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Diabetes

Definition


Disease: Diabetes Diabetes
Category: Endocrine and metabolic diseases

Disease Definition:

The group of diseases that affect the way a person’s body uses blood glucose (blood sugar) is called “diabetes mellitus”. Being the main source of energy for the cells that make up the muscles and tissues, glucose is vital to a person’s health. It is considered the body’s main source of fuel.

 

Having diabetes, no matter what type, means having too much glucose in the blood, though the causes may differ. Serious health problems can result from too much glucose in the blood. Type 1 diabetes and type 2 diabetes are considered chronic diabetes. On the other hand, gestational diabetes and prediabetes are considered potentially reversible conditions. Gestational diabetes occurs during pregnancy, while prediabetes occurs when someone’s blood sugar levels are higher than normal, but not high enough to be called diabetes.
 

Work Group:


Symptoms, Causes

Symptoms:

Depending on the type of diabetes, symptoms may differ. A person may not experience any signs or symptoms in case he/she has gestational diabetes or prediabetes, or they may experience some or all of the signs and symptoms of type 1 and type 2 diabetes, such as: 

  • Fatigue
  • Frequent urination
  • Frequent infections, such as vaginal and bladder infections and gum or skin infections
  • Increased thirst
  • Sores that heal slowly
  • Unexplained weight loss
  • Blurred vision
  • Extreme hunger

 

Type 1 diabetes usually develops during childhood or adolescence, but it could occur at any time. While type 2 diabetes can develop at any age. This type is usually preventable and is the most common type of diabetes. Contacting a doctor is necessary in case someone suspects that they may have diabetes or if they notice any of the possible symptoms of diabetes. The sooner the condition is diagnosed the sooner treatment can begin. On the other hand, until the blood sugar levels of a person diagnosed with diabetes stabilizes, he/she will need close medical follow-up care.
 

Causes:

People should understand how glucose is regularly processed in the body so that they can understand diabetes.

 

HOW DOES GLUCOSE WORK??

The cells that make up the muscles and other tissues rely on glucose as their main source of energy. The two major sources that provide glucose are the person’s liver, and the food that he/she eats. Sugar is absorbed into the bloodstream during digestion and then with the help of insulin, it enters the cells.

 

The pancreas, which is a gland located just behind the stomach, secretes the hormone insulin. The pancreas releases insulin into the bloodstream when a person eats. By unlocking microscopic doors that allow sugar to enter a person’s cells, insulin acts like a key when it circulates the bloodstream. The amount of sugar in a person’s bloodstream is lowered by insulin, and as the blood sugar level drops, so does the secretion of insulin. When a person hasn’t eaten in a while, his/her liver releases glucose that has been stored in order to keep the glucose level within a normal range. This means that the liver works as a glucose storage and manufacturing center.

 

WHAT CAUSES GESTATIONAL DIABETES??

When a woman is pregnant, her placenta produces hormones in order to sustain the pregnancy. The woman’s cells become more resistant to insulin due to the effect of these hormones. The placenta secretes more of these hormones as it grows larger in the second and third trimesters, making it even more difficult for the insulin to do its work. To overcome this resistance, the pancreas usually responds by producing enough extra insulin. However, the pancreas can’t keep up in some cases, causing too much glucose to stay in the blood and too little glucose to reach the cells, resulting in gestational diabetes.

 

WHAT CAUSES TYPE 1 DIABETES??

The immune system normally fights harmful bacteria or viruses. In type 1 diabetes, it attacks and destroys the cells of the pancreas that produce insulin. In this case, sugar will build up in the person’s bloodstream instead of being transported into the cells because the person’s body will have little or no insulin.

 

WHAT CAUSES TYPE 2 DIABETES AND PREDIABETES??

The cells become resistant to the action of insulin in type 2 diabetes and prediabetes (which could lead to type 2 diabetes), and the pancreas becomes unable to make enough insulin to overcome this resistance. This will cause sugar to build up in the bloodstream instead of moving into the cells. Inactivity and excess fat, particularly abdominal fat, seem to be important factors in the development of this type of diabetes, but its exact cause is still not known.
 

Complications

Complications:

Based on the type of diabetes, different complications may occur.

 

COMPLICATIONS OF TYPE 1 AND TYPE 2 DIABETES:

Immediate care is required for the temporary complications of type 1 and type 2 diabetes. These complications could cause seizures and coma in case they are left untreated.

 

Diabetic ketoacidosis:

A person’s body may begin to break down fat in case the cells have no energy whatsoever. This process will produce ketones, which are potentially toxic acids.

 

Hyperglycemia:

Being sick, not taking enough glucose-lowering medications and eating too much are some of the things that may cause a person’s blood sugar level to rise.

 

Hypoglycemia:

Hypoglycemia occurs when someone’s blood sugar level drops below their target range. Getting more physical activity than normal and skipping a meal are some of the things that can cause hypoglycemia. However, receiving insulin therapy or taking glucose-lowering medications that promote the secretion of insulin is the most common cause of hypoglycemia.

 

The long-term complications of diabetes usually develop gradually and they may eventually be disableing or even life-threatening. Someone’s risk of these complications will be higher in case he/she developed diabetes in an earlier age or if their blood sugar is poorly controlled.

 

Neuropathy:

Neuropathy means nerve damage. In this condition, the walls of the tiny blood vessels called capillaries that nourish the nerves may be damaged due to excess sugar. The capillaries in the leg are usually affected by this. Pain or burning that begins at the tips of the fingers or toes and then over a period of months or years spreads upward, numbness and tingling are some of the things that this injury can cause. A person may lose all sense of feeling in the affected limbs if this condition is left untreated. Diarrhea, constipation, nausea or vomiting may be caused by damage to the nerves related to digestion. Problems with erectile dysfunction may also result in men.

 

Cardiovascular disease:

Heart attack; atherosclerosis, which is narrowing of the arteries; coronary artery disease with angina; and stroke are some of the cardiovascular diseases that diabetes increases the risk of. A person will be twice as likely to have a stroke or heart disease in case he/she has diabetes.

 

Optic damage:

Blindness may result from diabetic retinopathy, a condition in which the blood vessels of the retina are damaged by diabetes.

 

Nephropathy:

There are millions of tiny blood vessel clusters called glomeruli in the kidneys that filter waste from the blood. This filtering system can be damaged by diabetes. Kidney failure or irreversible end-stage kidney disease may result from severe damage, requiring a kidney transplant or dialysis.

 

Skin and mouth conditions:

Itching, bacterial infections and fungal infections are some of the skin problems that people with diabetes are more susceptible to. In case a person has a history of poor dental hygiene, gum infections may also occur.

 

Bone and joint problems:

Someone with diabetes may have an increased risk of osteoporosis or other bone and joint problems.

 

Foot damage:

Someone’s risk of different foot complications is increased due to poor blood flow to the feet or nerve damage in the feet. Cuts and blisters could cause serious infections if this condition is left untreated. Additionally, toe, foot or leg amputation may be necessary if the damage is severe.

 

COMPLICATIONS OF GESTATIONAL DIABETES:

Healthy children are usually born to women who have gestational diabetes. However, problems for the woman and her baby may be caused in case the diabetes is left untreated or her blood sugar levels are uncontrolled. Listed below are some of the complications that gestational diabetes may cause in children:

 

Jaundice:

When the body recycles old or damaged red blood cells, a substance called bilirubin forms. In case the baby’s liver isn’t mature enough to break down bilirubin, jaundice may occur, which is the yellowing of the skin and whites of the eyes. Monitoring the baby carefully is very important despite the fact that jaundice usually isn’t a cause for concern.

 

Hypoglycemia:

Shortly after birth, babies born to mothers with gestational diabetes may develop low blood sugar because their own insulin production is high. To return the baby’s blood sugar level to normal, prompt feedings or an intravenous glucose solution may be required.

 

Excess growth:

The baby’s pancreas will be triggered to make more insulin in case extra glucose crosses the placenta. This may cause macrosomia, which is when the baby grows too large. This condition may require a C-section birth. Additionally, very large babies are more likely to sustain birth injuries or become wedged in the birth canal.

 

Type 2 diabetes later in life:

A baby’s risk of developing obesity and type 2 diabetes later in life is increased in case he/she was born to a mother with gestational diabetes.

 

Respiratory distress syndrome:

The baby may have respiratory distress syndrome, a condition in which breathing becomes difficult, in case he/she is delivered early. Until the lungs of babies with this condition become stronger, they may need help breathing.

 

Death:

In some rare cases, gestational diabetes may result in the death of the baby either before or shortly after birth.

 

Some of the complications that gestational diabetes may cause in the mother include:

 

Subsequent gestational diabetes:

Once a woman has had gestational diabetes in one pregnancy, she will be more likely to have it again with her next pregnancy. And as she gets older, she will be more likely to have diabetes, usually type 2.

 

Preeclampsia:

High blood pressure and excess protein in the urine is caused by this condition. Serious and life-threatening complications for both the mother and the baby may result if preeclampsia is left untreated.
 

Treatments:

Insulin, blood sugar monitoring, and oral medication could play a role in treating diabetes depending on the type a person has. To some people, pancreas transplant may be an available option. Exercising, maintaining a healthy diet and keeping a healthy weight are all important to manage diabetes, no matter what type.

 

TREATMENT FOR ALL TYPES OF DIABETES:

Maintaining a healthy weight through a healthy diet and following an exercise plan is very important in managing all the types of diabetes:

 

Healthy diet:

A person with diabetes should eat fewer sweets and animal products and plenty of vegetables, fruits and whole grains, which are foods that are high in nutrition and low in calories and fat. Someone with diabetes could also eat sugary foods once in a while but it has to be included in the meal plan. A registered dietitian can help the patient create a meal plan that fits his/her health goals, food preferences and lifestyle, because understanding what and how much to eat can be quite a challenge. A person should try eating the same amount of food with the same proportion of proteins, carbohydrates and fats at the same time every day in order to keep their blood sugar on an even level.

 

Physical activity:

By transporting sugar to the cells where it’s used for energy, exercise lowers the blood sugar level. The body will also need less insulin to transport sugar to the cells because exercise also increases a person’s sensitivity to insulin. The patient could choose an activity that he/she enjoys such as biking, walking or swimming, however, the doctor’s opinion should be asked first. The patient should exercise for at least 30 minutes most days of the week because making physical activity part of the daily routine is very important. However, a person should start slowly and build up gradually in case he/she hasn’t been active for a while.

 

HOW TO TREAT TYPE 1 AND TYPE 2 DIABETES:

Monitoring the blood sugar along with insulin, other diabetes medications or both is what treatment for type 1 and type 2 diabetes consists of.

 

Monitoring the blood sugar level:

A person can check and record their blood sugar level several times a week to several times a day, depending on their treatment plan. Monitoring the blood sugar level carefully is the only way of making sure that it remains within the target range. The amount of sugar in a person’s blood can change unpredictably even if he/she eats on a rigid schedule. The patient can learn from his/her diabetes treatment team how physical activity, medications, stress, illness, food, alcohol and for women fluctuations in hormone levels, changes the level of blood sugar.

 

Moreover, to measure the patient’s average blood sugar level for the past two to three months, the doctor may recommend A1C testing in addition to daily blood sugar monitoring. A1C testing indicates how well the diabetes treatment plan is working in a better way when compared with repeated daily blood sugar tests. A person’s insulin regimen or meal plan should be changed in case the A1C level is elevated. The patient’s target A1C goal will depend on their age in addition to other factors. However, most people are recommended an A1C of below 7%.

 

Insulin:

In order to survive, people with type 1 diabetes need insulin therapy. Some people with type 2 diabetes may also need insulin. Oral insulin can’t lower blood sugar because stomach enzymes interfere with it. Insulin is usually injected using a fine needle and syringe or an insulin pen, which is a device that looks like an ink pen but the cartridge is filled with insulin. Some people may also use an insulin pump. Worn on the outside of the body, the pump is a device about the size of a cell phone. A catheter that is inserted under the skin of the abdomen and connected to the reservoir of insulin by a tube. The pump dispenses specific amounts of insulin in an automatic way. Depending on meals, blood sugar level and activity, the pump can be adjusted to deliver more or less insulin. Long-acting insulin and rapid-acting insulin are some of the types of insulin. The doctor may prescribe a mixture of insulin types to be used throughout the day and night, depending on the needs of the patient.

 

Oral or other medications:

A person with diabetes may also be prescribed some other medications, such as medications that inhibit the production and release of glucose from the liver, meaning that the person will need less insulin to transport sugar into the cells; medications that block the action of stomach enzymes that break down carbohydrates or make the person’s tissues more sensitive to insulin; or medications that stimulate the pancreas to produce and release more insulin. In order to help prevent cardiovascular disease, the patient may also be prescribed a low-dose aspirin therapy.

 

Transplantation:

A pancreas transplant may be an option for some people with type 1 diabetes. The patient will no longer need insulin therapy in case the pancreas transplant is successful. However, this procedure has some serious risks and it isn’t always successful. To prevent rejection of the organ, the patient will need a lifetime of potent immune-suppressing medications. A high risk of cancer, infection and organ injury are some of the side effects that immunosuppressants cause. Usually, only people whose diabetes can’t be controlled or those who have serious complications undergo pancreas transplants because the side effects are more dangerous than the diabetes itself.

 

HOW TO TREAT GESTATIONAL DIABETES:

In order to keep the baby healthy and avoid complications during delivery, the mother’s blood sugar level should be controlled. The treatment plan may include monitoring the blood sugar and sometimes even using insulin, in addition to exercising and maintaining a healthy diet. During labor, the pregnant woman’s health care provider should also monitor her blood sugar level. The baby will release high levels of insulin in case the mother’s blood sugar rises, which will cause the baby to have low blood sugar right after birth.

 

HOW TO TREAT PREDIABETES:

Healthy lifestyle choices can help a person with prediabetes to bring their blood sugar level back to normal or prevent it from rising to the levels seen in type 2 diabetes. Eating healthy and maintaining a healthy weight through exercise can also help achieve this.

 

In case a person is at a high risk of diabetes, for instance if the person has fatty liver disease, polycystic ovary syndrome or cardiovascular disease, or if his/her prediabetes is becoming worse, the oral diabetes medications acarbose and metformin may be used. In some other cases, the patient may need high blood pressure medications and medications to control cholesterol, particularly statins. In order to prevent cardiovascular disease, the patient may be prescribed low-dose aspirin therapy. However, healthy lifestyle choices remain essential.
 

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Consultants Corner

Dr. Samer Al-Jneidy

Dr. Samer Al-Jneidy Pediatrician

Dr . Dirar Abboud

Dr . Dirar Abboud Hepatologist – Gastroenterologist

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

Samir Moussa M.D.

Samir Moussa M.D. ENT Specialist

Dr. Talal Sabouni

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Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology

Dr. Faisal Dibsi

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Dr. Tahsin Martini

Dr. Tahsin Martini Degree status: M.D. in Ophthalmology
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