Diabetes Types, Symptoms, Causes And Treatment

Diabetes mellitus is a group of diseases characterized by high blood glucose levels. This is due to the defects in insulin production or in insulin action or in some cases both. In diabetes mellitus, Secretion of insulin is impaired with or without the development of resistance to insulin. It is the most common form of the endocrine disorders. It is a chronic medical condition. It represents metabolic disorder characterized by hyperglycemia with disturbances in carbohydrate, fats and protein metabolism. The long term effects of diabetes are very serious.

Types

There are three main types of diabetes mellitus,

• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes

1. Type 1 Diabetes

In type 1 diabetes, your body is unable to produce insulin. As a result, your body becomes insulin dependent and you have to take artificial insulin in order to survive. This type is also known as juvenile diabetes. This type is caused by the destruction of the insulin-producing pancreatic β-cells. This destruction is due to autoimmune T-cell mediated destruction or idiopathic. If this destruction is due to autoimmune, then this is called type 1 A and if this destruction is idiopathic then this type 1 B. Then chances of developing type 1 A is 90% and type 1 B is 10%. The onset of this type is mostly below the age of 30. Extreme hyperglycemia in this type causes diabetic ketoacidosis.

2. Type 2 Diabetes

In type 2 diabetes, the action of insulin is impaired. Your body makes insulin but is unable to use this insulin in an effective way. This type is most common and is mostly due to obesity. It is more common above the age of 40. It is caused by a relative insulin deficiency and insulin resistance. Extreme hyperglycemia in type 2 diabetes causes hyperosmolar hyperglycemic state.

3. Gestational Diabetes

This type of diabetes occurs in pregnant women. Sometimes, in pregnancy the body becomes less sensitive to insulin and develops gestational diabetes. Gestational diabetes resolves after delivery and nowadays it is most common.

Symptoms

The clinical presentation of diabetes includes,

•  Polyuria (Frequent urination)
•  Tiredness
•  Nausea
•  Vomiting
•  Shortness of breath
•  Polyphagia (Increased hunger)
•  Polydipsia (Increased thirst)
•  Blurred vision
•  Headache
•  Itchy skin
•  Slow healing of cuts
•  Unexpected weight loss
•  Fatigue
•  Vaginitis and Pruritis

Causes

Both environmental and genetic factors are responsible for the development of diabetes. But the relationship between them is still unknown. In type 1 diabetes, your immune system attacks your insulin producing cells and destroys them. As a result, your body has little insulin and sometimes no insulin. Insulin controls the blood glucose level. When there is no insulin, then the glucose will buildup in the blood and blood glucose level increases. Overweight or obesity has no role in the development of type 1 diabetes. Type 2 diabetes occurs due to the progressive development of insulin resistance and β-cell dysfunction. As a result, the pancreas becomes unable to produce enough insulin to overcome the insulin resistance. Almost 85% of patients with type 2 diabetes are overweight. During pregnancy, your placenta produces specific hormones to maintain pregnancy and these hormones increase insulin resistance. Your placenta tries to overcome this resistance but sometimes fails to do so.

Treatment

Type 1 Diabetes

Patients with type 1 diabetes are treated with insulin. The onset of action, peak effect and duration of action are determined by the insulin type and by the physical and chemical form of the insulins. There are different types of insulin, fast, intermediate and long acting. Fast acting insulins are also called soluble insulins and they appear in the blood circulations within 10 minutes. Fast acting insulins includes insulin lispro, insulin aspart and insulin glulisine. The risk of hypoglycemia is reduced with fast acting insulins because of their shorter duration of action. Intermediate acting insulins are insoluble suspensions of insulins. That’s why they are complexed with either protamine or zinc. The onset of its action is 1-2 hours. When the time is over, then the insulin dissociates from protamine or zinc and performs its action. Intermediate acting insulins includes isophane or NPH insulin and lente insulin. Long-acting insulin is made by using recombinant DNA technology. Their duration of action is 24 hours. They include insulin glargine and insulin detemir. Insulin glargine differs from human insulin because two arginine molecules have been added to the B chain at the C-terminal end.

Type 2 Diabetes

The first line drug for the treatment of type 2 diabetes is metformin. This drug comes under the classification of biguanide and their mechanism of action is still not understood. It decreases hepatic glucose production by both gluconeogenesis and glycogenolysis by potentiation of insulin action. It also stimulates the uptake of glucose. Sulphonylureas increases pancreatic β-cell sensitivity to glucose and lowers blood glucose levels. It improves the action of insulin and increases the bioavailability of insulin. There are two generations of sulfonylureas, first and second. The first generation includes Chlorpropamide and Tolbutamide. The second generation includes Glimepiride, Gliclazide, Glipizide and Glibenclamide.  Meglitinides are also called post-prandial glucose regulators. They have rapid onset of action and short duration of action. Repaglinide was the first member of meglitinides. This drug is recommended when exercise, diet control and weight reduction are not working. Thiazolidinediones include glitazone, pioglitazone and rosiglitazone. They decrease fasting and post-prandial blood glucose levels. They enhance insulin sensitivity and promote glucose uptake. They do not have any direct effect on insulin secretion. α-glucosidase inhibitors reduce digestion of carbohydrates by interfering with GI activity of glucosidase. Dipeptidyl peptidase-4 inhibitors work on incretin system and they are also called gliptins. These drugs include Sitagliptin, Vildagliptin, Saxagliptin and Linagliptin. They block the normal inactivation of glucagon like peptide-1 [GLP-1] and glucose-dependent insulinotropic peptide [GIP]. They decrease blood glucose levels and increase insulin secretion.

Frequently Asked Questions

What are the risk factors for diabetes?

Obesity, family history, abnormal cholesterol level and physical inactivity are the risk factors for diabetes.

What is normal blood sugar level?

Before meals, normal blood glucose levels should be 80-130 and after meals the levels should be less than 180.