Diabetes

Diabetes is a chronic disease characterized by high blood sugar levels. Glucose is the main energy source for the cells of the human body. However, in diabetics, the glucose cannot be used by the body.

The level of sugar (glucose) in the blood is controlled by the hormone insulin, which is produced by the pancreas . However, in diabetics, the pancreas is unable to produce insulin according to the body's needs. Without insulin, the body's cells cannot absorb and process glucose into energy.

Glucose that is not properly absorbed by body cells will accumulate in the blood. This condition can cause various disorders in the organs of the body. If not properly controlled, diabetes can cause life-threatening complications.

Causes of Diabetes

In general, diabetes is divided into two, namely type 1 and type 2 diabetes.

Type 1 diabetes

Type 1 diabetes occurs when the body's immune system mistakenly attacks and destroys the insulin-producing cells of the pancreas. This causes blood glucose levels to increase thereby triggering damage to the organs of the body.

Type 1 diabetes is also known as autoimmune diabetes. The cause of type 1 diabetes is still not known with certainty. However, it is suspected that this disease is related to genetic factors and environmental factors.

Type 2 diabetes

Type 2 diabetes is the most common type of diabetes, which is around 90–95%. Type 2 diabetes occurs when the body's cells become less sensitive to insulin so that the insulin they produce cannot be used properly. This condition is also known as insulin resistance.

In addition to the two types of diabetes, there is another type of diabetes that usually occurs in pregnant women, namely gestational diabetes . This type of diabetes is caused by hormonal changes during pregnancy, but usually the patient's blood sugar will return to normal after childbirth.

Diabetes risk factors

A person will be more at risk of developing type 1 diabetes if they have the following risk factors :

4–7 years old or 10–14 years old
Have a family history of type 1 diabetes
Suffer from a disease caused by a viral infection
Suffering from an autoimmune disease, such as Grave's disease, Hashimoto's disease, and Addison's disease
Having an injury to the pancreas due to infection, tumor, injury, accident, or side effect after major surgery

Meanwhile, type 2 diabetes is more at risk for someone with the following factors:

Over 45 years old
Have a family history of type 2 diabetes
Rarely do physical activity or exercise
Are overweight or obese
Suffer from prediabetes
Suffering from high cholesterol
Suffering from high blood pressure ( hypertension )

Specifically for women , pregnant women who suffer from gestational diabetes can more easily develop type 2 diabetes. In addition, women who have a history of polycystic ovarian syndrome (PCOS) are also more prone to developing type 2 diabetes.

Diabetic Symptoms

Type 1 diabetes can develop rapidly within weeks or even days. Whereas in type 2 diabetes, many sufferers do not realize that they have had diabetes for years, because the symptoms tend to be non-specific.

Some of the characteristics of type 1 and type 2 diabetes include:

Often feel thirsty or very hungry
Frequent urination, especially at night
Weight loss for no apparent reason
Decreased muscle mass
Blurred vision
Urine contains ketones
The body is easily tired and weak
Wounds become more difficult to heal
Easy to get infections, such as in the gums, skin, vagina, or urinary tract

In addition, there are several other symptoms that people with diabetes can also experience, including:

Dry mouth
Itchy skin
Erectile dysfunction or impotence
Burning, stiffness, and pain in the legs
Reactive hypoglycemia, namely hypoglycemia that occurs several hours after eating due to excessive insulin production
Dark patches around the neck, armpits, and groin ( akantosis nigricans ) which is a sign of insulin resistance

Meanwhile, there are also some people who have prediabetes , which is a condition when the glucose in the blood is above the normal range but not high enough to be diagnosed as diabetes. However, a person with prediabetes can also develop type 2 diabetes if it is not treated properly.

When to go to the doctor

Check with your doctor if you experience the main symptoms of diabetes, namely:

Often feel thirsty
Easily tired
Urinating more often than usual, especially at night
Weight loss and loss of muscle mass
Itching around the penis or vagina
Wound healing is slow
Frequent thrush
Blurred vision

If you have factors that can increase your risk of developing diabetes, it is recommended to undergo regular blood sugar checks. The goal is that this disease can be detected and treated early.

Diabetes Diagnosis

The symptoms of diabetes usually develop gradually, except for type 1 diabetes where the symptoms can appear suddenly. However, because diabetes is generally not diagnosed at its onset, it is recommended that people who are at risk of developing the disease undergo regular check-ups, especially in the following groups:

People over 45 years of age
Women who have had gestational diabetes during pregnancy
People who have a body mass index (BMI) above 25
People who have been diagnosed with prediabetes

The blood sugar test is an absolute examination carried out to diagnose type 1 or type 2 diabetes. The results of blood sugar measurements will show whether a person has diabetes or not. The doctor will recommend the patient to undergo a blood sugar test at a certain time and with a certain method.

Several blood sugar test methods that patients can undergo include:

1. Blood sugar test while

This test aims to measure blood glucose levels at certain hours randomly. This test does not require the patient to fast beforehand.

If the blood sugar test results show a sugar level of 200 mg/dL or more, the patient can be diagnosed with diabetes.

2. Fasting blood sugar test

This test aims to measure blood glucose levels when the patient is fasting. Patients will be asked to fast for 8 hours before undergoing the test.

The results of the fasting blood sugar test can be said to be normal if the patient's blood sugar level is less than 100 mg/dL. Meanwhile, fasting blood sugar test results between 100–125 mg/dL indicate that the patient has prediabetes.

Meanwhile, a fasting blood sugar test result of 126 mg/dL or more indicates that the patient has diabetes.

3. Glucose tolerance test

The patient will first be asked to fast overnight, then undergo a fasting blood sugar test. Next, the patient will be asked to drink a special sugar solution. The patient's blood sugar sample will be taken back 2 hours after drinking the sugar solution.

A glucose tolerance test result below 140 mg/dL indicates normal blood sugar levels. Meanwhile, test results with a sugar level of 140–199 mg/dL indicate prediabetes.

Patients can be said to have diabetes if the glucose tolerance test shows a sugar level of 200 mg/dL or more.

**4. HbA1C test ( glycated hemoglobin test )**

This test aims to measure the patient's average glucose level over the past 2–3 months. This test measures blood sugar levels bound to hemoglobin, the protein that carries oxygen in the blood. In the HbA1C test, the patient does not need to fast beforehand.

An HbA1C test result below 5.7% is a normal condition, while a test result of 5.7–6.4% indicates prediabetes. Meanwhile, HbA1C test results above 6.5% indicate that the patient has diabetes.

In addition to the HbA1C test, an estimated average glucose (eAG) test can also be done to determine blood sugar levels more accurately. If the patient is diagnosed with diabetes, the doctor will plan the treatment method that will be undertaken.

Especially in patients suspected of having type 1 diabetes, the doctor will suggest an autoantibody test to detect antibodies that damage organs and body tissues, including the pancreas.

Diabetes Treatment

Diabetes treatment depends on the type of diabetes experienced by the patient. The following are some methods of diabetes treatment that can be done:

Drugs

In type 1 diabetes, the patient will need insulin therapy to regulate daily blood sugar. Some type 2 diabetes patients are also advised to undergo insulin therapy to regulate blood sugar.

Additional insulin will usually be given by injection, not in the form of an oral medication. The doctor will set the type and dose of insulin used, as well as tell how to inject it.

In severe cases of type 1 diabetes, the doctor will recommend a pancreas transplant procedure to replace the damaged pancreas. Type 1 diabetes patients who successfully undergo the transplant do not need insulin therapy anymore, but must take immunosuppressive drugs regularly.

In type 2 diabetes patients, doctors will prescribe drugs, one of which is metformin. Metformin reduces the production of glucose from the liver and helps the body process insulin effectively.

Doctors can also provide supplements or vitamins to reduce the risk of complications. For example, diabetic patients who often experience tingling symptoms will be given neurotropic vitamins.

Neurotrophic vitamins generally consist of vitamins B1, B6, and B12. These vitamins are useful for maintaining the function and structure of the peripheral nerves. This is very important for patients with type 2 diabetes to avoid complications of diabetic neuropathy which is quite common.

Lifestyle changes

Patients are advised to adjust their diet by increasing their consumption of fruits, vegetables, protein from grains, and low-calorie and fat foods. Food choices for diabetics should also really be considered.

If necessary, patients can also replace sugar intake with safer sweeteners, such as sorbitol . Patients and their families can also carry out nutritional and dietary consultations with doctors to regulate daily eating patterns.

To help convert blood sugar into energy and increase cell sensitivity to insulin, patients are advised to exercise regularly, at least 150 minutes a week. Patients can also consult with their doctor regarding appropriate sports and physical activity options.

Patients must control their blood sugar in a disciplined manner through a healthy diet so that blood sugar does not rise above normal. In addition, patients will also be given a schedule to undergo an HbA1C test independently to monitor blood sugar levels for the last 2-3 months.

Self blood sugar test

Self blood sugar tests are carried out at least 4 times a day, namely before each meal and before bedtime, especially for those undergoing insulin therapy. The frequency of tests carried out depends on the advice of the doctor. After that, the test results will be recorded and these records need to be brought to the doctor's check-up.

Diabetic complications

Diabetes causes various complications, both sudden (acute) and long-term (chronic). Acute complications that can occur in diabetics are diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS).

A number of complications that can arise from type 1 and 2 diabetes are:

stroke
Heart disease
Chronic kidney failure
Diabetic neuropathy
Visual disturbance
Cataract
Depression
Dementia
Hearing disorders
Frozen shoulder
Wounds and infections on the feet that are difficult to heal
Skin breakdown or gangrene from bacterial and fungal infections, including flesh-eating bacteria

Diabetes due to pregnancy can also cause complications in pregnant women and babies, for example is preeclampsia . Meanwhile, some complications that can arise in babies are:

Miscarriage
Premature birth
Excess weight at birth
Low blood sugar (hypoglycemia)
Jaundice
Increased risk of developing type 2 diabetes as an adult

Diabetes Prevention

Type 1 diabetes cannot be prevented because the trigger is not known. Meanwhile, type 2 diabetes and gestational diabetes can be prevented, namely with a healthy lifestyle. Some efforts that can be done to prevent diabetes include: