Diabetes Knowledge

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Diabetes Mellitus
Profile Of The Diagnosed
There are more than 1.2 million people in Malaysia who have diabetes. Diabetes is actually a general term for a number of separate but related disorders. These disorders fall into two main categories:

type 1, which usually occurs during childhood or adolescence, and
type 2, the most common form of the disease, usually occurring after age 30.
What is type 1 (insulin-dependent) diabetes?

• Type 1 (insulin-dependent) diabetes is a disease which results from the body's failure to produce insulin -- the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them.
• This is most often the result of an autoimmune process in which the body's immune system attacks and destroys the insulin-producing cells of the pancreas. Since glucose cannot enter the cells, it builds up in the blood and the body's cells literally starve to death.
• People with type 1 diabetes must take daily insulin injections and regularly monitor blood sugar levels.
• There are an estimated 24,000 people with type 1 diabetes in Malaysia today.
• The risk of developing type 1 diabetes is higher than virtually all other severe chronic diseases of childhood.
• Peak incidence occurs during puberty, around 10 to 12 years old in girls and 12 to 14 years old in boys. The symptoms for type 1 diabetes can mimic the flu in children.
• Type 1 diabetes tends to run in families. Brothers and sisters of children with insulin-dependent diabetes have about a 10% chance, or a 20-fold increased risk, of developing the disease.

What is type 2 (non-insulin-dependent) diabetes?

• type 2 (non-insulin-dependent) diabetes results from the body's inability to make enough or properly use insulin. Often type 2 diabetes can be controlled through diet and exercise alone, but sometimes these are not enough and either oral medications or insulin must be used.
• The fact that few people with type 2 diabetes require insulin has led to the myth that this is a "mild" form of the disease.
• Of the 1.2 million Malaysians with diabetes, more than 98% have type 2 diabetes.
• People with type 2 diabetes often develop the disease after age 30, but are not aware they have diabetes until treated for one of its serious complications.
• The risk for type 2 diabetes increases with age.
• Studies indicate that diabetes is generally under reported on death certificates, particularly in the cases of older persons with multiple chronic conditions such as heart disease and hypertension. Because of this, the toll of diabetes is believed to be much higher than officially reported.

High Blood Glucose Levels
Doctors diagnose diabetes on the basis of too-high levels of glucose in the blood. If you have diabetes, your blood glucose levels rise because of the foods you eat. Foods have little effect on blood glucose in people without diabetes.
Normally, insulin, a hormone that is made in the pancreas, allows glucose to enter your body's cells and be used as fuel. Insulin also makes the liver store excess glucose in the form of glycogen until it is needed. Insulin is the main tool your body uses to lower your blood glucose level.
People with diabetes can have insulin deficiency (they make too little insulin) or insulin resistance (their bodies don't respond well to insulin). Some people have a combination of the two. In people with diabetes, insulin is not doing its job, so glucose can't get into the cells to be used for energy.
Instead, the unused glucose builds up in the blood and, if high enough, passes through the kidneys. If a person's blood glucose level rises high enough, the extra glucose causes frequent urination. This in turn leads to thirst, as the body tries to make up for the fluid lost in urination.
What Urine Tests Measure
High urine glucose levels give doctors a clue that something is wrong. But urine tests are not a good way to diagnose diabetes. Urine tests are not as accurate as blood tests. And the level of blood glucose needed to make glucose appear in the urine is different for each person.

Your glucose level could be high, yet high levels of glucose may not appear in the urine. So in diagnosing diabetes, doctors measure glucose in the blood.
(Urine tests are a very useful way to measure ketones, substances that build up when blood glucose is very high. Because ketones are acids that are toxic to the body, they are flushed out in urine quickly.)

Blood Tests
The goal of blood glucose tests is to find out whether you have a very large amount of glucose in your blood. There are two types of tests, screening tests and diagnostic tests.
Screening tests are performed on people who have no symptoms of diabetes. On the other hand, diagnostic tests are done to confirm a diagnosis that is already suspected from the patient's symptoms.
Screening tests are fast, easy to perform, and cheap. (Health fairs often offer screening tests, for example.) Screening tests require as little as a drop of blood from your fingertip and take only a minute or two to complete.
Most doctors don't screen everyone for diabetes during regular checkups. The chance of finding the disease in most people is just too low. But screening tests are useful for people who may be at risk for developing diabetes. People at risk include:

• Blood relatives of people with diabetes.
• Women with unexplained miscarriages or stillbirths or who have had babies weighing 9 pounds or more at birth.
• People with a condition known as "impaired glucose tolerance" (see Oral Glucose Tolerance Test below).
• People with high blood pressure or very high blood cholesterol or triglyceride levels.
• People who are obese.
• People over age 35.

All pregnant women should be screened for gestational diabetes (diabetes that starts during pregnancy) between the 24th and 28th weeks.Having a screening test every three years is often enough as long as the results are normal. If you have an abnormal screening test result, you should have a diagnostic test.
For diagnostic tests, the doctor's office draws one or more samples of blood from a vein and sends them to a lab for analysis. When you get your test results, ask your doctor to explain them to you.
Comparing your test results with those of family or friends may confuse or alarm you. You may not have had the same type of test, and so your results could have a completely different meaning. You should ask your doctor to explain your results to prevent any confusion. Several types of diagnostic tests are commonly used to diagnose diabetes.

Normal response.
A person is said to have a normal response when the fasting glucose level is less than 5.6 mmol/L and the 2-hour glucose level is less than 7.8 mmol/L.

Impaired glucose tolerance.
A person is said to have IGT when the fasting plasma glucose is higher than 5.6 but less than 7.0 mmol/L, the 2-hour glucose level is between 7.8 and 11.1 mmol/L.

Diabetes
A person has diabetes when glucose tolerance test show that the blood glucose level at fasting is 7.0 mmol/L or more or the 2 hour level is more than 11.1 mmol/L.
In diagnosing your diabetes, your doctor needed test results. But test results are just part of the information that goes into the diagnosis of diabetes. Your doctor also took into account your physical exam, symptoms, and medical history in order to decide to test.
The Blood Test with a Memory

Once you've been diagnosed with diabetes, your doctor may order another type of blood test called glycated haemoglobin or glycohaemoglobin (HBA1c). This test is easy to do during routine office visits. HBA1c lets the doctor take a backward look at your diabetes control.