Diabetes 101

Diabetes is a metabolic syndrome that occurs due to a lack of insulin and/or the inability of insulin to properly exert its effects, causing an increase in glucose (sugar) in the blood.

 

Diabetes happens because the pancreas cannot produce enough insulin to meet the body's needs or because this hormone cannot act correctly (insulin resistance).

 

Importance of Insulin Production

Insulin promotes the reduction of blood glucose by allowing the sugar present in the blood to enter the cells to be used as an energy source.

 

Therefore, if there is a lack of this hormone, or even if it does not act appropriately, there will be an increase of glucose (sugar) in the blood, and consequently, diabetes.

 

Types

Pre-Diabetes

Pre-diabetes is when the patient can develop the disease, as if it were an intermediate state between healthy and type 2 diabetes.

 

After all, in type 1, there are no pre-diabetes: the person is born with a genetic predisposition to the problem and the inability to produce insulin and develop diabetes at any age.

 

Type 1 Diabetes

Type 1 diabetes is when the pancreas loses the ability to produce insulin due to an immune system defect, causing our antibodies to attack the cells that construct this hormone. Type 1 diabetes occurs in about 5-10% of diabetes patients.

 

Type 2 Diabetes

Type 2 diabetes is a consequence of two factors: decreased insulin secretion and a defect in insulin action, known as insulin resistance.

 

Type 2 diabetes can usually be treated with oral or injectable medications. However, over time, the disease can worsen. Type 2 diabetes occurs in about 90% of diabetes patients.

 

Gestational Diabetes

Gestational diabetes is the increased resistance to insulin action in pregnancy, leading to increased blood glucose levels first diagnosed during gestation and may not persist after delivery.

 

The actual cause of gestational diabetes is unknown, but insulin resistance-related mechanisms are involved.

 

Other Types of Diabetes

There are also types of diabetes that result from genetic defects associated with other diseases or medications. These can be:

• Diabetes caused by genetic defects in beta cell function

• Diabetes caused by genetic defects in insulin action

• Diabetes is caused by diseases of the exocrine pancreas (pancreatitis, neoplasia, hemochromatosis, cystic fibrosis, etc.)

• Diabetes is caused by defects induced by drugs or chemicals (diuretics, corticosteroids, beta-blockers, contraceptives, etc.)

 

Frequently Asked Questions

My blood glucose test is over 100 mg/dl. Do I have diabetes?

Not necessarily.

 

The fasting glucose test is the first step in investigating diabetes and monitoring the disease. Average fasting glucose values are between 70 and 99 mg/dl (milligrams of glucose per deciliter of blood).

 

Being slightly above these values indicates that the individual has altered fasting glucose.

 

This acts as a warning that insulin secretion may not be typical. Your doctor should follow up on the investigation by ordering a glycemic curve test, determining whether you have glucose intolerance, diabetes, or just an abnormal result.

 

Is Diabetes Contagious?

Diabetes is not passed from person to person.

 

Diabetes is not transmitted from person to person; what happens is, in type 1 diabetes, in particular, there is a genetic propensity to have the disease and not a standard transmission. It can happen, for example, that the mother has diabetes and the children are born healthy.

 

Type 2 diabetes, on the other hand, has a multifactorial role: it is a consequence of bad habits, such as a sedentary lifestyle and obesity, which can also be adopted by the entire family - explaining why people close to them tend to have the disease together, but it also has a genetic propensity.

 

Can I consume honey, brown sugar, and cane juice?

It is known that adult type 2 diabetes, which corresponds to 90% of diabetes cases globally, has a multifactorial cause; that is, many factors together trigger the disease. A sedentary life, genetic tendencies, and especially weight gain are the leading causes.

 

Weight gain is due to the excess of calories ingested. So, if the person overeats sugar and gains weight, then the sugar is the cause of the weight gain, leading to diabetes.

 

But if the person overeats bread, potatoes, or rice, and because of these calories becomes overweight, he or she is also at risk of developing diabetes.

 

Bottom line: it is not the fact of specifically eating sugar that causes diabetes, but the existence of overeating any food that ends up causing the person's weight to increase.

 

And, besides being overweight, it is necessary to add other factors, such as a sedentary lifestyle and family history, to have a higher risk of developing diabetes.

 

Is insulin addictive?

The application of insulin does not cause any chemical or psychological dependence.

 

The hormone is vital to allow glucose to enter the cell, becoming a source of energy.

 

It is not a chemical dependency but a vital need. The patient with diabetes needs insulin to survive, but he is not addicted to the substance.

 

Diabetes Symptoms

The main symptoms of diabetes are frequent urination, excessive hunger and thirst, and weight loss. These symptoms occur due to insufficient insulin production or the inability of insulin to exert its action correctly, thus causing an increase in blood glucose.

 

The following are the characteristic symptoms of each type of diabetes.

 

Pre-Diabetes Symptoms

Pre-diabetes is the clinical condition that precedes the diagnosis of type 2 diabetes. It is usually not accompanied by symptoms. Therefore, it is a health condition that often goes undiagnosed.

 

However, suppose the individual has weight gain, has a family history of diabetes, eats a high-calorie diet, and is sedentary. It is crucial to seek medical advice to investigate how the blood glucose levels are doing.

 

Symptoms of Type 1 Diabetes

People with type 1 diabetes may experience the following symptoms:

• Fatigue

• Nausea

• Vomiting

• Weight loss

• Weakness

• Nervousness

• Mood swings

• Excessive thirst

• Excessive hunger

• Frequent urge to urinate

Type 1 diabetes can occur through genetic inheritance in conjunction with viral infections. The disease can manifest itself at any age, but it is most commonly diagnosed in children, adolescents, or young adults.

 

Symptoms of Type 2 Diabetes

People with type 2 diabetes have no initial symptoms and may remain asymptomatic for many years.

 

However, due to an insulin resistance caused by the health condition, it is possible to manifest the following symptoms:

• Boils

• Excessive thirst

• Excessive hunger

• Tingling in the feet

• Visual alteration (blurred vision)

• Wounds that take a long time to heal

• Frequent infections (such as bladder, kidney, and skin infections)

 

Any individual can develop type 2 diabetes. However, being over the age of 45, being overweight or obese, and having a family history of type 2 diabetes may increase the disease's risk.

 

Symptoms of Gestational Diabetes

Gestational diabetes most often causes no symptoms, and the condition is discovered during periodic checkups. However, due to the rise in blood glucose during pregnancy, it is possible to manifest the following symptoms:

• Excessive hunger

• Excessive thirst

• Frequent urination

• Blurred vision

Any woman can develop gestational diabetes. However, having a family history of diabetes, being overweight before pregnancy, and gaining weight during pregnancy may favor the condition.

 

Read more: Diabetes Type 1 The Silent Killer

Diagnosing Diabetes

The diagnosis of diabetes is usually made using three tests:

 

Fasting Blood Glucose

Fasting glucose is a test that measures the level of sugar in your blood at that moment in time and is used to monitor diabetes treatment.

 

What abnormal results mean:

• Results between 100 mg/dL and 125 mg/dL are considered abnormal near the limit and should be repeated simultaneously.

• Values above 140 mg/dL are highly suspicious for diabetes but should also be repeated later (medical evaluation is always necessary).

 

Glycated Hemoglobin

Glycated hemoglobin (HbA1c) is a test that measures the fraction of hemoglobin (protein inside the red blood cell) that binds to glucose.

 

During the life cycle of the red blood cell (90 days on average), the hemoglobin builds up glucose as a function of glucose concentration in the blood.

 

If glucose levels are high during this period or increase occasionally, there will be an increase in glycated hemoglobin levels.

 

So, the glycated hemoglobin test can show you an average of the hemoglobin concentrations in your blood over the last three months.

 

The glycated hemoglobin values will indicate whether or not you are experiencing hyperglycemia, starting an investigation for diabetes. Typical glycated hemoglobin values:

• For healthy people: between 4.5% and 5.7%

• For patients already diagnosed with diabetes: below 7%

• Consistent for diabetes: greater than or equal to 6.5%

• Abnormal close to the limit: 5.7% and 6.4%, and the patient should investigate for pre-diabetes

 

Glycemic Curve

The simplified OGTT measures how quickly your body absorbs glucose after you eat it. You ingest 75 g of glucose, and the amounts of the substance in your blood are measured two hours later.

 

In Brazil, the simplified glycemic curve test is used for diagnosis, measured at zero and after 120 minutes.

 

The reference values are:

• Fasting: below 100mg/dl

• After 2 hours: 140mg/dl.

 

A glycemic curve greater than 200 mg/dl after two hours of ingesting 75g of glucose is suspicious for diabetes.

 

The Brazilian Diabetes Society recommends the following conditions as diagnostic criteria for diabetes:

• Glycated hemoglobin more significant than 6.5% was confirmed on another occasion (two altered tests).

• An A1c test combined with fasting glucose greater than 200 mg/dl in the presence of symptoms of diabetes.

• Symptoms of intense urination and thirst, weight loss despite food intake, with out-of-fasting blood glucose greater than 200 mg/dl.

• Fasting blood glucose greater than or equal to 126 mg/dl on at least two samples on different days.

• Blood glucose greater than 200 mg/dl two hours after ingesting 75 g of glucose.

Read more: Diabetes Type 2 The Silent Killer

Diabetes Treatment

The goal of diabetes treatment is to control the glucose present in the patient's blood, preventing it from spiking or dropping throughout the day.

 

How to Apply Insulin

Type 1 diabetes patients need daily insulin injections to keep their blood glucose at normal values.

 

To do this, you need a glucometer at home, a device that can measure the exact concentration of glucose in your blood.

 

Insulin must be applied directly to the subcutaneous tissue (layer of fat cells), just under the skin.

 

The best places to apply insulin are:

• Abdomen (belly)

• Waist area

• Thigh (front and outer side)

• Arm (back of upper third)

• Gluteus (upper and lateral part of the buttocks)

 

Type 1 Diabetes Medications

In addition to prescribing insulin injections to lower blood sugar, some doctors require that the patient also include oral medications in their treatment.

 

Careful Monitoring of Your Baby

Treatment for women who have gestational diabetes aims to lower the sugar levels in the mother's bloodstream to prevent it from harming the baby's development.

 

Women who have a condition of gestational diabetes need to observe how the baby is growing and developing with ultrasounds and other tests.

 

If a diet with exercise is not enough, the pregnant woman may need insulin injections to lower her blood sugar. 

Some doctors also prescribe oral medications to control blood sugar. People who have type 2 diabetes rely on specific practices in the treatment of the health condition. 

Type 2 diabetes is often accompanied by other problems such as obesity and overweight, a sedentary lifestyle, high triglycerides, and high blood pressure.

 

Therefore, it is important to consult your physician and take care of these other diseases and problems that may appear along with type 2 diabetes.

 

Treatment to Stop Diabetes from Advancing

In most cases, the treatment for pre-diabetes will start with modifying life habits: diet with reduction of calories, saturated fats, and carbohydrates, especially the simple ones, besides the stimulation of physical activity.

 

In some cases, the doctor in charge may choose, together with the patient, to start treatment with medication to prevent the evolution of diabetes.

 

In patients with pre-diabetes, if they are overweight or obese, the loss of about 5% to 7% of body weight already leads to an important metabolic improvement.

 

Stop Smoking

Diabetes and smoking multiply the risk of heart attack by up to five times. The substances in cigarettes help to create fatty deposits in the arteries, blocking circulation.

 

Consequently, the blood flow gets slower and slower until the artery gets clogged. In addition, smoking also contributes to hypertension in the patient with diabetes.

 

Take Care of Your Oral Health

Oral hygiene after every meal for the patient with diabetes is crucial. This is because the blood of people with diabetes, with its high concentration of glucose, is more prone to the development of bacteria.

 

As it is an entry route for food, the mouth also receives several foreign bodies that, added to the accumulation of food debris, favor the proliferation of bacteria—brushing well and visiting the dentist once every six months is essential.

 

Diabetes Medicines

Some medications are usually indicated for diabetes, depending on the case.

 

Only a doctor can tell you which medication is best for you, as well as the correct dosage and duration of treatment. Always follow your doctor's instructions to the letter and never treat yourself.

 

Do not discontinue using the drug without consulting a doctor first, and if you take it more than once or in much larger amounts than prescribed, follow the directions on the package insert.

 

In patients with diabetes, hypoglycemia (low blood sugar) may occur during therapy with fluoxetine hydrochloride and hyperglycemia (high blood sugar) after discontinuation.

 

Therefore, the dose of insulin and/or oral hypoglycemic agents should be adjusted when treatment with this drug is established and after discontinuation.

 

Possible Complications

Diabetic Retinopathy

Lesions that appear on the eye's retina can cause minor bleeding and, consequently, loss of visual acuity.

 

Arteriosclerosis

Hardening and thickening of the walls of the arteries.

 

Diabetic Nephropathy

Changes in the blood vessels of the kidneys cause a loss of protein through the urine. The organ may reduce its function slowly but progressively until it is completely paralyzed.

 

Diabetic Neuropathy

The nerves are unable to send and receive messages from the brain, causing symptoms such as tingling, numbness, or burning in the legs, feet, and hands, local pain and imbalance, muscle weakening, hair trauma, low blood pressure, digestive disturbances, excessive sweating, and impotence.

 

Diabetic Foot

Diabetic foot occurs when an injured or infected area on the feet of people with diabetes develops an ulcer (sore). It can happen when blood circulation is deficient, and blood glucose levels are poorly controlled.

 

Any foot injury should be treated quickly to avoid complications that can lead to amputation of the affected limb.

 

Myocardial Infarction and Stroke

These occur when large blood vessels are affected, leading to obstruction (arteriosclerosis) of vital organs such as the heart and brain.

 

Reasonable glucose control, physical activity, and medications that can combat high blood pressure, increase cholesterol, and stop smoking are essential safety measures. The incidence of this problem is two to four times higher in people with diabetes.

 

Infections

Excess glucose can damage the immune system, increasing the risk that a person with diabetes will get some infection. This is because the white blood cells (responsible for fighting viruses, bacteria, etc.) become less effective with hyperglycemia.

 

The high blood sugar level is conducive for fungi and bacteria to increase in areas such as the mouth and gums, lungs, skin, feet, genitals, and surgical incision sites.

 

Hypertension

It is a consequence of obesity - in the case of type 2 diabetes - and of the high concentration of glucose in the blood, which impairs circulation and arteriosclerosis, which also contributes to the increase in pressure.

 

Is There A Cure for Diabetes?

Technically, from a medical point of view, diabetes has no cure. However, the disease is controllable with the proper treatment and other lifestyle precautions that the patient should follow.

 

If the person secondarily develops the disease due to continuous corticosteroids, morbid obesity, and alcoholism, blood sugar levels can normalize with proper control of these conditions. And this is often seen as a cure.

 

But what happens is that the disease is well controlled. Thus, should the person regain weight or resume alcoholic habits, diabetes will most likely reappear. It is therefore essential to follow up with specialists to achieve a better quality of life.

 

Living with Diabetes/Prognosis

Patients with diabetes should be advised to:

• Maintain a healthy diet

• Practicing physical activities

• Maintain good glycemic control, correctly following the medical orientation

• Use the prescribed medications, strictly following the dosages indicated by the doctor

• Perform daily examination of the feet to prevent the appearance of lesions (it is worth using a mirror to view the soles of the feet every day)

 

Prevention

Patients with a family history of diabetes should be instructed to:

• Do not smoke

• Control blood pressure

• Maintain an average weight

• Practice regular physical activity

• Avoid medications that can potentially damage the pancreas