What is Diabetes?

Overview – Quick Facts– Definition– Risk Factors

Definition

Diabetes is avariable carbohydrate metabolic disorder. It occurs when the pancreas is unable to produce enough insulin in order to process glucose. It can also occur when there is inadequate utilization of the produced insulin. This leads to excess blood glucose and a host of complications.

Diabetes also occurs when there is a severe drop in the production of insulin due to a condition called the atrophy of the islet of Langerhans (cells in the pancreas).

The pancreas produces insulin.Carbohydrates are broken down into glucose and are released into the blood stream.Insulin assists in the absorption of glucose into the cells of all the muscles and tissues of the body.

Overview

Diabetes Mellitus is a chronic condition and a non-communicable disease. It is a major healthcare burden for many countries and causes numerous complications that leads to hospitalizations, disabilities, and even death.
As a chronic metabolic disease, diabetes can affect anyone. As of now, there is no cure for diabetes, and it is a condition one has to manage lifelong.
Improper management can reduce lifespan, create complications including eye disease leading to blindness, kidney disease leading to kidney failure, amputation of the feet, cardiovascular diseases, and a host of other conditions.
A report published by the WHO states that there are around 422 million adults with diabetes. These people are patients who have been diagnosed.There are more people who remain undiagnosed.
The precursor to diabetes is prediabetes where a person has insulin resistance. This leads to the increasing presence of glucose in the blood. When the blood glucose level crosses a threshold, a person is a known diabetic.
Diabetes usuallypresents itself with symptoms like increased urination, increased thirst, slow healing of wounds, fatigue, and blurry vision.
The mainstay of diabetes treatment includes medications (oral/injections), diet modification, lifestyle modification, and physical exercise. People with diabetes have to undergo certain changes in lifestyle and get periodical diagnostic tests.

Types of Diabetes

Type 1 Diabetes.
Type 2 Diabetes.
Gestational Diabetes.

Quick Facts

Here are a few interesting facts regarding diabetes.
The World Diabetes Day is on 14th November every year.
There are more than 69.1 million people with diabetes in India. Most of these people are from ages 20 to 79 yrs.
By 2040, there would be around 642 million people with diabetes in the world.
The highest age group with diabetes in the world are between 40 to 59 yrs.
The age of incidence of diabetes has come down drastically. More and more children and adolescents are diagnosed with diabetes.
46% of people with diabetes are not aware that they have diabetes as the classic symptoms of diabetes like extreme thirst or urination do not show up.
Diabetes is the leading cause of blindness, non-trauma related foot amputations, and end-stage kidney diseases along with increased risk ofAlzheimer’s disease and cardiovascular diseases.
Though type 1 and type 2 are called diabetes, the mechanisms of the diseases vary vastly in the molecular level.
Type 1 diabetes is an autoimmune disease where the cells of the immune system destroy beta cells of the pancreas that produce insulin.
Type 2 diabetes is the result of the cells of the body becoming resistant to insulin triggering certain mechanisms which leads to higher blood glucose levels.
Obesity, physical inactivity, bad dietary choices, and genetic predispositionincrease the risk of diabetes immensely.
Avoiding smoking, and restricting the intake of alcohol reduces the risk of diabetes significantly.
A physical activity of at least 30 minutes a day with activities like swimming, walking, or jogging reduces the risk of type 2 diabetes by 40%.
For people with diabetes, a diet full of fresh vegetables, fruits, whole grains, poultry, and fish is advised while consumption of refined sugars and saturated fats is not advised.
Self-monitoring of blood glucose levels, periodical medical checkups, and adherence to treatment plan allows a person with diabetes to lead a normal life.

Risk Factors

Many people young and old are at a risk of getting diabetes.Though diabetes is not specific to a certain place or age, risk factors range from ethnicity to diet. Here are a few risk factors increase the chances of getting diabetes.

  • Being overweight.
  • Leading a physically inactive life.
  • Having a family history of diabetes.
  • Dietary factors like consumption of refined sugars and saturated fats.
  • Ethnicity.
  • High blood pressure.
  • Environmental factors.
  • Certain viral infections.
  • Presence of autoantibodies.
  • Impaired glucose tolerance.
  • Poor nutrition during pregnancy.
  • History of gestational diabetes.

Complications of Diabetes

Diabetes affects all the parts of the body over a period of time. Damage occurs to the blood vessels and the nerves of the body. This leads to significant damage to the kidneys, eyes, and can even lead to cardiovascular diseases. Nerve damage in people with diabetes leads to diabetic foot and feet amputations.
Complications of diabetes include:

  • Diabetic Neuropathy.
  • Diabetic Nephropathy.
  • Diabetic Retinopathy.
  • Complications during pregnancy.

There are numerous long term and short term conditions that can arise due to diabetes, these include:

  • End-stage kidney disease.
  • Blindness.
  • Diabetic Ketoacidosis.
  • Diabetic Coma.
  • Hyperglycemic hyperosmolar syndrome.
  • Cataract.
  • Loss of consciousness.
  • Sexual Dysfunction.
  • Heart palpitations.
  • Poor blood circulation.
  • Impaired ability to focus/ impaired thought.
  • Mood swings.
  • Skin and bone problems.
  • Gum and teeth problems.
  • Diarrhea.
  • Constipation.

Why do people get Diabetes?

Type 2 diabetes:
Family History/Genetics/Ethnicity:

People who have a family history of diabetes are more prone to have type 2 diabetes. Having a parent, or a sibling with type 2 diabetes is certainly a risk factor for someone to get diabetes. This is because of the shared genes.
When both parents have type 2 diabetes, the chances of getting diabetes is around 50%. Such people can avoid/delay type 2 diabetes by taking certain precautions like maintaining proper dietary habits, and being physically active.
The genes of a person play a vital role in one’s susceptibility to type 2 diabetes. Research has isolated more than 70 genes that are associated with diabetes risk. Genes that control insulin secretion, regulate glucose levels, and genes that regulate the production of glucagon hormone are some of them.
Having such gene mutations along with the presence of higher body mass index, high cholesterol levels, and high blood pressure can lead to type 2 diabetes. Also, genetic predisposition when coupled with environmental factors increases the risk.

Environment:
It might come as a surprise for many that environmental factors could increase the risk of getting diabetes, but research proves that environmental factors do cause diabetes.
Environmental factors that make a person susceptible to get type 2 diabetes include:
Pollutants that cause changes in the endocrine functions. These include chemicals that contain:

  • Estrogen receptor agonists:Polycarbonate coating on food containers including baby products.
  • Androgen receptor antagonists:Toys, vinyl floors, nail polish, hair sprays, beauty products, perfumes, lotions, shampoos.
  • Hydrocarbon receptor agonists:Byproducts of industrial processes that get deposited into foods like dairy products, meat, fish and even the air and water.
  • Bisphenol A (BPA): Canned foods, beverage containers, Sports drink containers, sports safety equipment, and other food containers.

Lifestyles and environments that cause disrupted sleep patterns and reduced physical activity. These include housing communities with lack of lung spaces and open areas like parks and playgrounds.
Environments that promote bad dietary choices.These include rampant prevalence of fast foods, junk foods, and foods that contain high saturated oils and refined sugars.
Social environments that causestress. These include work environments that have untimely work hours and specific industries/educational institutions that induce stress.
These environments are guilty of causing obesity and stress that might lead to insulin resistance and ultimately glucose intolerance.

Obesity and conditions leading to insulin resistance:
In this day and age, we understand that obesity is like a gateway to numerous health conditions and diseases. However, it is a fact that obesity can be caused due to certain other health conditions. There is a definite overlap between the mechanisms that cause obesity and conditions like insulin resistance that is a result of obesity.
In metabolic disorders, increased cholesterol levels, and insulin resistance go together in a complex cellular mechanisms.
Insulin resistance is also known as prediabetes. It is a condition wherethe cells of the liver, muscle, and fat do not respond properly to insulin. This results in the lack of absorption of glucose from bloodstream. This leads to two things:

  • One wherethere is increased presence of glucose in the blood (though the blood glucose levels are in range).
  • And two, where the body tries to compensate the lack of response with more production of insulin.

Over a period of time, this leads to fatigue of the beta cells in the pancreas (cells that produce insulin) with increased production of insulin. This stage lasts as long the beta cells can produce more insulin to compensate the lack of response in the cells of the liver, muscles, and fat.
When the beta cells can no longer cope with the stress, it leads to type 2 diabetes.
The stage of insulin resistance might last for a few years before developing into full blown type 2 diabetes. It is in this stage that a person needs to undergo certain lifestyle modifications in order to prevent diabetes.
In most cases, insulin resistance is caused due to acquired and inherited influences.
In case of inherited influences, the gene mutations of insulin receptors, signaling proteins, and glucose transporters causes insulin resistance.
Acquired influences:

  • Aging.
  • Obesity.
  • Certain medications like HIV medicines, glucocorticoids, protease inhibitors, medications used of androgen-deprivation therapyand cyclosporine. The role of niacin (and the dosage) increasing insulin resistance is still unclear.

Among these, the prevalence of obesity is highest and a leading cause for insulin resistance and subsequently, type 2 diabetes.
Obesity and Insulin Resistance
Excess weight in a person with higher body mass index is generally stored as fat deposits. Fat deposits in our body are generally of two types – brown fat and white fat.
Brown fat is used to be burned as calories in order to generate heat. This fat is good.
White fat is the fat that is present in the connective tissues. Its function is to provide a cushioning effect to the internal organs and to protect them. White fat also acts as an endocrine organ where it produces estrogen. White fat also produces receptors for insulin. This is a key role.
When the tissues and muscles of the body have receptors to insulin, they accept insulin and thus aid the entry of the glucose into the cells so that it can be processed into energy.
Excess white fat tends to get stored deep inside the abdominal cavity and is called visceral fat that leads to obesity. This visceral fat consists of many adipose tissue layers. Excess visceral fat and related metabolic changes are major causes for type 2 diabetes, and cardiovascular diseases.
Excess visceral fat leads to a dysfunction at the cellular level. This causes defects in the insulin signaling and receiving mechanisms. However, the body puts up a fight in order to maintain glucose homeostasis (the balance between insulin and glucagon).
In this fight, the body starts to produce excess insulin in order to compensate the resistance offered by the cells due to impaired cellular metabolism. Over a period of time, it leads to the reduction of the beta cells and thus a reduction in insulin.
Insulin is one hormone that not only acts on glucose metabolism, it also regulates the vascular system, the brain, and the heart. So, ultimately insulin resistance and insufficient insulin leads to a type 2 diabetes, high cholesterol levels and high blood pressure.
Physical Inactivity/Poor dietary Choices
Both physical inactivity and poor dietary choices lead to obesity and thus increase the risk of type 2 diabetes.

Type 1 Diabetes

Unlike type 2 diabetes, type 1 diabetes is a condition where the patient is totally dependent on external insulin. And, when compared to the number of people type 2 diabetes, the incidence of type 1 diabetes is low. However, there is an increase in the number of reported cases (roughly 3-5%) every year in India.

Autoimmune disorder

Type 1 diabetes is an autoimmune condition in which there is destruction of the beta cells in the pancreas. This leads to total insulin deficiency. This type of diabetes has a strong hereditary connection.
People with a family history of type 1 diabetes are likely to get this condition and siblings are more likely to get it.
Generally, people with type 1 diabetes present themselves in the hospital with symptoms of high blood sugars (hyperglycemia), and ketoacidosis. Ketoacidosis is a serious condition that is characterized by very high level of ketones in the body along with high blood sugar levels.
In type 1 diabetes, there is either a defect in the immune system that leads to the destruction of the beta cells or there is a dysfunction of the pancreas due to various reasons.
Beta cells of the pancreas are destroyed due to an erroneous interaction between the genes of the immune system and the genes of the islet of Langerhans where the beta cells are present.
Research also suggests thatthe destruction of the beta cells is a due to autoantibodies. These are proteins produced by the immune system. Autoantibodies attack the body’s own organs, and tissues resulting in diseases like Celiac disease, Sjogren’s syndrome and type 1 diabetes.

Environment

Some children may get type 1 diabetes due to certain environmental factors. It has been found that exposure to some environments trigger the autoimmune factor that is responsible for the destruction of the beta cells in the pancreas.
People who have genes susceptible to type 1 diabetes when exposed to certain environments are known to get type 1 diabetes. In fact, this can even happen in the perinatal stage (even before birth). If the mother of the patient has certain infections like rubella, or enterovirus during pregnancy, it increases the chances of the newborn getting type 1 diabetes considerably.
Research is also under way to evaluate the role of dietary factors for type 1 diabetes. Intake of certain dietary nutrients (and lack of it) after the childbirth is associated with type 1 diabetes. Studies are also under progress to evaluate the relationship between the introductions of cereals (containing gluten) in the diet of the newborn (before three months) and type 1 diabetes.