Documents of diabetes

 

What is diabetes

LAST UPDATE: 26/03/2020

 

Diabetes is a chronic disease that occurs when the pancreas

is no longer able to make insulin, or when the body cannot 

make good use of the insulin it produces.

Insulin is a hormone made by the pancreas, that acts like

 a key to let glucose from the food we eat pass from the 

blood stream into the cells in the body to produce energy. 

All carbohydrate foods are broken down into glucose in 

the blood. Insulin helps glucose get into the cells. 

Not being able to produce insulin or use it effectively 

leads to raised glucose levels in the blood

 (known as hyperglycaemia). Over the long-term

high glucose levels are associated with damage to the body

and failure of various organs and tissues.

 

Types of diabetes

There are three main types of diabetes – 

type 1, type 2 and gestational.

VIDEO 

 

Type 1 diabetes

LAST UPDATE: 20/03/2020

 

Around 10% of all people with diabetes have type 1 diabetes.

Type 1 diabetes is caused by an autoimmune reaction where the body’s defence system attacks the cells that produce insulin. As a result, the body produces very little or no insulin. The exact causes of this are not yet known, but are linked to a combination of genetic and environmental conditions.

Type 1 diabetes can affect people at any age, but usually develops in children or young adults. People with type 1 diabetes need daily injections of insulin to control their blood glucose levels. If people with type 1 diabetes do not have access to insulin, they will die.

The risk factors for type 1 diabetes are still being researched. However, having a family member with type 1 diabetes slightly increases the risk of developing the disease. Environmental factors and exposure to some viral infections have also been linked to the risk of developing type 1 diabetes.

Symptoms of type 1 diabetes

The most common symptoms of type 1 diabetes include:

• Abnormal thirst and dry mouth
• Sudden weight loss
• Frequent urination
• Lack of energy, tiredness
• Constant hunger
• Blurred vision
• Bedwetting

Diagnosing type 1 diabetes can be difficult so additional tests may be required to confirm a diagnosis.

Management of type 1 diabetes

People with type 1 diabetes require daily insulin treatment, regular blood glucose monitoring and a healthy lifestyle to manage their condition effectively.

Insulin

All people with type 1 diabetes need to take insulin to control their blood glucose levels. There are different types of insulin depending on how quickly they work, when they peak, and how long they last. Insulin is commonly delivered with a syringe, insulin pen or insulin pump.

Types of insulin include:

• Rapid-acting: usually taken just before or with a meal. These insulins act very quickly to limit the rise in blood sugar, which follows eating. It is essential to avoid overdosage to minimize the risk of low blood sugar (hypoglycemia). Rapid-acting insulins include Asparat, Glulisine, Lispro.
• Short-acting: usually taken before meals. These insulins are also called regular or neutral insulins. They do not act as quickly as rapid-acting insulins and therefore may be more appropriate in certain people. Short-acting insulins include Actrapid, Humulin R, Insuman Rapid.
• Intermediate-acting: often taken together with a short-acting insulin. Intermediate-acting insulins start to act within the first hour of injecting, followed by a period of peak activity lasting up to 7 hours. Intermediate acting insulins include Humulin NPH, Protaphane, Insulatard.
• Long-acting: insulins that are steadily released and can last in the body for up to 24 hours. They are commonly taken in the morning or in the evening, before going to bed. Long-acting insulins include Detemir, Glargine.

Two common insulin treatment plans include:

• Twice-daily insulin: using both short-acting and intermediate-acting insulin.
• Basal bolus regimen: short-acting insulin taken with main meals (usually three times a day) and intermediate-acting insulin given once or twice daily (evening or morning and evening).

Self-monitoring

People with diabetes who require insulin need to check their blood glucose levels regularly to inform insulin dosage. Self-monitoring of blood glucose (SBMG) is the name given to the process of blood glucose testing by people with diabetes at home, school, work or elsewhere. SMBG helps people with diabetes and their healthcare providers understand how their blood glucose levels vary during the day so that their treatment can be adjusted accordingly.

People with type 1 diabetes are usually advised to measure their blood glucose level at least four times a day. 

Healthy nutrition

Healthy nutrition — knowing what and when to eat — is an important part of diabetes management as different foods affect your blood glucose levels differently.

A healthy diet for all people with diabetes includes reducing the amount of calories if you are overweight, replacing saturated fats (eg. cream, cheese, butter) with unsaturated fats (eg. avocado, nuts, olive and vegetable oils), eating dietary fibre (eg. fruit, vegetables, whole grains), and avoiding tobacco use, excessive alcohol and added sugar.

Physical activity

Regular physical activity is essential to help keep blood glucose levels under control. It is most effective when it includes a combination of both aerobic (eg. jogging, swimming, cycling) exercise and resistance training, as well as reducing the amount of time spent being inactive.

Prevention of type 1 diabetes

No effective and safe intervention currently exists to prevent type 1 diabetes despite a large number of clinical trials aimed at halting the on-going autoimmune destruction of pancreatic beta cells. However, there is some evidence that overweight and a high growth rate in children are weak risk factors, indicating that a healthy lifestyle that avoids both over-eating and a sedentary lifestyle is recommended for high-risk groups such as the siblings of children with type 1 diabetes. However, this is just one of a number of factors that have also been implicated. These include not being breast-fed, being the first-born, being born by caesarean section and having an older or obese mother.

Although a ‘cure’ for type 1 diabetes is being actively sought, preventing or delaying it in those known to be at risk or, in those already diagnosed, slowing down the auto-immune destruction of beta cells and protecting those cells that are still active are likely to be more achievable goals in the foreseeable future. Neither has been convincingly achieved as yet. However, several studies are underway using interventions such as oral insulin in people known to have markers of islet autoimmunity, trialling drugs already used, for example in psoriasis, to prolong beta cell life and the use of peptide immunotherapies to ‘retrain’ killer T cells, the lymphocytes that are closely involved in the underlying mechanism of type 1 diabetes.

Type 2 diabetes         GOTO HOME PAGE      

LAST UPDATE: 16/10/2020

COVID-19 and diabetes - Learn more

Type 2 diabetes is the most common type of diabetes, accounting for around 90% of all diabetes cases.

It is generally characterized by insulin resistance, where the body does not fully respond to insulin. Because insulin cannot work properly, blood glucose levels keep rising, releasing more insulin. For some people with type 2 diabetes this can eventually exhaust the pancreas, resulting in the body producing less and less insulin, causing even higher blood sugar levels (hyperglycaemia).

Type 2 diabetes is most commonly diagnosed in older adults, but is increasingly seen in children, adolescents and younger adults due to rising levels of obesity, physical inactivity and poor diet.

The cornerstone of type 2 diabetes management is a healthy diet, increased physical activity and maintaining a healthy body weight. Oral medication and insulin are also frequently prescribed to help control blood glucose levels.

Risk factors

Several risk factors have been associated with type 2 diabetes and include:

• Family history of diabetes
• Overweight
• Unhealthy diet
• Physical inactivity
• Increasing age
• High blood pressure
• Ethnicity
• Impaired glucose tolerance (IGT)*
• History of gestational diabetes
• Poor nutrition during pregnancy

*Impaired glucose tolerance (IGT) is a category of higher than normal blood glucose, but below the threshold for diagnosing diabetes.

Changes in diet and physical activity related to rapid development and urbanisation have led to sharp increases in the numbers of people living with type 2 diabetes.

Symptoms of type 2 diabetes

The symptoms of type 2 diabetes are similar to those of type 1 diabetes and include:

• Excessive thirst and dry mouth
• Frequent urination
• Lack of energy, tiredness
• Slow healing wounds
• Recurrent infections in the skin
• Blurred vision
• Tingling or numbness in hands and feet.

These symptoms can be mild or absent and so people with type 2 diabetes may live several years with the condition before being diagnosed.

Management of type 2 diabetes

The cornerstone of managing type 2 diabetes is a healthy lifestyle, which includes a healthy diet, regular physical activity, not smoking, and maintaining a healthy body weight.

Over time, a healthy lifestyle may not be enough to keep blood glucose levels under control and people with type 2 diabetes may need to take oral medication. If treatment with a single medication is not sufficient, combination therapy options may be prescribed.

When oral medication is not sufficient to control blood glucose levels, people with type 2 diabetes may require insulin injections.

Medications for type 2 diabetes

The most commonly used oral medications for type 2 diabetes include:

• Metformin: reduces insulin resistance and allows the body to use its own insulin more effectively. It is regarded as the first-line treatment for type 2 diabetes in most guidelines around the world.
• Sulfonylureas: stimulate the pancreas to increase insulin production. Sulfonylureas include gliclazide, glipizide, glimepiride, tolbutamide and glibenclamide.

Prevention of type 2 diabetes

There are a number of factors that influence the development of type 2 diabetes. The most influential are lifestyle behaviours commonly associated with urbanisation. Research indicates that a majority of cases of type 2 diabetes could be prevented through healthy diet and regular physical activity. A healthy diet includes reducing the amount of calories if you are overweight, replacing saturated fats (eg. cream, cheese, butter) with unsaturated fats (eg. avocado, nuts, olive and vegetable oils), eating dietary fibre (eg. fruit, vegetables, whole grains), and avoiding tobacco use, excessive alcohol and added sugar.

Regular physical activity is essential to help keep blood glucose levels under control. It is most effective when it includes a combination of both aerobic (eg. jogging, swimming, cycling) exercise and resistance training, as well as reducing the amount of time spent being inactive.

                                                                                        

Know your risk of type 2 diabetes

Brief questionnaires are simple, practical and inexpensive ways to quickly identify people who may be at a higher risk of type 2 diabetes and who need to have their level of risk further investigated.

The Finnish Type 2 Diabetes Risk Assessment Form, developed in 2001, is an example of an effective questionnaire that can be used as the basis for developing national questionnaires which take into account local factors. It has eight scored questions, with the total test score providing a measure of the probability of developing type 2 diabetes over the following 10 years. The reverse of the form contains brief advice on what the respondent can do to lower their risk of developing the disease, and whether they should seek advice or have a clinical examination. The test takes only a couple of minutes to complete and can be done online, in pharmacies or at various public campaign events.

IDF has developed a type 2 diabetes online diabetes risk assessment that aims to predict an individual’s risk of developing type 2 diabetes within the next ten years. The test is based on the Finnish Diabetes Risk Score (FINDRISC) developed and designed by Adj. Prof Jaana Lindstrom and Prof. Jaakko Tuomilehto from the National Institute for Health and Welfare, Helsinki, Finland. 

Diabetes complications

LAST UPDATE: 22/05/2020

People with diabetes have an increased risk of developing a number of serious health problems. Consistently high blood glucose levels can lead to serious diseases affecting the heart and blood vessels, eyes, kidneys, nerves and teeth. In addition, people with diabetes also have a higher risk of developing infections. In almost all high-income countries, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation.

Maintaining blood glucose levels, blood pressure, and cholesterol at or close to normal can help delay or prevent diabetes complications. Therefore people with diabetes need regular monitoring.

Cardiovascular disease: affects the heart and blood vessels and may cause fatal complications such as coronary artery disease (leading to heart attack) and stroke. Cardiovascular disease is the most common cause of death in people with diabetes. High blood pressure, high cholesterol, high blood glucose and other risk factors contribute to increasing the risk of cardiovascular complications.  diabetes and CVD.

 

Diabetes and cardiovascular disease

 

• Diabetes and elevated blood glucose are associated with an approximate doubling of cardiovascular disease risk.
• The risk of cardiovascular disease in people with diabetes can be reduced by lowering high blood pressure and high glucose levels, and using lipid-lowering medications.

Diabetes and cardiovascular disease (CVD) are associated with a wide range of cardiovascular conditions that collectively comprise the largest cause of disease and mortality for people with diabetes.

People with diabetes are two to three times more likely to have cardiovascular disease than people without diabetes. High levels of blood glucose can make the blood coagulation system more active, increasing the risk of blood clots. Diabetes is also associated with high blood pressure and cholesterol levels, which lead to increased risk of cardiovascular complications such as angina, coronary artery diseases (CADs), myocardial infection, stroke, peripheral artery disease (PAD), and congestive heart failure.

Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels and include:

 

 

Kidney disease (diabetic nephropathy): caused by damage to small blood vessels in the kidneys leading to the kidneys becoming less efficient or to fail altogether. Kidney disease is much more common in people with diabetes than in those without diabetes. Maintaining near normal levels of blood glucose and blood pressure can greatly reduce the risk of kidney disease.  diabetes and the kidneys.

Diabetes and the kidneys

LAST UPDATE: 02/03/2021

• Diabetes, hypertension, or a combination of both, cause 80% of end-stage renal disease globally.
• Both diabetes and chronic kidney disease are strongly associated with cardiovascular disease. Controlling blood glucose and blood pressure can reduce associated risks.
• The most effective strategies to reduce the impact of kidney disease in diabetes are to prevent type 2 diabetes and to diagnose and treat kidney disease early and effectively in people already living with diabetes.

 

    

 

·         Kidney disease (nephropathy) is far more common in people with diabetes than in people without diabetes. It is caused by damage to small blood vessels, which can cause the kidneys to be less efficient, or to fail altogether. Diabetes is one of the leading causes of chronic kidney disease (CKD).

·         Based on data from the UK and USA, up to 40% of people with diabetes will develop chronic kidney disease.¹ Pooled data from 54 countries reveal that more than 80% of cases of end-stage renal disease (ESRD) are caused by diabetes, hypertension or a combination of both.

·         Diabetes, hypertension and kidney failure are highly interlinked. On the one hand, type 2 diabetes is a leading cause of kidney failure, which is a risk for hypertension, and on the other, hypertension can often precede CKD and contribute to the progression of kidney disease.

·         Both diabetes and CKD are strongly associated with cardiovascular disease (CVD) and therefore, the major component in their management is control of CVD risk factors such as hypertension and high blood glucose (hyper glycaemia). It is important to control blood glucose and blood pressure to reduce the risk of kidney disease. Screening for abnormal quantities of albumin in the urine (albuminuria) and starting treatment with drugs that reduce the activity of the renin-angiotensin-aldosterone system when albuminuria is persistently found, even in the absence of hypertension, is very effective to prevent the development and progression of CKD in people with diabetes.

·         Screening for albuminuria should be done every year after diagnosis in people with type 2 diabetes and the same after the first five years in people with type 1 diabetes.

Nerve disease (diabetic neuropathy): diabetes can cause damage to the nerves throughout the body when blood glucose and blood pressure are too high. This can lead to problems with digestion, erectile dysfunction, and many other functions. Among the most commonly affected areas are the extremities, in particular the feet. Nerve damage in these areas is called peripheral neuropathy, and can lead to pain, tingling, and loss of feeling. Loss of feeling is particularly important because it can allow injuries to go unnoticed, leading to serious infections and possible amputations. People with diabetes carry a risk of amputation that may be more than 25 times greater than that of people without diabetes. However, with comprehensive management, a large proportion of amputations related to diabetes can be prevented. Even when amputation takes place, the remaining leg and the person’s life can be saved by good follow-up care from a multidisciplinary foot team. People with diabetes should regularly examine their feet.

Diabetes prevention

LAST UPDATE: 08/07/2019

At present, type 1 diabetes cannot be prevented. The environmental triggers that are thought to generate the process that results in the destruction of the body’s insulin-producing cells are still under investigation.

While there are a number of factors that influence the development of type 2 diabetes, it is evident that the most influential are lifestyle behaviors commonly associated with urbanization. These include consumption of unhealthy foods and inactive lifestyles with sedentary behavior. Studies from different parts of the world have established that lifestyle modification with physical activity and/or healthy diet can delay or prevent the onset of type 2 diabetes.

Modern lifestyles are characterized by physical inactivity and long sedentary periods. Community-based interventions can reach individuals and families through campaigns, education, social marketing and encourage physical activity both inside and outside school and the workplace. IDF recommends physical activity at least between three to five days a week, for a minimum of 30-45 minutes.

Taking a life course perspective is essential for preventing type 2 diabetes and its complications. Early in life, when eating and physical activity habits are established and when the long-term regulation of energy balance may be programmed, there is an especially critical window to prevent the development of overweight and reduce the risk of type 2 diabetes. Healthy lifestyles can improve health outcomes at later stages of life as well.

Population based interventions and policies allow healthy choices through policies in trade, agriculture, transport and urban planning to become more accessible and easy. Healthy choices can be promoted in specific settings (school, workplace and home) and contribute to better health for everyone. They include exercising regularly and eating wisely which will help to maintain normal levels of blood glucose, blood pressure and lipids.

Learn more about cost-effection solutions for the prevention of type 2 diabetes.

Type 2 diabetes prevention studies

There is overwhelming evidence from studies in the USA, Finland, China, India and Japan that lifestyle changes (achieving a healthy body weight and moderate physical activity) can help prevent the development of type 2 diabetes in those at high risk.

• The Da Qing Study examined the effect of a 6-year diet and exercise intervention in Chinese individuals with Impaired Glucose Tolerance (IGT) and an average age of 45. The diet intervention alone was associated with a 31% reduction in the risk of developing type 2 diabetes, while the exercise intervention alone showed a 46% reduction. The combined diet and exercise group had a similar 42% reduction in the risk of developing type 2 diabetes during a 6-year follow-up period.
• The Finnish Diabetes Prevention Study (DPS) was the first randomized controlled trial to specifically examine the effect of a lifestyle intervention in preventing type 2 diabetes. This study randomly assigned 522 overweight or obese individuals with IGT to either a lifestyle intervention or a control group and followed them for approximately 3 years. The lifestyle intervention provided individualized counseling focused on achieving and maintaining healthy body weight, reducing fat intake, increasing fiber intake and increasing physical activity. After two years, the incidence of type 2 diabetes in the intervention group was less than half that observed within the control group.
• The Diabetes Prevention Program (DPP) was conducted in 3234 US adults with IGT. Unlike most previous studies, the cohort was diverse and included a large proportion of women (68%) and ethnic minorities (45%), and compared lifestyle intervention versus drug intervention (metformin) and a placebo control group over 2.8 years. The DPP reported that both lifestyle intervention and metformin had positive effects on the prevention of type 2 diabetes and restoring normal glucose tolerance. The lifestyle intervention was more effective in preventing type 2 diabetes, particularly in older adults.
• The Indian Diabetes Prevention Program (IDPP) was a prospective community-based study, that examined whether the progression to type 2 diabetes could be influenced by interventions in native Asian Indians with IGT who were younger, leaner and more insulin resistant than in multiethnic American, Finnish and Chinese populations Results showed that progression of IGT to type 2 diabetes is high in native Asian Indians. Both lifestyle modification and metformin significantly reduced the incidence of type 2 diabetes in Asian Indians with IGT.

IDF recommendations for a healthy diet for the general population

1.   Choosing water, coffee or tea instead of fruit juice, soda, or other sugar sweetened beverages.

2.   Eating at least three servings of vegetable every day, including green leafy vegetables.

3.   Eating up to three servings of fresh fruit every day.

4.   Choosing nuts, a piece of fresh fruit, or unsweetened yoghurt for a snack.

5.   Limiting alcohol intake to a maximum of two standard drinks per day.

6.   Choosing lean cuts of white meat, poultry or seafood instead of red or processed meat.

7.   Choosing peanut butter instead of chocolate spread or jam.

8.   Choosing whole-grain bread, rice, or pasta instead of white bread, rice, or pasta.

9.   Choosing unsaturated fats (olive oil, canola oil, corn oil, or sunflower oil) instead of saturated fats (butter, ghee, animal fat, coconut oil, or palm oil.

A particular threat in terms of the associated risk of developing type 2 diabetes is the consumption of high sugar foods, particularly sugar-sweetened beverages, In 2014, the World Health Organization (WHO) issued new recommendations to limit sugar intake. IDF fully supports these recommendations and in a response published the IDF Framework for Action on Sugar.

 The Diabetic Foot

LAST UPDATE: 07/01/2020

• Diabetic foot and lower limb complications are severe and chronic. They affect 40 to 60 million people with diabetes globally. Chronic ulcers and amputations result in a significant reduction in the quality of life and increase the risk of early death.
• Less than one-third of physicians recognize the signs of diabetes-related peripheral neuropathy. The resulting missed diagnoses contribute greatly to the high rates of disease and mortality.

High blood glucose can cause damage to the nerves throughout the body. Neuropathy is a frequently encountered complication of diabetes. Nerve damage can be quite significant and allow injuries to go unnoticed, leading to ulceration, serious infections and in some case amputations.

 

 

 

 Diabetic neuropathy 

Diabetic neuropathy is an impairment of normal activities of the nerves throughout the body and can alter autonomically, motor, and sensory functions. Peripheral neuropathy is the most common form of diabetic neuropathy, affecting the outer nerves of the limbs, particularly those of the feet. It mainly alters sensory function, causing abnormal feelings and progressive numbness which facilitates the development of ulcers (diabetic foot).

Diabetic foot is one of the most common, costly and severe complications of diabetes. Amputation in people with diabetes is 10 to 20 times more common than in people without diabetes and it is estimated that every 30 seconds a lower limb or part of a lower limb is lost somewhere in the world as a consequence of diabetes.¹

Diabetic foot can result in an important economic, social, and public health burden; especially in low-income communities, if there is neither an appropriate educational program nor adequate and suitable footwear.

GOTO HOME PAGE