Belize Diabetes Association

What is Diabetes?

Diabetes (also known as diabetes mellitusis) is a disorder resulting from a hormonal imbalance that affects how the body turns food into energy. It develops when your body either isn’t producing enough insulin or has developed an insulin resistance thus causing your blood sugar (glucose) to become abnormally high.

Normally, our bodies break down the food we consume into glucose (a sugar) and release it into our blood. When our level of blood sugar rises, insulin produced by our pancreas signals the body to use excess glucose as energy or store it for later consumption.

Diabetes restricts the pancreas from producing this life-saving insulin properly, thus causing high blood sugar levels. These high glucose levels can over time lead to serious damage to the heart, blood vessels, eyes, kidneys, and nerves.

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Insulin

Insulin, a hormone released from the pancreas (an organ behind the stomach that also produces digestive enzymes), controls the amount of glucose in the blood. Glucose in the bloodstream stimulates the pancreas to produce insulin. Insulin helps glucose to move from the blood into the cells. Once inside the cells, glucose is converted to energy, which is used immediately, or the glucose is stored as fat or the starch glycogen until it is needed.

The levels of glucose in the blood vary normally throughout the day. They rise after a meal and return to pre-meal levels within about 2 hours after eating. Once the levels of glucose in the blood return to pre-meal levels, insulin production decreases. The variation in blood glucose levels is usually within a narrow range, about 70 to 110 milligrams per deciliter (mg/dL) of blood in non-diabetics. If people eat a large amount of carbohydrates, their blood glucose may increase to higher than normal levels. People older than 65 years tend to have slightly higher levels, especially after eating.

If the body does not produce enough insulin to move the glucose into the cells, or if the cells stop responding normally to insulin (called insulin resistance), the resulting high levels of glucose in the blood and the inadequate amount of glucose in the cells together produce the symptoms and complications of diabetes.

Type 1 Diabetes: In type 1 diabetes (formerly called insulin-dependent diabetes or juvenile-onset diabetes), the body's immune system attacks the insulin-producing cells of the pancreas, and more than 90% of them are permanently destroyed. The pancreas, therefore, produces little or no insulin. Fewer than 10% of all people with diabetes have type.

Most people who have type 1 diabetes develop the disease before age 30, although it can develop later in life. Causes are believed to be genetic and environmental. Scientists believe that an environmental factor—possibly a viral infection or a nutritional factor during childhood or early adulthood—causes the immune system to destroy the insulin-producing cells of the pancreas. A genetic predisposition makes some people more susceptible to environmental factors.

When an adult's immune system attacks the cells of the pancreas, diabetes develops more slowly than when a child's immune system attacks. Some adults do not need insulin when diabetes first develops. This form of diabetes, called latent autoimmune diabetes of adulthood (LADA), is rare but may initially be mistaken for type 2 diabetes.

Types of Diabetes

There are three main types of diabetes:

Type 2 Diabetes: In type 2 diabetes (formerly called non–insulin-dependent diabetes or adult-onset diabetes), the pancreas often continues to produce insulin, sometimes even at higher-than-normal levels, especially early in the disease. However, the body develops resistance to the effects of insulin, so there is not enough insulin to meet the body’s needs. As type 2 diabetes progresses, the insulin-producing ability of the pancreas decreases.

Type 2 diabetes was once rare in children and adolescents but has become more common. However, it usually begins in people older than 30 years and becomes progressively more common with age. About 30% of people older than 65 have type 2 diabetes.

Gestational Diabetes: A temporary form of diabetes that occurs in 3-5% of pregnant women. It normally goes away after the birth of the baby, but many of these women develop type 2 diabetes later in life.

Other symptoms of diabetes include:

• Blurred vision

• Drowsiness

• Nausea

• Decreased endurance during exercise

Type 1 diabetes symptoms

In people with type 1 diabetes, the symptoms often begin abruptly and dramatically. A serious condition called diabetic ketoacidosis, a complication in which the body produces excess acid, may quickly develop. In addition to the usual diabetes symptoms of excessive thirst and excessive urination, the initial symptoms of diabetic ketoacidosis also include nausea, vomiting, fatigue, and—particularly in children—abdominal pain. Breathing tends to become deep and rapid as the body attempts to correct the blood’s acidity (Acidosis), and the breath smells fruity or like nail polish remover. Without treatment, diabetic ketoacidosis can progress to coma and death, sometimes very quickly.

Type 1 diabetes progresses in stages:

• Stage 1: Presence in the blood of two or more diabetes-specific antibodies (substances or markers that indicate that there is inflammation or damage to the insulin-producing cells of the pancreas) in people with normal blood sugar levels and no symptoms of diabetes

• Stage 2: Higher than normal level of glucose in the blood in people without symptoms

• Stage 3: Symptoms of diabetes

After type 1 diabetes has begun, some people can have a temporary phase of near-normal glucose levels (honeymoon phase) due to partial recovery of insulin secretion.

Type 2 diabetes symptoms

People with type 2 diabetes may not have any symptoms for years or decades before they are diagnosed. Symptoms may be subtle. Increased urination and thirst are mild at first and gradually worsen over weeks or months. Eventually, people feel extremely fatigued, are likely to develop blurred vision, and may become dehydrated.

Because people with type 2 diabetes produce some insulin, ketoacidosis does not usually develop even when type 2 diabetes is untreated for a long time. Rarely, the blood glucose levels become extremely high (even exceeding 1,000 mg/dL. Such high levels often happen as the result of some superimposed stress, such as an infection or medication use. When the blood glucose levels get very high, people may develop severe dehydration, which may lead to mental confusion, drowsiness, and seizures, a condition called hyperosmolar hyperglycemic state. Most people with type 2 diabetes are diagnosed by routine blood glucose testing before they develop such severely high blood glucose levels.

Stages of Type 2 Diabetes

• Stage 1: Insulin Resistance.

• Stage 2: Prediabetes.

• Stage 3: Type 2 Diabetes.

• Stage 4: Type 2 Diabetes With Vascular Complications.

Blood Sugar (Glucose)

The three major nutrients that make up most food are carbohydrates, proteins, and fats. Sugars are one of three types of carbohydrates, along with starch and fiber.

There are many types of sugar. Some sugars are simple, and others are complex. Table sugar (sucrose) is made of two simpler sugars called glucose and fructose. Milk sugar (lactose) is made of glucose and a simple sugar called galactose. The carbohydrates in starches, such as bread, pasta, rice, and similar foods, are long chains of different simple sugar molecules. Sucrose, lactose, carbohydrates, and other complex sugars must be broken down into simple sugars by enzymes in the digestive tract before the body can absorb them.

Once the body absorbs simple sugars, it usually converts them all into glucose, which is an important source of fuel for the body. Glucose is the sugar that is transported through the bloodstream and taken up by cells. The body can also make glucose from fats and proteins. Blood "sugar" really means blood glucose.

Symptoms of Diabetes

Many patients with diabetes may have no symptoms, especially in the early phase of the disease. However, the two types of diabetes can have very similar symptoms if the blood glucose is significantly elevated.

The symptoms of high blood glucose levels include:

• Increased thirst

• Increased urination

• Increased hunger

When the blood glucose level rises above 160 to 180 mg/dL, glucose spills into the urine. When the level of glucose in the urine rises even higher, the kidneys excrete additional water to dilute the large amount of glucose. Because the kidneys produce excessive urine, people with diabetes urinate large volumes frequently (polyuria). The excessive urination creates abnormal thirst (polydipsia). Because excessive calories are lost in the urine, people may lose weight. To compensate, people often feel excessively hungry.

Complications of Diabetes

Diabetes damages blood vessels, causing them to narrow and therefore restricting blood flow. Because blood vessels throughout the body are affected, people may have many complications of diabetes. Many organs can be affected, particularly the following:

• Brain, causing a stroke

• Eyes (diabetic retinopathy), causing blindness

• Heart, causing a heart attack or heart failure

• Kidneys (diabetic nephropathy), causing chronic kidney disease

• Nerves (diabetic neuropathy), causing decreased sensation, mainly in the feet and legs

High blood glucose levels also cause disturbances in the body's immune system, so people with diabetes mellitus are particularly susceptible to bacterial and fungal infections.