What Is Diabetes Mellitus?
Diabetes is a lifelong condition that causes a person’s blood sugar level to become too high. Persons with diabetes have too much sugar in their blood. There is no cure for diabetes. People with diabetes need to manage their disease to stay healthy.
It is a metabolic disease in which the body’s inability to produce any or enough insulin causes elevated levels of glucose in the blood.
Persons with diabetes have too much sugar in their blood. This problem can start when a person is young (Type 1 diabetes) or older (Type 2 diabetes). Type 1 diabetes is usually more severe, this can only be controlled by insulin (drug/Injection).
Diabetes is a serious complex condition that can affect the entire body. Diabetes requires diesel care and if complications develop, diabetes can have a significant impact on quality of life and can reduce life expectancy. While there is currently no cure for diabetes, you can live an enjoyable life by learning about the condition and effectively managing it. It is often referred to by doctors as diabetes mellitus.
Types of Diabetes Mellitus
Diabetes is of two main types, aptly called type 1 and type 2. In addition, diabetes may develop in pregnant women and that is known as gestational diabetes
Type 1 diabetes
The body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes. Type 1 diabetes is usually more serious and young people need medicine called insulin to control it. This problem can start when a person is young or older
Type 1 diabetes is an auto-immune condition in which the immune system is activated to destroy the cells in the pancreas which produce insulin. We do not know what causes this auto-immune reaction. Type 1 diabetes is not linked to modifiable lifestyle factors. There is no cure and it cannot be prevented.
- Occurs when the pancreas does not produce insulin
- Represents around 10% of all cases of diabetes and is one of the most common chronic childhood conditions
- Onset is usually abrupt and the symptoms obvious
- Symptoms can include excessive thirst and urination, unexplained weight loss, weakness and fatigue, and blurred vision
- Is managed with insulin injections several times a day or the use of an insulin pump.
Symptoms
The symptoms of type 1 diabetes usually appear over a few days to weeks trusted Source. They include:
- increased hunger and thirst
- frequent urination
- blurred vision
- tiredness and fatigue
- weight loss without an apparent trigger or cause
For children, the first signs will be those of diabetic ketoacidosis (DKA). This is a potentially life-threatening condition where too many ketones circulate in the body, leading to acidosis. It needs immediate medical attention.
Symptoms include:
- a fruity smell on the breath
- dry or flushed skin
- nausea or vomiting
- abdominal pain
- breathing difficulty
- confusion and difficulty focusing
Type 2 diabetes
The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance). Most people with diabetes have Type 2, starting after age 40.
The most common form of diabetes is called type 2, or non-insulin dependent diabetes.
This is also called “adult-onset” diabetes since it typically develops after age 35. However, many younger people are now developing type 2 diabetes.
People with type 2 can produce some of their insulin. Often, it’s not enough. And sometimes, the insulin will try to serve as the “key” to open the body’s cells, to allow the glucose to enter. But the key won’t work. The cells won’t open. This is called insulin resistance.
Often, type 2 is tied to people who are overweight, and with a sedentary lifestyle.
Treatment focuses on diet and exercise. If blood sugar levels are still high, oral medications are used to help the body use its insulin more efficiently. In some cases, insulin injections are necessary.
Signs and Symptoms of Type 2 Diabetes
The symptoms of type 2 diabetes can be so mild that you don’t notice them. About 8 million people who have it don’t know it. Symptoms include:
- Being very thirsty
- Peeing a lot
- Blurry vision
- Being cranky
- Tingling or numbness in your hands or feet
- Fatigue/feeling worn out
- Wounds that don’t heal
- Yeast infections that keep coming back
- Feeling hungry
- Weight loss without trying
- Getting more infections
Gestational diabetes/Pregnant Diabetes
This kind of effects women while they are pregnant. Some women have very high blood glucose levels, and because their bodies can’t create enough insulin to get all of the glucose into their cells, their blood glucose levels continue to rise over time.
Because a pregnant woman needs two to three times as much insulin as a non-pregnant woman does, high blood sugar is brought on by the mother’s inability to make enough of it.
The mother needs higher insulin for two causes:
due to the release of certain hormones (produced by the placenta) during pregnancy. These hormones make it tougher for insulin to do its work since the growing demands of the fetus (growing baby) raise the mother’s need for insulin
What are the symptoms of gestational diabetes?
Causes of diabetes in Nigeria
Different causes are associated with each type of diabetes.
Type 1 diabetes
Genes may play a role in some people. It’s also possible that a virus sets off an immune system attack.
Type 2 diabetes
Type 2 diabetes stems from a combination of genetics and lifestyle factors. Having overweight or obese increases your risk, too. Carrying extra weight, especially in your belly, makes your cells more resistant to the effects of insulin on your blood sugar.
This condition runs in families. Family members share genes that make them more likely to get type 2 diabetes and be overweight.
Gestational diabetes
Gestational diabetes occurs as the result of hormonal changes during pregnancy. The placenta produces hormones that make a pregnant person’s cells less sensitive to the effects of insulin. This can cause high blood sugar during pregnancy.
People who are overweight when they get pregnant or who gain too much weight during pregnancy are more likely to get gestational diabetes.
What are the Preventive Measures of Diabetes?
There are no guarantees when it comes to preventing gestational diabetes — but the more healthy habits you can adopt before pregnancy, the better. If you’ve had gestational diabetes, these healthy choices may also reduce your risk of having it again in future pregnancies or developing type 2 diabetes in the future.
- Eat healthy foods. Choose foods high in fiber and low in fat and calories. Focus on fruits, vegetables, and whole grains. Strive for variety to help you achieve your goals without compromising taste or nutrition. Watch portion sizes.
- Keep active. Exercise can help you avoid getting gestational diabetes before, during, and after pregnancy. On the majority of days of the week, aim for 30 minutes of moderate exercise. Go for a quick walk each day. Take a bike ride. swimming laps Short spurts of activity, such as leaving your car farther from the store when running errands or taking a quick walk break, all add up.
- Start pregnancy at a healthy weight. If you’re planning to get pregnant, losing extra weight beforehand may help you have a healthier pregnancy. Focus on making lasting changes to your eating habits that can help you through pregnancy, such as eating more vegetables and fruits.
- Don’t gain more weight than recommended. Avoid gaining more weight than is advised. Pregnancy-related weight gain is normal and healthy. However, if you put on too much weight too rapidly, you run the risk of developing gestational diabetes. Find out from your doctor how much weight gain is appropriate for you.
Medications
Glucose control
Most medications used to treat diabetes act by lowering blood sugar levels through different mechanisms. There is broad consensus that when people with diabetes maintain tight glucose control – keeping the glucose levels in their blood within normal ranges – they experience fewer complications, such as kidney problems or eye problems. There is however debate as to whether this is appropriate and cost-effective for people later in life in whom the risk of hypoglycemia may be more significant.
We have several different classes of anti-diabetic medications. Type 1 diabetes requires treatment with insulin, ideally using a “basal-bolus” regimen that most closely matches normal insulin release: long-acting insulin for the basal rate and short-acting insulin with meals. Type 2 diabetes is generally treated with medication that is taken by mouth (e.g. metformin) although some eventually require injectable treatment with insulin or GLP-1 agonists.
Metformin is generally recommended as a first-line treatment for type 2 diabetes, as there is good evidence that it decreases mortality. It works by decreasing the liver’s production of glucose. Several other groups of drugs, mostly given by mouth, may also decrease blood sugar in type 2 diabetes. These include agents that increase insulin release (sulfonylureas), agents that decrease absorption of sugar from the intestines (acarbose), agents that inhibit the enzyme dipeptidyl peptidase-4 (DPP-4) that inactivates incretins such as GLP-1 and GIP (sitagliptin), agents that make the body more sensitive to insulin (a thiazolidinedione) and agents that increase the excretion of glucose in the urine (SGLT2 inhibitors). When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications. Doses of insulin are then increased until glucose targets are reached.
Blood pressure lowering
Cardiovascular disease is a serious complication associated with diabetes, and many international guidelines recommend blood pressure treatment targets that are lower than 140/90 mmHg for people with diabetes. However, there is only limited evidence regarding what the lower targets should be. A 2016 systematic review found potential harm to treating targets lower than 140 mmHg, and a subsequent systematic review in 2019 found no evidence of additional benefit from blood pressure lowering to between 130 – 140mmHg, although there was an increased risk of adverse events.
2015 American Diabetes Association recommendations are that people with diabetes and albuminuria should receive an inhibitor of the renin-angiotensin system to reduce the risks of progression to end-stage renal disease, cardiovascular events, and death. There is some evidence that angiotensin-converting enzyme inhibitors (ACEIs) are superior to other inhibitors of the renin-angiotensin system such as angiotensin receptor blockers (ARBs), or aliskiren in preventing cardiovascular disease. Although a more recent review found similar effects of ACEIs and ARBs on major cardiovascular and renal outcomes. No evidence combining ACEIs and ARBs provides additional benefits.
Aspirin
It is debatable if aspirin can prevent cardiovascular disease in people with diabetes. Some persons at high risk for cardiovascular disease advise using aspirin, however, studies have not shown that habitual aspirin use improves outcomes in people with simple diabetes. In persons with diabetes who are at intermediate risk of cardiovascular disease (10-year cardiovascular disease risk, 5-10%), low-dose aspirin administration is appropriate, according to 2015 American Diabetes Association recommendations (based on expert consensus or clinical experience). The National Institute for Health and Care Excellence (NICE) has issued national recommendations for England and Wales that for those with type 1 or type 2 diabetes who have no known cardiovascular disease, aspirin usage is not advised.
Diagram showing uses of Diabetes Medication
Surgery
Surgery to reduce weight is frequently an efficient treatment for people with obesity and type 2 diabetes. Following surgery, many people can keep their blood sugar levels within normal range with little to no medication, which lowers long-term mortality. However, there is a short-term mortality risk from the surgery of less than 1%. There is some uncertainty on the body mass index cutoffs for when surgery is justified. It is advised that those who are unable to control both their weight and blood sugar give this option some thought.
People with type 1 diabetes who have significant complications from their disease, such as end-stage kidney failure necessitating a kidney transplant, may occasionally be considered for a pancreas transplant.
