Introduction:

“Diabetes is an all-too-personal time bomb which can go off today, tomorrow, next year, or thirty years from now.”
[William James Mayo, Co-founder of the Mayo Clinic]

Diabetes Mellitus is among the most widespread diseases worldwide. According to the International Diabetes Federation (IDF), approximately 537 million adults (20-79 years) were living with diabetes in 2021, with almost half unaware that they are living with the condition. IDF predicted an increase of 46% in it by 2045. Understanding the philosophy of diabetes would be life-saving for managing this pervasive disease effectively!

Section 1: What is Diabetes Mellitus?

Diabetes Mellitus is a disease that impacts the body's ability to process blood glucose (sugar) properly, leading to high blood glucose levels. This occurs either because the pancreas does not produce enough insulin (a hormone that facilitates glucose uptake by cells) or because the body's cells become resistant to insulin's effects.
Diabetes is not just limited to humans. Pets, particularly dogs and cats, can also develop diabetes, requiring special diets and insulin injections.

Do You Know? / Interesting Fact:
Research is ongoing to develop an artificial pancreas that can automatically control blood glucose levels by delivering the appropriate amount of insulin in real time.

Section 2: Diabetes Signs & Symptoms

Etymology:

Let’s begin by understanding the etymology of diabetes mellitus; it will help you remember the two significant signs of diabetes.

• The word "diabetes" comes from the Greek word meaning "siphon," referring to the frequent urination symptom (Polyuria). This symptom occurs because the body attempts to rid itself of excess glucose through the urine.
  
• "Mellitus" means "honey-sweet" in Latin, referring to the sweet smell and taste of the urine. It occurs due to high levels of glucose excreted by the kidneys.
  

Signs and Symptoms:

1. Increased thirst due to frequent urination and dehydration.
2. Increased hunger because body cells are not getting enough glucose.
3. Weight loss as the body uses fat and muscles for energy.
4· Feeling tired due to lack of insulin.
5· Blurry vision (high blood glucose affects eyes)
6· Slow-healing sores and prone to infections because it can impair healing and immune response.

Section 3: Causes of Diabetes

Contrary to common belief, sugar doesn't cause diabetes. It’s a combination of genetic, lifestyle, and environmental factors. However, a diet high in sugar can contribute to obesity, which is a significant risk factor.
To understand the causes, it's essential to understand the normal glucose regulation in the body first.

Normal Glucose Regulatory Mechanism:

When we eat carbohydrates, they break down into glucose during digestion, which is absorbed into the bloodstream, causing blood glucose levels to rise. In response, the pancreas releases insulin, allowing glucose to enter cells for energy or storage. Cells throughout the body take up glucose, returning blood glucose to normal.
Any excess glucose is stored in the liver and muscles for later use. As blood glucose levels decrease, insulin secretion from the pancreas decreases to prevent hypoglycemia. This intricate feedback mechanism helps keep blood glucose levels stable.
However, this mechanism is disrupted in diabetes, leading to high blood glucose levels due to insufficient insulin action or insulin resistance.

Causes of Disrupted Glucose Regulation in Diabetic People:

There are three main types of diabetes: Diabetes Type 1, Type 2, and gestational diabetes. Each type is associated with different underlying causes.

1. Type 1 Diabetes

An autoimmune diabetes is when the body's immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. Without insulin, glucose cannot enter the cells, leading to high blood glucose levels.

It may involve genetic and environmental factors like family history and viral infections.

2. Type 2 Diabetes

In Type 2 diabetes, the body’s cells become resistant to the effects of insulin. As a result, more insulin is required to help glucose enter cells. The pancreas compensates by producing increased insulin, but over time, it cannot keep up with the increased demand, leading to elevated blood glucose levels.

It stems from several factors, including genetics, obesity, physical inactivity, and poor or unhealthy diet.

3. Gestational Diabetes

During pregnancy, the placenta produces hormones that make the mother's cells more insulin-resistant. Typically, the pancreas can increase insulin production to overcome this resistance, but if it cannot, blood glucose levels rise, resulting in gestational diabetes.

Women who are overweight or overage (above 25 years) and have a history of gestational diabetes in previous pregnancies are at higher risk. It increases the risk of Type 2 diabetes in women later in life and raises the risk of obesity and diabetes in their children.

Section 4: Diagnosis of Diabetes

If a person exhibits classic symptoms of hyperglycemia (high blood sugar), confirming abnormal results with repeat tests on a different day is recommended.

There are several ways to diagnose diabetes:

1. Glucometer or Fasting Plasma Glucose (FPG)

A glucometer is used to monitor blood glucose levels at home regularly. A small drop of blood is obtained by pricking the finger with a lancet. The blood is then applied to a test strip inserted into the glucometer, which provides a blood glucose reading.

It provides immediate readings but is less comprehensive than laboratory tests. Regular use helps daily management but should be complemented with other diagnostic tests.

Note: Convenient for daily monitoring and ongoing diabetes management.

Interpretation of Result:

2. Urine Dipstick Test

This test is primarily used to detect the presence of glucose and ketones in the urine. A urine sample is collected, and a dipstick is submerged. The dipstick has chemical pads that change colour based on the concentration of glucose and ketones.
Usually, there should be no glucose in the urine. The presence of glucose may indicate diabetes or poorly controlled blood glucose levels, and ketones can indicate diabetic ketoacidosis, a severe complication of diabetes, particularly Type 1 diabetes.

Note: It helps monitor blood glucose levels but is not definitive for the diagnosis of diabetes.

Interpretation of Test Results:

3. HbA1C Test

The hemoglobin A1C test reflects long-term glucose control by measuring the average blood glucose level over the past 2-3 months. A blood sample, usually from a vein, is taken and sent to a lab for analysis.

Interpretation of Test Results:

In some cases, the A1C test might not be appropriate. For example, certain conditions like anemia, kidney disease, or hemoglobinopathies can affect A1C results.

Did You Know?
Prediabetes is a condition where blood glucose levels are higher than usual but not yet high enough to be diagnosed as diabetes. Prediabetes increases the risk of developing Type 2 diabetes, heart disease, and stroke.

4. Oral Glucose Tolerance Test (OGTT)

It is an essential diagnostic test for diabetes and identifying any abnormality in glucose metabolism. The test begins after fasting for at least 8 hours. Blood samples are taken at intervals (1-2 hours) after drinking the glucose solution (usually 75 grams of glucose).
You must stay at the testing facility for the test, typically 2 hours.

Interpretation of Test Results:

Recent illnesses, medications, and stress can affect the results. Always consult your healthcare provider for personalised interpretation based on your health condition and risk factors.

Section 5: Diabetes Treatment

In 1921, Canadian scientists Frederick Banting and Charles Best discovered insulin. This breakthrough led to the first successful treatment of a diabetic patient in 1922.
Treating diabetes involves lifestyle changes, medication, and regular monitoring to keep blood glucose levels within the target range.

Lifestyle Changes

• Take a healthy diet rich in grains, fruits, vegetables, and lean proteins.
• Make a habit of exercise or any moderate aerobic activity (at least 150 minutes per week).
• Maintaining a healthy weight can also improve blood sugar control.

Research shows that lifestyle changes can reduce the risk of developing Type 2 diabetes by about 58%.

Medications

Insulin is the primary treatment for Type 1 diabetes and sometimes for Type 2. Since the body cannot produce insulin, patients must take insulin injections or use an insulin pump.

• Rapid-acting insulin: Take it before meals (starts to work within 15 minutes, and its effects last 2 to 4 hours).
• Long-acting insulin: Provides baseline insulin levels throughout the day (starts to work 2 hours after injection and lasts up to 24 hours).
• Oral medications: Metformin, sulfonylureas, DPP-4 Inhibitors, SGLT2 Inhibitors, and GLP-1 Receptor Agonists help manage Type 2 diabetes.

Do you know? / Interesting Fact:
Research is ongoing to explore the potential of stem cell therapy to regenerate insulin-producing cells in the pancreas.

Monitoring

Regular check-ups of blood glucose levels are essential to manage medication doses effectively.

Conclusion:

Stay informed, stay proactive, and take control of your health!

Additional Resources

For more information and resources on diabetes mellitus, we encourage you to visit the following reputable organisations and resources:

• [American Diabetes Association (ADA)]

/https://diabetes.org/

• [International Diabetes Federation (IDF)]

/https://idf.org/

• [Harvard Health]

/https://www.health.harvard.edu/topics/diabetes

• [Centers for Disease Control and Prevention (CDC)]

/https://www.cdc.gov/diabetes/

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