What is Diabetes? Types And Symptoms.

Diabetes is a chronic condition that occurs when the pancreas can no longer make insulin, or the body cannot effectively use insulin.

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Insulin is a hormone made by the pancreas that acts like a key to let glucose from the food we eat pass from the bloodstream into the cells in the body to produce energy. The body breaks down all carbohydrate foods into glucose in the blood, and insulin helps glucose move into the cells.

When the body cannot produce or use insulin effectively, this leads to high blood glucose levels, called 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

Type 1

Can develop at any age and requires insulin treatment for survival.

Type 2

Accounts for around 90% of all diabetes and is more commonly diagnosed in adults.

Gestational

Occurs with high blood glucose during pregnancy and can cause complications for both mother and child.

Type 1 diabetes

Type 1 diabetes can affect people at any age but usually develops in children or young adults. In 2022, around 8.75 million people with diabetes were living with the condition, with 1.52 million under 20. People living with type 1 diabetes need daily insulin injections to control their blood glucose levels. If they do not have access to insulin, they will die.

We do not know what exactly causes type 1 diabetes. However, research shows that the possibility of developing the condition increases slightly if a family member has it. There are also environmental factors, such as exposure to a viral infection, which, in turn, triggers an autoimmune reaction.

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. The three most common ways to take insulin are with a syringe, an insulin pen or an insulin pump.

Types of insulin include:

Rapid-acting like Aspart, Glulisine and Lispro is taken with or before meals to limit blood sugar spikes quickly.

Short-acting , also known as regular or neutral insulin, is taken before meals. It is slower-acting than rapid-acting insulin but may be more suitable for some people. Actrapid, Humulin R, and Insuman Rapid are examples of short-acting insulin.

Intermediate-acting is usually taken with a short-acting one. It begins working within an hour of injection and reaches its peak activity within seven hours. Examples of intermediate-acting insulin are Humulin NPH, Protaphane, and Insulatard.

Long-acting can last up to 24 hours in the body and are usually taken in the morning or before bed. Some examples are Detemir and 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).

Type 2 diabetes

By learning the causes and symptoms of type 2 diabetes, you can delay or prevent it altogether. The primary indicator of type 2 diabetes is insulin resistance, when the body cannot fully respond to insulin. 

Because insulin cannot work properly, blood glucose levels keep rising, releasing more insulin. Unfortunately, for some people with type 2 diabetes, this can eventually exhaust the pancreas. As a result, the body produces less and less insulin, causing even higher blood glucose levels (hyperglycaemia).

Accounting for around 90% of all diabetes, type 2 diabetes is the most common type of diabetes. Changes in diet and physical activity related to rapid development and urbanisation have led to sharp increases in people with type 2 diabetes. Previously, mainly older adults developed the condition. However, due to rising levels of obesity, sedentary lifestyles and poor diet, type 2 diabetes is increasing in children, adolescents and younger adults.

Symptoms of type 2 diabetes

The symptoms of type 2 diabetes are similar to those for 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, so people with type 2 diabetes can live several years with the condition before being diagnosed.

Risk factors for type 2 diabetes

• 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

*IGT is a category of higher than normal blood glucose, but below the threshold for diagnosing diabetes.

Know your risk of type 2 diabetes

IDF has developed an online risk assessment to predict a person’s risk of developing type 2 diabetes within the next ten years. The test is based on the Finnish Diabetes Risk Score (FINDRISC) developed and designed by Adj. Prof Jaana Lindstrom and Prof. Jaakko Tuomilehto from the National Institute for Health and Welfare, Helsinki, Finland.

Managing type 2 diabetes

The cornerstone of type 2 diabetes management is a healthy diet, increased physical activity, not smoking and maintaining a healthy body weight. Oral medication and insulin are also frequently prescribed to help control blood glucose levels.

Over time, a healthy lifestyle may not be enough to keep blood glucose levels under control, and people with type 2 diabetes may need oral medication. If treatment with a single medication is insufficient, combination therapy options may be prescribed.

When oral medication is insufficient to control blood glucose levels, people with type 2 diabetes may require insulin injections.

Oral medicines for type 2 diabetes

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

• Metformin: a medicine that reduces insulin resistance and allows the body to use its insulin more effectively. It is regarded as the first-line treatment for type 2 diabetes in most guidelines worldwide.
• Sulfonylureas: a medicine that stimulates the pancreas to increase insulin production. Sulfonylureas include gliclazide, glipizide, glimepiride, tolbutamide and glibenclamide.

Preventing type 2 diabetes

Several factors influence the development of type 2 diabetes. The most significant are lifestyle behaviours commonly associated with urbanisation. Consistent evidence shows that a relatively modest intentional weight loss achieved through a healthy diet and regular physical activity can prevent or delay type 2 diabetes.

A healthy diet includes:

• reducing 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)
• controlling portion sizes to avoid overeating
• avoiding tobacco use, excessive alcohol and added sugar
• choosing healthier cooking methods such as baking, grilling, steaming, or sautéing instead of frying

Regular physical activity is essential to help keep blood glucose levels under control. It is most effective when it includes a combination of aerobic exercise (e.g. jogging, swimming, cycling) and resistance training to build muscle mass. It is recommended to do at least 150 minutes of moderate-intensity aerobic exercise, such as brisk walking or cycling, per week.

Regular health check-ups are also recommended as early detection of the risk factors can help take proactive steps to prevent or delay type 2 diabetes.

Gestational diabetes

Lifestyle changes and medication can help manage gestational diabetes. Gestational diabetes mellitus (GDM) poses a threat to maternal and child health, with potential long-term consequences. It can lead to pregnancy-related complications, including high blood pressure, large birth weight babies and obstructed labour.

During pregnancy, the placenta produces hormones that can interfere with the body’s ability to use insulin effectively. This is known as insulin resistance, a normal part of pregnancy. However, in some women, insulin resistance becomes too high, leading to gestational diabetes.

In 2021, about 21.1 million live births or 16.7%, had some form of hyperglycaemia during pregnancy. The condition is more common in low- and middle-income countries with limited access to maternal care.

Women over 45 are at greater risk of hyperglycaemia during pregnancy, while women with a history of GDM have an increased risk of developing type 2 diabetes within five to ten years after delivery.

Children exposed to high blood sugar levels during pregnancy may also be at higher risk of becoming overweight or obese and developing type 2 diabetes.

Causes and risk factors

The exact cause of gestational diabetes is not yet known. Still, several risk factors can increase the chances of developing GDM. These include:

• being overweight or obese
• being over the age of 45
• having a family history of diabetes
• having a history of gestational diabetes in a previous pregnancy
• having polycystic ovary syndrome (PCOS)

Commons symptoms

Gestational diabetes often has no symptoms. However, some women may experience symptoms such as:

• Increased thirst and urination
• Fatigue
• Blurred vision
• Nausea
• Frequent infections, such as yeast infections

Managing GDM

Gestational diabetes can be managed with a combination of lifestyle changes and medication. In most cases, women with gestational diabetes can manage their blood sugar levels by making dietary changes and exercising regularly. However, some women may need insulin or other medications to control their blood sugar levels.

The importance of early detection

Early detection of gestational diabetes is crucial for prompt treatment, which can help prevent complications for both mother and baby. Women at high risk of gestational diabetes should be screened during their first prenatal visit. Further recommendations advise screening all pregnant women for gestational diabetes between 24 and 28 weeks.