Diabetes: Meaning, Types, Symptoms & Treatment

What is diabetes?

Diabetes is a life long disease that occurs when your blood glucose or blood sugar level is too high, which impairs your body’s ability of food breakdown. Blood glucose is integral to extracting energy from the food you consume.

The pancreas releases insulin, a hormone that controls the amount of glucose that enters your bloodstream, in response to the rise in blood sugar levels after a meal. Insulin also helps store glucose in your liver, fat (adipose tissue), and muscles. Another function of insulin is to allow the synthesis of proteins, carbohydrates, and lipids and aid in an enzymatic activity.

If you have diabetes, your pancreas is not producing enough insulin, which can throw your body off balance. Your blood sugar level may increase to a dangerously high level or drop too low. 

Diabetes is a condition that can impact your entire body and internal organs if it’s left undiagnosed and untreated. It is not curable, but it is possible to manage it and lead a healthy life. 

What are the types of diabetes?

These are the types of diabetes that afflict people:

Type 1 diabetes: is considered an autoimmune disorder, which means the body mistakenly attacks the insulin producing beta cells in your pancreas. This condition is usually diagnosed in children, teens, and young adults. In Type 1 diabetes, after the breakdown of food leads to glucose production, no insulin can be found available in the body to allow this glucose to enter the bloodstream and regulate its quantity. So, there is an unchecked rise (hyperglycaemia) or fall (hypoglycaemia) in glucose levels. Type 1 diabetes needs life long management with insulin therapy.

Type 2 diabetes: usually begins as insulin resistance, which means your muscles, fat, and liver do not respond as well to insulin as they are supposed to. When this happens, they cannot store and use the glucose from your blood efficiently. The pancreas then releases more insulin to help glucose travel to your cells. This results in elevated insulin levels, causing Type 2 diabetes. This is the most common type of diabetes and is primarily diagnosed in middle aged and older adults. However, more and more children and young people are developing this condition.

Gestational diabetes: usually occurs in pregnant women who have never had diabetes, making the mother and the baby vulnerable to various health issues. In most cases, diabetes goes away once the child is born. However, gestational diabetes leads to an increase in the risk of contracting Type 2 diabetes later in a woman’s life. Children whose mothers were diagnosed with gestational diabetes are also at a risk of being obese children or teens who may also have Type 2 diabetes. 

Prediabetes: means your blood glucose levels are higher than usual, and you are at a risk of contracting Type 2 diabetes. This condition also makes you susceptible to heart disease and stroke. Prediabetes can happen to people who have insulin resistance or whose pancreas is not producing enough insulin to keep the blood sugar level steady. Lifestyle changes can help stabilise your condition and bring your blood sugar level back to normal.

Then, there are steroid induced diabetes, cystic fibrosis diabetes, and diabetes caused by rare disorders that are relatively less common. 

What are the symptoms of diabetes?

If you are displaying any or all symptoms of diabetes, it is best to talk to your health practitioner for a concrete diagnosis. 

There are three signs of diabetes that almost always exist. In medical terms they are called polydipsia (extreme thirstiness, polyuria (increased urination), and polyphagia (excessive eating due to increased appetite).

The general symptoms of this disease that can affect adults and children are:

• Excessive thirst
• Increased hunger
• Frequent urination especially at night, and bed wetting in children
• Feeling more fatigued than usual
• Delay in wound healing
• Genital itching
• Blurred vision
• Unexplained weight loss
• Very dry and itchy skin
• Increased infections of any type 

People with Type 1 diabetes may also experience nausea, vomiting, and stomach pain. There are typically no symptoms during gestational diabetes, but some women may have increased thirst or feel the need to urinate more than usual. 

What are the causes of diabetes?

Type 1 diabetes is an autoimmune disease; so, it’s not clear what triggers the body to respond the way it does in this condition. The reasons could be genetic or caused by environmental factors. If you have a family history of Type 1 diabetes, you may also develop this condition.

In the case of Type 2 diabetes too, the causes remain unclear. However, genetics, inactive lifestyle, and being overweight or obese are considered contributing factors.

Gestational diabetes occurs because the body tends to produce insulin blocking hormones in pregnancy. Moreover, the body goes through significant changes during pregnancy, like weight gain, which can cause hormonal imbalances and insulin resistance. Other contributing factors linked to gestational diabetes are being overweight and obese. Having a family history of diabetes may also play a role. Consuming a lot of red meat and eating foods with high fat and carbohydrate content that can spike blood sugar levels are also linked to causing gestational diabetes.  

Health issues like high blood pressure also affect your probability of developing diabetes. If you smoke, then you are vulnerable to having diabetes.

Moreover, individuals with polycystic ovarian syndrome (PCOS) can have Type 2 diabetes and gestational diabetes because they usually have insulin resistance.

How common is diabetes in India?

India has the second largest population affected by diabetes in the entire world. In 2019, India had around 77 million people with diabetes, coming in at number two after China, which reported over 116 million people with diabetes. The affected age group lies is between 20 years to 79 years. It is also projected that India will have around 134 million people with diabetes by 2045. A 2017 study once found that most diabetes cases were from urban areas in India.

There are several reasons why there is a rise in diabetes among urban Indians:

• Sedentary lifestyles: More people are taking up corporate jobs that require a lot of sitting as well as screen usage and little to no physical activity
• A rise in junk and processed food consumption that is high in refined carbohydrates and trans fats
• Environmental pollution, which is on the rise in most metropolitan cities: Regular interaction with air pollutants can disrupt the production of insulin, can enter the bloodstream, and react poorly with organs
• High stress work and living conditions: This factor may not cause diabetes but can trigger adrenaline and cortisol production, which can harm your blood sugar levels
• Tobacco and alcohol use

The number of diabetes cases is on the rise in other Asian countries too. It’s been found that Asians have more visceral fat and less muscle; so, they tend to develop Type 2 diabetes more than other races.

Complications of diabetes

Undiagnosed and unmanaged diabetes can have long term adverse effects on the body. Because insulin is needed for the body to function appropriately, it’s excess or absence, can cause harm and increase the chances of other illness and diseases.

Here are some complications that may arise due to diabetes:

• Damage to blood vessels, which elevates the chances of heart disease and stroke
• Skin conditions like diabetic dermopathy, blisters, bacterial infections, fungal infections, and itching
• Eye problems such as diabetic retinopathy, diabetic macular oedema, cataracts, and glaucoma
• Over time, these eye problems can also lead to vision loss 
• Diabetic neuropathy or nerve damage that can lead to numbness and pain in any part of the body including internal organs
• Diabetic kidney disease 
• Diabetes foot that may require amputation
• Gum disease and dental problems like tooth decay
• Complications in pregnancy like pre eclampsia, stillbirth, congenital disabilities, high blood pressure, needing a caesarean delivery, and miscarriage
• Cancer 
• Some cancer treatments can also worsen diabetes
• Sexual problems, especially in men
• An increase in the risk of complications in case that COVID 19 is contracted
• Severe dehydration (hyperosmolar hyperglycaemic state) in people who have Type 2 diabetes
• Diabetic ketoacidosis 

A 2022 study that analysed the data of 88 million COVID 19 cases also found that people who have recovered from the virus are highly likely to have Type 2 diabetes. By contrast, people who exhibit mild COVID are at a low risk of developing Type 2 diabetes, but researchers advise to monitor for symptoms like increased thirst, fatigue, and urination. 

Why can diabetes lead to complications?

People with diabetes can face health complications because of this disease because the presence of high sugar levels in the blood for a prolonged time can lead to damaged blood vessels. If the blood vessels do not function properly, your circulation gets affected. This results in your nerves working inadequately; thus, you lose control over the workings of your organs. You can lose sensation in your limbs, which can escalate into something grave like heart problems.

The higher your glycated haemoglobin or hba1c, the higher the risk of health complications. It is a form of haemoglobin made when glucose sticks to your red blood cells. People with diabetes usually have an elevated level of hba1c in their blood. You must note that even a slight increase in the hba1c level over the accepted normal range can put you at risk of having diabetes. Besides blood sugar, lifestyle choices like smoking, drinking, and inactivity leading to obesity are some causes of diabetes.

You can prevent complications by keeping your diabetes in check, avoiding smoking, eating healthy, following your doctor’s advice, and going for regular check ups.

Diagnosis

If you suspect that you have diabetes, then it’s best to speak to a doctor about this. You can book a consultation with an experienced general physician at LivLong for a discounted rate of Rs 249. You can also book an Unlimited Doctor on Call package with LivLong for Rs. 1500.

You can find out whether you have prediabetes, diabetes, or gestational diabetes with blood tests. If you are experiencing symptoms or are pregnant, your doctor may suggest different tests. 

You will usually be directed to diabetologist to treat your diabetes. However, because diabetes is an endocrinological disorder, you may also seek help from an endocrinologist. 

Here are some standard lab tests that help doctors confirm their diagnosis:

Fasting blood glucose test: The fasting plasma glucose (FPG) test is utilised to measure the glucose level in the blood at one point of time. To acquire highly reliable results, your doctor will administer the test in the morning when you’ve fasted for a minimum of 8 hours. During this fasting, you should not eat or drink anything apart from water.

A1C test or hba1c test: This test is useful in identifying people who have prediabetes. The HbA1c test can also be used to screen for and diagnose diabetes in adults. Patients with diabetes should be tested to track their blood sugar levels and, in the long run, to reduce the health problems associated with diabetes. Fasting is not a prerequisite for this test. However, it would be best to consider which stage of pregnancy you are in and whether you are anaemic before this test. The results may also not be accurate if you have recently undergone a blood transfusion. Your doctor will prepare you before you undertake this test.

Random blood glucose test: When you are displaying the symptoms of diabetes, sometimes the doctor will want to get you tested without having you fast for 8 to 12 hours before. The levels of blood glucose are measured any time during the day, regardless of when you last ate. This test will help identify any variations in blood glucose levels.

Glucose tolerance test: This test helps in screening for Type 2 diabetes. The purpose here is to find out your sensitivity or tolerance to sugar. You will be asked to ingest a small amount of glucose, and after 30 minutes to an hour, your blood sample will be taken. If your blood glucose is high, then it’s likely that you have diabetes.

Postprandial glucose test: This test is usually done 2 hours after eating food to determine whether there is any change in blood glucose levels once you have had your meal. As mentioned earlier, blood glucose levels spike during digestion; so, your pancreas releases insulin to help this glucose reach other parts of the body. It’s expected that after 2 hours, the glucose levels will return to normal, but if that does not happen, you can have diabetes.

Several other diagnostic tests might be added to these when your doctor must screen for diabetes. This solely depends on and differs from case to case and is up to the doctor’s discretion.

Your test results may differ according to age, gender, medical history, and some other factors. Based on the lab used, your test results could differ. The results may indicate that there is a problem. Inquire with your doctor about the significance of your test results.

You can book a tele or video consultation with LivLong doctors by choosing the speciality you want a consultation for; fill in your details and verify the OTP, make the payment, and then select a slot suitable for you. A roster of doctors who will hear you, understand you, and treat you with care is available here. 

Treatment

After diagnosis, the goal is to maintain blood sugar levels within the normal range. Your doctor will advise you on the appropriate target range. Diabetes targets differ depending on the type of diabetes, age, and complications. Various treatments are available, and your doctor will decide which is the most appropriate for you, depending on your case specificities. 

Physical activity is an essential component of diabetes management. Consult your doctor about how many minutes of aerobic exercise you should do each week. Keeping diet in check is also necessary. You will also need to monitor your blood pressure and cholesterol levels.

Here is the general treatment course:

Insulin: People with Type 1 diabetes will have to take insulin all their lives because the pancreas’ malfunction is an autoimmune response. This is usually done by injection or using an insulin pump. Some cases of Type 2 diabetes may also require insulin treatment. 

Medication: Metformin is typically used to decrease the liver’s glucose production for Type 2 diabetes. If metformin fails to work, your doctor may recommend another medication. You must closely monitor your blood glucose levels. You may also require blood pressure and cholesterol meds. Sulphonylureas is also commonly given to stimulate insulin production in the pancreas. SGLT2 inhibitors are prescribed to adults with Type 2 diabetes along with managing diet and activity levels. They are also known as gliflozin or flozins. These flozins prevent the kidneys from lowering glucose levels and the excess glucose in the blood to be removed from the body through urine. 

Weight management: This can be either through diet and exercise or through weight loss surgeries. If you are overweight and obese, losing weight may help remove certain medications from your treatment course, improve your blood sugar levels, and lower your risk of other health complications. However, if this is done through a bariatric surgery, there are some adverse complications that your doctor must brief you on. 

Pancreas transplantation: A pancreas transplant may be an alternative available for some people with Type 1 diabetes. The diseased pancreas and islet cells are removed and replaced with healthy ones so that the effects of diabetes can be slowed down and you no longer require insulin therapy. However, transplants are not always successful. Moreover, these procedures are fraught with danger. To prevent organ rejection, you must take immunosuppressive drugs for the rest of your life. These medications can have severe side effects. As a result, transplants are typically restricted to individuals whose diabetes cannot be controlled or who require a kidney transplant.

Emotional support: Whether you have diabetes or some other ailment, emotional support plays an important role in your journey towards wellness. We can often feel alone or isolated when we have an illness, and sharing your feelings about your diagnosis and living with this illness with a therapist, your friends, and loved ones can be helpful. 

Diabetes distress is often experienced by people because of living with this disease and the relentless self management it requires, which can lead to diabetes burnout and depression. If diabetes distress is not addressed it can lead to the patient avoiding or paying less heed to their treatment plan, increased hbA1c levels, and the experience of hypoglycaemia more frequently; as a result, the patient may have a low quality of life. 

If you are looking to speak with someone about diabetes related emotional distress, you can book a consultation with a psychologist at LivLong for Rs 649. You can also book an appointment with a psychiatrist for Rs 999.

Diet: People who are diagnosed with diabetes are worried about giving up their favourite foods. You may continue eating foods you enjoy but must take small portions or reduce the frequency. Following a diet plan that includes all essential vitamins, nutrients, and minerals to maintain your blood glucose level may be helpful. It may also be helpful for weight management. It’s advisable to eat foods that are heart healthy, like nuts, seeds, fatty fish, and no red meat. You should avoid foods that are rich in saturated fats and trans fats, high in sodium, and too much refined sugar, including sweet beverages like colas, milkshakes, and fruit juices. Alcohol consumption should also be minimum or next to none.

Never skip a meal: Skipping a meal is a big no no if you are a person with diabetes. If you do so, your blood sugar levels can oscillate dangerously high or low. There are more chances of binging on junk food if you do not eat your meals on time or skip them altogether. Additionally, your energy levels will get affected, you may experience brain fog during the day, and you could also gain weight. Your medication may also become ineffective or cause hypoglycaemia. Usually, it is instructed to eat a full meal before taking a medicine.   

See a podiatrist: Having a support network of experts who can help you cope with diabetes is helpful in the long run and can provide relief when you are in distress. Seeking the help of a podiatrist can reduce your chances of getting foot diseases like ulcers, joint damage, and nerve damage. Having your feet checked once a year is a must for any person with diabetes. Many foot care treatments, as basic as trimming your nails, can also be done by podiatrists.

See other experts: As diabetes can also affect the eyes, having regular check ups with an ophthalmologist will help spot eye disorders and issues like glaucoma. Finding the issues early helps come up with an effective treatment plan. With gum disease, premature tooth decay, and cavities becoming a bigger possibility because of diabetes, dentists also become critical to the healthcare team. 

Diabetes emergency and what to do

A diabetes attack or any emergency is a genuine possibility. One may experience incoherence, anxiety, fatigue, and weakness when this happens. Sometimes all of this may even lead to shock. They may also experience trouble breathing, fever, clammy skin, sweating, numbness in the limbs, loss of consciousness, seizures, a pain in the left arm that could indicate a heart attack.

If the person collapses or is showing signs of weakness, it may be because their blood sugar levels have dropped. Giving them a sugary drink like a glucose drink, fruit juice, or an energy drink can help alleviate the problem till you get them to the hospital. The person’s situation may become grave enough not to be responsive to home treatment; so, taking them to the hospital is their best chance of getting better. 

Having an emergency time plan is also a good way of avoiding adversity.

Prevention of diabetes

Early detection can help manage this disease in time and even put it in remission. A complete cure is not available, but it is possible to live a healthy life despite having diabetes. 

In India, ayurvedic solutions are also popular, but there are no concrete results pointing out at their effectiveness. Holistic treatments are not harmful but should be done with your doctor’s knowledge. Yoga has also been found a useful tool to keep yourself healthy.