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May 31, 2014

Diabetes mellitus

by Helene van den Berg

DIABETES MELLITUS is a carbohydrate intolerance disorder. Diabetes mellitus refers to a group of diseases where you have too much glucose in your blood. It results from an insulin deficiency and/or insulin resistance. Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes (blood sugar levels are higher than normal, but not high enough to be classified as diabetes) and gestational diabetes (during pregnancy, but may resolve after the baby is delivered).

Symptoms of type 1 and type 2 diabetes include:

  • Increased thirst
  • Frequent urination
  • Unexplained weight loss
  • Extreme hunger
  • Fatigue
  • Slow-healing sores
  • Frequent infections – gums or skin infections, bladder and vaginal infections
  • High blood pressure
  • Ketones (breakdown of muscle and fat in the urine)

Type 1 diabetes can develop at any age, but it typically appears during childhood or adolescence. Type 2 diabetes (more common) can develop at any age and is often preventable.

Causes:

In type 1 diabetes, the immune system attacks and destroys the insulin producing cells in the pancreas. This leaves you with little or no insulin. The sugar builds up in the bloodstream, instead of being transported to the cells. It is caused by a combination of genetic susceptibility and environmental factors.

In prediabetes (which can lead to type 2 diabetes) and in type 2 diabetes, the cells become resistant to the action of insulin and the pancreas can’t make enough insulin to overcome this resistant. The sugar builds up in the bloodstream, instead of moving into the cells. It is also caused by a combination of genetic susceptibility and environmental factors, but being overweight is strongly linked to the development of type 2 diabetes. Not everyone with type 2 diabetes is overweight though.

In gestational diabetes, the placenta produces hormones to sustain the pregnancy and these hormones make the cells more resistant to insulin.

Risk factors:

In type 1 diabetes, the risk factors are genetic – the risk increases if you have a parent or sibling who has type 1 diabetes. Environmental factors include:

  • Exposure to a viral illness
  • Presence of damaging immune system cells that make autoantibodies
  • Dietary factors – low vitamin D consumption; early exposure to cow’s milk/cow’s milk formula. Exposure to cereals before 4 months of age.
  • Race – type 1 diabetes is more common in whites.
  • Geography – Finland and Sweden have higher rates of type 1 diabetes.

Risk factors in prediabetes and type 2 diabetes :

  • Weight – the more fatty tissue you have, the more resistant your cells become to insulin.
  • Inactivity – physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin. Exercising less than 3 times a week may increase your risk of diabetes.
  • Family history – (parent or sibling).
  • Race – Blacks, Hispanics, American Indians and Asians, are at higher risk.
  • Age – the risk increases as you get older (exercise less and gain weight), BUT it is also increasing among children and younger adults.
  • Gestational diabetes – if you developed it during pregnancy, your risk is higher in developing it later.
  • Polycystic ovary syndrome ( characteristics- irregular menstruation, obesity, excess hair growth)
  • High blood pressure (over 140/90 mm/Hg).
  • Abnormal cholesterol levels – low levels, (below 35mg/dL) of HDL, the “good cholesterol”.
  • High levels of triglycerides in the blood – (above250 mg/dL) .

Risk factors in gestational diabetes:

Any woman can develop gestational diabetes, but some women are at greater risk than others. The risk factors include:

  • Age – women older than 25 are at increased risk.
  • Family /personal history – your risk increases if: you have prediabetes; had gestational diabetes with previous pregnancy; or if a close family member has type 2 diabetes; if you delivered a baby over 4 kg; if you had an unexplained stillbirth.
  • Weight – being overweight before pregnancy.
  • Race – women who are Black, Hispanics, American Indians and Asians, are at higher risk.

Complications:

Long- term complications of diabetes develop gradually. The longer you have diabetes (not controlling your blood sugar), the higher the risk of complications. Eventually it may be disabling or life-threatening.

Possible complications include:

  • Cardiovascular disease – angina (chest pain), heart attack, stroke, atherosclerosis.
  • Neuropathy (nerve damage) – excess sugar can injure the walls of the capillaries that nourish your nerves, especially in the legs – causes numbness, tingling, pain that usually begins at the tip of the toes or fingers and gradually spreads upward. If untreated you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause vomiting, nausea, constipation or diarrhea. For men, it may lead to erectile dysfunction.
  • Nephropathy (kidney damage) – diabetes damage the glomeruli, that filters waste from the blood. It can lead to kidney failure or end-stage kidney disease, which require dialysis or a kidney transplant.
  • Retinopathy (eye damage) – diabetes damage the blood vessels of the retina, potentially leading to blindness. Other serious vision conditions include cataracts and glaucoma.
  • Foot damage( poor blood flow to the feet) – Cuts and blisters can become serious infections, left untreated. Severe damage might require toe, feet, or even leg amputations.
  • Skin and mouth conditions – bacterial and fungal skin infections; gum infections.
  • Osteoporosis – diabetes may lead to lower than normal bone mineral density.
  • Alzheimer’s disease – diabetes could contribute to dementia by blocking blood flow to the brain or causing strokes. Another theory is that too much insulin in the blood, leads to brain-damaging inflammation, or lack of insulin in the brain deprives brain cells of glucose.
  • Cancer – people with diabetes have a higher risk of some cancers. Further research is needed.

Gestational diabetes complications:

Most women who have gestational diabetes, deliver healthy babies, but untreated blood sugar levels can cause problems for you and your baby.

Complications in your baby:

  • Excess growth – extra glucose can cross the placenta, which triggers your baby’s pancreas to make extra insulin, causing your baby to grow too large (macrosomia), requiring a C-section birth.
  • Low blood sugar – babies develop low blood sugar (hypoglycemia) shortly after birth, because of too high insulin production. Prompt feedings or an intravenous glucose solution can return the baby’s blood sugar levels to normal.
  • Respiratory disease syndrome – breathing is difficult, if the baby is delivered early.
  • Jaundice (yellow discoloration of skin) – the baby’s liver is not mature enough to break down bilirubin (forms when the body recycle damaged/old red blood cells).
  • Type 2 diabetes later in life.
  • Death – untreated gestational diabetes can result in death before or shortly after birth.

Complications in the mother:

  • Preeclampsia – characterized by high blood pressure, excess protein in the urine, swelling in the legs and feet. Preeclampsia can lead to life-threatening complications for both mother and baby.
  • Subsequent gestational diabetes in next pregnancy and possibly type 2 diabetes as you get older.

SCREENING GUIDELINES FOR DIABETES:

  1. Body mass index higher than 25, regardless of age…with additional risk factors such as high blood pressure, high cholesterol levels, a history of heart disease, history of diabetes in pregnancy and having delivered a baby more than 4kg, having a close relative with diabetes.
  2. Anyone older than 45 is advised to receive an initial blood sugar screening and with normal results, to be screened every three years thereafter.

TESTS FOR TYPE 1 AND TYPE 2 DIABETES:

  • Glycated hemoglobin test (A1C) – This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin. An A1C level 6.5 % and higher on two separate tests indicates diabetes.

If this test is unavailable/inconsistent (due to pregnancy) – the doctor will use other tests to diagnose diabetes:

  • Random blood sugar test. A blood sugar sample will be taken at a random time. A blood sugar level of 200mg/dL or 11.1 mmol/L or higher suggests diabetes.
  • Fasting blood sugar test – Prediabetes = 100-125mg/dL (5.6 – 6.9 mol/L); Diabetes = 126mg/dL (7mmol/L) or higher.

TREATMENT for all types of diabetes:

Healthy eating– there is NO diabetes diet BUT centre your diet on foods that are high in nutrition and fiber and low in fats and calories and cut down on animal products, refined carbohydrates and sweets – eat more fruits, vegetables, legumes and whole grains.

Physical activity – aerobic exercises, like walking, swimming, biking for at least 30 minutes five days of the week, will lower your blood sugar levels and will increase your sensitivity to insulin (less insulin to transport sugar to the cells).

Lose excess weight- losing 4.5 kg/10 pounds can reduce the risk of diabetes.

Treatment for type 1 diabetes involves insulin injections, an insulin pump, frequent blood sugar checks and carbohydrate counting. Treatment of type 2 diabetes primarily involves monitoring of your blood sugar, along with diabetes medications, insulin or both.

LIFESTYLE for type 1 and type 2 diabetes:

Wear a bracelet that says you have diabetes. Keep a glucagon kit nearby. Schedule yearly physical and regular eye exams. Keep immunizations up to date (high blood sugar weakens your immune system) – get a flu shot every year; pneumonia vaccine is usually recommended; hepatitis B vaccination for type 1 and 2 diabetes between 19-59 of age. Check your feet every day for cuts, sores or swelling that doesn’t want to heal. Keep your blood pressure and cholesterol under control. Take care of your teeth – brush and floss your teeth at least twice a day and consult your dentist with bleeding/swollen gums; schedule dental exams once a year; Quit smoking with the doctors help. Drink alcohol in moderation and always with food. Take stress seriously – learn to relax and get plenty of sleep!.

There are no treatments that can cure diabetes –so diabetics should not stop using insulin.

ALTERNATIVE MEDICINE that can help control diabetes are: alpha-lipoic acid; cassia cinnamon; flaxseed; ginseng; chromium; magnesium; oat bran; soy; caffeine; guar gum.

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