Diabetes mellitus

Overview

Diabetes mellitus is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that cells need to process glucose (sugar) that comes from the food we eat -- the body's main source of energy. Without insulin glucose cannot enter the cells; instead it spills over into the bloodstream and is excreted in urine. Over time this accumulation of sugar in the blood can damage major organs in the body and result in a variety of complications including heart kidney and eye disease as well as nerve damage and other health problems.

The growth of diabetes in Canada is at epidemic levels. Almost 3-million Canadians have diabetes and one-third of them are undiagnosed. There is no cure for diabetes. However it can be well-managed and in many cases prevented.

Cause

There are three main types of diabetes:

Type 1 diabetes develops when the body's own immune system destroys islet cells in the pancreas. These cells are needed to produce insulin the hormone that regulates blood glucose. Researchers believe genetic factors exposure to certain viruses and diet all play a role. Type 1 diabetes was once known as juvenile-onset diabetes because although it can occur at any age it is most prevalent in childhood and adolescence. Of all the people with diabetes only one in ten have this more severe form of the disease.

Type 2 diabetes occurs when the pancreas does not produce enough insulin or when the body does not effectively use the insulin that is produced. Type 2 affects 90 percent of people with diabetes. It used to be called non-insulin-dependent diabetes mellitus or adult-onset diabetes because it usually occurs later in life (after the age of 20). However in recent years more and more young people are being diagnosed adding to the theory that lifestyle factors including excess weight and fatty tissue along with a lack of exercise may trigger certain genetic abnormalities that are believed to cause this form of diabetes.

Gestational diabetes is a temporary form of glucose intolerance that is diagnosed in about 3.5 per cent of women during pregnancy. It is more common among obese women and those with a family history of diabetes. In fact after pregnancy some women are found to have had undiagnosed Type 2 diabetes. Having gestational diabetes also increases the risk of the mother and/or child developing diabetes later in life.

There are other forms of diabetes but these are relatively rare.

Risk Factors

  • Family History. If a parent or brother or sister has diabetes you are more likely to come down with the disease yourself. This is true for both type 1 and 2 diabetes.
  • Weight. Carrying too much weight especially around your abdomen is one of the main risk factors for diabetes. This is because fatty tissue makes your cells all the more resistant to insulin. Eighty per cent of people who are diagnosed with Type 2 diabetes are overweight.
  • Inactivity. If you are not physically active you will likely find it more difficult to control your weight. Exercise also helps your cells use insulin more efficiently burns up glucose and builds muscle mass which absorbs glucose in the blood.
  • Age. Because people often tend to be less physically active and gain weight as they get older the risk of getting Type 2 diabetes increases after the age of 40. However in recent years younger people have also become more at risk because of their lifestyle.
  • Race. Some races are more at risk than others. If you are of Aboriginal Hispanic African Asian or South Asian descent you have a higher risk of getting Type 2 diabetes. Type 1 diabetes typically affects more White North Americans and Europeans.
  • Medical History. If you have been diagnosed with certain other conditions including polycystic ovary syndrome or if you had a baby that weighed more than nine pounds at birth you are at an increased risk of diabetes.

Symptoms

There are two classic symptoms of diabetes increased thirst and frequent urination. Other warning signs include:

  • Weight change (gain or loss)
  • Extreme fatigue or lack of energy
  • Blurred vision
  • Frequent or recurring infections
  • Cuts and bruises that are slow to heal
  • Tingling or numbness in the hands or feet
  • Trouble getting or maintaining an erection
  • Swollen or tender gums

If you have any of these symptoms especially increased thirst and urination you should see your doctor immediately.

Some people who have Type 2 diabetes may display no symptoms at all so it is important to ask your doctor if you should be screened for this condition. It tends to develop slowly over the course of many years. The earlier it is detected the sooner it can be treated. Undiagnosed diabetes can lead to serious complications.

There are a number of tests to determine if you have diabetes. Your doctor will likely first prick your finger and test your blood for sugar in his office. The normal range in non-diabetics is between 5 and 7 mmol/L. If it is higher you may be scheduled for a fasting blood glucose test. In this case you will have to go to a lab for a blood test after fasting (not eating) for at least 8 hours. This may be repeated on another day. If your blood sugars remain higher than normal you will likely be diagnosed with diabetes.

Treatment

Despite intensive research efforts there is still no cure for diabetes. However the disease can be well managed.

Type 1 diabetes is always treated with insulin. This most often involves injecting yourself daily with a small syringe although you can also use an insulin pump. People with Type 1 also need to monitor their blood sugar throughout the day and must learn how to adjust their insulin intake according to the amount they plan to eat and exercise.

Type 2 diabetes is generally managed through physical activity and meal planning but may also require pills to help your body produce or use insulin more effectively. Testing for blood sugar is also recommended but you may only have to do so a few times each week.

  • Regardless of which type of diabetes you have it is important that you:
  • Keep your blood glucose levels (the amount of sugar in your blood) in your target range
  • Take your insulin or other medications as prescribed
  • Keep your cholesterol and other blood fats in your target range
  • Keep your weight in a healthy range
  • Keep your blood pressure close to target level
  • Manage stress effectively
  • Follow a balanced meal plan
  • Be physically active
  • Don't smoke
  • Take care of your feet teeth and eyes

People with diabetes can lead active independent and vital lives and even prevent complications if they are seriously committed to managing their condition.

Complications

There are both short and long-term complications associated with diabetes.

  • Short-term. Your blood sugar levels can drop below normal if you skip a meal or exercise too vigorously. This is known as an insulin "reaction". Not everyone experiences the same symptoms and your own symptoms may change over time. Often people feel dizzy hungry and sick to the stomach. You might also sweat feel sleepy or be confused. When this happens you must eat or drink something that will raise your blood sugar quickly or you could go into a life-threatening coma. Your diabetic educator will explain how best to deal with such reactions. If your blood sugars climb excessively high you could experience diabetic ketoacidosis. When your body isn't getting the energy it needs it breaks down its own fat. This produces toxic acids called ketones. When this happens you need to see a doctor immediately.
  • Long-term. Long term complications of diabetes may include nerve kidney and eye damage. Diabetes also dramatically increases your risk of cardiovascular problems including high blood pressure heart attack and stroke. You could also be more susceptible to infections. Diabetes is the seventh leading cause of death in Canada.

Prevention

Currently there is no known way to prevent Type 1 diabetes. However you can dramatically lower your risk for Type 2 diabetes by living a healthy lifestyle.

Eight out of ten people who are diagnosed with Type 2 diabetes are overweight. People with a Body Mass Index (BMI) of 30 or greater have a five-fold greater risk of diabetes than people with a normal BMI of 25 or less. (Body Mass Index is a calculation of your height to weight ratio. Body Mass Index can be used to indicate if you are overweight obese or underweight.

If you keep your weight under control you can significantly lower your risk of getting diabetes. Research shows that losing just 5 to 7 per cent of your body weight can make a dramatic difference. Eating right and getting at least 30 minutes of moderate physical activity daily is the best prevention against this chronic disease.