Diabetes: Types, Symptoms, Causes & Risks, Diagnosis, Treatment & Prevention

A research paper in 2011 stated that the estimated number of people suffering from diabetes was 51 million in 2009. According to a report by the International Diabetes Federation, in 2021, around 537 million people between the age of 20 to 79 years live with diabetes globally, out of which nearly 90 millions are from South East Asia.

Introduction

Diabetes is a very common metabolic disorder that causes build-up of excessive sugar in the blood that further causes damage to various organs. Normally, in a healthy individual, the sugar present in the blood acts as a source of energy, and it is regulated by a hormone called insulin, which is produced by the pancreas.

However, among the diabetics, either there is a problem with the production of insulin, or there is insensitivity against the produced insulin that leads to excessive build-up of sugar in blood causing hyperglycaemia.

Types

There are primarily three types of diabetes on the basis of disease development:

1. Type 1 Diabetes: It is usually seen in young patients, and thus also called juvenile diabetes. It is primarily an autoimmune condition in which antibodies are formed and directed against the beta cells of pancreas producing insulin. The damage to the cells decreases the amount of insulin in blood causing severe rise in the blood sugar levels. It comprises 10% of all the diabetes cases.

2. Type 2 Diabetes: This is a condition that can be genetic as well as acquired and is usually seen in the adult population. Here, there is no damage to the pancreas, and the level of insulin in the blood is also normal, but the cells become insensitive to insulin causing an increase in sugar levels in the blood. This forms about 90-95% of all the diabetes cases.

3. Gestational diabetes: This is found among pregnant women due to hormonal fluctuations in their bodies. Though this condition usually regresses on its own once the pregnancy is over, the female becomes predisposed to developing type 2 diabetes later in life.

** Pre-diabetes is a condition where the sugar levels in the blood are at the borderline levels for development of diabetes but not enough to diagnose it:

1. HbA1C levels are between 5.7-6.4%
2. Fasting blood sugar is between 100-119 mg/dl 
3. Post prandial sugar is between 140-199 mg/dl

** Diabetes insipidus although seems to be related to diabetes but is a completely different health condition where due to deficiency in ADH, there is excessive urination and has nothing to do with blood sugar levels.

Symptoms

Common symptoms seen in all the types of diabetes are:

1. Frequent urination
2. Increased thirst
3. Increased hunger
4. Weight loss
5. Fatigue
6. Decreased healing of wounds
7. Frequent UTIs in women
8. Blurring of vision
9. Dry and itchy skin in women
10. Decreased libido in men
11. Tingling sensation in the extremities of body

Causes and Risk Factors 

For type 2 diabetes mellitus:

1. Family history
2. Obesity
3. Hyperlipidemia
4. Hypertension
5. Increased age
6. PCOS in females
7. Gestational Diabetes
8. Smoking and alcohol intake 

For type 1 diabetes:

1. Autoimmune diseases 
2. Trauma to pancreas 
3. Viral diseases 
4. Genetic predisposition 

Hormonal fluctuations and weight gain during pregnancy are the risk factors for gestational diabetes.

Complications

High levels of sugar for a very long period of time can cause severe damage to various organs like:

1. Eye damage causing cataract, glaucoma and retinal damage.
2. Nerve damage causing tingling sensations in fingers and toes.
3. Kidney damage causing decreased GFR and proteinuria.
4. Poor healing sores and increased secondary infection on them.
5. CVS diseases like heart attack , stroke , hypertension, etc.
6. Repeated UTI and skin infections.
7. Mental disorders like dementia and depression.

Diagnosis

The primary approach of diagnosis is to measure the free circulating glucose in the blood by taking the fasting blood sugar (before food consumption) and post-prandial or PP blood sugar (after food consumption) along with measuring the levels of glycated sugar in the blood.

For confirmatory diagnosis, the levels have to be:

1. Fasting blood sugar of more than 120 mg/dl 
2. Post prandial sugar of more than 200 mg/dl 
3. HbA1C (Glycated haemoglobin) of more than 6.4%

In case of type 1 diabetes, besides these, the presence of autoantibodies against pancreatic cells are checked in the blood with the presence of ketone bodies in the urine.

In addition to these, various other tests to check the lipid profile, kidney function, eye sight, etc. are also done.

Treatment 

The aim of the treatment is to bring the sugar levels within the normal range either by medications, hormones or lifestyle changes.

1. For type 1 diabetes, the need for insulin is very high. So, usually insulin pumps and injections are used.
2. For type 2 diabetes, medications increasing the sensitivity of cells towards the insulin are given, such as metformin, sitagliptin, glitazones, etc.

Along with medications, regular exercise and healthy lifestyle changes are advised.

Prevention

Although type 1 diabetes cannot be prevented, the risk of type 2 diabetes can be reduced by lifestyle modifications. Maintaining a healthy weight, consumption of healthy food with less fats and regular physical activity helps in maintaining good pancreatic functioning as well as insulin sensitivity.

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