What is diabetes mellitus?
Diabetes mellitus is essentially chronically raised levels of blood glucose in our body. Usually, we are able to self-regulate raised blood glucose levels by the action of the hormone ‘insulin’, which is released by a gland in our body called the ‘pancreas’.
However, those with diabetes mellitus are unable to self-regulate their blood glucose levels often due to a combination of deficient insulin levels and/or a resistance of the action of insulin.
We, as healthcare professionals, often talk about different ‘types’ of diabetes. You may have heard terms such as, type I diabetes, type II diabetes, pre-diabetes, gestational diabetes, amongst a few others.
Type I tends to develop in childhood / early adult life. It is a disorder where the insulin-producing cells of the pancreas are ‘attacked and destroyed’ by our immune system, which leads to an absolute deficiency of insulin, and hence, raised blood glucose levels.
Type II diabetes is the more commonly known form of diabetes. It is mainly caused by the cells in your body not responding normally to insulin. This is called ‘insulin resistance’. In the long run, your pancreas tries to make more insulin, but eventually can’t keep up, and hence blood glucose levels rise.
Prediabetes is a term used when your blood tests show a raised blood glucose level, but do not meet the formal criteria for diagnosis of diabetes. Gestational diabetes is when there are raised blood glucose levels during pregnancy, which needs to be managed to avoid any complications for mother and baby.
In this article, we will mainly focus on type II diabetes and its significant impact.
Am I at risk of having diabetes? What symptoms should I look out for?
Some risk factors for developing type II diabetes include:
- Being overweight or obese, diet and leading a sedentary lifestyle
- Age above 45 years old
- Family history of type II diabetes (parents or siblings)
- Certain medications, such as use of long-term steroids
- Certain ethnicities, e.g. Asian, African, Afro-Carribean
- History of other metabolic disorders, such as non-alcoholic fatty liver disease
- Have prediabetes
- History of gestation diabetes
Type II diabetes may be present for a longtime with no symptoms and only picked up on routine health checks by measuring your blood glucose levels.
Some people may also notice the following:
- Increased thirst
- Increased urinary frequency
- Weight loss
- Some skin pigmentation changes
How do we make a diagnosis?
Blood glucose levels are used for the diagnosis of diabetes. These tests are a part of your routine annual health screening and can help identify those at risk of developing diabetes, as well as those who have diabetes.
Normal fasting blood glucose levels is 6.0 mmol/L or below. A fasting blood glucose level of 7.0 mmol/l or greater is diagnostic for diabetes. However, a fasting blood glucose level between 6.1 and 6.9 mmol/L implies ‘prediabetes’ and requires further testing. This test, called the OGTT (oral glucose tolerance test) is performed as two blood tests – one to measure your fasting blood glucose, and a repeat test 2 hours after you’ve had a sugary drink to measure how your body ‘copes’ with a sugar load.
Some countries also use a blood test that measures glycated haemoglobin (HbA1c) (i.e. glucose sticking to your red blood cells) to diagnose diabetes. As blood glucose levels can vary throughout the day, as well as, on different days, the HbA1c blood test gives an average of what your glucose control is over the last 2 – 3 months. A HbA1c level of 6.5% or more is diagnostic of diabetes. However, this test does have its limits in ‘diagnosis’ and is often used together with other diagnostic tests.
So what if I have slightly higher glucose levels – why is diabetes so important?
High blood glucose levels will have a damaging and long-lasting effect to your body. It can cause several significant health problems, such as heart disease, stroke, kidney disease, foot problems, nerve problems and vision loss.
One of the other impacts that are often missed is the psychosocial impact diabetes can have for the individual diagnosed and their loved ones.
I have been diagnosed with diabetes. What does this mean?
The management of diabetes is led by you, with care and support provided by your family doctor, diabetes nurse and other specialists (dietitians, podiatrists, mental health professionals). It is a collaborative effort, with you being at the center of it and empowered with knowledge and support to ensure a healthy and optimized quality of life for yourself.
Often the first step in diabetes treatment is modifying your diet and activity levels. Depending on what your initial results show, your doctor will discuss with you the use of oral medications. There are many new medications now available for diabetic patients, which can have a significant improvement not only in their diabetic control, but also for their cardiovascular health (blood pressure, heart disease) and kidney function.
In some instances, if your blood glucose levels are very high, your doctor may suggest the use of injectable insulin to help optimise your blood glucose levels.
Your doctor will recommend a follow-up plan for the management of your diabetes. This often includes rechecking your blood tests, discussing your medications and other concerns. A HbA1c test is very useful in the follow-up of diabetes care and this test may be done every 3 – 6 months in the initial period of your diabetes care.
In addition to the above, it is vital to monitor your blood pressure, blood cholesterol levels and kidney function. An annual feet and eye screen is an essential part of holistic diabetes management.
The diagnosis and management of diabetes can be very overwhelming and challenging. At Osler Health International, we ensure you are well looked after in all aspects of diabetes care and aim to support you to maintain your best health.
Dr Trisha is a British trained family doctor who is based at Osler Health Star Vista clinic.
For appointments call: T: 63392727
References:
- American Diabetes Guidelines 2022.
- NICE guidelines for Diabetes mellitus (July 2021).
- Royal Australian College of General Practitioners,
- org.uk.
