Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin. It has become a major public health problem throughout the world. In 2000, 171 million people were known to have diabetes mellitus. This number is estimated to double by 2030!
How it happens?
Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin.
Insulin, a hormone released from the pancreas, controls the amount of sugar in the blood. When people eat or drink, food is broken down into materials, including the simple sugar glucose, the body’s main currency of energy. Sugar is absorbed into the bloodstream and stimulates the pancreas to produce insulin. Insulin allows sugar to move from the blood into the cells. Once inside the cells, it is converted to energy which is either used immediately or stored as fat or glycogen until it is needed.
The levels of sugar in the blood vary normally throughout the day. They rise after a meal and return to normal within about 2 hours after eating in response to the release of insulin. Once the levels of sugar in the blood return to normal, insulin production decreases. The variation in blood sugar levels is usually within a narrow range, about 4 to 6.5 mmol/L (70-110 mg/dl). If people eat a large amount of carbohydrates, the levels may increase more.
If the body does not produce enough insulin to move the sugar into the cells, the resulting high levels of sugar in the blood and the inadequate amount of sugar in the cells together produce the symptoms and complications of diabetes.
Increasingly Common
Approximately 5-10% of diabetics have type 1 diabetes, and 90-95% have type 2 diabetes. Type 2 diabetes mellitus is the type most often diagnosed in adults. Alarmingly, in recent years, this condition has been diagnosed with increasing frequency in older children and adolescence.
This article focuses on Type 2 diabetes in adults and refers briefly to diabetes in children.
Risk factors
- Genetic: The lifetime risk of developing type 2 diabetes is five to ten times higher in first-degree relatives (sister, brother, son, daughter) of a person with diabetes compared to a person with no family history of diabetes. The likelihood of developing type 2 diabetes is greater in certain ethnic groups, such as people of Hispanic, African, and Asian descent.
- Habits: People, who eat lots of sweets, lots of “white” carbohydrates (white bread, rolls, anything made from white flour), also people, who drink lots of sugary drinks (soft drinks, juices, too much sugar in coffee, tea) are at higher risk for diabetes. Regular aerobic exercise will decrease the chances for diabetes.
- Obesity: This factor is closely related to habits. If a person eats more calories than he/she needs and does not exercise, it will lead to weight gain and eventually increase the risk of diabetes. However it is important to note that obesity can be a result of hormonal imbalance and requires medical evaluation.
- Pregnancy: About 3 to 5 percent of pregnant women develop gestational diabetes. Gestational diabetes generally resolves after a woman delivers her baby. Women who have gestational diabetes are at slightly increased risk of developing diabetes later in life.
Diagnosing diabetes mellitus
The diagnosis of diabetes is based upon symptoms and the results of blood tests.
Diabetes symptoms:
Often people with type 2 diabetes have no symptoms at all. In those who do have symptoms, the most common include:
- Needing to go to the bathroom to urinate frequently
- Feeling thirsty
- Blurred vision
- Unintended weight loss
Laboratory test:
Random blood sugar: For a random blood sugar test, you can have blood drawn at any time, regardless of when you last ate. If your blood sugar is 11.1 mmol/L (200 mg/dL) or higher and you have symptoms of high blood sugar, this confirms diabetes mellitus.
Fasting blood sugar: Fasting blood sugar is a blood test done after not eating or drinking for 8 to 12 hours (usually overnight). A normal fasting blood sugar level is less than 5.55 mmol/L (100 mg/dL). A fasting blood sugar of 7.0 mmol/L 126 mg/dL) or higher indicates diabetes.
Hemoglobin A1C test (A1C): The A1C blood test measures the average blood sugar level during the past two to three months. Normal values for A1C are 4 to 6 percent. If it is higher than 6.5 percent, patient is considered diabetic.
Oral glucose tolerance test (OGTT): In OGTT, the patient has a blood sugar test before and 2 hours after drinking a 75 gm sugar containing solution. It is done only when the other more simple tests do not show clearly the diagnosis.
The blood tests must be repeated on another day to confirm that they remain abnormally high.
Complications
Most complications are the result of narrowing of blood vessels caused by high sugar levels over a long time period. The narrowing reduces blood flow in many parts of the body. Over time elevated blood sugar and poor circulation can harm the heart, brain, eyes, kidney, nerves and skin, resulting in angina, heart failure, stroke, poor vision, kidney failure, damage to the nerves (neuropathy) and poorly healing skin ulcers, as the immune system is harmed, too.
Treatment
Type 2 diabetes is treated with special diet, exercise and for most people medication(s). In some cases insulin may be needed as well. The goal is to achieve close to normal glucose levels to prevent/postpone the appearance of complications. If people with diabetes strictly control blood sugar levels, complications are less likely to develop. Therefore it is essential to monitor blood sugar at home and to see the doctor every 3-4 months even if the blood sugar seems to be well controlled. Testing for and treating high blood pressure and cholesterol levels is important too because this can prevent some of the complications of diabetes. In addition, yearly monitoring of heart, kidney function, feet and eyes is very important.
Medical care for children with diabetes is an evolving field of medicine. To get the best medical care, patients and their parents are strongly recommended to work with one of the centers of excellence in Budapest. There are specialist centers at Semmelweiss University and Heim Pal for children with diabetes (which is mostly type 1 diabetes). All of these centers offer similar treatment possibilities with Multiple Daily Injections (MDI) of human recombinant and analog insulins using the standard range of injectable devices. Special pumps are also available.
Optimal diabetic care requires a long-term relationship between patient and doctor/diabetic center. Motivated patients who follow the recommendations regarding treatment and monitoring will have a much better long term outlook than those that neglect this.
Diabetic Care at FirstMed
Being diagnosed with diabetes mellitus can be a frightening and overwhelming experience. Most people have many questions about why it developed, what it means for long-term health, and how it will affect everyday life.
At FirstMed, our goal is to help patients better control their diabetes, to understand the nature of their illness and to educate them about what kind of life style change is needed and why it is important. We also want to ease the stress of making necessary life style changes. Further, we recognize that the rapid pace and mobility of modern life make it difficult for some patients to get the regular care they need.
For this reason we are offering a new Diabetic Clinic to adult patients run by Dr. Tünde Györgyi, internal medicine specialist with broad experience in treating adult diabetic patients and in preventative medicine. After a consultation, patients will be examined, given dietary information, guidance on exercise, self monitoring blood sugar levels and blood pressure. There will also be a discussion regarding possible drug therapy and an opportunity to get answers to any questions. Laboratory tests will be done the same day. Dietitian and eye exams will be arranged as needed. We will teach you to monitor your blood sugars at home if needed and schedule you into a regular program of checks to ensure that you stay on track with your diabetes. This includes getting a reminder when your next check up is due.
Children with diabetes can be seen at FirstMed by Dr. Andrea Luczay, who has specialization in pediatric endocrinology. She also heads the Pediatric Diabetic Center at SOTE II.
