Dr Tendani Matoro provides practical information on this disease and how it can be managed
THE ancient Greeks are known for their keen observational skills and curiosity. It is no surprise that they were able to find a link between diabetics and excessive urination.
At some point, diabetes was seen as a death sentence owing to its complexity and lack of effective treatment at the time.
To differentiate the other form of diabetes which also involves excessive urinating (diabetes insipidus) from the commonly known “sugar diabetes”, the term diabetes mellitus is commonly used. From Latin origin, mellitus means sweet.
Four broad types of diabetes mellitus are known.
Type 1 diabetes usually results from destruction of pancreatic cells that produce insulin. Insulin is like a key that opens cells to allow sugar (glucose) uptake. Without adequate production of this key in the pancreas, glucose levels in the blood will increase.
Type 2 diabetes is more common than type 1. In these patients, the key is generally produced in good quantities. The problem is with the lock (cell receptors) that does not respond well to the key. Unopened cells will not take up glucose well, amounting to excess glucose in the blood.
Specific types of diabetes also exist. These are related to abnormal genetic coding (that tells cells or the pancreas how to behave), diseases of the pancreas, endocrine (gland) disorders, chemical or drug-induced causes.
Gestational diabetes is related to pregnancy.
Type 1 vs Type 2
Most people differentiate type 1 from type 2 by the need for insulin in the former. Although mostly true, some type 2 patients may need insulin later in life.
Age of onset
Type 1 diabetes generally starts at an earlier age (below 30). Type 2 is linked with lifestyle diseases thus is commonly seen in older people. There are emerging cases of type 2 diabetes in the young and adolescence.
Type 1 sufferers are usually lean. This may be related to the ongoing disease process that breaks down the body’s muscle and fat cells for use as fuel for the cells, since glucose cannot readily enter the cells. Type 2 is commonly found in overweight or obese people that may show signs of glucose resistance on physical examination by the trained eye.
Type 2 patients may be picked up on random screening or sugar test. This type of diabetes tends to show itself slowly over time. They may be asymptomatic (without any problems or complaints) and may not show ketones in the blood. Ketones are the alternative form of fuel described above used by cells when glucose uptake/availability is insufficient.
Type 1 patients usually present with thirst, increased water/fluids intake, excessive urination, blurred vision or weight loss. Type 1 tends to show its face rather fast compared to type 2.
Type 1 patients tend to develop high levels of ketones in the blood that ultimately alter the pH of blood. The acidic pH from ketones (ketoacidosis) can be life-threatening. Coma or death can result if not well managed. This highlights the importance of good health-seeking behaviour in people who may manifest diabetic symptoms. Type 1 patients on treatment are also at risk of this complication if they are not adhering well to their prescribed treatment.
Type 2 patients may have complications from other lifestyle diseases. Obesity, high cholesterol, heart disease or stroke may co-exist with type 2 diabetes.
When checking your glucose level, inform the health professional of when last you ate. After eating (or within 8 hours) or randomly during the day, the acceptable blood glucose (plasma blood) should be less than 11.1 mmol/l. A test of 11.1 mmol/l or above is diagnostic of diabetes. Additional tests can be done to confirm the diagnosis.
If your sugar is taken more than 8 hours after you had food, or if you were asked to “fast” the night before, a glucose level of 7.0 mmol/l or more is indicative of diabetes.
Note that these figures are more accurate if blood is sent to the laboratory for diagnosis. If a finger-prick test (capillary blood) is used, The Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) recommends a conversion factor that validates finger-prick test results. Finger-prick tests are commonly used in most screening setups at clinic, doctor’s office and hospital level.
An additional test, HbA1c is not routinely used for diabetes diagnosis. It can, however, support the diagnosis where laboratory services are easily accessible.
HbA1c measures haemoglobin (a molecule in red cells that carries oxygen) that has picked up glucose from the blood. Because red cells survive in the blood for about 4 months, HbA1c gives a good overall impression of blood glucose control over time.
High risk groups: Type 2
If you are an adult, with a body mass index (BMI) above 25, consider getting screened for type 2 diabetes. These additional factors (by SEMDSA) put you at a higher risk of developing type 2 diabetes:
- Lack of exercise
- High blood pressure
- Family history of diabetes (first degree relative)
- High cholesterol/lipids
- Polycystic ovarian syndrome (PCOS)
- Heart disease history
- n Previous diabetes in pregnancy (or a baby weighing more than 4 kg)
Living with diabetes
Diabetic patients may already have an idea of how their bodies feel when their glucose levels are too high or too low.
A tight glucose control may reduce complications related to eyes, feet and penile erection in males. Other complications are recurrent infections (general, oral or flu), neurological (including decreased feet sensation or pins and needles). Persistent high blood glucose (hyperglycaemia) is related to these complications. Low blood glucose (hypoglycaemia) should however be avoided as this can be fatal.
General care of diabetic patients on subsequent visits should include:
- Lifestyle adjustment (weight control, exercise, smoking or alcohol)
- Counselling and empowerment on living with diabetes
- Family support and hypoglycaemia prevention
- Home care (glucose testing, symptoms awareness and feet self-examination)
- Dietary advice
- Oral, eye and feet care
- Blood pressure measurement
- Chronic medication review and side effect monitoring
- Glucose and urine test
- Cholesterol and lipid tests
- Infection prevention, treatment and Flu vaccination
- HbA1c monitoring.
Dr Tendani Matoro is a Medical Doctor (MBChB, UCT), General Practitioner (Polokwane), Clinical Advisor (Advanced Clinical Care HIV/AIDS and TB), Social Commentator (News24 and WordPress Blog) and Medical Columnist (Weekly Publications in African Times Newspaper)