Diabetes

What is diabetes?

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.

In 2014, 9% of adults 18 years and older had diabetes. In 2012 diabetes was the direct cause of 1.5 million deaths. More than 80% of diabetes deaths occur in low- and middle-income countries.

Type-1 diabetes

Type-1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. The cause of type 1 diabetes is not known and it is not preventable with current knowledge.
Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly.

Type-2 diabetes

Type-2 diabetes (formerly called non-insulin-dependent or adult-onset) results from the body’s ineffective use of insulin. Type-2 diabetes comprises 90% of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity.
Symptoms may be similar to those of Type-1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen.
Until recently, this type of diabetes was seen only in adults but it is now also occurring in children.

Gestational diabetes

Gestational diabetes is hyperglycemia with blood glucose values above normal but below those diagnostic of diabetes, occurring during pregnancy. Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. They are also at increased risk of type-2 diabetes in the future.

Gestational diabetes is diagnosed through prenatal screening, rather than reported symptoms.
Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG)
Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at high risk of progressing to type-2 diabetes, although this is not inevitable.

The size of the problem

A diabetes epidemic is underway. An estimated 30 million people world-wide had diabetes in 1985. By 1995, this number had shot up to 135 million. The latest estimates for the number of people with diabetes world-wide in 2000 was is 177 million. This will increase to at least 300 million by 2025.

Economics

The costs of diabetes affect everyone, everywhere, but they are not only a financial problem. Intangible costs (pain, anxiety, inconvenience and generally lower quality of life etc.) also have great impact on the lives of patients and their families and are the most difficult to quantify.

World Diabetes Day

On November 14th there is a celebration that builds awareness on the global epidemic of diabetes. It focuses on population-wide approaches to promote healthy diet and regular physical activity, thereby reducing the growing global problem of overweight and obesity.

Screening and Testing

For screening only:
Sometimes urine samples are tested for glucose, protein, and ketones, often as part of a urinalysis, during a routine physical examination. If glucose and/or protein or ketones are present in the urine sample, the person has a problem that needs to be addressed. Additional testing is usually done to identify the cause of the abnormal urine result.
Tests for monitoring:

  • Glucose – type 1 diabetics must monitor their own blood glucose levels, often several times a day, to determine how far above or below normal their glucose is and, based on their healthcare provider’s instructions, what modifications they should make to their medications. This is usually done by placing a drop of blood (obtained by pricking the skin with a small lancet device), onto a glucose strip and then inserting the strip into a glucose meter, a small machine that provides a digital readout of the blood glucose level. Some type-2 diabetics and pregnant women diagnosed with gestational diabetes may also need to monitor their blood glucose in this way.
  • A1c and estimated average glucose (eAG) – this is a test and a calculation that are ordered several times a year to monitor diabetics and sometimes people with prediabetes. A1c is a measure of the average amount of glucose present in the blood over the last 2 to 3 months and helps a health practitioner to determine how well a treatment plan is working to control someone’s blood glucose levels over time.