Diabetes Mellitus : the DM , Diabetes ) is a disorder involving the removal of glucose utilization in connection with a deficiency of the hormone insulin * The body’s blood sugar levels higher than normal. Leaving the body in this state for a long time will cause various organs to degenerate, causing symptoms and complications. People with diabetes often have a family history. (Parents or direct relatives) also have this disease. And tend to be overweight as well
Diabetes is a disease that is highly common in people of all ages and both genders. And is found to increase with increasing age In our home, there are around 4-6% of people with diabetes, 7.1% of Thais aged 20-79 years and 9.6% of Thais aged 35 years or more (Data as of October 30, 2017) 2013, with more than 3.5 million people with diabetes in Thailand) and the International Diabetes Federation estimates that the number of people with diabetes worldwide will increase from 415 million in 2015 to 642 million in the year. 2040 B.E.
More than half of people do not know they have diabetes. The statistics of the patients being found in this disease are increasing in number, therefore there must be a continuous campaign about the danger of this disease. Because diabetes is a chronic disease that cannot be treated. There is a risk of serious complications and loss of important organs of the body. For this reason, the International Diabetes Federation (International Diabetes Federation: IDF) and the World Health Organization (WHO) has determined that November 14 every year is World Diabetes Day. In order to be aware of the importance of this disease
Note : Insulin (Insulin) is a hormone produced by the beta cells (Beta cells) of the pancreas (Pancreas) will be served by the hormone insulin helps sugar or glucose in the blood. (Which is obtained from the food we eat Especially starchy foods, carbohydrates and desserts) into the body To burn into energy for the functions of various organs.
Causes of diabetes
Diabetes is caused by deficiency of insulin hormones. People with diabetes will find that the pancreas produces little or no insulin. Or can be produced normally But the effectiveness of insulin decreased Such as those found in obese people, which are called ” insulin resistance ” (Insulin resistance) when a lack of insulin or the insulin does not act. Blood sugar therefore enters the cells less than normal. Resulting in congestion in the blood sugar And sugar will be excreted through urine This is why we call this disease ” diabetes “.
Diabetic patients (There are very high blood sugar levels) often have frequent and extreme urination. Because the sugar that comes out through the kidneys will bring out the water as well Resulting in more urine coming out than usual When patients urinate a lot, they will feel thirsty and have to frequently drink water. Because the body of the diabetic patient is not able to consume sugar to burn as energy. The body then turned to burn muscle and fat instead. Therefore thin the body Muscle atrophy, lack of fat, fatigue, exhaustion. In addition, prolonged high blood sugar can cause abnormal organs change and can cause many complications.
Type of diabetes
Diabetes can be divided into many types. Which will have different causes, severity, and treatment, including
- Diabetes type 1 ( the Type 1 Diabetes Mellitus ), which was originally the patients in this group will be called ” Diabetic Insulin Dependent ” (Insulin-dependent diabetes mellitus: IDDM) diabetic type found at least 5% of diabetes. But is highly violent and dangerous Symptoms of the disease will develop rapidly and occur acute. This type of diabetes usually occurs in children and young people aged under 20 years (then known as the ” Diabetes in Children and Adolescents ” or Juvenile diabetes mellitus), but it can be found in some older people. In this group of patients, the pancreas will produce very little insulin or cannot produce at all. The doctors believe that the patient’s body has an antibody created to destroy the pancreas and can not produce insulin. As it is called ” autoimmune disease”(Autoimmune). This is a result of hereditary disorders. Together with infection or external poisoning This group of patients will have a slim body. Have clear symptoms and need to rely on insulin injections to replace them everyday for life The body will be able to burn sugar as normal. Otherwise the body will turn to burn fat instead, causing the body to slim down quickly. And if severe, there will be a congestion of Ketones, a substance that is toxic to the nervous system (This ketone substance is a substance caused by fat burning.) Therefore, patients quickly lose consciousness, known as ” ketosis “.
- Diabetes mellitus type 2 ( the Type 2 Diabetes Mellitus ), which was originally the patients in this group will be called ” diabetes is insulin dependent ” (Non-insulin-dependent diabetes mellitus: NIDDM) is diabetes that is found mostly around 90. -95% of total diabetes When talking about diabetes Therefore often referring to this type of diabetes The type 2 diabetes is often found in people older than 30-40 years (so called ” adult diabetes.”Or Adult onset diabetes mellitus), but today is more likely to be found in children and teens. This type of diabetes is usually mild. Because the pancreas of this group of patients can still produce insulin But not enough for the needs of the body (Symptoms of the disease develop gradually in a long time) or produce sufficient, but insulin resistance. Causing the sugar in the blood to become diabetic These patients tend to be overweight or obese. The cause may be due to hereditary overweight. Most patients do not have obvious symptoms and usually do not develop ketones. Diet or the use of oral diabetes drugs often result in normal blood sugar levels. (But sometimes at very high sugar levels, insulin may be occasionally used), except for those who are resistant to oral medications that may require insulin forever.
- Gestational diabetes ( Gestational Diabetes Mellitus : , GDM ) found for around 2-5% of all diabetes. During pregnancy, the placenta generates many hormones into the body of the pregnant woman. (Some hormones have an effect against insulin), resulting in insulin resistance. Causing high blood sugar levels to become diabetic But after giving birth, the mother’s blood sugar level will usually return to normal (This group of women may give birth to an adult baby weighing more than 4 kilograms at birth and often have diabetes again when pregnant. And will have a risk of chronic diabetes in the long run).
- Diabetes with other specific causes, such as those caused by the use of certain drugs (such as steroids, diuretic drugs, azide Thyroid hormones Nicotinic acid), diabetes that is common with diseases or congenital disorders such as diabetes that is found together with infectious diseases (such as mumps, rubella by birth Cytomegalovirus infection, diabetes, common with other diseases (such as chronic pancreatitis Pancreatic cancer Multiple cyst of the ovarian cyst syndrome Chung adrenal tumor adrenal fibroid disease Chromosomal disease).
- In which the number is not much (Blood glucose level is not more than 200 mg / dl), which is most commonly found in type 2 diabetes. Patients will still feel comfortable and without any abnormal symptoms and are usually detected by accident. Examination of urine or blood tests while visiting a doctor for other reasons or from general health examination
- In many cases (Blood glucose levels greater than 200 mg / dL), which is found in the type 2 diabetes and type 2 diabetes, which is severe. Patients will have frequent urination and leave a lot at a time, often thirsty, dry mouth, frequent hunger or large amounts of rice. Feeling tired easily Be asleep And some may notice that the urine has ants
- Urinating frequently and releasing a lot at a time because of insufficient or insufficient production of insulin Therefore causing high blood sugar levels And the kidneys are unable to filter the excess sugar back into the blood Therefore released with water to become urine Diabetic patients therefore urinate frequently and have large amounts.
- Thirsty Because of frequent water loss from urination The body therefore needs to compensate for the waste water, causing thirst and wanting to drink more water than usual.
- Frequent hunger or overeating Because of lack of insulin Therefore the cells do not receive energy The body then tries to find more food sources by sending out signals of hunger.
- Easily tired because sugar cannot enter the cells to burn into energy.
- In most cases of type 2 diabetes, there are no obvious symptoms. There is only a small portion of the above symptoms. Body weight may be slightly reduced. But some people may gain weight. These patients tend to be overweight or obese in the past. In chronic cases for a long time, both with symptoms and without frequent urination May have an itch Frequent abscess or fungal skin infections Or is a chronic wound that heals more slowly than usual (Especially the sores on the feet) or may see a doctor with other complications, such as numbness or burning pain on the hands and feet Resulting in erectile dysfunction Chest pain due to ischemic heart disease, paralysis, paralysis, amblyopia, or having to change glasses frequently, etc.
- Unusual weight loss Because the cells can’t use the sugar to burn as energy The body then turned to burn muscle and fat instead. Therefore thin the body Muscle atrophy without fat
- Blurred vision, seeing images that are unclear Caused by high blood sugar levels Resulting in the congestion in the lens of the eye until the retina develops abnormal symptoms Or high sugar levels for a long time until the retinal disorders. In some cases, the embarrassment may be severe to the blind.
- In people with type 1 diabetes, symptoms tend to occur rapidly with a sudden decrease in weight. (Lasts weeks or months) in some children may have bed wetting at night. Some patients may come to the hospital with unconscious symptoms of ketoacidosis. (Ketoacidosis). These patients are often young and slim.
Complications of diabetes
- Complications often occur with diabetic patients who neglect treatment or incorrect care. The complications are both acute (such as unconsciousness, severe infection) and chronic. (Usually occurs in patients who cannot control sugar levels for a long time. Some people may need 5-10 years or more to make the arteries, both large and small, hard and constricted. Resulting in many organs, such as the nervous system, brain, heart, eyes, kidneys, feet, lack of blood to feed, causing these organs to become impaired Disabled or lost duty)
- People with diabetes who have poor control of blood sugar levels are more likely to get infected. Due to low immunity (Because white blood cells are responsible for eliminating less pathogens). In addition, diabetic patients can cause changes in other ways, causing many complications. In this case, we would like to mention only major or common complications, which are
- Unconsciousness from diabetes Is a severe and severe complication If patients do not receive immediate assistance, it may result in death, possibly due to
- Hypoglycemia (Hypoglycemia) is a common cause. Which is often found in diabetic patients who regularly eat or inject Or control blood sugar levels quite well. But often occurs in cases where the patient takes too much diabetes, dieting, or eating too little food Or eating the wrong food for too long Drink a lot of alcohol Or exerted too hard and too long In the initial phase, patients will feel hungry, palpitations, trembling hands, headache, dizziness, dizziness, fatigue, nausea, restlessness, irritability, sweating, coldness, blurred vision or double vision. If the patient rushes to eat sugar or nectar, the symptoms will subside in a short period of time. Will have jaw stiffness, spasms, unconsciousness or unconsciousness Urine test, no sugar in urine And detected low blood sugar
- Ketosis (Ketoacidosis) can only be found in patients with type 1 diabetes who lack long-term insulin injections. Or found in an infection or injury, which is when the body needs more insulin. The body burns fat instead of sugar, resulting in congestion of ketones in the blood until diabetic ketoacidosis causes patients to experience nausea, vomiting, extreme thirst, deep breath, breath with aromatic fragrance from ketones. Restlessness, fever, severe dehydration (withered skin, blurred eyes, low pressure, rapid pulse) may have abdominal pain, diarrhea, the patient will continue to penetrate until unconscious.
- Severe high blood sugar (Nonketotic hyperglycemic hyperosmolar coma: NKHHC) often found in patients with type 2 diabetes, a disease without knowing it, or lack of treatment. Or with severe infections (such as pneumonia, nephritis, septicemia), or with certain drugs (such as diuretics, steroids), the patient has very high blood sugar levels ( More than 600 mg / dL), resulting in severe dehydration, seizures, delirium, convulsions, unconscious by days before or unconscious days Patients will have symptoms of fatigue. Frequent thirst, frequent urination
- Complications of the nervous system include Neuropathy, which is caused by small arteries that fed the nervous system, resulting in stiffness and stenosis. If the nerve endings that raise the limbs In the initial stage, there may be symptoms of burning hands, sore feet, sore feet, or stabbing pain. Which is very common at night until some people may not sleep The symptoms will alleviate or disappear when you control your diabetes well.
- In addition, patients may also have autonomic neuropathy, which controls various organs within the body, causing dizziness due to pressure drop, standing pain, diarrhea, or chronic constipation due to irritable bowel syndrome. Symptoms of indigestion or epigastric pain from GERD The penis doesn’t erect. Bladder dysfunction (Causing no urination Chronic gastritis) sweat glands do not work. (Causes dry skin)
- Some may have nerve damage to the eye muscles. Paralyzing the eye muscles Strabismus, falling eyelids, not closing eyes, enlarged pupils, double vision But these symptoms usually disappear by themselves within 6-12 weeks
- The most important complications of the eye are macular degeneration or diabetic retinopathy. (Retinopathy), in which the patient initially does not feel abnormal Until a lot of blindness can occur, so should see an ophthalmologist to check the eyes once a year. (Diabetic patients with pregnancy should be checked from the first 3 months of pregnancy and periodically until 1 year after birth due to Pregnancy can cause more macular degeneration). If found at an early stage, treatment can be given to prevent blindness. It was also found that diabetic patients may have premature cataracts. Or chronic glaucoma Bleeding in the vitreous, which may cause blindness if untreated.
- The major kidney complications are Nephropathy or Chronic renal failure due to narrowing of the small arteries that fed the kidneys. Resulting in gradual deterioration of the kidneys. In the initial stages, there are small amounts of egg white matter coming out in the urine In this phase, there are still therapies to prevent renal insufficiency. Therefore, patients should visit a doctor to check the egg white substances in the urine at least once a year. If neglected until the kidney deterioration to the end, it will become a chronic kidney failure. Which may ultimately require dialysis or kidney transplantation
- Large arteriosclerosis (Atherosclerosis) causes the arteries to become clogged with blood supply to the vital organs, including the heart and brain, causing stroke. Ischemic heart disease Especially if there are other risk factors (such as high blood pressure Hyperlipidemia or abnormal), it is more likely to have these complications. People with diabetes have to control diabetes and risk factors at the same time, including taking aspirin to prevent these complications. In addition, blood may also lack blood to feed the legs and feet. Which will cause the patient to experience pain in the calf muscles while walking a lot The wound is difficult to heal. Or the toes are gangrene And may often experience cramps at night
- Infection. People with diabetes are easily infected due to low immunity. Which may be a repetitive infection (such as cystitis Vaginitis Candida eczema is a chronic infection (such as pulmonary tuberculosis) or it can be a severe infection. (Such as severe external otitis, pneumonia, acute nephritis cone The feet are infected wounds, which may spread until the feet rot.)
- Other complications such as inflammation of the tissues around the teeth (Very likely to have periodontitis or gingivitis Which causes loss of teeth), bile stones, myocardial infarction, which can cause a heart attack, high blood triglycerides, fatty liver, which may lead to cirrhosis or liver cancer, The hand nerves were tightened. Including the increased risk of pancreatic cancer as well.
- Complications during pregnancy Increases the risk of preeclampsia Drawing it high blood during pregnancy There is a greater chance of miscarriage or the fetus may die. Babies may be overweight, causing difficulty giving birth. And there is a high chance of danger during labor.
Each type of diabetes can be prevented differently. Type 1 diabetes may be difficult to find or can rarely prevent it from occurring. (Because the cause is caused by uncontrollable factors), while type 2 diabetes can be prevented by changing lifestyle habits to suit (The key to preventing all types of diabetes is to keep an eye on blood sugar and cholesterol to normal levels), which can be done with the following recommendations.
- Eat healthy food Complete with nutrients And high in fiber such as vegetables, fruits, whole grains, whole wheat bread, brown rice (may divide the main meal into small meals each day to help maintain the balance of sugar and insulin hormones)
- Good diet By reducing sweets and fats Eat rice as a staple food alternately with starchy foods. Eat fish, lean meat, tofu, soy regularly. And eating a lot of vegetables, fruits and grains
- Exercise regularly to help increase the body’s energy metabolism and reduce blood sugar levels. It also helps to strengthen the blood vessels and circulatory system better as well.
- Maintaining body weight to normal levels Where the body mass index should be at 18.5-22.9 kg / m 2, the waist line in men should be less than 90 centimeters, in women should be less than 80 centimeters
- No longer used anabolic steroids And always consult a doctor or pharmacist before using any medication
- Avoid smoking Do not drink alcohol (Because it may cause pancreatitis or liver cirrhosis that can lead to diabetes later)
- People at risk should be screened for diabetes (see the Diabetes screening criteria for people without symptoms).
- Pregnant women should undergo antenatal care at an early stage. See your doctor regularly for an appointment. And should be screened for diabetes to see if they are gestational diabetes or not Especially in high-risk groups (With one of the following characteristics: over 35 years of age, before pregnancy, overweight 23 kg / m 2, detected sugar in the urine, had born a congenital baby, have a group history Many types of ovarian cyst, family history of diabetes, having gestational diabetes in the previous pregnancy, having a baby weighing more than 4 kilograms, ever giving birth to a baby who died in a pregnancy If unknown cause, with more amniotic fluid), if found to have gestational diabetes, will receive serious care from an obstetrician and an internist. As well as strictly control the diet and exercise according to doctor’s advice
- In general, doctors in risk factors will recommend a blood test to check their blood sugar levels from the age of 30 (including checking if they have high blood fats and / or high blood pressure because of all 3 diseases). Often occur together). In general, blood tests for glucose should start at around 40 years of age.
Diabetes screening criteria for people without symptoms
- People who are overweight (Body mass index greater than 25 kg / m 2) together with one of the following risk factors Should be screened for diabetes under the age of 45 or should be screened more frequently as recommended by a doctor
- Lack of exercise (Because exercise helps to control weight and helps cells to be sensitive to the use of sugar or help to burn blood sugar better enough)
- There are direct family members. (Parents, siblings of the same stomach) have diabetes
- Is a national or ethnic risk group for diabetes (Because it is found that people of certain races have higher diabetes, such as Asians and blacks)
- Have high blood pressure (Greater than or equal to 130/80 mm Hg or more)
- Having HDL fat less than 35 mg / dl and / or triglycerides greater than 250 mg / dL
- Have diseases or other conditions related to insulin resistance, such as multiple polycystic ovary syndrome, thick, brown or black skin like acanthosis nigricans, etc.
- Have ever been detected that there is a ” latent diabetes ” (blood sugar level after fasting for 8 hours is 100-125 mg / dl or blood sugar level after 75 grams of glucose after 2 hours is 140-199 Mg / dl)
- Have had a history of gestational diabetes (GDM) or childbirth greater than 4 kilograms
- Have a history of arteriosclerosis
- If there are no such risk factors, screening for diabetes should be started at the age of 45 (because the age is very high The chances of becoming sweeter are higher. Which may be caused by degeneration of pancreatic cells or lack of exercise from deteriorating health)
- If the blood test results are normal, repeat the test every 3 years (the frequency of the test depends on the puncture sugar level and the risk)
Source by website Medline Thailand