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12 November, 2019 00:00 00 AM
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About diabetes

International Diabetes Federation (IDF)
About diabetes

Diabetes is a chronic disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces.

Insulin is a hormone made by the pancreas, that acts like a key to let glucose from the food we eat pass from the blood stream into the cells in the body to produce energy. All carbohydrate foods are broken down into glucose in the blood. Insulin helps glucose get into the cells.

Not being able to produce insulin or use it effectively leads to raised glucose levels in the blood (known as hyperglycaemia). Over the long-term high glucose levels are associated with damage to the body and failure of various organs and tissues.

Types of diabetes

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

Type 1 diabetes can develop at any age, but occurs most frequently in children and adolescents. When you have type 1 diabetes, your body produces very little or no insulin, which means that you need daily insulin injections to maintain blood glucose levels under control.  

Type 2 diabetes is more common in adults and accounts for around 90% of all diabetes cases. When you have type 2 diabetes, your body does not make good use of the insulin that it produces. The cornerstone of type 2 diabetes treatment is healthy lifestyle, including increased physical activity and healthy diet. However, over time most people with type 2 diabetes will require oral drugs and/or insulin to keep their blood glucose levels under control.

Gestational diabetes (GDM) is a type of diabetes that consists of high blood glucose during pregnancy and is associated with complications to both mother and child. GDM usually disappears after pregnancy but women affected and their children are at increased risk of developing type 2 diabetes later in life.

Type 1 diabetes

Around 10% of all people with diabetes have type 1 diabetes.

Type 1 diabetes is caused by an autoimmune reaction where the body’s defence system attacks the cells that produce insulin. As a result, the body produces very little or no insulin. The exact causes of this are not yet known, but are linked to a combination of genetic and environmental conditions.

Type 1 diabetes can affect people at any age, but usually develops in children or young adults. People with type 1 diabetes need daily injections of insulin to control their blood glucose levels. If people with type 1 diabetes do not have access to insulin, they will die.

The risk factors for type 1 diabetes are still being researched. However, having a family member with type 1 diabetes slightly increases the risk of developing the disease. Environmental factors and exposure to some viral infections have also been linked to the risk of developing type 1 diabetes.

At present, type 1 diabetes cannot be prevented. The environmental triggers that are thought to generate the process that results in the destruction of the body’s insulin-producing cells are still under investigation.

Symptoms of type 1 diabetes

 The most common symptoms of type 1 diabetes include:

Abnormal thirst and dry mouth

Sudden weight loss

Frequent urination

Lack of energy, tiredness

Constant hunger

Blurred vision

Bedwetting

Diagnosing type 1 diabetes can be difficult so additional tests may be required to confirm a diagnosis.

Management of type 1 diabetes

People with type 1 diabetes require daily insulin treatment, regular blood glucose monitoring and a healthy lifestyle to manage their condition effectively.

Insulin

All people with type 1 diabetes need to take insulin to control their blood glucose levels. There are different types of insulin depending on how quickly they work, when they peak, and how long they last. Insulin is commonly delivered with a syringe, insulin pen or insulin pump.

Types of insulin include:

Rapid-acting: usually taken just before or with a meal. These insulins act very quickly to limit the rise in blood sugar, which follows eating. It is essential to avoid overdosage to minimize the risk of low blood sugar (hypoglycemia). Rapid-acting insulins include Asparat, Glulisine, Lispro.

Short-acting: usually taken before meals. These insulins are also called regular or neutral insulins. They do not act as quickly as rapid-acting insulins and therefore may be more appropriate in certain people. Short-acting insulins include Actrapid, Humulin R, Insuman Rapid.

Intermediate-acting: often taken together with a short-acting insulin. Intermediate-acting insulins start to act within the first hour of injecting, followed by a period of peak activity lasting up to 7 hours. Intermediate acting insulins include Humulin NPH, Protaphane, Insulatard.

Long-acting: insulins that are steadily released and can last in the body for up to 24 hours. They are commonly taken in the morning or in the evening, before going to bed. Long-acting insulins include Detemir, Glargine.

Two common insulin treatment plans include:

Twice-daily insulin: using both short-acting and intermediate-acting insulin.

Basal bolus regimen: short-acting insulin taken with main meals (usually three times a day) and intermediate-acting insulin given once or twice daily (evening or morning and evening).

Self-monitoring

People with diabetes who require insulin need to check their blood glucose levels regularly to inform insulin dosage. Self-monitoring of blood glucose (SBMG) is the name given to the process of blood glucose testing by people with diabetes at home, school, work or elsewhere. SMBG helps people with diabetes and their healthcare providers understand how their blood glucose levels vary during the day so that their treatment can be adjusted accordingly.

People with type 1 diabetes are usually advised to measure their blood glucose level at least four times a day.

Healthy nutrition

Healthy nutrition — knowing what and when to eat — is an important part of diabetes management as different foods affect your blood glucose levels differently.

A healthy diet for all people with diabetes includes reducing the amount of calories if you are overweight, replacing saturated fats (eg. cream, cheese, butter) with unsaturated fats (eg. avocado, nuts, olive and vegetable oils), eating dietary fibre (eg. fruit, vegetables, whole grains), and avoiding tobacco use, excessive alcohol and added sugar.

Physical activity

Regular physical activity is essential to help keep blood glucose levels under control. It is most effective when it includes a combination of both aerobic (eg. jogging, swimming, cycling) exercise and resistance training, as well as reducing the amount of time spent being inactive.

Type 2 diabetes

Type 2 diabetes is the most common type of diabetes, accounting for around 90% of all diabetes cases.

It is generally characterized by insulin resistance, where the body does not fully respond to insulin. Because insulin cannot work properly, blood glucose levels keep rising, releasing more insulin. For some people with type 2 diabetes this can eventually exhaust the pancreas, resulting in the body producing less and less insulin, causing even higher blood sugar levels (hyperglycaemia).

Type 2 diabetes is most commonly diagnosed in older adults, but is increasingly seen in children, adolescents and younger adults due to rising levels of obesity, physical inactivity and poor diet.

The cornerstone of type 2 diabetes management is a healthy diet, increased physical activity and maintaining a healthy body weight. Oral medication and insulin are also frequently prescribed to help control blood glucose levels.

Risk factors

Several risk factors have been associated with type 2 diabetes and include:

Family history of diabetes

Overweight

Unhealthy diet

Physical inactivity

Increasing age

High blood pressure

Ethnicity

Impaired glucose tolerance (IGT)

History of gestational diabetes

Poor nutrition during pregnancy

Impaired glucose tolerance (IGT) is a category of higher than normal blood glucose, but below the threshold for diagnosing diabetes.

Changes in diet and physical activity related to rapid development and urbanisation have led to sharp increases in the numbers of people living with type 2 diabetes.

Symptoms of type 2 diabetes

The symptoms of type 2 diabetes are similar to those of type 1 diabetes and include:

Excessive thirst and dry mouth

Frequent urination

Lack of energy, tiredness

Slow healing wounds

Recurrent infections in the skin

Blurred vision

Tingling or numbness in hands and feet.

These symptoms can be mild or absent and so people with type 2 diabetes may live several years with the condition before being diagnosed.

Management of type 2 diabetes

The cornerstone of managing type 2 diabetes is a healthy lifestyle, which includes a healthy diet, regular physical activity, not smoking, and maintaining a healthy body weight. Over time, a healthy lifestyle may not be enough to keep blood glucose levels under control and people with type 2 diabetes may need to take oral medication.

If treatment with a single medication is not sufficient, combination therapy options may be prescribed.

When oral medication is not sufficient to control blood glucose levels, people with type 2 diabetes may require insulin injections.

Medications for type 2 diabetes

The most commonly used oral medications for type 2 diabetes include:

Metformin: reduces insulin resistance and allows the body to use its own insulin more effectively. It is regarded as the first-line treatment for type 2 diabetes in most guidelines around the world.

Sulfonylureas: stimulate the pancreas to increase insulin production. Sulfonylureas include gliclazide, glipizide, glimepiride, tolbutamide and glibenclamide.

Prevention of type 2 diabetes

There are a number of factors that influence the development of type 2 diabetes. The most influential are lifestyle behaviours commonly associated with urbanisation. Research indicates that a majority of cases, up to 80% according to some studies, of type 2 diabetes could be prevented through healthy diet and regular physical activity.

A healthy diet includes reducing the amount of calories if you are overweight, replacing saturated fats (eg. cream, cheese, butter) with unsaturated fats (eg. avocado, nuts, olive and vegetable oils), eating dietary fibre (eg. fruit, vegetables, whole grains), and avoiding tobacco use, excessive alcohol and added sugar.

Regular physical activity is essential to help keep blood glucose levels under control. It is most effective when it includes a combination of both aerobic (eg. jogging, swimming, cycling) exercise and resistance training, as well as reducing the amount of time spent being inactive.

Know your risk of type 2 diabetes

 Brief questionnaires are simple, practical and inexpensive ways to quickly identify people who may be at a higher risk of type 2 diabetes and who need to have their level of risk further investigated.

The Finnish Type 2 Diabetes Risk Assessment Form, developed in 2001, is an example of an effective questionnaire that can be used as the basis for developing national questionnaires which take into account local factors. It has eight scored questions, with the total test score providing a measure of the probability of developing type 2 diabetes over the following 10 years. The reverse of the form contains brief advice on what the respondent can do to lower their risk of developing the disease, and whether they should seek advice or have a clinical examination. The test takes only a couple of minutes to complete and can be done online, in pharmacies or at various public campaign events.

IDF has developed a type 2 diabetes online diabetes risk assessment that aims to predict an individual’s risk of developing type 2 diabetes within the next ten years.

Diabetes complications

 People with diabetes have an increased risk of developing a number of serious health problems. Consistently high blood glucose levels can lead to serious diseases affecting the heart and blood vessels, eyes, kidneys, nerves and teeth. In addition, people with diabetes also have a higher risk of developing infections. In almost all high-income countries, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation.

Maintaining blood glucose levels, blood pressure, and cholesterol at or close to normal can help delay or prevent diabetes complications. Therefore people with diabetes need regular monitoring.

Cardiovascular disease: affects the heart and blood vessels and may cause fatal complications such as coronary artery disease (leading to heart attack) and stroke. Cardiovascular disease is the most common cause of death in people with diabetes. High blood pressure, high cholesterol, high blood glucose and other risk factors contribute to increasing the risk of cardiovascular complications.  

Kidney disease (diabetic nephropathy): caused by damage to small blood vessels in the kidneys leading to the kidneys becoming less efficient or to fail altogether. Kidney disease is much more common in people with diabetes than in those without diabetes. Maintaining near normal levels of blood glucose and blood pressure can greatly reduce the risk of kidney disease.

Nerve disease (diabetic neuropathy): diabetes can cause damage to the nerves throughout the body when blood glucose and blood pressure are too high. This can lead to problems with digestion, erectile dysfunction, and many other functions. Among the most commonly affected areas are the extremities, in particular the feet.

Nerve damage in these areas is called peripheral neuropathy, and can lead to pain, tingling, and loss of feeling. Loss of feeling is particularly important because it can allow injuries to go unnoticed, leading to serious infections and possible amputations.

People with diabetes carry a risk of amputation that may be more than 25 times greater than that of people without diabetes.

However, with comprehensive management, a large proportion of amputations related to diabetes can be prevented. Even when amputation takes place, the remaining leg and the person’s life can be saved by good follow-up care from a multidisciplinary foot team. People with diabetes should regularly examine their feet.  

Eye disease (diabetic retinopathy): most people with diabetes will develop some form of eye disease (retinopathy) causing reduced vision or blindness. Consistently high levels of blood glucose, together with high blood pressure and high cholesterol, are the main causes of retinopathy.

It can be managed through regular eye checks and keeping glucose and lipid levels at or close to normal.  

Pregnancy complications: Women with any type of diabetes during pregnancy risk a number of complications if they do not carefully monitor and manage their condition.

To prevent possible organ damage to the fetus, women with type 1 diabetes or type 2 diabetes should achieve target glucose levels before conception. All women with diabetes during pregnancy, type 1, type 2 or gestational should strive for target blood glucose levels throughout to minimize complications.

High blood glucose during pregnancy can lead to the foetus putting on excess weight. This can lead to problems in delivery, trauma to the child and mother, and a sudden drop in blood glucose for the child after birth. Children who are exposed for a long time to high blood glucose in the womb are at higher risk of developing diabetes in the future.  

Oral complications: People with diabetes have an increased risk of inflammation of the gums (periodontitis) if blood glucose is not properly managed. Periodontitis is a major cause of tooth loss and is associated with an increased risk of cardiovascular disease (CVD).

Regular oral check-ups should be established to ensure early diagnosis, particularly among people with previously undiagnosed diabetes and prompt management of any oral complications in people with diabetes. Annual visits are recommended for symptoms of gum disease such as bleeding when brushing teeth or swollen gums.

Diabetes prevention

At present, type 1 diabetes cannot be prevented. The environmental triggers that are thought to generate the process that results in the destruction of the body’s insulin-producing cells are still under investigation.

While there are a number of factors that influence the development of type 2 diabetes, it is evident that the most influential are lifestyle behaviours commonly associated with urbanization.

These include consumption of unhealthy foods and inactive lifestyles with sedentary behaviour. Studies from different parts of the world have established that lifestyle modification with physical activity and/or healthy diet can delay or prevent the onset of type 2 diabetes.

Modern lifestyles are characterised by physical inactivity and long sedentary periods. Community-based interventions can reach individuals and families through campaigns, education, social marketing and encourage physical activity both inside and outside school and the workplace. IDF recommends physical activity at least between three to five days a week, for a minimum of 30-45 minutes.

Taking a life course perspective is essential for preventing type 2 diabetes and its complications. Early in life, when eating and physical activity habits are established and when the long-term regulation of energy balance may be programmed, there is an especially critical window to prevent the development of overweight and reduce the risk of type 2 diabetes. Healthy lifestyles can improve health outcomes at later stages of life as well.

Population based interventions and policies allow healthy choices through policies in trade, agriculture, transport and urban planning to become more accessible and easy. Healthy choices can be promoted in specific settings (school, workplace and home) and contribute to better health for everyone.

They include exercising regularly and eating wisely which will help to maintain normal levels of blood glucose, blood pressure and lipids.

IDF recommendations for a healthy diet for the general population

1. Choosing water, coffee or tea instead of fruit juice, soda, or other sugar sweetened beverages.

2. Eating at least three servings of vegetable every day, including green leafy vegetables.

3. Eating up to three servings of fresh fruit every day.

4. Choosing nuts, a piece of fresh fruit, or unsweetened yoghurt for a snack.

5. Limiting alcohol intake to a maximum of two standard drinks per day.

6. Choosing lean cuts of white meat, poultry or seafood instead of red or processed meat.

7. Choosing peanut butter instead of chocolate spread or jam.

8.Choosing whole-grain bread, rice, or pasta instead of white bread, rice, or pasta.

9. Choosing unsaturated fats (olive oil, canola oil, corn oil, or sunflower oil) instead of saturated fats (butter, ghee, animal fat, coconut oil or palm oil.

A particular threat in terms of the associated risk of developing type 2 diabetes is the consumption of high sugar foods, particularly sugar-sweetened beverages, In 2014, the World Health Organization (WHO) issued new recommendations to limit sugar intake.

 

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Copyright © All right reserved.

Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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