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Understanding diabetes part 2

How do I know if I have diabetes?

The word diabetes mellitus comes from the Greek “to produce excessive sweet urine.” Obvious symptoms include:

Passing urine frequently
Excessive thirst
Feeling tired all the time

Your doctor may also suspect a diagnosis of diabetes if you get recurrent infections, in particular fungal infections such as those caused by yeast, like thrush. Occasionally, diabetes may be picked up during routine health examinations, like insurance check ups, or even eye exams. If you are worried that you may have diabetes, speak to your doctor. The doctor can arrange for a blood test that requires you to fast overnight.

If, by some chance, your test comes back with borderline results, you will most likely go on to have another test called an oral glucose tolerance test. This involves fasting for 12 hours, a blood sample is then taken. You will then be given a “sugar load,” usually a defined amount of Lucozade. After 2 hours, another blood sample is taken. This test is regarded as the gold standard of diabetic testing and gives more detailed results on how the body is handling glucose.

Diabetes and its consequences

Diabetes is more than just about your pancreas. The lack, or absence of insulin, causes high sugar levels, which results in damages to various organs over time. Diabetes should be thought of as a multi system disease. The raised glucose levels affect your blood vessels, and therefore, they have a knock on effect on your heart, brain, kidneys and eyes. The high sugar levels also cause damage to your nerves. This can affect everything from your sense of touch, your ability to maintain your blood pressure on changing posture, to how your gut works.

Diabetes is a serious disease with deadly consequences. With type 1 diabetes the risk of death due to kidney disease is significantly increased as compared to the general population. In type 2 diabetes, the risk of dying from a heart attack or stroke becomes ever more probable. The good news is that diabetes can be managed. The take home message is that if you have diabetes you need to master it, and ensure that you work with healthcare professionals to achieve the best control possible.

How is diabetes managed?

In general diabetic treatments can be broken down in to 3 main groups. These include:

Lifestyle changes (diet, exercise and education)
Tablets
Insulin

In type 1 diabetic patients, the pancreas fails to produce insulin; therefore, insulin has to be injected. Normally the body produces insulin surges as blood sugar levels rise, so in type 1, patients will often inject insulin just prior to eating a meal. Insulin comes in both short acting and long acting versions. Short acting insulin's are usually taken just prior to meals, while long acting insulin helps to improve diabetic control by mimicking human background insulin secretion.

Those with type 2 diabetes usually produce some insulin, or their tissue cells are slightly resistant to their own insulin. In most cases, patients are first controlled using diet and lifestyle changes. Many, however, will go on to need tablets and eventually insulin as well.

Tablets in diabetes aim to achieve one of the following results:

Increase tissue cell sensitivity to their own insulin
Stimulation of the pancreas to produce more insulin

Further information

This two part series was written to help introduce diabetes and to give you an insight into the condition. If you have diabetes, or are carer for some one with diabetes, and would like more information, I recommend visiting the Diabetes UK website. If you have a specific question, please don't hesitate to ask one of our DrAdvice doctors through a confidential email.

Dr Shazan Chughtai MB BS

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