Diabetes is a group of metabolic disorders characterised by high blood sugar level over a prolonged period of time. Symptoms often include frequent urination, increased thirst and hunger. If left untreated, diabetes can cause many health complications. Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state or death. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, damage to the nerves, damage to the eyes and cognitive impairment.
World Diabetes Day is held on November 14 each year. Primarily it is used as a campaign for focusing global awareness on diabetes mellitus. Led by the International Diabetes Federation (IDF), the World Diabetes Day focuses on a theme related to diabetes. Type-2 diabetes is largely preventable. It is a treatable non-communicable disease that is rapidly increasing worldwide. Type 1 diabetes is not preventable but can be managed with insulin injections. While the campaigns last the whole year, the day itself marks the birthday of Frederick Banting who, along with Charles Best and John James Rickard Macleod, first conceived the idea which led to the discovery of insulin in 1922.
Diabetes occurs due to either the pancreas not producing enough insulin, or the cells of the body not responding properly to the insulin produced. There are three main types of diabetes mellitus:
a) Type 1 diabetes results from failure of the pancreas to produce enough insulin due to loss of beta cells. This form was previously referred to as ‘insulin dependent diabetes mellitus’ or ‘juvenile diabetes’. The loss of beta cells is caused by an autoimmune response. The cause of this autoimmune response is unknown.
b) Type 2 diabetes begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses, a lack of insulin may also develop. This form was previously referred to as ‘non-insulin dependent diabetes mellitus’ or ‘adult-onset diabetes’. The most common cause is a combination of excess body weight and insufficient exercise.
c) Gestational diabetes is the third form; it occurs when pregnant women without previous history of diabetes develop high blood sugar levels.
Type 1 diabetes must be managed with insulin injections. Prevention and treatment of type 2 diabetes involves maintaining a healthy diet, regular physical exercise, a normal body weight and avoiding use of tobacco.
As of 2019, an estimated 463 million people had diabetes worldwide with type 2 diabetes making up about 90 per cent of the cases. Rates are similar in women and men. Trends suggest that rates will continue to rise. Diabetes at least doubles a person’s risk of early death. In 2019, diabetes resulted in approximately 4.2 million deaths.
Diabetes is the seventh leading cause of death globally. The classic symptoms of untreated diabetes are unintended weight loss, increased urination, increased thirst and hunger. Symptoms may develop rapidly in type 1 diabetes, while they usually develop much more slowly and may be subtle or absent in type 2 diabetes. Several other signs and symptoms can mark the onset of diabetes although they are not specific to the disease. In addition to the known symptoms listed above, they include blurred vision, headache, fatigue, slow healing of cuts and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. Long-term vision loss can also be caused by diabetic retinopathy. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.
People with diabetes may also experience diabetic ketoacidosis (DKA), a metabolic disturbance characterised by nausea, vomiting and abdominal pain, the smell of acetone on the breath, deep breathing and in severe cases a decreased level of consciousness. DKA requires emergency treatment in hospital. A rarer but more dangerous condition is Hyperosmolar Hyperglycemic State (HHS), which is more common in type 2 diabetes and is mainly the result of dehydration caused by high blood sugars.
Insulin is the principal hormone that regulates the uptake of glucose from the blood into most cells of the body, especially liver, adipose tissue and muscle, except smooth muscle, in which insulin acts. Therefore, deficiency of insulin or the insensitivity of its receptors plays a central role in all forms of diabetes mellitus. There is no known preventive measure for type 1 diabetes. Type 2 diabetes, which accounts for 85–90 per cent of all cases worldwide, can often be prevented or delayed by maintaining a normal body weight, engaging in physical activity, and eating a healthy diet.
Diabetes management concentrates on keeping blood sugar levels as close to normal, without causing low blood sugar. This can usually be accomplished with dietary changes, exercise, weight loss and use of appropriate medications, insulin injections and oral medications. Learning about the disease and actively participating in the treatment is important, since complications are far less common and less severe in people who have well-managed blood sugar levels. Attention is also needed to be paid to other health problems that may accelerate the negative effects of diabetes.
The writer is working with Southeast University, Bangladesh