What is Diabetes
What is diabetes mellitus?
The term ‘diabetes’ means excessive urination and the word ‘mellitus’ means honey. In years gone by, doctors diagnosed this type of diabetes by tasting the patient’s urine, and finding it tasted sweet.
What goes wrong in diabetes mellitus?
Diabetes mellitus is a lifelong condition caused by a lack, or insufficiency of insulin. Insulin is a hormone - a substance of vital importance that is made by your pancreas. Insulin acts like a key to open the doors into your cells, letting sugar (glucose) in. In diabetes, the pancreas makes too little insulin to enable all the sugar in your blood to get into your muscle and other cells to produce energy. If sugar can't get into the cells to be used, it builds up in the bloodstream. Therefore, diabetes is characterized by high blood sugar levels. Excess sugar is also excreted in the urine, hence the practice, in days gone by, of tasting it to diagnose the condition.
Types of diabetes
There are two main categories of diabetes: Type 1 diabetes tends to occur in childhood or early adult life, and always requires treatment with insulin injections. It is caused by the body’s own immune system destroying the insulin-making cells (beta-cells) of the pancreas. Type 2 diabetes usually develops slowly in adulthood. It is progressive and can sometimes be treated with diet and exercise, but more often Type 2 diabetes may require antidiabetic medicine and/or insulin injections.
What causes Type 2 diabetes?
Type 2 diabetes (formally called non-insulin-dependent diabetes, or NIDDM) develops when the beta-cells in the pancreas start to become inefficient and produce too little insulin for the body’s needs. This inadequacy is most pronounced after eating. In addition, the cells in the body may become less responsive to insulin. In this case, even though you may still be making some insulin, it cannot do its job properly.
Who is at risk of getting Type 2 diabetes?
The causes of Type 2 diabetes may differ from one patient to another. In most cases, the cause is unclear, but a few cases can be attributed to specific genetic defects. Indeed, most cases are likely to have a genetic basis, as Type 2 diabetes tends to run in families. Type 2 diabetes is diagnosed more often in certain ethnic groups. Lifestyle is also important in determining whether or not a person with a tendency to Type 2 diabetes will actually develop the condition; it is more common in people who take too little exercise, eat a high-fat or high-calorie diet and/or are overweight. Women who develop diabetes during pregnancy (gestational diabetes) are more prone to the condition in their later life.
Before you got diabetes
Before you got diabetes, your body automatically kept your blood sugar exactly at the right level. Here is how that worked. After a meal containing carbohydrates, sugar is absorbed into the blood stream very quickly. The amount of sugar in your blood must not get too high or too low. Two hormones - insulin and glucagon - were produced in the pancreas - to ensure that the blood sugar was always well controlled no matter how much you had to eat and how much you exercised.
Community Orientated Diabetes Education (CODE)
CODE is a Community Orientated Diabetes Education programme for all types of diabetes. CODE for Type 2 diabetes is a structured education programme delivered in the community setting through local primary care teams. More Information
Blood sugar rising after eating
The blood sugar rises after eating. Before you had diabetes, insulin was released into your blood and flowed together with the sugar to your body's cells. Insulin acts like a key. It opens doors in the muscle cell walls, enabling sugar from your blood to get into the cell to produce energy. This lowers the blood sugar to its normal level again. Before you had diabetes, your blood sugar was lower than 7 mmol/l in the morning.
Normal values for type 2 diabetes
Guidelines exist to help doctors diagnose diabetes. According to these guidelines, people without diabetes have fasting blood glucose no higher than 6.0 mmol/l (110 mg/dl); after a meal blood glucose does not exceed 7.8 mmol/l (140 mg/dl). If fasting blood glucose is 7.0 mmol/l (125 mg/dl) or above, and /or it rises to more than 11.1 mmol/l (200 mg/dl) after a meal, you are diagnosed as having diabetes.
Normal values for type 2 diabetes
People who have blood glucose levels between normal and diabetic values are said to have “impaired glucose tolerance”, a condition which increases the likelihood of developing diabetes in the future. Your doctor may need to perform a special test to obtain the exact diagnosis.
Now that you have type 2 diabetes
Insulin acts like a key. But now that you have diabetes, you can't produce enough of those keys to open the doors into your cells. When sugar can't get into your muscle and other cells to produce energy, you feel tired, and if the sugar can't get into the cells to be used, it builds up in the bloodstream.
Sugar in urine
Urine forms in the kidneys when the blood is filtered. Without enough insulin, the amount of sugar in your bloodstream rises to high levels. When that happens, some sugar spills through the kidneys into the urine. The sugar that spills into the urine carries a lot of water along with it. That makes you very thirsty. You drink a lot and urinate frequently.
Treating type 2 diabetes
Once you have been diagnosed you should aim to keep your blood glucose under control. This will help you feel good, lead a normal life and avoid the long-term complications associated with diabetes. The risk of developing complications increases if pre-meal blood glucose is above 6.0 mmol/l (110 mg/dl) and/or if blood glucose 1.5-2 hours after a meal is above 7.5 mmol/l (135 mg/dl). You should set targets for your blood glucose with your doctor. Remember that any improvement of your blood glucose values would reduce the risk of complications.
Treating type 2 diabetes
To keep your blood sugar under control, you must now do what your body once did automatically. The goal is to mimic the insulin pattern you had before you got diabetes and to keep the blood sugar level as near normal as possible. You may be able to make better use of the insulin that your body does still produce by improving your diet and eating times, and by exercising and losing weight if you need to. If these measures are not successful you can take medicines that increase your body’s insulin production or your sensitivity to insulin. If they are not effective, or if your body is under stress, including illness, you may require insulin injections.
The Diabetes Care team
The team of specialists who will help you look after your diabetes are often based in your health centre or doctor’s practice. If not, your doctor will establish links with the care team to ensure you have easy access to the advice and treatment you need. The specialists involved may include your own family doctor, diabetes nurse specialist, practice nurse, dietitian, chiropodist and psychologist.
Other support services
Most practices will be able to give you advice leaflets to take away and read in your own time. There may be a support group in your neighbourhood. This provides a friendly and supportive environment in which to meet others and learn how to deal with diabetes by sharing experiences and advice.
APP/KOL/AC 22/02/07