Diagnosis of Diabetes

 Persons at HIGH RISK for diabetes

a) All persons manifesting any of the following signs and symptoms: polyuria, polydipsia, polyphagia, weight loss inspite of adequate food intake, undue tiredness and fatigue etc.

b) All persons with a family history of diabetes.

c) All obese patients, especially those with central obesity, waist-hip (W-H) ratio, approx. >0.95 in men and >0.85 in women, and/or a Body Mass Index (BMI) >25.

d) All adult patients with tuberculosis, atherosclerosis, recurrent infections, high blood pressure and lipid abnormalities, non- healing ulcers etc.

e) All women with a bad obstetric history, recurrent fetal wastage, and those who give birth to large weight babies.

f) Persons who show an acute rise in the blood glucose levels at time of physical (myocardial infarction, cerebrovascular accidents, acute infections, trauma, etc.) or mental stress.

g) Persons taking drugs which are known to increase blood glucose levels like steroids, thiazide diuretics, oral contraceptives, beta-blockers, phenytoin sodium, etc. 

ALL PERSONS OVER THE AGE OF 30 YEARS SHOULD UNDERGO AN ANNUAL TEST FOR THE PRESENCE OF DIABETES.

METHODS:

A. Glycated hemoglobin (HbA1C) test :

This blood test indicates your average blood sugar level for the past two to three months. It's also called HbA1c, glycated hemoglobin test, and glycohemoglobin. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached.

How the Test Works

The sugar in your blood is called glucose. When glucose builds up in your blood, it binds to the hemoglobin in your red blood cells. The A1c test measures how much glucose is bound.

Red blood cells live for about 3 months, so the test shows the average level of glucose in your blood for the past 3 months.

If your glucose levels have been high over recent weeks, your hemoglobin A1c test will be higher.

What's a Normal Hemoglobin A1c Test?

For people without diabetes, the normal range for the hemoglobin A1c level is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% mean you have a higher chance of getting of diabetes. Levels of 6.5% or higher mean you have diabetes.

B. Random blood sugar test :

 A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst.

C. Fasting blood sugar test :

 A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.

D. Oral glucose tolerance test : For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours.

Glucose Test
	Glucose Concentration (mg/100ml)
	Whole Blood		Plasma
	Venous	Capillary	Venous
Diabetes Melittus
Fasting	>/=110	>/=110	>/=126
2 hours post Glucose Load or both	>180	>200	>200
Impaired Glucose Tolerance
Fasting(If measured)	<110	<110	<126
2 hours post Glucose Load	>/=120 & </=180	>/=140 & </=200	>/=140 & </=200
Impaired Fasting Glycemia
Fasting	>/=100 & </=110	>/=100 & </=110	>/=110 & </=126
2 hours PG (If measured)	<120	<140	<140

 

A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes. A reading of 200 mg/dL (11.1 mmol/L) or higher after two hours may indicate diabetes.

Risk factors of Diabetes

 

Researchers aren’t sure what exactly causes the insulin process to go awry in some people. There are several risk factors, though, that make it more likely that you’ll develop pre-diabetes. 

Risk factors for diabetes depend on the type of diabetes.

ü  Risk factors for type 1 diabetes

Although the exact cause of type 1 diabetes is unknown, factors that may signal an increased risk include:

• Family history. Your risk increases if a parent or sibling has type 1 diabetes.
• Environmental factors. Circumstances such as exposure to a viral illness likely play some role in type 1 diabetes.
• The presence of damaging immune system cells (autoantibodies). Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes autoantibodies. If you have these autoantibodies, you have an increased risk of developing type 1 diabetes. But not everyone who has these autoantibodies develops diabetes.
• Dietary factors. These include low vitamin D consumption, early exposure to cow's milk or cow's milk formula, and exposure to cereals before 4 months of age. None of these factors has been shown to directly cause type 1 diabetes.
• Geography. Certain countries, such as Finland and Sweden, have higher rates of type 1 diabetes.

 

ü  Risk factors for prediabetes and type 2 diabetes

Researchers don't fully understand why some people develop prediabetes and type 2 diabetes and others don't. It's clear that certain factors increase the risk, however, including:

• Weight. The more fatty tissue you have, the more resistant your cells become to insulin.
• Inactivity. The less active you are, the greater your risk. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
• Family history. Your risk increases if a parent or sibling has type 2 diabetes.
• Race. Although it's unclear why, people of certain races — including blacks, Hispanics, American Indians and Asian-Americans — are at higher risk.
• Age. Your risk increases as you get older. This may be because you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults.
• Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes later increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes.
• Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.
• High blood pressure. Having blood pressure over 140/90 millimeters of mercury (mm Hg) is linked to an increased risk of type 2 diabetes.
• Abnormal cholesterol and triglyceride levels. If you have low levels of high-density lipoprotein (HDL), or "good," cholesterol, your risk of type 2 diabetes is higher. Triglycerides are another type of fat carried in the blood. People with high levels of triglycerides have an increased risk of type 2 diabetes. Your doctor can let you know what your cholesterol and triglyceride levels are.

 

ü  Risk factors for gestational diabetes

Any pregnant woman can develop gestational diabetes, but some women are at greater risk than are others. Risk factors for gestational diabetes include:

• Age. Women older than age 25 are at increased risk.
• Family or personal history. Your risk increases if you have prediabetes — a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You're also at greater risk if you had gestational diabetes during a previous pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth.
• Weight. Being overweight before pregnancy increases your risk.
• Race. For reasons that aren't clear, women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.

 

Symptoms and Cause of Diabetes

 SIGNS & SYMPTOMS

Diabetes symptoms vary depending on how much your blood sugar is elevated. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. In type 1 diabetes, symptoms tend to come on quickly and be more severe.

Some of the signs and symptoms of type 1 and type 2 diabetes are:

·        Increased thirst

·        Frequent urination

·        Extreme hunger

·        Unexplained weight loss

·      Presence of ketones in the urine (Ketones are a by-product of the breakdown of muscle and fat        that happens when there's Not enough available insulin)

·        Fatigue

·        Irritability

·        Blurred vision

·        Slow-healing sores

·        Frequent infections, such as gums or skin infections and vaginal infections

 

Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age, though it's more common in people older than 40.

 

Causes of Diabetes

Prediabetes develops when your body begins to have trouble using the hormone insulin. Insulin is necessary to transport glucose—what your body uses for energy—into the cells via the bloodstream. In pre-diabetes, your body either doesn’t make enough insulin or it doesn’t use it well (that’s called insulin resistance).

If you don’t have enough insulin or if you’re insulin resistant, you can build up too much glucose in your blood, leading to a higher-than-normal blood glucose level and perhaps prediabetes.

To understand diabetes, first you must understand how glucose is normally processed in the body.

 

How insulin works?

Insulin is a hormone that comes from a gland situated behind and below the stomach (pancreas).

·        The pancreas secretes insulin into the bloodstream.

·        The insulin circulates, enabling sugar to enter your cells.

·        Insulin lowers the amount of sugar in your bloodstream.

·        As your blood sugar level drops, so does the secretion of insulin from your pancreas.

 

 The role of glucose:

Glucose — a sugar — is a source of energy for the cells that make up muscles and other tissues.

·        Glucose comes from two major sources: food and your liver.

·        Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.

·        Your liver stores and makes glucose.

·        When your glucose levels are low, such as when you haven't eaten in a while, the liver 

     breaks down stored glycogen into glucose to keep your glucose level within a normal range.

 

ü  Causes of type 1 diabetes:

The exact cause of type 1 diabetes is unknown. What is known is that your immune system — which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream.

 

ü  Causes of prediabetes and type 2 diabetes:

In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells where it's needed for energy, sugar builds up in your bloodstream.

 

ü  Causes of Gestational diabetes:

During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin.

 

Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can't keep up. When this happens, too little glucose gets into your cells and too much stays in your blood, resulting in gestational diabetes.

 

ü  Genetic Causes of Diabetes

Genetics play a strong role in the chances of developing both Type-1 and Type 2 diabetes. The risk of developing diabetes is affected by whether your parents or siblings have diabetes.

The likelihood of developing Type 1 diabetes or Type 2 diabetes differs, as you can see below.

Type 1 diabetes and genetics - average risks

• Mother with diabetes increases risk of diabetes by 2%
• Father with diabetes increases risk of diabetes by 8%
• Both parents with diabetes increases risk by 30%
• Brother or sister with diabetes increases risk by 10%
• Non-identical twin with diabetes increases risk by 15%
• Identical twin with diabetes increases risk by 40%

Type 2 diabetes and genetics - average risks

• If either mother of father has diabetes increases risk of diabetes by 15%
• If both mother and father have diabetes increases risk by 75%
• If non-identical twin has diabetes increases risk by 10%
• If identical twin has diabetes increases risk by 90% 

ü  Drug Induced Diabetes

A number of medications have side effects which include the raising of blood glucose levels. Drug induced diabetes is when use of a specific medication has lead to the development of diabetes.

 

Certain toxins such as Vacor (a rat poison) and intravenous pentamidine can permanently destroy pancreatic β-cells. Such drug reactions fortunately are rare. There are also many drugs and hormones that can impair insulin action. Examples include nicotinic acid and glucocorticoids. Patients receiving α-interferon have been reported to develop diabetes associated with islet cell antibodies and, in certain instances, severe insulin deficiency.

 

Which drugs can induce diabetes?

A number of drugs have been linked with an increased risk development of Type 2 diabetes.

• Corticosteroids
• Thiazide diuretics
• Beta-blockers
• Antipsychotics
• Statins 

ü  Diabetic ketoacidosis

Sometimes a person's blood sugar level rises greatly before he or she knows something is wrong. Because insulin isn't available, the cells in the body are unable to get the sugar (glucose) they need for energy. The body begins to break down fat and muscle for energy.

When fat is used for energy, ketones-or fatty acids-are produced and enter the bloodstream. This causes the chemical imbalance diabetic ketoacidosis. This can be a life-threatening condition.

Diabetes : A silent killer

 

Diabetes Mellitus (DM) is a metabolic, endocrine disorder. It is a chronic non-communicable disease which generally starts insidiously (over a period of long time), and even in the absence of symptoms (hence called as a silent killer). Many individuals are accidently detected as a case of DM when they are investigated for some other reasons like preoperative investigations. It is characterized by a state of hyperglycemia (high blood sugar level) due to insulin deficiency. Insulin is essential hormone produced by the beta cells of Langerhans of pancreas. It is required for metabolism of glucose. In the absence of insulin body cannot metabolize glucose hence it cannot be utilized for body functions leading to a state of chronic hyperglycemia. If this hyperglycemia is not treated in due time it can lead to serious consequences on body like damage to nerves (neuritis) and blood vessels (micro-angiopathies and atherosclerosis).

When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should. This causes sugars to build up in the blood. Diabetes can cause serious health complications including high blood pressure, heart disease, blindness, kidney failure, nervous system failure, and feet problem and lower-extremity amputations.

In the year 2012, DM was a direct cause of death of 1.5 million people and most of them (80%) belonged to low and middle income countries. Asian countries contribute to more than 60% of world’s diabetic burden. The prevalence of DM is expected to raise from 285 million in 2010 to 438 million cases of diabetes in 2030. WHO projects that DM will be a 7th leading cause of death in 2030.

 The three major symptoms of diabetes are:

• Polyuria - the need to urinate frequently.
• Polydipsia - increased thirst & fluid intake.
• Polyphagia - increased appetite.

 Type I diabetes

Type I diabetes usually occurs in people who are below the age 20 and that is why it is also called as juvenile diabetes. In this type, the body becomes partially or completely unable to produce insulin. Type I diabetes is an autoimmune disease. In this, your immune system attacks the pancreas from where the insulin is produced, thereby making the pancreas inefficient or unable to produce insulin. Type I diabetes cannot be prevented, it can only be controlled with healthy lifestyle changes.

Type II diabetes

Type II diabetes is more common than Type I diabetes in India. Type II diabetes usually happens to people who are above the age of 40. This type of diabetes is caused due to insulin resistance. In this case, the pancreas produces insulin but the body is not able to respond to it properly. There can be many reasons behind type II diabetes. Some of the reasons can be being overweight, high blood pressure, having a poor diet, taking too much stress, hormone imbalance, certain medications and leading a sedentary lifestyle. Though type II diabetes can be reversed.

Other types of Diabetes are as follows:

Gestational Diabetes: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The definition applies whether insulin or only diet modification is used for treatment and whether or not the condition persists after pregnancy. It does not exclude the possibility that unrecognized glucose intolerance may have antedated or begun concomitantly with the pregnancy.

Prediabetes: Prediabetes means that your blood sugar level is higher than normal but not yet high enough to be type 2 diabetes. Without lifestyle changes, people with prediabetes are very likely to progress to type 2 diabetes. If you have prediabetes, the long-term damage of diabetes — especially to your heart, blood vessels and kidneys — may already be starting.

Secondary Diabetes: Secondary diabetes is diabetes that results as a consequence of another medical condition. Because the cause of diabetes ranges between different conditions, the way in which blood glucose levels are controlled can also vary. Secondary diabetes will often be permanent but for some forms, it may be possible to reverse or eradicate the effects of hyperglycemia.

Maturity Diabetes: Maturity onset diabetes of the young ( MODY), it is a rare form of diabetes which is different from both Type 1 and Type 2 diabetes, and runs strongly in families. MODY is caused by a mutation (or change) in a single gene. If a parent has this gene mutation, any child they have, has a 50 per cent chance of inheriting it from them.

If a child does inherit the mutation they will generally go on to develop MODY before they’re 25, whatever their weight, lifestyle, ethnic group etc.

Both Type-1 and Type-2 form of diabetes are lifelong conditions. Once diagnosed, one will always have it. However one can manage proactively for their diabetes, long term risks and complications can be minimised. Genetics and Environmental factors are two of the known risk factors for developing diabetes. In Type-1 diabetes, the symptom generally comes on rapidly and in case of Type-2 diabetes, the symptom usually developed gradually.         

Type-1 diabetes treatment: Insulin therapy is required with healthy food plan and physical activity.

Type-2 diabetes treatment: DM (Type 2) is a preventable disease with simple life style modifications like diet and regular physical exercise.

In general screening is important for early detection of Diabetes. In gestational diabetes, the mother may go on to develop Type-2 diabetes. To prevent and manage the gestational diabetes, physical exercise and cut off addiction of alcohol and smoking may reduce the risk factors.     

I had thoroughly studies on Diabetes Mellitus in my researched based ISC Biology Project / Assignment work. I have informed / discussed my project work about different types of Diabetes, its signs, symptoms, risk factors, complications, Management and Control through different articles of my Blog. DM is a treatable disease. DM can be controlled and complications can be prevented with early diagnosis and prompt treatment.

I believe my effort will be only successful if all such information helps in Prevention, Control, Manage and finally Survive lives in society from Diabetes.