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An Introduction to Diabetes

Diabetes Mellitus is a chronic, metabolic disease where the blood glucose, or blood sugar, is too high, and the body has a difficult time in responding properly to correct it. Blood glucose is the main source of energy for the body and is provided by the foods we eat; specifically carbohydrate-rich foods such as bread, cereal and pasta. Blood glucose requires insulin, a hormone produced by the pancreas, to be absorbed by the cells of the body where glucose can be used as energy. When the body cannot adequately produce insulin or properly transfer the glucose from the blood into the cells, the cells starve for fuel. Chronically high blood glucose levels, when left untreated, result in a myriad of health complications, most notably Diabetes Mellitus type 2- the most common type of diabetes.

The most two common chronic form of diabetes mellitus are Type 1 and Type 2, which we will refer to as DM Type 1 and DM Type 2, respectively. DM Type 1, also known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little-to-no insulin after the insulin producing cells in the pancreas get destroyed often due to auto-immune causes. Type 1 diabetics depend on multiple daily insulin injections and medications. DM Type 1 is often diagnosed in children and young adults, although it may present at any age. Often the patient will start having symptoms fairly soon after the onset of the condition.

DM Type 2, the most common type, classically develops later in life and is more commonly known as adult-onset diabetes. However, with the increasing prevalence of obesity and sedentary lifestyle in children and teenagers over last few decades, it is also more increasingly seen in younger population. However, type I still accounts for about two thirds of diabetes diagnosed in children and adolescents.

DM Type 2 is result of insulin resistance and inadequate insulin secretion. Insulin resistance means the cells do not respond appropriately to the insulin. This results in the body trying to make more insulin to compensate adequately for its insulin resistance. DM Type 2 develops when the body can no longer increase its insulin secretion to compensate for the insulin resistance.  If one’s blood glucose never gets adequately controlled, the insulin producing cells in the pancreas eventually get exhausted from overworking to overproduce insulin to further decrease the blood glucose and stop producing insulin. This causes insulin deficiency and eventually ends in a state where there is lack of insulin production similar to that of DM Type 1.

Both types of diabetes result in chronically elevated blood glucose levels. Common symptoms of high blood glucose levels can present as increased thirst, increased urination, blurry vision, mood changes, irritability, fatigue, slow healing wounds, nausea, weight loss or weight gain, tingling, pain or numbness in the hands and feet, and fruity or acetone-smelling breath.

However, in DM Type 2, insulin resistance is often present years before the onset of noticeably high blood glucose levels or such symptoms. This is also why lifestyle changes and preventive annual physicals with your primary care doctor, who knows you well, is important!

If the blood glucose is not adequately controlled, it can start negatively affecting organs, with some of these effects being potentially irreversible. Uncontrolled diabetes significantly increases one’s risk of cardiovascular disease (eg heart attack or stroke). It can also affect one’s kidneys and potentially lead to kidney failure, affect one’s eyes and potentially cause blindness, and lead to increased infections and poor wound healing with a potential result in limb amputation.

There are several blood tests that may be used to detect and diagnose diabetes. The most common blood markers reviewed include blood glucose and Hemoglobin A1C. Blood glucose indicates the current blood sugar level whereas Hemoglobin A1C (HbA1c) is a measure of average blood glucose levels over the past 3 months. Table below will give a nice summary of these values.

Test Normal Prediabetes Diabetes
HbA1c < 5.7 % 5.7 – 6.4 % 6.5 % or greater
Fasting blood glucose < 100 100-125 mg/dL 126 mg/dL or greater
Random blood glucose < 140 140-199 mg/dL 200 mg/dL or greater
75 g two hour oral glucose tolerance test < 140 140-199 mg/dL 200 mg/dL or greater

A person with prediabetes already has a level of insulin resistance and is at high risk developing diabetes soon. A prediabetic often may not have any obvious symptoms; therefore, it is important to note if you are at an increased risk for developing diabetes. There are some risk factors for diabetes that we cannot modify; these are include being male, having a first degree relative with diabetes, being of Asian, Hispanic, African American, or Native American descent. However, there are also important risk factors that can be modified, and these include excessive weight, fat distribution around midline or stomach region, high cholesterol, high blood pressure, sedentary lifestyle, smoking, excessive alcohol consumption, and unhealthy diet choices.

Looking over the modifiable risk factors, we can easily see that what we eat and how we move can play a significant role in diabetes management and progression. Prediabetes and type 2 diabetes, especially when detected early, can be managed and sometimes even reversed through healthy lifestyle changes! Although DM Type 1 cannot be reversed due to the body’s dependence on insulin from external sources, healthy lifestyle changes can still significantly improve the quality of life of a person living with DM Type 1 and significantly decrease the amount of daily-required insulin.

Diabetes is a huge topic but an important one! Numerous textbooks are written on the subject. This post is not supposed to be an all-extensive and comprehensive text about diabetes. My goal in this post is to help briefly explain the chronic condition while allowing it to serve as a helpful background for our upcoming posts later this week called “Lifestyle Changes for Diabetes” and “Diabetes Meal Planning and Carb Counting.”  Make sure to check back within a few days for these two posts this week! It is not diabetes awareness month until November, yet it is never early to start educating and helping raise awareness to conditions that affect so many of patients and our very own loved ones.

 

Take care and have a wonderful week,

Dr. Efe Sahinoglu with Birmingham Direct Primary Care

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