Overview
Diabetes is a metabolic disorder characterized by high blood sugar levels due to insufficient insulin production or impaired insulin function. It leads to a variety of symptoms and complications, including the excretion of glucose in the urine.
Medical Departments and Related Organs
This condition is typically managed by endocrinology, pediatrics, and family medicine. The pancreas is the primary organ affected, and diabetes often correlates with other diseases like metabolic syndrome, obesity, hypertension, and cardiovascular diseases.
Definition of Diabetes
Diabetes is primarily a metabolic disorder marked by elevated blood glucose (hyperglycemia) due to either a lack of insulin or a failure of cells to respond properly to insulin. This results in glucose being excreted in the urine, often accompanied by a range of symptoms and complications.
Causes
Diabetes is categorized into two main types:
Type 1 Diabetes
Previously referred to as 'juvenile diabetes', Type 1 diabetes occurs when the body fails to produce insulin. This type is caused by autoimmune factors and typically manifests early in life.
Type 2 Diabetes
In Type 2 diabetes, the body produces insulin, but cells develop resistance to its effects. This form of diabetes is linked to environmental factors such as a high-calorie diet, lack of exercise, and stress, though genetic factors and pancreatic surgery or infections may also contribute.
Symptoms
In mild hyperglycemia, symptoms may be absent or difficult to detect. However, as blood sugar rises significantly, common symptoms include excessive thirst, frequent urination, and unexplained weight loss. Prolonged high blood sugar can lead to severe complications like retinopathy (which can cause blindness), kidney dysfunction (potentially leading to dialysis), neuropathy (causing numbness or pain), and an increased risk of cardiovascular diseases.
Diagnosis and Tests
Blood tests are the primary method for diagnosing diabetes. It is confirmed if fasting blood glucose levels exceed 126 mg/dL or if blood sugar levels exceed 200 mg/dL two hours after an oral glucose tolerance test. If symptoms like excessive thirst, frequent urination, and weight loss are present, diabetes can also be diagnosed if random blood glucose levels are 200 mg/dL or higher.
Treatment
Type 1 Diabetes
Insulin therapy is necessary for managing Type 1 diabetes.
Type 2 Diabetes
Treatment primarily involves lifestyle changes, including diet and exercise. Medications may also be prescribed, and they can be broadly divided into insulin stimulators and insulin sensitizers.
Medications
Oral medications for diabetes include insulin secretagogues like sulfonylureas (Amaryl, Diamicron) and meglitinides (Novonorm, Glufast), which stimulate insulin release. Another category, insulin sensitizers, such as metformin and thiazolidinediones (Actos, Avandia), improve how cells respond to insulin.
Additionally, newer drugs like GLP-1 agonists (e.g., liraglutide) and DPP-4 inhibitors (e.g., Januvia) target hormones involved in glucose regulation. Recently developed SGLT2 inhibitors also reduce glucose reabsorption in the kidneys and offer cardiovascular benefits.
Insulin Types
Insulin injections remain the most effective way to manage blood sugar, with types including rapid-acting (e.g., insulin lispro), short-acting (regular insulin), intermediate-acting (NPH insulin), and long-acting insulin (e.g., insulin glargine). While highly effective, insulin therapy has limitations like the need for injections and potential patient discomfort.
Complications
Acute Complications
Severe insulin deficiency can result in acute complications such as diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome, both of which require immediate medical attention.
Chronic Complications
Chronic complications include microvascular diseases like retinopathy, nephropathy, and neuropathy, as well as macrovascular diseases like coronary artery disease, peripheral arterial disease, and stroke.
Prevention
While Type 2 diabetes cannot always be prevented, lifestyle modifications, such as reducing body weight by 5–7%, can delay or prevent its onset in many cases. These lifestyle changes are considered the most effective and safest preventive measures.
Diet and Lifestyle Guidance
Self-monitoring of blood sugar levels is crucial, as symptoms alone can be misleading. Weight loss and regular exercise are essential for managing diabetes, and dietary changes, such as reducing fat intake, can be beneficial. Low-fat dairy products can be a good alternative.
Related Diseases
Diabetes is often associated with other health issues, including metabolic syndrome, obesity, hypertension, high cholesterol, and cardiovascular diseases.
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