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What is diabetes?
Diabetes is a group of conditions linked by an inability to produce sufficient insulin and/or to respond to insulin. Thiscauses high blood glucose levels (hyperglycemia) and can lead to a number of acute and chronic healthproblems, some of them life-threatening.
Glucose is the body’s primary energy source. After a meal, carbohydrates usually are broken down into glucose andother simple sugars. This causes blood glucose levels to rise and stimulates the pancreas to release insulin into thebloodstreamIf someone is unable to produce enough insulin, or if the body’s cells are resistant to its effects(insulin resistance), then less glucose is transported from the blood into cells. Blood glucose levels remain highand the body’s cells “starve.” This can cause both acute and chronic problems depending on the severity of theinsulin deficiency.
Acute hyperglycemia can be a medical emergency. The body tries to rid the blood of excess glucose by flushing it outof the system with increased urination. This process can cause dehydration and upset the body’s electrolytebalance as sodium and potassium are lost in the urine. With severe insulin deficiency, glucose is not available to thecells and the body may attempt to provide an alternate energy source by metabolizing fatty acids. This less efficientprocess leads to a buildup of ketones and upsets the body’s acid-base balance, producing a state known asketoacidosis. Left unchecked, acute hyperglycemia can lead to severe dehydration, loss of consciousness, andeven death.
Glucose levels that rise over time and become chronically elevated may not be initially noticed. The body tries tocontrol the amount of glucose in the blood by increasing insulin production and by eliminating glucose in the urine.Symptoms usually begin to arise when the body is no longer able to compensate for the higher levels of bloodglucose. Chronic hyperglycemia can cause long-term damage to blood vessels, nerves, and organs throughout thebody and can lead to other conditions such as kidney failure, loss of vision, strokes, cardiovascular disease andcirculatory problems in the legs.
Types of Diabetes
There are three main types of diabetes: type 1, type 2, and gestational diabetes.
Type 1 diabetes, which used to be called insulin dependent or juvenile diabetes, makes up about 10% of thediabetes cases in the United States. Most cases of type 1 diabetes are diagnosed in those under the age of 30.
Symptoms often develop abruptly and the diagnosis is often made in an emergency room setting. The affectedperson may be seriously ill, even comatose, with very high glucose levels and high levels of ketones(ketoacidosis). Type 1 diabetics make very little or no insulin. Any insulin-producing beta cells they do have at thetime of diagnosis are usually completely destroyed within 5 to 10 years, leaving them entirely reliant on insulininjections to live.
Type 2 diabetes used to be known as non-insulin dependent diabetes or adult onset diabetes. Those affected domake their own insulin, but it is either not in a sufficient amount to meet their needs or their body has becomeresistant to its effects. At the time of diagnosis, people with type 2 diabetes will frequently have both high glucoselevels and high insulin levels, but they may not have any symptoms. It generally occurs later in life, in those who are obese, sedentary, and over 45 years of age.
Factors associated with diabetes include:
Gestational diabetes is a form of hyperglycemia seen in some pregnant women, usually late in their pregnancy.
The cause is unknown, but it is thought that some hormones from the placenta increase insulin resistance in themother, causing elevated blood glucose levels. Most women are screened for gestational diabetes between their24th and 28th week of pregnancy. If gestational diabetes is found and not addressed, the baby is likely to be largerthan normal, be born with low glucose levels, and be born prematurely. The hyperglycemia associated withgestational diabetes usually goes away after the baby’s birth, but both the women diagnosed with gestationaldiabetes and their babies are at an increased risk of eventually developing type 2 diabetes. A woman who hasgestational diabetes with one pregnancy will frequently experience it with subsequent pregnancies.
Pre-Diabetes is a term for impaired fasting glucose or impaired glucose tolerance. It is characterized by glucoselevels that are higher than normal, but not high enough to be diagnostic of diabetes. Usually those who have pre diabetes do not have anysymptoms but, if nothing is done to lower their glucose levels, they are at an increased risk of developing diabeteswithin about 10 years. Experts are recommending that everyone who has any of the risk factors for type 2 diabetesbe tested for pre-diabetes.
Signs and Symptoms
The signs and symptoms of diabetes are related to high glucose levels (hyperglycemia), low glucose levels(hypoglycemia), and complications associated with diabetes. The complications can be related to lipid production,damage to blood vessels (vascular and microvascular), organ damage – for example, kidney (diabetic nephropathy),nerve (diabetic neuropathy), and eye (diabetic retinopathy) damage – and/or to the slower healing associated withdiabetes. Type 1 diabetics are often diagnosed with acute severe symptoms that require hospitalization. With prediabetes,early type 2 diabetes, and gestational diabetes, there usually are no symptoms.
Symptoms of type 1 and type 2 diabetes with hyperglycemia:
Symptoms of impending hypoglycemia:
Temporary hypoglycemia in the diabetic may be caused by the accidental injection of too much insulin, not eatingenough or waiting too long to eat, exercising strenuously, or by the swings in glucose levels seen with “brittle”diabetes. Hypoglycemia needs to be addressed as soon as it is noticed as it can rapidly progress tounconsciousness. Symptoms include:
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