Watson and Basina (2020) define diabetes mellitus (commonly known as diabetes), as a metabolic disease that causes high blood sugar. The hormone insulin moves sugar from the blood into your cells to be stored or used for energy. With diabetes, your body either doesn’t make enough insulin or can’t effectively use the insulin it does make. Untreated high blood sugar from diabetes can damage your nerves, eyes, kidneys, and other organs.
Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels (World Health Organisation [WHO], 2021).
Types of Diabetes
Advanced Diabetes Supply (2021), diabetes which is a group of diseases that result in too much sugar (glucose) in the bloodstream can be classified in four (4) main groups:
- Type 1 diabetes;
- Type 2 diabetes;
- Gestational diabetes; and
Type 1 Diabetes
Type 1 diabetes results from the body’s failure to produce insulin, the hormone that unlocks the cells of the body, allowing glucose to enter and fuel them. Having type 1 diabetes increases the risk for many serious complications. Some complications of type 1 diabetes include heart disease (cardiovascular disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy) (Advanced Diabetes Supply, 2021).
Type 2 Diabetes
Type 2 diabetes is as a result of insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Having type 2 diabetes increases your risk for many serious complications. Some complications of type 2 diabetes include heart disease (cardiovascular disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy) (Advanced Diabetes Supply, 2021).
Gestational diabetes is diabetes diagnosed for the first time during pregnancy (gestation). Like other types of diabetes, gestational diabetes affects how the cells use sugar (glucose). Gestational diabetes causes high blood sugar that can affect pregnancy and the baby’s health. Expectant mothers can help control gestational diabetes by eating healthy foods, exercising and, if necessary, taking medication. Controlling blood sugar can keep you and your baby healthy and prevent a difficult delivery. In women with gestational diabetes, blood sugar usually returns to normal soon after delivery. However, women who have had gestational diabetes, have a higher risk of getting type 2 diabetes (Mayo Clinic, 2020).
Pre-diabetes is a condition that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes (Advanced Diabetes Supply, 2021).
Causes of Diabetes
According to Diabetes.co.uk (2019), the causes of diabetes vary depending on your genetic makeup, family history, ethnicity, health and environmental factors. There is no common diabetes cause that fits every type of diabetes as the causes of diabetes vary depending on the individual and the type. For instance; the causes of type 1 diabetes vary considerably from the causes of gestational diabetes. Similarly, the causes of type 2 diabetes are distinct from the causes of type 1 diabetes. In fact, type 1 diabetes and type 2 diabetes causes are very different. Type 1 diabetes is an autoimmune condition where the pancreas cannot produce insulin, whereas type 2 diabetes is the body’s resistance to insulin.
Type 1 Diabetes Causes
Type 1 diabetes is caused by the immune system destroying the cells in the pancreas that make insulin. This causes diabetes by leaving the body without enough insulin to function normally. This is called an autoimmune reaction, or autoimmune cause, because the body is attacking itself. There is no specific diabetes causes, but this may be triggered by viral or bacterial infection, chemical toxins within food and unidentified component causing autoimmune reaction (Diabetes.co.uk, 2019)
Type 2 Diabetes Causes
Type 2 diabetes causes are usually multifactorial – more than one diabetes cause is involved. Often, the most overwhelming factor is a family history of type 2 diabetes. There are a variety of risk factors for type 2 diabetes, any or all of which increase the chances of developing the condition. These include obesity, living a sedentary lifestyle, increasing age and bad diet (Diabetes.co.uk, 2019)
Gestational Diabetes Causes
The causes of diabetes in pregnancy also known as gestational diabetes remain unknown. However, there are a number of risk factors that increase the chances of developing this condition which include family history of gestational diabetes, overweight or obese, suffering from polycystic ovary syndrome and having had a large baby weighing over 9lb. Causes of gestational diabetes may also be related to ethnicity – some ethnic groups have a higher risk of gestational diabetes (Diabetes.co.uk, 2019)
Other Diabetes Causes
There are a variety of other potential diabetes causes. These include the following:
- Pancreatitis or pancreatectomy as a cause of diabetes. Pancreatitis is known to increase the risk of developing diabetes, as is a pancreatectomy.
- Polycystic Ovary Syndrome (PCOS). One of the root causes of PCOS is obesity-linked insulin resistance, which may also increase the risk of pre-diabetes and type 2 diabetes.
- Cushing’s syndrome. This syndrome increases production of the cortisol hormone, which serves to increased blood glucose levels. An over-abundance of cortisol can cause diabetes.
- Patients with glucagonoma may experience diabetes because of a lack of equilibrium between levels of insulin production and glucagon production.
- Steroid induced diabetes(steroid diabetes) is a rare form of diabetes that occurs due to prolonged use of glucocorticoid therapy.
Signs and Symptoms of Diabetes
Signs and symptoms of diabetes vary with different types of diabetes. According to Watson and Basina (2020), diabetes symptoms are caused by rising blood sugar. The general symptoms of diabetes include increased hunger, increased thirst, weight loss, frequent urination, blurry vision, extreme fatigue and sores that don’t heal. In addition to the general symptoms of diabetes, men with diabetes may have a decreased sex drive, erectile dysfunction (ED), and poor muscle strength. While women with diabetes can also have symptoms such as urinary tract infections, yeast infections, and dry, itchy skin (Watson & Basina, 2020).
Signs and Symptoms of Type 1 Diabetes
Symptoms of type 1 diabetes can include extreme hunger, increased thirst, unintentional weight loss, frequent urination, blurry vision and tiredness. It may also result in mood changes (Watson & Basina, 2020).
Signs and Symptoms of Type 2 Diabetes
Symptoms of type 2 diabetes can include increased hunger, increased thirst, increased urination, blurry vision, tiredness and sores that are slow to heal. It may also cause recurring infections. This is because elevated glucose levels make it harder for the body to heal (Watson & Basina, 2020).
Most women with gestational diabetes don’t have any symptoms. The condition is often detected during a routine blood sugar test or oral glucose tolerance test that is usually performed between the 24th and 28th weeks of gestation. In rare cases, a woman with gestational diabetes will also experience increased thirst or urination (Watson & Basina, 2020).
Risk Factors of Diabetes
According to Cleveland Clinic (2021), Factors that increase the risk of diabetes differ depending on the type of diabetes an individual ultimately develops.
Risk factors for type 1 diabetes include:
- Having a family history (parent or sibling) of type 1 diabetes.
- Injury to the pancreas (such as by infection, tumor, surgery or accident).
- Presence of autoantibodies (antibodies that mistakenly attack your own body’s tissues or organs).
- Physical stress (such as surgery or illness).
- Exposure to illnesses caused by viruses.
(Cleveland Clinic, 2021).
Risk factors for prediabetes and type 2 diabetes include:
- Family history (parent or sibling) of prediabetes or type 2 diabetes.
- Being African-American, Hispanic, Native American, Asian-American race or Pacific Islander.
- Being overweight.
- Having high blood pressure.
- Having low HDL cholesterol (the “good” cholesterol) and high triglyceride level.
- Being physically inactive.
- Being age 45 or older.
- Having gestational diabetes or giving birth to a baby weighing more than 9 pounds.
- Having polycystic ovary syndrome.
- Having a history of heart disease or stroke.
- Being a smoker.
(Cleveland Clinic, 2021).
Risk factors for gestational diabetes include:
- Family history (parent or sibling) of prediabetes or type 2 diabetes.
- Being African-American, Hispanic, Native American or Asian-American.
- Being overweight before your pregnancy.
- Being over 25 years of age.
(Cleveland Clinic, 2021).
Complications associated with Diabetes
According to Mayo Clinic (2020), long-term complications of diabetes develop gradually. The longer an individual have diabetes — and the less controlled the blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include:
- Cardiovascular Disease: Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). People who have diabetes are more likely to have heart disease or stroke (Mayo Clinic, 2020).
- Nerve Damage (Neuropathy): Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish the nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. If left untreated, the individual could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction (Mayo Clinic, 2020).
- Kidney Damage (Nephropathy): The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant (Mayo Clinic, 2020).
- Eye Damage (Retinopathy):Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma (Mayo Clinic, 2020).
- Foot Damage: Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. If left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation (Mayo Clinic, 2020).
- Skin Conditions: Diabetes may leave an individual more susceptible to skin problems, including bacterial and fungal infections (Mayo Clinic, 2020).
- Hearing impairment: Hearing problems are more common in people with diabetes (Mayo Clinic, 2020).
- Alzheimer’s Disease: Type 2 diabetes may increase the risk of dementia, such as Alzheimer’s disease. The poorer your blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved (Mayo Clinic, 2020).
- Depression: Depression symptoms are common in people with type 1 and type 2 diabetes. Depression can affect diabetes management (Mayo Clinic, 2020).
Complications of Gestational Diabetes
Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for the pregnant woman and the baby (Mayo Clinic, 2020). Complications in the baby can occur as a result of gestational diabetes, including:
- Excess Growth: Extra glucose can cross the placenta, which triggers the baby’s pancreas to make extra insulin. This can cause the baby to grow too large (macrosomia). Very large babies are more likely to require a C-section birth (Mayo Clinic, 2020).
- Low Blood Sugar: Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Prompt feedings and sometimes an intravenous glucose solution can return the baby’s blood sugar level to normal (Mayo Clinic, 2020).
- Type 2 Diabetes Later in Life:Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life (Mayo Clinic, 2020).
- Death: Untreated gestational diabetes can result in a baby’s death either before or shortly after birth (Mayo Clinic, 2020).
Complications in the mother also can occur as a result of gestational diabetes, including:
- Preeclampsia: This condition is characterized by high blood pressure, excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby (Mayo Clinic, 2020).
- Subsequent Gestational Diabetes: Women who had gestational diabetes in one pregnancy are more likely to have it again with the next pregnancy. They also more likely to develop diabetes — typically type 2 diabetes — as they get older (Mayo Clinic, 2020).
Complications of Prediabetes
Prediabetes may develop into type 2 diabetes (Mayo Clinic, 2020).
Treatment and Management of Diabetes
According to Felman and Falck (2020), the main aim of diabetes treatment is to return blood sugar to a safe threshold and reduce the risk of complications while helping a person with diabetes to resume daily function. However, people can manage some cases of type 2 diabetes with lifestyle adjustments. The main medication for managing type 1 diabetes is insulin.
Taking insulin at the right times of day can improve quality of life for a person with diabetes. People with type 1 diabetes must take insulin, as the pancreas of a person with type 1 does not produce the hormone. Supplementary insulin helps the cells in the body to absorb glucose and use energy. A person with type 1 diabetes will need to receive insulin at several points throughout the day. Some doses of insulin will occur before or after a meal. With type 2 diabetes, insulin is not always necessary (Felman & Falck, 2020). Insulin has several different delivery methods. The most common methods include the following.
- Insulin Pump: This delivers small, continuous doses of insulin throughout the day.
- Needle and Syringe: An individual draws insulin fluid from a bottle and injects a shot. The most effective location is on the stomach, but a person can also administer a shot into the upper arm, the buttocks, or the thigh.
- Pen: Some insulin pens are disposable, while others offer space for a replaceable insulin cartridge. They are costlier than needles but easier to use and resemble a pen with a needle instead of a nib.
- Inhaler: Some types of insulin can be breathed in as a powder from an inhaler device. Inhaled insulin can reach the blood faster than other types. However, it is only suitable for adults who have type 1 or type 2 diabetes.
- Jet Injector: This method delivers a fine, high-pressure spray into the skin instead of a needle injection.
- Injection Port: This contains a short tube that the person who needs insulin slots just beneath the skin. They would then inject insulin into the port with a pen or needle and syringe and fit a replacement every few days. An injection port gets around having to puncture the skin every day.
(Felman & Falck, 2020).
Medications for Type 2 Diabetes
A person with type 1 diabetes will always need insulin. However, alongside lifestyle measures, such as a balanced, low-sugar diet and regular exercise, a person with type 2 diabetes might need to manage blood sugar in other ways. Metformin is a key medication for type 2 that people take in pill form or as a liquid. It helps reduce blood sugar and make insulin more effective, as well as assisting weight loss, which can also reduce the effects of diabetes. Other oral medications can also help reduce blood glucose in people with type 2 diabetes, such as:
- alpha-glucosidase inhibitors, such as acarbose and miglitol, which slow the breakdown of starches into glucose after a meal and slows down the increase in blood sugar levels
- biguanides, including metformin, which reduce the production of glucose in the liver and make muscle tissue more sensitive to insulin to improve the absorption of glucose
- bile acid sequestrants (BASs), which reduce cholesterol and blood sugar and are safe for people who also have liver problems, as they do not enter the bloodstream
- DPP-4 inhibitors, such as alogliptin, linagliptin, and saxagliptin, which help improve the binding of glucose to the blood without causing low blood sugar
- meglitinides, such as nateglinide and repaglinide, which stimulate the release of insulin but might cause low blood sugar
- SGLT2 inhibitors, such as canagliflozin and dapagliflozin, which help block the reabsorption of glucose in the kidneys, resulting in sugars leaving the body in the urine
- sulfonylureas, including glimepiride, glipizide, and chlorpropamide which stimulate the release of insulin in the pancreas
- thiazolidinediones, or TZDs, such as rosiglitazone and pioglitazone, which improve the function of insulin in the fat and muscle and slow glucose production in the liver
- GLP-1 agonists-including albiglutide, dulaglutide, exenatide, liraglutide, lixisenatide, and semaglutide can help with weight loss and some decrease cardiovascular events
(Felman & Falck, 2020).
Physical activity is vital for using up spare glucose in the body and making the muscles more sensitive to insulin. Exercise can help reverse diabetes in its early stages and prevent heart-related complications in more severe presentations. Aerobic exercise can support weight management, reduce blood glucose, and improve insulin use in the body. Examples include brisk walks or long hikes, cycling, whether outdoor or using a machine, dance, water aerobics or low-impact aerobics classes, swimming, racquet sports, climbing the stairs, rowing and gardening. Strength training is also important, as improving muscle buildup increases how much glucose the body burns while it is at rest. Activities that can improve muscle strength include lifting weights, either using machines, free weights, or household objects, resistance bands, calisthenics, such as squats, push-ups, or lunges and activities that involve high exertion, such as gardening (Felman & Falck, 2020).
A person with diabetes can still eat the foods that they enjoy, just less frequently or in smaller portions. Some people with diabetes should eat at the same time each day, while others have a little more flexibility when it comes to the timings of meals. Portion size is also very important in people with diabetes. The following are some of the best options in each food group for people with diabetes.
- Vegetables: Starchy and non-starchy vegetables are fine to consume, including broccoli, carrots, tomatoes, peppers, leafy greens, such as kale, potatoes, corn and green beans (Felman & Falck, 2020).
- Fruits: Be wary of high sugar fruits, such as watermelon, but moderate amounts of oranges, berries, melon, apples, grapes and bananas are great for people with diabetes (Felman & Falck, 2020).
- Grains: Whole grains should make up at least half of all grains in the diet of a person with diabetes, including oats, barley, quinoa, cornmeal, rice and wheat
- Proteins: Low-fat and lean proteins can help build muscle mass without pushing up fat and glucose levels, such as eggs, lean beef or pork, fish, skinless chicken or turkey, peanuts and nuts, dried beans, peas, such as chickpeas or split peas and meat alternatives, such as tofu (Felman & Falck, 2020).
- Dairy: Consume only low-fat, non-dairy, or nonfat cheese, milk, and yogurt. Not all fat contributes to diabetes, and some types of fat help protect against its effects on the heart, including seeds and nuts, salmon, tuna, and mackerel, avocado and oils that take a liquid form at room temperature, such as olive oil (Felman & Falck, 2020).
Prevention of Diabetes
Gundersen Health System (2021), the following are some of the most remarkable ways to prevent diabetes:
- Cut Sugar and Refined Carbohydrates from Your Diet: Eating foods high in refined carbohydrates and sugar increases blood sugar and insulin levels, which may lead to diabetes over time. Examples of refined carbohydrates include white bread, potatoes and many breakfast cereals. Instead, limit sugar and choose complex carbohydrates such as vegetables, oatmeal and whole grains (Gundersen Health System, 2021).
- Quit Smoking: For current tobacco user. Smoking can contribute to insulin resistance, which can lead to type 2 diabetes. Quitting has been shown to reduce this risk of type 2 diabetes over time (Gundersen Health System, 2021).
- Watch Portion Sizes: Avoiding large portion sizes can help reduce insulin and blood sugar levels and decrease the risk of diabetes. Eating too much food at one time has been shown to cause higher blood sugar and insulin levels in people at risk of diabetes (Gundersen Health System, 2021).
- Exercise for at Least 30 Minutes Daily: Try to be intentionally active by taking a walk, dancing, lifting weights or swimming for 30 minutes, five days per week. For people who get no or very little physical activity—and sit during most of their day—thereby leading a sedentary lifestyle, and it’s time to get moving (Gundersen Health System, 2021).
- Drink Water: Drinking water instead of other beverages may help control blood sugar and insulin levels, thereby reducing the risk of diabetes. Sticking with water most of the time helps individuals to avoid beverages that are high in sugar, preservatives and other unneeded ingredients (Gundersen Health System, 2021).
- Eat Fiber: Getting plenty of fiber is beneficial for gut health and weight management. Consuming a good fiber source at each meal can help prevent spikes in blood sugar and insulin levels, which may help reduce the risk of developing diabetes (Gundersen Health System, 2021).
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