Diabetes

Diabetes is a chronic condition associated with abnormally high levels of sugar (glucose) in the blood. When our body is unable to produce sufficient insulin to absorb the glucose, or there is inability to utilize the insulin properly will cause diabetes. It is also known as sweet urine, as the elevated levels of blood glucose levels causes the glucose to come the urine and thus can damage the vital organs.

• It is a simple sugar found in food.
• The proper functioning of the body needs energy, which is provided by glucose, which is an essential nutrient.
• The digestion of food consists of breaking down of carbohydrates in the small intestine, converts into glucose is absorbed by the intestinal cells, into the bloodstream, which is carried by the bloodstream, and utilized.
• Glucose transportation into the cells is possible only in combination with insulin.
• Even if, there is ample of glucose, present in the blood, without insulin the cells of the body get starved of the energy from glucose.

• Pancreas is a deep-seated organ in the abdomen located behind the stomach, which consists of specialized cells (beta cells) produces the hormone insulin.
• It not only helps glucose to enter the bloodstream, it also helps to regulate the blood sugar levels.
• There is a rise in the blood glucose level after a meal, because of which the pancreas releases more insulin in the bloodstream, to let the glucose enter the cells to maintain the blood glucose levels.
• When the blood sugar levels are maintained the release of insulin is turned down.
• In normal individuals, the insulin release mechanism helps to control the blood sugar levels in normal range.

 In the diabetic patients, there is disturbance in the absorption of blood glucose either due, to insufficient release of insulin or due to lack of proper mechanism of insulin combination of glucose and insulin, which causes hyperglycemia.

Diabetes are of two major types, types 1 and type 2 diabetes.

• Type 1
• This is an autoimmune disease, the immune system produces the antibodies and the inflammatory cells that are directed against, which causes there is a damage to the patients’ own body tissues by the immune system response, in which the antibodies are produced and inflammatory cells that are directed against, damages the patients’ own body tissues.
• The misdirected immune system, attacks the beta cells of the pancreas, which produces the insulin.
• There may be certain toxins or certain viral infections which may trigger abnormal antibody responses that damages the pancreas cells.
• Individuals who are at risk of developing type 1 diabetes, can be detected with these antibodies.
• Type 2
• In this, there is production of insulin, but does not meet up the needs of the body.
• The production of insulin, more than in normal quantities of insulin, but is lack of sensitivity to insulin by the cells of the body, i.e, fat and muscle cells.
• Some additional problems may include, an increase in insulin resistance, defective and suboptimal release of insulin by the pancreas.
• There is worsening of glucose control as contributed by the steady decline in the beta cell production of insulin in type 2 diabetes.
• There is a continuous production of glucose by the liver in patients with the type 2 diabetes by the process of gluconeogenesis despite of elevated glucose levels.
• Most of the cases will have these common habits, like poor eating habits, high body weight and lack of exercise.

Other types of diabetes

• Gestational diabetes
• In 2% to 10% of all pregnancies, there is temporary elevation of blood sugar due to hormonal changes.
• This elevation in the blood sugar levels lead to gestational diabetes which resolves automatically post-delivery.
• The women who were on insulin during the pregnancy or remain overweight post-delivery have a risk of developing type 2 diabetes over next 10-20 years.
• Secondary diabetes
• There is a chance of elevated blood sugar levels from another medical condition.
• Inflammation of the pancreas by toxins like excessive alcohol, known as chronic pancreatitis, trauma or surgical removal of the pancreas, may cause secondary diabetes.
• Hormonal disturbances
• Hormonal disturbances like excessive growth hormone secretion (acromegaly), sometimes a pituitary gland tumor at the base of the brain cause excessive production of growth hormone and cushing’s syndrome, there is excess production of cortisol, by adrenal gland which can lead to hyperglycemia.

1. Early symptoms of untreated diabetes, results in elevated blood sugar levels, loss of glucose in the urine. High glucose levels in the urine can cause frequent urination and dehydration.
2. Dehydration can increase the thirst and thus the water consumption.
3. A relative or absolute insulin deficiency results weight loss
4. Inspite of an increased appetite, there is weight loss in diabetes.
5. General fatigue is another complaint of untreated diabetes.
6. Nausea and vomiting are another symptom of untreated diabetes.
7. Untreated or poorly controlled diabetes result in frequent infections like bladder infections, skin and vagina.
8. Blurred vision is a consequence of blood glucose level fluctuations.
9. Extreme glucose level elevation can result in lethargy and coma.

• Obesity or overweight
• High blood pressure
• Elevated levels of triglycerides and low levels of “good cholesterol” (HDL)
• Sedentary lifestyle
• Family history
• Increasing age
• Poly cystic ovary syndrome
• Impaired glucose tolerance
• Insulin resistance
• Gestational diabetes
• Ethnic background: Hispanic/latino americans, African- americans, native americans, Asian americans, pacific islanders and alsaka natives are at greater risk.

• Fasting blood glucose test is preferred way to diagnose diabetes. This should be done after eight hours of fasting (overnight).
• Normal fasting plasma glucose levels should be less than 100mg/dl
• Fasting plasma glucose levels of more than 126mg/dl on two or more tests on different days indicate diabetes.
• A random test can also be used for the diagnosis. If it is 200mg/dl or high indicates diabetes.
• When fasting blood sugar is more than 100mg/dl, but ranges from 100-126mg/dl, is known as impaired fasting glucose or prediabetes.

Hemoglobin A1c (HbA1c)

• The blood sugar when stays longer in the blood sugar sticks to the proteins, so it stays in the blood stream with the red blood cells for about 3 months before they die off, this is also known as glycosylated hemoglobin or HbA1c.
• Normal range 4% - 5.9%.
• Poor control range is 8% or above
• Well controlled patients it is less than 7%
• Advantage is to get a reasonable and stable idea about the exact situation over the course of time.
• This is a standard tool to determine the blood sugar control in the patients.

• Severe elevated blood sugar levels are a result of lack of insulin or relative deficiency of insulin.
• Abnormally low blood sugar levels are a result of too much insulin or other glucose lowering medications.
• Stress, infection and medication (such as corticosteroids) can elevate the blood sugar levels.
• Elevated blood sugar levels along with dehydration can lead to increase in blood osmolality (hyperosmolar state). This can worsen and lead to coma.
• It is important to reverse the hyperosmolar state with immediate treatment with intravenous fluid.
• Hypoglycemia is abnormal low blood sugar (glucose). Excessive use of insulin or other glucose lowering medications, can cause excessive low blood sugar in presence of a delayed or absent meal.
• Insulin reaction occurs when there is low blood sugar due to too much insulin.
• Insufficient caloric intake or sudden excessive physical exertion can cause low blood sugar.
• Blood sugar level is very essential for the proper functioning of brain cells
• Drop in blood sugar levels less than 50mg/dl can impair the central nervous system such as:
• Dizziness
• Confusion
• Weakness
• Tremors
• Untreated severely low blood sugar can result in:
• Coma
• Seizures
• Irreversible brain death
• Low blood sugar can be treated quickly by administering
• Glucose source
• Orange juice
• Soft drinks
• Glucose tablets of 15-20g at a time
• Cake frosting inside the cheeks in a pinch if patient is uncooperative
• Intramuscular injection of glucagon hormone
• Glucagon release glucose from the liver
• It is lifesaving in patients with a history of hypoglycemia.

1 As there is requirement of exogenous insulin to regulate the
blood sugar levels.
2 If the blood sugar levels are elevated, there is increased urine
glucose, which leads to excessive loss of fluid and electrolytes
in the urine.
3 There is breakdown of existing fat and protein stores due to
lack of insulin.
4 Ketosis and release of ketones will happen as a result.

5 The blood turns acidic due to ketones which is called diabetic
ketoacidosis (DKA).
6 Symptoms of diabetic ketoacidosis (DKA):
7 Nausea
8 Vomiting
9 Abdominal pain
10 The patient can go into shock, coma and even death if there is
no prompt medical treatment given.
Other complications
11 Diabetic Retinopathy
12 Cataracts
13 Glaucoma
14 Diabetic Nephropathy
15 Protein in the urine
16 Diabetic Neuropathy
17 Nausea
18 Weight loss
19 Diarrhea
20 Gastroparesis

1 As there is requirement of exogenous insulin to regulate the
blood sugar levels.
2 If the blood sugar levels are elevated, there is increased urine
glucose, which leads to excessive loss of fluid and electrolytes
in the urine.
3 There is breakdown of existing fat and protein stores due to
lack of insulin.
4 Ketosis and release of ketones will happen as a result.

5 The blood turns acidic due to ketones which is called diabetic
ketoacidosis (DKA).
6 Symptoms of diabetic ketoacidosis (DKA):
7 Nausea
8 Vomiting
9 Abdominal pain
10 The patient can go into shock, coma and even death if there is
no prompt medical treatment given.
Other complications
11 Diabetic Retinopathy
12 Cataracts
13 Glaucoma
14 Diabetic Nephropathy
15 Protein in the urine
16 Diabetic Neuropathy
17 Nausea
18 Weight loss
19 Diarrhea
20 Gastroparesis