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Diabetes is a chronic disease that arises
when the pancreas does not produce enough insulin, or when the body cannot
effectively use the insulin it produces. Insulin is a hormone made by the
pancreas that enables cells to take in glucose from the blood and use it for
energy. Failure to produce insulin, or of insulin to act properly, or both,
leads to raised glucose (sugar) levels in the blood (hyperglycaemia). This
is associated with long-term damage to the body and failure of various
organs and tissues.
There are three main types of diabetes:
Type 1 diabetes is sometimes
called insulin-dependent, immune-mediated or juvenile-onset diabetes. It is
caused by an auto-immune reaction where the body’s defence system attacks the
insulin-producing cells. The reason why this occurs is not fully understood.
People with type 1 diabetes produce very little or no insulin. The disease can
affect people of any age, but usually occurs in children or young adults. People
with this form of diabetes need injections of insulin every day in order to
control the levels of glucose in their blood. If people with type 1 diabetes do
not have access to insulin, they will die.
Type 2 diabetes accounts for at least 90% of
all cases of diabetes.
Type 2 diabetes is sometimes
called non-insulin dependent diabetes or adult-onset diabetes, and accounts for
at least 90% of all cases of diabetes. It is characterised by insulin resistance
and relative insulin deficiency, either of which may be present at the time that
diabetes becomes clinically manifest. The diagnosis of type 2 diabetes usually
occurs after the age of 40 but can occur earlier, especially in populations with
high diabetes prevalence. Type 2 diabetes can remain undetected for many
yearsand the diagnosis is often made from associated complications or
incidentally through an abnormal blood or urine glucose test. It is often, but
not always, associated with obesity, which itself can cause insulin resistance
and lead to elevated blood glucose levels.
Gestational diabetes (GDM) is a
form of diabetes consisting of high blood glucose levels during pregnancy. It
develops in one in 25 pregnancies worldwide and is associated with complications
in the period immediately before and after birth. GDM usually disappears after
pregnancy but women with GDM and their offspring are at an increased risk of
developing type 2 diabetes later in life. Approximately half of women with a
history of GDM go on to develop type 2 diabetes within five to ten years after
Other specific types of diabetes also exist.
Complications of diabetes
Type 1 and type 2 diabetes
are chronic, life-long conditions that require careful
monitoring and control. Without proper management they
can lead to very high blood sugar levels which can
result in long term damage to various organs and
disease: affects the heart and blood vessels
and may cause fatal complications such as coronary heart
disease (leading to heart attack) and stroke.
Cardiovascular disease is the major cause of death in
people with diabetes, accounting in most populations for
50% or more of all diabetes fatalities, and much
(diabetic nephropathy): can result in total kidney
failure and the need for dialysis or kidney transplant.
Diabetes is an increasingly important cause of renal
failure, and indeed has now become the single most
common cause of end stage renal disease, i.e. that which
requires either dialysis or kidney transplantation, in
the USA2, and in other countries.
(diabetic neuropathy): can ultimately lead to ulceration
and amputation of the toes, feet and lower limbs. Loss
of feeling is a particular risk because it can allow
foot injuries to escape notice and treatment, leading to
major infections and amputation.
(diabetic retinopathy): characterised by damage to the
retina of the eye which can lead to vision loss.
gestational diabetes may have children who are
large for their gestational age.
The risk factors for type 1
diabetes are still being researched. However, having a
family member with type 1 diabetes increases the risks
for developing the condition, as do the presence of some
genetic factors. Environmental factors, increased height
and weight development, increased maternal age at
delivery, and exposure to some viral infections have
also been linked to the risk of developing type 1
Several risk factors have been associated with type 2
diabetes and include:
- Diet and physical
- Increasing age
- Insulin resistance
- Family history of
Changes in diet and
physical activity related to rapid development and
urbanisation have led to sharp increases in the numbers
of people developing diabetes.
Pregnant women who are overweight, have been diagnosed
with Impaired Glucose Tolerance (IGT), or have a family
history of diabetes are all at increased risk of
developing Gestational diabetes (GDM). In addition,
having been previously diagnosed with gestational
diabetes or being of certain ethnicities puts women at
increased risk of developing the condition.
Warning signs of diabetes
Individuals can experience
different warning signs, and sometimes there may be no
obvious warning, but some of the signs of diabetes are
- Frequent urination
- Excessive thirst
- Increased hunger
- Weight loss
- Lack of interest
- Vomiting and
stomach pain (often mistaken as the flu)
- A tingling
sensation or numbness in the hands or feet
- Blurred vision
- Frequent infections
- Slow-healing wounds
The onset of type 1
diabetes is usually sudden and dramatic while the
symptoms can often be mild or absent in people with type
2 diabetes, making this type of diabetes gradual in
onset and hard to detect.
If you show these signs,
consult a health professional.
Management of diabetes
Today, there is no cure for
diabetes, but effective treatment exists. If you have
access to the appropriate medication, quality of care
and good medical advice, you should be able to lead an
active and healthy life and reduce the risk of
Good diabetes control
means keeping your blood sugar levels as close to normal
as possible. This can be achieved by a combination of
Activity: a goal of at least 30 minutes of
moderate physical activity per day (e.g. brisk walking,
swimming, cycling, dancing) on most days of the week.
weight loss improves insulin resistance, blood glucose
and high lipid levels in the short term, and reduces
blood pressure. It is important to reach and maintain a
avoiding foods high in sugars and saturated fats, and
limiting alcohol consumption.
tobacco use is associated with more complications in
people with diabetes.
complications: monitoring and early detection
of complications is an essential part of good diabetes
care. This includes regular foot and eye checks,
controlling blood pressure and blood glucose, and
assessing risks for cardiovascular and kidney disease.
At present, type 1 diabetes
cannot be prevented. The environmental triggers that are
thought to generate the process that results in the
destruction of the body’s insulin-producing cells are
still under investigation. Type 2 diabetes, however, can
be prevented in many cases by maintaining a healthy
weight and being physically active. Studies in China,
Finland and the United States have confirmed this.
IDF recommends that all people at high risk of
developing type 2 diabetes be identified through
opportunistic self-screening. People at high risk can be
easily identified through a simple questionnaire to
assess risk factors such as age, waist circumference,
family history, cardiovascular history and gestational
Once identified, people at high risk of diabetes should
have their plasma glucose levels measured by a health
professional to detect Impaired Fasting Glucose or
Impaired Glucose Tolerance, both of which indicate an
increased risk of type 2 diabetes. Prevention efforts
should target those at risk in order to delay or avoid
the onset of type 2 diabetes.
There is substantial evidence that achieving a healthy
body weight and moderate physical activity can help
prevent the development of type 2 diabetes. In primary
prevention there is an important role for the diabetes
educator to help people understand the risks and set
realistic goals to improve health. IDF recommends a goal
of at least 30 minutes of daily exercise, such as brisk
walking, swimming, cycling or dancing. Regular walking
for at least 30 minutes per day, for example, has been
shown to reduce the risk of type 2 diabetes by 35-40%.