A bunch of cells called islets of Langerhans is a group of cells that produce insulin in the pancreas. In people with type 1 diabetes, these insulin-producing beta cells are destroyed or damaged, usually as a result of their own immune system (by an autoimmune process).
The pancreas no longer produces insulin. The illness generally manifests itself before the age of 30. The symptoms are usually rapidly progressive. This form is also called insulin-dependent diabetes.
It is caused by the pancreas's islets of Langerhans no longer being able to produce insulin. That is why this form of diabetes was also called juvenile diabetes because the condition usually manifests itself at a young age (< 25 years).
Symptoms like thirst and frequent urination are commonly used to make the diagnosis. The blood sugar level is much too high and sometimes there are ketones in the urine. This form of diabetes affects roughly 1% of the population.
Because insulin is needed to move glucose from the blood to the cells of the body, you have to inject insulin every day with this form of diabetes. Otherwise, the glucose level in the blood will remain much too high. In DM type 1, being overweight rarely plays a role (BMI < 27 years) and is rarely hereditary. Insulin therapy is usually indicated.
1c. DM type 2:
Both environmental and genetic factors play a key role in the development of DM type 2. The development of this form of DM is characterized by 2 phenomena:
reduced insulin secretion due to beta-cell dysfunction
an insulin resistance: insensitivity to insulin (insulin resistance) in the liver, muscle, and adipose tissue. The latter is known as insulin resistance or metabolic syndrome, a cluster of metabolic and hemodynamic abnormalities characterized by: large waist circumference (central adiposity), elevated blood pressure, (slightly) elevated blood glucose and insulin levels, elevated triglyceride levels, and decreased HDL cholesterol levels.
In this type of diabetes, the islets of Langerhans do produce insulin, but the glucose cannot be absorbed sufficiently into the cell. As a result, insufficient glucose is removed from the blood. The following factors play an important role in this form of diabetes:
a) An insensitivity of body cells to insulin (insulin resistance). The insulin can no longer do its job properly because the body is insensitive to the insulin or
b) A reduced insulin secretion (secretion), too little insulin is produced by the islets of Langerhans.
Given the increased risk of cardiovascular disease, treatment focuses not only on reducing hyperglycemia (high blood sugars) – thus reducing the risk of microvascular complications and to a lesser extent macrovascular complications – but also addressing other cardiovascular risk factors, such as smoking, hypertension (high blood pressure) and dyslipidemia (abnormal fat levels)
The disease usually manifests itself in old age, > 25 years but usually above 40 years. The condition can go undetected for years. This form is also familiar with non-insulin-dependent diabetes. This type of diabetes can be seen in people who are much overweight (BMI > 27). Being overweight makes the liver produce extra glucose. This will cause the blood sugar level, which was already elevated anyway, to rise even further. This form of diabetes is also known as 'adult diabetes'.
Read this What are the differences between type 1 and type 2 diabetes
The symptoms of type1 and type2 are the same. The symptoms only occur much more gradually, because the effective amount of insulin in the body decreases much more slowly than in type 1 diabetes. Diabetes is often discovered by chance, for example during a blood or urine test for an examination. Type 2 diabetes occurs in 15 to 20 out of 1000 people, which is 1.5 to 2% of the Dutch population. In these people, fat metabolism and blood pressure are often disrupted.
Type 2 diabetes is usually treated with medication, nutrition, and exercise advice. Sometimes you also have to start injecting insulin after a while. In the past, people who were older than 60 years mainly developed type 2 diabetes. That is why it is frequently referred to as "old age sugar.". But that term is obsolete because type 2 diabetes is now also common in younger people, even children.
2. Effects of diabetes on physical processes
Because too little insulin is present, too little glucose ends up in the cells. Glucose is the energy source of a cell. In diabetes, the cells rely on other substances for energy, mainly fats. This causes more fat to be broken down, and the fat products end up in the blood. In addition, other symptoms occur in DM, which are caused by the elevated glucose level in the blood.
Insulin deficiency not only causes a disturbance in sugar metabolism but also in protein and fat metabolism. The effects of this can be seen in vital organs such as the central nervous system, the cardiovascular system (heart and blood vessels), and the kidneys.
Insulin deficiency has the following effects:
2a. Influence on sugar metabolism
Because glucose cannot enter the cells sufficiently, a high sugar level in the blood occurs (called hyperglycemia). When the blood glucose level exceeds a specific threshold, the glucose is expelled into the urine. This is accompanied by a loss of water. This causes complaints of weight loss (calorie loss), frequent urination, and a feeling of thirst.
2b. Influence on fat metabolism
Due to a shortage of glucose in the cells, fat is broken down on a large scale, so that large amounts of waste products from this fat breakdown (fatty acids) appear in the blood. These fatty acids in the blood are broken down by the liver into certain waste products. This ultimately leads to further dehydration of the patient.
2c. Influence on protein metabolism
Due to a shortage of glucose in the cells, fewer proteins are built up in the cell. In addition, more protein is broken down. The waste products of these proteins enter the bloodstream and are partly converted back into glucose in the liver. This causes the blood glucose level to rise even further.
2d. Influence on the other substances in the cell (electrolyte ratio)
Insulin also has an effect on the electrolytes in the cell: potassium loss occurs, which can make the patient feel tired.
3. Complaints
Typically, blood glucose levels range between 4 and 10 mmol/l. If this falls outside this range, a hyper (hyperglycemia, too high glucose level) or a hypo (hypoglycemia, too low glucose level) may occur.
3a. Hyper
The glucose in the blood rises above 10, causing the diabetic to suffer from fatigue, sleepiness, thirst, dry mouth, tingling, numbness, tingling, frequent and frequent urination. If this hyper is not treated in time, someone can become unconscious. The treatment consists of drinking plenty of water, possibly adding insulin, and consulting with the doctor or diabetes nurse.
3b. hypo
One speaks of hypoglycemia when blood glucose levels are below 3.5 mmol/l. This is more common with hyperglycemia. Patients who use insulin sometimes suffer from it. A good attitude increases the chance of a hypo because normal and low blood sugar levels are close to each other. As a result, organs do not receive enough glucose to burn. The brain is especially sensitive to this because it is mainly dependent on glucose combustion. Low glucose levels in the blood can cause the following complaints: sweating, shaking, hungry stomach. If the glucose drops even further, complaints will arise that have to do with the reduced functioning of the brain (confusion, fatigue, dizziness, anxiety, concentration problems, difficulty speaking, etc.).
Treatment consists of increasing the level of glucose in the blood by:
have the patient take a carbohydrate-rich drink with at least 30 grams of sugar (fast-acting carbohydrates, lemonade).
glucose or glucagon injection. If the patient is unable to drink this due to a lowered consciousness, the GP injects 20-40 ml of a 50% glucose solution intravenously or, if this causes difficulties for example due to the patient's agitation, 1 mg glucagon subcutaneously (under the skin) or intramuscularly. (in the muscle). After the patient regains consciousness (within 2-3 minutes after glucose administration or within 15 minutes after glucagon injection), carbohydrate-rich food is still given.
hospital admission. Patients with severe hyperglycemia associated with drowsiness or coma, rapid and/or deep breathing, dehydration, or vomiting are hospitalized
Read this 7 tips for healthy recipes lowering sugar levels
4. Complications
In the long term, diabetes mellitus can be associated with complications in the form of damage to various organs. This is true for both kinds of diabetes, type 1 and type 2. An important factor in the development of these complications and the speed at which they progress is the degree of diabetes regulation. The worse a person is set, the greater the chance of this complication developing and rapidly aggravating. The complications can occur in different parts of the body:
- Impairment of large, medium, and small blood vessel abnormalities
- Damage to the smallest vessels and capillaries (capillaries)
- Nerve damage
Insulin increases glucose transfer from the blood to the cells. This is true for insulin-sensitive cells. Due to a (relative) shortage of insulin, a sugar level (glucose) that is too high in the blood and a sugar level that is too low in the cells occurs.
As a result, too high a blood sugar level directly leads to an increase in the glucose level in various tissues.
This excess of glucose leads to organ damage in a number of ways.
- Accumulations of glucose metabolism intermediates occur in cells, eg sorbitol, triggering a large number of chemical processes that lead to the eventual damage.
- Glucose can attach itself to all kinds of proteins, creating insoluble and harmful 'saccharification products'.
In the long run, symptoms occur in DM, which are caused by, among other things:
4a. Affecting abnormalities of large, medium, and small blood vessels.
This is called arteriosclerosis. Examples include the narrowing of blood vessels in the heart, brain, and legs. Mortality (death) from coronary heart disease is two times higher for men with DM type 2 and three times higher for women than in the general population.
4b. Damage to the smallest vessels and capillaries (capillaries).
The damage to the small blood vessels is called microangiopathy. This can occur in almost all organs, for example:
in the kidneys: This is called nephropathy. The kidney is located under the ribs (see left drawing, right in the picture, bean-shaped). This can lead to insufficient functioning of the kidneys (renal insufficiency), with an increase in protein excretion in the urine, fluid retention, and high blood pressure. Approximately 10% of dialysis patients have DM type-2 as their primary diagnosis. It is expected that nephropathy will occur more frequently in the future because DM type-2 develops at an increasingly younger age and life expectancy increases due to better treatment of cardiovascular risk factors.
in the retina: This is called retinopathy. This website is mainly about the eye defects that can arise in diabetes mellitus. There is a special folder about diabetes and eyes and many retinal photos and retinal abnormalities ( photo gallery ).
4c. Nerve damage
This is called neuropathy. This can affect various nerves, such as:
the motor or movement nerves: the muscles become thinner, paralysis may develop.
the sensory or sensory nerves: sensory disturbances can develop, especially in the legs and feet. In the Netherlands, about 2% of people with DM type-2 develop a diabetic ulcer (ulcer) every year and 0.6% undergo an amputation.
the 'autonomic' nerves: bladder problems, impotence, stomach problems.
Sometimes more serious abnormalities occur in the legs, called diabetic gangrene: this is usually the result of a combination of the above 3 factors: arteriosclerosis, microangiopathy and neuropathy, and sometimes an additional infection.
Foot clinic
Patients with diabetes mellitus can develop problems with their feet. A special risk group is dialysis patients who also suffer from diabetes. A podiatrist, orthopedic shoe technician, possibly a rehabilitation doctor and internist work together at the foot clinic to treat serious ulcers and inflammations on the foot at the earliest possible stage. If necessary, other specialists can be consulted. By working together with the various disciplines, a diagnosis can be made faster and the threatened foot can be treated more quickly. V Policy aimed at preventing and treating foot problems
Patients with a moderate or high risk of a diabetic foot ulcer (ulcer) are advised to have their feet inspected daily and to wear well-fitting footwear and socks without thick seams. In the event of an ulcer, they should immediately contact their GP. In patients with pressure sores and excessive callus formation, the GP checks whether the footwear is the main problem. If so, then advise buying well-fitting footwear or referral to a podiatrist. Sometimes treatment with antibiotics is necessary for an ulcer.
In the case of deformities or an abnormally wide foot, the general practitioner refers to a podiatrist, a rehabilitation doctor, or an orthopedic surgeon.
5. Epidemiology: how common is diabetes
5a. General
Based on various GP registration projects, the annual incidence (the number of new cases per year) of diabetes mellitus in the Netherlands is estimated at more than 3.5 per 1000, which amounts to approximately 60,000 new patients per year.
The prevalence (the total number of patients) of diabetes mellitus is estimated at 29.8 per 1000 (absolutely 475,000), with the prevalence in old age being higher among women than among men.
The number of people with diabetes mellitus, and therefore the number of diabetic patients with retinopathy (retina abnormalities), is steadily increasing; in 1993 there were 2500,000 diabetes patients, now 4750000 are registered by the general practitioners.
An increase of more than 50% is expected between 2020 and 2030. The number of type 2 diabetes patients is not only increasing due to aging and extended lifespan, type 2 diabetes mellitus is also becoming more common at a younger age. The incidence of type 1 diabetes is also increasing and the diagnosis is being made at a younger age than before.
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