A state of starvation in the midst of plenty

Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose levels.

Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose levels. Generally, two main types of Diabetes mellitus exists: Type 1 and Type 2 Diabetes Mellitus. The most common is type 2 diabetes. Usually onset is in adulthood and occurs when the body becomes resistant to insulin or doesn’t make enough insulin. Type 1 diabetes, once known as juvenile diabetes is insulin-dependent diabetes. It is a chronic condition in which the pancreas produces little or no insulin by itself. About 422 million people worldwide have diabetes, particularly in low-and middle-income countries.

Chart 1: WHO key facts on diabetes 2018

A state of starvation in the midst of plenty…

In humans, diabetes occurs usually due to destruction of beta cells of pancreas or due to decreased sensitivity of insulin receptors to insulin. It is a state of starvation in the midst of plenty. In untreated diabetes, plasma glucose concentration is always high. In spite of high blood glucose levels, the tissue cannot utilize glucose either due to insulin deficiency or due to insulin resistance. In this condition, cells cannot utilize glucose though they are surrounded by a high concentration of glucose. Therefore, diabetes is called a disease of “starvation in the midst of plenty” as tissues starve of glucose despite they being surrounded by plenty glucose levels.

Diabetes is primarily classified into two types: type­1 and type­2.

  • Type 1 Diabetes Mellitus is characterized by insulin deficiency, which is usually caused by selective destruction of cells of pancreas that produce insulin. The disease usually starts early in childhood. The disease is treated by insulin replacement.
  • Type-2 Diabetes Mellitus is characterized by impaired ability of the target cells to respond to insulin. The insulin secretion may be normal or even more. The chance of identical twin developing the disease is 100%. The disease usually starts late, in third or fourth decade of life. The patients are usually overweight and have a sedentary lifestyle. Feeding habit and environment also contribute. Chronic stress is usually associated with it.

Multiple factors contribute to insulin resistance with weight gain having been noted to be highly correlated in addition to a few other factors. Summarily, the following  factors contribute to insulin resistance:

Obesity: In obesity, insulin fails to transport glucose into the tissues. This eventually leads to raised insulin levels, raised lipids level and accelerated fat deposition in blood vessels. With reduction in body weight, insulin resistance and abnormal lipid levels decrease.

Adipokines: The chemical signals originating from fat tissue are recently proposed to be contributing factors for insulin resistance. Fat cells secrete a group of hormones- called adipokines- that influence insulin resistance.

Diabetes mellitus is characterized by:

  • Excessive eating
  • Excessive drinking water
  • Excessive thirst and drinking lots of water
  • Weight loss in spite of increased food intake
  • Raised blood glucose levels
  • Presence of glucose in urine.

The persistently high blood glucose levels leads, over time, to serious damage to the heart, blood vessels, eyes, kidneys, and nerves.

Diagnosis

Diagnosis of diabetes is done by demonstrating persistent high blood glucose levels and high urine glucose levels. Estimation of fasting and post­prandial blood glucose is performed to demonstrate high blood glucose levels, and estimation of glucose in urine is carried out to demonstrate high urine glucose levels. Such tests include Glucose Tolerance Test, estimation of fasting blood glucose (FBG), and estimation of glycated hemoglobin (HbA1c)

Diabetes mellitus is one of the most common non communicable conditions in our society. It is important to have blood and glucose levels checked during routine medical check-up, more so for anyone with risk factors for Diabetes mellitus or presenting with some of the above-highlighted symptoms

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