Diabetes

Diabetes Mellitus is a health condition that affects the body’s ability to regulate sugar, in the form of glucose, in the body.¹ After consuming food and drink, the body (in a healthy, non-diabetic individual) breaks down this food into macro (and micro) nutrients, including fat, protein, and carbohydrates. Carbohydrates include glucose (and other sugars), which makes up “blood sugar” and is ultimately the body’s primary energy source. When blood sugar levels increase, the pancreas begins to secrete the hormone insulin. Problems with the body’s sensitivity to, or ability to secrete, insulin is what characterizes diabetes mellitus. There are three primary forms of diabetes mellitus: Type 1, Type 2, and Gestational. 

Type 1 Diabetes Mellitus (T1DM), previously called juvenile diabetes, is often diagnosed in early childhood, though it can develop at any time.² T1DM is significantly less common, presenting in approximately 5-10% of people who are diagnosed with diabetes². T1DM is caused by an autoimmune reaction resulting in the destruction of beta cells in the pancreas, where insulin is producedd¹, causing a reduction in or the complete cessation of insulin production. When insulin isn’t being made in the body,

]there’s a resulting increase in blood sugar, which can cause organ damage and ultimately be life-threatening. Insulin is essential for cells to take up sugar from the bloodstream; therefore, if this does not occur, the resulting build-up in the bloodstream over days, weeks, or even months will result in classic diabetes symptoms³. Common symptoms of T1DM include increased thirst (polydipsia), frequent urination (polyuria), increased hunger (polyphagia), weight loss without effort, mood swings, blurry vision, and extreme hunger. T1DM currently has no cure⁴.

There is no exact known cause for T1DM, though family history, genetics, and certain viruses can impact one’s risk.⁴ There are two ages at which the diagnosis of Type 1 Diabetes peaks: between 4-7 and 10-14. The most common test used to diagnose T1DM would be a Hemoglobin A1c, medically known as a Glycated Hemoglobin test. This test shows a trend, or average, in blood sugar over the previous two to three months, and a value greater than 6.5% on two different Hemoglobin A1c (HbA1c) tests indicates diabetes mellitus.⁴ Other tests include random blood sugar and fasting blood sugar.  

Treatment for T1DM can be tricky as not every regimen will work for every patient; however, the patient must take insulin as their body does not make any or enough. Insulin is most often given via injections or an insulin pump; however, there are many different types of insulin a patient may inject, including regular/short-acting, intermediate-acting, long-lasting, ultra-long-lasting, and premixed (a combination of intermediate and short-acting insulin). Fast-acting insulins (rapid-acting injected and rapid-acting inhaled) may be prescribed to some patients to use with long-acting insulin. These treatments have different efficacies depending on how quickly they must act or the necessary duration of potency for a patient’s specific need.⁵

Those who have T1DM and are well-controlled can still have complications; sometimes, insulin pumps fail, or the dosage is incorrect. A rise in blood sugar, called hyperglycemia, typically presents with a gradual onset of the symptoms previously discussed. However, if too much insulin is administered, a patient will experience low blood sugar or hypoglycemia. This has a much more rapid onset and becomes a life-threatening emergency quickly. Symptoms of hypoglycemia include dizziness, shakiness, weakness, shallow breathing, hunger or nausea, headache, and seizures.4 When someone with T1DM feels any of these symptoms, they should immediately check their sugar levels and ingest something that can help raise their sugar levels quickly, like juice, glucose tablets, or candy.⁴ 

Type 2 Diabetes (T2DM), previously termed adult-onset diabetes, can develop at any age. T2DM is a twofold problem: first, cells that typically take up insulin become resistant, resulting in starvation of the cells⁶; second, the pancreas cannot secrete adequate amounts of insulin to keep blood sugar levels in an appropriate range6. The largest risk factor for developing T2DM is being overweight or obese. Additional risk factors include a sedentary lifestyle, large fat storage in the abdomen, family history, age, prediabetes, and pregnancy-related diabetes.⁶ T2DM makes up 90-95% of diabetes diagnoses.⁶ This condition often happens over time, as the risk factors suggest. Many symptoms of  T2DM resemble those of T1DM: increased thirst and hunger, frequent urination, weight loss without effort, slow-healing sores, blurry vision, areas of skin that are darker, especially in creases like those in the neck and armpits, and extreme hunger.^4,6 

The most common test used to diagnose T2DM is Hemoglobin A1c, though an oral glucose tolerance test, most commonly used to screen for Gestational Diabetes Mellitus (GDM) in pregnant females, may be used to help confirm findings. For the glucose tolerance test, the patient will fast for 12, 8, or 2 hours, depending on the test duration ordered by the clinician. After fasting for the designated period, a blood draw is collected. Next, the patient will consume a glucose drink (equivalent to 50-75mg). Next, depending on the specific testing ordered by the clinician, the patient will have a series of blood draws at the 1, 2, and/or 3-hour mark(s) to assess the changes in blood glucose. If the blood glucose is less than 140 mg, the patient is unlikely to have diabetes; at 140-199 mg, the patient is considered prediabetic; and if the results are 200+ mg, the patient is most likely diabetic.⁷ Additionally, a combination of midrange elevated values from the testing series could prove to be diagnostic for diabetes as well. Other tests include random blood sugar and fasting blood sugar.⁶  

Just like T1DM, T2DM can be tricky to treat. Every patient is different, and not all medications work for every patient. Patients should implement healthy eating habits, increase physical activity, and monitor blood sugar.⁶ If weight loss, exercise, and healthy eating do not help, the patient may be prescribed a medication like metformin, which may help with insulin sensitivity and lower glucose production, amongst other functions. If metformin doesn't work for the patient, other options, like insulin, are explored.

Finally, Gestational Diabetes Mellitus (GDM) is a form of diabetes that is diagnosed during gestation (pregnancy) and often resolves at the end of the pregnancy. GDM is similar to Type 2 Diabetes, where the body can't process insulin optimally and may be managed with diet or require insulin.⁸ Routinely, all pregnancies are screened for GDM between 24-26 weeks, as it is most likely to develop around week 24 of gestation. However, only 2-10% of pregnancies per year are affected in the United States.⁸ The cause of GDM is linked to insulin resistance, which can be partially due to hormonal changes and weight gain during pregnancy.⁸ The importance of screening for GDM is significant because it does not usually present with symptoms that a patient would report,⁸ but the repercussions of unmanaged GDM can be extreme. They include high birth weight (>9 lbs), preterm labor/birth due to intrauterine growth restriction (IUGR), respiratory distress after birth, hypoglycemia, and sometimes, in rare cases, stillbirths or death shortly after birth.⁸ GDM also puts the mother at an increased risk for hypertension, preeclampsia, cesarean section (C-Section), and Type 2 Diabetes later in life (it also increases the baby’s risk for T2DM later in life).⁹ Overall, Diabetes is a life-changing disease that puts individuals at a greater risk for comorbidities and health complications. 

 

References

1. Centers for Disease Control and Prevention (2023, September 5). What is Diabetes? CDC. Retrieved January 12, 2024, from https://www.cdc.gov/diabetes/basics/diabetes.html
2. Centers for Disease Control and Prevention (2023, September 5). What is Type 1 Diabetes? CDC. Retrieved January 12, 2024, from https://www.cdc.gov/diabetes/basics/what-is-type-1-diabetes.html
3. Herndon, J., & Griffith, M., MD. (2021, September 13). What’s the difference between hyperglycemic hyperosmolar nonketotic syndrome (HHNS) and diabetic ketoacidosis (DKA)? Healthline. Retrieved January 16, 2024, from https://www.healthline.com/health/diabetes/hhns-vs-dka
4. Mayo Foundation for Medical Education and Research (MFMER) (2023, September 15). Type 1 Diabetes. Mayo Clinic. Retrieved January 12, 2024, from https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011
5. Centers for Disease Control and Prevention (2022, December 30). Type of Insulin. CDC. Retrieved January 12, 2024, from https://www.cdc.gov/diabetes/basics/type-1-types-of-insulin.html
6. Mayo Foundation for Medical Education and Research (MFMER) (2023, March 14). Type 2 Diabetes. Mayo Clinic. Retrieved January 12, 2024, from https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193
7. Glucose tolerance test - Mayo Clinic. (2022, March 24). https://www.mayoclinic.org/tests-procedures/glucose-tolerance-test/about/pac-20394296
8. Centers for Disease Control and Prevention (2022, December 30). Gestational Diabetes. CDC. Retrieved January 12, 2024, from https://www.cdc.gov/diabetes/basics/gestational.html
9. Mayo Foundation for Medical Education and Research (MFMER) (2022, April 9). Gestational Diabetes. Mayo Clinic. Retrieved January 12, 2024, from https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339