Diabetes

MaxBax

Hi,

What would be some indications that someone is a diabetic? My grandmother went many years, in my opinion, without getting diagnosed. I'm not worried myself about being a diabetic, if I was I'd go and talk with my GP about it. I'm just asking, for general reference what are the symptons of a diabetic particularly those diabetics that aren't being treated medically and who aren't conciously monitoring their blood-sugar levels?

Also, for a diabetic person, what would be symptons of very low blood sugar levels and very high blood sugar levels?

I'm slightly aware there are 2 types of diabetes, one which is result of insuccifient insulin production and type 2 which is a result of very little or no insulin production.

John

Dr Indy, correct me where I go wrong but untreated diabetes tends to show up as a degradation in vision, a smell of ketones on the breath, increased frequency of urination, impotence in men and sometimes altered mental states like mania or depression. The standard test is a measure of ketone levels in urine if I remember correctly.

Stark

A dramatic loss of weight as well as the above factors mentioned is often seen in people with undiagnosed type I diabetes. Type II diabetes usually develops after years of obesity and living a sedentary lifestyle so if someone is in that boat, they should be getting checkups.

MaxBax wrote:

I'm slightly aware there are 2 types of diabetes, one which is result of insuccifient insulin production and type 2 which is a result of very little or no insulin production.

Type I is when the pancreas no longer produces insulin. It's the type most frequently associated with young people. It often occurs as a result of an autoimmune response (the immune system attacks pancreas). This can be from a genetic abnormality or it can be from some huge shock to the immune system. (I know a guy who had a tractor roll over his leg and the resulting immune system response destroyed his pancreas).

Type II is adult onset diabetes associated with a sedentary lifestyle. The pancreas still produces insulin, but the body no longer responds to it.

DrIndy

MaxBax wrote:

Hi,

What would be some indications that someone is a diabetic? My grandmother went many years, in my opinion, without getting diagnosed. I'm not worried myself about being a diabetic, if I was I'd go and talk with my GP about it. I'm just asking, for general reference what are the symptons of a diabetic particularly those diabetics that aren't being treated medically and who aren't conciously monitoring their blood-sugar levels?

People are diagnosed by absolute levels - by World Health Organisation standards, if you're fasting blood sugar level is over 7, then you have diabetes. If it is between 6 and 7 then you have IGT - impaired glucose tolerance and will go on to develop diabetes unless there is intervention.

Diabetes has many symptoms, but the dramatic ones such as weight loss and diabetic coma are generally associated with Type I diabetes where you have no insulin, people with type II have some insulin and can protect their metabolism by taking up some albeit meagre amount of glucose.

Having a family history of diabetes means you are more likely to have it, so it does not harm to get peace of mind by a trip to your GP.

Long term poor glucose control, be it type I or Type II has significant morbidity associated with it including heart disease, stroke, kidney failure, blindness and nerve damage.

Also, for a diabetic person, what would be symptons of very low blood sugar levels and very high blood sugar levels?

Low blood sugar results in bad-temperedness, shakes, cold sweats, feeling of fainting, all the way to going into a coma. This usually results from someone taking their insulin and then not bothering to eat enough or accidently taking too much.

Too much glucose results in thirst, frequency of urination, ketosis, all the way to Diabetic Ketoacidosis.

Generally, these extremes are more common in Type I diabetics who have no endogenous insulin control. Type II diabetics have some insulin control and uptake so are not as sensitive to these extremes. However, they also can silently carry diabetes without knowing it and so when they are diagnosed, have already developed some of the complications of poor glucose control.

I'm slightly aware there are 2 types of diabetes, one which is result of insuccifient insulin production and type 2 which is a result of very little or no insulin production.

Type I is an autoimmune disease, where the immune system destroys the pancreatic insulin producing cells, these people have NO insulin at all and therefore need to self medicate with insulin injections.

Type II diabetics have insulin resistance, they have plenty of insulin, all the way until their pancreas goes into failure as it simply cannot produce any more, however, the peripheral tissues which take up glucose are INSULIN RESISTANT so they need much more insulin to have the same effect.

People with Type I insulin only need a couple dozen units of insulin to keep them going throughout a day. People with type II diabetes who are insulin dependent sometimes need hundreds of units to keep glucose control as their tissues are resistant to the effects.

No one fully understands Type II diabetes or the mechanism of action for insulin resistance, but it is associated with being overweight and genetics.

MaxBax

Thanks very much guys. Yeah I think the fasting for 48hrs and getting the blood sugar level test would be best for the person I'm thinking of.

Again Thanks I'll look into it.

DrIndy

not 48 hours, just from the night before!

wheresthebeef

Type I and Type II are what they are called now.
They used to be known as Insulin Dependant Diabetes Mellitus: IDDM (Type I) and Non Insulin Dependant Diabetes Mellitus: NIDDM (Type II), but as understanding increased those terms were dropped as they caused confusion.

On my first ward placement, the older nurses would write down IDDM or NIDDM for patients with diabetes.

DrIndy

wheresthebeef wrote:

Type I and Type II are what they are called now.
They used to be known as Insulin Dependant Diabetes Mellitus: IDDM (Type I) and Non Insulin Dependant Diabetes Mellitus: NIDDM (Type II), but as understanding increased those terms were dropped as they caused confusion.

On my first ward placement, the older nurses would write down IDDM or NIDDM for patients with diabetes.

Thats because many people with type II diabetes end up needing insulin after tablets cannot have an effect anymore and hence become insulin dependent.

Many people still refer to NIDDM, I do at times, but technically not correct

Rogueish

I was just wondering after reading Dr. Indy's post..

DrIndy wrote:

People are diagnosed by absolute levels - by World Health Organisation standards, if you're fasting blood sugar level is over 7, then you have diabetes. If it is between 6 and 7 then you have IGT - impaired glucose tolerance and will go on to develop diabetes unless there is intervention.

What are the implications of not getting IGT clinically diagnosed, if you are aware of the dietary requirements and follow them as part of a healthy diet anyway? Given the fact that the early intervention is usually dietary (coupled with exercise) in nature anyway.

Thanx

lucernarian

Another reason for diagnosis of diabetes is if the blood sugar level is greater than 8.9 mmol/L, 2 hours after 75 grams of glucose.

Indications of developing diabetes would be chronic tiredness and thirst. When there are a lot of fluids to quench the thirst, urinating increases in frequency.

That is caused by the kidneys being forced to remove large amounts of glocose from the blood. The kidneys can't discriminate so water and various ions are removed from the blood too.

After a while, potassium and perhaps calcium levels in the blood fall to very low levels. This can cause spasms in muscles and can cause heart problems if not treated eventually.

There are public health clinics in places from time to time, where they test the blood sugar levels of members of the public. They will tell you if there are any problems.

Also I would like to stress that it's quite possible to get diabetes even with no genetic history of the condition whatsoever.

IGT may or may not go on to develop diabetes. Things can settle down if the person is obese and can lose weight.

Edit: Can exam stress trigger that autoimmune response that causes type 1 diabetes?

DrIndy

Rogueish wrote:

I was just wondering after reading Dr. Indy's post..



What are the implications of not getting IGT clinically diagnosed, if you are aware of the dietary requirements and follow them as part of a healthy diet anyway? Given the fact that the early intervention is usually dietary (coupled with exercise) in nature anyway.

Thanx

Research has shown that people who have IGT who do make the neccesary lifestyle changes can actually reverse their potential to develop diabetes. However, people who have clinical diabetes, by a fasting blood sugar over 7 have already damaged their pancreas too much and the cascade cannot be stopped which will result in them going onto diabetes.

Pregnancy unmasks latent diabetes due to the increased metabolic stresses and those who develop gestational diabetes can make lifestyle changes to prevent true diabetes developing.

DrIndy

Rogueish wrote:

I was just wondering after reading Dr. Indy's post..



What are the implications of not getting IGT clinically diagnosed, if you are aware of the dietary requirements and follow them as part of a healthy diet anyway? Given the fact that the early intervention is usually dietary (coupled with exercise) in nature anyway.

Thanx

Research has shown that people who have IGT who do make the neccesary lifestyle changes can actually reverse their potential to develop diabetes. However, people who have clinical diabetes, by a fasting blood sugar over 7 have already damaged their pancreas too much and the cascade cannot be stopped which will result in them going onto diabetes.

Pregnancy unmasks latent diabetes due to the increased metabolic stresses and those who develop gestational diabetes can make lifestyle changes to prevent true diabetes developing.

MaxBax

Hmm,

I was just wondering, If you had type II diabetes, due to obsesity etc. etc. and you lost weight and changed your diet, could you cease to be a type II diabetic?

Maxbax.

CathyMoran

MaxBax wrote:

Also, for a diabetic person, what would be symptons of very low blood sugar levels and very high blood sugar levels?

Am a type 1 diabetic over 21 years. Personal experiences of a hypo (low blood sugar) - feeling a bit light in the head, palpitations...as it gets worse my eyesight gets blurry, my speach gets slurred. I found that I got a very severe hypo after changing my insulins, if you are ill it is also very hard to balance your insulin (as your insulin requirements can change), stress may also affect it (normally raising your blood sugars). If you are keeping your blood sugars under a very tight reign like I am at the moment (I want to have a baby), then you may be likely to have more hypos.

Hypers (high blood sugars) make you feel heavy in the head, you feel thirsty and are running to the toilet a lot.

In the past 21 years I have seen vast improvements in treatment - my blood tests only take 5 seconds (10 including the time to get the machine out) in the past they took up to 3 minutes. There are human based insulins available (when I was first diagnosed the only insulin available was pig/bovine insulin which may have had some side effects). When I was first diagnosed you had to use syringes which was horrible, now you have the insulin pen (which looks like a fountain pen with a needle at the top). While diabetes is not nice it is something that you can live with quite sucessfully.