Understanding Diabetes: Types, Diagnosis, and Management

Diabetes is a chronic medical condition characterised by high levels of glucose in the blood. This occurs due to the body’s inability to produce insulin, an essential hormone that regulates blood sugar, or the body’s inability to use insulin effectively. Diabetes affects millions of people around the world and comes in various forms. In this blog, we will explore the different types of diabetes, the importance of early diagnosis, and how healthcare professionals can help manage this condition.

Types of Diabetes

Diabetes comes in several types, each with its unique characteristics:

1. Type 1 Diabetes: This form of diabetes results from an absolute deficiency of insulin, often due to genetic factors. It is a lifelong autoimmune disease with an unknown exact cause. Individuals with Type 1 diabetes require daily insulin replacement to survive. Common symptoms include increased thirst, fatigue, frequent urination, and unexplained weight loss.
2. Type 2 Diabetes: Type 2 diabetes is the most common form, often associated with insulin resistance. In this condition, the body either does not produce enough insulin or cannot effectively use the insulin it produces. It typically occurs later in life and can often be managed through lifestyle changes and medication.
3. Gestational Diabetes: Gestational diabetes develops during the 2nd or 3rd trimester of pregnancy and usually resolves after childbirth. However, it significantly increases the risk of developing Type 2 diabetes later in life for both the mother and the baby. Management typically involves dietary and exercise changes, with some cases requiring medication.
4. Other Specific Types: There are other, less common forms of diabetes caused by factors such as diseases of the exocrine pancreas, drug-related issues (such as treatment of HIV/AIDS or after organ transplantation), and even conditions like Alzheimer’s disease linked to glucose damage to brain vessels.
5. Double Diabetes: This occurs when poorly controlled Type 1 diabetes leads to the development of Type 2 diabetes.
6. Pre-diabetes: Pre-diabetes refers to impaired glucose tolerance or impaired fasting glucose, which are warning signs that a person may develop Type 2 diabetes.

Diagnosis and Testing

To diagnose diabetes, healthcare professionals rely on several tests:

1. Glycated Haemoglobin (hBA1c):This is the gold standard measure of glycaemic control. It reflects three-month blood glucose control. For well-controlled diabetes, it’s measured twice a year, while for poorly controlled diabetes or when treatment changes, it’s checked every three months. A diagnosis of diabetes is made if hBA1c exceeds 6.5% (48 mmol/mol).
2. Fasting Plasma Glucose (FPG):This measures acute blood glucose control. The target range is 3-6.5 mmol/L.
3. Postprandial Blood Glucose: This is measured two hours after a meal and should be below 7.8 mmol/L.
4. Oral Glucose Tolerance Test (OGTT):This clinical test helps diagnose impaired glucose tolerance and Type 2 diabetes. It measures blood glucose levels after fasting and two hours after consuming a standardised glucose-rich drink.

Management of Diabetes

Managing diabetes involves a multifaceted approach:

1. Medication: Depending on the type and severity of diabetes, medications may be necessary to help regulate blood sugar levels.
2. Exercise: Physical activity plays a crucial role in diabetes management. Exercise helps lower blood glucose, increase insulin sensitivity, and improve overall health.
3. Diet: A balanced and healthy diet is essential for people with diabetes to maintain blood sugar control.

Exercise Prescription for Type 2 Diabetes

Healthcare professionals should consider the following when prescribing exercise for individuals with Type 2 diabetes:

• Aerobic Training: This should involve large muscle group activities and last at least 10 minutes per session. The intensity can start low and gradually increase, promoting aerobic fitness and improving glucose control.
• Resistance Training: Incorporating multi-joint exercises and working to near fatigue helps improve muscular strength, insulin sensitivity, and body composition.

Special Considerations

Prior to an exercise session, healthcare professionals should obtain information from the patient regarding their food intake, medications, blood glucose levels, and any new symptoms or health concerns. Additionally:

• Patients with diabetes should check their feet before and after exercise sessions.
• Medication dosages may need adjustment.
• Adequate fluid intake is crucial.
• Patients should avoid exercising in extreme temperatures.
• Any sign or symptom of feeling unwell should be considered a contraindication to exercise.
• Continuous glucose monitoring can help individuals better understand how exercise affects their blood glucose levels.

Conclusion

Diabetes is a complex condition that requires a holistic approach to management. Healthcare professionals play a critical role in diagnosing and guiding patients with diabetes toward healthier lifestyles, which can significantly improve their quality of life. By staying informed about the latest research and guidelines, health professionals can better support individuals living with diabetes.