Melomed Articles


12 June 2020 - Dr. Jean-Paul Kanyik

Diabetes


Many ancient civilizations recognized an ailment which they called differently such as honey urine by a Egyptians. In the first century CE, a Greek physician described an illness characterized by intense thirst and melting down of flesh and limbs into urine, he called it diabetes from Greek Siphon.                              
Diabetes is a condition where the amount of glucose in the circulating blood exceed certain limits. It is associated with multiple complications, some studies have shown that, the risk of dying is almost double in diabetics than in non-diabetics, hence public health problem. Statistics speaks by themselves: over 463 million affected Worldwide, in South Africa the number of adults with diabetes was 4.6 million in 2019 (12.7%), with more than 90 000 diabetes related deaths. 

Commonly used words
Glucose: Breakdown product of starch, it is the major source of energy
Lipid: Breakdown product of fat
HbA1c (Glycated haemoglobin): Protein that bind free glucose on the red blood cells. HbA1c can be used to monitor glucose control in the last 3 months.
Insulin: Produced in the Pancreas, insulin promote glucose uptake by tissues

Types
Type 1 diabetes: generally, start at a young age, it is cause by complete lack of insulin production by insulin producing cells in the pancreas.  Those cells may have been destroyed by the body own immunity.

Type 2 Diabetes: Start later in life, it is caused by insufficient insulin production and or resistance. There is familial predisposition to develop type 2 diabetes and overweight play an important role.

Gestational diabetes mellitus: Diabetes diagnosed in pregnancy that was not clearly overt prior gestation.

Diabetes due to other diseases (such as pancreatitis) or medications (such as prednisone). 

Symptoms
Thirst
Polyuria (increased urination)
Nocturia (increased nocturnal urination)
Hyperphagia
Tiredness and fatigue
Weight loss
Other symptoms: Nausea, headaches, blurred vision, irritability, difficult in concentrating. 


Diagnostic
Blood glucose level is the mainstay of diagnosis, this can be done Fasting or Random.

A fasting blood glucose of 7 mmol/l or more and random glucose of 11 mmol/l or more are usually diagnostic. When the diagnosis is not clear, doctors normally perform what is called glucose tolerance test, this entailed ingestion of 75 g of glucose then testing blood glucose after 2 hours.  

HbA1c is a useful test, it is not only used to monitor patient's glucose control but also to make diagnosis of diabetes mellitus.


Complications
In type 1 diabetes, insulin production is lacking, patients usually present with what we call Diabetic Ketoacidosis. When the body is not able to use glucose for energy production, whilst using lipids as alternative source of energy, glucose level builds up in the blood leading to dehydration and accumulation of ketone bodies. Ketones are acidic; Just like when we use fossils to generate electricity, there is increase carbon emission with detrimental consequences on the environment, acidic blood is not good for the body, apathy, confusion, air hunger, cold extremities and signs of dehydration occur.

As opposed to type 1, type 2 diabetes is characterized by slow and progressive insulin deficiency and/or resistance therefore associated organ damage. Diabetes complications are related to changes in blood vessel's structure, depending on the location and the size of the blood vessel this may affect the following organs:
Brain: Stroke, dementia
Eyes: blindness, bleeding in the eye, cataract
Heart: Myocardial infarction, commonly called Heart attack
Kidneys: Various stage of Kidney failure
Lower limbs: Pins and needle, numbness, poor blood circulation and Leg ulcers which can lead to amputation.

Management
First step and very important in diabetes management is dietary and lifestyle modification. This is achieved with diabetes education which will address issues related to healthy diet, exercise, smoking cessation, alcohol intake and self-glucose monitoring.

The second step is medications, its choice will depend on the type of diabetes and the presence of complications. For type 1 diabetes the treatment is insulin injections, for type 2 it might be oral medications, oral medications with insulin injections or insulin alone.

In parallel to diabetes treatment, doctors will treat other cardiovascular risk factors such as high blood pressure and high cholesterol.

Conclusion
Diabetes is a common illness and has devastating complications therefore public awareness is important. Lifestyle modification and good glycaemic control will reduce complications.

Melomag

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