Diabetes Mellitus- Types, 10 Early Signs You Shouldn’t Ignore

Introduction

What is Diabetes and Why Should We Care?

Diabetes is a chronic condition that affects how your body regulates blood sugar. When you have diabetes mellitus, your body either doesn’t produce enough insulin or it can’t use the insulin it produces efficiently. The insulin hormone facilitates the body’s use of glucose, or sugar, as fuel. Without enough insulin, glucose builds up in your blood, leading to various health problems.

Diabetes is a major global health concern, affecting millions of people worldwide. It’s a complex condition that can significantly impact your quality of life, so understanding diabetes is crucial for managing your health.

Definition of Diabetes Mellitus

Diabetes mellitus is a condition characterized by high sugar (glucose) levels in your blood. It happens when your pancreas either fails to function correctly, does not produce sufficient insulin, or when your body cannot use insulin effectively. This condition can affect individuals of all ages, with most types being chronic and manageable through medications and lifestyle adjustments.

Glucose, primarily sourced from carbohydrates in food and beverages, is the body’s primary energy source. Insulin, a hormone produced by the pancreas, acts as a key to help glucose enter cells to be used for energy. When insulin production is insufficient or ineffective, glucose accumulates in the bloodstream, leading to high blood sugar levels (hyperglycemia). Persistent high blood glucose can lead to various health issues such as heart disease, nerve damage, and eye problems.

Technically diabetes is called diabetes mellitus, which differs from diabetes insipidus. While both conditions share symptoms like increased thirst and frequent urination, diabetes insipidus is far less common.

How does insulin work?

The pancreatic beta cells release a hormone called insulin. It is vital for maintaining blood glucose levels. Here’s a detailed look at how insulin functions in the body:

1. Glucose Uptake: After eating, carbohydrates are broken down into glucose, which enters the bloodstream. Elevated blood glucose levels cause the pancreas to release insulin.
2. Cellular Glucose Absorption: Insulin makes it easier for cells, especially muscle and fat cells, to absorb glucose. It attaches itself to insulin receptors on the surface of cells, starting a series of actions that permit glucose transporters (like GLUT4) to migrate to the cell membrane and take up glucose.
3. Glycogen Storage: Insulin encourages glucose to be converted into glycogen, a stored form of glucose, in the liver and muscle cells. We call this process glycogenesis. As a reserve, glycogen can be converted back to glucose as needed.
4. Inhibition of Gluconeogenesis: Insulin prevents the liver’s process of gluconeogenesis, which produces glucose from non-carbohydrate sources, from increasing too much, leading to dangerously high blood glucose levels.
5. Fat Storage: Insulin also facilitates the conversion of surplus glucose into fat within adipose tissues. It increases the synthesis of fatty acids and triglycerides while inhibiting lipolysis, the breakdown of fats.
6. Protein Synthesis: Insulin supports protein synthesis by facilitating amino acid uptake into cells, contributing to muscle growth and repair.

The Role of Glucose

Glucose is a simple form of sugar and a major energy source for the body’s cells. Here’s an overview of its role:

1. Energy Production: Adenosine triphosphate, or ATP, is the energy unit of the cell and is produced when glucose is digested by cellular respiration. This process occurs in the mitochondria and involves glycolysis, the Krebs cycle, and the electron transport chain.
2. Brain Function: The brain gets most of its energy from glucose. Neurons are highly active cells and require a constant supply of glucose to function properly. Low glucose levels can impair cognitive functions and lead to symptoms: of confusion and irritability.
3. Muscle Activity: Muscles use glucose to provide instant energy when exercising. Stored glycogen in muscles can be broken down into glucose to meet increased energy demands.
4. Homeostasis: Glucose levels are tightly regulated to maintain homeostasis. Insulin and glucagon are key hormones in this regulation. While insulin reduces blood glucose by increasing cellular absorption, glucagon raises it by activating glycogen breakdown and gluconeogenesis in the liver.
5. Metabolic Pathways: Glucose is a central molecule in various metabolic pathways. It serves as a precursor for producing other important macromolecules such as nucleic acids, amino acids, and lipids.

The Impact of Diabetes: A Global Health Challenge

Diabetes is a serious health concern with a significant global impact. The high global burden of diabetes places a strain on individuals, healthcare systems, and nations. The World Health Organization (WHO) estimates that over 422 million people worldwide have diabetes, the number is projected to rise to 783 million by 2045. Diabetes is a major cause of death, disability, and economic hardship. It contributes to heart disease, stroke, blindness, kidney failure, and amputations. Diabetes has a significant financial impact due to the expenditures of medical care, lost productivity, and early mortality. Understanding diabetes, its causes, symptoms, and management is crucial for addressing this global health challenge and improving the well-being of individuals and communities worldwide.

Brief overview of types of diabetes

What are the types of diabetes?

There are several types of diabetes, including:

• Type 1 Diabetes mellitus
• Type 2 Diabetes mellitus
• Gestational Diabetes
• Other Types
  • Prediabetes
  • Type 3c Diabetes
  • Latent Autoimmune Diabetes in Adults (LADA)
  • Maturity-Onset Diabetes of the Young (MODY)
  • Neonatal Diabetes
  • Brittle Diabetes

Type 1 Diabetes mellitus: An Autoimmune condition

Diabetes mellitus type-1 is an insulin-dependent diabetes also referred to as autoimmune disease or juvenile diabetes. This suggests that the body’s immune system unintentionally attacks and destroys the pancreatic beta cells, producing insulin. The body cannot effectively control blood sugar levels without insulin, which causes a build-up of glucose in the blood.

Although the precise origin of type 1 diabetes mellitus is uncertain, environmental factors and genetic predisposition are thought to play a combined role. It can happen at any time and usually manifests itself in childhood or adolescence, although it can also strike adults.

Type 1 diabetes cannot be cured, but it can be effectively controlled with insulin therapy, a balanced diet, and frequent exercise. To keep blood sugar under control and avoid complications, regular blood sugar monitoring is essential.

Diabetes Mellitus Type 2

Type 2 diabetes mellitus, the most prevalent form of diabetes, develops when your body either insufficient insulin production or from the body’s inability to utilize the insulin that is produced. This condition, often referred to as “insulin resistance,” leads to a buildup of glucose in your bloodstream, ultimately causing the complications associated with diabetes.

While genetics play a role, type 2 diabetes is strongly linked to lifestyle factors. Obesity and a lack of physical activity are major contributors to insulin resistance. A diet high in unhealthy fats and processed foods can also contribute to the development of type 2 diabetes.

Understanding how lifestyle choices impact insulin resistance is crucial for preventing and managing type 2 diabetes. Maintaining a healthy lifestyle can help your body better control blood sugar levels.

Diabetes Mellitus Type 2 Risk factors

• obesity
• lack of physical activity
• unhealthy diets
• environmental factors like Viruses (Mumps, Coxsackie B4 virus, retroviruses, rubella, CMV, Epstein Barr virus)
• bovine milk protein
• genetic factors

Gestational Diabetes

What is Gestational Diabetes?

Gestational diabetes develops during pregnancy. It’s not the same as type 1 or type 2 diabetes, but it can have similar effects on blood sugar levels. Your body experiences a lot of hormonal changes when you are pregnant. These changes can make it harder for your body to use insulin effectively, leading to higher blood sugar levels.

Risks for mother and baby

While most women with gestational diabetes don’t experience any symptoms, it can affect both the mother and the baby. For mothers, gestational diabetes can increase the risk of complications like preeclampsia, premature labor, and a larger-than-average baby. For babies, it can lead to breathing problems, low blood sugar, and even jaundice.

Management during pregnancy

Fortunately, gestational diabetes can usually be managed through diet, exercise, and sometimes insulin therapy. Regular blood sugar monitoring is essential to keep levels within a healthy range. Working closely with your doctor and a registered dietitian can help you develop a personalized plan for managing gestational diabetes and ensuring a healthy pregnancy for you and your baby.

Other Types

• Prediabetes: A precursor to Type 2 diabetes where blood glucose levels are higher than normal but not yet high enough for a diabetes diagnosis.
• Type 3c Diabetes: caused by diseases like pancreatitis or pancreatic cancer that cause damage to the pancreas.
• Latent Autoimmune Diabetes in Adults (LADA): Like Type 1, but with a slower rate of development and a higher diagnosis rate in people over 30.
• Maturity-onset Diabetes of the Young (MODY): a type of diabetes that is hereditary and impacts insulin synthesis and use.
• Neonatal Diabetes: A rare type occurring within the first six months of life, with either a permanent or transient form.
• Brittle Diabetes: A serious variant of Type 1 diabetes marked by frequent and extreme swings in blood sugar levels.

Causes and Risk Factors

What causes diabetes?

• Insulin resistance: Most commonly linked to Type 2 diabetes mellitus.
• Autoimmune response: Linked to Type 1 diabetes and LADA.
• Hormonal changes: Due to hormonal changes during pregnancy can lead to gestational diabetes.
• Pancreatic damage: Can result in Type 3c diabetes.
• Genetic mutations: Cause MODY and neonatal diabetes.
• Prolonged use of certain medications, such as corticosteroids and treatments for HIV/AIDS, can lead to the development of Type 2 diabetes.
• Genetic predisposition
• Lifestyle factors (diet, exercise)
• Obesity
• Pregnancy-related hormonal changes (for gestational diabetes)

Signs and Symptoms of Diabetes Mellitus

What are the 10 warning signs of diabetes?

• Here are 10 warning signs and symptoms of diabetes:
  1. Frequent urination: Increased urine may indicate high blood sugar levels, particularly at night.
  2. Excessive thirst: Feeling unusually thirsty can occur because the body is trying to flush out excess sugar through urine.
  3. Extreme hunger: increased appetite when the body can’t adequately use the glucose after eating.
  4. Unexplained weight loss: It is possible to lose weight naturally because the body uses muscle and fat rather than glucose as fuel.
  5. Fatigue: Feeling very tired and weak because the body’s cells aren’t getting enough glucose.
  6. Blurred vision: Vision impairment may result from fluid being drawn out of the eye’s lenses by high blood sugar levels.
  7. Slow-healing sores: Slow-healing cuts or wounds may be caused by elevated blood sugar and inadequate blood circulation.
  8. Frequent infections: Recurrent infections, such as gum or skin infections and vaginal or bladder infections.
  9. Tingling or numbness in hands or feet: Nerve damage caused by high blood sugar can result in a tingling or numb sensation.
  10. Darkened skin: Patches of dark skin in areas of body creases and folds (acanthosis nigricans) can be a sign of insulin resistance.
• It’s critical to get medical help for a correct diagnosis and course of therapy if you or someone you know experiences these symptoms.

Importance of early detection and diagnosis

1. Prevention of Complications: Early diagnosis allows for timely management of blood sugar levels, which can prevent or delay serious complications such as heart disease, kidney damage, nerve damage, and eye problems.
2. Improved Quality of Life: Proper management and lifestyle changes initiated early can help individuals maintain a better quality of life, reducing symptoms like fatigue, excessive thirst, and frequent infections.
3. Reduced Healthcare Costs: Managing diabetes early can reduce the long-term healthcare costs associated with treating advanced complications. Preventive care and early interventions are often less expensive than treating severe complications.
4. Better Blood Sugar Control: Early diagnosis allows for better and more consistent blood sugar control through medication, diet, and exercise, reducing the risk of hyperglycemia and hypoglycemia.
5. Prevention of Severe Symptoms: Identifying and treating diabetes early can prevent the development of severe symptoms such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), which require emergency care.
6. Lifestyle Modification: Early detection provides an opportunity for individuals to make essential lifestyle modifications, such as improving diet, increasing physical activity, and quitting smoking, which can have a positive impact on overall health.
7. Education and Support: Patients who receive an early diagnosis have more access to information and support services that can help them manage their symptoms, have a better understanding of their condition, and change their lifestyle.
8. Monitoring and Management: Early diagnosis allows for regular monitoring and more effective management of the disease, which can help prevent the progression of diabetes and its associated health risks.
9. Avoidance of Acute Complications: Early detection helps in preventing acute complications like severe hypoglycemia and infections, which can be life-threatening if not managed promptly.
10. Psychological Benefits: Knowing one’s health status early can reduce anxiety and stress associated with unexplained symptoms and allow individuals to take proactive steps in managing their health.

Diagnosis of Diabetes Mellitus

How is diabetes diagnosed?

• Clinical features (signs and symptoms)
• Blood glucose tests
  • Fasting blood glucose test: Conducted after at least eight hours of fasting.
  • Random blood glucose test: This test can be performed at any time.
  • A1c test: Measures average blood glucose over the past 2-3 months.
• Oral glucose tolerance test (for gestational diabetes)
• Interpretation of test results:

Diagnosis	HbA1c (glycated hemoglobin level)	Fasting plasma glucose (mg/dl)	Oral Glucose tolerance test (OGTT) in mg/dl	Random plasma glucose test in mg/dl
Normal	Below 5.7	99 or below	139 or below
Prediabetes	5.7 to 6.4	100 to 125	140 to 199
Diabetes	6.5 or above	126 or above	200 or above	200 or above

Complications of Diabetes Mellitus

Short-term complications

• Hyperosmolar hyperglycemic state (HHS)
• Diabetic ketoacidosis (DKA)
• Hypoglycemia

Long-term complications

• Cardiovascular diseases
• Neuropathy
• Nephropathy
• Retinopathy
• Foot problems
• Skin infections
• Oral health issues

Management and Treatment of Diabetes Mellitus

How is diabetes managed?

• Monitoring blood sugar levels
  • Self-monitoring with glucose meters
  • Continuous glucose monitoring (CGM)
• Medications
  • Oral medications
  • Insulin therapy
• Lifestyle changes
  • Diet and nutrition
  • Exercise and physical activity
  • Weight management
• Preventive measures
  • Regular health check-ups
  • Managing stress and mental health

Prevention of Diabetes Mellitus

How can I prevent diabetes?

• Healthy eating habits
• Regular physical activity
• Maintaining a healthy weight
• Managing risk factors
• Preventing complications through regular monitoring

Prognosis

What is the prognosis for diabetes?

The outlook for diabetes depends on its type, how well it is managed, and any complications that arise. Persistently high blood sugar levels can cause serious complications and shorten life expectancy. However, effective management through lifestyle changes, regular monitoring, and treatment adherence can lead to a healthy life with diabetes.

Living with Diabetes Mellitus

Daily Management Tips

• Regular Monitor Blood Sugar Levels
• Healthy Eating habits: Follow a balanced diet rich in vegetables, fruits, whole grains, and lean proteins. Limit sugary foods and refined carbohydrates. Consider talking to a dietician about created meal planning.
• Exercise Regularly: Engage in at least 150 minutes of moderate aerobic activity per week, such as walking, cycling, or swimming. Include strength-training workouts twice a week.
• Medication Adherence: Take your medications as prescribed. Use reminders or a medication organizer to ensure you don’t miss doses.
• Stay Hydrated: Drink plenty of water throughout the day to help maintain optimal blood sugar levels and overall health.
• Foot Care: Examine your feet every day for wounds, blisters, and symptoms of infection. Wear appropriate footwear and keep your feet clean and dry.
• Stress Management: Practice deep-breathing exercises, yoga, or meditation to help maintain stable blood sugar levels.
• Sleep Well: Aim for 7-9 hours of sleep per night. Good sleep hygiene can improve insulin sensitivity and overall health.

Coping with the Psychological Impact

• Educate Yourself: Understanding diabetes can reduce anxiety. Learn about your condition and management techniques.
• Set Realistic Goals: Set manageable goals for blood sugar control, diet, and exercise. Celebrate small achievements to stay motivated.
• Mindfulness and Relaxation: Engage in mindfulness practices, relaxation techniques, or hobbies that you enjoy to reduce stress and improve your emotional well-being.
• Seek Professional Help: If you experience feelings of depression or anxiety, consult a mental health professional who can provide counseling or therapy.
• Stay Connected: Maintain solid relationships with your family and friends. Social support is vital for emotional health.

Support Groups and Resources

• Local Support Groups: Join local diabetes support groups to share experiences, tips, and encouragement with others living with diabetes.
• Online Communities: Participate in online forums and social media groups dedicated to diabetes management. Websites like the American Diabetes Association and Diabetes UK offer valuable resources.
• Educational Workshops: Attend workshops and seminars to stay updated on the latest diabetes management techniques and research.
• Apps and Tools: Use diabetes management apps to track your blood sugar levels, diet, exercise, and medication.
• Helplines and Counseling: Utilize helplines and counseling services offered by diabetes organizations for immediate support and guidance.

Importance of a Strong Healthcare Team

• Comprehensive Care: A multidisciplinary team, including your primary care physician, endocrinologist, dietitian, diabetes educator, and mental health professional, provides comprehensive care tailored to your needs.
• Regular Check-ups: Routine visits with your healthcare team help monitor your condition, adjust treatment plans, and address any concerns promptly.
• Personalized Treatment Plans: Your healthcare team can develop and adjust personalized treatment plans based on your specific health status and lifestyle.
• Education and Support: Healthcare professionals provide essential education about managing diabetes, preventing complications, and maintaining a healthy lifestyle.
• Emergency Support: In case of emergencies or severe fluctuations in blood sugar levels, having a reliable healthcare team ensures you receive prompt and effective treatment.

Recent Advances and Research

• New treatment options: New diabetes drugs
  • In recent years, various new medications have been developed to treat diabetes, including both oral and injectable drugs.
  • New Oral Drugs: Except for Steglatro, the majority of new oral diabetic medicines are combo therapies.
    • Xigduo XR: Approved in 2014, this extended-release tablet combines metformin, which enhances insulin sensitivity, and dapagliflozin, which increases glucose excretion via urine.
    • Synjardy: Approved in 2015, it combines metformin with empagliflozin, which works similarly to dapagliflozin.
    • Glyxambi: Approved in 2015, it includes linagliptin, which stimulates insulin release and slows glucose absorption, and empagliflozin.
    • Steglujan: Approved in 2017, it combines ertugliflozin, similar to empagliflozin, and sitagliptin, which also promotes insulin release and slows glucose absorption.
    • Segluromet: Approved in 2017, it pairs ertugliflozin with metformin.
    • Steglatro: Approved in 2017, this drug contains only ertugliflozin, used to increase glucose excretion through urine.
• New Injectables
  • New injectable medications for diabetes include various forms of insulin and GLP-1 agonists, used to treat either type 2 diabetes or both type 1 and type 2 diabetes.
    • Tresiba: Approved in 2015, this long-acting insulin degludec lasts up to 42 hours and is injected daily.
    • Basaglar and Toujeo: Both are forms of insulin glargine approved in 2015. Basaglar lasts 24 hours, whilst Toujeo is more intense and lasts 36.
    • Xultophy: Approved in 2016, it is used to treat type 2 diabetes with once-daily injections of insulin degludec and the GLP-1 agonist liraglutide.
    • Soliqua: Approved in 2016, it combines insulin glargine and the GLP-1 agonist lixisenatide, and is used to treat type 2 diabetes with once-daily injections.
    • Ozempic and Rybelsus: Approved in 2017, these medications contain the GLP-1 agonist semaglutide. Ozempic is injected weekly, whereas Rybelsus is taken orally.
    • Adlyxin: Lixisenatide, a GLP-1 agonist approved in 2016, is used to treat type 2 diabetes with daily injections.
• Technological advancements (like insulin pumps and CGMs)
  • Recent technological advancements have significantly improved the management of diabetes, particularly through the development of insulin pumps and continuous glucose monitors (CGMs).
  • Insulin Pumps
    • Insulin pumps are small, automated devices that continually administer insulin throughout the day. They offer several benefits:
      • Precise Insulin Delivery
      • Convenience
      • Flexible Lifestyle
      • Advanced Features: Many pumps come with features like bolus calculators, alarms for missed doses, and connectivity to smartphones for easier management and data tracking.
  • Continuous Glucose Monitors (CGMs)
    • CGMs are devices that continuously track glucose levels in real time, providing insights that help users manage their condition more effectively.
  • Hybrid Closed-Loop Systems
    • Also known as artificial pancreas systems, hybrid closed-loop systems combine insulin pumps and CGMs to automate insulin delivery.

Conclusion of Diabetes

Key Points and Encouragement

• Understanding Diabetes: Diabetes is a chronic condition affecting blood sugar regulation due to inadequate insulin production or utilization.
• Global Health Concern: Diabetes affects millions worldwide, significantly impacting health, quality of life, and healthcare systems.
• Types of Diabetes: Includes Type 1 diabetes mellitus, Type 2 diabetes mellitus, Gestational Diabetes, and other less common forms.
• Insulin’s Role: Insulin helps cells absorb glucose for energy, stores excess glucose as glycogen, and regulates fat and protein metabolism.
• Symptoms: Frequent urination, excessive thirst, extreme hunger, weight loss, fatigue, blurred vision, slow-healing sores, frequent infections, tingling in extremities, and darkened skin patches.
• Early Detection: Crucial for preventing complications, improving quality of life, and reducing healthcare costs.
• Management: Regular blood sugar monitoring, medication adherence, lifestyle changes (diet, exercise), and stress management.
• Support: Importance of a strong healthcare team and support systems for effective diabetes management.
• Advances and Research: New treatment options, medications, and technological advancements like insulin pumps and continuous glucose monitors (CGMs).

Encouragement for Regular Check-Ups and Proactive Management

• Regular Health Check-Ups: Essential for monitoring and managing diabetes effectively.
• Proactive Management: Involves medication adherence, healthy lifestyle choices, and regular monitoring of blood sugar levels.
• Support and Education: Utilize available resources, support groups, and educational materials to stay informed and motivated.

By understanding diabetes and taking proactive steps in management, individuals can lead healthier lives and minimize the risk of complications. Regular check-ups, lifestyle adjustments, and support from healthcare professionals and community resources are key to effective diabetes management.

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