Diabetes mellitus is a group of diseases that affect how the body uses glucose. Glucose is vital for the body because it is the primary source of energy for the cells that make up muscles and tissues. Glucose, or sugar, is also the main fuel for the human brain.
Glucose enters the body from two main sources: food and reserves stored in the liver. When we haven’t eaten for a while, the liver breaks down stored glycogen into glucose to provide energy. Once glucose enters the bloodstream from the intestines or liver, it enters the cells with the help of the hormone insulin. Insulin is produced by specialized cells in the pancreas and is released into the blood in response to the amount of carbohydrates consumed.
It’s important to note that “sugar” shouldn’t only be understood as the crystalline substance we use to sweeten various foods and beverages. Any carbohydrate-containing food ultimately contains sugars, such as bread, fruits, vegetables, and so on. When insulin enters the bloodstream, it reduces the amount of sugar in the blood by “transporting” it into the cells.
Regardless of the type of the disease, the main consequence is an elevated level of glucose in the blood plasma. Chronically elevated blood sugar levels have been proven to lead to serious health problems. The most severe impairments affect the nerves, nerve endings, and blood vessels, ranging from the smallest arterioles to the largest arteries.
There are also potentially reversible conditions of the disease, known as prediabetes, where the blood sugar level is higher than normal but not elevated enough to be classified as a developed disease, and gestational diabetes, which occurs during pregnancy but may disappear after giving birth.
Type 1 diabetes (Insulin-dependent): For unknown reasons, the immune system sometimes attacks and destroys the pancreatic cells that produce insulin. This leads to a deficiency or complete absence of insulin. Consequently, the sugar obtained from food cannot enter the cells and tissues, resulting in high levels of sugar in the blood. It is called “insulin-dependent” because the disease is directly related to the lack of sufficient insulin, and patients must inject this hormone in order to survive.
Risk factors for the development of insulin-dependent diabetes include:
Being overweight is not considered a risk factor for this type of diabetes.
In this type, cells become resistant (insensitive) to the action of insulin, even though initially the body produces it in sufficient quantities. To overcome this resistance, the pancreas attempts to produce more insulin, but ultimately the gland becomes exhausted without compensating for the condition. As a result, instead of entering cells for their needs, sugar accumulates in the blood in excessive amounts.
The exact causes of insulin resistance in cells are not established. Scientists believe it is a combination of genetic factors and environmental factors.
Risk factors for the development of Type 2 diabetes include:
Initially, complaints are due to high levels of blood sugar in the bloodstream. It is not uncommon for the disease to be discovered only when it causes complications such as a heart attack, stroke, or slow-healing wounds. Typically, the symptoms vary depending on how high the blood sugar rises. In Type 1 diabetes, symptoms often appear quickly and are more severe, while Type 2 diabetes can go undetected for a long time.
Main symptoms for both types of diabetes include:
The most reliable way is the laboratory measurement of glucose in the blood:
This is a specific health condition that affects some women during pregnancy who have not previously been diagnosed with diabetes. Gestational diabetes should not be confused with pre-existing diabetes that was present before pregnancy and was undiagnosed.
During pregnancy, the placenta produces specific hormones to support the pregnancy. These hormones can make cells more resistant to insulin. Normally, the pancreas responds by producing enough additional insulin to overcome this resistance. However, sometimes the pancreas cannot cope with the increased demand. When this happens, too little glucose enters the cells, and too much remains in the blood, leading to gestational diabetes. In many cases, this condition disappears after childbirth and does not require any treatment.
Women who are at a higher risk of developing this condition include:
Possible complications of diabetes:
In modern times, very few patients reach this condition, primarily if they are unaware, they are sick or have missed their insulin doses. Diabetic ketoacidosis is a life-threatening emergency that requires immediate medical intervention.
The good news is that with proper treatment and a comprehensive lifestyle approach, these patients can live long lives with a preserved quality of life. The longer the duration of the disease and the poorer the control of blood sugar, the greater the risk of complications.
One of the complications during treatment is excessively low blood sugar levels. This most commonly occurs in patients taking insulin, but it can also happen in individuals on oral therapy.
Symptoms of hypoglycaemia include weakness, trembling, sweating, pallor, nausea, and blurred vision. Every patient should be familiar with this condition and take fast-acting carbohydrates such as sugar, glucose syrup, honey, etc., at the onset of symptoms. Severe hypoglycaemia can lead to permanent damage and even death.
A definitive cure for diabetes is still unknown. However, with proper disease management, the quality and duration of life can be comparable to those without the condition.
Normalizing blood sugar levels is mandatory but not sufficient. Recent studies have found that the most important goal of treating this disease is comprehensive intervention to reduce cardiovascular risk and prevent acute and chronic complications.
In type 1 diabetes, insulin treatment is most commonly required, which serves as a substitute therapy. Type 2 diabetes is often managed with oral medications (tablets), but some patients may require insulin supplementation.
The fear of starting insulin treatment is completely unjustified. Modern forms of this medication are highly precise, with different types of insulin available, including rapid-acting, long-acting, mixed, and others, which closely match patients’ needs.
One concern with this life-saving medication, used for millions of people since its discovery, is that it is administered by injection. The reason for this is that it gets destroyed in the digestive system and cannot reach the bloodstream in an active form. However, injection is made convenient and effective through insulin pens, which allow for strict dosing and minimal discomfort.
There are various types of tablets available that improve the impaired glucose metabolism through different mechanisms. Some stimulate the pancreas to produce more insulin, while others block sugar production in the liver. Some medications act within the digestive system, inhibiting carbohydrate breakdown. There are also medications that increase tissue sensitivity to insulin.
In the global medical context, the first medication prescribed for diabetes is metformin. It can also be used for preventing the progression of the condition in patients with prediabetes and metabolic syndrome. Metformin is one of the most commonly prescribed medications.
New medications In clinical practice, there are now medications (SGLT-2 inhibitors) that not only effectively lower blood sugar but also successfully control and reduce cardiovascular risk. These medications are prescribed to patients whom the doctor deems at risk for cardiovascular incidents. Their mechanism of action is related to the elimination of excess sugar from the blood through the kidneys and urine. This also reduces the overall volume of fluids in the body and, consequently, lowers blood pressure.
Insulin pumps High-tech devices about the size of a mobile phone that can be programmed to deliver the required amount of insulin based on factors such as meals, physical activity, and other criteria.
The role of nutritional supplements Various substances and herbs have been studied to determine if they can lower blood sugar levels and their role in patients with similar conditions. Currently, there is no scientific evidence that herbs or nutritional supplements alone can control the disease. However, this does not mean they have no place in a comprehensive approach to managing the condition. It is important to consider not only blood sugar levels but also how other risk factors are controlled.
Products containing alpha-lipoic acid have been shown to have a proven positive effect in protecting nerve endings from damage due to high blood sugar. Its intake serves as prevention and treatment for one of the most common complications, diabetic polyneuropathy.
Cinnamon can sometimes help in controlling blood sugar. Studies have shown that individuals regularly consuming cinnamon have lower glycated hemoglobin levels under similar conditions.
Any other herbs and supplements that reduce the degree of “silent inflammation” in the body and lower oxidative stress can be beneficial.
Consult your doctor about taking additional substances to ensure they do not interact with your primary treatment.
How to eat with diabetes The rules for healthy eating are valid for everyone, regardless of whether they have diabetes or not. The time of absolute prohibitions is over. If you have a strong craving for sweets, don’t deprive yourself, but limit it to occasional indulgences and, to compensate, reduce your intake of other carbohydrates, such as bread. It is important that your diet is balanced and contains everything necessary for the proper functioning of the body.
Recommended foods: Fruits and vegetables are a must. Prefer raw or steamed vegetables. Carbohydrate-containing foods, which are sources of sugar, can be divided into those that contain “fast” and “slow” carbohydrates. The former lead to a rapid increase in blood glucose, which the body has difficulty managing.
These include foods and drinks with refined sugar, honey, white flour products, sweet grapes, and bananas. Prefer “slow” carbohydrates such as whole-grain bread and pasta, brown rice, and unprocessed oats. Choose lean meat options without visible fat, such as chicken breasts, lean pork, and lamb.
Fish is particularly recommended, but avoid frying and opt for baking or grilling: mackerel, salmon, sea bass. Nuts and legumes are valuable sources of protein. Dairy products are a good option for meals, but avoid sweetened yogurts and fresh milk.
Not only for high blood sugar, but for every individual, it is not recommended to consume:
Currently, there is no specific method identified by science to prevent insulin-dependent diabetes. Inheritance plays a significant role in this condition.
However, even in individuals predisposed to type 2 diabetes, lifestyle choices can delay or even prevent the onset of the disease.
The primary factors for prevention include:
In the past, patients would often die shortly after experiencing diabetic ketoacidosis. However, with the discovery of insulin and other medications, survival rates have significantly improved.
Today, the main concern lies in chronic complications that can reduce life expectancy and diminish its quality. Most individuals with diabetes succumb to cardiovascular complications such as heart attacks, strokes, pulmonary embolism, and other acute circulatory disorders. Kidney damage is also a significant issue.