By Dr Ananya Mandal, MD
Diabetes is a condition where the body fails to utilize the ingested glucose properly. This could be due to lack of the hormone insulin or because the insulin that is available is not working effectively.
The term diabetes is the shortened version of the full name diabetes mellitus. Diabetes mellitus is derived from:
the Greek word diabetes meaning siphon - to pass through
the Latin word mellitus meaning honeyed or sweet
This is because in diabetes excess sugar is found in blood as well as the urine. It was known in the 17th century as the “pissing evil”.
Diabetes is the fastest growing long term disease that affects millions of people worldwide. According to the charity Diabetes UK, more than two million people in the UK have the condition and up to 750,000 more are unaware of having the condition.
In the United States 25.8 million people or 8.3% of the population have diabetes. Of these, 7.0 million have undiagnosed diabetes. In 2010, about 1.9 million new cases of diabetes were diagnosed in population over 20 years. It is said that if this trend continues, 1 in 3 Americans would be diabetic by 2050.
Types of diabetes
There are two types of diabetes – Type 1 and type 2. Type 1 diabetes is called insulin-dependent diabetes mellitus and occurs at a younger age or childhood. In these patients there is complete lack of the hormone insulin that mandates external administration of the hormone regularly as treatment.
Around 75% of people with diabetes have type 2 diabetes mellitus. This was earlier termed non-insulin dependent diabetes mellitus (NIDDM) or maturity-onset diabetes mellitus. The number of people with type 2 diabetes is rapidly increasing. In type 2 diabetes, not enough insulin is produced or the insulin that is made by the body is insufficient to meet the needs of the body. Obesity or being overweight predisposes to type 2 diabetes.
Gestational diabetes occurs in pregnant women who have never had diabetes before but who have high blood sugar levels during pregnancy. Gestational diabetes affects about 4% of all pregnant women. After childbirth the mother may go on to develop type 2 diabetes.
How is blood sugar regulated normally?
When food is taken, it is broken down to smaller components. Sugars and carbohydrates are thus broken down into glucose for the body to utilize them as energy source. The liver is also able to manufacture glucose.
In normal persons the hormone insulin, which is made by the beta cells of the pancreas, regulates how much glucose is in the blood. When there is excess glucose in the blood, insulin stimulates cells to absorb enough glucose from the blood for the energy that they need. Insulin also stimulates the liver to absorb and store any glucose that is excess in blood. Insulin release is triggered after a meal when there is rise in blood glucose. When blood glucose levels fall, during exercise for example, insulin levels fall too.
A second hormone manufactured by the pancreas is called glucagon. It has the opposite function of stimulating the liver to release glucose when necessary.
Symptoms of diabetes
The main symptoms of diabetes are three – polydipsia, polyphagia and polyuria. These mean increased thirst, increased hunger and increased frequency of urination. In addition patients complain of feeling very tired and weight loss and loss of muscle bulk. Type 1 diabetes can develop quickly, over weeks or even days whereas type 2 diabetes may develop gradually.
What happens in diabetes?
Due to lack or insufficiency of insulin there is high blood glucose in diabetes. Excess glucose in the blood can damage the blood vessels. This leads to several complications like heart disease, kidney damage, nerve damage, eye damage and blindness, impotence and stroke.
Diabetes, when not controlled, may raise the propensity for infections. Infections and gangrene of the lower limbs is common in uncontrolled diabetes. This may necessitate an amputation if severe. People with diabetes are also 15 per cent more likely to have an amputation than people without the condition.
Prevention, treatment and care
The risk of complications with diabetes can be reduced by adhering to medical advice and keeping diabetes under control. Blood sugar should be regularly monitored so that any problems can be detected and treated early.
Treatment involves both healthy diet and exercise as well as oral medications to regulate blood sugar. In all type 1 diabetics and in severe uncontrolled type 2 diabetics one or more injections of insulin a day may be needed.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)