Diabetes


Overview of Diabetes

  • Diabetes Mellitus: A disorder of carbohydrate metabolism due to impaired insulin production/response, characterized by elevated blood glucose levels.

  • Chronic disease impacting various body systems and leading to complications over time (heart, blood vessels, eyes, kidneys, nerves).

Blood Glucose Regulation

  • Insulin:

    • Produced by the pancreas, facilitates glucose uptake into cells for energy.

    • In diabetes, insufficient or ineffective insulin leads to high blood glucose levels.

  • Glucagon:

    • Hormone secreted by the pancreas in response to low blood glucose; stimulates liver glycogen breakdown and gluconeogenesis.

Categories of Diabetes

  1. Type 1 Diabetes (T1DM):

    • Autoimmune disease destroying insulin-producing beta-cells.

    • Requires daily insulin supplementation.

    • Typically diagnosed in children and young adults.

  2. Type 2 Diabetes (T2DM):

    • Characterized by insulin resistance and progressive beta-cell dysfunction.

    • Often associated with lifestyle factors, prevalent in adults.

    • May involve treated with lifestyle modifications and medications.

  3. Gestational Diabetes:

    • Occurs during pregnancy; leads to insulin resistance due to hormonal changes.

    • Can affect both mother and child.

  4. Prediabetes:

    • Intermediate stage where blood sugars are elevated but not high enough for diabetes diagnosis.

Diagnosis of Diabetes

  • Blood Glucose Levels:

    • Fasting Plasma Glucose (FPG):

    • Diabetes: ≥7.0 mmol/L

    • IGT: <7.0 mmol/L and ≥7.8 mmol/L < 11.1 mmol/L

    • Oral Glucose Tolerance Test (OGTT):

    • Diabetes: 2 hour plasma glucose ≥11.1 mmol/L

  • HbA1c Test:

    • Measures average blood glucose levels over 2-3 months.

    • Normal: less than 39 mmol/mol, Diabetes: ≥48 mmol/mol.

Symptoms of Diabetes

  • Common Symptoms:

    • Type 1: Extreme thirst, weight loss, frequent urination, fatigue.

    • Type 2: Often less acute; includes fatigue, excessive thirst, blurred vision, and possible neuropathy.

  • Mechanism of Symptoms: Elevated glucose leads to dehydration (frequent urination) and energy usage disruption, manifesting as fatigue and increased hunger.

Risk Factors for Type 2 Diabetes

  • Key Risk Factors:

    • Obesity and high waist circumference.

    • Lack of physical activity.

    • Family history of diabetes.

    • Age (risk increases over 40 years of age).

  • Other Considerations: Ethnicity, history of gestational diabetes, high blood pressure/cholesterol.

Complications of Diabetes

  1. Microvascular Complications:

    • Retinopathy: Affects vision; increased risk of cataracts and glaucoma.

    • Neuropathy: Nerve damage leading to pain or loss of sensation in pregnancy.

    • Nephropathy: Kidney disease due to damaged blood vessels.

  2. Macrovascular Complications:

    • Increased risk of coronary heart disease, strokes, and peripheral vascular disease due to atherosclerosis.

Management of Diabetes

  • Type 1 Diabetes Management:

    • Insulin therapy (injections or pump).

    • Regular blood glucose monitoring.

    • Carb counting and dietary management.

  • Type 2 Diabetes Management:

    • Lifestyle changes: balanced diet, regular physical activity, weight management.

    • Medications if lifestyle changes are insufficient (e.g., Metformin, Sulfonylureas).

Prevention of Diabetes

  • Strategies:

    • Maintain healthy weight, engaging in physical activity, and adopting a balanced diet rich in fiber while limiting processed foods.

  • Regular health check-ups to monitor blood glucose levels are recommended to prevent progression to diabetes.