Symptoms of diabetes, causes, and treatment

Diabetes is a serious metabolic disorder that has been increasing at a rapid rate globally. According to the World Health Organisation, diabetes was the seventh leading cause of death in the year 2016,  with about 1.6 million deaths accounted directly due to diabetes. 

The number of people affected with diabetes has been increasing at an alarming rate in middle and low-income countries. It has been observed that diabetes has also led to blindness, kidney failure, heart attacks, stroke and lower limb amputation (1) in many cases.

Types of Diabetes

There are three types of diabetes (2)

Type 1 diabetes

Type 1 diabetes (T1D) occurs usually in children, teenagers and young adults. In this type of diabetes body does not produce insulin or it produces insufficient amount and insulin needs to be administered externally.

Type 2 diabetes

Type 2 diabetes (T2D) occurs mostly in adults and in this type of diabetes insulin is not effectively used by the body to regulate blood glucose levels. It develops over years and it can be prevented or at least delayed if proper measures are taken. 

Gestational diabetes

Gestational diabetes is the type of diabetes that occurs in pregnant women. It gets resolved once the baby is born but it increases the risk of type 2 diabetes for these women later in their life.

Symptoms of diabetes (2, 3, 4) 

Here are the common symptoms of diabetes

• Frequent urination (Polyuria)
• Unusual thirst (Polydipsia)
• Extreme hunger
• Unexplained weight loss
• Extreme fatigue
• Irritability

Those affected with type 2 diabetes may also suffer from other issues such as

• Frequent and recurring infections of skin, gum, or bladder
• Wounds such as cuts and bruises may heal slowly 
• Vision problems
• Numbness or tingling of hands or feet
• Erectile dysfunction
• Dry mouth
• Itching
• Abdominal obesity

In the case of type 1 diabetes, the onset of symptoms of diabetes may be sudden (1). The destruction of pancreatic cells can go on for months or years before any symptoms are noticeable (2).

Symptoms may be less pronounced in type 2 diabetes, so much so that the affected person may not realize that diabetes is creeping up on him/her slowly for some years. 

In the case of gestational diabetes, there are no obvious symptoms of diabetes (5). Regular health monitoring of pregnant women very important

Causes

Type 1 diabetes

T1D is caused by an autoimmune disorder in which the body’s immune system releases antibodies that destroy the beta cells of pancreas which secrete insulin (2). 

In some people, there may be a genetic predisposition for developing T1D. But it is not a must that only if a person has the specific genes, T1D will develop (2). 

In some cases, there may be a trigger present in the environment such as a virus which may cause T1D. The mechanism by which a virus can trigger autoimmune response is not known. Another environmental parameter that has been discussed is the climate. The incidence of T1D in the northern parts of the earth is more than the southern parts (2). 

Type 2 diabetes

In T2D cells do not respond to insulin as they should. This condition is called insulin resistance and the pancreas end up secreting more insulin. Finally, the pancreas will not be able to produce sufficient insulin to regulate glucose levels which will lead to hyperglycemia, which is elevated levels of glucose in blood (2). Producing insufficient insulin and insulin resistance are the main causes of T1D.

The other causes or risk factors maybe because of being overweight, family history of diabetes, less physical activity and ethnicity (1, 6).

Gestational diabetes

There are no clear causes or symptoms of diabetes in this case but there are some risk factors which may cause a pregnant woman to develop gestational diabetes (5, 7, 8).

• Obesity
• Family history of diabetes
• Advanced age
• Previously if the mother has given birth to a baby weighing more than 4.5 kgs
• Ethnicity

Treatment

People with type 1 diabetes require insulin to be administered as part of their treatment (1). To utilize the glucose in blood, for converting it to energy, insulin is required and since it cannot be administered by mouth in the form of a tablet it has to be injected. The dose and frequency are fixed by the health provider (2).  

People with type 2 diabetes cannot use the insulin they produce properly, but can mostly manage their condition through exercise and diet, although many may require medication, including insulin, to control blood glucose levels (9, 10).

Gestational diabetes is treated by dietary management and medication may be prescribed by the doctor as required. But the condition is resolved once the baby is delivered.

Prevention

At present with the information available prevention of type 1 diabetes is not known (1). In a review, it was concluded that T1D disease can be predicted by measuring the islet autoantibodies. In future general population screening methods for these autoantibodies and safe therapy need to be developed for T1D intervention (11). 

The goal of research should be delaying the onset and progression of diabetes and finally preventing T1D, by early identification of the symptoms of diabetes.

Certain measures can be taken to prevent or delay the onset of T2D. Maintaining a healthy weight, being physically active, avoiding tobacco use and consuming a healthy, balanced diet (1). Adopting a healthy lifestyle is very important.

In the case of gestational diabetes, a doctor may be able to help prevent gestational diabetes after weighing the risk factors a pregnant woman may have and giving proper suggestions. It would be better to talk to the doctor in the pre-pregnancy period itself when you start planning to have a baby (2).

References

1. World Health Organisation (2019). Diabetes

https://www.who.int/news-room/fact-sheets/detail/diabetes

1. Centers for Disease Control and prevention (2019). Diabetes

https://www.cdc.gov/diabetes/basics/diabetes.html

1. Duyff, R.L. (2002) Complete Food and Nutrition Guide, Smart eating to prevent and treat disease, 567. American Dietetic Association, Second Edition. Hoboken: John Wiley & Sons.

1. Ramachandran A. (2014) Know the signs and symptoms of diabetes, The Indian journal of medical research. Vol. 140 (5).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311308/

1. Mayo clinic (2017). Gestational diabetes.

https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339

1. Mayo Clinic (2019). Type 2 diabetes.

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193

1. Mirghani Dirar, A. and Doupis, J. (2017) Gestational diabetes from A to Z, World journal of diabetes. Vol.8 (12).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5740094/

• Moosazadeh, M., Asemi, Z., Lankarani, K.B., Tabrizi, R., Maharlouei, N., Naghibzadeh-Tahami, A., Yousefzadeh, G., Sadeghi, R., Khatibi, S.R., Afshari, M., Khodadost .M. and Akbari, M. (2016) Family history of diabetes and the risk of gestational diabetes mellitus in Iran: A systematic review and meta-analysis, Diabetes Metab Syndr.

https://www.ncbi.nlm.nih.gov/pubmed/28017634

1. Wildman, R. (2009) The Nutritionist-Food, Nutrition and Optimal Health. Routledge, Taylor and Francis Group. Second Edition. New York and London.

1. Truswell, A. S. (2003) ABC of Nutrition. BMJ Publishing Group, BMA House Tavistock Square. Fourth Edition. London WC1H 9JR.
2. Simmons, K. M. and Michels, A. W. (2015) Type 1 diabetes: A predictable disease, World journal of diabetes. Vol. 6(3).

         https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4398895/