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Diabetes: Symptoms, Treatment and Latest Research
#1
Information 
Diabetes is a disease characterized by a 'prolonged' increase in blood sugar level, leading to an array of physiological disorders. Uncontrolled increase in blood sugar level (also termed as: Hyperglycaemia) if left untreated, eventually culminates into damaging various organs of the body. According to recent reports of WHO, about 347 million people worldwide have been affected by diabetes!

Causes and Types of Diabetes
Cause of diabetes may be linked to two factors. The two factors have lead to classification of diabetes into two types as well.

a) Type I Diabetes
Type 1 Diabetes occurs under the lack of production of the hormone that controls blood sugar. That hormone is "Insulin" and it is produced by Pancreas ( a glandular organ in the digestive and endocrine system of vertebrates). When body is unable to produce enough insulin, the blood sugar levels tend to rise up, but it can be controlled by external administration of insulin. This type of diabetes is thus also referred to as insulin-dependent diabetes. Type-1 diabetes often begins before the age of 40 and affects youngster mostly, hence also called Juvenile/child-onset diabetes.
Following is a very intuitive depiction of Type-1 diabetes (source: medicinenet)
[Image: 42943_type1diabetes.jpg]

Symptoms of Type-1 diabetes:
Type-1 diabetes is often characterized by polyuria (excessive urination) , polydipsia (high thirst), constant hunger, weight loss, vision changes and fatigue.

a) Type II Diabetes
Type 2 diabetes results from body's resistance to insulin and thus inability to use it, despite adequate production of the same. It's thus often dubbed as non-insulin-dependent diabetes. According to WHO, type 2 diabetes comprises 90% of people with diabetes around the world. It's genereally a result of unhealthy lifestyle, obesity, physical inactivity; which tends to be prevalent with age. Type-2 diabetes is thus dubbed as adult-onset diabetes as well.
Following is a very intuitive depiction of Type-1 diabetes (source: medicinenet)
[Image: diabetes_basics_bloodvessels2.jpg]

Symptoms of Type-2 diabetes:
Symptoms are often similar to Type 1 diabetes, but generally less marked than those in type-1. It's due to this less marked nature of the symptoms that, Type-2 diabetes may be diagnosed several years after onset post complications.

Recently, Children have also been observed to be affected by it.


Other types of Diabetes:

Gestational diabetes

Gestational diabetes, as the name suggests occurs during pregnancy. Hyperglycaemia does occur in this type of diabetes with blood glucose values above normal but below those diagnostic of diabetes. It often leads to increased risk of complications during pregnancy and at delivery with risk of type 2 diabetes in future.

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG)

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are termed as intermediate conditions in the transition between normality and diabetes. Althought not necessary, people with IGT or IFG are at high risk of progressing to type 2 diabetes.

Diagnosis of Diabetes

Diagnosis of Diabetes in general:
1. Glycated hemoglobin (A1C) test
A1C test is used to index the average blood sugar level of past two to three months of an individual. The A1C test is based on the attachment of glucose to hemoglobin (the oxygen carrying protein in RBCs). The typical life span of an RBC in body is around 3 months. Thus, the A1C test helps indexing the average of a person’s blood glucose levels over the past 3 months. Reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been. A normal A1C level is below 5.7 percent.

2. Random blood sugar test
Irrespective of the time of meal, a person's random blood sugar level shouldn't be at or above 200 mg/dL (11.1 mmol/L). Above the 11.1 mmol/L level, a person can be suspected of diabetes, especially when observed to report symptoms of diabetes, such as frequent urination and thirst. Thus, Random Blood Sugar test is aimed at probing the concentration of sugar in blood at any random time.

3. Fasting blood sugar test
Fasting blood sugar test is done to observe the level of sugar in the blood of a person who has fasted for atleast 12 hours (often overnight). Fasting blood sugar levels less than 100 mg/dL (5.6 mmol/L) are considered normal, while those between 100 to 125 mg/dL (5.6 to 6.9 mmol/L) are considered prediabetes. Levels at 126 mg/dL (7 mmol/L) or above on two separate tests indicate that the person is having diabetes.

Diagnosis of Type-1 Diabetes vs Type 2 Diabetes
Once diagnosed with diabetes, it becomes important to ascertain the exact type of diabetes one is suffering from, as it is extremely significant in getting right line of treatment.

Apart from the indicative parameters of age of onset, precise tests for autoantibodies, C-peptide assay and test for presence of ketone bodies in urine can mark the difference between two types of diabetes.

Diagnosis of Gestational Diabetes
Gestational diabetes is diagnosed through prenatal screening, rather than through the reported symptoms.[/i]

Treatment of Diabetes
Type-1 Diabetes Treatment
External administration of Insulin becomes a necessity in the treatment of Type-1 diabetes. Insulin is injected subcutaneously (under the skin) in the fat layer where it gets absorbed into the bloodstream and thus reaches all body cells. Though the research is on, oral insulin administration hasn't come into practice in current state of art. Being a hormone, insulin is a hormone (protein in nature) oral administration might lead to denaturation (destruction of functional structure of protein) by the acidic environment of the stomach. Scientists are looking for other innovative ways to give insulin as the injections lead to puncturing holes into the skin of the already suffering patients. As of today, shots are the most widely used method.  Recently, insulin pumps as depicted below have also been developed (Image source: nlm.nih.gov):
[Image: 18035.jpg]
Type-2 Diabetes Treatment
Being more related to life-style issues, the first line of treatment of Type-2 diabetes involves:
Exercise (atleast 3-4 hours a week) and appropriate diet (not more than 1800 calories a day being the ideal way to go).

In most cases, insulin administration is not needed and some oral medicines like Metformin (which works by limiting liver's production of glucose and increasing insulin sensitivity) are prescribed.

External administration of insulin might be needed if life style changes and medications aren't able to control blood sugar level.

Some Scientific Updates on Diabetes

1. Stem Cells in Diabetes Treatment (CLICK HERE for updates)




2. Betatrophin, a new hormone for diabetes control (CLICK HERE for updates)




3. Successful use of Gene Therapy in treating Type-1 Diabetes (CLICK HERE for updates)

and many more to come...

Sunil Nagpal
MS(Research) Scholar, IIT Delhi (Alumnus)
Advisor for the Biotech Students portal (BiotechStudents.com)
Computational Researcher in BioSciences at a leading MNC


Suggested Reads:
Top Biotech Companies | Top places to work
Indian Biotech Companies and Job Openings
Aiming a PhD in Top Grad School? | These are the Important Points to Consider
Careers in Biotechnology | A list of various Options
Biotechnology Competitive Exams in India
#2
Being a diabetes patient myself, I would like to add some additional information on ...
How to keep your Diabetes under control.

#1: Every Diabetic is unique and his personal treatment and recommended tests may vary due to many factors. Therefore it is important to get a personalized check dome from a good doctor/diabetologist at least twice a year.

#2: These tests indicate your current health status and health complications that may arise in future. Doctor will prescribe medications accordingly.

#3: Visit your Doctor (once a year): Will check your blood pressure, weight, feet and possible recommend you to a dentist.

#4: Eye exams (once a year): Diabetes can damage the small blood vessels in your retina, which is the back part of your eye. This condition is called diabetic retinopathy. Diabetes also increases your risk of having glaucoma, cataracts, and other eye problems. Smoking can be extremely bad for Diabetics. If you at all find difficulty in dim light, or start developing blind spots, double or hazy vision, get frequent headaches or have problem seeing in the sides, then get a checkup done ASAP. If you develop a problem like glaucoma, your doctor may advice you to get your eye checkups done a lot more frequently. Note: High impact or Heavy weight lifting exercises can make your eye problems worse.

#5: Foot exam (once a year): Doctor will check pulses in your feet and also examine for infections, sores or any loss of feeling.

#6: Hemoglobin A1c tests ( every 3 months): Diabetics should aim for A1c of less than 7%. This test tells how well you are controlling your blood sugar levels.

#7: Cholesterol levels check: If you have high cholesterol, get these tests done twice a year, otherwise an annual test is just fine. A Lipid Panel test will check for your total cholesterol, triglycerides, good and bad cholesterol.

#8: Kidney/Urine test (once a year): Has there been any damage to your kidneys? Doctors specifically look for a protein called Albumin.

#9: Healthy lifestyle: By controlling your sugar intake and doing mild workout every day can be really beneficial. This includes walking and mild running/exercising. Avoiding smoking and reducing alcohol intake.

#10: Other tests: Depending on your personal health indicators or family history other tests may come into play like serum creatinine test, heart disease test, or if you have sexual and fertility problems.

This list might look too exhaustive and scary. Overall a diabetic person will be just fine if they visit doctor/hospital and get recommended tests done every 3 months to 6 months. These tests are not time consuming, all your checkups will be done within a few hours only. So mark your calendars, and start living a healthy life.

All the best !!
- Greg
#3
Fish oil reduces nerve damage caused by diabetes

About half of all diabetic patients suffer from nerve damage or neuropathy.


A study conducted at the VA Medical Center in Iowa City, however, found that Resolvin D1, a metabolite produced by an omega-3 fatty acid found in fish, not only stops the progression of neuropathy in mice, but actually reverses it.

http://www.research.va.gov/currents/fall...014-31.cfm
#4
FDA has very recently issued a warning on the use of SGLT2 inhibitors that are suspected to be linked to the fatal condition called KETOACIDOSIS.

SGLT-2 inhibitors (sodium-glucose cotransporter-2 inhibitors) like Canagliflozin, Dapagliflozin and Empagliflozin are reported to elevate blood ketones levels, which can lead to diabetic coma or even death!

Some brand names of these drugs include:
  • Invokana (canagliflozin)
  • Glyxambi (empagliflozin and linagliptin)
  • Farxiga (dapagliflozin)
  • Invokamet (canagliflozin and metformin)
  • Xigduo XR (dapagliflozin and metformin)
  • Jardiance (empagliflozin)

It is thus advised to patients of Type-2 diabetes to monitor their ketone levels (ketoacidosis) regulary while consuming SGLT-2 inhibitors. Symptoms like difficulty breathing, nausea, vomiting, abdominal pain, unusual fatigue or sleepiness, confusions should be immediately addressed.

Best wishes
Sunil Nagpal
MS(Research) Scholar, IIT Delhi (Alumnus)
Advisor for the Biotech Students portal (BiotechStudents.com)
Computational Researcher in BioSciences at a leading MNC


Suggested Reads:
Top Biotech Companies | Top places to work
Indian Biotech Companies and Job Openings
Aiming a PhD in Top Grad School? | These are the Important Points to Consider
Careers in Biotechnology | A list of various Options
Biotechnology Competitive Exams in India
  

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