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How do you get diabetes?
Diabetes mellitus (DM) is a syndrome of chronic hyperglycaemia
due to relative insulin deficiency, resistance or both.Diabetes is usually irreversible and, although patients can lead a reasonably normal lifestyle, its late complications result in reduced life expectancy and major health costs.
These include macrovascular disease, leading to an increased prevalence of coronary artery disease, peripheral vascular disease and stroke, and microvascular damage causing diabetic retinopathy and nephropathy. Neuropathy is another major complication.
Primary diabetes is classified into:
- Type 1 diabetes, which has an immune pathogenesis and is characterized by severe insulin deficiency.
- Type 2 diabetes, which results from a combination of insulin resistance and less severe insulin deficiency.
How do you get diabetes?
Type 2 diabetes mellitus which was previously referred to as non-insulin-dependent diabetes mellitus (NIDDM) is the predominant form worldwide, accounting for 90% of patients with DM. Tissue insensitivity to insulin action (i.e. insulin resistance), and an inability of the pancreatic b-cells to compensate adequately for this, leads to overproduction of glucose by the liver and under utilisation by other tissues, with an inevitable rise in blood glucose levels – i.e. there is relative insulin deficiency.
Genetics
Typically, in Type 2 Diabetes Mellitus (DM) there is a positive family history. In most affected individuals the inherited component is likely to be polygenic, involving interaction between multiple genes involved in both insulin secretion and insulin action. Overall, the risk of a sibling or offspring of a person with type 2DM developing the condition is high (as much as 33%; identical twins are affected in 60–100% of cases).
Environmental/other factors
Type 2 DM, is strongly linked to obesity, which predisposes to insulin resistance. So any daily activity which make you obese will lead to diabetes after many years.
- Diet – Consuming high Carbohydrate and Fat diet is a major predisposing factor for diabetes. So, food for people with diabetes should be:
- Low in sugar (though not sugar free)
- High in starchy carbohydrate (especially foods with a low glycaemic index), i.e. slower absorption
- High in fibre
- Low in fat (especially saturated fat).
The overweight or obese should be encouraged to lose weight by a combination of changes in food intake and physical activity.
- Physicaal Inactivity – Lack of physical activity is one of the major causes for having obese as well as diabetes in future. So Excerxise should be encouraged for normal people and patients who are having Diabetes Mellitus. Diet treatment is incomplete without exercise. Any increase in activity levels is to be encouraged, but participation in more formal exercise programmes is best. Where facilities for this exist, exercise should be prescribed for everyone with diabetes. Several trials have shown that regular exercise reduces the risk of progression to type 2 diabetes by 30–60%, and the lowest long-term morbidity and mortality is seen in those with established disease who have the highest levels of cardiorespiratory fitness. Both aerobic and resistance training improve insulin sensitivity and metabolic control in type 1 and type 2 diabetes, although reported effects on metabolic control are inconsistent. Patients on insulin or sulfonylureas should be warned that there is an increased risk of hypoglycaemia for up to 6–12 h following heavy exertion.
CLINICAL PRESENTATION OF DIABETES
Presentation may be acute, subacute or asymptomatic.
Acute presentation
Young people often present with a 2–6-week history and report the classic triad of symptoms:
- Polyuria – due to the osmotic diuresis that results when blood glucose levels exceed the renal threshold
- Thirst – due to the resulting loss of fluid and electrolytes
- Weight loss – due to fluid depletion and the accelerated breakdown of fat and muscle secondary to insulin deficiency.
- Ketonuria is often present in young people and may progress to ketoacidosis if these early symptoms are not recognized and treated.
Subacute presentation
The clinical onset may be over several months or years, particularly in older patients. Thirst, polyuria and weight loss are typically present but patients may complain of such symptoms as lack of energy, visual blurring (owing to glucose-induced changes in refraction) or pruritus vulvae or balanitis that is due to Candida infection.
Complications as the presenting feature
These include:
- Staphylococcal skin infections
- Retinopathy noted during a visit to the optician
- A polyneuropathy causing tingling and numbness in the feet
- Erectile dysfunction
- Arterial disease, resulting in myocardial infarction or peripheral gangrene.
Asymptomatic diabetes
Glycosuria or a raised blood glucose may be detected on routine examination (e.g. for insurance purposes) in individuals who have no symptoms of ill-health. Glycosuria is not diagnostic of diabetes but indicates the need for further investigations. About 1% of the population have renal glycosuria. This is an inherited low renal threshold for glucose, transmitted either as a Mendelian dominant or recessive trait.
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