Diabetes Symptoms, Types, Diagnosis & Treatment
Energy Metabolism and Diabetes
Sugar is the body's primary source of energy. Sugar is obtained in two ways;
- It can be taken with foods containing carbohydrates (external source),
- It is stored in the liver; when necessary, it is given to the blood (internal origin).
Sugar taken with food passes into the stomach to the intestines and is absorbed into the blood. The insulin hormone produced in the pancreas regulates the sugar level in the circulation. When blood sugar rises, it is released from the pancreas and reduces blood sugar to normal levels.
How Are Carbohydrates Used in Our Body?
After the carbohydrates are digested, they are absorbed from the intestines and pass into the blood as sugar. Sugar is stored as glycogen in the liver and muscles. The brain does not store sugar but uses it constantly.
Pancreas: It is an organ located in the abdomen behind the stomach and produces essential enzymes and hormones for the body. Insulin is one of them.
Insulin: It is a hormone that controls the energy balance in the body. Its task is to ensure that the sugar in the blood enters the cell. The sugar entering the cell is used as an energy source. Thus, the rise of sugar in the blood is prevented.
Normal Blood Sugar Values
The glucose level measured after fasting for at least 8 (ideally 10) hours is called fasting blood sugar. Normal value is 70-100 mg/dl. The blood sugar measured 2 hours after starting the meal is called 'postprandial blood sugar' and should be below 140 mg/dl under normal conditions.
Insulin is necessary for sugar to enter the cell. Insulin acts as the key that opens the cell's door for sugar to enter the cell. When the pancreas cannot produce enough insulin or perform its vital function (insulin resistance), sugar cannot enter the cell and turn into energy. Therefore, sugar begins to rise in the blood. In healthy individuals, blood sugar and insulin levels vary in parallel and within narrow limits. For example, it increases after eating and decreases during sleep and rest periods.
Diabetes develops when insulin production is decreased in the pancreas or when insulin production is sufficient but fails to show sufficient effect at the level of tissues and organs. It is called 'Diabetes Mellitus' in the medical language and is known as 'Diabetes' in the common language.
What are the types of diabetes?
- Type 1 Diabetes
- Type 2 Diabetes
- Gestational Diabetes
- Other Types
Type 1 Diabetes Symptoms and Diagnosis
- After 8 hours of fasting, if the blood glucose level of the person is above 126 mg/dl,
- After 2 hours of the Oral Glucose Tolerance Test if the glucose level of the person is above 200 mg/d.,
- In individuals with symptoms such as polydipsia and polyuria, if the blood glucose level is above 200 mg/dl at any time, it is defined as “diabetes.”
In people with type 1 diabetes, the pancreas cannot produce enough insulin. Due to the lack of insulin, circulating sugar cannot enter the cell and cannot be converted into energy. The inability of circulating sugar to enter the cell causes blood sugar to rise and is filtered through the kidneys and excreted in the urine. The passing of sugar into the urine also causes fluid loss in the urine, and if this loss is not met, it leads to thirst in the body.
Signs and Symptoms of Type 1 Diabetes:
- Weakness and fatigue.
- Persistent thirst/dry mouth.
- Drinking a lot of water: To compensate for the lack of body water lost through urine.
- Frequent and copious urination: To remove excess circulating sugar from the body.
- No nighttime urination or even bedwetting.
- Eating frequently: Since the sugar taken with food cannot pass into the cell and cannot be used to produce energy, there is a feeling of hunger. This leads to frequent eating. In young children, this may not be noticed.
- Weight loss: Since sugar cannot enter the cells, the body burns its fat and protein to produce energy. Weight loss occurs due to fatty tissue and muscle destruction.
- Behavior change: A person who wakes up frequently to urinate at night cannot sleep well, and high sugar levels also cause behavioral changes.
Diabetes symptoms are less than a month in most people with diabetes. When these symptoms are not noticed, children often come to the hospital in a coma called diabetic ketoacidosis. Ketoacidosis coma is a severe and life-threatening condition.
What are the Causes of Type 1 Diabetes?
There are three significant risk factors for the development of type 1 diabetes:
- Hereditary (genetic) factors
- Allergy developed by the person against himself
- Environmental factors (virus, chemical substances)
Type 2 Diabetes Symptoms and Diagnosis
The most common clinical symptoms of type 2 diabetes are;
- Drinking a lot of water,
- Urination a lot
- Frequent urination at night
- Eating a lot,
- Weight gain or weakening
- Blurred vision,
- Vaginal itching in women,
- Weakness and fatigue.
Diagnosis of Type 2 Diabetes and Hidden Diabetes (Prediabetes)
Three different tests can be used to diagnose diabetes: Measuring blood glucose, testing blood glucose after fasting, and HbA1c (glycosylated hemoglobin A1c) in the Oral Glucose Tolerance Test. Diabetes is diagnosed based on the symptoms of the applicant and the results of these tests.
Type 2 Diabetes Risk Factors
- Genetic predisposition: Those who have a history of diabetes in their first-degree relatives,
- Those with a history of cardiovascular disease,
- Those who are overweight (especially those with high abdominal fat accumulation; abdominal obesity; apple type obesity),
- Those with high blood pressure
- Mothers who have given birth to over 4 kg,
- Diagnosed with gestational diabetes,
- Those with prediabetes: those with a fasting blood glucose level of 100–125 mg/dl or a blood glucose level of 140–199 mg/dl at the 2nd hour in an oral glucose tolerance test,
- Those with low physical activity
- Those whose triglyceride level is 250 mg/dl and above and High-Density Lipoprotein-Cholesterol 35 mg/dl and below,
- Unhealthy diets (rich in carbohydrates and saturated fats, low in fiber)
- Those over 45 years old,
- Women with Polycystic Ovary Syndrome are candidates for diabetes.
Preventable risk factors
- Lack of physical activity,
- Unhealthy diet (a diet rich in carbohydrates and saturated fats, low in fiber).
What is Hidden Diabetes (Prediabetes)?
The intermediate period between normal and diabetes is called 'Prediabetes (Hidden Diabetes).’ An individual with impaired glucose tolerance or any of the high-risk status stages is prediabetic. If this person cannot adopt and implement healthy lifestyle changes, diabetes may develop. The progression from prediabetes to diabetes often takes years.
Gestational Diabetes (Gestational Diabetes Mellitus)
Gestational diabetes mellitus is defined as glucose intolerance that first appears during pregnancy. However, this definition is sometimes insufficient to distinguish cases diagnosed during pregnancy (pregestational diabetes not diagnosed before pregnancy) even though they had diabetes before pregnancy from cases of gestational diabetes.
With the increase in obesity and diabetes, pregnant women with undiagnosed type 2 diabetes increase. For this reason, it is recommended to diagnose 'overt diabetes' instead of gestational diabetes in pregnant women who are diagnosed with diabetes according to standard criteria at the first prenatal visit. GDM is estimated to occur in approximately 10% of pregnancies. This rate varies between 1% and 22%, depending on the population studied and the diagnostic methods used.
Gestational diabetes usually develops after the 24th week of pregnancy due to placental hormones blocking the effects of insulin (increasing insulin resistance). Dysregulation of blood glucose during pregnancy can negatively affect both mother and baby, especially in patients with diabetes before pregnancy.
The risk of preeclampsia and preterm birth is increased in mothers who are diagnosed with gestational diabetes. In newborns, it may cause macrosomia, neonatal hypoglycemia, jaundice, hypocalcemia, polycythemia, respiratory distress syndrome (RDS), congenital malformations, and stillbirth.
Although most women with gestational diabetes improve glucose metabolism after delivery, the risk of recurrence of gestational diabetes in subsequent pregnancies is high (approximately 50%). The risk of developing type 2 diabetes in their future lives reaches up to 70-80%. For this reason, women diagnosed with gestational diabetes should be considered as prediabetic and included in diabetes prevention programs and followed-up, even if their diabetes improves after delivery.
Other Types of Diabetes
Apart from type 1, type 2, and gestational diabetes, some conditions (drug use, pancreatic diseases, infections, endocrine diseases, etc.) may also cause diabetes, or some rare genetic syndromes may be accompanied by diabetes.
In addition, familial forms of diabetes due to a single gene mutation (monogenic) can also be seen. These monogenic forms of diabetes, which are generally seen rarely, include; It should be kept in mind that ‘maturity-onset diabetes of the young' may occur in patients who have at least three generations of diabetes in their family and who have most of the characteristics of type 2 diabetes apart from obesity, especially although it starts at a young age.
The most crucial treatment component of the disease is establishing a healthy lifestyle. To create a healthy lifestyle, eating healthy, increasing physical activity, maintaining an ideal body weight, quitting smoking, and limiting alcohol consumption are fundamental. A critical component is also drug therapy. These are oral sugar-lowering drugs, insulin, and non-insulin drugs. Treatment should be planned individually. Diabetes education is necessary for the successful implementation of these treatment components by the individual with diabetes.
Education raises awareness of individuals with diabetes. Individuals who receive diabetes education are more successful in providing diabetes control. For this reason, it is recommended that all people with diabetes receive diabetes education. Diabetes education should cover not only the diabetic patient but also the family of the diabetic, healthcare professionals, and decision-makers.