DIABETES

What is Diabetes?

Your body converts carbohydrates to glucose. Glucose is the simple sugar that is the main source of energy for the body's cells. To enter cells, glucose needs the help of insulin. Insulin is a hormone produced by the pancreas. When a person does not make enough insulin, the body can’t utilise glucose. The glucose builds up in the blood. High levels of glucose in the blood or urine lead to a finding of diabetes.

Diabetes mellitus is a disorder where the pancreas does not make enough insulin or the insulin is not effective. This insulin imbalance causes the body’s blood sugar level to rise, and eventually many unhealthy changes can occur in different body organs.

The normal and target blood glucose ranges are:

Normal Blood Glucose level in people who do not have Diabetes
Fasting	4.4 - 6.1mmol/L
Non-Fasting	4.4 - 8.0mmol/L
Target Blood Glucose level in people who have Diabetes
Fasting	5.0 - 7.2mmol/L
Non-Fasting	<10.0mmol/L

(Ref: American Diabetes Association Guidelines & The Malaysia Clinical Practice Guidelines 2005)

There are more than 1 million people in Malaysia have diabetes. Many times the disease can lead to kidney damage and even kidney failure. Diabetes is the most common cause of kidney failure in Malaysia.

Latest statistics indicated that 57% of kidney failure was due to diabetes. Most people’s diabetes does not damage the kidneys enough to cause kidney failure. Proper control of diabetes and blood pressure, together with certain medications may prevent the onset of kidney complications or reduce further kidney damage if that has already occurred.

 

What are the symptoms of Diabetes?

People who think they might have diabetes must visit a physician for diagnosis. They might have SOME or NONE of the following symptoms:

• Frequent urination
• Excessive thirst
• Unexplained weight loss
• Extreme hunger
• Sudden vision changes
• Tingling or numbness in hand or feet
• Feeling very tired much of the time
• Very dry skin
• Sore that are slow to heal
• More infection than usual

What are the types of Diabetes?

Type 1 Diabetes

Also called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, accounts for 5% to 10% of all diagnosed cases of diabetes. Occurs mainly in young people below 30 years and is caused by an inability of the pancreas to produce enough insulin. These people need insulin injections.

Type 2 Diabetes

Also called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes usually develops in people older than 40 years, accounts for about 90% to 95% of all diagnosed cases of diabetes. The abnormal blood sugar in these people is usually controlled with diet and / or medications.

Gestational Diabetes

Type of diabetes that only pregnant women get. If not treated, it can cause problems for mothers and babies. Gestational diabetes develops in 2% to 5% of all pregnancies but usually disappears when a pregnancy is over.

 

What are the risk factors for Diabetes?

Risk factors for Type 2 Diabetes include old age, obesity, a family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity.

Risk factors are less well defined for Type 1 Diabetes than for Type 2 Diabetes, but autoimmune, genetic, and environmental factors are involved in developing this type of diabetes.

Gestational diabetes occurs more frequently in people with a family history of diabetes than in other groups. Obesity is also associated with higher risk. Women who have had gestational diabetes are at increased risk for developing Type 2 Diabetes in the later part of their life.

Studies have shown that nearly 40% of women with a history of gestational diabetes developed diabetes later. Other specific types of diabetes, which may account for 1% to 2% of all diagnosed cases, result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses.

 

What is the treatment for Diabetes?

Healthy eating, physical activity, and insulin injections are the basic therapies for Type 1 Diabetes. The amount of insulin taken must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose testing.

Healthy eating, physical activity, and blood glucose monitoring are the basic therapies for Type 2 Diabetes. Most people will require oral medications and eventually will require a combination of oral medications and insulin or a switch to insulin to control their blood glucose levels. People with diabetes must take responsibility for their day-to-day care, and keep blood glucose levels from going too low or too high.

People with diabetes should see a health care provider who will monitor their diabetes control and help them learn to manage their diabetes. In addition, people with diabetes may see endocrinologists (specialist deals with diseases that affect organs that make hormones), who may specialize in diabetes care; ophthalmologists for eye examinations; podiatrists (specialist deals with disorders of lower limbs) for routine foot care; and dietitians and diabetes educators who teach the skills needed for daily diabetes management.

 

How can Diabetes affect the kidneys?

Over many years diabetes affects the small blood vessels throughout the body. Damage may be caused to the kidneys as well as the eyes, skin, nerves, muscles, intestine and heart.

The kidneys contain tiny filters made up of small blood vessels and as these become damaged, protein leaks into the urine and the kidneys are less able to filter (purify) the blood properly.

The normal removal of excess salt and water from the body is reduced and toxic substances build up in the blood. Kidney failure caused by diabetes is called “diabetic nephropathy”.

If the nerves in the body are damaged by diabetes, it is called neuropathy, and this can affect bladder control, resulting in difficulty in emptying the bladder.

Urine can remain in the bladder and the pressure that builds up can back-up and damage the kidneys. In addition, if urine stays in the bladder for long periods of time, infection may develop because of the rapid growth of bacteria in urine that has high sugar content. In diabetic kidney disease (also called diabetic nephropathy); cells and blood vessels in the kidneys are damaged, affecting the organs’ ability to filter out wastes. Wastes build up in your blood instead of being excreted. In some cases this can lead to kidney failure. When the kidneys fail, a person has to have his or her blood filtered through a machine (a treatment called dialysis) several times a week, or has to get a kidney transplant.