Diabetes Mellitus (DM), The Silent Killer
In this article we will understand the chronic disease diabetes mellitus (DM), metabolic disorder, blood sugar, prediabetes, diabetes diagnosis, diabetes causes, diabetes symptoms, type 1 diabetes, type 2 diabetes and insulin resistance. Diabetes Mellitus commonly known as Diabetes is a Silent Killer. If remained unmanaged, it brings-in some serious complications along which ultimately may lead to death. In DM the blood sugar level is elevated from its normal range. To clarify, if a person has recurrent or persistent high blood sugar, we would say the person is Diabetic.
Diabetes is Dangerous
DM is a Chronic disease and unfortunately there is no known diabetes cure of it in medical; at least past studies keep demonstrating that. However recent studies have shown that we can cure diabetes type 2 which can be reversed in early ages and in very specific situations following a highly strict life style. I have explained this in my other post Diabetes cure is a reality now. To clarify, for them who do not know what a chronic disease exactly, it is a disease that comes with time and keep persistent. In medical terms, if a disease lasts for more than three months, it could be classified as the chronic disease. DM is a dangerous lifelong condition that causes a person’s blood sugar level to become persistently too high.
Diabetes mellitus (DM) is a group of metabolic diseases in which the blood sugar levels remain high over a prolonged period. If left untreated, It can cause many complications. For example, few of the acute complications are diabetic ketoacidosis, nonketotic hyperosmolar coma, kidney diseases, heart disease, heart attack, stroke or death. While serious long-term chronic complications include kidney failure, Arthritis, heart attack, stroke, blindness and death.
Prediabetes is a condition in which people have blood sugar levels above the normal range, but not high enough to be diagnosed as having diabetes. So if your blood sugar level is above the normal range, your risk of developing full-blown diabetes is increased.
It is very important have your diabetes diagnosis done as early as possible because once it starts, it will get worse and worse progressively, if left untreated.
There could be two conditions associated with Diabetes
A. Hyperglycemia (High Blood Glucose)
In diabetes mellitus when the body being unable use (insulin resistance) or to produce any, or enough, insulin to regulate the blood sugar, the blood glucose levels may become very high. To clarify, Insulin is a hormone required to move glucose out of your bloodstream into your cells to produce energy. Hyperglycemia is when the blood sugar level becomes too high. Though the symptoms of Hyperglycemia are similar to the symptoms of common diabetes, but they may appear as of sudden and could be more severe.
Above all, if Hyperglycemia left untreated it can lead to diabetic ketoacidosis, a dangerous situation in which the body starts breaking-down the fat and muscle as an alternative source of energy. Consequently this process leads to a build-up of acids in blood stream causing vomiting, dehydration, unconsciousness and death.
B. Hypoglycemia (Low Blood Glucose)
If a person has type 1 diabetes and has to live on Insulin, sometimes too much intake of insulin can lead the blood glucose levels to become very low. This condition is known as Hypoglycemia (or a “Hypo”). a Hypo is triggered when the insulin injected in your body moves out too much glucose out of your bloodstream.
Though mostly a Hypoglycemia occurs as a result of taking too much insulin but it can also be triggered by some other reasons such as drinking alcohol having empty stomach, doing lot of uncontrolled exercise or skipping your meal.
Metformin overdose can also lead to hypoglycemia. To clarify, Metformin is the medication prescribed by American Diabetes Association (ADA) to improve blood sugar level in type 2 diabetes patients. Metformin also helps in reducing the insulin resistance and to prevent from other DM complications such as kidney failure, heart attach, blindness, stroke and cardio vascular diseases.
Remember, a diabetic has to be on a very strict diabetic diet but can never miss the meal for long. Try to take your meal in chunks in short time intervals rather than to fill your stomach at one time and then not eat anything for another 6 hours or so.
Symptoms of a Hypoglycemia include:
- Sweating on head area
- Feeling week, shaky and irritated
- Feeling very tired
- Tingling lips
- Feeling confused
- Increased hunger
- Nausea feeling to vomit or vomiting
- Slow healing of cuts and grazes
However, a hypo situation can be brought under control simply by eating or drinking something sugary.
A Hypoglycemia if doesn’t brought under control can cause confusion, slurred speech, unconsciousness and eventually death. However, an emergency injection of a hormone called Glucagon is required in this condition to increases the glucose level in blood.
A person diagnosed with DM whether Type 1 or Type 2 diabetes must have to concentrate on keeping blood sugar levels as close to normal as possible. But at the same time without causing the blood sugar going low. Above all, it require a permanent change in life style and must include healthy diet, good amount of exercise, losing weight, eat healthy foods, and the prescribed medicine. Because the most responsible causes of getting one with DM are weight gain, lack of regular exercise, high cholesterol levels, smoking, obesity and high blood pressure.
There are several ways for diabetes diagnosis so we can check if a person has prediabetes or diabetes given below.
1. Fasting Plasma Glucose Test (FPGT)
This is the most recommended test to check Prediabetes and Diabetes. Though in most of the cases this single test is enough to check for Prediabetes and Diabetes. To clarify, Fasting Plasma Glucose Test is commonly referred to as Fasting Blood Sugar. The test is done when your stomach is empty for 8-9 hours.
Normal – If blood glucose level is between 70 mg/dL and 100 mg/dL
Prediabetes – If blood glucose level is between 100 mg/dL and 126 mg/dL
Diabetes – If blood glucose level is more than 126 mg/dL
Impaired Fasting Glucose (IFG) – This is another term for Prediabetes when the Prediabetes is diagnosed with FPGT (Fasting Plasma Glucose Test).
According to WHO (World Health Organization) People with fasting glucose levels from 6.1 to 6.9 mmol/l (110 to 125 mg/dl) are considered as Prediabetic also known as Impaired fasting glucose (IFG).
Prediabetes refers to a condition in which the fasting blood glucose level is being elevated consistently than the normal levels; however, it is not high enough to be diagnosed as DM. This is the alarm and time to take precautions and change your life style.
2. Oral Glucose Tolerance Test (OGTT)
The doctor will test your blood glucose level at the beginning when your stomach is empty for 8-9 hours. This involves the same FPGT process as described above.
Then, the doctor will give you a drink of 75 gm Glucose mixture which is a very high sugary dose. Then your blood glucose level is measured again after two hours. To sum up, objective of this test is to check Glucose tolerance level of your body.
Normal – If blood glucose level is less than 140 mg/dL
Prediabetes – If blood glucose level is between 140 mg/dL and 199 mg/dL, two hours after drinking the glucose mixture
Diabetes – If blood glucose level is above 200 mg/dL in an OGTT, two hours after drinking the glucose mixture
If a person has plasma glucose above 7.8 mmol/l (140 mg/dl), but less than 11.1 mmol/l (200 mg/dl), two hours after a 75 g oral glucose dose, it also indicates the sing of Prediabetes and known as Impaired Glucose Tolerance. (IGT).
3. Hemoglobin A1C (HA1C or Glycated hemoglobin Test)
This is also called Average Blood Sugar test and shows the average blood sugar level for past 3 months.
Normal – If HA1c level is less than 5.7%
Prediabetes – If HA1c level is between 5.7% and 6.4 %
Diabetes – If HA1c level is more than 6.4%
However, if a result is found positive, it must be checked with some repeated tests of any of the above methods on a different day. The most common and accurate way is to do some repeated Fasting Blood Sugar tests. Normally if fasting sugar level is more than 126 mg/dl (7.0 mmol/l) in two consecutive tests on different days, considered it diagnostic for diabetes mellitus.
So we have seen that there are two possible conditions of being Prediabetes i.e. Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance. (IGT). Out of these two the latter in particular is a major risk factor for progression to full-blown DM as well as cardiovascular disease. This shows the increased level of insulin resistance in body cells.
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Causes of Diabetes Mellitus
Our body tissue cells get energy from glucose. Glucose is circulated through blood to the body tissue cells in our body. Then insulin is required as a catalyst in the process of breaking down of glucose as energy into cells. When food gets digested and enters into bloodstream, insulin hormone moves the glucose out of blood into cells, where it is broken down to produce energy to cells.
When there is no insulin available (Type 1) or our tissue cells start resisting insulin (Type 2), the blood glucose remain unused in blood. This increases the level of glucose in Blood.
While in case of Type 1 diabetes, a person has to take insulin to live but Type 2 is most often caused by being overweight and can be controlled by lifestyle change, taking healthy food and doing regular exercise.
There are many unhealthy foods which increases insulin resistance in our body and causes diabetes. To sum up, we should avoid high carb, high sugar and high omega-6 foods. To clarify, Omega-6 is bad fat which increase inflammation in cells making them insulin resistance. Instead, Choose Omega-3 foods which is a good fat and decreases insulin resistance in our body cells.
Symptoms of Diabetes Mellitus
When glucose level increases in our blood stream, our body tries to reduce blood glucose levels by getting rid of the excess glucose in your urine which leads to the most common symptoms of diabetes.
Typical symptoms of Diabetes Mellitus include:
- Passing urine more often than usual, especially at night
- Feeling very thirsty and dry throat
- Feeling very tired because cell tissues are not able to convert glucose into energy
- Weight loss
- Loss of muscles
- Blurry vision
Types of Diabetes Mellitus
Though main types of diabetes include Type 1 and Type 2 but there could be few other types of DM. So lets understand all the possible types step by step.
A. Diabetes Mellitus Type 1 Commonly Known as Type 1 Diabetes
In Type 1 diabetes the body’s own immune system attacks and destroys the cells which produce insulin . In this process the beta cells of Pancreatic islets in pancreas (responsible for insulin production) are burnt out and got dead. This leads the insulin deficiency in patient. In this type of diabetes not enough insulin is produced by the pancreas and this lack of insulin results in high blood sugar levels.
A.1. Diagnosis of Type 1 Diabetes
Type 1 diabetes can be diagnosed by blood sugar test or A1C. Type 1 may be distinguished from type 2 by autoantibody test. An autoantibody is an antibody (a type of protein) produced by the immune system that is directed against one or more of the individual’s own proteins.
A.2. Prevention and Cure of Type 1 Diabetes
Unfortunately there is no way to prevent type 1 diabetes. The person with Type 1 must have to take insulin from external sources to live. Insulin is usually given by injection just under the skin but can alternatively can also be delivered by an insulin pump.
Type 1 diabetes is not a common type of diabetes and makes up an estimated 5–10% of all cases. Type 1 can develop at any age, but usually appears before the age of 40, particularly in childhood.
A.3. Causes of Type 1 Diabetes
Type 1 diabetes occurs as a result of the body being unable to produce insulin which leads the increased blood glucose level. Without insulin, your body will break down its own fat and muscle, resulting in weight loss. This can lead to a serious short-term condition called diabetic ketoacidosis, where the bloodstream becomes acidic and you develop dangerous levels of dehydration.
In Type 1 our body’s own immune system (The body’s natural and required defense system against infection and illness) mistakenly assumes beta-cells of our pancreas as a harm for our body. Then naturally our body’s immune system attacks beta-cells and burns out them. This situation could arise due to any illness or infections.
B. Diabetes Mellitus Type 2 Commonly Known as Type 2 Diabetes
While Type 1 is characterized by the stopped or less production of insulin by the pancreas due to burnt out of beta cells of Pancreatic islets in pancreas (responsible for insulin production), the Type 2 Diabetes Mellitus is characterized by insulin resistance by the body tissue cells. It may also be combined with relatively reduced insulin production. In this condition the insulin receptors in our body resist to use the insulin.
In the early stage of type 2 diabetes , our body starts losing insulin sensitivity in our body tissue cells. This situation can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce the liver’s glucose production.
B.1. Causes of Type 2 Diabetes Mellitus
The main reason of Type 2 diabetes is our urban and inactive lifestyle, weigh gain (obesity), lack of physical activity, lack of exercise, poor diet and stress. Sometimes it could be genetic as well.
Consumption of sugar-sweetened drinks too much is also one of the factors behind being diabetic . Eating lots of white rice also may increase the risk of DM.
A lack of exercise and being obese is a definite invitation to diabetes type 2.
In medical terms, DM type 2 is a long term metabolic disorder characterized by high blood sugar, insulin resistance, and relative lack of insulin.
Type 2 diabetes is the most common type of diabetes. Among all diabetes cases, around 90% are diabetes type 2.
C. Gestational diabetes
This is a special type of short term diabetes which has almost same symptoms as of type 2 diabetes. Gestational diabetes occurs in women during pregnancy.
It occurs in about 2–10% of all pregnancies cases and is fully treatable, but requires careful medical supervision throughout the pregnancy. Management may include dietary changes, blood glucose monitoring, and in some cases, insulin may be required.
Though it may disappear after delivery in most cases but sometimes in 5-10 % cases it can be changed to type 2 diabetes in women after delivery.
Untreated gestational diabetes can damage the health of the fetus or mother.
D. Other Types of Diabetes
Though not very common but there could be few other types of diabetes given below.
D.1. Type 3 diabetes
It is a type of dementia which causes problems with your memory, thinking and behavior. It has been suggested as a term for Alzheimer’s disease. Symptoms of it usually develop slowly and get worse over time. It is a progressive disease that destroys memory and other important mental functions
D.2. Diabetes Insipidus
It is a rare condition in which the kidneys become unable to prevent excretion of water. Diabetes Insipidus has similar symptoms to common DM, but without disturbances in the sugar metabolism. It is characterized by when a person’s kidneys pass an abnormally large volume of urine that which is insipid, dilute and odorless.
Comparison of Symptoms of Type 1 and Type 2 Diabetes
Though most of the symptoms in Type 1 diabetes and Type 2 diabetes are common but in case of type 1, they typically develop over a short period of time.
In young people and children the symptoms of type 1 usually appear very quickly may be over a few weeks or even few days in some cases. While in adults, the symptoms often take longer to develop may be a few months or even few years.
Type 2 diabetes mostly occurs as a result of obesity and not doing regular exercise. Typically the type 2 attacks in middle or old age but due to our inactive lifestyle and unhealthy eating habits it is increasing in young people too. A person with Type 2 is like to live a 10 years shorter life.
As the symptoms of both the major types of DM are mostly common we can measure few other factors to characterize the Type 1 and Type 2 diabetes. The comparison chart below should add help understanding the difference.
|S.No.||Feature||Type 1 Diabetes||Type 2 Diabetes|
|1||Occurrence of symptoms||Quick or Sudden||Slow and gradually|
|2||Age of symptoms occurrence||Mostly in childhood||Mostly in adults|
|3||Person Body size||Thin or normal||Overweight|
|4||Ketoacidosis||Very common||Very rare|
|6||Insulin Production||Absent or very low||Decreased, Increase|
Complications of Diabetes Mellitus
All forms of diabetes bring-in dangerous complications along with. Generally the complications appear in a long time of span but they will come for sure if it left unmanaged and untreated. But if you do not get your diabetes diagnosed in early stage, then your diagnosis can start from the occurrence of these complications itself and it is too late now to manage the damage. So it is recommended that you get your regular health checkups if you are above 30 and overweight. Not all but most possible complications include
If left untreated, diabetes cause damage to small blood vessels which eventually leads to damage to the eyes, kidneys, and nerves.
1. Damage to the kidneys
Damage of small blood vessels in kidneys also known as diabetic nephropathy, can lead to tissue scarring. Loss of protein in urine and eventually chronic kidney disease sometimes require dialysis or kidney transplant.
Damage to the eyes, known as diabetic retinopathy, gradual vision loss and blindness.
2. Cardiovascular disease
About 75% of deaths in diabetics are due to coronary artery disease.
3. Stroke and peripheral vascular disease
4. Nerve damage (neuropathy)
Body nerves get damaged which is serious conditions also known as diabetic neuropathy. Symptoms include tingling, numbness and pain which can lead to damage to the skin.
5. Alzheimer’s disease.
6. Foot problems
7. Loss of muscles and weakness.
When to See a Doctor
If you feel few or all of the below symptoms, this is an alarming situation and is the time to immediately visit your doctor. feeling very thirsty
- Frequently urination than usual, particularly at night
- Weight loss
- Increase thrust
- Feeling very tired
- Loss of muscle bulk
- Slow healing of cuts or wounds
- blurred vision
Prevention and Treatments of Diabetes Mellitus
Type 1 diabetes is nor preventable nor curable. The person with type 1 has to live with insulin intake following the ideal changed lifestyle for diabetic patients.
There are two ways a person with Type 1 can intake insulin
Injecting Insulin Directly – with the help of injection, the most common way to get insulin.
Using Insulin pump therapy – Not very common. A small device constantly pumps insulin into your bloodstream through a needle. The needle is inserted under the skin and amount of insulin to pump can be controlled.
Type 2 diabetes can however be prevented or even reversed by doing regular physical exercise, maintaining a normal body weight and following a healthy diabetic friendly diet.
I will cover how to prevent and reverse diabetes in my next exclusive post “How to Reverse Type 2 Diabetes”.
To summarize, a person with diabetes has to follow the below lifestyle and food habit changes.
- Stop or limit intake of sugary beverages
- Higher levels of physical activity and regular exercise. It reduces the risk of diabetes by 28%.
- Change your food habits and follow a healthy and diabetic friendly diet which is rich in fiber. Consume only good fats i.e. polyunsaturated fats fish and some nuts.
- Quit smoking
- Stop or limit eating sources of saturated fat producing foods such as red meat, oil and ghee etc.
Treatments Medications for Diabetes Mellitus
DM treatment means keep your blood sugar managed and under control. There are a number of different anti-diabetic medications.
1. Treatment of Diabetes Type 2
For treatment of Type 2 , the most recommended medication is Metformin, taken orally. There are good evidence that the Metformin decreases rate mortality. Metformin decreases the production of glucose in liver. Other available medication is GLP-1 agonists taken through injection.
2. Treatment of Diabetes Type 1
Type 1 can only be treated with insulin intake.
3. Surgery to cure Diabetes Mellitus
Not very often but sometimes a pancreas transplant may be considered for people with type 1 DM who have severe complications of disease. The transplant is subject to availability of islet cell from the pancreas of a deceased donor.
In obese people the weight loss surgery can also aid a help in preventing risk of type 2 DM.
Remember, never ignore diabetes. If left unmanaged or untreated, it can cause a number sever complications which eventually lead to death. Ignoring means, you are going to die 10 years before your potential age to die.
4. Diabetic Eye Screening
Person having diabetes is on high risk of being blind due to diabetic retinopathy. Everyone with diabetes must get his eyes screened once a year.