Diabetes mellitus is the Latin name for diabetes. Millions of people are diagnosed with diabetes all over the globe. It is classified under metabolism disorders. The way the human body uses the digested food for energy and growth is generally referred to as metabolism.
Diabetes is a long-term or chronic condition. Food consumed will be broken down into glucose, which is a form of sugar in the blood which the body uses for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into cells, where it is broken down to produce energy.
However, in a diabetic condition, the glucose in the body does not break down into energy. This is because the body either does not produce enough insulin or produces no insulin or has cells that do not respond properly to the insulin the pancreas produces. This results in the elevated levels of sugar in the blood, which is termed as hyperglycemia. This condition of hyperglycemia produces the following three conventional symptoms:
- polyuria (frequent urination);
- polydipsia (increased thirst); and
- polyphagia (increased appetite/hunger).
Diabetes can cause acute health complications, including heart disease, blindness (diabetic retinopathy), kidney failure (diabetic nephropathy), and lower-extremity amputations.
Hypoglycemia is another condition which is caused by a lower than normal level of blood glucose levels observed more often in diabetics. Glucose is absorbed into the bloodstream and carried to the body’s cells after a meal. If a person takes in more glucose than the body needs at the time, the body stores the extra glucose in the liver and muscles in a form called glycogen. Extra glucose can also be changed to fat and stored in fat cells. Fat can also be used for energy.
When blood glucose begins to fall, glucagon, another hormone made by the pancreas, signals the liver to break down glycogen and release glucose into the bloodstream. Blood glucose will then rise toward a normal level. In some people with diabetes, this glucagon response to hypoglycemia is impaired leading to low blood sugar levels. Some of the symptoms of hypoglycemia include the following:
- increased appetite;
- nervousness;
- sweating;
- confusion;
- anxiety;
- vertigo; and
- weakness.
Types of diabetes mellitus
Diabetes is classified under three broad categories:
- type 1 diabetes;
- type 2 diabetes; and
- gestational diabetes.
Rare types of diabetes mellitus include maturity onset diabetes of the young (MODY), latent autoimmune diabetes of adulthood (LADA), and diabetes insipidus.
HbA1c and diabetes diagnosis
When glucose molecules stick to the hemoglobin (Hb) molecules, it forms a glycosylated/glycated hemoglobin molecule known as A1c or HbA1c. Hemoglobin molecules pile up to form the red blood cells (RBCs) in the bloodstream. By measuring HbA1c, an average blood glucose concentration can be understood. As the normal life-span of RBCs is 120 days, the build-up of HbA1c within the RBCs implicates the average level of glucose to which the cell has been exposed during its lifecycle. The usual reading in non-diabetics is 3.5 to 5.5%. In patients with diabetes, HbA1c level of 6.5% is reflected as a good control.
HbA1c levels differ from blood sugar/glucose levels. Blood sugar/glucose levels are the amount of glucose in the blood, often called serum glucose level. In non-diabetics, the usual reading is 4 to 8 millimoles per liter (mmol/l) which is considered to be stable. This reading fluctuates widely in people with diabetes.
Diabetes monitoring
Self-monitoring of blood glucose (SMBG) provides people with diabetes mellitus with an accurate method of measuring blood glucose concentrations and therefore detecting both hyperglycemia and hypoglycemia. The aim of SMBG is to collect complete information about blood glucose levels at many time points and help maintain a more constant glucose level by more precise regimens. This helps people to adjust their diet, exercise, and insulin (as instructed by the health care provider). Diabetics (patients with type 1 and type 2 diabetes) who use insulin usually should test their blood sugar at least three to 10 times per day.
SMBG helps to determine both the effectiveness of their prior insulin dose and their next insulin dose. However, regular self-testing comes with several barriers for some people, such as testing sites. To overcome this hurdle, self-monitoring devices were developed which help check the blood glucose levels anywhere. These devices include diabetes test strips, alternate site testing (AST), continuous glucose monitoring (CGM), and downloadable meters.
Diabetes test strips are used in conjunction with a blood glucose monitor. In this technique, blood drops are drawn from other places (usually the palm or forearm) than the finger. A diabetic pricks themselves and a small drop of blood is then applied to the test strip. The blood glucose monitor (an electronic device for measuring blood glucose level) is then able to detect level of blood glucose which will be displayed on the digital display within few seconds.
Usually, less blood flows to alternate sites, which prevents the reading from being accurate when the blood sugar level is changing. This is the main disadvantage of this technique.
In a CGM system, a disposable glucose sensor is used, which is placed just beneath the skin. The sensors measure the glucose in interstitial fluid (the fluid in and around body’s cells). This technique has generated interest due to the option of getting up to 288 glucose level readings a day without having to do finger pricks as in blood glucose monitoring.
This is can be worn 24 hours a day. Also, it can include alarms to indicate when glucose levels are too high or too low.This system allows examination of how the blood glucose level reacts to insulin, exercise, food, and other factors. Some of the products of CGM system include FreeStyle Navigator (approved by FDA) and Medtronic MiniMed Paradigm® REAL-Time Revel™ System.
Downloadable meters are software tools that run on personal computers, the iPhone and the iPod Touch to manage records associated with glucose measurements, insulin and other medicine, meals, exercise, blood pressure, test results, diabetes logbooks, statistical evaluations, and other notes. Some of these software tools include Diabetes Pilot, CoPilot® Health Management System (Abbott), Diasend®, and CareLink™ (MiniMed). CareLogger is an online, free diabetes logbook.
Diabetes, a chronic condition, is affecting millions of people. It produces three conventional symptoms: polyuria, polyphagia, and polydipsia. Self-monitoring of blood glucose (SMBG) helps people overcome barriers like traveling to testing sites. Diabetes test strips, alternative site testing, continuous glucose monitoring (CGM), and downloadable meters are some of the most helpful ways of self-monitoring the blood glucose levels from anywhere.
Disclaimer: The information contained in this article is for educational purposes only; it should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his/her health should contact a licensed medical professional.
Reference:
American Diabetes Association “Overview of Diabetes” Accessed 27 August 2010
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