Mona Nasrallah, MD
Assistant Professor of Endocrinology
Department of Internal Medicine, AUBMC
NOTE: All of the below information is intended to provide an overview ONLY about diabetes; it is important to refer to your doctor, diabetes educator, and dietician for actual management.
What Is Diabetes Mellitus?
‘Diabetes mellitus’ or ‘sugar diabetes’ refers to a problem in the body’s metabolism which results in high level of sugar (glucose) in the blood, the normal level of fasting glucose being between 70-100 mg/dL; in diabetes, it is higher than 126 mg/dL.
How Common Is It?
Diabetes constitutes a world epidemic, with the highest rates of rise occurring in the Middle-East. In Lebanon, a study conducted in 2005, estimated that one in six adults above age 40 years has diabetes.
How To Recognize Diabetes Mellitus?
Half of the people who have adult-type of diabetes do not know it or feel it. It is only when the blood sugar increases above 180 mg/dL on the long run that symptoms may develop; these are increased urination, increased thirst and hunger, weight loss, fatigue, blurry vision, and burning in feet.
How Do We Diagnose It?
The diagnosis of diabetes mellitus is based on a blood test: for fasting, if two levels are above 126 mg/dL, the diagnosis is made in adults and children. Also, we can rely on the blood test for hemoglobin A1C, which reflects the average blood glucose levels in the past 3 months. If the level is above 6.5%, we can usually make the diagnosis. Occasionally, if there are symptoms, a random glucose level above 200 mg/dL is also diagnostic.
It is important to note that these numbers do not apply to diabetes of pregnancy (or gestational).
When Should You Do A Diabetes Test? And How?
Since diabetes may not give symptoms, everyone above 45 years of age should do a fasting glucose or hemoglobin A1C test, at least once every 3 years; and once a year if there are risk factors.
People who have symptoms should do a diabetes test immediately; and people who have risk factors such as strong family history, or obesity, or other associated health problems such as hypertension, lipid excess, should do the above test at an even younger age.
What Are The Different Diabetes Types (Briefly Type 1, Type 2, Gestational, Other)?
The American Diabetes Association classifies diabetes mellitus into 4 categories:
Type 1 Diabetes, is characterized by the pancreas not making enough insulin. Most type 1 diabetes occurs in younger age group and it usually gives symptoms rapidly. The treatment of type 1 diabetes is INSULIN FOR LIFE to replace the pancreas’s secretions.
Type 2 Diabetes, is characterized by the pancreas making some insulin, but the body not responding well to it. This type is the much more common type. It is linked to obesity and lack of exercise, and constitutes an epidemic. The treatment can be mixed (see below).
Gestational diabetes, is diabetes which occurs during pregnancy due to all the changes in the hormones.
Other types are more rare, and are secondary to other diseases.
Why Is It Important To Treat Diabetes?
It is important to treat type 1 and type 2 diabetes to prevent complications from high sugar. The complications are on several organs, mainly: the retina of the eyes, the kidneys, the vessels of the heart, and the feet.
It is important to treat gestational diabetes mainly to prevent developmental abnormalities as the fetus is forming, and later in pregnancy, to prevent the baby from growing too large, as this may cause him/her to have some metabolic problems at birth and later.
What Are Some Pearls About Diabetes Therapy?
- Since almost everything can affect blood sugar, education regarding diabetes (no matter what type) and lifestyle adherence are pillars in successful management.
- The treatment for both type 1 and type 2 diabetes is LIFE-LONG, as these are chronic conditions. The management may change according to the different phases in life, but the principles remain the same.
- As already emphasized, the ONLY currently available treatment for type 1 diabetes is insulin.
- The treatment for type 2 diabetes can be pills which improve insulin or the response to it. Also, as mentioned, losing some weight and exercising greatly improves the response to pills.
- Other than blood sugar control, it is also very important to pay attention to other factors related to complications of diabetes, such as keeping blood pressure and cholesterol under check; and doing regular eye and foot examinations.
- The treatment in gestational diabetes can be limited to pregnancy; however the mother will need to always be careful in keeping a healthy weight as she will be at risk to develop type 2 diabetes later in life.
- Whenever we treat diabetes, it is important to learn how to manage hypoglycemia or low blood sugar.
What Is Hypoglycemia?
Hypoglycemia refers to low blood sugar level, below 70 mg/dL, with or without symptoms. The symptoms are dizziness, shakiness, sweating, extreme hunger, and palpitations. It is important to recognize low blood sugar to prevent it from dropping even lower. If feeling low, one should always check with the dextrometer to confirm, whenever possible; then, take one glass of water with 3 teaspoons of sugar, or half a cup of juice; and recheck glucose 15 minutes later.