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Diabetes: causes, symptoms and complications

By Cristiano Antonino On Nov 23, 2022

Diabetes is a chronic disease characterised by an increase in glycaemia, i.e. the concentration of sugar in the blood that the body is unable to maintain within normal limits

A condition of hyperglycaemia occurs when blood sugar exceeds 100 mg/dl on an empty stomach or 140 mg/dl two hours after a meal.

This condition may depend on a defect in the function or a deficit in the production of insulin, the hormone secreted by the pancreas, which is used to metabolise sugars and other components of food to be transformed into energy for the entire body (such as petrol for the engine).

When blood glucose levels are twice as high as 126 mg/dl or higher, diabetes is diagnosed: high blood glucose levels – if left untreated – lead over time to chronic complications with damage to the kidneys, retina, peripheral nerves and cardiovascular system (heart and arteries).

Types of diabetes

There are three types of diabetes: type 1 diabetes, type 2 diabetes and gestational diabetes.

Type 1 diabetes (abbreviated as DM1 or T1DM)

Type 1 (or insulin-dependent) diabetes is a chronic, autoimmune disease due to the failure of the pancreas to produce insulin due to the destruction of the insulin-producing islets by immune causes.

It is a form of diabetes that mainly begins in childhood and adolescence (between the ages of 2 and 25 years, which is why it was once called childhood diabetes), although cases in adulthood before the age of 40 years are not uncommon.

It often manifests itself suddenly and with symptoms such as fatigue, intense thirst and production of large amounts of urine, weight loss and dehydration.

People living with type 1 diabetes must therefore take insulin from outside, either through several subcutaneous injections during the day (3+1) or through a small pump (pump) that continuously infuses the insulin they need under the skin.

Type 2 diabetes (abbreviated as DM2 or T2DM)

Type 2 diabetes (non-insulin-dependent) is a chronic disease due to an alteration in the amount and function of insulin produced, characterised by high blood glucose levels.

It is the most frequent form of diabetes (96%), usually occurring in adulthood, especially in overweight or obese people who have a family history of diabetes.

The onset is gradual and often remains symptom-free for a long time, until blood glucose levels are consistently high enough to give rise to intense thirst and frequent urination or the appearance of urinary or genital infections.

In Type 2 diabetes, insulin production is there, but the functioning on the target tissues (muscles, liver and adipose tissue) is impaired, which is why we speak of ‘insulin resistance’ as the main defect of the disease.

The main therapy for Type 2 diabetes is regular and constant physical activity and a proper diet, suitable for reducing excess weight, to restore proper insulin functioning.

In addition to a suitable lifestyle, there are medications, which today offer a very varied choice, but the first one to be used is metformin, which helps improve insulin functioning.

Gestational diabetes (abbreviated as GDM)

Gestational diabetes (GDM) or diabetes gravidarum is a form of type 2 diabetes that occurs in approximately 10% of pregnancies in the second half or last trimester and tends to disappear at delivery, but represents a risk condition for the mother to have diabetes in the years to come.

The risk factors for GDM are: age > 35 years, family history of diabetes, obesity, high risk ethnicity.

Intermediate forms: LADA diabetes

It is a form of diabetes of autoimmune origin like type 1 diabetes, which maintains residual insulin production for a long time, so the evolution of the disease is more similar to type 2 diabetes.

It arises in thin subjects and can be treated for a long time with oral therapies: it constitutes about 10% of all forms of diabetes.

Causes of diabetes and risk factors

The causes of type 1 diabetes are not completely clear, but even trivial viral infections that can attack and destroy the insulin-producing cells of the pancreas are recognised, such as

measles
cytomegalovirus
Epstein-Barr
coxsackie virus.

For Type 2 diabetes, on the other hand, the main risk factors are

overweight and obesity;
genetic factors: family history increases the risk of developing type 2 diabetes;
ethnicity: the highest number of cases is recorded in the populations of sub-Saharan Africa and the Middle East and North Africa;
environmental factors, especially related to unhealthy lifestyles (sedentary lifestyle and obesity);
gestational diabetes, i.e. diabetes that appears during pregnancy;
age: type 2 diabetes increases with increasing age, especially over the age of 65;
high-fat diet that promotes obesity
alcohol consumption;
sedentary lifestyle.

Signs and symptoms of diabetes

The symptoms of the disease, which depend on blood sugar levels, are

polyuria, i.e. a high amount of urine production even during the night (nocturia)
intense feeling of thirst (polydipsia);
polyphagia (intense hunger);
the body’s need to replenish fluids and severe dehydration (dry mucous membranes);
feeling of tiredness (asthenia);
weight loss;
frequent infections;
blurred vision

In type 1 diabetes, they manifest themselves rapidly and with great intensity; in T2 diabetes, on the other hand, the symptoms are less obvious, develop much more slowly and may go unnoticed for months or years.

Diagnosis often occurs by chance, during examinations carried out for whatever reason: the finding of a blood glucose level > 126 mg/dl allows the diagnosis of Type 2 diabetes to be made, which must be confirmed with a second blood glucose and HbA1c test.

Diagnosis

The diagnosis of diabetes is made through blood tests.

The main tests are:

blood glucose in the morning after observing at least 8 hours of fasting. Values of 126 mg/dl or more are indicative of ‘diabetes’;
glycated haemoglobin (HbA1c), which expresses the average of blood glucose levels over the last 2-3 months. Values above 6.5% indicate the presence of diabetes;
glucose load test: if there are fasting blood glucose values between 100 and 126, this test can be done to make a diagnosis. You take 75 grams of glucose dissolved in water and assess your blood glucose at time 0 and after 2 hours. If the blood glucose after two hours is equal to or greater than 200 mg/dl, it indicates the presence of diabetes.

Complications of diabetes

Type 1 can lead to acute and chronic complications.

The most frequent and dreaded acute complication is hypoglycaemia, i.e. a sudden drop in blood sugar with blood glucose below 70 mg/dl (due to an excess of injected insulin or the meal not eaten), which is accompanied by sweating, trembling, hunger, palpitations, to which confusion and weakness may be added.

It is corrected by taking sugar, fruit juice, honey or a sweet drink, according to the rule of 15: 15 g of sugar, then check after 15′, until blood glucose exceeds 100 mg/dl.

Diabetics taking insulin should always carry a few sachets of sugar with them for every emergency.

A second acute complication is severe and prolonged hyperglycaemia, which can occur from eating a meal and forgetting the insulin dose or due to a concomitant febrile illness or infection, or trauma.

In the case of hyperglycaemia, the alarm bells that should prompt an early check of glycaemia and the presence of ketones in the urine are: blurred vision, irritability, the need to urinate often, intense thirst, tiredness and difficulty concentrating.

According to diabetologists’ advice, if blood glucose remains above 250 mg/dl for a long time, it is important to administer additional insulin (correction dose) and to notify your diabetologist immediately.

These complications are less frequent in type 2 diabetics and depend on the therapies adopted: if insulin or sulphonylureas are used, hypoglycaemia may occur.

Chronic complications, on the other hand, are the same for both T1 and T2, affect several organs and are the consequence of a poorly controlled or neglected history.

They can be disabling or even fatal:

cardiovascular diseases such as angina, heart attack, stroke, atherosclerosis in the arteries of the legs, with difficulties in circulation;
eye diseases such as diabetic retinopathy, cataracts and glaucoma;
neuropathy with nerve damage, manifested by tingling, burning, or loss of feeling in the toes, which then extends to the whole foot and leg; diarrhoea or constipation, nausea and vomiting may also appear, and erectile dysfunction may occur in men;
nephropathy i.e. progressive reduction in kidney function, leading to chronic renal failure;
ulcers in the lower limbs and minor and major amputations as a result of serious infections from even small wounds, which become infected if not treated properly and in time.

The risk of such complications can be minimised by maintaining good control of blood glucose and other risk factors, such as hypertension and high cholesterol, and by having annual check-ups as prescribed by a diabetologist.

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