Diabetes

If left untreated, Diabetes can lead to a spectrum of chronic complications that develop gradually over time.

• Foot problems are a significant concern, potentially leading to amputation if untreated, as nerve damage and impaired circulation slow the healing process.
• Diabetic retinopathy poses a threat to eyesight, detectable through regular screening tests, with timely treatment preventing sight loss.
• Kidney disease, particularly diabetic nephropathy, can result from damage to blood vessels in the kidneys, potentially leading to kidney failure.
• Sexual problems, heart disease, nerve damage affecting various bodily functions, a heightened risk of certain cancers, and an increased susceptibility to dental issues are additional complications associated with diabetes.
• Severe complications, such as Hyperosmolar Hyperglycemic State (HHS), a life-threatening emergency exclusive to type 2 diabetics, can occur unexpectedly. HHS is characterized by severe dehydration and extremely high blood sugar levels.
• Diabetic ketoacidosis (DKA), another life-threatening emergency, is marked by insulin deficiency and elevated blood sugar levels, resulting in the accumulation of ketones.
• Hypoglycemia, when blood sugar levels drop excessively low, is also a critical concern associated with diabetes.

Patients with diabetes have to be vigilant about monitoring and managing these complications to ensure their overall health and well-being. They should habitually visit specialized centers where there is interaction among various specialists (diabetologists, ophthalmologists, nephrologists, cardiologists) for the adequate control of risk factors, screening for complications, as well as the treatment of complications, and the use of innovative therapies.

There are three main types of diabetes: type 1, type 2, and gestational diabetes.

Prediabetes

Prediabetes is a health condition in which blood sugar levels is higher than normal, but not high enough to be classified as diabetes. Prediabetes often has no symptoms, so many people with the condition are unaware that they have it and are at increased risk of developing Type 2 diabetes. As well as other health problems such as heart diseases and stroke. It often goes unnoticed, as it usually doesn’t have any noticeable signs or symptoms. However, in some cases, darkened skin on certain parts of the body can be a possible sign of prediabetes. Areas such as the neck, armpits, and groin can be affected.

Type 1 diabetes 

Type 1 diabetes also called insulin-dependent diabetes or juvenile diabetes is an autoimmune chronic disease in which the immune system attacks and destroys the insulin-producing cells in the pancreas. This results in a lack of insulin, which is necessary for glucose to enter cells and produce energy. Type 1 diabetes is usually diagnosed in children or adolescence, it also can develop in adults. The symptoms of Type 1 are: 

• Feeling an excessive amount of thirst
• Urinating more frequently than usual, especially during the night
• Experiencing persistent fatigue
• Weight loss and decrease in muscle mass
• Frequent infections such as thrush.

Type 2 Diabetes 

Type 2 diabetes is the most common form of diabetes, accounting for about 90% -95% of all cases. It occurs when the body becomes resistant to insulin, or when the pancreas is unable to produce enough insulin to meet the body’s needs. Type 2 diabetes is more diagnosed in older adults. However, the increased obesity rate among children has led to an increase in type 2 diabetes among younger people. Type 2 diabetes symptoms include:

• Experiencing increased thirst
• Frequent urination
• Feeling increased hunger
• Experiencing unintentional weight loss
• Persistent fatigue
• Blurred vision
• Slow-healing sores
• Frequent infections
• Numbness or tingling in the hands or feet
• Presence of darkened skin patches, usually found in the armpits and neck areas.

Gestational diabetes 

Gestational diabetes is a type of diabetes that occurs during pregnancy. It is a condition in which a woman’s blood sugar levels become higher than normal during pregnancy, usually around the 24th to 28th week of gestation. Gestational diabetes can occur in women who have never had diabetes before, and it typically goes away after the baby is born. However, women who have had gestational diabetes are at increased risk of developing type 2 diabetes later in life.

Monogenic diabetes 

Monogenic diabetes also called Maturity-onset diabetes of the young (MODY), it is a rare type of diabetes that is caused by mutations in a single gene. It usually appears in childhood or adolescence, and may be mistaken for type 1 or type 2 diabetes.

There are several different types of monogenic diabetes, including

HNF1-alpha which is responsible for approximately 70% of MODY cases, and causes diabetes by reducing insulin production in the pancreas. 

HNF4-alpha is less common and commonly inherited in individuals who had a birth weight of 9lb or more and low blood sugar at birth. 

HNF1-beta leads to various issues such as renal cysts, uterine abnormalities, gout, and diabetes. 

Glucokinase is responsible for determining the blood glucose level in the body, and when it malfunctions, it allows the blood glucose level to rise higher than normal. People with glucokinase MODY typically have blood glucose levels only slightly higher than normal, usually ranging from 5.5-8mmol/l.

Other, rare forms of diabetes may include:

• Type 3c diabetes, also known as pancreatogenic diabetes, is a rare form of diabetes that is caused by damage to the pancreas (other than autoimmune damage) which affects the pancreas ability to produce insulin.
• Latent autoimmune diabetes in adults (LADA)
  LADA is a form of autoimmune diabetes, progresses slowly. It shares similarities with type 1 diabetes in that the pancreas fails to produce sufficient insulin due to gradual damage to the insulin-producing cells. However, unlike type 1 diabetes, LADA patients may not require insulin for many months or even years after diagnosis. LADA is considered by some to fall between type 1 and type 2 diabetes on a continuum. Usually, people with LADA are over 30 years of age and are often misdiagnosed with type 2 diabetes initially because of their age and the continuing insulin production in their pancreas.
• Neonatal diabetes can be transient, meaning it resolves on its own within the first year of life, or permanent, requiring lifelong treatment.
• Brittle diabetes
  Brittle diabetes is a rare form of diabetes that is characterized by unstable blood sugar levels and affecting 3% of every 1,000 people with insulin-dependent diabetes. People with brittle diabetes often experience frequent and severe fluctuations in blood sugar levels, which can lead to complications. The exact cause of brittle diabetes is not fully understood, but it is believed to be related to problems with insulin production and/or insulin sensitivity.

The exact cause of most types of diabetes is not yet known. However, in all cases, the high blood sugar levels occur due to the inability of the pancreas to produce enough insulin. Both type 1 and type 2 diabetes may be caused by a combination of environmental and genetic factors. Despite ongoing research, the exact factors responsible for developing diabetes remain unclear.

General Symptoms of diabetes include: 

• Experiencing increased thirst compared to normal
• Urinating frequently
• Losing weight unintentionally
• Presence of ketones in the urine due to breakdown of muscle and fat when there is not enough insulin
• Feeling weak and tired
• Experiencing irritability or mood changes
• Blurry vision
• Slow-healing sores
• Frequent infections such as gum, skin and vaginal infections.

Testing for diabetes is essential for individuals experiencing symptoms of the disease. Moreover, even those without noticeable symptoms but with risk factors for type 2 diabetes should undergo testing. Additionally, it is advisable for most pregnant women to be tested for gestational diabetes. This proactive approach to testing enables doctors to identify diabetes at an earlier stage, allowing them to collaborate with patients in managing the condition and preventing potential health complications.

To identify type 1 and type 2 diabetes, a blood test is required. Diagnosis can be made based on a fasting blood glucose level exceeding 126 mg/dl on at least two separate days. Alternatively, confirmation may come from glycated hemoglobin levels of 6.5% or higher, supported by a second blood sample, or if symptoms are present, a blood glucose level surpassing 200 mg/dl.