabetes.

Fortunately, insulin is an easily availble medication for people affected with type 1 diabetes. Insulin is injected under the skin or directly injected into the bloodstream. There are many types of insulin also. Only an endocrinologist can confirm which type of insulin will work best for the diabetic person. However, insulins can be categorised into the following types:

• Short-acting insulin 
• Rapid-acting insulin
• Combination or premixed insulin
• Ultra-long-acting insulin

2. Amylinomimetic Injectables: The drug category amylinomimetics is used for treating type 1 and type 2 diabetes. It is given to patients in whom insulin is ineffective. The medication slows the time taken by the stomach to empty itself and reduces the secretion of glucagon post-meal. The medicine is known to curb appetite also.

3. Alpha-glucosidase Inhibitors: Alpha-glucosidase inhibitors inhibit the carbohydrate-digesting enzymes in the small intestine, reducing carbohydrate absorption. This includes the controlling of enzymes like sucrase, glucoamylase, isomaltase, and maltase. It is best to consume alpha-glucosidase prior to meals.

4. Biguanides: Biguanides reduce the production rate of glucose as well as the absorption of glucose in the intestine. Instead, these help in the absorption of glucose by the muscles, making the body more reactive to insulin medication.

• Surgical Treatment

In case of severe diabetes and other diabetic complications arising, there are a few treatment options available.

1. Bariatric Surgery: Bariatric or weight-loss surgery is an effective treatment method for diabetes type 2 patients. It helps obese people with a higher BMI by controlling the sugar level in the blood. The most common type of bariatric surgery is the duodenal switch, which can help reduce the risk of diabetes from worsening or causing severe complications.
2. Pancreas Transplant: For severe cases of insulin-dependent diabetic patients, often pancreas transplant is the only solution. Since the pancreas fails to produce insulin in the case of type 1 diabetes, this can help patients as their body once again can produce its own insulin.
3. Islet Transplant: The islet cell transplant is most effective for treating type 1 diabetes patients. The treatment helps reduce the occurrence of hypoglycaemia, where the glucose level reduces significantly in the blood.

Risk and Complications if Left Untreated

• Cardiovascular Complications

If left untreated, diabetes can increase the risk of atherosclerosis. This is a condition where the blood vessels become narrow, causing chest angina, heart attack, and even stroke.

• Retinopathy

Atherosclerosis is also associated with multiple complications, such as diabetic retinopathy. This can cause permanent blindness.

• Neuropathy

Diabetic neuropathy or nerve damage is common in diabetes patients. Due to the high glucose level in the blood, nerves throughout the body can be damaged. But the most prominent outcome is seen in the lower limbs, such as the feet and legs.

• Nephropathy

Shrinking of the blood vessels also impacts the kidneys, which have tiny glomeruli to filter waste from the blood. Since people with diabetes have a fragile filtering system, the high level of ketone can cause further problems, damaging the kidney permanently.

• Alzheimer’s Disease

Cognitive decline is highly prevalent in diabetes patients. Adult patients with type 2 diabetes are most susceptible to Alzheimer’s, while type 1 patients are likely to develop dementia.

Additional Information

• Stages of Type -1 Diabetes

Both Type 1 and Type 2 diabetes have been known to develop in the following stages:

1. Stage 1 defines the presence of β-cell autoimmunity with two or more islet antibodies with normoglycemia
2. Stage 2 develops with dysglycemia 
3. Stage 3 confirms the onset of symptomatic diabetes

• Effect of Smoking on Diabetes

Controlling diabetes can become even more challenging if an individual has a smoking habit. This is due to nicotine which can raise the level of blood sugar. Smokers tend to require a higher dose of insulin to keep their blood sugar levels in check.