What is Diabetes Mellitus?

Diabetes Mellitus is a chronic disease that affects your blood sugar levels. Diabetes comes about in two different ways. The first is when the body does not produce enough insulin. The second is when the body cells develop resistance to insulin. The overall result is lack of proper regulation of blood sugar levels.

Insulin is one of the hormones that regulate blood sugar levels. Its role is to lower the levels of glucose in the blood. By doing so, it ensures that your blood sugar level remains within the optimum limits for normal body functioning.

The pancreas, which is located in the abdomen, produces insulin it works by facilitating the movement of glucose from the blood into the cells. It also causes conversion of glucose to storage forms such as glycogen.

When the regulatory mechanisms of insulin are impaired, the blood sugar levels remain high. High blood sugar levels have long-term consequences such as nerve damage, kidney disease, cardiovascular conditions, and several health complications. When the blood sugar level is high, this is termed hyperglycaemia. When the blood sugar level is low, we call that hypoglycaemia.

Worldwide, there are currently 463 cases of diabetes mellitus. According to the International Diabetes Federation, Kenya has more than 552,400 cases of diabetes among adults which represents 2.2% of the adult population.

What Are the Types of Diabetes Mellitus?

There are different types of diabetes mellitus.

Type 1 Diabetes: It results from very little or no insulin production. It comes about when the body’s immune system attacks the cells of the pancreas that are responsible for insulin production. This type tends to occur in younger people. When it occurs in adulthood, it is termed Latent Autoimmune Diabetes in Adults (LADA).

With no insulin, the body is unable to lower blood sugar levels. People with type one diabetes need insulin replacement therapy.  This type comprises about 10% of the cases of diabetes.

Type 2 Diabetes: This type occurs when the body cells become resistant to insulin. Unlike type 1 diabetes, these individuals have normal insulin levels in the body but the body’s response to the hormone is impaired. People with this type of diabetes need oral medication that helps lower their blood sugar levels as opposed to insulin replacement therapy. We have listed some of these drugs on this article.

Gestational Diabetes: in this type, there is increased blood sugar during pregnancy. This is mainly due to placental products that counter the effects of insulin.

Prediabetes: This comes about when one has a slightly elevated blood sugar level that has not crossed the threshold for diabetes type 2. Here, aggressive lifestyle modification in terms of diet and physical activity is highly recommended as one can easily tip over to full-blown diabetes

Other forms of Diabetes: Other forms of diabetes are rare. Other hormonal disturbances, cancers or drugs that affect insulin production by the pancreas cause them.

The Differences between Type 1 and Type 2 Diabetes

What Causes Diabetes Mellitus?

The causes of diabetes mellitus have not been established in entirety. However, there are some conditions that put you at risk of developing diabetes. The different types of diabetes are associated with different risk factors. Listed below are the risk factors for type 2 diabetes:

• Overweight
• Physical inactivity
• Family history of diabetes
• High lipid levels
• Increasing age
• Diet rich in refined sugars
• Smoking
• History of gestational diabetes

What are The Signs and Symptoms of Diabetes Mellitus?

Signs of diabetes manifest as a result of the high blood glucose levels.

They include:

• Weight loss
• Frequent urination termed as polyuria. Young children will wet the bed frequently.
• Excessive thirst. This is also called polydipsia.
• Feeling fatigued.
• Excessive hunger
• Skin infections
• Problems with vision.

Diagnosis of Diabetes mellitus

To diagnose diabetes mellitus, your doctor will determine your blood sugar level using some tests. Measuring the fasting blood sugar, the oral glucose tolerance test (OGTT) or by measuring your HbA1C level. Another quick test that is commonly done is the random blood sugar.

Fasting blood sugar refers to the measure of blood sugar level after an individual has been deprived of caloric intake for at least 8 hours. Diabetes mellitus is diagnosed when the fasting blood sugar level is above 7.0 mmol/L or 126mg/dL.

The oral glucose tolerance test (OGTT), is performed by giving the person a 75g glucose load to ingest. The blood glucose level is then measured. When the 2-hour glucose level is above 11.1mmol/L or 200mg/ dL then a diagnosis of diabetes is considered

HbA1C refers to the haemoglobin that is chemically attached to a sugar. The more sugar in your blood, the more it attachés to your haemoglobin. The levels rise in cases of diabetes. A level above 6.5% is diagnostic of diabetes mellitus. In blacks, the threshold is higher− about 7%.

The Complications of Diabetes

Having high blood sugar levels has effects on many body organs including the heart, eyes, kidneys, skin and brain. These complications are broadly classified into acute and chronic complications. The acute complications include diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state and hypoglycaemia. The chronic complications include diabetic neuropathy, nephropathy, retinopathy, skin infections, diabetic foot, sexual dysfunction, stroke and other cardiovascular conditions. We have discussed these complications below.

Diabetic Ketoacidosis

This acute complication of diabetes mellitus occurs mostly in type 1 diabetes although it has occurred in type 2. It results from very high levels of blood sugars.  A life-threatening complication requires prompt intervention. The symptoms of DKA include nausea, vomiting, body weakness and abdominal pain. The patient shows signs of dehydration; might have laboured breathing and a sweet-smelling breath as a result of acetone.

DKA comes about when a diabetic person hasn’t been using their meds consistently or because of an infection. Sometimes, this is the first serious manifestation of undiagnosed diabetes.

Hyperosmolar Hyperglycaemic State (HHS)

This occurs mainly in type 2 diabetics. It comes about because of a build-up of blood sugar in the body. The glucose levels are much higher than in diabetic ketoacidosis. It is also characterised by dehydration and elevated levels of blood urea.

Hypoglycaemia

Hypoglycaemia refers to lower than normal blood sugar levels. Symptoms develop when blood levels fall below 4mmol/L. The blood sugar can drop when one has an insulin overload, engages in strenuous exercises, delay of a meal, overdose of diabetes meds, or poor insulin injection technique. A hypoglycaemic person will feel weak, appear confused, sweat profusely, experience headaches and severe hunger.

Heart Disease

Diabetes increases your chances of getting heart disease twofold. Hyperglycaemia causes damage to blood vessels. When this affects the blood vessels that supply the heart, its functioning is greatly impaired. Damage of the blood vessels will generally put a strain on the normal heart functioning.

When diabetes coexists with other conditions such as hypertension and increased lipid levels, the progression to develop heart disease is faster.

Neuropathy

Neuropathy refers to nerve disease. Diabetic neuropathy is a long term complication of diabetes. It manifests as tingling, pain, numbness or weakness. Neuropathy can be peripheral, proximal, focal or autonomic, depending on the specific nerves affected. This complication predisposes one to chronic non-healing wounds especially on the legs and feet, mainly because they have lost sensation and take a while to detect when injured.

Nephropathy

Diabetic nephropathy refers to the kidney damage that is a result of chronic hyperglycaemia. The symptoms of kidney disease in diabetes include easy fatigability, generalised body swelling, loss of appetite and dry skin. Your doctor will order some tests to confirm the presence of kidney impairment such as the serum levels of creatinine and urea and urinalysis.

Retinopathy

Damage to blood vessels supplying the retina causes eye problem. It occurs when one has constantly elevated blood sugar for a long time. In diabetic retinopathy, one starts experiencing vision problems such as seeing dark spots, poor night vision or blurred vision. Diabetic retinopathy is one of the major causes of blindness.

Susceptibility to Infections

Diabetes mellitus affects the function of the immune system. Poor blood circulation caused by high blood sugars interferes with nourishment of the skin. People with diabetes are therefore susceptible to infections.

Gestational Diabetes can lead to the birth of a premature infant, stillbirth or an overweight baby.

Prevention of Diabetes

The risk factors of diabetes type 2 Mellitus can be either modifiable or non-modifiable. The modifiable risk factors can be changed because you have control over them. Here is how you can prevent diabetes.

• Maintain a healthy diet.
• Exercise regularly
• Getting enough sleep
• Limiting alcohol intake.
• Quitting use of tobacco.

Treatment of Diabetes

The mode of treatment depends on the type of diabetes.

The mainstay of treatment of Type 1 diabetes is insulin therapy. This is because, in type 1 diabetes, the body cannot produce its own insulin. There are different types of insulin grouped mainly on their duration of action. These are rapid-acting, short-acting, intermediate-acting, long-acting and the mixed insulin.

The treatment of type 2 diabetes can initially be achieved with lifestyle modifications. Medications are the next step if lifestyle changes do not cause the desired changes.

The drugs used work in different ways to lower blood sugar. Below are the different classes of medications used in the treatment of diabetes.

Biguanides: Work by reducing glucose production in the liver. Metformin falls in this class of drugs.

Sulfonylureas: They work by stimulating the pancreatic cells to release insulin. They include glibenclamide and glipizide.

Thiazolidinedione’s: Work by improving insulin sensitivity in different body cells and by reducing glucose output in the liver. An example is pioglitazone.

Alpha-glucosidase inhibitors: Delays the absorption of sugars from the digestive system. An example of a drug in this class is acarbose.

DPP 4 inhibitors (Gliptins): These drugs improve insulin secretion and an example is sitagliptin.

SGLT-2 inhibitors: This group of drugs work by increasing urine excretion of glucose.

References:

(2020, April 23). International Diabetes Federation. Retrieved from https://idf.org/our-network/regions-members/africa/members/13-kenya.htm

KENYA NATIONAL CLINICAL GUIDELINES FOR THE MANAGEMENT OF DIABETES MELLITUS (2nd ed.). (2018).