DIABETES IS A condition where the body is unable to maintain a healthy glucose level in the bloodstream. This leads to a multitude of complications, including visual loss from retinopathy, vascular damage which leads to increased risk for stroke, heart attack and peripheral vascular disease, as well as nerve damage, which causes a painful condition called neuropathy.
Diabetes can develop along several pathways, hence leading to different classifications of the disease. There are essentially four classifications of diabetes:
• Type 1 diabetes
• Late-onset diabetes type 1, also known as diabetes type 1.5
• Type 2 diabetes
• Gestational diabetes.
Approximately 5-10% of all diabetics are type 1. This form of diabetes results from what is believed to be an autoimmune process, which means that the body destroys its own pancreatic cells that produce insulin. This most often occurs in young people under the age of 30 at presentation, often in children. Typical symptoms include increased thirst and urination and increased hunger, blurred vison, and in some cases diabetic ketoacidosis, which is a severe electrolyte imbalance related to the excess glucose and fluid shifts in the body that can lead to coma and death.
In those afflicted with diabetes type 1, whose own bodies have injured the pancreatic cells that make insulin, insulin must be taken in order to achieve good glucose control. An oral pill that affects insulin resistance would not work. Current studies are looking at different delivery systems of insulin, and hopefully in the future there may be different options. There are patients who are able to get a pancreatic cell transplant, which in essence corrects the insulin issue.
Type 1.5 diabetes, also known as late-onset diabetes type 1, involves much of the same process as that seen in type 1 patients. However, for whatever reason, the destruction of pancreatic cells is slower in these patients; hence, they may first be diagnosed with type 2 diabetes. Often a diagnosis is made of diabetes 1.5 when oral medications seem to have no effect on blood glucose levels. The patient’s PCP or endocrinologist can order labs that include insulin type antibodies that can point to a diagnosis of diabetes type 1.5.
It is important to note that patients can also get diabetes type 1 following removal of the pancreas from cancer surgery or trauma.
In type 2 diabetes, the main issue is insulin resistance. Insulin resistance occurs when the pancreas makes insulin but the insulin is unable to bind to the cell properly and, hence, the glucose in the bloodstream cannot get into the cells. Insulin resistance is, in some instances, hereditary, but it is also caused by obesity and sedentary lifestyle.
At the onset of type 2 diabetes, patients often have no symptoms. They may struggle with weight, which can be a sign of insulin resistance. As time progresses, the pancreas must increase production of insulin to compensate for this resistance, and eventually the cells can no longer keep up with demand and the blood glucose levels begin to rise. This time is critical for type 2 diabetics. If they do not change their lifestyle, lose weight, or take medication to assist with insulin resistance, their pancreatic cells will reduce the production of insulin and, often, they will then need insulin to control glucose adequately. Significant weight loss often results in the ability to discontinue many, if not all, of the diabetic medications.
The symptoms of type 2 diabetes are very similar to those associated with type 1 in that they include increased thirst, urination, and increased hunger. Vision blurring may occur at high glucose levels, and advanced cases may exhibit burning and numbness in the extremities.
Gestational diabetes occurs due to the production of insulin-blocking hormones during pregnancy, which causes an increase in glucose. Often these patients need insulin during their pregnancy. Many patients’ hyperglycemia resolves after pregnancy, but 50% of patients who develop gestational diabetes go on to develop type 2 diabetes later in life.
Overall, regardless of the type of diabetes, the main goal is the reduction of blood sugar levels to reduce the serious complications of coronary artery disease, peripheral vascular disease, visual loss, stroke, and neuropathy.
Dr. Lisa Graves-Austin is a board-certified Internal Medicine physician who focuses on preventative care while also managing conditions such as diabetes, migraines, PCOS treatment and menopausal treatment, and hormone replacement. She is conveniently located in Perrysburg, has over 20 years of experience, and is welcoming new patients. ✲
