Diabetes mellitus, or diabetes, is a condition in which levels of glucose in the blood are higher than normal, either because the pancreas does not produce enough insulin or cells do not respond to the insulin produced. Diabetes comes from the Greek work’ diabainein’ which means ‘pass through’ referring to the flow of urine. Mellitus is a Latin word which means honey. Generally speaking it means sweet urine flow.
Diabetes is rising at an alarming rate in Australia. An estimated 280 Australians develop diabetes every day. Australian Diabetes, Obesity and Lifestyle Study in 2005 showed that 1.7 million Australians have diabetes but that up to half of the cases of type2 diabetes remain undiagnosed. By 2031 it is estimated that 3.3 million Australians will have type2 diabetes. This trend is visible in Indian Community in Australia at a much worse proportion. Indians are more likely to develop to Type 2 diabetes compared to Caucasians. Indians migrating to Australia are more than eager to pick up the Alcohol consumption and rich food intake of westerners but aloof towards adopting the sportive, athletic life style of westerns.
How the human body works
Human body is made up of millions of cells. Glucose and oxygen are required for these cells to function and survive. These cells convert Glucose and oxygen to energy, carbon dioxide and water. This process of converting energy from Glucose is known as respiration. The resultant carbon Dioxide is breathed out.
Our digestive system breaks down carbohydrates as soon as it enters our mouth. An enzyme named amylase in our saliva, breaks down carbohydrates to long chains of sugars. Once the food reaches the stomach, it mixes with stomach acids and gets breakdown further. The small intestine converts the carbohydrate to glucose molecules. From small intestine sugars are absorbed into the blood stream. The blood coming from small intestine reaches the liver and the liver converts the glucose to glycogen. This glycogen can be converted back into glucose when the body requires. When you starve, the level of glucose goes down in the body and Glycogen will be converted back to glucose. But there is a limit for liver’s storage capacity. It can store glucose enough for a child to last approximately 12 hours. The glucose left in the blood will be passed around as it circulates for the cells to produce energy. Blood glucose levels are controlled by hormones. An organ named Pancreas produces insulin and glucagon, two hormones for the control of blood sugar. They are released into small intestine by Pancreas. Insulin allows cells to use the glucose in the blood, effectively reducing the blood glucose levels. It sticks to the cells and acts like a gatekeeper to allow glucose to enter the cells. Insulin also stimulates the liver to use the glucose for storage as glycogen. Insulin has one more function to stimulate the conversion of excess carbohydrate to fat. When someone eats a meal, the beta cells in pancreas detect the rise in blood sugar, and start to release insulin. The correct amount is released depending on the glucose produced in the body. On the other hand glucagon produced by the pancreas triggers the liver to release glucose from its stores of glycogen.
If the glucose levels increase, Pancreas produces insulin to bring them down. If the sugar levels decrease Pancreas produces glucagon to prompt the liver to release glucose.
Prolonged starvation results in the body to use up all the glycogen stored in the liver. The body starts to break down fat when it cannot access glucose. A by-product of breaking down of fat is ketone.
What is diabetes?
For Diabetes patients, glucose is absorbed in the blood stream from intestines. But without insulin it can’t get into the cells. This will result in high levels of glucose in the blood. Some of these excess glucose is passed out of body through the kidneys giving the urine sweetness.
As the cells cannot access the glucose, which is a plenty in the blood stream, they act as if the body is in starvation and prompts a signal that blood sugar is low. Pancreas will secrete glucagon, resulting in the release of glucose from liver. Once that stock is exhausted, the body will start breaking down the fat. The fat cells will be broken down into fatty acids and glycerol. The glycerol will be further broken down to glucose and ketones. Both of which are remove through urine. Meanwhile the blood glucose level will be still high despite the fact that, body has alerted its process to handle low blood sugar level. The Kidney will release the excess glucose through urine.
What is type1 Diabetes?
It is the most severe form of diabetes and also known as insulin dependent diabetes. It is an auto immune disease which means, the body attacks itself. The insulin producing cells are attacked by the body so that insulin is no longer produced. It is a gradual process and eventually pancreas no longer produces any insulin.
The exact cause of type1 Diabetes is yet to be found out. But there are many unproven theories circulating. It is possible that a virus triggers the auto immune process which results in destroying insulin producing cells of Pancreas. Certain infections like rubella virus during pregnancy are also blamed on children getting type1 diabetes. Giving children, cow’s milk before the age of 6 months is also blamed for triggering type1 diabetes.
What is Type 2 Diabetes?
In type 2 diabetes, the pancreas makes some insulin but it is not produced in the amount your body needs and it does not work effectively. As the body cannot respond to insulin, it becomes increasingly less sensitive to insulin. The blood glucose level goes up and pancreas tries to produce more insulin to control this. Gradually Pancreas will get exhausted and may stop functioning altogether. Type 2 Diabetes results from a combination of genetic and environmental factors. The risk is greatly increased if associated with high blood pressure, obesity , poor diet and lack of exercise.
The likely hood of inheriting type 2 diabetes is much higher than inheriting type1 diabetes . Many of those with type 2 diabetes have family history of type2 diabetes .
Certain ethnic groups like Asian or African are more likely to develop Type 2 Diabetes.
The symptoms for type 2 diabetes are similar to type1 diabetes. They are frequent urination, increased thirst, increased hunger, prolonged fatigue, blurred vision, numbness or tingling sensation of legs and feet.
The Fasting Plasma Glucose Test – This test is performed after a person has not eaten for 8 to 12 hours, usually in the morning. Glucose levels higher than 7mmol/l in two consecutive test is considered as diabetic.
Oral Glucose tolerance test – It begins with a fasting blood sample taken after a person has eaten a high carbohydrate diet for three days. After that sample is taken, the person drinks a glucose solution. Blood samples are taken every 30 minutes for two hours and another sample is taken another hour later. Those samples show how the body handles glucose. In people with diabetes blood sugar levels don’t fall that quickly
How Diabetes is diagnosed
The level of glucose is measured by a blood test. Blood glucose levels are measured in millimoles per litre of blood (mmol/L). The ‘normal’ range for blood glucose is about 4 to 6 mmol/L (fasting). A fasting blood glucose level of 7mmol/l is considered as diabetic. A random test is also conducted two hours after 75g glucose load. Less than 7mmol/l is considered normal , between 7 and 11.1mmol/l is considered as impaired glucose tolerance and above 11.1mmol/l is considered as diabetic. If the readings are above the normal range but below the diabetic range the condition is called impaired glucose tolerance.
Treatment for Type 1 Diabetes
For type 1 diabetes Pancreas does not produce insulin . The treatment is to replace the body’s natural production of insulin with insulin injections. It is a complex and continuous regime and out of scope for this article. But we will give a brief description about insulin later in the article
Treatment for Type 2 Diabetes
The initial treatment for type 2 diabetes is diet, weight control and physical activity. If your blood glucose level remains high despite a trial of these lifestyle measures then tablets to reduce the blood glucose level are usually advised. Insulin injections are needed in some cases if the blood glucose level remains too high despite taking tablets.
Hypoglycaemia is a condition of abnormally low blood glucose level. It can produce variety of symptoms. It happens when a diabetic patient has not eaten enough food, too much insulin has been injected or too much of physical activity that resulted in reduced blood sugar levels.
The treatment is to increase the blood glucose level. This can be done by giving sugar, glucose drink, if none available sweets or chocolates. Simultaneously, conduct a blood sugar test . If the situation gets worse, the patient may require an injection of Glucagon.
The General Symptoms for Hypoglycaemia
Looking pale, Feeling sick and hungry, shakiness and trembling, feeling hot, feeling numb in finger tips and toe tips, blurring or double vision, problem with concentrating, drowsy, headaches, fit or seizures etc.
Hyperglycaemia is a condition when blood sugar level shoots above the normal range. It happens due to insulin deficiency. There may or may not be symptoms related to hyperglycaemia. The only way may be to monitor blood glucose level. The possible symptoms are passing urine more than normal, feeling thirsty, skin itchiness, tiredness and blurred vision.
There are several kinds of insulin. Beef derived insulin is obtained from beef pancreases and pork derived insulin from pork. Human insulin a drug chemically identical to the insulin normally produced by human body is manufactured in one of the two ways: either by using recombinant DNA technology or by chemical modification pork insulin. The human insulin’s are known as synthetic and semi synthetic.
Insulin is available indifferent forms. They are short acting, intermediate acting and long acting. Short acting insulin’s are sometimes referred to as fast acting insulin as the word fast refers to the speed with which the insulin begins to lower blood glucose levels.
Most short acting will begin to act in 30 -45 minutes and reach their peak of effectiveness in 1 to 3 hours and work for 5 to 8 hours. A new short acting insulin called lispro works even more quicker and has a shorter duration. It starts acting in 10 minutes and peaks in 1 hour and lasts 3 hours.
Intermediate acting insulin come in two forms. lente and NPH . Preparations with a predetermined proportion of NPH mixed with regular, such as 70 percent NPH to 30 percent regular are considered intermediate acting insulin. These begin acting in 1.5 hours reach peak in 4 to 14 hours and work for 18 to 24 hours.
Long acting insulin includes PZI and ultralente. These begin to take effect in 4 to 12 hours, peak at 12 to 24 hours after injection and last from 20 to 30 hours.
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