Diabetes is one of the leading causes of death in the world.
422 million People worldwide Have diabetes, particularly in low-and middle-income countries and 1.5 million deaths are directly attributed to diabetes each year. what the signs and symptoms and how to prevent & treat it?
Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, usually in adults.
It is two main types: Type 1 diabetes (lack of insulin)
type 2 diabetes (ineffective use of insulin)
Risk factors for type 1 diabetes
Although the exact cause of type 1 diabetes is unknown, factors that may signal an increased risk include:
Risk factors for type 2 diabetes
Researchers don’t fully understand why some people develop prediabetes and type 2 diabetes and others don’t. It’s clear that certain factors increase the risk, however, including:
• Weight: The more fatty tissue you have, the more resistant your cells become to insulin.
• Inactivity: The less active you are, the greater your risk.
• Family history: Your risk increases if a parent or sibling has type 2 diabetes.
• Age: Your risk increases as you get older
• Gestational diabetes: If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you’re also at risk of type 2 diabetes.
• Polycystic ovary syndrome: For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.
• High blood pressure: Having blood pressure over 140/90 millimeters of mercury (mm Hg) is linked to an increased risk of type 2 diabetes.
• Abnormal cholesterol and triglyceride levels: If you have low levels of high-density lipoprotein (HDL), or “good,” cholesterol, your risk of type 2 diabetes is higher.
Type 1 diabetes include:
These symptoms may occur suddenly.
Type 2 diabetes are generally similar to those of type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen. For this reason, it is important to be aware of risk factors.
1-Cardiovascular disease: Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you’re more likely to have heart disease or stroke.
2-Nerve damage (neuropathy): Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain
Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.
3-Kidney damage (nephropathy): The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood.
4-Eye damage (retinopathy): Diabetes can damage the blood vessels of the retina
5-Foot damage: Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infection
6-Skin conditions: Diabetes may leave you more susceptibility, including bacterial and fungal infections.
7- impairment, Hearing problems are more common in people with diabetes.
8-Alzheimer’s disease: Type 2 diabetes may increase the risk of dementia, such as Alzheimer’s disease.
9-Depression: Depression symptoms are common in people with type 1 and type 2 diabetes.
people with type 1 and type 2 diabetes.
Prevention
Type 1 diabetes can’t be prevented. However, the same healthy lifestyle choices that help treat prediabetes, type 2 diabetes and gestational diabetes can also help prevent them:
1-Eat healthy foods: Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom.
2- More physical activity: Aim for about 30 minutes of moderate aerobic activity on most days of the week, or at least 150 minutes of moderate aerobic activity a week.
3-Lose excess pounds: If you’re overweight, losing even 7% of your body weight — for example, 14 pounds (6.4 kilograms) if you weigh 200 pounds (90.7 kilograms) can reduce risk of diabetes
To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.
Sometimes medication is an option as well. Oral diabetes drugs such as metformin (Glumetza, Fortamet, others) may reduce the risk of type 2 diabetes — but healthy lifestyle choices remain essential. Have your blood sugar checked at least once a year to check that you haven’t developed type 2 diabetes
Diagnosis of Diabetes
Is usually done by the tests
Paper strips or dipsticks Clinistix® and Diastix® change color when immersed in urine. Based on the change in color, the test strip is compared to a chart that indicates the amount of glucose in the urine.
Although it is inaccurate method, it provides a quick and easy result.
1. Fasting Glucose Test:
The patient is fasting at least 8 hours before the test and usually the test is done in the morning before breakfast, the blood is taken from patient’s vein and the amount of glucose is measured in the plasma.
A plasma level of >126 mg/dl indicates diabetes
2.Postprandial Plasma Glucose Test: The Blood is taken after 2 hours of ingestion of high carbohydrates meal or 75g glucose drink. Glucose levels > 140mg/dL are abnormal; levels of 120 to 140 mg/dL are ambiguous; and levels <120mg/dL are normal
Despite being a commonly used test method, it is inaccurate because of a number of factors, including age, weight, etc.
3. Oral Glucose Tolerance Test (OGTT):
The patient should have been fasting for 8-14 hours. first blood sample is taken and consider as the zero time (baseline), the patient is then given a glucose solution to drink within five minutes. Following the drink, the level of glucose in the blood rises immediately and then gradually falls as the body uses insulin to metabolize or absorb the sugar. In diabetic, after consuming the sweetened liquid, the blood glucose level rises and remains high.
Diagnosis of diabetes is confirmed by a plasma glucose level of ≥ 200 mg/dL two hours after consuming the syrup and at one other time during the two-hour test period.
4. Glycated Hemoglobin and Plasma Albumin Test
HbA1c is a minor hemoglobin derivative that is formed by glycosylation. the amount of HbA1c produced is directly proportional to the average plasma glucose level, in normal, HbA1c represent 4% to 5% of total hemoglobin, , but it is much higher in diabetics, reaching 6.5%. Also, Serum albumin is glycosylated in proportion to plasma glucose levels
Type 1 diabetes requires replacement insulin through injection, pump, or inhalation.
Type 2 diabetes or prediabetes frequently begins with metformin, followed by further drugs as needed
In certain cases, type 2 diabetes requires injectable insulin as the first medication.
Insulin:
Injected insulin
There are different types classified according to its source, duration, and dosage form:
Types of insulin with examples
Other medication
MOA: The drug suppresses gluconeogenesis in liver and thus suppresses hepatic glucose output. Also, it enhances insulin mediated glucose disposal in muscle and adipose tissue.
Adults: Initial dose: 250mg 2-3 times/day with meals. Increase gradually at two week intervals, if required to a maximum of 3g daily.
Children: Not applicable
Insulin secretagogues: It used if metformin alone is not effective
MOA: stimulate pancreatic beta cells to release insulin.
Examples of Sulfonylureas
First Generation Sulfonylureas | Second Generation Sulfonylureas |
CHLORPROPAMIDE (PAMIDIN) | GLIMEPIRIDE (AMARYL) |
GLIBENCLAMIDE (DAONIL) | |
GLIPIZIDE, GLICLAZIDE |
Examples of meglitinides
REPAGLINIDE (DIAROL)
NATEGLINIDE (DIABEX)
It is not effective as metformin but added to other treatment if needed
MOA: They are inhibiting intestinal enzymes that digest carbohydrates and thus reducing it digestion which leads to reducing postprandial blood sugar level.
Examples: MIGLITOL (LITOMEN) ACARBOSE (GLUCOBAY)
It must be taken in combination with other drugs such as Metformin, Sulfonylureas or insulin
MOA: it is stimulating GLUT4 expression and translocation which leads to enhance the entry of glucose into muscle and adipose tissue and reverses insulin resistance
Examples PIOGLITAZONE (ACTOS)
Children: Not applicable
used as monotherapy if the combination of the first line of treatment is ineffective
MOA: It inhibit DPP4 enzyme that rapidly inactivates incretins which increase insulin secretion
Example: SITAGLIPTIN (JANUVIA),
SAXAGLIPTIN (FORMIGLIPTIN),
LINAGLIPTIN (LINAJENTA),
ALOGLIPTIN (DELTAGLIPT)
it is new method for treatment diabetes
MOA: it is lowering glucose blood level by inhibiting reabsorption of glucose & increase its excretion
Examples: CANAGLIFLOZIN (DIACANRAM)
DAPAGLIFLOZIN (DAPABLIX)
EMPAGLIFLOZIN (DIACURIMAP