Diabetes mellitus is a condition where the blood sugar is too high, the human body is used to a certain level of blood sugar, and in fact, it's tightly managed by many systems of the body. Diabetes happens when those systems are not functioning normally and the blood sugar is too high for the body to handle in a normal way over many years.
Insulin is a hormone produced by an organ called the pancreas, which sits right behind your stomach. Insulin is produced by cells called beta cells, and they sit next to other cells that are also designed to help your body manage normal levels of blood sugar, fats, proteins and electrolytes.
Without insulin, we aren't able to store fuel of the body, and we're not able to use the fuel which is blood sugar. The main way diabetes affects the body has to do with the level of blood sugar. Too high levels of sugar can actually impair certain parts of your body's functions.
The small blood vessels behind the eyes are very sensitive to high blood sugar and don't function normally when are exposed to high level of blood sugar over time.
The second part of the body that can be affected would be the nerves, especially the little, tiny blood vessels that coat the nerves, the tips of the fingers and the tips of the toes.
The kidney actually has very tiny, sensitive blood vessels as well. So over time, the kidney can be affected.
Why does diabetes mellitus occur?
Diabetes mellitus can occur due to several factors. The most simple one to understand is when the pancreas stops making insulin. Insulin controls blood sugar. The reason why that might happen is typically we talk about in type one diabetes, an autoimmune destruction of those special cells that make insulin, the beta cells.
The most common type of diabetes is called type 2 diabetes mellitus. It runs in families most often, and it's related to body fat and body weight as well. There're other types of diabetes mellitus that are less common than type two diabetes mellitus, but probably more common than we recognize, like a purely genetic form of diabetes mellitus called monogenic or sometimes we say, MODY or a mature onset diabetes of youth.
MODY is usually caused by one gene that is dysfunctional, and this gene is responsible for normal insulin signaling in the pancreas. MODY is usually identified in younger people who don't match the usual characteristics of type 2 diabetes mellitus or type 1 diabetes mellitus.
How long does it take to develop diabetes mellitus?
When we talk about type 2 diabetes mellitus, the process is very long, usually, and it could even begin in childhood. So if we think about that, that child might not develop diabetes mellitus for 20 years, but the process started so early. That's why in diabetes mellitus, we really talk about prevention and trying to help children, especially develop good exercise and eating habits.
Type 1 diabetes mellitus also takes time to develop, but the window is shorter. It's really less than a year, sometimes it's actually very fast. It could be a matter of weeks.
Are the different types of diabetes mellitus treated differently?
The answer is yes, we'll start by just talking about people with primary insulin deficiency, or folks with type 1 diabetes mellitus, insulin is the treatment for that condition in most other types of diabetes mellitus. However, insulin may be needed, but is often not needed for a long time.
This is because those beta cells that are making insulin are still working hard to make insulin. So often, people with type two diabetes are treated with what we say are different classes of medications, because we know that if we can help the body in different ways, almost like different avenues to get to the same place, it helps the blood sugar come down even more effectively.
What are the symptoms of diabetes mellitus?
Well, diabetes can range from having no symptoms at all to having pretty dramatic symptoms, so there's a large spectrum of diabetes mellitus symptoms. The symptoms of high blood sugar include increased urination, this is when the kidney is trying to flush out the sugar from the blood.
Other symptoms of diabetes mellitus include but not limited to:
- Weight loss without trying
- Increased hunger
- Blurry vision
- Numbness and tingling of the hands or feet
- Tiredness
- Very dry skin
- Sores that heal slowly or having more infections than usual.
What is A1c test?
The A1c test is also called the hemoglobin A1c test or simply HBA1c, and it's really a measurement of the glucose that naturally attaches to your red blood cells, the A1c actually measures your average blood sugar over the last 60 to 90 days. A normal level is below 5.7%, a healthy level in people with diabetes mellitus is below 7%.
What conditions am I at higher risk for because I have diabetes mellitus?
The most important ones that we consider are heart and kidney diseases, various types of heart and kidney diseases are more common in people with diabetes mellitus, along the same lines is stroke. Stroke can be devastating in anyone's life, and it is preventable, and one of the ways to prevent stroke is to control blood sugar and to manage other things related to diabetes mellitus, which includes hypertension.
Other less commonly understood and known risks include things like cancer, this is important because we want to make sure our patients with diabetes mellitus do have normal and usual screen for cancer.
What is pre-diabetes mellitus?
It is the condition or the stage of diabetes mellitus that happens before the blood sugar is high enough for us to call it diabetes mellitus. This is a stage in type 2 diabetes mellitus where we know certain interventions can actually delay the onset of diabetes mellitus, keeping somebody in that prediabetes range for more time.
So when we identify prediabetes mellitus, and this is defined as the hemoglobin A1c level between 5.7 and 6.4 we can ask that individual to undertake some lifestyle changes that we know are very powerful to prevent the onset of diabetes mellitus.
So those lifestyle modifications would include a mix of exercise, aerobic and strength exercise, about 150 minutes a week, and a reduced calorie diet, and usually where we're advising people to choose more of a plant based diet where healthy proteins and Leaner Proteins are used, and carbohydrates are kept minimum, and when carbohydrates are chosen that they're high quality carbohydrates those that are high in fiber, that come from fruits and vegetables.
When these lifestyle modifications are well established, it can takes up to 20 years for the body to have a complication related to high blood sugar, identifying pre diabetes actually extends that time to much longer, potentially even preventing any complications at all in a lifetime, and that is the goal.
What is gestational diabetes mellitus?
Gestational diabetes mellitus is a unique form of diabetes mellitus that is defined specifically as diabetes mellitus that only happens because of a pregnancy. In pregnancy, the body is trying to make sure that the growing fetus has optimal nutrition. That's hard to do, because if the body provides too much food, the baby will grow too big. If there's too little food, the baby won't grow enough. The treatment for most women includes diet and exercise, and when treated well, outcomes are excellent.
When can diabetes mellitus be really dangerous?
When there's very high blood sugar, especially when it happens fast, within short period if time, can cause severe dehydration and diabetic ketoacidosis. On the other side, people can have very low blood sugar, and that is always an urgency and sometimes an emergency. But if the blood sugar drops dangerously low, the individual might not even be able to help themselves. We call this severe hypoglycemia, and we train patients and family members and friends how to deal with that. You can check our post in Hausa on how to deal with common diabetic emergencies. "Taimakon gaggawa da ya kamata kowa ya sani don ceto rayuwar masu ciwon sugar."
Why do I have to worry about my feet when I have diabetes mellitus?
The first reason is because of peripheral artery disease, where blood flow might be impaired to especially the small blood vessels in your toes. The other is diabetic neuropathy, where the small nerves in your feet and toes are no longer able to sense normally.
Is there a cure for diabetes?
There is no cure for diabetes mellitus, diabetes is considered a lifelong condition, and that includes all forms of diabetes mellitus. There are people who can achieve long lasting glycemic remission. This is a term sometimes we use to describe people who keep that A1c test so low that it's as if they don't have diabetes.
It's not a cure, but it's almost just as good, especially if we can help our patients stay there for as long as possible to avoid complications. Thanks for joining me today.
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