What is diabetes?
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The differentiation between type 1 and type 2 diabetes in adults is not always clear-cut, as some individuals display features of both types. Blood tests are often necessary to identify the specific type of diabetes (refer to Diabetes tests for more information).
Diabetes can be associated with sudden or long-term complications or additional diseases. Sudden complications include low blood sugar (hypoglycemia) and too high blood sugar (hyperglycemia), as well as acid poisoning, or ketoacidosis.
Diabetic eye damage (retinopathy), nerve disease (neuropathy), and kidney disease are all long-term consequences (nephropathy). Diabetes also increases the risk of developing arterial diseases (coronary heart disease, cerebrovascular disorders, circulatory disorders of the legs) by a factor of two to four.
Tips to treat hyperglycemia in type 1 diabetes
Prevalence of diabetes
It is currently estimated that there are a total of about 1 in 5 people with diabetes. The great majority (75-80 percent) of them have type 2 diabetes. The next highest number of people with type 1 diabetes is about 50,000. There are fewer other types of diabetes.
According to Kela's statistics, 368,861 people bought antidiabetic drugs in 2016, and 326,354 people had special reimbursement for diabetes drugs. Of these, 6,840 people were under 20 years of age and 187,885 people were 65 years of age or older.
Type 1 diabetes is diagnosed every year in six out of 10,000 people under the age of 15. Its incidence has steadily increased until the last decade, after which it has stabilized at a level that is the highest in the world.
In practice, just over 600 people under the age of 20 get sick each year, which is about half of all people with type 1 diabetes.
Detection of diabetes
If necessary, a sugar stress test can also be used. In this case, fasting blood sugar is first measured. The person then drinks 75 g of glucose-containing fluid and the blood sugar is measured again after two hours.
The upper limit of normal blood sugar in the morning, after an overnight fast of at least 8 hours, is 6.0 mmol / l (millimoles per liter). If the blood sugar is 6.1 to 6.9 mmol / l, it is an elevated fasting sugar. The lower limit of diabetes is a blood sugar level of 7.0 mmol / l.
After eating, blood sugar typically increases by about 2 mmol/L. Normal blood glucose levels are below 7.8 mmol/L two hours after a meal or during a glucose test.
Blood sugar levels between 7.8 and 11.0 mmol/L indicate poor glucose tolerance. Diabetes is diagnosed when blood sugar levels reach or exceed 11.1 mmol/L.
Elevated fasting sugar and impaired sugar tolerance mean that sugar metabolism is disrupted. This condition is called pre-diabetes because the disorder without preventive measures progresses and turns into “real” diabetes over the years.
Glycated hemoglobin (measured as HbA1c in the blood) indicates the average blood sugar level over the past two to eight weeks. Elevated blood sugar levels cause more glucose to bind to the hemoglobin protein in red blood cells as they circulate over time.
The normal value is less than 42 mmol/mol (millimoles per mol), expressed as previously used percentages less than 6%. The lower limit for diabetes is HbA 1c 48 mmol/mol (6.5%). A value between 42 and 48 mmol/mol (6.0–6.5%) corresponds to pre-diabetes.
Read The role of insulin in diabetes
Different types of diabetes
Type 1 diabetes is caused by autoimmune inflammation of beta cells located in the insulin-producing islets of the pancreas. As a result, the cells and the production of insulin in them gradually cease.
Insulin replacement therapy is required for treatment. Diabetes usually breaks out when there are only about one-fifth of functional cells left. The disease itself, or autoimmune inflammation, has been in the pancreas for months or years before the actual onset of diabetes.
At the diagnosis stage, about 80% have detectable GAD antibodies in the blood as a sign of autoimmune inflammation. Type 1 diabetes is indicated by ketones in the blood in insulin deficiency and by insulin deficiency in a blood test (C-peptide).
It is still not known exactly what causes autoimmune inflammation that destroys cellular islets in each individual. This is due to hereditary susceptibility and the interaction of viruses and the gut's own microbes.
Only a small percentage of people with type 1 diabetes have a family history of the disease. If a sibling has type 1 diabetes, there is a 6% chance (6 out of 100) that other children in the family will develop the condition.
If the father has diabetes, the risk of the child getting the disease by the age of 20 is 8% (8 out of 100), and if the mother has diabetes, the risk is 5% (out of 5 hundred).
LADA (Latent Autoimmune Diabetes in Adults) is an autoimmune condition where the insulin-producing beta cells in the pancreas become inflamed. This form of diabetes typically affects individuals between 40 and 60 years old and shares characteristics of both type 1 and type 2 diabetes.
Depletion of one's own insulin production does not usually occur as rapidly as in classic type 1 diabetes, and a person may survive on lifestyle and tablet therapy for a long time. LADA diabetes can be considered as a slowly developing type 1 diabetes.
In type 2 diabetes, there is a reduced effect of insulin on the tissues, ie insulin resistance, for years before the blood sugar rises. Other features of insulin resistance include obesity in the waist, fatty liver, high blood pressure, an increase in blood fat levels, and a decrease in good HDL cholesterol. Insulin resistance is also called metabolic syndrome.
Insulin resistance occurs when the transfer of glucose from the blood into the cells requires more insulin than normal. To facilitate this transfer, the pancreas must produce extra insulin, leading to an initially higher level of insulin in the blood.
Over time, the pancreatic insulin-producing beta cells do not function enough to meet the increased need and blood sugar rises. In general, pre-diabetes, which develops into diabetes, is usually diagnosed unless effective lifestyle therapy, such as weight loss, exercise, and diet, reduces insulin requirements and meets pancreatic insulin secretion.
Following the diagnosis of diabetes, the activity of insulin-producing beta cells in the pancreas continues to decline over the years.
About a third of people have an inherited predisposition to type 2 diabetes. Hereditary predisposition alone rarely leads to illness if a person remains at normal weight and exercises. This tendency often leads to diabetes, especially if weight gain results in central obesity.
Middle-aged individuals who are 15 pounds or more overweight have a 10 to 20 times higher risk of developing diabetes compared to those of normal weight. Additionally, lack of exercise is a significant contributing factor to type 2 diabetes.
MODY diabetes (maturity-onset diabetes in the young ) is an inherited type of diabetes that occurs in less than 5% of people with diabetes. The disease is predominantly inherited, so if one parent has the disease, half of the children inherit it.
There are many different subtypes of MODY. Some have enough diet and exercise to treat them, and some need diabetes pills or insulin treatment.
MODY diabetes may not appear in a woman for the first time until pregnancy. In addition to MODY, other types of hereditary diabetes are known and are very rare.
Diabetes due to pancreatic disease results in varying degrees of insulin deficiency that requires tablets or insulin to treat. Insulin-producing islet beta cells are located in the pancreas, so various pancreatic diseases can impair their function.
Such pancreatic diseases include, for example, pancreatitis caused by cholelithiasis or heavy alcohol consumption, tumors, and iron accumulation disease.
Gestational diabetes (gestational diabetes) means an increase in blood sugar during pregnancy. Insulin requirements are increased by pregnancy hormones and weight gain.
Mother and baby will be adversely affected in pregnancy if the blood sugar goes up. In addition to diet therapy, some require tablet therapy or insulin therapy.
Blood sugar usually returns to normal after childbirth. Elevated blood sugar during pregnancy may also be due to undiagnosed type 2 diabetes, incipient type 1 diabetes, or MODY diabetes.
After gestational diabetes, the mother’s risk of developing type 2 diabetes, later on, is greatly increased, and therefore preventive measures and follow-up are important.
Symptoms of diabetes
In type 1 diabetes, symptoms appear gradually over a few days or weeks. If the detection of type 1 diabetes is delayed, insulin deficiency can lead to acid poisoning or ketoacidosis.
This weakens the general well-being and makes breathing throbbing. Immediate hospitalization is required as the situation is life-threatening.
Type 2 diabetes begins to creep. The disease develops gradually over several years and does not cause severe symptoms.
When tests are done for other reasons diabetes is diagnosed often by chance. Sometimes type 2 diabetes is diagnosed only based on advanced co-morbidities or in connection with a heart clot.
Symptoms of type 2 diabetes can encompass tiredness, particularly after meals, mood swings or depression, leg pain or altered sensations, vision problems, and heightened susceptibility to infections. When blood sugar levels increase significantly, the early signs of high blood sugar become more evident.
Read Hypoglycemia in diabetes symptoms and treatment
Treatment of diabetes
The primary objective of diabetes treatment is to regulate blood sugar levels to be as close to normal as possible. Besides insulin secretion and its effects, factors such as diet, exercise, stress, and other illnesses also influence blood sugar.
Various antidiabetic medications can help lower blood sugar levels. Along with insulin, there are other injectable drugs and several oral medications that work through different mechanisms.
insulin is a necessity to type diabetes from the time when it is detected. In type 2 diabetes, if diagnosed at an early stage, it is possible to do without medication if weight loss, diet, and increased exercise restore blood sugar to normal.
If your morning or pre-meal blood sugar is above 6 mmol / l or your HbA 1c is above 42 mmol/mol, add oral medications. Over time, several different drugs, often including insulin, are usually needed simultaneously.
Self-measurements of blood sugar, tissue sugar (sensing), and sugar hemoglobin are used to assess the treatment's effectiveness. According to the treatment recommendation, the target hemoglobin value for sugar is less than 53 mmol/mol (7.0%).
In addition to blood sugar, attention is paid to the prevention of cardiovascular disease, especially through diet and lifestyle that promotes heart health.
Because people with diabetes have a higher risk of arterial disease, they have lower target blood pressure and blood cholesterol levels. People with type 2 diabetes, as well as those who have had type 1 diabetes for a long time, frequently require medicine for high blood pressure and cholesterol.
Additional diseases of diabetes
Long-term blood glucose levels are reflected by the “sugaring” of red blood cells, or the HbA 1c test, with an upper limit of normal for normal hemoglobin of 42 mmol/mol (6%) and a general therapeutic goal of less than 53 mmol/mol (7%). (8%), the risk of co-morbidities is 5-fold and at 86 mmol/mol (10%).
The risk is 18-fold higher than with normal blood glucose (see figure ). In this case, the target for HbA 1c is less than 42-53 mmol/mol (6-7%), depending on the type of diabetes, the treatment, and the sensitivity of low blood sugar.
Picture the Relationship between hemoglobin concentration in diabetes and organ changes in diabetes. Relationship between glycemic hemoglobin levels and organ changes in diabetes (see Diabetes ).
The risk associated with an upper limit of 6.0% (42 mmol/mol) of the hemoglobin reference value (normal value) is indicated in section 1.0. The risk increases sharply as the hemoglobin value of the sugar rises. At 9% (75 mmol/mol) hemoglobin, the risk is tenfold, and at 12% (108 mmol/mol) fifty-fold.
High blood sugar damages small blood vessels (capillaries) and arteries, which can cause serious damage to certain organs. The retinal disease of the eye, or retinopathy, can result, which can impair vision over time.
Another significant additional disease is kidney disease or nephropathy. Its first manifestation is the continuous excretion of protein in the urine (albuminuria). The progression of kidney changes can be prevented with good treatment of diabetes and blood pressure
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