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Diabetes ClearlyExplained.Com

Diabetes

ClearlyExplained.Com

14th May 2007

by Dr. Pradeep Bhandari M.B.B.S., M.MED

A straightforward and fast information
guide to diabetes from ClearlyExplained.Com

Image: Sugar (crystals) is the the most signficant factor in Diabetes.
image credit: R.Conan-Davies

What is diabetes?

Diabetes Mellitus, or just ‘diabetes’, as it is generally called, is a chronic medical condition in which the blood glucose level is abnormally high due to the inability of the body to use it for energy. It affects over 150 million people around the world. Many more who have the disease are not even aware that they have diabetes. The number of people suffering from diabetes is increasing so rapidly that it is even referred to as an epidemic.

Diabetes Mellitus must not be confused with ‘diabetes insipidus’, which is a disease where the body is unable to retain excess water due to the lack of a hormone made by the pituitary gland in the brain.

The hyperglycaemia in diabetes is the result of either complete absence or the lack of utilisation of insulin, a vital hormone produced in the pancreas that helps in the intake of glucose into the cells. A fasting blood glucose level between 100 and 125 mg/dl, or a two-hour postprandial level between 140 and 199 mg/dl is considered pre-diabetes, where as a fasting level of 126mg/dl or higher, or after a meal a level of 200 mg/dl or higher is considered definitely diabetes.

Symptoms

Some of the early symptoms of untreated diabetes mellitus include frequent urination and the consequent excessive thirst and dehydration, excessive hunger, fatigue, weight loss, blurred vision, and itchy skin and genitals that are also prone to minor infections that heal slowly.

What
Why
News
How
History
Future

Why is diabetes important?

Managing diabetes effectively is extremely important not just for the sufferer because of the cost of treatment and the disability or death that it can lead to, but is also of paramount significance to the nation as it consumes a significant amount of healthcare resources. For an example, approximately 5% of the total health expenditure in Britain is spent on diabetes and its management alone.

Prevalence of diabetes

The global prevalence of diabetes is estimated at 6% of the adult population in the world. A rise of 122% is projected for the year 2025 as compared to that in 1995. Rapid urbanisation and industrialisation has contributed to the prevalence of diabetes due to factors such as obesity, unhealthy diets and sedentary lifestyles.

Complications of diabetes

Complications due to diabetes include:

• blurred vision due to macular degeneration that can eventually lead to blindness;
• tingling, numbness and weakness of the extremities due to nerve damage;
• repeated infections due to impaired immune system;
• atherosclerosis with subsequent risk of heart attack and stroke;
• neuropathy; and,
• kidney failure.

News about diabetes

Diabetes is often reported in the press, particularly in relation to new treatments.

• Google News Search - Diabetes
• Yahoo! News Search - Diabetes

Some reliable and user-friendly information on diabetes can be obtained from the following websites:

• Diabetes UK
• American Diabetes Association
• Information about Diabetes
• Patient Health International
• British Medical Journal
• Canadian Diabetes Association

How does diabetes occur?

The exact cause of diabetes is unknown, although a number of factors that include genes, as evidenced by the hereditary predisposition towards the disease, and environmental issues such as lack of exercise and obesity, seem to play important roles in the development of this condition. The damage to the pancreas in Type 1 diabetes is thought to be of auto-immune nature that is sometimes triggered by a viral or other infection.

Blood glucose is tightly regulated by the hormone insulin produced in the pancreas in response to the rise in glucose level in the blood. Insulin lowers the glucose by transporting it into the cells where it can be utilised as energy.

Long term deficiency of insulin not only causes the body to be starved of energy with consequent decline in health, but the high level of glucose in the blood also leads to damage of the end organs such as eyes, heart, kidney and nerves.

In Type 1 diabetes, there is an absolute lack of insulin due to destruction of insulin producing cells in the pancreas, where as in Type 2 it is the resistance towards the available insulin that causes clinical symptoms of the disease.

Accordingly, Type 1 patients need insulin injections for life, where as Type 2 patients generally need oral tablets that help utilisation of available insulin, and sometimes insulin on top of that temporarily, in addition to a healthy lifestyle and eating habit for both the types.

The risk of diabetes is more for those over 40 years of age, especially for those of South Asian origin, and for those over 25 if they are of Afro-Caribbean origin. The risk is also high if someone has a close member of the family with Type 2 diabetes, and is overweight, has a high blood pressure, or a history of heart attack or stroke. Other factors that increase the risk of diabetes include women with polycystic ovaries, people with impaired glucose tolerance, high serum triglyceride level, and severe mental health problems. Uncontrolled gestational diabetes can result in a large baby and a difficult birth. It can also increase the risk of developing type 2 diabetes later in life.

Treating Diabetes

There is no cure for diabetes, but it can be successfully controlled with appropriate measures. Treatment for diabetes is aimed at controlling the blood glucose and bringing it to a near normal level. This means a strict healthy diet devoid of fat, salt and sugar, and with high fibre, regular exercise and weight reduction.

Insulin injections are vital for Type 1 diabetes and oral hypoglycaemic, with or without insulin as necessary for Type 2 diabetes. Type II diabetics become insulin resistant in course of time, and although the body produces insulin, it is can not be effectively used.

They may thus need insulin later on. Oral hypoglycaemic agents also help the body become more receptive to insulin when it is required. Some of the commonly used oral anti-diabetic drugs are: Sulfonylurea, Meglitinides, Biguanides and Alpha-Glucosidase Inhibitors.
Gestational diabetes generally requires healthy diet and regular exercise with insulin at times.

 

 

History of diabetes

The word ‘diabetes’ is derived from Greek and means, “a syphoning of water through the body”. Polyuria as a medical condition had been recorded by an Egyptian physician way back in 1552 B.C. Until the 11th century diabetes was commonly diagnosed by tasting the sweetness of the urine of those suspected of having the condition. The first chemical test to detect and measure sugar in the urine was developed in the 16th century. Varieties of dietary advices, both favourable and unfavourable from the modern point of view, were prescribed by the physicians throughout the next few centuries.

During the early 20th century, diabetes started to be related with the defective function of pancreas. Finally in the summer of 1921, insulin was discovered and tested in a de-pancreatised dog. It was not until January 1922 that insulin was tested in a teenage boy. Mass production of insulin commenced in May of the same year. November 14 is now celebrated every year as the ‘world diabetes day’ in honour of Sir Frederick Grant Banting who had discovered insulin for the treatment for diabetes.

Future of diabetes

The future for diabetes cure is bright as the pace of research and developments have remained considerably fast. There have been many advances in the type of insulin injections available in the markets that are immunologically better and clinically more effective.

Pancreas transplant has already been attempted in human, and although just a few diabetics have been able to come off insulin after the transplant, many others have had either reduced need for insulin, or dramatic improvement in the hypoglycaemic episodes they otherwise had.

Stem cell research that can solve the problem of lack of organ donation has also shown promising results as the insulin-producing cells can be implanted anywhere in the body unlike in the case of regeneration of bigger organs such as the kidney. The aim of such research will be to stimulate stem cells to become beta cells that produce insulin.