Diabetes

Dr Noureen Ahmad

General Practitioner, Belgium

Diabetes mellitus (DM) – more commonly known as diabetes – is a medical condition associated with a high blood glucose (hyperglycaemia) level in the body and impaired carbohydrate metabolism. 

In the UK, three to four million people have been diagnosed with diabetes and 90% of them have type 2 diabetes. More surprisingly, 12 million people in the UK are at high risk of developing type 2 diabetes. In 2016, diabetes was the seventh leading global cause of death worldwide.

In this chronic disease, there are abnormalities in the glucose metabolism. Glucose enters our body through food and is essential for the normal functioning of the cells. The glucose is primarily taken up from the intestines where it is transported to the bloodstream. The pancreas produces a hormone called insulin which acts on a variety of cells of the liver, fat and muscles. 

Insulin allows blood glucose to enter these cells for fuel consumption or storage.
However, if insulin levels are low or absent, glucose cannot enter these cells, which causes deprivation of glucose (energy) and thus leading to diabetes due to the high blood glucose levels.  

There are two types of diabetes, type 1 and type 2. The symptoms, diagnosis, follow up and the long-term complications are almost similar for both types. An unusual form of diabetes is the gestational diabetes, which only occurs in pregnant women. After the pregnancy this form of diabetes disappears, however these women are at a high risk of developing type 2 diabetes later on, especially in the first five years, and thus should have a proper follow up of the blood glucose levels. 

Type 1 diabetes is a chronic disease that is characterised by reduced or absent production of insulin, usually as a result of antibody production against the insulin producing cells in the pancreas. When 90% of these cells get damaged, it will cause symptoms. Type 1 diabetes usually develops at a young age (< 30-40 years). This type of diabetes can also occur in individuals with other autoimmune disorders or within families with a family history for type 1 diabetes. 

The other type, type 2 is characterised by reduced production of insulin by the cells of the pancreas. Another cause for type 2 diabetes is that body cells become unresponsive to the insulin hormone produced. Some groups have a high risk of developing this type of diabetes such as the elderly, aged above 65, obese individuals and pregnant women. 

Men have an increased risk than women. Noteworthy to mention is that Asians and people from African origins have five to ten times more risk to develop type 2 diabetes.

The symptoms of patients with type 1 and 2 diabetes usually include extreme thirst, frequent urination, nausea, tiredness, concentrating problems, blurred vision and a decreased appetite. 

Type 1 diabetes can even lead to a medical condition known as diabetic ketoacidosis, which can result in coma and death. Diagnosis of diabetes is based on the clinical symptoms and a blood glucose test. When the fasting blood glucose exceeds 7 mmol/L (126 mg/dl) or the non-fasting blood glucose exceeds 11 mmol/L (200 mg/dl), measured two times separately, then it is indicative of diabetes. 

Usually Hemoglobin A1c (HBA1c) is also tested in the blood which represents the average blood glucose of the past two to three months and should normally be below 48 mmol/mol (6.5%). Follow up exists of controlling the fasting blood glucose and HBA1c every two to three months.

The primary treatment of diabetes is based on lifestyle changes. It is advised to consume a variety of foods such as fresh vegetables and fruits. It is necessary to stop smoking and avoid alcohol consumption as well as reducing sugar intake. Doctors will mostly recommend a dietician. Besides changes in food, regular exercise is important for obtaining a normal weight (BMI) and can improve the response of the body cells to insulin. Education about diabetes is also an essential part of a good treatment which will be provided by the doctor or diabetes educators.

In type 1 diabetes, treatment exists of insulin therapy. The dose of insulin depends on the calorie intake and the amount of exercise. These patients have to check the blood glucose with a finger prick test daily and multiple times for a good regulation of glucose in the blood. If there is too much insulin in the blood, hypoglycaemia (low blood glucose level) can occur leading to symptoms such as sweating, paleness, headache and fainting.

In type 2 diabetes, medication is started if there is no improvement of the blood glucose levels after lifestyle changes. Medication for type 2 diabetes include metformin, sulfonylureas, GLP-1 receptor agonist, DDP-4 inhibitors, SGLT2 inhibitors and insulin therapy. Usually the doctor will start with metformin and can add the other medications depending on the blood glucose levels, response to the drugs and the patient’s profile.

Diabetes is a chronic disease which can lead to many complications on a long-term basis. There is an increased chance of developing strokes, heart attacks and vascular diseases. Therefore, good control of blood pressure and high lipid level in the blood are important besides the blood glucose level. If necessary, medication for high blood pressure and high lipid levels in blood can be added to the therapy.

In addition to this, high glucose levels in the blood can damage the small vessels and lead to kidney and eye diseases. It can also cause dry and sensitive skin and lead to a delayed wound healing. Thus, patients with diabetes are required to have regular eye, kidney and feet check-ups to prevent further complications.

The last complication which occurs frequently, is neuropathy or nerve damage. This usually leads to numbness, tingling or pain mostly in the lower limbs. In a late stage of nerve damage, pain is no longer felt. Neuropathy in men can lead to reproductive problems such as impotence. 

Finally, it is important to realise that diabetes patients are at an increased risk of infections and it is advised to receive influenza and a pneumococcal vaccination.

Good diabetic care requires good education for patients and a multidisciplinary approach by health professionals with the aim to obtain a normal life.

(Please always consult a doctor or specialist to diagnose health conditions and follow the advised plan of a qualified doctor)