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In the past I have written a number of articles on diabetes.  Today I want to bring all this diabetes information together and give the topic an extensive write up.

WHAT IS DIABETES?

Diabetes  mellitus (often abbreviated to simply diabetes) is a disease that develops when your blood glucose levels become extremely high because either:
- Your body is not producing enough insulin.
- Your body is not responding to insulin properly.

In non-diabetic people the pancreas responds to high blood glucose levels by releasing insulin.  Insulin allows your body’s cells to take glucose from the blood and either use it for energy or store it for later use in the form of glycogen or fat.  This causes your overall blood glucose levels to fall.  When they reach a certain level your pancreas stops releasing insulin and starts to release glucagon.  Glucagon causes your liver to convert glycogen stores back into glucose and then release it into the blood.  This causes your overall blood glucose levels to rise.  When they reach a certain level your body stops releasing glucagon, starts releasing insulin and the whole process starts again.

The above process allows your pancreas to regulate blood glucose levels ensuring that they are never too high and never too low.  However, in diabetic people this process goes wrong and their pancreas stops producing enough insulin or their cells stop responding to insulin properly.  This inability to use or produce insulin means that diabetic people’s cells cannot easily take glucose from the blood.  As a result the blood glucose levels in diabetic people become extremely high.  This can cause numerous problems which I will be discussing later on in this article.

WHAT TYPES OF DIABETES ARE THERE?

There are four main types of diabetes:

1) GESTATIONAL DIABETES:- Gestational diabetes (also known as gestational diabetes mellitus or the abbreviated GDM) is a temporary form of diabetes that develops during pregnancy.  It normally occurs during the second half of a woman’s pregnancy and then goes away after the baby is born.  Around 5% of pregnant women are believed to suffer from GDM.

Since GDM is a temporary form of the disease it does not pose an immediate threat to your health.  However, it still needs to be managed properly by making good dietary choices and participating in regular exercise (more on this later in the article).  Failure to manage GDM in this way can lead to pre-eclampsia (a form of high blood pressure) and macrosomia (a new born baby with a high birth weight) which can have a negative impact on your pregnancy and make giving birth more difficult.  Badly managed GDM can also increase your chances of contracting the condition during future pregnancies and makes you more likely to develop type 2 diabetes in later life.

2) PRE-DIABETES:- Pre-diabetes describes people with higher than normal blood glucose levels.  A pre-diabetic’s blood glucose levels are not considered high enough to be classed as type 2 diabetes.  However, pre-diabetes almost always develops into full type 2 diabetes if positive lifestyle changes are not made.  Fortunately, pre-diabetes can be reversed if modify your diet and exercise routine accordingly.

3) TYPE 1 DIABETES:- Type 1 diabetes (also known as juvenile onset diabetes or insulin dependent diabetes) develops when your pancreas can no longer produce insulin.  It is not as common as type 2 diabetes representing between 5% and 10% of diabetes cases.  However, it is a much more serious disease and can be fatal if it is not managed properly.  Type 1 diabetes always needs to be treated with insulin injections although a healthy diet and regular exercise can help you better manage the condition.

If you suffer from type 1 diabetes your body will not be able to produce insulin.  Therefore, it needs to be managed a lot more closely than other types of diabetes.  First, you will need to eat right and exercise regularly.  However, you will also need to monitor your blood glucose levels regularly using a glucometer and supply your body with insulin through daily injections.

4) TYPE 2 DIABETES:- Type 2 diabetes (also known as non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes) develops when your pancreas stops producing enough insulin or your body’s cells become resistant to insulin.  It is much more common than type 1 diabetes representing between 90% and 95% of diabetes cases.  Type 2 diabetes can often be managed through lifestyle changes alone but approximately 40% of sufferers require insulin injections.

In most cases type 2 diabetes can be managed through a good diet and regular exercise routine alone.  You will still need to monitor your blood glucose levels at regular, daily intervals using a glucometer but in 60% of cases no insulin injections are required.

WHAT CAUSES DIABETES?

1) GESTATIONAL DIABETES:- GDM is thought to be caused by hormonal changes that occur during the second and third trimester of pregnancy.  During this time the placenta produces insulin resistant hormones in an effort to make sure the growing baby gets enough glucose.  This can cause a pregnant woman’s insulin requirements to increase by two or three times the normal rate.  If their pancreas cannot supply enough insulin to meet this increased demand GDM develops.

2) TYPE 1 DIABETES:- Type 1 diabetes develops when the pancreas becomes damaged and cannot produce insulin.  In most cases this damage happens when your immune system malfunctions and starts to attack the insulin producing beta cells of the pancreas.  It is not known what causes the body’s immune system to malfunction in this way.  Some believe it is a reaction to certain types of infection.  Others believe it is an inherited genetic weakness.  Another theory is that faulty nerves cause this immune system response.

3) PRE-DIABETES AND TYPE 2 DIABETES:- Pre-diabetes is an early sign of type 2 diabetes and therefore develops in the same way.  Type 2 diabetes develops when your cells start to resist insulin for some unknown reason.  This makes it more difficult for them to use glucose.  Since your cells are not getting enough insulin or glucose your pancreas responds by releasing more insulin and your liver responds by breaking down glycogen and releasing more glucose.  In the long run these responses impair your pancreas’s ability to produce insulin, make your cells more resistant to insulin and raises your blood glucose levels.

The exact reason for your cells becoming insulin resistant is unknown.  Age, ethnicity, having other family members with type 2 diabetes and contracting GDM whilst pregnant are all thought to increase your risk of developing this condition.  However, the biggest risk factors are obesity and a sedentary lifestyle.  Being obese increases the amount of fat cells in your body.  This makes you more resistant to insulin because fat cells have less insulin receptors than muscle cells and also increase the total number of cells that your pancreas has to supply with insulin.  A lack of exercise contributes to obesity and also makes your body less effective at controlling blood glucose levels.

WHAT ARE THE SYMPTOMS OF DIABETES?

1) HYPERGLYCAEMIA:- Hyperglycaemia refers to blood glucose levels that are consistently higher than 126 milligrams per decilitre (mg/dL)  In diabetics it is almost always the result of a low insulin levels.  Hyperglycaemia can be aggravated by eating too many sugars or carbohydrates, not doing enough exercise or becoming stressed.  It has a number of noticeable symptoms which include; blurred vision, hunger, frequent urination and thirst.  Mild hyperglycaemia can be treated with insulin injections but more serious hyperglycaemia requires hospital treatment.

2) HYPOGLYCAEMIA:- Hypoglycaemia refers to blood glucose levels that are consistently lower than 70 mg/dL.  It is normally the result of having too much insulin in your body.  In diabetics, hypoglycaemia is often caused by excessive alcohol consumption, not eating enough before exercising or injecting too much insulin.  It is therefore most common in type 1 diabetics because they have to inject insulin on a regular basis.  The symptoms of hyperglycaemia include; blurred vision, confusion, dizziness, shaking and sweating.  Mild hypoglycaemia can be treated by consuming 10g – 20g of sugar with glucose tablets being a good way to do this.  However, more serious hypoglycaemia leads to unconsciousness and therefore requires medical attention.

3) DIABETIC KETOACIDOSIS (DKA):- DKA refers to a high concentration of ketone bodies in your blood stream.  In diabetics it develops when your body’s cells cannot get the glucose they need because of low insulin levels.  This leads to muscle and fat being broken down for energy instead.  The breakdown of fat causes ketones to be released into your blood stream as a by product.  If your body continues to use fat for energy these ketones build up in the blood which causes your body to enter a state of DKA.  The symptoms of DKA include; abdominal pain, fruity smelling breath, loss of appetite and vomiting.  DKA is a very serious condition and can be fatal if immediate medical treatment is not applied.

4) HYPEROSMOTIC NON-KETOTIC ACIDOSIS (HONK):- HONK (also referred to as nonketotic hyperosmolar coma, nonketotic hyperglycaemia and hyperosmolar hyperglycemic nonketotic coma (HHNKC)) is a diabetic coma.  It develops when low insulin levels lead to your blood glucose levels becoming excessively high.  Your body attempts to remove this excess glucose by passing more urine.  This can then lead to extreme dehydration and eventually HONK.  HONK has multiple symptoms which include; dry skin, a fever and increased thirst.  Like DKA, HONK is a very serious condition and requires immediate medical attention.

5) PERIPHERAL NEUROPATHY:- Peripheral neuropathy refers to the loss of nerve function in your arms or legs.  In diabetics, it is often the result of long term nerve damage that diabetes can cause but it can also be due to alcoholism, disease, infection and vitamin deficiency.  The main symptoms of peripheral neuropathy include; a high sensitivity to being touched, a lack of co-ordination and tingling in your hands and feet which can spread into your arms and legs.  Mild peripheral neuropathy can be managed by eating a healthy, vitamin rich diet but more serious peripheral neuropathy may need to be treated with painkillers.

6) DIABETIC RETINOPATHY:- Diabetic retinopathy refers to damaged blood vessels in the retina.  It is the result of high blood glucose levels causing your eyes to swell and ultimately damaging the capillaries which supply your retina with blood.  Diabetic retinopathy can affect your vision in various ways such as; dark streaks that block your vision, floating spots in your vision and poor night vision.  For mild diabetic retinopathy these symptoms can be reduced by making good nutrition and exercise choices.  However, for sever diabetic retinopathy corrective laser surgery may need to be applied.

WHAT ARE THE TESTS FOR DIABETES?

1) FASTING PLASMA GLUCOSE (FPG) TEST:- The FPG test measures the levels of glucose in a person’s blood following a fast.  It is one of the most popular diabetes tests around but cannot be used to test for GDM.  The test involves fasting for eight hours.  Following this a blood sample is taken and the glucose levels in this sample are measured.  A reading of 99 mg/dL is considered normal whilst a reading between 100 mg/dL and 125 mg/dL suggests that you have pre-diabetes.  A reading of 126 mg/dL or above indicates that you have type 1 or type 2 diabetes which then leads to a re-test to confirm.

2) ORAL GLUCOSE TOLERANCE TEST (OGTT):- The OGTT measures the levels of glucose in a person’s blood following the consumption of a glucose drink.  It can be used to test for all types of diabetes.  The first stage of the OGTT is identical to the FPG test where you fast for eight hours and have a blood sample taken.  For the second stage you are given the glucose drink and then have a blood sample taken at three hourly intervals following consumption.  If the OGTT is being used to test for GDM then only the second stage is performed.  The results of the test are based on the final blood sample with a reading of 139 mg/dL considered normal and a reading between 140 mg/dL and 199 mg/dL indicating pre-diabetes.  Readings of 200 mg/dL and above suggest that you have either type 1, type 2 or gestational diabetes.

3) RANDOM BLOOD GLUCOSE (RBG) TEST:- The RBG test is relatively simple and involves pricking your finger with a lancing device, placing a drop of blood on a test strip then putting this strip into a glucometer.  If the glucometer shows a reading of 200 mg/dL or above this suggests you might have diabetes.  However, since glucometers are designed for home testing they are not accurate enough to be the sole basis of a diabetes diagnosis.  Therefore, if a RBG test indicates that you have diabetes go to your doctor for a second opinion and further testing.

4) KETONE TEST:- This test looks for ketones in your blood stream or urine.  High levels of ketones can indicate that your cells are not using glucose properly.  This may be due to low levels of insulin in your body and therefore can indicate diabetes.  The blood ketone test involves a blood sample being taken and tested by your doctor.  The urine ketone test can be performed at home and involves the use of special test strips.  Whilst the urine test is more convenient the blood test is more accurate.

5) URINE GLUCOSE TEST:- This test looks for glucose in the urine.  It involves urinating in a plastic container which is then passed to your doctor for testing.  Urine does not normally contain glucose.  However, when your blood glucose levels reach 180 mg/dL and above it starts to appear in your urine.  Having glucose in your urine does not mean you definitely have diabetes but it does act as an indicator for the disease.

6) GLYCOSYLATED HAEMOGLOBIN TEST:- This test measures your glycosylated haemoglobin levels through a blood sample.  Unlike the above tests, the glycosylated haemoglobin test is not a test for diabetes but a test to see how well diabetics are managing their condition.  Glycosylated haemoglobin levels of between 4% and 6% are normal for non-diabetics whilst levels of 7% are normal for diabetics who are managing their condition effectively.  Levels of glycosylated haemoglobin above 7% suggest that your diabetes is not being managed effectively.

HOW CAN DIABETES BE TREATED?

All types of diabetes cause one fundamental problem – poor blood glucose control.  Therefore, the key to treating diabetes is keeping your blood glucose levels within a normal range.  Whilst diabetes cannot be 100% cured the treatments below will allow you to keep the condition under control.

1) MONITOR YOUR BLOOD GLUCOSE LEVELS:- Regular blood glucose checks will allow you to see if your diabetes is under control and also how your body is responding to current treatments.  Generally, type 1 diabetics will need to check their blood glucose levels much more frequently than type 2 diabetics.  However, this is not always the case and you should consult your doctor on this.  You can monitor your blood glucose levels by performing a RBG test with a portable glucometer.  Levels between 70 mg/dL and 130 mg/dL before eating, less than 180 mg/dL after eating and around 140 mg/dL before going to bed are all considered normal and suggest that your diabetes is under control.  Readings that are consistently above normal suggest that your current treatment program is not working properly in which case you should go see your doctor immediately.

2) EAT THE RIGHT FOODS:- The food you eat can have a big effect on your blood glucose levels.  Eating more high fibre foods, reducing your alcohol intake, reducing your intake of sugars, eating slow digesting carbohydrates and eating more fruits and vegetables are all dietary changes that can help keep your blood glucose levels under control.

3) INCREASE YOUR ACTIVITY LEVELS:- Exercise can increase your body’s responsiveness to insulin and stimulate the use of glucose in your cells.  In the long term it can also reduce your body fat levels which further improve your body’s responsiveness to insulin.  Although exercise is a very good way to manage diabetes it is important that you check your blood glucose levels regularly whilst exercising, stay hydrated and have a source of glucose and insulin to hand if needed.

4) USE INSULIN IF NEEDED:- As discussed above, all type 1 diabetic require insulin whilst 40% of type 2 diabetics need it.  There are four main types of insulin; rapid acting insulin (which reaches the blood 15 minutes after injecting and can last up to 5 hours), short acting insulin (which reaches the blood 30 minutes after injection and can last up to 8 hours), intermediate acting insulin (which reaches the blood 2 to 6 hours after injection and can last for up to 20 hours) and long acting insulin (which reaches the blood 6 to 14 hours after injection and lasts for up to 24 hours).  To determine the type of insulin you will need you should consult your doctor.  They will be able to tell you which type is most suitable for you.  When taking insulin you need to be sure that you do not overdose and also that it does not interact with any other medications you are taking.

5) ALWAYS HAVE RAPIDLY DIGESTING CARBOHYDRATES TO HAND:- Overdosing on insulin, drinking too much alcohol and not eating enough can all cause your blood glucose to drop below normal levels.  In these situations you need to increase your blood glucose levels relatively quickly.  Rapidly digesting carbohydrates enter your blood stream quickly, increasing your glucose levels and therefore should be carried at all times.  Good sources of rapidly digesting carbohydrates include; sweets and chocolate, fruit and glucose tablets.

6) TRY NATURAL REMEDIES:- There are a number of natural remedies for diabetes.  Whilst they are not a substitute for the above five steps they can be a useful addition to any diabetes treatment program.  Some examples of natural remedies include fish oil supplementation, hydrotherapy and massage.

WHAT DAMAGE CAN UNTREATED DIABETES CAUSE?

1) DAMAGE TO YOUR HEART:- Consistently high blood glucose levels damages your blood vessels which in turn restricts the flow of blood to your heart.  If your heart is not getting enough blood it becomes weak and this increases your risk of heart disease.

2) DAMAGE TO YOUR KIDNEYS:- Poorly controlled diabetes can damage the blood vessels which supply your kidneys.  This damage which is referred to as diabetic nephropathy makes the kidneys function less effectively and in the worst cases can lead to kidney failure.

3) DAMAGE TO YOUR EYES:- Poorly managed diabetes can damage the light sensitive tissues of your retina which leads to the symptom diabetic retinopathy (discussed above).  Diabetes also increases your risk of developing cataracts (clouding of the clear lens that covers your eye) and glaucoma (damage to the optic nerve).

4) DAMAGE TO YOUR NERVES:- Poorly controlled diabetes can lead to a type of nerve damage called diabetic neuropathy.  Diabetic neuropathy can be further broken down into; autonomic neuropathy (nerve disorders affecting the bowel, bladder, digestive system, perspiration and sexual response), focal neuropathy (sudden, specific damage to a nerve or group of nerves), peripheral neuropathy (nerve disorders affecting the feet, toes, lower and upper legs, the hands and the arms) and proximal neuropathy (nerve disorders affecting the hips, buttocks and thighs).

5) DAMAGE TO YOUR FEET:- Diabetes can damage the blood vessels that supply your feet, which restricts their blood supply and ultimately causes long term damage.  Diabetes can also cause peripheral neuropathy which means you lose the feeling in your feet.  This indirectly damages your feet because you fail to notice cuts and sores which makes them more likely to get infected.  To minimise this damage you should inspect your feet on a daily basis and if you notice any cuts, sores or infections that do not disappear after a few days you should go see your doctor.

6) DAMAGE TO YOUR GUMS:- Poorly managed diabetes can weaken your gums and make them more likely to get infected.  High levels of glucose in your mouth fluids can also encourage bacteria to grow which causes further damage to your gums.  To reduce the risk of gum damage you should follow a good oral health routine by brushing your teeth daily, flossing daily and visiting your dentist on a regular basis.

7) DAMAGE TO YOUR SEXUAL ORGANS:- Diabetes can damage the blood vessels which supply the sexual organs and restrict the flow of blood to them.  In men this can lead to erectile dysfunction.  In women it can cause vaginitis (inflammation of the vagina), cystitis (inflammation of the bladder lining) and limited clitoral stimulation during sex (because of the poor blood supply).

I hope this article has given you a full overview of diabetes.  Whilst there is a lot of information here I hope you have learnt something new about this condition.  There are multiple types of diabetes but they all cause the same fundamental problem – poor blood sugar control.  Your ability to keep your blood sugar levels close to normal ultimately dictates how diabetes will affect you.  Whilst medical assistance may be required, leading a healthy lifestyle can go a long way to minimising the impact diabetes has on you.

Whilst every intention has been made to make this article accurate and informative, it is intended for general information only. Diabetes is a medical condition and this article is not intended as a substitute for the advice of your doctor or a qualified medical practitioner. Before making any lifestyle changes you should always seek your doctors advice. If you have any concerns regarding any form of diabetes then you should speak to your doctor right away.