Diabetes: Types, Symptoms, Causes, Diagnosis and Treatment

Diabetes is a condition that arises when there is excessive increase in  blood glucose levels also referred to as blood sugar. Glucose is used As the main fuel for the body. Even though the body has the ability to make glucose, food is also a source of glucose.

In order to get glucose into cells so it can be used as an energy source, the pancreas creates the hormone insulin. But in case of diabetes the body either produces no insulin at all or uses it incorrectly so the glucose does not enter the cells and it stays in the bloodstream.

Heart, renal, nerve, eye, and kidney function damage are among the risks that are heightened by diabetes. Diabetes is also associated with  some types of cancer. It's possible to lower your risk of developing health problems associated with diabetes by taking methods to avoid this condition.

Read this blog further to get a quick overview of this important topic Diabetes: Types, Symptoms, Causes, Diagnosis and Treatment for Medicine to ace your NEET PG exam preparation.

Types Of Diabetes

There are present different forms of Diabetes including:

• Type 1- Diabetes caused by an autoimmune condition. The immune system attacks on the pancreatic cells and leads to apoptosis of pancreatic insulin-producing cells. There is no known cause for this attack.
• Type 2- Diabetes of this kind develops when the body becomes resistant to insulin and due to this the blood sugar levels rise. This form of diabetes affects 90% to 95% of the population. A dependable source reports on individuals with type 2 diabetes.
• Type 1.5 diabetes- It  is also known as latent adult-onset autoimmune diabetes (LADA). It develops gradually and strikes throughout adolescence, much like type 2 diabetes. An autoimmune disorder called LADA is unresponsive to dietary or lifestyle modifications.
• Gestational Diabetes- Excessive blood sugar during pregnancy is known as gestational diabetes. The placenta secretes chemicals that inhibit insulin, which cause this type of diabetes.

Type 1 Diabetes Mellitus

Diabetes mellitus type 1 is a chronic condition which is commonly known as juvenile diabetes or insulin-dependent diabetes. In this condition, the pancreas generates very little or no insulin. The hormone insulin is used by the body to let glucose (sugar) into cells where it can be converted to energy.

Numerous things, including certain viruses and genetics, can cause type 1 diabetes. Although type 1 diabetes usually develops in childhood or adolescence, it can also affect adults.

Despite much research, type 1 diabetes still has no known cure. By regulating blood sugar levels with insulin, diet, and lifestyle modifications we try to avoid the complications associated with diabetes.

Causes Of Type 1 DM

Following are mentioned some of the causes of Type 1 Diabetes Mellitus:

• Autoimmunity- It is the most common cause. The genes which are involved in this condition are HLA DQ2, DR 3, and DR 4 genes.
• Viral causes
  • Fulminant Diabetes- Diabetes developing within 8-12 weeks period
  • Coxsackie B- It is the most common viral cause. It can also cause viral myocarditis 
  • Mumps, Rubella
• Bronze diabetes- It is caused due to Iron toxicity. Triad of bronze Diabetes Mellitus includes:
  • Liver Cirrhosis
  • Bronzing / Hyperpigmentation of skin (increase in melanin)
  • Beta cell mass decrease which is also known as Insulinopenia

Symptoms Of Diabetes Mellitus Type 1

Type 1 diabetes symptoms can appear suddenly and include the following:

• More thirsty than usual
• Frequent urination
• Growing bedwetting difficulties in kids who have never moistened their bed at night
• Gaining weight without making an effort and experiencing mood swings like anger
• Experiencing weakness and tiredness
• Fogginess in the vision

Treatment of Diabetes Mellitus Type 1

Long-term management of type 1 DM

Management of DM type 1 can be done with the help of :

• Carbohydrate counting- Regulate the amount of carbohydrate intake & give insulin proportionate to it. 1 unit of lispro is sufficient to neutralize 15g of Carbohydrates
• Insulin supplementation

Insulin Supplementation                              

 The most common route of administration of insulin is Subcutaneous. Sites of insulin injection are: 

• Arm
• Anterolateral aspect of the thigh
• Buttock
• Anterior abdominal wall 2cms away from umbilicus in the form of round circular band)

 Insulin Delivery

• Insulin Pump- It is the best method and it mimics artificial pancreas. It is done with the help of a Microprocessor device which helps in providing continuous Subcutaneous insulin infusion by continuously releasing basal Insulin into the body. Bolus insulin delivery at Mealtimes is also programmed proportionate to carbohydrate intake.
• Insulin Pen: (31 G)- It is Painless and Bloodless delivery of insulin
• Inhaled Insulin- Afreeza / Exubera
• Multidose Vial with 1ml syringe 
• Longest acting insulin: Degludec. It Act for 42 hours
• Insulin calculated is given as: 50% basal, 50% prandial.

The Complications of Insulin

Hypoglycemia

In this condition, the Blood sugar is less than 54mg%

Clinical Features of Hypoglycemia

• Sympathetic system stimulation
• Rage attacks
• Emotional lability
• Diaphoresis
• Drowsy
• Stupor
• Seizures

Treatment of Hypoglycemia

• IV 25-50% Dextrose
• In case of failed IV access INJ glucagon SC
• Avoid long-acting insulin
• Avoid intramuscular injection 

Somogyi Phenomenon

In this phenomenon, there is Early morning hypoglycemia due to intake of an overdose of insulin at bedtime.

At 4A.M. Person wakes up with sympathetic symptoms like Palpitations, Tremors, Diaphoresis, etc and at At 7A.M. there is present Glucagon in circulation which leads to glycogenolysis and we can find changes in  Blood sugar value leading to pre-breakfast hyperglycemia. Thus, the main manifestation of the Somogyi phenomenon is early morning hypoglycemia.

Dawn Phenomenon

In this phenomenon, there is Early morning hyperglycemia, due to the downregulation of GLUT-4 receptors in muscle in T2DM and there is Pre-breakfast hyperglycemia for diagnosis of this phenomenon we use Insulinoma which is a 72-hour prolonged fasting test.

Diabetes Mellitus Type 2

Type 2 diabetes is a disorder that develops when the body's ability to control and utilize sugar as fuel is compromised. Too much sugar is constantly moving through the blood as a result of this chronic illness. Eventually, problems with the brain, immunological, and cardiovascular systems can result from excessive blood sugar levels.

There are essentially two issues with type 2 diabetes. The hormone that controls the entry of sugar into cells, insulin, is not produced by the pancreas in sufficient amounts. Additionally, cells don't react well to insulin and take up less sugar.

Causes Of Diabetes Mellitus Type

Few of the causes of diabetes mellitus type 2 are mentioned below:

• Polygenetic 
• Insulin resistance is due to
  • Resistin
  • High levels of Adipokines → promote weight gain
  • Decreased levels of Adiponectin: Guardian angel against obesity

Symptoms Of Diabetes Mellitus Type 2

Diabetes type 2 symptoms frequently appear gradually. In actuality, type 2 diabetes can be present for years without symptoms. When present, symptoms could include:

• An increased thirst.
• Urinating frequently.
• A rise in hunger.
• Loss of weight without effort.
• Fatigue.
• Visional haze.
• Wounds that take a while to heal.
• Several infections.
• Hands or feet that are numb or tingly.
• Areas of darker skin, typically in the neck and armpits.

Treatment Of Diabetes Mellitus Type 2

We can manage Diabetes mellitus type 2 by following methods:

• Diet control (1st line intervention in Type 2 DM)
  • Carbohydrate intake is strictly regulated.
  • Carbohydrates with low glycemic index: Oats, multigrain bread, egg white, brown rice, white meat, and multigrain Atta
  • Fats: Butter / Ghee
  • PUFA: Safflower Oil
  • Trans fat: Olive Oil, Sunflower Oil
• Exercise
  • Helps to Increases GLUT4
  • Promotes Sugar entry into muscle resulting in decreased blood sugar level
  • Jogging for 30 mins for 5 DAYS/week is recommended (150 min/week)
• Oral Hypoglycemic Drugs- They help to Control HbA1C levels.

Oral Hypoglycemic Drugs

Biguanides

These drugs inhibit hepatic gluconeogenesis. With the use of these drugs  HbA1C is decreased by 1.5 - 2% over a period of 3-6 months (slow-acting). Drugs that fall into this category are  Metformin, Phenformin. Metformin comes as 500 mg / 850 mg / 1 gm. The maximum dose given is  2.5 g/day. These drugs are excreted via the kidney. These drugs Causes Lactic Acidosis if given in patients with nephropathy so these drugs are Avoided in kidney damage

Side effects of metformin

• Nausea/vomiting
• Lactic acidosis: If there is Concomitant renal failure
• B12 deficiency

Side effects of Phenformin

• Not given Nowadays as it causes lactic acidosis 
  • If Biguanides are not successful, give sulfonylureas.

Types of lactic acidosis

• Type A: Due to under perfusion of the tissues, shock: decreased perfusion: DM with septic shock
• Type B: Diabetes mellitus, Metformin/phenformin

Sulfonylureas

These drugs are ATP sensitive and K+ channel is blocked, which causes Burst of Insulin, leading to increased receptor sensitivity. There is a Decrease in  HbA1C by 1.5%

Side effects include Hypoglycemia attack (mealtime Regulation)

Drugs that are included in this category are;

• 1^st Generation → Tolbutamide 
• 2^nd Generation → Glibenclamide, Glipizide, Gliclazide
• 3^rd Generation → Glimepiride

Thiazolidinone 

These drugs Increase the peripheral utilization of glucose by increasing GLUT4 Receptors on muscle/adipose tissue and reduce serum triglycerides. There is a Decrease in HbA1C by 1%

Drugs which are included in this group are  Pioglitazone, and Rosiglitazone. Both drugs have good compliance but worsen cardiovascular mortality in preexisting CAD patients

α-Glucosidase inhibitors

These are taken with meals. They act by inhibiting sugar absorption from GIT. These drugs help to Control Postprandial spikes.  Osmotic diarrhea can be present as a side effect of these drugs . there is a Decreases  in HbA1C by 0.25%

Drugs included in this group are Acarbose, Voglibose, miglitol

Meglitinide

These drugs have Insulinogenic action. These drugs act by Improving  sensitivity of receptors. These drugs are Short-acting drug with a half life of  1-2 hours, So these are used  for control of postprandial spike of Sugar

Drugs included in this group are Repaglinide, nateglinide. These drugs Behave like sulfonylureas

Dipeptidyl peptidase-4 inhibitors                    

These drugs  inhibit degradation of GLP-1 Glucose linked insulinotropic Peptide which Sends sugar into muscles. Thus, increases the duration of action of GLP-I. Drugs included in these groups are Linagliptin (metabolized by Liver); Sitagliptin (metabolized by kidney)

Incretins

These drugs increase GLP-1. Terminal ileum has 'L' cells, which produce a hormone which Behaves like insulin and Increases GLP - 1. Drugs

Exenatide: Injection once a week. Nut it is Expensive and can cause  Hemorrhagic Pancreatitis

Liraglutide

SGLT – 2 Inhibitors

These drugs promote urinary loss of sugar resulting in decrease of blood sugar level. These drugs can have higher chances of causing UTI in patients as a Side effect. But these drugs help to Reduce cardiovascular mortality

Drug which are included in this group is  Canagliflozin.

SGLT-2 Transporters are present in PCT and help in reabsorption of both salt and sugar.

Drugs Used in both Type 1 & Type 2 DM

Pramlintide (best), Acarbose, insulin 

• If Hba1c is <9%, then mono therapy is recommended along with  lifestyle modification 
• If Hba1c 9-10%, dual therapy, metformin + SGL2 inhibitors
• If Hba1c >10% insulin + metformin +/- SGLT 2 inhibitors 

Insulin used in:

• Type 1
• Type 1.5
• Type 2, In beta cell exhaustion, sulfonylureas will stop working. Insulinopenia will be present in all forms of diabetes.
• Acute hyperkalemia
• Diabetic ketoacidosis
• Nonketotic hyperosmolar coma

Type 1.5 Diabetes Mellitus

• Latent autoimmune diabetes in adults (LADA), also known as type 1.5 diabetes, is a disease that resembles both type 1 and type 2 diabetes.
• LADA, like type 2 diabetes, is diagnosed in adulthood and develops gradually. But unlike type 2 diabetes, LADA is an autoimmune condition that cannot be reversed with dietary and lifestyle modifications.
• Type 1.5 diabetes causes your beta cells to quit working substantially more quickly than type 2. LADA is thought to affect 10%Trusted Source of people with diabetes.
• Diabetes type 1.5 is frequently and readily mistaken as type 2. If you have type 2 diabetes and are in a healthy weight range and have an active lifestyle, there are chances that you are suffering from LADA.

Causes of Type 1.5 Diabetes Mellitus

Autoimmune

• Anti-GAD: Anti-Glutamic acid decarboxylase antibody (Main Antibody)
• Anti-ICA: Islet cell Antibody (2nd Antibody)
• Anti-GAD: Also present in the paraneoplastic manifestation of oat cell Ca of the lung known as Stiff Person Syndrome
  • Insulinopenia is seen

Symptoms Of Diabetes Mellitus Type 1.5

Initial signs of type 1.5 diabetes may be nebulous. Among them could be:

• Continual thirst
• Excessive urination, especially at night, and unexplained weight loss
• Vision that is hazy and jittery
• Type 1.5 diabetes, if untreated, can result in diabetic ketoacidosis, a state in which the body begins to burn fat for energy because it lacks the ability to use sugar as fuel as a result of the lack of insulin. Because of this, poisonous ketones are produced.

Treatment Of Type 1.5 Diabetes Mellitus

Treatment is started initially with Sulfonylureas like Glipizide

Treatment Of Type 1.5 Diabetes Mellitus

Insulin type	Insulin name	Onset
Rapid	LISPRO, ASPART, GLULISINE	20 minutes
Short	Regular SC/IV	30 minutes
Intermediate	NPH (neutral protamine haged orn)	2 hours
long	Glargine/Detemir	24 hours
Ultra-long acting	Degludec	42 hours

Peakless insulin is long and ultra-long acting .

Uses of insulin: 

• Type 2 DM (β cell exhaustion): insulinogenic
• Newly diagnosed type 2 DM: HbA1c >10%
• Pregnancy
• End organ damage
• Acute illness

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Diagnosis of Diabetes Mellitus

The symptoms of type 1 diabetes  appear quickly and are the main justification for evaluating blood sugar levels. Without any relation with age everyone who  has a body mass index over 25 (or 23 for Asian Americans) have an extra risk factor of developing diabetes.

These include having diabetes in a close relative, high blood pressure, abnormal cholesterol levels, an inactive lifestyle, a history of polycystic ovarian syndrome or heart disease.

An initial blood sugar check is indicated for everyone older than 35. They should thereafter get screenings every three years if the results are normal. Every three years, women who have experienced gestational diabetes are urged to get tested for the disease.

A yearly test is indicated for everyone with prediabetes who has received a diagnosis.

Testing is suggested for everybody who has HIV.

• A1C Examination.  Average blood sugar level over the previous two to three months is revealed by this blood test, which doesn't need you to fast. In red blood cells, hemoglobin, the protein that carries oxygen, is measured in terms of how much blood sugar is connected to it. It is also known as the Haemoglobin test with glycation.
  • More Sugar. Attached hemoglobin will be present in blood if blood sugar levels are high. Diabetes is diagnosed when the A1C result is 6.5% or above on two different tests. You have prediabetes if A1C ranges from 5.7% to 6.4%. The usual range is below 5.7%.
• Random Blood Sugar Test. A random moment will be chosen to draw a blood sample. A blood sugar level of 200 mg/dL (11.1 mmol/L), or greater, indicates diabetes regardless of when you last had food.
• Fasting Blood Sugar Assessment. You won't be given anything to eat or drink the night before (fast) before a blood sample is obtained. Normal fasting blood sugar is less than 100 mg/dL (5.6 mmol/L). Prediabetes is defined as having a fasting blood sugar level between 100 and 125 mg/dL (5.6 to 6.9 mmol/L). You have diabetes if it is 126 mg/dL (7 mmol/L) or greater on two different occasions.
• Test for Glucose Tolerance. You must fast the night before this test. The level of fasting blood sugar is then determined. After consuming a sugary beverage, blood sugar levels are checked every two hours.

It's usual to have blood sugar levels under 140 mg/dL (7.8 mmol/L). After two hours, a result of greater than 200 mg/dL (11.1 mmol/L) indicates diabetes. You have prediabetes if your blood sugar level is between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L).

Your healthcare practitioner may do a urine test to check for the presence of ketones if they suspect you may have type 1 diabetes. When muscle and fat are burned for energy, ketone bodies are created as a consequence.

Your doctor will likely perform a test to discover if you have autoantibodies, which are harmful immune system cells linked to type 1 diabetes.

Early on in your pregnancy, your doctor will probably determine if you have a high risk of developing gestational diabetes. At your initial prenatal appointment, your doctor might do a diabetes test if you're at high risk. If your risk is average, you'll likely undergo screening sometime in the second trimester.

Gestational diabetes

Gestational diabetes is a form of diabetes that is first discovered during pregnancy. Gestational diabetes changes how your cells use glucose, much like other types of diabetes do. Gestational diabetes can result in high blood sugar levels, which can affect both your health and the health of your unborn child.

Despite the fact that any pregnancy issue is concerning, there is good news. You can manage gestational diabetes by maintaining a healthy diet, getting regular exercise, and, if necessary, taking medication. Blood sugar control can safeguard your health and the health of your unborn child and reduce the probability of a difficult delivery.

When you give birth, your blood sugar levels usually recover to normal if you had gestational diabetes while pregnant. However, your likelihood of getting type.

Symptoms Of Gestational Diabetes

Gestational diabetes frequently has no obvious signs or symptoms. Possible symptoms include an increase in thirst and more frequent urination.

Cause Of Gestational Diabetes

Researchers still don't understand why some pregnant women get gestational diabetes while others do not. In this condition we can find that there is excessive weight in the patients.

Usually, a number of hormones control blood sugar levels. However, as a result of changing hormone levels during pregnancy, the body has a tougher time effectively processing blood sugar so there is an increase in blood glucose levels.

Diagnosis Of Gestational Diabetes

You'll most likely get a screening test in your second trimester, which is between 24 and 28 weeks of pregnancy, if you have an average risk of gestational diabetes.

Your doctor may perform a diabetes test early in pregnancy, most likely at your first prenatal appointment, if you have a high risk of developing the disease, such as if you were overweight or obese before becoming pregnant, have a parent who has the disease, a sibling, or a child who does, or if you previously had gestational diabetes.

Depending on the condition the  health care provider may advice some screening tests which  include:

• Initially Challenging Glucose Test. You will consume a syrupy glucose solution. You'll undergo a blood test to check your blood sugar level one hour later. Pregnancy-related diabetes is identified by a blood sugar level of 190 mg/dL, or 10.6 mmol/L.
• On a glucose challenge test, a blood sugar level below 140 mg/dL (7.8 mmol/L) is typically regarded as being within the normal range, though this can vary by clinic or lab. You will require a second glucose tolerance test to determine if you have gestational diabetes if your blood sugar level is greater than expected.tests to monitor your glucose tolerance.
• Similar to the first test, this one involves monitoring your blood sugar hourly for three hours while also using a sweet solution that contains more sugar. You will be given a gestational diabetes diagnosis if at least two of your blood sugar levels are greater than normal.

Gestational diabetes

Gestational diabetes is a form of diabetes that is first discovered during pregnancy. Gestational diabetes changes how your cells use glucose, much like other types of diabetes do. Gestational diabetes can result in high blood sugar levels, which can affect both your health and the health of your unborn child.

Despite the fact that any pregnancy issue is concerning, there is good news. You can manage gestational diabetes by maintaining a healthy diet, getting regular exercise, and, if necessary, taking medication. Blood sugar control can safeguard your health and the health of your unborn child and reduce the probability of a difficult delivery.

When you give birth, your blood sugar levels usually recover to normal if you had gestational diabetes while pregnant. However, your likelihood of getting type.

Symptoms Of Gestational Diabetes

Gestational diabetes frequently has no obvious signs or symptoms. Possible symptoms include an increase in thirst and more frequent urination.

Cause Of Gestational Diabetes

Researchers still don't understand why some pregnant women get gestational diabetes while others do not. In this condition we can find that there is excessive weight in the patients.

Usually, a number of hormones control blood sugar levels. However, as a result of changing hormone levels during pregnancy, the body has a tougher time effectively processing blood sugar so there is an increase in blood glucose levels.

Diagnosis Of Gestational Diabetes

You'll most likely get a screening test in your second trimester, which is between 24 and 28 weeks of pregnancy, if you have an average risk of gestational diabetes.

Your doctor may perform a diabetes test early in pregnancy, most likely at your first prenatal appointment, if you have a high risk of developing the disease, such as if you were overweight or obese before becoming pregnant, have a parent who has the disease, a sibling, or a child who does, or if you previously had gestational diabetes.

Depending on the condition the  health care provider may advice some screening tests which  include:

• Initially Challenging Glucose Test. You will consume a syrupy glucose solution. You'll undergo a blood test to check your blood sugar level one hour later. Pregnancy-related diabetes is identified by a blood sugar level of 190 mg/dL, or 10.6 mmol/L.
• On a glucose challenge test, a blood sugar level below 140 mg/dL (7.8 mmol/L) is typically regarded as being within the normal range, though this can vary by clinic or lab. You will require a second glucose tolerance test to determine if you have gestational diabetes if your blood sugar level is greater than expected.tests to monitor your glucose tolerance.
• Similar to the first test, this one involves monitoring your blood sugar hourly for three hours while also using a sweet solution that contains more sugar. You will be given a gestational diabetes diagnosis if at least two of your blood sugar levels are greater than normal.

Treatment Of Gestational diabetes

Among the treatments for gestational diabetes are:

The treatment of gestational diabetes typically involves a combination of lifestyle modifications and, in some cases, medication. Here are the main components of gestational diabetes treatment:

• Healthy eating plan: A registered dietitian will work with you to create a personalized meal plan that helps control blood sugar levels. The plan will typically involve consuming a balanced diet that includes a variety of nutrient-rich foods while limiting the intake of carbohydrates. It will emphasize portion control and may include spacing out meals and snacks throughout the day.
• Regular physical activity: Engaging in moderate-intensity physical activity, as advised by your healthcare provider, can help lower blood sugar levels. Exercise helps your body use insulin more effectively, which can improve blood sugar control. It's important to choose activities that are safe during pregnancy, such as walking, swimming, or prenatal exercise classes. Always consult your healthcare provider before starting or modifying an exercise regimen.
• Blood sugar monitoring: Regular monitoring of blood sugar levels is crucial in managing gestational diabetes. Your healthcare provider will guide you on how often to check your blood sugar using a glucose meter. Typically, you'll be advised to test before and after meals to understand how different foods affect your blood sugar levels.
• Medication (if necessary): If lifestyle modifications alone are not enough to control blood sugar levels, your healthcare provider may prescribe insulin or other oral medications. Insulin is the most common medication used during pregnancy as it does not cross the placenta and is considered safe for both the mother and the baby. Your healthcare provider will determine the appropriate medication, dosage, and administration schedule.
• Regular prenatal care: Regular visits to your healthcare provider are important to monitor your pregnancy and manage gestational diabetes. They will monitor your blood sugar levels, check the growth and development of your baby, and provide guidance on managing your condition.
• Fetal monitoring: Due to the increased risk of certain complications, your healthcare provider may recommend additional tests to monitor your baby's well-being. This may include ultrasounds to measure the baby's growth and non-stress tests to assess fetal heart rate patterns.

Remember, the treatment plan for gestational diabetes is individualized, and it's important to work closely with your healthcare provider to determine the best approach for you. By effectively managing gestational diabetes, you can reduce the risk of complications and ensure the health of both you and your baby.

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