Diabetes 101

Dr Jacqueline E Campbell

Sunday, November 12, 2017

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RECENTLY a patient told me that she is not really diabetic.

“Doc, I just have a little touch of it,” she said.

I am always fascinated by that statement, which is grounded in misconception. No one is just touched by diabetes — either you have it or you don't. It's like thinking that I have a touch of pregnancy!

When I graduated from medical school in 1988, it was mainly 'older people who were afflicted with diabetes mellitus. This picture has changed dramatically. Worldwide we have been experiencing what currently appears to be epidemic levels of diabetic individuals of all ages.

Sadly, I have seen many individuals go blind, have heart attacks, develop kidney disease, and have limbs amputated because of diabetes. Diabetes is the second-leading cause of death for Jamaicans under the age of 70 years. This is cause for concern.

Types of diabetes

There are three major types of diabetes mellitus: Type 1, type 2 and gestational.

Type 1 diabetes: This is also called insulin-dependent diabetes and occurs most frequently in children and young adults, but can appear at any age.

This is the most serious type of diabetes, as it signals that the body has lost its ability to produce insulin in sufficient quantities to process the sugar that enters the bloodstream. This causes high levels of sugar to be in the blood. Fortunately, type 1 diabetes affects only about five to 10 per cent of the population.

Type 1 diabetes is caused by the body's immune system attacking the insulin-producing cells in the pancreas. Scientists are not exactly sure why the immune system acts in that manner, but they think that a virus may trigger the immune system to begin its attack. When this happens, the body cannot produce insulin and so is unable to process the sugar which enters it. Simply put: Type 1 diabetics need insulin to survive.

Type 2 diabetes: If you have been diagnosed with type 2 diabetes it means you are not able to maintain normal sugar levels, so sugar remains unprocessed because your body cannot use its own natural insulin properly.

Type 2 is the most common form of diabetes; about 90–95 per cent of individuals with diabetes have type 2.

With type 2 diabetes, although the pancreas is still functioning, and producing some insulin, it is not being properly utilised by the body and so the sugar levels are higher than normal.

Gestational diabetes: This occurs in pregnant women who did not have the disease before becoming pregnant. It affects about four per cent of pregnant women. Most times it goes away after delivery.

There is also a condition called prediabetes. Individuals are said to be prediabetic when their blood glucose levels are higher than normal, but not high enough for a diagnosis of type 2 diabetes, and the symptoms of the disease are not yet evident.

Causes of diabetes

Type 1 and type 2 diabetes have different causes, but they do share some things in common, namely, family history and environmental factors.

Let's take family history first. Some traits are passed on from one generation to another, from our grandparents to our parents, and we in turn pass them on to our children. If your family has a history of diabetes, it's likely that individuals in your family will carry this trait in their genes and so are predisposed to having diabetes.

Environmental factors such as diet and lifestyle can trigger type 2 diabetes. Here are some other situations, commonly called risk factors, that can lead to diabetes:

• Ageing;

• Obesity;

• Prior history of gestational diabetes;

• Impaired glucose tolerance (pre-diabetes);

• Physical inactivity;

• Race/ethnicity;

• Stress.

Why is it so dangerous?

Now is a good time to explain why diabetes is so dangerous. Since the cells in the body cannot absorb the glucose, it means excess sugar is literally hanging out in the blood. As more food, (especially carbohydrates) is eaten, more glucose enters the body and keeps being added to the blood, making the blood too sweet.

High levels of blood glucose can damage the tiny blood vessels in various organs, including the kidneys, heart, eyes, and nervous system. That is why diabetes is so dangerous and if not diagnosed and treated, can eventually lead to serious problems like heart disease, stroke, kidney disease, blindness, and damage to the nerves in the feet.

I need to stress again that part of what makes diabetes so dangerous is that someone can have it for years and not know, (remember, it's also called the silent killer), and during that time the unusually high sugar levels may be causing damage to internal organs.

Excerpts taken from my book A patient's guide to the treatment of diabetes mellitus.

©Jacqueline Elaine Campbell

Dr Jacqueline E Campbell is a family physician, university lecturer and pharmacologist. She is the author of the book A patient's guide to the treatment of diabetes mellitus.





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