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Diabetes



The term diabetes includes several disorders in the process of catabolism and building - metabolism - (Metabolism) of carbohydrates.

normal metabolism process

The carbohydrates that the body gets from eating bread, potatoes, rice, cake, and many other foods, break down and break down gradually.

This process of disintegration and decomposition begins in the stomach, then continues in the duodenum and in the small intestine.

This process of disintegration and decomposition results in a group of sugars (carbohydrates) that are absorbed into the circulation.

Internal secretion cells in the pancreas, called beta cells, are very sensitive to high blood sugar levels and secrete the hormone insulin.

Insulin is an essential bridge for the entry of sugar molecules, glucose, into the muscles where it is used as an energy source, and into fat tissues and the liver where it is stored.

Glucose reaches the brain, too, but without the help of insulin.

In the pancreas, another type of cell is alpha cells, which secrete another extra hormone called glucagon. This hormone causes the release of sugar from the liver and activates the work of other hormones that block the action of insulin.

The balance between these two hormones (insulin and glucagon) keeps the level of glucose in the blood stable and avoids sharp changes.

People of a healthy weight who do a lot of physical activity need a small amount of insulin to balance the action of glucose in the blood. The more obese and less physically fit a person is, the more insulin they need to process a similar amount of glucose in the blood. This condition is called " insulin resistance ".

diabetes

When the beta cells in the pancreas are damaged, the amount of insulin secreted gradually decreases, and this process continues for many years.

If this condition is accompanied by the presence of "insulin resistance", this combination of a small amount of insulin and a low level of effectiveness, leads to a deviation from the proper level of glucose (sugar) in the blood, in which case the person is defined as having diabetes (Diabetes).

It is known that the healthy level of sugar in the blood after fasting for eight hours should be less than 108 mg/dl, while the borderline level is 126 mg/dl.

But if a person's blood glucose level is 126 mg/dL and above, in two or more tests, then that person is diagnosed with diabetes.


Types of diabetes

Types of diabetes are:

1- Type 1 diabetes

Type 1 diabetes (Juvenile Diabetes) is a disease in which the immune system destroys beta cells in the pancreas, for unknown reasons that have not yet been identified.

In boys, this process of destruction occurs quickly and lasts from a few weeks to a few years, but in adults, it may last for many years.

Type 1 diabetes may strike a person at any age, but it often appears in childhood or adolescence.

Many people who develop type 1 diabetes at an advanced age are misdiagnosed as type 2 diabetes.

2- Type 2 diabetes

 Type 2 diabetes (or: type 2 diabetes/adult diabetes) is a disease in which the beta cells of the pancreas are destroyed and destroyed for genetic reasons, most likely, supported by external factors, this process is very slow and lasts decades.

A person of a healthy weight and in good physical shape has a small chance of developing diabetes, even if he or she has low insulin secretion.

As for the possibility of an obese person who does not engage in physical activity developing diabetes, it is a high possibility, given that he is more likely to develop “insulin resistance” and thus diabetes.

It is the most common, it can appear at any age, as statistics indicate that the number of people with type 2 diabetes in the world has recorded a very large increase in recent decades, reaching about 150 million people, and it is expected to rise to 330 million people with diabetes. Diabetes, until 2025. Fortunately, it can often be prevented and avoided. 

Diabetes symptoms

diabetes symptoms

Symptoms of diabetes vary depending on the type of diabetes.

Sometimes, people with prediabetes or gestational diabetes may not feel any symptoms at all.

Or they may feel some of the symptoms of type 1 diabetes and type 2 diabetes, or all of the symptoms together.

Symptoms of diabetes:

  • thirst
  • Urinating a lotoften
  • very hungry
  • Weight loss for unknown and unknown reasons
  • Tired
  • blurred vision
  • Slow healing (healing) of wounds
  • Frequent infections in gums, skin, vagina, or urinary bladder.

Causes and risk factors of diabetes

Causes and risk factors of diabetes

Among the main reasons for this sharp rise in diabetes are:

  • obesity
  • lack of physical activity
  • Changes in the types of foods: Today's popular foods include prepared foods that cause diabetes, as they are rich in fats and sugars that are easily absorbed into the blood, which leads to an increase in "insulin resistance".

Learn about the causes and risk factors for developing diabetes according to the type:

Type 1 diabetes factors

In type 1 diabetes, the immune system attacks and damages the insulin-producing cells in the pancreas, rather than attacking and destroying harmful germs and/or viruses, as it normally does in normal (healthy) conditions.

As a result, the body is left with little or no insulin. In this case, the sugar accumulates and accumulates in the blood circulation, rather than being distributed to the various cells in the body.

The true ocular cause of type 1 diabetes is not yet known, but it seems likely that family history plays an important role.

The risk of developing type 1 diabetes increases in people whose parents or brothers and sisters have diabetes. There are additional factors, too, that may cause diabetes, such as exposure to viral diseases.

Type 2 diabetes factors

In people with “ prediabetes, ” which may progress to type 2 diabetes, cells resist the action of insulin while the pancreas fails to produce enough insulin to overcome this resistance.

In these cases, sugar accumulates and accumulates in the blood circulation instead of being distributed to cells and reaching them in various parts of the body.

The direct cause of these conditions is still unknown, but it appears that excess fat - especially in the abdomen - and lack of physical activity are important factors in this.

Researchers are still searching for a real and accurate answer to the question: Why do prediabetes and type 2 diabetes affect specific people and not others?

However, several factors clearly increase the risk of developing diabetes, including: 

  • Age: Age greater than or equal to 45
  • Weight: Overweight is defined as a BMI greater than or equal to 25.
  • Genetics: A first-degree relative has diabetes.
  • Ethnicity: Certain ethnic groups are known to have a high risk of developing diabetes.
  • Physical activity: lack of physical activity.
  • Hypertension/hypertension: defined by blood pressure values ​​greater than 140/90 mmHg.
  • Hypercholesterolemia: What is meant by harmful LDL
  • High level of triglycerides in the blood: it is one of the types of fats found in the body Values ​​higher than 250 mg/dL.
  • Polycystic ovary syndrome.
  • Vascular diseases: a personal history of these diseases.
  • Birth of a Large Baby: A personal history of women including the birth of a baby weighing more than 4.1 kg (the birth weight of the baby).
  • Gestational diabetes: a personal history of gestational diabetes.
  • Glycosylated hemoglobin: HBA1C is greater than or equal to 5.7%.
  • Glucose tolerance: from deficient / impaired glucose tolerance Impaired glucose tolerance
  • Glucose values: Those who have an abnormality/problem with the glucose values ​​(sugar) in the post-fasting test

When these factors - high blood pressure, hyperglycemia, and lipids in the blood above the normal level - appear, along with obesity (excess weight), a relationship arises between them, together, and insulin resistance.

gestational diabetes factors

During pregnancy, the placenta produces hormones that help and support pregnancy. These hormones make cells more resistant to insulin.

In the second and third trimesters of pregnancy, the placenta grows and produces large amounts of these hormones, which make insulin work harder.

In normal conditions, the pancreas reacts by producing an extra amount of insulin to overcome this resistance.

But the pancreas sometimes fails to keep pace, which leads to a very small amount of sugar (glucose) reaching the cells, while it accumulates and a large amount of it accumulates in the blood circulation. This is how gestational diabetes (diabetes during pregnancy) is formed.

Any pregnant woman may develop gestational diabetes, but some women are more likely than others.

The risk factors for diabetes include:

  • Women over 25 years old
  • Family or personal history
  • Overweight

Diabetes complications

Diabetes may lead to:

  • A gradual rise in blood pressure
  • Characteristic disorders of blood lipids, especially high triglycerides
  • Low high-density lipoprotein (HDL) cholesterol.
  • In general, diabetics suffer from distinctive damages: in the kidneys, in the retina of the eyes (retina), and in the nervous system.

But complications resulting from diabetes vary depending on the type of diabetes.

Complications of type 1 and type 2 diabetes

Short-term complications of type 1 and type 2 diabetes require immediate treatment. Such cases that are not treated immediately, may lead to convulsions and coma.

  • Hyperglycemia
  • High level of ketones in the urine ( diabetic ketoacidosis)
  • Low blood sugar (hypoglycemia).

As for the long-term complications caused by diabetes, they appear gradually.

The risk of complications increases the younger the diabetes age and in people who do not keep their blood sugar level in check. Ultimately, complications of diabetes can lead to disabilities or even death.

  • Cardiovascular disease (of the heart and blood vessels)
  • Nerve damage ( neuropathy )
  • Kidney damage (nephropathy)
  • eye damage
  • Damage to the feet
  • Diseases in the skin and in the mouth
  • Bone and joint problems.

Complications of gestational diabetes

The majority of women who develop gestational diabetes give birth to healthy babies. However, if a pregnant woman's blood sugar is unbalanced and not properly monitored and treated, it can cause harm to both the mother and the newborn.

Complications that may occur in a newborn due to gestational diabetes:

  • overgrowth
  • Hypoglycemia
  • Respiratory distress syndrome
  • jaundice
  • Type 2 diabetes at an advanced age
  • the death

Complications that may occur in the mother due to gestational diabetes:

  • Preeclampsia (pre-eclampsia)
  • Gestational diabetes in the next pregnancy also

Complications of prediabetes

Prediabetes can progress to type 2 diabetes.

Diagnosis of diabetes

Diagnosis of diabetes

There are many blood tests, by which the symptoms of type 1 diabetes or type 2 diabetes symptoms can be diagnosed, including:

  • Random blood sugar level check.
  • Checking blood sugar level while fasting.

If a person is diagnosed with symptoms of diabetes, according to the results of the tests, the doctor is likely to decide to conduct additional tests to determine the type of diabetes, to choose the appropriate and effective treatment, knowing that treatment methods differ from one type of diabetes to another.

The doctor may also recommend a glycosylated hemoglobin A1C / glycosylated hemoglobin test.

Tests to detect gestational diabetes

Tests to screen for gestational diabetes are an integral part of regular, routine examinations during pregnancy.

Most medical professionals recommend a blood test for diabetes called a " glucose challenge test ." Which takes place during pregnancy, between the twenty-fourth and twenty-eight weeks of pregnancy, or earlier in women at high risk of developing gestational diabetes.

The "glucose challenge test" begins with drinking a solution of sugar syrup. An hour later, a blood test is performed to measure the level (concentration) of sugar in the blood. If your blood sugar is higher than 140 mg/dl, this usually indicates the presence of gestational diabetes.

In most cases, a repeat test is needed to confirm the diagnosis of diabetes.

In preparation for the repeat (additional) examination, the pregnant woman undergoing the examination should fast throughout the night before the examination. Here, again, a sweet solution is drunk, this time containing a higher concentration of glucose, and then the blood glucose level is measured hourly, over three hours.

 Screening for prediabetes

The American College of Endocrinology usually recommends screening for "prediabetes" for everyone with a family history of type 2 diabetes, who are obese or have metabolic syndrome.

It is also preferable to undergo this examination, as well, for women who have had gestational diabetes in the past.

Your doctor may recommend one of the following two tests to diagnose prediabetes:

  • Checking blood sugar during fasting
  • Glucose tolerance test.

Diabetes treatment

diabetes treatment

As we mentioned, the diabetes treatment depends mainly on its type, and this means the following:

Type 2 diabetes treatment

Diabetes treatment varies from one person to another, according to the personal laboratory tests that each patient performs and their blood glucose (sugar) values. 

It is worth noting that, according to the complications of diabetes that we presented previously, the risk of developing microvascular and macrovascular diseases is higher than the concentration of sugar in the blood over long periods of the disease.

In addition to cardiovascular diseases, the risk of which also increases with the age of the patient and the length of time for diabetes is greater. That is why we have to treat this category seriously and balance glucose (sugar) concentration values ​​in the blood as much as possible.

Treatment in this category of people to contain the prevention of cases of the sharp drop in blood glucose concentration (Hypoglycemia), or a sharp decline in circulation ( a sharp drop in blood pressure hypotension).

As well as paying attention to the overall health status of the patient and the totality of the medications he is being treated with so that a diabetic patient can suffer from more than one disease in addition to diabetes.

We can divide the treatment of diabetes into several sections:

1- Lifestyle changes

  • Healthy and appropriate nutrition for this category of patients.
  • The physical exercise recommended by the attending physicians, which is particularly suitable for each patient, according to all the diseases he suffers from, can affect the practice of physical exercise on a regular and healthy basis, such as heart diseases, physical disabilities, and other diseases.
  • Reducing weight and BMI, which would help the body reduce insulin resistance, which causes diabetes.

2- Oral medications

  • Metformin: It is considered a first-line treatment especially for obese people. It works by suppressing the production of glucose in the liver, which leads to a decrease in its concentration in the blood.

One of the well-known side effects of this drug is weight loss and its effects on the digestive system. For people with chronic kidney disease, this type of medicine can be inappropriate and even harmful.

  • Sulfonylurea: It is a drug that helps to secrete insulin in the body through changes in the electrical charge of the membranes of the cells that secrete insulin.

Among the well-known and common side effects of these drugs are excessive weight gain and a sharp drop in the concentration of glucose (sugar) in the blood (hypoglycemia).

Elderly people and those who are prone to frequent cases of a severe drop in the concentration of glucose (sugar) in the blood (Hypoglycemia) should be careful not to take these medicines, which may be unsuitable for them.

  • Thiazolidinediones: This type of medication improves insulin resistance in the body, as well as may stimulate insulin secretion.
  • Meglitinides: These medications work similarly to sulfonylureas. A known side effect of this class of medication is weight gain.
  • Alpha-glucosidase inhibitors: These medications work by slowing down the absorption of sugar in the digestive system. Common side effects of this class of medication include flatulence (bloating) and diarrhea.
  • DPP-IV inhibitors: These medications help regulate glucose (sugar) concentration in the body. In general, these drugs are not as potent and not as highly effective at lowering HBA1C as significantly as other drugs.

It is worth noting that these drugs do not increase weight and are not at a high risk of a sharp drop in glucose (sugar) concentration in the body.

  • GLP-1 drugs: These drugs work through the role of peptides in the digestive system to balance the concentration of glucose in the blood, including GLP-1. The known side effects of this drug include weight loss, vomiting, nausea, and diarrhea.

3- injection

  • Insulin: Insulin treatment has become more and more common in the recent period, although many patients refuse to accept treatment with daily injections. Insulin therapy is divided into two types:
  1. Long-term effective insulin therapy, which is daily injections that provide the body with the basic amount of insulin. This makes it easier for the patient to accept the treatment because there is no need for injections more than once a day. It is possible to prescribe this type of treatment in combination with other medicines taken orally to balance the disease more effectively.
  2. Treatment with insulin with short-term effectiveness, which is insulin that is taken immediately after eating daily meals, and the amount of food is usually appropriate to the amount of short-term insulin taken after it.
  • Pramlintide: It is generally given by injection along with insulin.

4- Monitoring the concentration of glucose in the blood

Monitoring the concentration of glucose (sugar) in the blood, especially in the morning hours, is important and usually gives us information about the equilibrium of the disease in these patients.

Doctors also usually take care of these records to decide the appropriate treatment for patients and the need to add other medications to better balance the disease. 

In addition to the direct treatment to reduce the concentration of glucose in the blood, there is an equally important treatment that is concerned with reducing the risk of developing cardiovascular diseases, which includes:

  • Reduce smoking as much as possible. Sometimes there are organized group sessions in which doctors advise to help you quit smoking:
  • High blood pressure treatment
  • Treatment of hyperlipidemia
  • Treatment with aspirin
  • As we mentioned earlier, live healthy and sound in terms of food and exercise.

Type 1 diabetes treatment

1- Monitoring and recording the values ​​of glucose concentration (blood sugar)

Research has proven the importance of monitoring and recording blood glucose values ​​daily and more than once, and the extent to which it helps in treating this category of patients better, as well as to match the appropriate insulin dose.

We can monitor and record the glucose concentration values ​​in the body in two ways:

  • Measuring with a fingerstick to measure glucose concentration with a drop of blood from the finger.
  • Sophisticated electronic devices under the skin to measure glucose concentration in the body sequentially and throughout the day (according to a pre-programmed program from the treating party).

2- Insulin injection

We can divide the treatment by insulin for this category into two parts:

  • Long-term (daily) insulin therapy is a daily injection that provides the body with the basic amount of insulin. This makes it easier for the patient to accept the treatment because there is no need for injections more than once a day.
  • Insulin treatment with short-term effectiveness, which is insulin taken immediately after eating the daily meals, and usually the amount of food and the concentration of glucose in the blood is appropriate to the amount of short-term insulin taken after it.

Treating gestational diabetes

To maintain the health of the fetus and prevent complications during childbirth, the level of sugar in the blood must be balanced.

In addition to ensuring healthy nutrition and exercise, diabetes treatment can also include monitoring the level of sugar in the blood, and even the use of insulin in some cases.

The treating medical staff monitors your blood sugar level, including during the birth process. Because the blood sugar level of a pregnant woman rises, the fetus's body may secrete the hormone insulin at a high concentration, which will lead to a drop in blood sugar level immediately after birth.

Prediabetes treatment

Many people with prediabetes are able, by maintaining a healthy lifestyle, to return their blood sugar level to a normal (healthy) level or at least prevent it from rising to levels similar to those recorded in patients with type 2 diabetes.

It may also be helpful to maintain a healthy weight through exercise and a healthy diet.

Medicines may, in some cases, be an appropriate and effective alternative treatment for diabetes mellitus and treatment, for people in one of the at-risk groups. These include cases in which "prediabetes" is exacerbated, or in which the diabetic suffers from another disease, whether it is cardiovascular disease, fatty liver disease (FLD - Fatty liver disease), or polycystic ovary syndrome (Polycystic). ovary syndrome).

The medicines intended here are medicines for treating diabetes that is taken orally, such as Metformin.

In other cases, medications are needed to balance cholesterol levels - especially statins and medications for high blood pressure.

Your doctor will likely prescribe low-dose aspirin as a measure to prevent disease. However, a healthy lifestyle remains the key to success.

Diabetes prevention

Diabetes prevention

It is not possible to prevent type 1 diabetes, but a healthy lifestyle that contributes to treating the stage and symptoms of pre-diabetes, type 2 diabetes and gestational diabetes can also contribute to its prevention and prevention.

  • Take care of a healthy diet
  • Increase physical activity
  • Get rid of excess weight.

Sometimes, medicines can be used. Oral diabetes medications, such as metformin and rosiglitazone, can reduce the risk of type 2 diabetes. However, maintaining a healthy lifestyle is very important.

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