In a healthy individual the body is able to automatically control the level of blood glucose depending on the body's needs. However, in the case of a diabetic this automatic control mechanism does not function properly. Blood glucose levels in a healthy person range from around 3.5 to 7 mmol/l. Diabetics will have higher blood glucose levels, often in excess of 15 mmol/l.
Glucose is produced when the body digests carbohydrates, starch or sugars. This glucose is transported in the blood to cells where they can be converted to energy to power the muscles. Any surplus is stored in the liver. Insulin is an essential hormone which enables the glucose to enter the cells or be stored in the liver. In a diabetic patient however, insulin is either not produced at all or does not perform as expected.
There are 3 main forms of diabetes:
Type 1 or Juvenile onset diabetes. This is commonly diagnosed in patients under the age of 30. In type one diabetes the body's immune system attacks and destroys the cells in the pancreas that produce insulin. As a result the pancreas no longer produces insulin. This type of diabetes is less common than type 2 and occurs in people with a genetic predisposition.
Type 2 also called mature onset diabetes occurs usually in the age group above 30 but is known to also occur in obese teenagers and children. In this case the body produces insulin but it is not effective.
The third form of diabetes is Gestational diabetes, which is a temporary condition occurring during pregnancy. However, women who suffer gestational diabetes have a high likelihood of developing type 2 diabetes at some point in their life.
High levels of blood glucose over long periods of time can cause many health problems including blood vessel damage, nerve damage, kidney and liver damage, impotence, problems with feet as well as increased risk of heart disease and stroke. It is therefore extremely important to diagnose diabetes as early as possible so appropriate treatment can be provided. However, many patients may have the disease but have no symptoms till glucose levels become extremely high.
Common symptoms of diabetes are:
Extreme thirst - as glucose builds up in the blood the kidneys have to work overtime to clear it out. As a result frequent urination is also common.
Tiredness and lethargy
Infections such as thrush
Unexplained weight loss (usually associated with type 1 diabetes)
Appropriate treatment depends on the type of diabetes. In the case of type 1 diabetes the body no longer produces insulin. Hence, treatment invariably includes insulin replacement therapy in the form of insulin injections.
Gestational diabetes occurs in pregnancy. Since oral diabetes medication may be harmful to the fetus, insulin injections may be prescribed where dietary adjustments and exercise are found to be inadequate.
Type 2 diabetes is by the far the most common and is reaching almost epidemic proportions in western countries. This is very much a lifestyle related disease and is closely connected with obesity and lack of exercise. Type 2 diabetes is often treated with a combination of dietary changes and an exercise regime. Where these prove insufficient to control blood glucose levels oral medications may be used. There are many categories of tablets used for treatment of type 2 diabetes each of which may act different. It is therefore quite common to combine more than one form of medication. Categories of medication include:
Category 1 - Sulphonylureas - This includes medications such as daonil, Glimel and Diamicron and helps by making the pancreas secrete more insulin.
Category 2 - Meglitinides - Similar to Sulphonylureas these drugs stimulate production of insulin in the pancreas. However, it generally has a shorter term effect, typically about 4 hours.
Category 3 - Biguanides - reduces absorption of glucose into the blood stream and also helps improve sensitivity to insulin.
Category 4 - Acarbose - Affects the absorption of glucose from the small intestines.
Category 5 - Thiazolidinediones - Reduces glucose released from the liver and helps insulin work more effectively to reduce glucose levels in the blood.
Many herbs have also been credited with an ability to reduce blood sugar levels or increase insulin tolerance. These include Bitter Melon, Garlic, Onion, Fenugreek, Bilberry, Asian Ginseng. While limited success has been recorded in lab tests, especially on animal subjects there is no evidence that herbs have sufficient impact on blood glucose levels to warrant use of herbs as a treatment to the exclusion of all others.
Diabetes has no cure and treatment is geared towards reducing and postponing complications as long as possible while trying to maintain blood glucose levels as close as possible to normal levels. It is also a sad fact that oral diabetes medication becomes less and less effective as time passes and most diabetics will in the long term find themselves with no option other than insulin injections.