Diabetes mellitus
Symptoms.. Causes.. Diagnosis..
Treatment.. Prevention..
Complications
Diabetes mellitus is a chronic condition
caused by too much glucose in your blood. Your blood sugar
level can be too high if your body does not make enough of
the hormone insulin. Insulin is produced by the pancreas (a
gland behind the stomach) and moves glucose out of the blood
and into cells, where it is broken down to produce energy.
If diabetes is not treated it can cause long-term health problems
because the high glucose levels in the blood damage the blood
vessels.
There are two types of diabetes.
Type 1 or insulin-dependent diabetes
In type 1 diabetes the body produces little or no insulin.
Someone with this type of diabetes needs treatment for the
rest of their life. They must check the levels of glucose
in their blood regularly and watch out for complications.
Type I diabetes is also known as juvenile diabetes or early
onset diabetes because it usually develops before the age
of 40, often in the teenage years.
Type 2 or non-insulin dependent diabetes
In type 2 diabetes the body does not make enough insulin or
cannot use insulin properly. This type of diabetes is usually
linked with obesity. It used to be referred to as maturity
onset diabetes because it occurs mostly in people over the
age of 40.
Some pregnant women have such high levels of glucose in their
blood that their body cannot produce enough insulin to absorb
it all. This is known as gestational diabetes or diabetes
in pregnancy. It affects less than 1 in 20 pregnant women.
Gestational diabetes usually disappears after the baby is
born. However, women who develop gestational diabetes are
more likely to develop type 2 diabetes later in life.
Diabetes affects 1.3 million people in the UK and there may
be as many as a million more people who have the condition
but do not know it yet. Nine out of ten people with diabetes
have type 2 diabetes and over 80% of these people are overweight.
Symptoms ...TOP
Without treatment, the main symptoms are:
feeling very thirsty, producing excessive amounts
of urine (going to the toilet a lot),
tiredness, weight loss and muscle wasting (loss of muscle
bulk).
Other symptoms can include:
itchiness around the vagina or penis, or getting thrush
regularly, due to the excess sugar in your urine encouraging
infections, blurred vision, caused by the lens of
your eye becoming very dry, Symptoms of type 1 diabetes can
develop quickly, over days or weeks.
If your blood glucose levels become too high you can
suffer a hyperglycaemic attack. This can happen if
you haven’t taken your insulin. The symptoms of a hyperglycaemic
attack can include dehydration, drowsiness and a frequent
need to urinate. If left untreated, hyperglycaemia can lead
to diabetic ketoacidosis, which can eventually cause unconsciousness
and even death. Diabetic ketoacidosis occurs when your body
begins to break down fats for energy instead of glucose, leading
to a build up of ketone acids in your blood.
If your glucose levels become too low you can suffer a hypoglycaemic
attack. This can happen if you have taken too much insulin.
Symptoms of a ‘hypo’ include feeling shaky and
irritable and can be brought under control by eating or drinking
something containing fast acting carbohydrates, such as a
fizzy drink, sugar cubes or raisins.
Symptoms of type 2 diabetes usually develop over weeks or
months. Some people with type 2 diabetes have few symptoms
or even no symptoms at all. However, they still need to have
treatment so that other health problems do not develop later
on.
Causes..TOP
Diabetes is usually caused by the pancreas (a gland behind
the stomach) not producing or not producing enough of the
hormone insulin. It can also be caused by your body being
unable to use insulin properly. Rarely, diabetes can be caused
by a disease of the pancreas called pancreatitis.
Type 1 diabetes
If you have type 1 diabetes your body is unable to produce
insulin, or is not able to produce enough. This is because
your immune system attacks the cells in your pancreas, destroying
them or damaging them enough to reduce insulin production.
In some cases, a virus infection can trigger type 1 diabetes.
You are more at risk of developing type 1 diabetes if it runs
in your family.
Type 2 diabetes
If you have type 2 diabetes your body does not produce enough
insulin, or the cells in your body do not react properly to
the insulin. Type 2 diabetes is closely linked to obesity.
If you are overweight then, losing weight, eating a healthy
diet and taking regular exercise will greatly reduce your
risk of developing diabetes.
You are more at risk of developing type 2 diabetes if:
you have high blood pressure or high cholesterol, type 2 diabetes
runs in your family, you are of Asian, Afro-Caribbean or Middle-Eastern
background, or you are a woman who has given birth to a large
baby (over 9 lbs/4 kg).
The risk of developing type 2 diabetes also rises as you get
older.
Diagnosis ..TOP
In order to diagnose diabetes, your GP will ask for a urine
sample. They will test this to see if it contains glucose.
Sometimes you will also need to have a blood test to make
sure that the diagnosis is right.
If your glucose levels are not high enough for your doctor
to diagnose diabetes, you may need to have an oral glucose
tolerance test. Your doctor will give you a glucose drink
and take blood tests every half an hour for two hours to see
how your body is dealing with the glucose.
Treatment ..TOP
Although diabetes cannot be cured, you can control the symptoms
and help to prevent health problems later on in life.
It is important to diagnose diabetes as early as possible
so that you can start treatment. If you experience symptoms
you should see your GP as soon you can.
Type 1 diabetes
If you have type 1 diabetes you will need to have regular
insulin injections for the rest of your life to keep your
glucose levels normal. Insulin injections can be administered
using a syringe or an injection pen. Most people need either
2 or 4 injections a day and your GP or diabetes nurse will
teach you and/or a friend or relative how to inject the insulin
properly.
An alternative to injecting insulin is insulin pump therapy.
An insulin pump is a small device - about the same size as
a pack of cards – that holds the insulin. The pump is
attached to you via a long piece of thin tubing with a needle
at the end, inserted under your skin. Most people insert the
needle into their stomach, but the hips, thighs, buttocks
or arms can also be used. The pump allows insulin to flow
into your bloodstream at a rate that you can control. This
means that you no longer need to give yourself injections.
A new device for delivering insulin without using a needle
is now available on the NHS. Known as the insulin jet system,
it can be used on the stomach, buttocks and thighs. It works
by forcing a very small stream of insulin through a nozzle
placed against the skin. The insulin travels at such high
speed it goes through the skin.
You will need to regularly check your glucose levels. This
can be done at home using a simple finger prick blood test.
Your GP will talk to you about your ideal glucose blood level
as it varies between people, and varies throughout the day.
The normal blood glucose level is between 4 and 7 mmol/l before
meals, and less than 10 mmol/l two hours after meals. Mmol/l
means millimoles per litre; it is a way of defining the concentration
of glucose in the blood.
You should also make sure you have a healthy diet and take
regular exercise because this will help to reduce the level
of glucose in your blood.
Type 2 diabetes
You can usually control type 2 diabetes by making changes
to your diet (see Prevention), losing weight if you are overweight
and taking regular exercise. Some people with type 2 diabetes
also need to take tablets or have insulin injections.
There are several different types of medicines used to treat
type 2 diabetes. It may be necessary to take a combination
of two or more of these medicines to control the blood glucose
level.
metformin - this is often the first medicine that is advised
for type 2 diabetes. It mainly works by reducing the amount
of glucose that the liver releases into the bloodstream, sulphonylureas
(e.g. glibelclamide, gliclazide, glimerpirizide, glipizide,
gliquidone) - these increase the amount of insulin produced
by the pancreas. Also, they make the body’s cells more
sensitive to insulin so that more glucose is taken up from
the blood, acarbose - this slows down the absorption of carbohydrate
from the stomach and digestive tract, preventing a high peak
in the blood glucose level after eating a meal, thiazolidinediones
(glitazones) (eg. pioglitazone, rosiglitazone) - these make
the body’s cells more sensitive to insulin so that more
glucose is taken up from the blood. They are not usually used
alone, but are an option to take in addition to metform and
a sulphonylurea, nateglinide and repaglinide. These stimulate
the release of insulin by the pancreas. They are not commonly
used but are an option if other medicines do not control the
blood glucose levels. If you have type 2 diabetes, you need
to keep a regular check on your blood glucose levels. This
is usually done with a finger prick blood test or sometimes
a urine test.
Other treatments
If you have type 1 or type 2 diabetes, you are at
risk of developing heart disease, stroke and kidney disease.
To reduce the chance of this, you may be advised to take
anti-hypertensive medicines to control high blood pressure.
a statin e.g. simvastatin, atorvastatin to reduce high cholesterol
levels. low dose aspirin to prevent stroke, an Angiotensin
Converting Enzyme Inhibitor (ACE Inhibitor) e.g.
enalapril, lisnopril, ramipril, if you have the early signs
of diabetic kidney disease.
This is identified by the presence of small amounts of albumin
(a protein) in the urine and is often reversible if treated
early enough. You are advised to have an influenza (“flu”)
vaccine each year and a one-off pneumococcal vaccine, as these
infections can be particularly unpleasant and more serious
if you have diabetes.
Regular check-ups
You will need to see your GP for regular check-ups to see
how well you are managing the symptoms of your diabetes. You
will have regular blood tests and blood pressure tests. Your
GP will also need to check your eyes, feet and nerves regularly
as these can be affected by diabetes (see Complications).
Your GP may also refer you to a dietician who will be able
to give you advice on maintaining a healthy lifestyle.
Complications ..TOP
If diabetes is not treated it can lead to many different
health problems. This is because large amounts of glucose
can damage the blood vessels, nerves and organs.
Even a mildly raised glucose level that does not cause any
symptoms in the short-term can affect the blood vessels, nerves
and organs in the long-term. This may lead to complications
often years after the diabetes was first diagnosed.
These include:
heart disease and stroke - if you have diabetes, you have
an up to fivefold increased risk of heart disease and stroke
compared with those without diabetes. Prolonged, poorly controlled
blood glucose levels increases the likelihood of atherosclerosis
(furring up and narrowing of the blood vessels). This may
result in poor blood supply to the heart, causing angina.
Also, it increases the chance that a blood vessel in the heart
or brain will become completely blocked, causing a heart attack
or stroke, retinopathy (damage to the retina at the back of
the eye) - Blood vessels in the retina of your eye can become
blocked, leaky or grow haphazardly. This damage gets in the
way of the light passing through to your retina and if left
untreated can damage vision, kidney disease - the small blood
vessels of the kidney become blocked and leaky, making the
kidneys work less efficiently, foot problems - damage to the
nerves of the foot can mean that small nicks and cuts are
not noticed leading to the development of a foot ulcer. About
1 in 10 people with diabetes get foot ulcers, which can cause
serious infection. You should keep your nails short and feet
clean. Wear shoes that fit properly and see a podiatrist or
chiropodist regularly so that any problems are found early,
impotence in men – damage to the nerves can lead to
erection problems in men. This may be treated with medication.
In general, the risk of developing complications is greatly
reduced if the blood glucose level is well controlled and
if other risk factors, particularly high blood pressure and
high cholesterol are controlled.
Pregnant women with diabetes are at increased risk of miscarriage
and stillbirth. If their blood-sugar level is not carefully
controlled in the early stages of pregnancy there is also
an increased risk of the baby developing a serious birth defect.
Pregnant women with diabetes will usually have their antenatal
check-ups in hospital or in a diabetic clinic, where doctors
can keep a close watch on their blood-sugar levels and control
their insulin dosage more easily.
Prevention
You may be at risk of developing type 2 diabetes if it runs
in your family or if you are overweight and don’t get
a lot of exercise. The best thing you can do to try and prevent
diabetes is to eat a healthy diet and take regular exercise.
A healthy diet is one that is low in saturated fat, salt and
sugary snacks and drinks. Try to eat regular meals throughout
the day to keep your blood-sugar level constant and eat at
least five portions of fruit and vegetables every day. Stop
smoking and reduce your alcohol intake. If you have diabetes,
you can still eat foods such as chocolate and sweets as long
as you keep your overall diet healthy.
Ideally you should take thirty minutes of exercise at least
three times a week. However, regular exercise does not have
to be a chore; you can make sure you keep active by walking
instead of taking the bus and using the stairs instead of
the lift.
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