Dr Dulcy Rakumakoe
It’s estimated that about 66% of adults with diabetes don’t know they have it. Currently, 5% of South Africans are diabetic – that is 2.5 million people.
About a million new cases of diabetes are diagnosed each year worldwide, and diabetes is the direct or indirect cause of at least 200 000 deaths each year. Incidences of type 1 diabetes and type 2 diabetes are increasing rapidly. This is due to many factors, but the most significant reasons for type 2 are the increasing incidence of obesity.
Diabetes mellitus is a chronic or lifelong condition that affects your body’s ability to use the energy found in food.
There are three major types of diabetes: type 1, type 2, and gestational diabetes – and they all have something in common. Normally, your body breaks down the sugars and carbohydrates you eat into a special sugar called glucose. Glucose fuels the cells in your body. But the cells need insulin, a hormone, in your bloodstream in order to take in the glucose and use it for energy.
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With diabetes mellitus, either your body doesn’t make enough insulin or it can’t use the insulin it produces or a combination of both.
If left untreated, diabetes can cause heart disease, stroke, kidney disease, blindness and damage to nerves in the feet.
The body stops producing insulin or produces too little insulin to regulate blood glucose levels. This type affects about 5% of all people with diabetes. It is typically diagnosed during childhood or adolescence. It used to be referred to as juvenile-onset diabetes or insulin-dependent diabetes mellitus. This insulin deficiency can also occur in adulthood due to destruction of the pancreas by alcohol, disease or removal by surgery.
Type 1 diabetes also results from progressive failure of the pancreatic beta cells, the only cell type that produces significant amounts of insulin.
People with type 1 diabetes require daily insulin injections.
Although the pancreas still secretes insulin, the body of someone with type 2 diabetes is partially or completely incapable of responding to insulin.
This is often referred to as insulin resistance. The pancreas tries to overcome this resistance by secreting more and more insulin.
People with insulin resistance develop type 2 diabetes when they fail to secrete enough insulin to cope with their body’s demands. It is typically diagnosed during adulthood, usually after age 45 years.
This form of diabetes occurs during the second half of pregnancy. Although gestational diabetes typically resolves after the delivery of a baby, a woman who develops gestational diabetes is more likely than other women to develop type 2 diabetes later in life. Women with gestational diabetes are more likely to have largebabies.
This is quite a common condition related to diabetes. In people with prediabetes, the blood sugar level is higher than normal but not yet high enough to be considered diagnostic of diabetes. Prediabetes increases a person’s risk of developing type 2 diabetes, heart disease or stroke. Prediabetes can typically be reversed (without insulin or medication) by lifestyle changes, such as losing a modest amount of weight and increasing physical activity levels.
Weight loss can prevent, or at least delay, the onset of type 2 diabetes.
About 20% more adults are believed to have this condition and may develop diabetes within 10 years unless they change to healthier lifestyles.
Type 1 diabetes is an autoimmune disease. The body’s immune system specifically attacks the cellsin the pancreas that produces insulin. A predisposition to developing type 1 diabetes may run in families, but genetic causes (a positive family history) are much more common for type 2 diabetes. Environmental factors, including common and unavoidable viral infections, may also contribute to type 1 diabetes. Type 1 diabetes is slightly more common in men than in women.
It has strong genetic links, so it tends to run in families. Several genes have been linked to type 2 diabetes, and many are under study related to type 2 diabetes.
Type 1 diabetes is usually recognised in childhood or early adolescence, often in association with an injury or illness (such as a virus or urinary tract infection).
The extra stress can cause di- abetic ketoacidosis (DKA). Symptoms of ketoacidosis include nausea and vomiting. Dehydration and often-serious disturbances in blood levels of potassium and other factors follow.
Without treatment, ketoacidosis can lead to coma and death. Symptoms of type 2 diabetes are often subtle and may be at- tributed to ageing or obesity.
A person may have type 2 for many years without knowing it. Type 2 diabetes can be precipitated by steroids and stress. If not properly treated, type 2 diabetes can lead to complications such as blindness, kidney failure, heart disease, and nerve damage.
Fatigue, or feeling constantly tired: In diabetes, the body is inefficient and sometimes unable to use glucose for fuel. The body switches over to metabolising fat, partially or completely, as a fuel source. This process requires the body to use more energy. The end result is feeling fatigued or constantly tired.
Unexplained weight loss: People with diabetes are unable to process many of the calories in the foods they eat. Thus, they may lose weight even though they eat an apparently appropriate or even an excessive amount of food. Losing sugar and water in the urine and the accompanying dehydration also contributes to weight loss.
Excessive thirst (polydipsia): A person with diabetes develops high blood sugar levels, which overwhelms the kidney’s ability to reabsorb the sugar as the blood is filtered to make urine. Excessive urine is made as the kidney spills the excess sugar. The body tries to counteract this by sending a signal to the brain to dilute the blood, which translates into thirst. The body encourages more water consumption to dilute the high blood sugar back to normal levels and to compensate for the water lost by excessive urination