Introduction

The goal of this chapter is to provide an easy understanding of Diabetes. This disease can cause complications that can lead to death if not managed properly. The chapter will cover the two types of diabetes known as Type 1 and Type 2, and it will elaborate on each one of them. You will better understand this disease, how it is diagnosed, how it is managed, and what complications result from poorly controlled management. 

What is Diabetes?

The two types of Diabetes this chapter will cover are Type 1 and Type 2. The pathophysiology of them differs from each other, but they both result in similar complications. With Type 1 Diabetes, there is no insulin production from the pancreas, which results in high blood sugar levels known as hyperglycemia. In Type 2 Diabetes, there is some insulin production; however, it is not utilized properly by the body cells resulting in hyperglycemia. 

Now, you may be asking yourself, what is insulin? Insulin is a hormone produced by the pancreas’ beta cells and is secreted when there are high blood glucose levels in the body. Insulin regulates blood glucose levels by guiding glucose into cells, specifically the liver, muscle, and adipose tissues. When there is an excess of glucose, the liver stores it as glycogen for later use.

As mentioned, Type 1 Diabetes is when there is no insulin production. This is known as insulin deficiency, and this form of diabetes is considered an autoimmune disease because there is destruction to the pancreas’ beta cells. This results in insulin dependency because individuals with this type of diabetes will require exogenous insulin to control their glucose levels. Type 2 Diabetes is not considered an autoimmune disease because there is no destruction to the pancreas. Type 2 Diabetes is insulin resistance; the body’s cells do not respond appropriately to the insulin. This type of Diabetes develops from obesity, sedentary lifestyle, and unhealthy dietary intake, and it was commonly seen in older adults over the age of 40. Still, it is now seen in young children and adolescents due to the increased incidence of obesity. These individuals do not necessarily require insulin, but if they do not manage their Diabetes appropriately, they can become insulin-dependent.  

How do I know if I am at risk for Diabetes?

Several modifiable and non-modifiable factors can increase your risk of diabetes. Non-modifiable risk factors include age, hereditary, gender, and family history. Modifiable risk factors can be altered, including obesity/overweight, high blood pressure, sedentary lifestyle, and smoking.  

What causes Diabetes?

The cause of Type 1 diabetes is not quite well known. Still, there may be a relationship between genetics and environmental factors that may have triggered the immune system to attack itself, specifically the pancreas’ beta cells.

The cause for Type 2 diabetes is unknown, but there is a belief that there is a genetic and environmental predisposition to it. There has also been a link between obesity and type 2 diabetes. 

Clinical Findings

The symptoms for Diabetes type 1 and type 2 are similar, and that includes

• Increased thirst
• Frequent urination
• Extreme hunger
• Fatigue
• Unexplained weight loss (Type 1 DM)
• Slow-healing sores
• Frequent infections

Acute Complications

Acute complications of diabetes are conditions called hypoglycemia, Diabetic Ketoacidosis (DKA), and Hyperosmolar Hyperglycemia State (HHS). These are life-threatening conditions, and immediate medical intervention is required. In hypoglycemia, there is a low level of blood sugar in the body, and this is dangerous because the brain requires glucose for energy. Hypoglycemia can occur using insulin, skipped meals, alcohol, and unplanned exercise without medication adjustment. DKA occurs mostly in Type 1 DM due to the no insulin production in the body. With the lack of insulin, the glucose remains in the bloodstream, and the body’s natural response is to burn adipose tissue to utilized that stored glucose for energy. The problem with this process is the byproduct that results from the adipose tissue, which is ketones, which can turn the body into an acidotic state, damaging cells. HHS is when a higher concentration of solutes (glucose) in the bloodstream leads to dehydration. This results when blood sugars are greater than 600 mg/dL, which causes the body to excrete urine to eliminate the glucose that way. This only increases glucose in the bloodstream due to the excretion of fluids in urine, worsening the dehydration status, which can be fatal. There are no ketones if any, very minimal byproducts with this complication, making this a common Type 2 DM situation. 

Author: Jocelin Flores

Diagnostics

Diagnosis of type 1 diabetes symptoms often appear suddenly and unexpectedly. It can appear through flu-like symptoms for the individual.

Pre-diabetes is when blood sugar levels are higher than normal but not yet high enough to be diagnosed as diabetes. An individual diagnosed with pre-diabetes put them at a higher risk for developing type 2 diabetes and cardiovascular disease. There are no clear pre-diabetes symptoms, so it can be possible for an individual to have pre-diabetes and not know it. Results that are considered to be pre-diabetes are an A1c of 5.7% to 6.4% and fasting blood glucose of 100 to 125 mg/dl.

HgA1c Testing

hgA1c test measures an individual’s average blood sugar for the past two to three months. The pro of this test is that an individual does not have to fast or drink anything. Diabetes is diagnosed at an A1C of greater than or equal to 6.5%. If an individual has a normal A1C, it should read less than 5.7%; for pre-diabetes, it is 5.7% to 6.4%, and for diabetes, it is 6.5% or higher.

Fasting Plasma Glucose

Fasting Plasma Glucose is a test that checks for fasting sugar levels. Having to fast helps give doctors a clear look at how the body manages blood sugar levels without food intake. It is done when they suspect the individual to have type 1 or type 2 diabetes. Diabetes is diagnosed with a fasting blood sugar level of 126 mg/dl or greater. A normal fasting plasma glucose level is less than 100mg/dl, and a plasma glucose level of 100 mg/dl to 125 mg/dl is considered pre-diabetes.

Random Plasma Glucose Testing

Random Plasma Glucose Test is a blood test that checks at any time of the day when an individual has diabetes symptoms. It is measuring how much glucose is circulating in an individuals’ bloodstream. A level that is under 200 mg/ml is acceptable; a level higher than 200 mg/ml with symptoms of diabetes such as blurry vision, excessive urination/ thirst is a signal of diabetes.

Nutritional Strategies

There is no exact or single diet plan for an individual with diabetes. Nutritional strategies for diabetic individuals are diets that consist of whole grains, fruits, vegetables, legumes, and nuts; lower in refined grains, red or processed meats, and sugar-sweetened drink/foods. Also, exercise, which can manage weight and enhance insulin sensitivity, can go a long way with just a 30-minute walk. Avoid alcoholic beverages, which can cause hypoglycemia, a drop of blood glucose that can lead to fainting, confusion, and clumsiness. Weight loss can aid with blood sugar levels, by just controlling portions and eating healthy are simple ways to start taking the weight off.

Medical Management

Insulin

Insulin helps regulate blood- sugar levels throughout the day and night. Individuals who struggle with type 1 diabetes depend on insulin therapy to help manage their blood glucose levels. Insulin is a stabilizer for individuals who struggle with diabetes.

Rapid- Acting Insulin

A rapid-acting insulin is an insulin that starts to work in minutes and can last a couple of hours. This is usually taken when blood sugars are too high or when eating. Some brand names include Lispro (Humalog), Aspart (Novolog), and Glulisine (Apidra)

Short-acting insulin

This is used to cover insulin needs at mealtime to control blood sugars. Some brand names include Regular(R) or Novolin and Velosulin.

Intermediate-acting

This insulin is used the least compared to the other ones mentioned. It is mostly used for overnight insulin coverage. A brand name for intermediate insulin is NPH (N).

Long-acting

This insulin will give you coverage to keep blood sugar controlled and not have them unbalanced for the whole day. Some brand names include Insulin glargine (Basaglar, Lantus, Toujeo), Insulin detemir (Levemir), and Insulin (Tresiba)

Oral Mediation

This is taken by mouth, which helps manage blood sugar levels when individuals still form insulin. This can be combined with insulin, which can better improve blood sugar control.

Long Term Complications 

When left untreated, long-term effects of diabetes include kidney failure, blindness, cardiovascular disease, nerve damage, and amputation. Hyperglycemia (high amounts of sugar in the blood) is a great contributor to those effects.

Kidney failure

The tiny blood vessels in the kidney get clogged with sugar in the blood, causing diabetic kidney disease. Not only is it the number one cause of kidney failure in the United States, but it also keeps kidneys from processing fluids the body needs and keeping the toxins out.

Blindness

The small vessels behind the retina become clogged and can erupt due to the large amounts of sugar in the blood. Diabetic Retinopathy’s early symptoms are blurry vision, if left unchecked, can cause blindness.

Cardiovascular Disease

High blood sugar can also damage the vessels and nerves that control the heart. Diabetic people have a higher rate of getting a cardiovascular disease than those who do not have diabetes. According to the American Heart Association, “adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes” and “at least 68 percent of people age 65 or older with diabetes die from some form of heart disease, and 16% die of stroke.”

Nerve Damage

Hyperglycemia damages the blood vessels that are responsible for transporting oxygen to the nerve. Therefore the nerve stops sending pain signals, leaving areas of the body without feeling. Numbed nerves cause significant issues with the feet and wounds. Feet get poor blood circulation, cuts don’t get felt, and due to diabetes, the wound will take longer to heal. That leads to a higher rate of infection and ulcers that lead to the next subject.

Amputation

Due to the nerve damage, poor blood circulation, and slow healing wounds, the infection spreads faster than the body can heal itself. Once that infection gets to the bone, doctors will opt to amputate the limb before the infection continues to spread. The most common body parts amputated due to diabetes-related infections are the toes, feet, and legs.

Diabetes is a worldwide issue affecting millions of people. Having two categories, Type 1 being genetic and incurable, and Type 2 a controllable and preventative. Many factors are determining if someone is at high risk of developing Type 2 Diabetes.

For more information on Diabetes, visit any of the following resources

• https://defeatdiabetes.org/get-healthy/diabetes-support-groups/
• https://www.diabetes.org/
• https://azdhs.gov/
• https://www.cdc.gov/diabetes/library/factsheets.html
• https://www.diabeteseducator.org/living-with-diabetes/Tools-and-Resources

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