Diabetes is the name given to a group of different conditions in which there is too much glucose in the blood. The pancreas either cannot make insulin or the insulin it does make is not enough and cannot work properly. Without insulin doing its job, glucose builds up in the blood leading to high blood glucose levels which cause the health problems linked to diabetes.

What actually goes wrong?
The body needs a special sugar called glucose as its main source of fuel or energy. The body makes glucose from foods containing carbohydrate such as breads, breakfast cereals, rice, pasta, potatoes, milk, yoghurt and fruit. The glucose is carried around the body in the blood – the level should not go too high or too low. When the glucose goes above a certain level, some has to move out of the blood and into the body tissues to supply the energy the cells need to keep your body working properly. Some glucose is also stored in the liver so that it can be used later if needed. When the glucose level drops too low, some of the glucose stored in the liver is released into the blood to bring the level back up again.

Insulin is a hormone made by the pancreas, a gland sitting just below the stomach. Insulin is like a key that opens the “doors” of the body cells (glucose channels) and allows the glucose to move from the blood into the cells where it can be used for energy. This process is called glucose metabolism. In diabetes, the pancreas either cannot make insulin or the insulin it does make cannot work properly. Without insulin doing its job, the glucose channels are shut. Glucose builds up in the blood leading to high blood glucose levels which cause the health problems linked to diabetes.

Are there different types of diabetes?
There are two main types of diabetes – type 1 and type 2.
Type 1: This used to be called insulin dependent diabetes or juvenile diabetes. However this was confusing as many mature people with type 2 diabetes need insulin to manage their diabetes well. While type 1 diabetes can and does occur at any age‚ it’s usually diagnosed in children and young adults. Type 1 diabetes is the less common form of diabetes, affecting just 10–15% of all people with diabetes. In type 1 diabetes, the pancreas cannot produce enough insulin because the cells that actually make the insulin have been destroyed by the body’s own immune system. This insulin must be replaced. Therefore people with type 1 diabetes must have insulin every day to live. At present insulin can only be given by injection or by insulin pump, but other methods of getting it may be possible in the future.

We don’t yet know the exact cause of type 1 diabetes but we do know it has a family link. However it can only occur when something such as a viral infection triggers the immune system to destroy the insulin-making cells in the pancreas. This is called an autoimmune reaction. While the cause of type 1 diabetes has nothing to do with lifestyle, a healthy lifestyle is very important in helping to manage the condition. While a great deal of research is being done, at this stage nothing can be done to prevent or cure type 1 diabetes

Type 2: This used to be called non-insulin dependent diabetes or mature-age onset diabetes. It is by far the most common form, affecting 85–90% of all people with diabetes. While adults are usually affected, more and more younger people, even children, are now developing type 2 diabetes. Type 2 diabetes is a lifestyle disease and is strongly associated with high blood pressure, abnormal blood fats and the classic ‘apple shape’ body where there is extra weight around the middle People with type 2 diabetes are usually insulin resistant. This means that their pancreas is making insulin but the insulin is not working as well as it should. The pancreas responds by working harder to make more insulin. Eventually it can’t make enough to keep the glucose balance right and blood glucose levels rise. Adopting a healthy lifestyle may delay the need for tablets and/or insulin. However it is important to know that if you do need tablets and/or insulin, this is just the natural progression of the disease. By taking tablets and/or insulin as soon as they are needed, complications caused by diabetes can be reduced.

While there is no single cause for developing type 2 diabetes, there are well known risk factors. Some of these can be changed and some cannot. People who are most likely to get type 2 diabetes often have these risk factors:

• A family history of diabetes
• Age – the risk increases as we get older
• Are from ethnic backgrounds more likely to have type 2 diabetes
• Women who have given birth to a child over 4.5kg (9lb) or had gestational diabetes when pregnant, or have a condition known as Polycystic Ovarian Syndrome.

Among the risk factors that can be changed in diabetic patients: Lifestyle, weight, level of physical activity, blood pressure, the type of food we eat, cholesterol and smoking.

People at risk of type 2 diabetes can delay and even prevent developing it by following a healthy lifestyle. This includes regular physical activity, making healthy food choices and achieving a healthier body weight, especially if they have been told that they have risk factors for diabetes. The aim is to get blood glucose levels as close as possible.

What are the main symptoms of diabetes?
In type 1 diabetes, symptoms are often sudden and can be life-threatening; therefore it is usually diagnosed quite quickly. In type 2 diabetes, many people have no symptoms at all, while other signs can go unnoticed because they are seen as part of ‘getting older’. Therefore, by the time symptoms are noticed, complications of diabetes may already be present.
Common symptoms include:

• Being more thirsty than usual and going to the toilet more often, especially at night.
• Feeling tired and lethargic and always feeling hungry.
• Having cuts that heal slowly or itching, skin infections or rashes.
• Blurred vision.
• Unexplained weight loss (type 1) or Weight changes.
• Mood swings or headaches and feeling dizzy.
• Pain or tingling in the legs or feet

How is diabetes managed?
In type 1 and type 2 diabetes, the aim of diabetes treatment is to get your blood glucose levels as close to target as possible. For people with type 1 diabetes: insulin injections every day plus leading a healthy lifestyle.

For people with type 2 diabetes: healthy eating and regular physical activity may be all that is required at first, sometimes tablets and/or insulin later on.

What do I aim for and why?

• Ideally blood glucose levels are kept as close to target as possible. This will help prevent the short term effects of very low or very high blood glucose levels as well as the possible long term problems which can affect the eyes, kidneys and nerves.
• Keeping your blood pressure and cholesterol within recommended ranges also helps to prevent problems like heart attack and stroke.

Who will help me?
A lifelong condition like diabetes is best managed with the support of a diabetes team, of which you are the most important member. Other members include your doctor, diabetes educator, dietitian and podiatrist. Depending on your needs, the team may also include medical specialists and exercise physiologists. Your team will help you to learn all you need to know about your diabetes. They will be there to support you and with their guidance you will soon become confident about making day-to-day decisions for a fit and healthy life.

Basic guidelines for looking after your diabetes: There are many steps you can take to care for your diabetes. Here are some tips:

• Link up with the diabetes team in your area.
• Test your blood glucose levels regularly.
• Always take your insulin (for those who require it).
• If your doctor gives you tablets to help manage your diabetes, blood pressure and/or Cholesterol, be sure to take them.
• Be as active as you can as often as possible.
• Follow a healthy eating plan.
• Achieve and maintain a healthier body weight and shape .
• Keep a positive mental attitude.
• Don’t be afraid to ask for help as soon as you feel you need it.

Dr Mahir Khalil Jallo
Associate Professor of Medicine & Senior Consultant – Diabetes & Endocrinology
Gulf Medical University Hospital & Research Centre Ajman