Diabetes- Everything about it

Did you know? Nearly 420 million people worldwide suffer from diabetes and claim the lives of 1.5 million people. Sounds morbid, doesn’t it? If left undetected and untreated, a simple metabolic disorder could morph into something complex like heart and kidney disease. Early detection and prompt treatment can save lives and prevent the further progression of this disease. Read on for a refresher course on diabetes!

What is Diabetes?

Diabetes is a chronic lifestyle disease that is prevalent all across the globe. If one has this condition, their body is not able to regulate the blood sugar levels in the body. It is common knowledge that most of the food we eat gets broken down into glucose and gets released into the bloodstream. When the body detects that sugar levels have gone haywire, it signals the pancreas to secrete insulin. Insulin is a hormone that promotes the entry of blood sugar into cells to be used as energy. When one has diabetes, either, the pancreas does not produce enough insulin to regulate sugar levels or cells fail to respond to insulin. 

Depending on the scenario, researchers categorized diabetes into types. Here’s some more information about the types of diabetes mellitus to get you up to speed.

Type 1 Diabetes

A patient is diagnosed with type 1 diabetes when the body is not able to produce sufficient amounts of insulin to keep glucose levels under control. Up to 10% of the population that have diabetes are diagnosed with type 1. There is no known way to prevent or cure this type of diabetes. Someone with type 1 will have to rely on external insulin to survive. 

What causes Type 1 diabetes?

Although the exact cause remains ambiguous, scientists believe that this particular type of diabetes occurs due to an autoimmune reaction. Our immune systems target the beta cells in the pancreas (cells that produce insulin), which hinders insulin production. Furthermore, this type of diabetes also tends to run in families.

Type 2 Diabetes

This is the most common type of diabetes, and most of the patients visiting your clinic will be suffering from this type. It affects up to 95% of people with diabetes mellitus. The silver lining is that it can be prevented by simple lifestyle changes. 

What causes Type 2 diabetes?

Type 2 diabetes has many causative factors. Here are some listed below

• Obesity and Sedentary lifestyles

It is common knowledge that being overweight/obese and leading a sedentary lifestyle predisposes people to a plethora of health problems. Type 2 diabetes is one of them. Advise your patients to shed those extra kilos to prevent the progression of this deadly disease.

• Insulin resistance

Let’s revisit Pharmacology 101! Insulin is a hormone that is responsible for maintaining glucose homeostasis. It binds to the insulin receptors present in the liver, adipocytes, and skeletal muscle tissue. The binding of hormones and receptors leads to a signal cascade and further processing of glucose in the blood occurs. However,  a defect in this insulin-signaling cascade causes the body to fall into an insulin-resistant state that is often seen in this type of diabetes.

• Genetic factors
  Obesity and diabetes can be hereditary. Make sure to find out a patient’s family history to know if they are at risk of getting diabetes.

Gestational Diabetes

As the name suggests, it is seen in pregnant women. This is quite commonly seen and usually goes away after the baby is born. However, it increases the risk of the development of type 2 diabetes in mothers.

A guide to diagnosis

Quick, prompt, and precise diagnosis is desired by both the doctors and the patients. Here are a few tools and questions you can include in your practice for a better diagnosis of diabetes. 

Prepare a set line of questioning

Most people will visit you when they experience one or more symptoms of diabetes. Preparing a questionnaire based on the symptoms might help you get a clear view of the risk and progression of the disease. Here’s a line of questioning that you can follow:

Personal information:

• Name: ________
• Age:____
• Sex: ____
• Weight: _______
• Height: _______
• Do you have any vices (Eg. Smoking, drinking, etc.): __________
• Does anyone in your family have diabetes: ________

Rate from 1-5 (1- Lowest & 5- Highest)

• Increased thirst
• Increased hunger
• Frequency of urination
• Energy levels over the past couple of weeks
• Numbness or tingling sensations in your hand and feet
  
  

You can print out pamphlets and questionnaires along the lines mentioned above to better understand the severity of symptoms. Of course, this is a preliminary diagnostic aid and does not provide conclusive proof that a patient suffers from diabetes. Here are some diagnostic tests that have to be performed in order to confirm the presence of diabetes in a patient.

Diagnostic tests for diabetes mellitus

The following tests may be performed to confirm diabetes mellitus in patients. Most of these tests are quick, easy to perform, and reliable.  Here are some of the following tests you can perform:

• Fasting Plasma Glucose or FPG test
  The FPG is easy to perform and a time saving test that gives reliable and quick results. However, for this test to be accurate, the patient must be fasted for at least 8-10 hours. Hence, it is recommended that this test be done in the morning.

• A1C or Glycated Hemoglobin Test
  The patients need not fast for this test. The glycated hemoglobin test provides the average level of blood glucose over the past 3 months. It determines the percentage of blood sugar that is attached to hemoglobin. The drawback of this test is that it cannot be used on patients who are anemic or pregnant since it may produce false results.

• Oral Glucose Tolerance Test (OGTT)
  This test is recommended for patients who are suspected of having prediabetes, type 2 diabetes, or gestational diabetes. This test involves drawing the blood from the upper arm of a patient before and after giving him/her a sugary fluid to drink. The timeline of the test goes as follows:
  • Blood is drawn before the drink (Fasting glucose levels)
  • The patient is given the drink
  • Blood is drawn periodically at the following times
    • 1-hour mark
    • 3-hour mark

The drawback of this test is that it is time-consuming as compared to the previous two and is quite expensive. High glucose levels at the fasting, 1 hour, and 3-hour time point indicate that a patient has diabetes.

Interpretation of the tests

Depending on the blood glucose levels you can definitely conclude if your patient has diabetes or not.

	Normal	Prediabetes	Diabetic
FPG Test (mg/dL)	≤99	100-125	≥126
A1C Test (%)	<5.7	5.7-6.4	≥6.5
OGTT (mg/dL)	≤139	140-199	≥200

Treatment of diabetes

Unfortunately, diabetes of any type cannot be treated. It lasts for a lifetime and can only be kept under check. Here are some therapies most doctors suggest for managing diabetes:

• For type 1 the treatment is pretty straightforward. The patient has to keep on taking insulin to survive. 
• Medications like metformin help control blood sugar levels by limiting the amount of glucose that the liver makes. 
• Lifestyle modifications: Eating a healthy diet. Avoiding a calorie and fat-rich diet. Getting sufficient amounts of exercise.

Complications that can occur

Letting diabetes run rampant has morbid effects on health and may be fatal. Having too much glucose in your body can cause the following complications

• Eye diseases – Caused due to swelling, fluid volume changes, and rupturing of blood vessels in the eye.
• Heart problems: One is more susceptible to cardiac arrests and stroke. This may be caused due to damage to blood vessels and high Blood pressure
• Kidney disease: High blood pressure because of diabetes can cause damage to the kidneys.
• Diabetic Neuropathy

We hope that the article so far has refreshed your knowledge on diabetes and how dangerous a threat it poses. Studying more about it will do wonders for your career and your patients’ lives.

Fellowship in Diabetology

Doing a fellowship in diabetology will allow you to gain in-depth knowledge about the condition and its complications. The skills you obtain from this degree will help you boost your practice. A fellowship in diabetology is usually a short-term course that lasts a few months. Although the subjects taught change from university to university, the crux of the course remains common. You will gain the following skills and knowledge if you pursue this fellowship:

• Complete knowledge on
  • Symptoms and diagnosis of all types of diabetes
  • Pathophysiology of the disease
  • Treatment options and selections
• How to deal with complications like
  • Diabetic nephropathy
  • Diabetic neuropathy
  • Diabetic retinopathy
  • Dyslipedamia in diabetes
  • Hypertension in diabetes
  • Ketosis-prone diabetes (Flatbush diabetes)

Here’s how it will help:

• Wide array of career opportunities
• Better pay and job security
• Increased recognition due to high demand
• Better respect in the community

Most universities offer online/distance learning options for this course and pursuing this course will spice up your CV. 

We hope that this article has refreshed your knowledge about diabetes and has motivated you to enhance your practice. Happy learning!

References: 

1. Diabetes. Available from: https://www.who.int/health-topics/diabetes#tab=tab_1 Accessed on: 17th January 2022.   
2. What is diabetes? Available from: https://www.cdc.gov/diabetes/basics/diabetes.html Accessed on: 17th January 2022.
3. Diabetes tests & diagnosis. Available from: https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis Accessed on: 18th January 2022. 
4. Fröjdö S et al. Alterations of insulin signaling in type 2 diabetes: a review of the current evidence from humans. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease. 2009 Feb 1;1792(2):83-92.
5. Diabetes complications. Available from: https://medlineplus.gov/diabetescomplications.html Accessed on: 18th January 2022
   
   

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