Living with Diabetes

Diabetes is a disease when there is down regulation of blood sugar that interferes with normal glucose metabolism in your body. Because of this, the blood sugar remains high in the bloodstream and unable to enter the cell in the body. Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles, tissues and brain. Because of underutilization of blood glucose, those who suffer from diabetes will always feel tired and exhausted even when the blood sugar is high in the circulation. 

There are 2 common types of diabetes, which is type 1 diabetes and type 2 diabetes. Other types of diabetes which can be potentially reversible are called prediabetes and gestational diabetes. Prediabetes occurs when your blood sugar level is higher than normal, but not high enough to be classified as diabetes. And it is important to diagnose prediabetes as it is often a precursor of diabetes unless appropriate measures are taken to prevent the progression of prediabetes to diabetes. Gestational diabetes is a condition when the blood glucose is high during pregnancy and resolved after the baby is delivered.

The regulation of blood sugar is controlled by insulin, a hormone produced by an organ named pancreas which is situated behind and below the stomach. After the pancreas secretes insulin to the bloodstream, the insulin will circulate to the entire body and enable sugar to enter your cells. When the sugar enters the cells, the cell can function properly and this will reduce the amount of sugar in your bloodstream. When the blood sugar level drops, the insulin secretion from pancreas will be reduced. This is called the “negative feedback system” in which the body automatically regulates blood sugar to normal levels. 

There are many symptoms of diabetes, mostly depending on how high the blood sugar level is. Some patients with prediabetes or diabetes type 2 might have no symptoms at all. However, in patients with type 1 diabetes, symptoms tend to come on faster and more severe compared to other types of diabetes. The common symptoms of patient having type 1 diabetes and type 2 diabetes are:

• Increase thirst

• Frequent urination

• Extreme hunger

• Unexplained weight loss

• Presence of ketones in the urine

• Fatigue

• Irritability 

• Blurred vision

• Slow-healing sores

• Frequent infections (especially gums, skin or vaginal infections)

The difference between type 1 diabetes and type 2 diabetes is, type 1 diabetes usually appears during childhood or adolescence while type 2 diabetes, which is the most common type of diabetes, usually appears in people aged older than 40. 

The exact cause of type 1 diabetes is unknown. It is postulated that your immune system is attacking and destroys your insulin-producing cells in the pancreas. Due to this, insulin secretion is reduced and blood sugar unable to be transported in the cells leading to high glucose level in the bloodstream. Type 1 diabetes is said to be a combination of genetic susceptibility and environmental factors. 

For people with prediabetes, if not treated early can lead to type 2 diabetes. Different from type 1 diabetes, type 2 diabetes happens when your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Due to high resistance towards insulin receptors, there is a build up of glucose in the bloodstream. Being overweight is strongly linked to development of type 2 diabetes, however not all people with diabetes are overweight. 

For gestational diabetes, which is a condition where blood sugar level is high during pregnancy, placenta will produce hormones to sustain the pregnancy. However, these hormones will make your cells more resistant to insulin. Usually, the pancreas will try to keep up with the glucose level in the bloodstream by secreting more insulin to the circulation, but sometimes your pancreas just can’t meet the demand and this will further increase the blood glucose level.

These are the most common risk factors for developing diabetes which are being obese or overweight, physical inactivity, strong family history of diabetes, older age group, history of gestational diabetes, polycystic ovarian syndrome, high blood pressure and lastly abnormal cholesterol and high triglycerides level in the bloodstream. 

Diabetes can affect your life and causes a series of complications which may be disabling or even life-threatening. Some of the examples of possible long-term complications of diabetes include cardiovascular disease, nerve damage (neuropathy), kidney damage (nephropathy), eye damage (retinopathy), foot damage (diabetic foot), skin conditions such as bacterial infections, hearing impairment, Alzheimer’s disease and depression.

For people with gestational diabetes, complications that may arise to the baby from high glucose in the bloodstream is excess growth. Due to high insulin secretion by the baby’s pancreas, this can cause the baby to grow very large, a condition called macrosomia. When the baby develops macrosomia, it will be impossible for the baby to be delivered naturally and usually end up with cesarean section. Not only that, there is a high risk of fetal death with mothers with uncontrolled gestational diabetes. 

There are many preventive ways that we can adopt to reduce the risk for us to develop diabetes. Eating healthy foods which are low in fat and calories and high in fibers. Always make sure to get more physical activity at least 150 minutes of exercise in one week (or 30 minutes every other day in 1 week). Weight reduction plays an important role in improving insulin sensitivity in the body. By reducing body weight, the risk for developing diabetes is reduced. 

When should you come and see a doctor? There will be 2 situations where you should consult a doctor, one if you noticed you have typical symptoms of diabetes. The earlier the condition is diagnosed; the sooner treatment can begin. Another situation is when you are already being diagnosed to have diabetes. In this situation, the patient needs to be under regular follow up until the blood glucose is optimized. Regular follow up for patients with diabetes is important as patients with diabetes in a long run can develop end organ complications such as kidney impairment, heart disease, and stroke. With good blood glucose control, all this complication can be delayed. 

If you want to know more about IJN’s Diabetes Clinic, you may contact us at +603 – 2617 8200 or visit our website www.ijn.com.my. For latest updates, you may also follow our Facebook page @IJN.Malaysia.