Introduction
The state in which a person’s body stops properly using or producing insulin is known as diabetes. When insulin is not used or produced properly then the sugar or glucose levels in our body rise, which results in diabetes. Insulin can be described as a hormone that helps sugar, starch and other food material to get converted into energy.
If elevated sugar level is not controlled then it might lead to very serious health conditions like loss of vision, kidney failure, amputation of limbs, stroke, heart attack etc. Diabetes has become a very common disease and hence there is a huge risk of a large number of people getting affected by these complications. There are also millions of people who are suffering of pre diabetes – a condition in which the blood sugar level is higher than normal but not as high as in patients of diabetes. This category of people has immense risk of turning diabetic if they do not bring changes in their lifestyle.
Charateristics of diabetes
Diabetes can be broadly divided into three categories – Type 1, Type 2 and Gestational diabetes. The maximum numbers of people suffer from Type 2 diabetes. According to Smith, “Type 2 diabetes is the most common type, affecting 90 – 95% of persons with diabetes.” (2006, p.3) Type 1 diabetes affects a minimal number of diabetic patients. Around 5-10% of persons with diabetes get affected by it. The majority of them are young adults and children. Whereas, Type 2 diabetic patients are mostly over 40 years of age. In very few instances children develop it. The people who have developed Type 1 diabetes are generally thin or have normal body weight. The patients of Type 2 diabetes are overweight. The rate of onset is quick in Type 1 patients while the rate of onset is slow in Type 2 patients. While there is no family history involved in Type1 diabetes, family history is a cause of Type 2 diabetes. More than one shot of insulin is required per day to control Type 1 diabetes whereas Type 2 diabetes is controlled by increase of body activity and nutritional changes. However, “For some sufferers of Type 2 diabetes treatment with dietary changes and tablets is not entirely effective for diabetes management, and they may then need insulin injections.” (Dr. Sims, 2007. para. 12) It is difficult to control the fluctuative range of blood sugar in Type 1 diabetes while it is easy to control that in Type 2 diabetes. The similarities between these two types of diabetes are that both respond to changes in diet and body activity.
As the name suggests Gestational diabetes is related to pregnant women and is temporary. Gestational diabetes, though harmful for baby and mother, gets cured completely after the birth of the baby. It is a temporary phase, which about 8 % of pregnant women suffer from each year. It is a condition of increased sugar level during pregnancy and puts women in danger of getting Type 2 diabetes in future. Pregnant women develop this disease at the later stage of their pregnancy. Most of the child’s body gets formed by then. Neglecting it is not good because if left untreated it might affect and harm the baby in the mother’s womb. There are high chances of developing this problem again in the consecutive pregnancies.
There are three methods in which diabetes can be diagnosed. These are “a random or casual glucose level of greater or equal to 200 mg / dl, a fasting blood glucose of greater or equal to 126 mg / dl or 2 hours blood glucose greater or equal to 200 mg / dl during an oral glucose tolerance test.” (Smith, 2006, p. 5)
Symptoms of diabetes
Excessive hunger (polyphagia), excessive thirst (polydipsia), frequent urination (polyuria), slow healing of wounds, frequent infections, feeling of tiredness, dry skin, weight loss are the most common symptoms of diabetes.
Physiology of diabetes
In Type 1 diabetes, the pancreatic beta cells undergo cellular-mediated autoimmune destruction. There is difference in the rate of destruction of beta cells in different people. Environmental as well as genetics factor are responsible for this difference. Islet cell autoantibodies, autoantibodies to glutamic acid decarbooxylase, autoantibodies to the tyrosine phosphatases IA – 2 AND IA – 2B and autoantibodies to insulin are the markers of the immune destruction of beta cells. Around 85-90% of diabetic patient suffer from the presence of one or more of these antibodies when there is initial detection of fasting hyperglycemia. In some forms of type 1 diabetes no evidence of autoimmunity is found. These forms of diabetes are known as ‘idiopathic’. In such cases the individuals are prone to ketoacidosis as their body suffer permanent decrease in concentrations of insulin.
In Type 2 diabetes, the cells prevent glucose from entering them as they become resistant to insulin. The level of insulin needed to maintain normal level of blood glucose stops being produced or released by the pancreas as time passes.
When a woman is pregnant her placenta supports the foetus growing in her womb. But sometimes hormones of the placenta start blocking the insulin’s action in the pregnant women’s body. Since her body does not get appropriate amount of insulin she develops gestational diabetes.
Treatment of diabetes
Diabetes can be treated by both pharmacologic and non-pharmacologic ways. Nutrition therapy and physical activities are the non-pharmacologic ways of treatment. Per week a diabetic patient should have at least 150 minutes of moderate to vigorous physical activity. If one is not in the habit of exercising then he should begin with moderate exercises to the more vigorous exercises in order to reach to the desired level of physical activity. There should be a balance of carbohydrates, fats and protein in the diet as part of the nutritional therapy. Type 2 diabetic patients suffer from excess weight so their aim should be to control their increasing weight. They should follow a diet chart, which consists of 50–60 % of calories from carbohydrates, 30 % of calories from fat and 10–20 % of calories from protein. Calories from saturated fat should not increase from more than 10% each day.
Patients should stop smoking and go for regular blood glucose monitoring to check how much more they need to control. There are many options of pharmacologic treatment. These options are insulin, inhaled medication, oral agents and new inhaled injectibles. Insulin is injected through pen needles or syringes. Hip / buttock area, outer thigh, abdomen and back of arm are the areas in which it is injected. The dose depends upon the complications of the case. Inhaled medication is also insulin, but is available in powder form. Insulin should be taken within 10 minutes of a meal. Sulfonylureas, meglitinides, thiazolidinediones, biguanide and alpha glucosidase inhibitors are some of the different classess of oral agents. All these classess have different dosing and side effects. These should be prescribed after studying the complete medical history of the patients. The injectible medications are exenatide (byetta) and pranlintide (smylin). Exenatide can be prescribed only to Type 2 diabetes, while pranlintide can be prescribed to both Type 1 and Type 2 diabetic patients. The doses of both these injectibles are different. Side effects like vomiting, nausea, weight loss, diarhhea etc. can be expected after the administration of these injectibles. They should be administered on the abdomen, thigh or upper arm.
Apart from the above-mentioned non-pharmacologic treatments Type 1 diabetic patients should also go for psychosocial counseling and regular glucose monitoring. Pharmacologic treatments include either continuous subcutaneous insulin infusion with the help of an insulin pump or multiple doses of insulin daily. If the patient is above 18 years of age then he can also take inhaled insulin before meals.
Treatment of gestational diabetes is simple. It requires a good meal plan and a good regimen of physical activity. In some cases it might also require regular blood glucose testing and insulin treatments. “Maternal follow-up, with an oral glucose tolerance test, should be performed 6-8 weeks postpartum, then at least every 2 years, because of the increased risk of developing permanent diabetes.” (Hoffman et.al., 1998, para.9)
Outcomes of diabetes
If the blood glucose level is not controlled then there can be several complications of this disease. The quality of a person’s life gets affected by it.
It impairs large and small blood vessels. These impairments are also known as macrovascular and microvascular impairments respectively. Macrovascular impairments result in coronary heart disease, cerebral vascular disease and peripheral vascular disease. As a result there is high risk of stroke and heart attack. There is also difficulty in proper circulation of limbs.
Microvascular complications result in nephropathy, neuropathy and retinopathy. This results in autoimmune thyroid disease, celiac disease, gum disease, end stage renal disease, decline in kidney function, cataracts, glaucoma and even blindness.
The outcome of gestational diabetes is that there is great risk of caesarean births. Also there are chances of delivering a fat baby. Due to excessive fat on the shoulders the baby can even damage his shoulders during the normal birth procedure. Also there is risk of him growing into an obese child and developing type 2 diabetes at later stage of his life.
Myth about diabetes
There is a very common myth that one should completely avoid fruits and starchy foods like potatoes, rice etc. if he is suffering from diabetes. But this is not true; one should not stop eating fruits and starchy foods completely thinking it to be a part of his treatment. Rather he should consult his physician and eat the recommended portions of these food items. People also completely avoid eating sugar and sweets as a measure to control their diabetes but there is no need to take such a stringent step. According to Funnel, “Sugar and sweets do raise your blood glucose, but people with diabetes can safely eat sugar as part of their meal plan. And just to clear up another myth, you can’t get diabetes from eating too much sugar.” (2008, para.2) Thus there should be a healthy meal plan in which you should manage your food intake for eg. 3 – 4 servings of carbohydrate, which you get from starchy food item, is not harmful.
Conclusion
Diabetes is a common disease in which the blood glucose level in a person is higher than normal. If the glucose level is not controlled then it can give rise to many complications. Fortunately with a well-planned meal, physical activity and medication, a person suffering from diabetes can lead a healthy life, free of any complications. “Many studies now show that good glucose control can significantly reduce or even stop complications. This means keeping the blood sugar level as close to normal as possible.” (Campbell, Song, 2004, para.54)
References
Smith, D.E. (2006). Type 2 Diabetes: 2006 Update. Pharmacy Tech Topics. Vol. 11. Illinois: Illinois Council of Health-System Pharmacists.
Smith, D.E. (2006). Type 2 Diabetes: 2006 Update. Pharmacy Tech Topics. Vol. 12. Illinois: Illinois Council of Health-System Pharmacists.
Campbell, I.W., Song, S. (2004). Diabetes overview. Web.
Dr. Sims, J. (2007) Type 2 Diabetes Mellitus Symptoms, Control and Management. Web.
Funnel, M.M. (2008). 10 Myths about Diabetes. Web.
Hoffman, L. et.al. (1998). Gestational diabetes mellitus — management guidelines. Web.