Definition

Diabetes is a chronic condition that arises when the pancreas fails to produce insulin or when the body cannot efficiently utilize the insulin it generates. Insulin is a hormone that manages blood sugar levels in the body, while sugar, or glucose, is the essential energy source for cells.

Hyperglycemia is a common effect in patients with uncontrolled diabetes and can cause serious damage to other organ systems in the body, particularly the nervous system and blood vessels.

Diabetes continues to be one of the most fatal chronic diseases, impacting numerous individuals globally. The rise in cases is attributed to lifestyle changes, including increased consumption of sugary foods and reduced physical activity. In 2019, the WHO reported that 2 million people died due to diabetes mellitus and its complications.

Diabetes mellitus is a metabolic disease with several categories:

Type 1 Diabetes Type 1 diabetes is caused by an autoimmune condition in which the body attacks the insulin-producing cells in the pancreas. As a result, over 90% of these cells are permanently destroyed, leaving patients without enough insulin to regulate blood sugar.

About 5-10 percent of people have type 1 diabetes, which is usually diagnosed in children and young adults. Patients require lifelong insulin to manage the condition.

Type 2 Diabetes involves an imbalance between insulin levels and the body's reduced sensitivity to insulin. The body becomes resistant to insulin, leading to insufficient insulin to meet its needs. Over time, the body's ability to produce insulin also decreases.

Type 2 diabetes is typically diagnosed in older adults and is often the result of poor lifestyle choices, such as high consumption of sugary foods, obesity, and lack of physical activity.

Maturity-Onset Diabetes of the Young (MODY) MODY is a type of diabetes typically diagnosed in young people under 25. Some patients have genetic mutations, while others exhibit clinical symptoms of diabetes without clear genetic mutations.

Gestational Diabetes This type of diabetes develops during pregnancy and usually resolves after childbirth. It is thought to result from hormonal changes during pregnancy that affect insulin production. Women who experience this are at increased risk of developing type 2 diabetes later in life.

Neonatal Diabetes is found in newborns up to six months old and is caused by genetic changes affecting insulin production.

Causes

The body digests food into various substances that are easier to absorb. For example, carbohydrates in rice, pasta, or bread are broken down into glucose, which circulates in the bloodstream.

Insulin is released into the bloodstream to prevent glucose from remaining in the blood and to help it enter the body’s cells for energy, ensuring tissues and organs function properly.

When there is excess glucose, insulin also helps store glycogen (a form of glucose) in the liver. Blood sugar levels rise if glucose remains in the bloodstream for various reasons and cannot be used for energy.

Diabetes can be caused by several conditions:

• The pancreas does not produce insulin at all or only produces very little
• The pancreas produces insulin, but the body’s cells are less sensitive or resistant, so they do not respond well
• Genetic mutations or certain medical conditions
• Pregnancy

Risk factor

 Factors that increase the risk of diabetes mellitus include:

• African, Asian American, American Indian, Alaska Native, Hispanic, or Latino heritage
• Family history (parents or siblings) with diabetes mellitus
• Obesity
• Low levels of HDL ("good cholesterol") and high levels of triglycerides (a type of fat) in the blood
• Sedentary lifestyle
• Age over 45 for type 2 diabetes
• History of heart disease, stroke, or high blood pressure
• Smoking
• For pregnant women, the risk of gestational diabetes increases with age over 25
• Pancreatic injuries can increase the risk of type 1 diabetes
• Certain medical conditions linked to diabetes mellitus, such as:
• Acromegaly (excess growth hormone production)
• Hyperthyroidism (overproduction of thyroid hormone)
• Hyperaldosteronism (overproduction of aldosterone by the adrenal glands)

Symptoms

General symptoms of diabetes mellitus include:

• Polydipsia (increased thirst)
• Polyphagia (increased hunger)
• Polyuria (increased urination)
• Fatigue
• Blurred vision
• Numbness, tingling, or prickling sensations in the feet or hands
• Slow-healing wounds
• Persistent infections without clear cause
• Dry mouth
• Dry and itchy skil
• Erectile dysfunction and decreased sexual desire in men

Diagnosis

 Doctors may ask patients about the following to diagnose diabetes:

• Main complaints and accompanying symptoms
• Family medical history
• Past treatments
• Previous illnesses
• Diet and lifestyle

A physical exam may reveal obesity, skin issues, vision problems, or nerve complaints. Slow-healing foot wounds may also be present.

The doctor will perform additional tests, including blood and urine tests. For diabetes mellitus, the focus is on:

• HbA1C test (measures the percentage of red blood cells with glucose attached over the past 3 months)
• Fasting blood sugar and 2-hour post-meal blood sugar tests
• Random blood sugar test
• Oral glucose tolerance test (drinking 75-100 grams of glucose in 5 minutes)
• A urine test is performed to check for glucose, which should not be present

Management

Diabetes mellitus treatment varies for each patient. Consistent monitoring is crucial for managing the condition and preventing complications.

Lifestyle changes, including dietary adjustments and increased physical activity, can lower blood sugar levels in early-stage diabetes. Doctors may prescribe blood sugar-lowering medications or insulin injections based on the patient’s condition and disease progression.

Complications

Diabetes mellitus leads to numerous complications, which are common causes of diabetes-related mortality. If blood sugar levels are uncontrolled, the patient's condition can deteriorate over time. Complications include:

• Cardiovascular issues like coronary heart disease, high blood pressure, high cholesterol, and narrowed blood vessels
• Peripheral nerve problems (neuropathy) cause numbness that spreads
• Kidney issues leading to kidney failure, dialysis, or transplant
• Eye problems (retinopathy) cause blindness, cataracts, or glaucoma
• Foot damage, including nerve damage, reduced blood flow, and poor wound healing
• Skin infections
• Erectile dysfunction
• Hearing loss
• Depression
• Dementia
• Dental problems
• Pre-eclampsia (high blood pressure and protein in urine during pregnancy)
• Hypoglycemia in newborns (low blood sugar)

You can read further about dementia here.

Prevention

To prevent diabetes mellitus, lifestyle changes can help:

• Reduce weight by 7-10% to reach an ideal range, especially if your BMI is over 25
• Regular physical activity boosts immunity and reduces diabetes risk
• Lower your intake of high-glycemic index carbohydrates like white rice by substituting it with brown rice, cassava, or sweet potatoes
• Increase vegetable and protein intake, like tofu, tempeh, or fish
• Reduce consumption of oily foods and excessive sugar

When to see a doctor?

Consult a doctor if you experience any of the mentioned symptoms or have a family history of diabetes mellitus. Regular screenings are recommended to monitor your condition.

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