By Dr Ali Omar
Diabetes mellitus or simply diabetes is defined as a clinical syndrome characterised by high blood sugar/glucose level (hyperglycemia) due to absolute or relative insulin deficiency.
Diabetes is on the rise in Kenya and around the world. About 1% of total deaths in Kenya were due to Diabetes in 2012 according to WHO. The prevalence of diabetes in 2014 in Kenya was at 6%. According to CDC 2011, 1 million Americans are suffering from type 1 diabetes, 26 million have type 2 and 79 Million have pre-diabetes in the United states of America.
There are mainly two types of Diabetes. Type 1 and type 2 diabetes mellitus.
Diabetes is due to combination of genetic and environmental factors such as diet, obesity and lack of exercise.
Diabetes is a serious disease due to its complications which can lead to death. It affects the eye, kidneys and the nervous system.
There is also less severe high blood sugar level termed as Pre-diabetes or impaired glucose tolerance.
Diabetes increases the susceptibility of getting infections especially skin (commonly involve the feet) and urinary tract infections.
Type 1 diabetes mellitus – It is usually due to autoimmune destruction of the pancreas leading to profound insulin production deficiency. It is mainly in people below the age of 40 years of age. In this type, the symptoms of diabetes present acutely.
Type 2 diabetes mellitus – It is due to peripheral insulin resistance and later relative insulin deficiency due to pancreatic cells inability to sustain increased insulin demand because of the resistance of peripheral tissues. Commonly in people older than 40 years of age. Symptoms of diabetes present slowly over a period of few years (3-4) and mostly it is diagnosed coincidentally in routine hospital check-ups but patients can present with symptoms.
Gestational Diabetes – in which high blood sugar levels occurs for the first time during pregnancy.
Recently type 2 diabetes has become common in the young due to increased childhood obesity and inactivity and hence the Maturity onset diabetes of the young (MODY) type was introduced in people of the age of 25 and below.
After a meal, the pancreas produces insulin which lowers the blood glucose levels by reducing production of glucose from the liver, turning glucose to storage glycogen in the liver and increasing glucose uptake in the peripheral tissues such as skeletal muscles.
When blood glucose level is low, pancreas produces Glucagon hormone and insulin hormone reduces. This leads to the reverse of the above process.
Patients may present with increased thirst (Polydipsia), increased production of urine (Polyuria), excessive urination at night (nocturia), recent change in weight, fatigue and sometimes blurring of vision. Glucose can be detected in urine in the hospital using urine analysis in the laboratory.
As mentioned earlier, in type 1 these symptoms appear acutely within few weeks and in type 2 symptoms appear over prolonged period of time and diagnosis is mostly coincidentally but patients can presents with symptoms.
Blood sugar level is the investigation used to diagnose and monitor Diabetes Mellitus.
There are 3 ways of diagnosing Diabetes Mellitus;-
- Symptoms and random blood sugar level of 11.1mmol/l or more.
- Fasting blood sugar level of 7.0mmol/l or more.
- Blood sugar level of 11.1mmol/l or more 2 hours after 75g of oral glucose load.
Pre-diabetes is when you have fasting blood sugar level of 5.6mmol/l to 6.9mmol/l or random blood sugar level of 7.8mmol/l to 11.0mmol/l.
Urine analysis can detect presence of glucose (Glycosuria).
Glycated Hb (Hba1c) provides accurate measure of glycemic control over a period of 2 to 3 months. It is an important measure of how sugar level has been controlled in patients with diabetes. Normal values ranges between 4-7%. It should be less than 7%.
For pre-diabetes, dietary and lifestyle modification is used in preventing development of diabetes.
There are oral diabetic medications for type 2 such as metformin and glibenclamide in combination with lifestyle modifications and later insulin may be used to control the sugar depending on the need.
Type 1 we use insulin and strict diet as advised by nutritionist or dietician.
Complications of diabetes are also addressed.
Consult your doctor for better choice of management if you have diabetes.
Lifestyle modifications include healthy diet such as LCHF diet read here http://healthjournal254.com/low-carb-high-fat-lchf-lifestyle-weight-loss-preventing-type-2-diabetes/ , regular exercise, avoid alcohol and cigarette smoking and reduce salt intake.
For Complications of diabetes Mellitus read here
It is my hope we live healthy lives!
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