Diabetes Mellitus

Diabetes mellitus, commonly referred to as diabetes, is a group of metabolic disorders characterized by high blood sugar levels, which can lead to a variety of complications if left untreated or poorly managed.

Types of Diabetes

• Type 1 Diabetes: An autoimmune condition where the body's immune system attacks and destroys the insulin-producing beta cells in the pancreas. This results in a lack of insulin production, requiring individuals to rely on insulin therapy for survival.
• Type 2 Diabetes: The most common form of diabetes, accounting for about 90% of all cases. It is characterized by insulin resistance (when the body's cells do not respond effectively to insulin) and impaired insulin secretion. Type 2 diabetes can often be managed through lifestyle changes and oral medications, though insulin therapy may also be necessary.
• Gestational Diabetes: A condition that develops during pregnancy in women who didn't have diabetes before pregnancy. It is thought to result from hormonal changes, insulin resistance, and the pancreas not being able to produce enough insulin. Gestational diabetes typically goes away after pregnancy but increases the risk of developing type 2 diabetes later in life for both mother and child.
• LADA (Latent Autoimmune Diabetes in Adults): Often misdiagnosed as type 2 diabetes, LADA is a form of type 1 diabetes that progresses slowly and appears in adults. It shares characteristics with both type 1 and type 2 diabetes, including autoimmune markers and initial insulin independence.
• MODY (Maturity-Onset Diabetes of the Young): A rare form of diabetes caused by genetic mutations that affect insulin production. MODY is typically diagnosed at a young age and can be managed with lifestyle changes or medication, depending on the specific mutation.

Symptoms of Diabetes

The symptoms of diabetes can vary depending on the level of blood sugar elevation. Common symptoms include:

• Increased thirst and hunger
• Frequent urination
• Fatigue
• Blurred vision
• Slow healing of cuts and wounds
• Tingling or numbness in the hands and feet

Diagnosis of Diabetes

Diabetes is diagnosed based on plasma glucose values, measured either after an overnight fast (fasting plasma glucose) or following an oral glucose challenge (oral glucose tolerance test). The criteria for diagnosis can vary slightly between different health organizations but generally include:

• Fasting Plasma Glucose: 126 mg/dL or higher
• Oral Glucose Tolerance Test: 200 mg/dL or higher at the 2-hour mark
• Hemoglobin A1c (HbA1c): 6.5% or higher, which reflects average blood glucose levels over the past 2-3 months

Management and Treatment of Diabetes

The management of diabetes involves a combination of lifestyle modifications and medical therapies aimed at maintaining blood glucose levels within a target range to prevent complications.

• Lifestyle Changes: Include dietary adjustments (such as following a balanced diet, managing carbohydrate intake), regular physical activity, weight management, and avoiding tobacco use.
• Medications: For type 2 diabetes, initial treatment may involve metformin. Other medications, including sulfonylureas, thiazolidinediones, SGLT2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors, can be added as needed based on the patient's response and side effect profile.
• Insulin Therapy: Required for type 1 diabetes and often necessary for type 2 diabetes that is not adequately controlled with oral medications or lifestyle changes. Insulin regimens can vary widely among individuals, including basal insulin, bolus (mealtime) insulin, and premixed insulins.

Complications of Diabetes

If not properly managed, diabetes can lead to a variety of serious complications, including:

• Cardiovascular Disease: Increased risk of heart attacks, strokes, and peripheral artery disease due to high blood pressure, high cholesterol, and atherosclerosis.
• Nephropathy (Kidney Disease): Damage to the kidneys' filters (nephrons), potentially leading to end-stage renal disease requiring dialysis or kidney transplantation.
• Neuropathy (Nerve Damage): Numbness, tingling, and pain in the hands and feet due to damage to the peripheral nerves.
• Retinopathy (Eye Disease): Potential blindness due to damage to the blood vessels in the retina.
• Foot Ulcers and Amputations: Due to neuropathy, poor circulation, and impaired healing, leading to infections that can necessitate amputation if not properly managed.

Prevention of Diabetes

While the onset of type 1 diabetes cannot be prevented, lifestyle interventions can significantly reduce the risk of developing type 2 diabetes. These include:

• Maintaining a healthy weight through diet and exercise
• Eating a balanced diet low in added sugars and saturated fats
• Engaging in regular physical activity, such as walking for at least 150 minutes per week
• Avoiding tobacco use

Early detection through screening and timely intervention can also improve outcomes for individuals with diabetes.