Diabetes Mellitus and its Treatment

Diabetes, commonly known as diabetes, is a chronic metabolic disease caused by a lack of the hormone insulin and/or insulin resistance - the result of insulin working with little efficiency. There are about 7 types of diabetics in our society.

How Is The Diagnosis Made? 

For the diagnosis of the disease, it is sufficient to have at least one of the following.

• Blood glucose of 200 mg/dL (180 mg/dl in serum) or more measured at any time during the day, accompanied by drinking too much water, frequent urination, or unexplained weight loss,
• Fasting blood glucose 126 mg/dL (110 mg/dL in serum) or higher,
• Determination of blood sugar level 200 mg/dL or higher 2 hours after the sugar loading test using 75 grams of glucose solution.

How Many Types of Diabetes are There?

Types of Diabetes:

• Type-1
• Type-2
• Gestational Diabetes
• Other Types

Type-1 Diabetes: It is a type of insulin-dependent diabetes. Type 1 diabetes, which occurs as a result of the effect of genetic, environmental, and immunological factors and the deficiency of insulin hormones, is often seen in childhood and adolescence.
Type-2 Diabetes: It is the most common type of diabetes. It occurs when the pancreas does not produce enough insulin or when body cells do not respond to insulin. It usually occurs in people over the age of 35 - 40. A significant portion of the patients are overweight. When type 2 diabetes is diagnosed, 9.9-20.8% of the patients have eye involvement and 5-10% have kidney involvement.
Gestational Diabetes: It is first detected during pregnancy. Sometimes it disappears after birth. However, people with gestational diabetes are at higher risk of developing type 2 diabetes in the future. This is why sometimes diabetes diagnosed during pregnancy actually indicates type 2 diabetes.
Other Types: Less common types include diabetes due to genetic disorders and some medications used.

What are the Symptoms of Diabetes Disease?

• Dryness of the mouth and drinking a lot of water (Polydipsia)
• Excessive and frequent urination (Polyuria)
• The feeling of hunger and overeating (Polyphagia)
• Weakness and fatigue
• Weight loss
• Blurred vision
• Slow/delayed healing of wounds or cuts on the skin
• Insensitivity or numbness and tingling in the feet 
• Involuntary weight loss

Who Should Be Examined for Diabetes?

• Persons younger than 45 years of age who need to be investigated for diabetes;
• Overweight and obese people
• Those who have first-degree relatives with diabetes
• Mothers who gave birth to babies weighing more than four kilograms
• People with high blood pressure
• Those with HDL cholesterol < 35 mg/dl
• Those with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) in previous tests
• Those with polycystic ovary syndrome
• Those with high cholesterol
• Those who lead a sedentary life

How Should Nutrition Be in Diabetes?

In the ideal diet, sugar and sugar-containing foods that will cause a rapid rise in blood sugar, fat and fatty foods that will cause weight gain and adversely affect heart health should be avoided.

• At least three meals a day should be eaten, a small intermediate meal should be taken between meals and before going to bed at night. Meals should be consumed at the same times each day.
• Small portions should be preferred in the diet.
• Whole grain bread, oat, or rye bread should be preferred instead of white bread.
• Legumes should be frequently included in the diet schedule.
• Care should be taken to consume raw fruits and cooked vegetables.
• Foods such as milk, yogurt, ayran, and cheese that are sources of calcium must be included.

Oral Antidiabetic Medications in Diabetes Disease

Oral antidiabetic medications are used in patients with non-insulin-dependent diabetes and only if their blood sugar cannot be controlled by diet.

Effects of diabetes medications:

• Decreases liver glucose production (metformin)
• Reduces peripheral insulin resistance (pioglitazone)
• Delays carbohydrate absorption (acarbose, miglitol)
• Stimulates the release of insulin from beta cells of the pancreas (medications in the sulfonylurea group, short-acting insulin secretagogues, and DPP-IV inhibitors)

Insulin

• Insulin therapy aims to replace the missing insulin in the body.
• Insulin is not addictive.
• It has no side effects other than very rare allergies.

Diabetes and Exercise

Exercise helps in better control of blood sugar. Before starting the exercise program, a medical check should be made in consultation with the physician.

How to Treat Diabetes?

Diabetes is not a life-limiting disease. It is possible to live a healthy life with diabetes. Compliance with the treatment and recommendations given by a team of physicians, dietitians, nurses, and diabetes educators should be ensured. Which treatment is appropriate should be determined by the physician.

The most important point for diabetics is to learn the necessary rules for the treatment of the disease and to ensure that daily life continues as before with these rules.

In this direction, it is necessary to

• Regulate nutritional habits,
• Do regular exercise,
• Use the medications recommended for treatment regularly.

How to Follow Up Patients with Diabetes?

• Hemoglobin A1c (HbA1c) should be evaluated every three months.
• The fundus should be examined every six months.
• Urine albumin measurement should be done once a year.
• Annual cholesterol measurements should not be neglected.

In addition:

• Dental controls should not be interrupted,
• Daily care of the feet should not be neglected.

What are the Goals of Diabetes Treatment?

                                     Fasting Blood Sugar     Postprandial Blood Sugar       HbA1c

Ideal Individuals         Up to 110 mg/dl                  Up to 140 mg/dl                   Up to %6

Diabetic Patients               80-120 mg/dl                 100-140 mg/dl                     Up to %7