Diabetes – Signs, Diagnosing, Treatments and Monitoring
Diabetes, characterized by high blood glucose level, happens to be far more common than most people realize. It is estimated that at least 5% of the population in westernized word have the disease and by 2035 this ratio is projected to rise to 10% or one person in ten. Furthermore, additional 3% have some degree of glucose intolerance, which can potentially lead to diabetes. Yet, almost half of the people who have diabetes do not know about it.
Diabetes, particularly the type 2 diabetes, which develops later in life, often goes unrecognized for years because its symptoms which develop gradually can be easily mistaken for other conditions. Diabetes is not a condition you want to ignore. If left untreated, it can cause blindness, kidney disease, heart damage and limb infections that can lead to amputation. Some of these complications can eventually cause death.
Subtle Signs of Diabetes
One of the earliest signals of oncoming diabetes is often nothing more than a feeling of constant tiredness that people tend to dismiss as a sign of growing older. A run-down feeling may indeed have nothing to do with diabetes. However, if you experience several of the following symptoms for an extended period of time, you should seriously consider paying a visit to your doctor:
- extreme thirst
- frequent urination
- unexplained weight loss
- increased hunger
- constant fatigue
- blurred vision
- repeated infections of the skin, gums, bladder or vagina
- cuts or bruises that are slow to heal
- tingling or numbness in the hands or feet
- dry, itchy skin
Two Types of Diabetes
The above symptoms result from the body’s failure to process food efficiently. During digestion, sugars and starches from foods are broken down into a simpler form of sugar, called glucose. The bloodstream then transports glucose throughout the body, where it fuels everything from the brain to the muscles. As blood glucose levels rise, the pancreas releases insulin into the bloodstream. This tells body tissues to absorb and use the glucose, bringing blood glucose levels back to normal. Insulin also enables the body to store unused glucose in its tissues.
However, in people with diabetes the mechanism for using glucose breaks down and glucose starts accumulating in the blood. This breakdown is sometimes due to the body’s inability to produce insulin (type 1 diabetes) or its inability to use insulin properly (type 2 diabetes). Type 1 diabetes is, therefore, also called insulin-dependent diabetes and it often develops before age 30 and requires daily insulin injections.
Type 2 diabetes is far more common among people over 40, in which the problem is not lack of insulin but insulin resistance. This form of diabetes is also known as noninsulin-dependent diabetes. Although it is not exactly known what causes this form of diabetes, it is clear that excess fat tissue can hamper insulin’s absorption and, hence, its effect. And indeed, four out of five patients with type 2 diabetes are middle-aged and older adults who are overweight.
Causes and Risk Factors for Diabetes
Besides being overweight, other factors that affect your chances of developing diabetes include genetic predisposition and family history of the disease, age, race, sex, physical activity and diet. In general, diabetes is more common in blacks and Latinos than in whites. Women are more likely than men to develop type 2 diabetes, especially if they had elevated blood glucose levels during a pregnancy.
Probably the best index of risk is family history. When one parent has diabetes, a child’s risk of developing this disease increases by 30%. When both parents have the disease, risk increases by 60%. If you also happen to be obese, the risks are yet higher. Anyone with excess weight, elevated blood pressure and a family history of diabetes is at high risk for diabetes.
The first and the most common test for diabetes is the glucose tolerance test, which measures the level of glucose in the blood before and at specific intervals after drinking a concentrated form of glucose. Although a very high blood glucose level called hyperglycemia causes the most noticeable symptoms, they can be sometimes overlooked in older adults and those in poor health. Such signs include weakness, dryness of the lips and tongue, cold hands and confusion.
Very low blood glucose level called hypoglycemia is equally dangerous. Hypoglycemia occurs when a patient with diabetes has not eaten enough to balance the glucose-lowering effects of insulin or oral medication, causing weakness, hunger, nervousness, sweating or headache. Prolonged, strenuous exercise and excessive alcohol consumption can also lead to hypoglycemia. Both hyper- and hypoglycemia can lead to loss of consciousness and require prompt medical attention.
Diabetes may sometimes remain undiscovered until it causes a serious condition called diabetic ketoacidosis. This condition occurs when cells are so much deprived of glucose that the body begins to break down its own fat and muscle tissue to produce energy sources such as fatty acids and ketones. If there is no insulin to regulate the process, fatty acids and ketones accumulate in the blood and cause frequent urination and thirst, rapid breathing, nausea and vomiting. Increased urination depletes the body of essential minerals required for normal body functioning. This can lead to diabetic coma and even death. Immediate medical attention is needed for this emergency condition.
Complications Commonly Associated with Diabetes
The longer diabetes goes unrecognized and hence untreated, the more likely it is to cause severe complications. It can seriously damage some of your vital organs before you even begin to feel sick. Working insidiously over a span of years, diabetes can seriously affect your heart health, kidneys, eyes, feet, teeth and gums.
Heart Disease. Diabetics are four times more likely to die of coronary artery disease than the average person. Diabetes undermines the protective effects of female hormone estrogen in middle-aged women, leaving them more vulnerable to heart attack at a younger age compared with women without diabetes.
Kidney Disease. Although most diabetics never develop kidney disease, their chances are definitely worse than normal as they make up nearly one-fourth of all new kidney dialysis patients. Kidney problems are also more likely in diabetic patients because of their greater likelihood of developing urinary tract infections.
Eye Disorders. Uncontrolled diabetes is one of the leading causes of new cases of blindness in people between the ages of 20 and 75. Blurred vision is both a symptom and a consequence of uncontrolled diabetes. Fluctuating levels of blood glucose can negatively influence the balance of fluid in the lens of the eye and diminish its focusing power. Diabetes may also affect the nerves that govern focus. Other eye problems frequently associated with diabetes include cataracts and glaucoma. A cataract is a clouding of the normally clear lens of the eye. Glaucoma is a disorder that results in the damage of the optic nerve that transmits visual images to the brain due to increased intraocular pressure. Diabetic retinopathy is yet another eye disorder caused by diabetes, affecting nearly half of the diabetics. This condition damages the tiny blood vessels that supply the light-sensing retina at the back of the eye, making them to swell and leak, causing blurred vision. Diabetics who experience blurred vision that lasts longer than a day, black spots, lines or flashing lights in the field of vision or sudden loss of vision in either eye should immediately contact an eye doctor.
Foot Problems. Diabetics typically face increased risk of developing two conditions that can do serious damage to their feet and legs. Peripheral vascular disease reduces the blood supply to the legs and feet as the small blood vessels at the end of the circulatory system become narrowed by fatty deposits. Due to poor circulation, a simple problem such as ingrown toenail can progress rapidly to infection. Foot ulcers and gangrene can take hold unnoticed in diabetics and lead to eventual limb amputation. Another condition, called diabetic neuropathy, can dull the sensitivity of nerves, causing a dangerous loss of sensation in the hands and feet which often leads to accidental burns.
Skin Problems. Diabetic patients have less resistance to injury and infection, which can lead to skin infections developing in cuts or scratches.
Tooth and Gum Infections. People with diabetes are due to their lower resistance to infection also more vulnerable to periodontal disease, an inflamed infection of tissue surrounding the teeth. In addition, different kinds of bacteria thrive on sugars, so the high glucose levels found in the mouth of an untreated diabetic turn it into an ideal breeding ground for the germs that trigger gum inflammation.
Other Health Conditions. People with diabetes can also suffer from a number of additional conditions. Some become incontinent because glucose acts as a diuretic, provoking frequent urination. Therefore, sufficient fluid intake is essential to prevent dehydration. Moreover, some patients with diabetes perceive pain more intensely and some can also suffer memory impairment.
Keeping Complications at Bay
Although there is no ultimate cure for diabetes, careful self-management of the disease enables you to control blood glucose levels and prevent possible damage to your organs. Remember that high blood pressure makes complications more likely, so you need to take any blood pressure-lowering medications as prescribed. However, by far the most important factors involve diet and exercise as lifestyle modifications alone can often help keep blood glucose levels within a normal range.
Weight control happens to be one of the most effective strategies for treating type 2 diabetes. Overweight diabetics often manage to control their blood sugar successfully by losing just 10% of their body weight. Eating the right foods on a regular schedule is just as important as maintaining a reasonable weight. A proper diet can enable diabetics to hold their weight down, stabilize their blood glucose levels and prevent cardiovascular diseases. Overall, an older diabetic patient should eat a healthy breakfast and two to four additional meals a day that are equally spaced, moderate in size and balanced with selections from the four basic food categories:
- proteins, including lean meat, oily fish, chicken, turkey, tofu, peanut butter and cooked dried beans
- fruits and vegetables, fresh, frozen or canned with no added sugar, including some with vitamin C, such as grapefruit or oranges and dark green or leafy vegetables such as spinach or cruciferous vegetables
- starches and breads, specifically whole grain and fortified breads and cereals, noodles and rice
- milk and dairy products, such as low-fat or skim milk and plain low fat yogurt
In general, diabetic patients should emphasize whole grains, fresh fruits and vegetables, while downplaying sweet deserts, candies and processed foods with high content of saturated and trans fats. Fat intake should be no more than 30% of total calories. An important dividend of a balanced healthy diet is the protection it affords against cardiovascular disease which is one of the most common complications of diabetes.
While most diabetics can enjoy an occasional alcoholic beverage, avoid drinking on an empty stomach as it can cause low blood sugar, a particular risk for older adults and patients using oral medications or insulin. Certain oral medications for diabetes can cause flushing, dizziness and nausea when combined with alcohol.
Exercise and Weigh Reduction
For someone with diabetes, regular exercise combined with a healthy nutritious diet provides double insurance against high blood glucose. Exercise not only burns calories, which helps you to achieve weight reduction but it also improves the body’s response to insulin. Walking is one of the best forms of exercise for people with diabetes. It is considered ideal if you can manage to walk 30 minutes a day, five days a week. If reduced sensitivity in the feet prevents you from walking, biking (incl. stationary bicycle) and swimming offer similar health benefits. But, if you have elevated blood pressure or glaucoma, avoid exercises that raise blood pressure, such as doing push-ups or lifting weights. If you are taking insulin or oral medications for diabetes, keep in mind that strenuous exercise can lower your blood glucose level. Hence, carry a food or drink high in sugar in case symptoms of low blood sugar begin to develop.
Oral Medications for Diabetes
Diet and exercise are not always the answer, especially for diabetics over the age of 70. Oral medications for diabetes are designed to lower blood glucose in patients with type 2 diabetes. Although they are an option if diet and exercise alone fail to control the blood glucose level, they are not a substitute for a healthy diet and lifestyle.
There are several oral medications available while each one of them either increases insulin secretion and affects its use in the body and/or slows the rise in blood sugar by blocking enzymes that help digest starches and sugar. Oral antidiabetics are most helpful for patients who developed diabetes after the age of 40, have had diabetes for less than five years, maintain a normal weight and have never received insulin. Oral diabetes medications usually do not cause serious side effects, though some patients may experience temporary nausea, headache, water retention, increased urination, skin rashes, sensitivity to direct sunlight or low blood sugar (hypoglycemia). However, some studies suggest that the sulfonylureas may increase the risk of heart attack whereas metformin should not be used in patients with serious liver and kidney problems.
Sulfonylureas. These medications work by stimulating the pancreas to make more insulin and most of them have been on the market for a number of years. Chlorpropamide (Diabinese) is the only first generation sulfonylurea that is still being prescribed today. The second generation sulfonylureas include glyburide (Micronase, Glynase, DiaBeta), glimepiride (Amaryl) and glipizide (Glucotrol).
Meglitinides, such as repaglinide (Prandin) and nateglinidean (Starlix), are newer antidiabetic drugs than sulfonylureas. They work the same way as sulfonylureas but act faster and leave the bloodstream sooner, allowing you more flexibility with mealtimes.
Biguanides, such as metformin (Glucophage), lower blood glucose levels by decreasing the amount of glucose produced by the liver while also helping the body to use its own insulin more efficiently. In addition, metformin also improves cholesterol readings. Side effects, including nausea, diarrhea and decreased appetite, are usually temporary but patients with severe kidney and liver problems should not use biguanides because of potentially serious complications.
Alpha-glucosidase inhibitors, including acarbose (Precose) and miglitol (Glyset), work by delaying the digestion of starches and sugar, thereby leveling off the spikes in blood sugar that follow meals. The most common side effect includes gas, though diarrhea and cramping can also occur.
Thiazolidinediones, such as rosiglitazone (Avandia) and pioglitazone (Actos), are antidiabetic medications that work by increasing the body’s sensitivity to insulin, thus enhancing its effect. Possible side effects include increased vulnerability to infection, headache, muscle pain and back pain.
DPP-4 inhibitors, including alogliptin (Nesina), linagliptin (Tradjenta), saxagliptin (Onglyza) and sitagliptin (Januvia), are a new class of oral medications for treating diabetes. By blocking the breakdown of GLP-1, a naturally occurring compound in the body, DPP-4 inhibitors lower blood glucose levels only when they are elevated and thus do not cause hypoglycemia.
SGLT2 inhibitors, such as canagliflozin (Invokana) and dapagliflozin (Farxiga), are new antidiabetic drugs that work by reducing the amount of glucose our body absorbs and, hence, increasing the amount that leaves the body in the urine. Since SGLT2 inhibitors increase glucose levels in the urine, their side effects may include urinary yeast infections.
Bile acid sequestrants, such as colesevelam (Welchol), are cholesterol-lowering drugs that can also be used to control blood sugar in patients with type 2 diabetes. Their side effects may include constipation and flatulence.
Insulin or Oral Medications
Like oral antidiabetic drugs, insulin is considered an alternative when diabetes cannot be controlled with diet and exercise alone. In certain situations, such as surgery, insulin can be the only way of controlling blood glucose. It is sometimes hard to tell whether oral medications or insulin will be more effective in controlling blood glucose. A person’s age and weight and the severity of the diabetes must be considered before prescribing any medication. Insulin will be typically prescribed if diet, exercise and oral medications do not do the job or if the patient has suffered an adverse reaction to oral antidiabetic drugs. However, studies show that early intervention with insulin is more important than was previously thought as keeping a tight lid on blood glucose levels with insulin delays the onset and slows the progression of complications associated with diabetes.
Monitoring Blood Glucose Levels
Diabetics have to regularly check their blood sugar levels in order to make necessary adjustments, if necessary. A doctor can measure blood glucose during an appointment but levels change from one hour to the next. To solve this problem, home test kits allow diabetics to check their sugar levels at home. This test involves pricking a finger to draw a drop of blood and placing it on a chemically treated testing strip. This self-monitoring procedure allows the patient to see how their body reacts to different foods, exercise, antidiabetic medication and stress.
A urine test can also be done at home. However, this test is not accurate because the reading reflects the level of glucose a few hours earlier and actually measures the excess sugar spilled into the urine, rather than the amount in the blood. Certain medications and vitamin C can also affect the accuracy of urine testing.
A different kind of test which measures the long-term effectiveness of diabetic treatment is the hemoglobin A1C test, also called HbA1c test or glycosylated hemoglobin test. This test measures the amount of glucose that has bonded to hemoglobin. By measuring this form of glucose, a doctor can determine a patient’s average blood glucose level over a two to three month period. If the test indicates that the diabetes is not well controlled, adjustments in therapy will need to be made (also see additional information on coping with diabetes).
Where to Find Related Information: American Diabetes Association