An Overview of Diabetes

Why do we need glucose? After eating a meal, the gut digests complex carbohydrates into glucose, and the cells break down these glucose molecules to release energy. Intrinsic mechanisms keep blood glucose levels in-check to maintain our mental and physical well-being.

If these levels fall too low, this could lead to a life-threatening condition known as hypoglycemia, which may progress to complete unconsciousness. Normally, our hunger will drive us to eat before we become hypoglycemic. Even if we decide to fast, chemical reactions start utilizing the glucose stores present inside the body until we eat again. Why do we need insulin? Eating carbohydrates elevates blood glucose levels and triggers the secretion of a pancreatic protein called insulin. It facilitates glucose transport into the cells and allows them to produce energy properly. Every time we eat, enough insulin is secreted to effectively reduce the high glucose levels to its normal range. What is diabetes? In diabetes, insulin does not work. It could be that insulin molecules are defective in quantity or quality, and this is a mostly genetic state known as type 1 diabetes. More commonly, the person could have type 2 diabetes, which is a condition of insulin resistance where the body responds poorly to the normal insulin.

Both abnormal states cause elevated blood glucose levels, which is known as hyperglycemia. Hyperglycemia can also occur secondary to other diseases, such as Polycystic Ovary Syndrome or Cushing’s syndrome. Pregnancy can trigger a state of hyperglycemia known as Gestational Diabetes (GD). Some medical studies have reported that GD occurs in nearly 10 % of pregnancies.

What are the signs of hyperglycemia? High blood glucose levels can cause a state of drowsiness, increased urination, an increased craving for water or food and abnormal weight fluctuations. If it remains uncontrolled over a long time, this elevated glucose level may be a risk factor for concealed heart disease, peripheral nerve damage, blindness or kidney disease. It can also lead to poor healing of wounds and increased incidence of serious infections, such as a condition known as diabetic foot. In pregnancy, elevated glucose levels may harm the unborn baby. How do doctors test for diabetes? During a check-up, the medical team will assess the blood glucose after several hours of fasting (fasting glucose level), and then again two hours after the intake of a standard dose of glucose (2 hours post-prandial test). A test for a type of hemoglobin, known as hemoglobin A1c, may also be performed to reveal the average glucose level over the preceding few months. Lifestyle modification Having high blood glucose levels does not necessarily require medications, as some people exhibit a condition known as pre-diabetes. This is when the fasting glucose is higher than normal (5.6 to 6.9 mmol/L), but is not as high as in diabetic individuals (more than 7.0 mmol/L). Pre-diabetes is a warning sign that indicates a higher risk of getting diabetes later on. The disease can still be prevented by healthy food regimens and losing weight, especially from the waist, through regular exercise. How can diabetes be treated? Upon diagnosis of diabetes, its treatment will depend on the cause. As type 1 diabetes is caused by defective endogenous insulin, the doctor may prescribe doses of exogenous insulin. In type 2 diabetes, the body does not respond to insulin and will mostly need oral hypoglycemic medications which improve insulin response. These include drugs such as sulfonylureas, metformin and glitazones.

The hyperglycemic scare If a diabetic individual misses their medications, experiences an infection or undergoes physical stresses, they may suffer a medical emergency known as diabetic keto-acidosis (DKA). Due to the deficient insulin, the tissues will not be able to use glucose and its level will skyrocket. Furthermore, the body has to resort to secondary sources of energy, like fats. Abnormal fat metabolism releases toxic levels of keto-acids in the blood, hence the name, diabetic keto-acidosis. It causes nausea, vomiting, abdominal pain and drowsiness with a characteristic acetone odor in the breath. This emergency condition needs immediate medical attention because the uncompensated blood acidosis decreases the blood pressure and deteriorates vital cellular functions. A blood glucose monitor may report exceedingly high blood glucose levels and commercially available strips can detect acetone in urine or hydroxybutyrate in the blood. After monitoring the vital signs, emergency doctors will administer abundant intravenous fluids and an insulin infusion. Blood gases and potassium are also monitored closely until the insulin infusion is no longer needed. During that time, the doctors will also search for any source of infection, such as a chest or urinary infection, and give antibiotics to treat it. Imagine that you are sitting with a friend who has a history of diabetes. Alarmingly, they start getting confused and pale. They may be shivering with a degree of cold sweat. The appropriate step is to assess their glucose levels using a glucose monitoring device. A glucose level less than 3.9 mmol/L indicates hypoglycemia. Unfortunately, you have no accessible glucose monitor or medical help nearby. What do you do in that situation? Are they hypoglycemic or is it a case of diabetic keto-acidosis? If the person has skipped previous meals, just received their insulin shots or had engaged in active exercise, it is more probably an attack of hypoglycemia. Diabetic patients taking oral sulfonylurea as a hypoglycemic medication, such as glimepride or glipizide, are more prone to these attacks. Even if you are still in doubt, the right thing to do when you encounter a drowsy individual who is still responsive, is to give them oral glucose. You can give them 5 sugary pieces of chocolate, a tablespoon of honey or an accessible sugary drink. Diet drinks will not do the trick as they only contain artificial sweeteners. If the person is truly hypoglycemic, oral glucose will dramatically save their lives. Until you are able to access glucose monitors or medical personnel, if you are in doubt, giving glucose to a drowsy person is the best possible choice.

About Author: Mohammad A. Saleh has a Bachelor’s degree in Medicine and Surgery (MBBCh) from Cairo University, a Master’s degree of Anesthesia (MSc) from Ain Shams University and the European Diploma of Anesthesiology and Intensive Care (EDAIC) from the European Society of Anesthesiology (ESA).