Diabetes is a persistent health condition resulting from insufficient insulin production by the pancreas or ineffective utilization of insulin by the body. Insulin is crucial in regulating blood sugar levels. Uncontrolled diabetes often leads to hyperglycemia, which can cause severe damage to nerves and blood vessels.
In 2022, 14% of adults worldwide were living with diabetes, marking a significant increase from 7% in 1990. Shockingly, over half of diabetic adults were not receiving any medication for their condition in 2022, especially in low- and middle-income countries.
In 2021, diabetes directly caused 1.6 million deaths, with 47% of these fatalities occurring before the age of 70. An additional 530,000 deaths from kidney diseases were linked to diabetes. Moreover, high blood glucose levels accounted for approximately 11% of cardiovascular-related deaths.
Mortality rates from diabetes have been on the rise since 2000. On the contrary, the likelihood of dying from major noncommunicable diseases between the ages of 30 and 70 decreased by 20% globally from 2000 to 2019.
Symptoms
Symptoms of diabetes may manifest suddenly, while in type 2 diabetes, they can be mild and gradual, taking years to become noticeable.
Common symptoms of diabetes include:
- Excessive thirst
- Frequent urination
- Blurred vision
- Fatigue
- Unintended weight loss
Over time, diabetes can result in damage to blood vessels in vital organs like the heart, eyes, kidneys, and nerves, increasing the risk of health issues such as heart attacks, strokes, and kidney failure. Diabetes can also cause vision loss and foot complications.
Type 1 diabetes
Type 1 diabetes is characterized by inadequate insulin production and necessitates daily insulin injections. As of 2017, there were 9 million individuals living with type 1 diabetes, predominantly in high-income nations. The exact cause and preventive measures for type 1 diabetes remain unknown.
Type 2 diabetes
Type 2 diabetes affects the body’s utilization of sugar for energy, leading to high blood sugar levels if untreated. This condition hinders the proper functioning of insulin, potentially causing severe damage to nerves and blood vessels over time.
Risk factors for type 2 diabetes include obesity, sedentary lifestyle, and genetic predisposition. Early detection is critical, considering that over 95% of diabetes cases are type 2 diabetes.
Gestational diabetes
Gestational diabetes is a type of diabetes that develops during pregnancy. It is characterized by high blood sugar levels, which can pose risks to both the mother and the baby. Women with gestational diabetes are at an increased risk of developing preeclampsia, giving birth to a large baby, and requiring a cesarean section.
Managing gestational diabetes involves following a healthy eating plan, monitoring blood sugar levels regularly, and, in some cases, taking insulin. It is important for women with gestational diabetes to work closely with their healthcare team to ensure a healthy pregnancy and reduce the risk of complications.
After giving birth, women with gestational diabetes should continue to monitor their blood sugar levels regularly, as they have a higher likelihood of developing type 2 diabetes in the future. By maintaining a healthy lifestyle, including regular exercise and a balanced diet, women can reduce this risk and lead a healthy life.
Impaired glucose tolerance and impaired fasting glycaemia
Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are two conditions that fall between normal blood sugar levels and diabetes. Individuals with IGT have higher than normal blood sugar levels after consuming a glucose-rich drink, but not high enough to be classified as diabetic. Those with IFG have higher than normal blood sugar levels after fasting, but again not high enough to be considered diabetic.
Both IGT and IFG are considered pre-diabetic conditions, indicating an increased risk of developing type 2 diabetes if not managed appropriately. It is crucial for individuals with these conditions to adopt healthy lifestyle habits such as regular exercise, maintaining a balanced diet, and monitoring blood sugar levels regularly to prevent the progression to diabetes.
Prevention
Adopting lifestyle changes is crucial in preventing type 2 diabetes. Maintaining a healthy weight, engaging in physical activities, consuming a balanced diet, and avoiding tobacco can help prevent complications associated with diabetes.
Diagnosis and treatment
Early diagnosis through blood glucose testing is vital. Individuals with type 1 diabetes require insulin injections for management. A healthy lifestyle is paramount in diabetes treatment, and medications may be necessary to manage blood sugar levels and reduce the risk of complications.
Monitoring blood sugar levels regularly is important for individuals with diabetes to ensure they are within target range. It is also crucial for individuals with diabetes to maintain a balanced diet, engage in regular physical activity, and avoid smoking and excessive alcohol consumption.
In addition to insulin injections, some individuals with type 1 diabetes may also use insulin pumps to deliver insulin continuously throughout the day. Continuous glucose monitoring systems can help individuals track their blood sugar levels more closely and make adjustments to their treatment plan as needed.
WHO response
The World Health Organization (WHO) endeavors to facilitate effective diabetes surveillance and prevention measures by providing guidelines, setting standards, raising awareness, and conducting diabetes surveillance. In 2021, WHO launched the Global Diabetes Compact to improve prevention and care strategies.
Causes of Diabetes Complications
Most diabetes complications arise from blood vessel problems, with high glucose levels causing blood vessels to constrict, leading to various health issues. Factors contributing to narrowing of blood vessels include complex sugar buildup and inadequate blood glucose control.
Types of Diabetes Complications
Blood vessel complications in diabetes
Atherosclerosis, a condition characterized by plaque buildup in arteries, is more prevalent in individuals with diabetes and can result in heart attacks and strokes. Narrowing of blood vessels can cause harm to different body parts, leading to severe complications.
Infections in diabetes
People with diabetes are prone to bacterial and fungal infections, particularly of the skin and mouth, due to elevated blood glucose levels. Infections may be challenging to treat as white blood cells struggle to combat these infections effectively. In some cases, infections can serve as initial indicators of diabetes.
Individuals with diabetes are also at a higher risk of developing yeast infections like candidiasis. Candida yeast, typically harmless, can overgrow on mucous membranes and skin in diabetic patients, resulting in skin rashes.
Poor circulation in individuals with diabetes increases the risk of ulcers and infections in the feet and legs, with slow healing wounds potentially leading to severe complications like gangrene and osteomyelitis, sometimes requiring amputation.
Eye problems in diabetes
Damage to blood vessels in the eyes, known as diabetic retinopathy, can lead to vision loss, which can be prevented through treatments like laser surgery. Regular eye examinations are crucial for the early detection of eye damage.
Liver damage in diabetes
Many individuals with diabetes also experience steatotic liver disease, characterized by abnormal fat accumulation in the liver, potentially leading to severe liver conditions like cirrhosis. Proper weight management, blood sugar control, and cholesterol management are imperative in addressing this condition.
Kidney damage in diabetes
Diabetic kidney diseases such as chronic kidney disease may necessitate dialysis or kidney transplantation. Early detection through urine tests and proper medication usage can help slow down the progression of kidney damage in diabetes patients.
Nerve damage in diabetes
Nerve damage associated with diabetes can result in weakness, abnormal sensations, and pain in limbs. Diminished function of skin nerves increases the risk of injuries in individuals with diabetes.
Foot problems in diabetes
Diabetes can lead to foot complications due to neuropathy, impaired circulation, and reduced infection resistance. Adequate foot care, including regular check-ups, moisturizing, and suitable footwear, is crucial in preventing ulcers and infections that may necessitate amputation.
Various diabetes complications can impact various tissues and organs, ranging from plaque buildup in arteries to nerve damage and poor wound healing.
Monitoring and Preventing Diabetes Complications
Regular monitoring and screening for diabetes-related complications such as kidney and eye damage are recommended for individuals with diabetes. Managing blood glucose levels and other risk factors such as high blood pressure and cholesterol can help prevent serious complications.
Prevention of hypoglycemia
Controlling blood glucose levels in diabetes can sometimes lead to hypoglycemia with certain medications, which requires immediate recognition and treatment to prevent severe symptoms like confusion and sweating.
In cases of severe hypoglycemia, quick ingestion of sugar is essential to prevent harm. Individuals can consume sugar in various forms like glucose tablets, gel packs, milk, fruit juice, cake, fruit, or other sweet foods. In emergencies, healthcare professionals may need to administer glucose intravenously.
Another treatment for hypoglycemia is glucagon, which can be injected into a muscle or inhaled as a nasal powder. Glucagon stimulates the liver to release glucose rapidly. Portable kits containing syringes or autoinjector pens filled with glucagon are available for emergency situations.
More Information
The following English resources may be beneficial. THE MANUAL neither endorses nor controls the content of these resources:
American Diabetes Association: Comprehensive information and resources on diabetes
JDRF (formerly Juvenile Diabetes Research Foundation): Information focusing on type 1 diabetes
National Institute of Diabetes and Digestive and Kidney Diseases: Information on diabetes, research, and community programs