Diabetes is a common, chronic metabolic condition in which the concentration of glucose in the blood becomes higher than normal (hyperglycemia).

When food is broken down into simple sugar (glucose) inside our body, glucose must be removed from the blood and be taken up by cells in the liver. Inside the cells, glucose is processed into energy that the body can use. The key player of this process is insulin, a hormone that allows the glucose to enter cells. In diabetes, there is either a lack of insulin or insulin no longer becomes as effective as it should be. This will lead to accumulation of glucose in the blood, exceeding the normal range.

Standards

Fasting plasma glucose (measured after fasting for at least 8 hours):

• Normal: <100 mg/dL
• Prediabetes: 100-125 mg/dL
• Diabetes: ≥126 mg/dL

Oral glucose tolerance (measured 2 hours after consumption of a sugary drink post-overnight fasting):

• Normal: <140 mg/dL
• Prediabetes: 140-199 mg/dL
• Diabetes: >200 mg/dL

While diabetes currently has no cure, it can be well-controlled under persistent and careful management. Close glucose monitoring and injection therapies, along with lifestyle changes, are among the top management strategies. On the other hand, unregulated diabetes is likely to have long-term consequences that affect different systems of the body.

General symptoms of diabetes

– Excessive thirst/Dehydration
– Frequent urination
– Fatigue/Lethargy
– Blurred vision
– Weight loss
– Increased hunger
– Numbness or tingling in hands or feet
– Frequent infections
– Slow-healing sores
– Areas of darkened skin (eg. armpits or neck)

Most common forms of diabetes:

Type I Diabetes (~5% of diabetes cases)
Type I diabetes is an autoimmune disorder in which the body’s immune cells attack the insulin producing cells in the pancreas. This causes absence or significant deficiency of insulin, requiring insulin therapy as a part of chronic treatment. Although type I diabetes may develop at any age, it typically manifests in early stages of childhood up to young adulthood.

Type II Diabetes (~95% of diabetes cases)
Type II diabetes occur due to body’s resistance to insulin and/or inadequate production of insulin from the pancreas. This particular type is closely associated with obesity and high blood pressure, and typically develops later in adulthood. Usually, there is a stage before the full onset of diabetes, also known as prediabetes. In prediabetes, a body’s blood glucose level is higher than normal, but lower than those diagnosed with diabetes. Healthy and active lifestyle habits can play significant roles in preventing or delaying the progression from prediabetes to diabetes.

Gestational Diabetes
Diabetes that initially occurs during pregnancy is called gestational diabetes. Some women are at higher risk of developing gestational diabetes than others. Associated risk factors may include obesity, inactivity, prediabetes, PCOS (polycystic ovary syndrome), and family history of diabetes. Like type II diabetes, complications of gestational diabetes, such as the need of C-section during delivery, preeclampsia, or preterm birth, may be prevented by managing blood glucose level during the pregnancy term. In most cases, the rise in blood glucose returns to normal after delivery. However, those who are diagnosed with gestational diabetes during pregnancy are more likely to develop type II diabetes later in life, and so such women should receive routine check-ups even after the end of their pregnancies.

Treatments
The top two objectives of most treatment plans are the following: 1) to lower and monitor blood glucose level to be in the target range and 2) to provide insulin as adequate.

All types of diabetes can be well managed through persistent physical activity (150 or more minutes of exercise per week recommended) and healthy diets that are focused on consuming less calories but in balanced nutrition through fruits, vegetables, lean proteins, and whole grains. Foods high in carbohydrate or trans and saturated fats should be consumed in limited amounts.

Apart from these two essential management strategies, type 1 diabetes often requires insulin therapy through injections or a pump. Type 2 diabetes patients may also be treated with insulin or medications that inhibit production and release of glucose from the liver or those that stimulate the production and release of insulin from the pancreas. Those who are being treated with insulin are advised to use glucose meters or monitors often throughout the day to watch out for hyperglycemia or hypoglycemia. Patients with type 1 diabetes are also reported to be more prone to diabetic ketoacidosis (DKA) so glucose and ketone monitoring are very important. Other treatment options include pancreas transplantation or implantation of an artificial pancreas. Bariatric surgery may be considered as a plan to lower body mass index. All treatment options should be discussed with and followed up by a certified medical provider.

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