Diabetes, also known as diabetes among the people, is one of the most important public health problems today. Diabetes is a metabolic disease characterized by high circulating glucose, that is, high blood sugar. The hormone insulin secreted from the pancreas regulates the glucose metabolism in the body.
What is Diabetes, What are the Causes of Diabetes?
According to the data of the International Diabetes Federation, 1 out of every 11 people between the ages of 20-79 has diabetes. This number is expected to increase to 1 in 10 by 2045.
Diabetes, which has many undiagnosed cases, affects the organs and vital functions of patients, reducing their quality of life.
Diabetes is a metabolic disease characterized by high blood glucose levels. The hormone insulin secreted from the pancreas regulates the glucose metabolism in the body. Incomplete or no secretion of this hormone causes diabetes.
The biggest energy source of all cells in the human body is glucose, that is, blood sugar. The brain uses only glucose as an energy source.
Carbohydrates, fats and proteins taken with food; In the intestines, glucose is decomposed into building blocks such as fatty acids and amino acids and passes into the circulatory system.
In order for glucose to be used as an energy source, it must enter the cell from the circulatory system. This is where the hormone insulin comes into play.
Insulin hormone secreted from the pancreas to the blood circulation plays a role in the entry of glucose from the blood into the cell. In case of decreased insulin secretion from the pancreas, the absorption of glucose into the cell will be impaired, so the glucose level in the blood increases and diabetes develops.
High circulating blood sugar in the blood; It causes many diseases by accumulating in capillaries, organs and nerves. The rise in blood sugar in the blood is called 'hyperglycemia'. For the diagnosis of hyperglycemia, the normal value of blood sugar after 8 hours of fasting should be 100-110 mg/dl. p;
If the high blood sugar level in the blood is not controlled and the elevation continues continuously, it causes serious structural damage to the internal organs. Symptoms of diabetes that are related to high blood sugar are called the classic 3P symptoms of diabetes. These symptoms can be listed as follows;
- Polydipsia (Excessive thirst and desire to drink water, significant increase in fluid intake),
- Polyuria (Very frequent urination),
- Polyphagia (Desire to eat too much, increased appetite).
- Fatigue and weakness,
- Dry mouth ,
- Frequent and excessive hunger,
- Intolerance of hunger,
- Acetone odor in the mouth,
- Unintentional weight gain loss,
- Blurred vision due to fluid withdrawal from the lens of the eye,
- Visual disorders may be observed.
What are the Diabetes Types?
Although there are some very rare types, there are some very rare types in society. Diabetes is observed as 2 types.
- Type 1 Diabetes
- Type 2 Diabetes
Type 1 diabetes is a type of diabetes, also called Juvenile Type, that often occurs in children and young people. . There is a defect in the secretion of insulin hormone from beta cells in the pancreas. In type 1 diabetes, the immune system attacks and destroys pancreatic beta cells for unknown reasons. When this damage reaches 80%, Type 1 diabetes occurs. The risk of developing Type 1 diabetes is high in those who have Type 1 diabetes in their first-degree relatives and those who have many Type 2 diabetes relatives.
To diagnose Type 1 Diabetes, Type 1 Diabetes is diagnosed if the blood glucose level measured at any time, regardless of hunger or satiety, is above 200 mg/dl. Tests should be repeated to detect errors that may arise from the laboratory. Sugar, which should not be found in the urine tests of these patients under normal conditions detected. Considering that some drugs such as cortisone increase blood sugar, it should be ensured that all patients with suspected diabetes (Type 1 and Type 2) are not using such drugs before the diagnosis is made.
Type 2 DiabetesType 2 diabetes is the most common form of diabetes in the community. There is no impairment in insulin secretion from the pancreas or the effect of insulin on tissues in type 2 diabetes patients. Antibodies against beta cells are not detected in these patients, that is, an autoimmune disorder cannot be mentioned. There is a decrease in the secretion of insulin or a disorder in the absorption of glucose in the tissues. In type 2 diabetes, an increasing insulin resistance in the liver or other tissues or a disorder of insulin secretion in the pancreas is detected. Type 2 diabetes is closely related to obesity. The risk of developing Type 2 diabetes is higher in patients who have Type 2 diabetes in their relatives or who have gestational diabetes during pregnancy. Diagnosis of type 2 diabetes is made with a glucose load test performed after the blood glucose level is determined above 126 mg/dl.
To diagnose type 2 diabetes, fasting blood glucose is measured. If the fasting blood sugar measured after at least 8 hours of fasting is above 126 mg/dl, the "Oral Glucose Tolerance Test (OGTT)" is performed. In OGTT, after at least 8 hours of fasting, individuals are given 75 g of glucose dissolved in water. At the 1st, 2nd and 3rd hours, blood is drawn and the postprandial blood sugar is measured. Type 2 diabetes is diagnosed if the blood glucose is above 200 mg/dl in the generally accepted 2nd hour measurement. If the blood glucose measurement at the 2nd hour in OGTT is between 140-199 mg/dl, the diagnosis of 'impaired glucose tolerance' is made. Since these individuals are more likely to develop Type 2 diabetes in the future, patients should be followed closely. HbA1C (glucosylated hemoglobin) is a test normally used to measure blood sugar regulation in diabetics. Hemoglobin is a protein found in red blood cells that carries oxygen in the blood. The type of hemoglobin combined with glucose is called HbA1C and its value is between 4.7% and 5.6% in normal individuals. Normally, it is used to monitor the blood sugar for 3 months after the diagnosis of diabetes, and it is expected to be below 6.5% for correct blood sugar regulation. Rather than target glucose level measurement in the follow-up of diabetes Target HbA1C monitoring is also used. In recent years, some researchers have argued that diabetes can be diagnosed with an HbA1C value above 6%.
How to Treat Diabetes?
- Treatment of type 1 diabetes: With oral antidiabetic drugs ( It cannot be treated with oral sugar pills. These patients need to take insulin hormone from the outside throughout their lives. For this reason, Type 1 diabetes is also called "Insulin Dependent Diabetes". Since insulin is a hormone in protein structure and is digested in the stomach, it cannot be taken orally, it can only be administered by injection or pump. Blood sugar can be controlled with exercise programs. However, an important issue to keep in mind is that Type 2 diabetes is a progressive disease and regular check-ups should not be neglected. In the treatment of type 2 diabetes, if blood sugar remains high despite physical activity and diet, oral antidiabetic drugs, also called sugar pills, should be used.
What are Non-Drug Methods in Diabetes Treatment?
In order for diabetes treatment to reach its goal, patients must first be informed correctly. Patients diagnosed with diabetes should be directed to diabetes outpatient clinics and trained by dietitians and training nurses.
In the treatment of diabetes, patient education, appropriate dietary support, adequate physical activity, self-control of the patient's blood sugar and regular use of the right drugs are important for the success of the treatment. Obesity and lack of physical activity are the most important risk factors for the development of diabetes. Therefore, patients should be directed to exercise regularly, and a regular exercise program should be applied according to their age and capacity.
Diabetic diet is the most important factor in terms of glycemic control. Glycemic control is the regulation of blood sugar in a more natural way, which allows the variability between fasting and postprandial blood sugars to remain within narrow limits. In patients with type 2 diabetes who cannot be controlled with oral antidiabetic drugs, they will have surgery or are pregnant. In the presence of diabetes in obese patients, bariatric surgery is also a treatment method that has started to be seen as a definitive solution in the treatment of Type 2 diabetes and is becoming widespread.
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What is Gestational Diabetes?
Another type of diabetes is gestational diabetes. Gestational diabetes is the occurrence of diabetes during pregnancy in pregnant women who have not had any complaints before. Pancreatic beta cells, which can secrete enough insulin before pregnancy, cannot secrete enough insulin as the pregnancy progresses and the fetus grows. In the later stages of pregnancy, blood sugar begins to rise. If high blood sugar is not controlled, serious problems may occur in the fetus.
Serious risks such as a decrease in amniotic fluid, excessive growth and weight gain due to fluid accumulation in the fetus, and the risk of preterm birth necessitate the control and treatment of gestational diabetes with great care. Gestational diabetes usually returns to normal at the end of pregnancy. The risk of gestational diabetes is higher in pregnant women who are overweight and have a family history of Type 2 diabetes. Young mothers are at lower risk.
How is Gestational Diabetes Diagnosed?
For the diagnosis of gestational diabetes, expectant mothers should have a glucose load test between 24 and 28 weeks. For the test, first of all, the pregnant woman is given 50 g of glucose to drink and one hour later, the glucose level in the blood is measured.
If the blood sugar is below 140 mg/dl, it is determined that the expectant mother does not have gestational diabetes. If the pregnant woman's blood sugar is high, a glucose load test is performed for a definitive diagnosis. If normal values are obtained in this test, the pregnant woman is followed up, and if high values are found, the mother-to-be is diagnosed with gestational diabetes. and it is important to be followed up by the Endocrinology Specialist together. In case of gestational diabetes that cannot be controlled with diet and exercise, insulin therapy should be started to prevent the risks that may develop in the baby.
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