What is diabetes and the types of diabetes

Diabetes mellitus, or commonly referred to as diabetes, is a group of metabolic diseases characterised by recurrent or persistent hyperglycemia (high sugar or glucose level in the blood). People with diabetes are either not producing enough insulin or their cells are unable to respond well to the insulin produced. Insulin is produced by the beta cells of the islets of Langerhans in the pancreas. In Singapore, diabetes affects 10 percent of its population and is one of the top six killers.

The 3 main types of diabetes are:
• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes

Type 1 diabetes

Type 1 diabetes results from the body’s inability to produce insulin, requiring the person to inject insulin. This type of diabetes is due to the loss of beta cells of the islets of Langerhans, which may be immune-mediated or idiopathic. There are no known preventive measures against type 1 diabetes. The cause of this type is partly inherited and then triggered by certain factors with some evidence pointing at Coxsackie B4 virus. There is a genetic element in the individual susceptibility to some of the triggers which has been traced to a particular HLA genotype. However, even in those who inherited the susceptibility, type 1 diabetes seems to require an environmental trigger.

Type 2 diabetes

Type 2 diabetes results from insulin resistance, a condition whereby cells are fail to utilise the insulin properly. It may also be combined with relatively decreased insulin secretion. The defective responsiveness of the cells to insulin is believed to involve the insulin receptor. Type 2 diabetes is the common type with 90 to 95 percent of diabetics population

Gestional diabetes

Gestational diabetes mellitus (GDM) occurs when pregnant women, who had never had diabetes before, have high blood glucose levels in pregnancy. It resembles type 2 diabetes and occurs in 2 to 5 percent of all pregnancies. It may improve or disappear after delivery. GDM is fully treatable but requires careful medical supervision in the course of the pregnancy. About 20 to 50 percent of affected women develop type 2 diabetes later in life. Untreated GDM may damage the health of the foetus or mother. The risks to the baby or foetus include:
• Macrosomia (high birth weight)
• Congenital cardiac anomalies
• Central nervous system anomalies
• Skeletal muscle malformations
• Respiratory distress syndrome
• Hyperbilirubinaemia
• In severe cases, perinatal death may occur resulting from poor placental perfusion due to vascular impairment

Diagnosis of diabetes

Diabetes is diagnosed by demonstrating one of the following:
• Fasting plasma glucose level of more than or equal to 7.0 mmol/L (126 mg/dL)
• Plasma glucose of more than or equal to 11.1 mmol/L (200 mg/dL) two hours after a 75 g oral glucose load in a glucose tolerance test
• Symptoms of hyperglycemia and casual plasma glucose of more than or equal to 11.1 mmol/L
• Gylcated haemoglobin (HbA1c) of more than or equal to 6.5 percent

Signs and symptoms of diabetes

The classical symptoms of diabetes are:
• Polyuria (frequent urination)
• Polydipsia (Increased thirst)
• Polyphagia (Increased hunger)
Symptoms may progress rapidly (weeks or months) in type 1 diabetes but tend to develop at a much slower pace in type 2. Other symptoms include unexplainable weight loss, sores that heal slowly, having blurred vision and losing sensation or having tingling in your hands or feet.

Complications of diabetes

Management of type 2 diabetes

Diabetes is a chronic disease that is difficult to cure. Management concentrates on keeping the blood sugar levels as close to normal as possible without presenting undue danger to the patient. This can usually be done through lifestyle modifications and the use of appropriate medications. Lifestyle modifications include having a well balanced, closely monitored diet as well as sensible exercise. The goal is to keep both the short term and long term blood glucose levels within acceptable bounds.
Patient education, understanding and participation are important as the complications of diabetes are far less common and less severe in those who manage their blood sugar levels well. Several other factors including smoking, obesity, elevated cholesterol levels, hypertension and lack of regular exercise may accelerate the effects of diabetes.
People may be at risk for type 2 diabetes if they:
• Are overweight
• Exercise less than 3 times a week
• Have had gestational diabetes
• Have high cholesterol or high blood pressure
• Have a parent or siblings with diabetes
• Have blood glucose levels that are higher than normal
• 45 years of age or older
• Have polycystic ovary syndrome (PCOS)
• Have dark, thick and velvety skin around the neck and armpits that appears dirty no matter how much they scrub it. A condition called acantosis nigricans.

If you consider yourself in the high risk group, find out more on how you can prevent the onset of diabetes