Saturday, August 20, 2016

Diabetes - An Overview


The number of people with diabetes has nearly quadrupled since 1980.

About 422 million people worldwide have diabetes, a number likely to more than double in the next 20 years.
The prevalence of diabetes has been steadily increasing for the past 3 decades, mirroring an increase in the prevalence of obesity and overweight people.  In particular, the prevalence of diabetes is growing most rapidly in low- and middle-income countries.

In 2012, diabetes was the direct cause of 1.5 million deaths. More than 80% of diabetes deaths occur in low- and middle-income countries.  

In 2014, 8.5% of adults aged 18 years and older had diabetes.

Type 2 accounts for around 90% of all diabetes worldwide. Reports of type 2 diabetes in children have increased worldwide.



Diabetes, Infographic, WHO
Source: WHO


Key Facts

  • The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014.
  • The global prevalence of diabetes* among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014.
  • Diabetes prevalence has been rising more rapidly in middle- and low-income countries.
  • Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
  • In 2012, an estimated 1.5 million deaths were directly caused by diabetes and another 2.2 million deaths were attributable to high blood glucose**.
  • Almost half of all deaths attributable to high blood glucose occur before the age of 70 years. WHO projects that diabetes will be the 7th leading cause of death in 2030.
  • Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.
  • Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications.
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* Defined as fasting blood glucose equal to or higher than mmol/L, or on medication for raised blood glucose, or with a history of diagnosis of diabetes.
** High blood glucose is defined as a distribution of fasting plasma glucose in a population that is higher than the theoretical distribution that would minimize risks to health (derived from epidemiological studies). High blood glucose is a statistical concept, not a clinical or diagnostic category.
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Diabetes, Infographic, CDC
Source: CDC

 

Definition

Diabetes is a chronic disease, which occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. This leads to an increased concentration of glucose in the blood (hyperglycaemia).

Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.

Diabetes Consequences

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves:
  • Adults with diabetes have a 2-3-fold increased risk of heart attacks and strokes.
  • Combined with reduced blood flow, neuropathy (nerve damage) in the feet increases the chance of foot ulcers, infection and eventual need for limb amputation.
  • Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. 2.6% of global blindness can be attributed to diabetes.
  • Diabetes is among the leading causes of kidney failure.

Diagnosis and Treatment

Early diagnosis can be accomplished through relatively inexpensive testing of blood sugar.

Treatment of diabetes involves diet and physical activity along with lowering blood glucose and the levels of other known risk factors that damage blood vessels. Tobacco use cessation is also important to avoid complications.

Interventions that are both cost-saving and feasible in developing countries include:
  • blood glucose control, particularly in type 1 diabetes. People with type 1 diabetes require insulin, people with type 2 diabetes can be treated with oral medication, but may also require insulin;
  • blood pressure control; and
  • foot care.
Other cost saving interventions include:
  • screening and treatment for retinopathy (which causes blindness);
  • blood lipid control (to regulate cholesterol levels);
  • screening for early signs of diabetes-related kidney disease and treatment.


Source: WHO



Type 1 Diabetes

Type 1 diabetes (previously known as insulin-dependent or childhood-onset diabetes) is characterized by a lack of insulin production and requires daily administration of insulin. The cause of type 1 diabetes is not known and it is not preventable with current knowledge.

Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly.




Diabetes, Visual Guide, WebMD
Source: WebMD


When you have type 1 diabetes, your pancreas can’t make insulin. This vital hormone helps your body's cells convert sugar into energy. Without it, sugar builds up in your blood and can reach dangerous levels. To avoid life-threatening complications, people with type 1 diabetes must take insulin for their entire lives.

Early Warning Signs

The symptoms of type 1 diabetes tend to come on suddenly and may include:
  • Feeling more thirsty than usual
  • Dry mouth
  • Fruity breath
  • Peeing a lot


Later Red Flags

As blood sugar levels remain high, type 1 diabetes often leads to:
  • Weight loss
  • Bigger appetite
  • Lack of energy, drowsiness


Skin Problems

Many people with type 1 diabetes get uncomfortable skin conditions, including:
  • Bacterial infections
  • Fungal infections
  • Itching, dry skin, poor circulation 
Girls with type 1 diabetes are more likely to have genital yeast infections. Babies can get candidiasis, a severe form of diaper rash caused by yeast. It can easily spread from the diaper area to the thighs and stomach.

Dangerous Complications

When blood sugar isn't controlled, type 1 diabetes can cause more serious symptoms, like:
  • Numbness or tingling in the feet
  • Blurred vision
  • Low blood sugar (called hypoglycemia)
  • Passing out
If your blood sugar gets too high or too low, you could go into a diabetic coma. You may not have any warning signs before this happens. You will need to get emergency treatment.

Ketones and Ketoacidosis

Without treatment, type 1 diabetes deprives your cells of the sugar they need for energy. Your body starts burning fat instead, which causes ketones to build up in the blood. These are acids that can poison your body. This plus other changes in your blood can trigger a life-threatening condition called diabetic ketoacidosis. This is an emergency that must be treated quickly. You may need to go to the ER.

Type 1 vs. Type 2 Diabetes

In type 1 diabetes, your immune system destroys cells in your pancreas that make insulin. In type 2 diabetes, the pancreas isn’t under attack. It usually makes enough insulin. But your body doesn’t use it well. The symptoms of the two forms are similar, but usually come on more quickly in people with type 1.



Diabetes, Visual Guide, WebMD
Source: WebMD


What Causes It?

Doctors aren't sure what makes your immune system attack the pancreas. Scientists have found 50 genes or gene regions that make you more likely to get type 1 diabetes. But that alone doesn’t mean you will. Some researchers believe that environmental triggers also play a role. These could include a virus or things that happen to your body during pregnancy.

Who Gets It?

Type 1 diabetes can happen at any point in life. But it's mostly diagnosed before the age of 19. It affects boys and girls equally, but it's more common in whites than in other ethnic groups. According to the World Health Organization, type 1 diabetes is rare in most African, Native American, and Asian people.

How Is It Diagnosed?

Your doctor will probably check your fasting blood sugar or he may do a random blood sugar test. He could also get your A1c level, which shows average blood sugar readings for the past 2-3 months. The tests should be repeated on 2 separate days. A more complex glucose tolerance test could also help him make the call.

Long-Term Problems

Having high blood sugar for a long time can damage many of your body's systems. Type 1 diabetes can make you more likely to have:
  • Heart disease and stroke
  • Kidney failure
  • Blindness or other problems seeing
  • Gum disease and tooth loss
  • Nerve damage in the hands, feet, and organs

Exercise With Caution

You need to get some physical activity, but be careful when you do it. To prevent a sudden drop in blood sugar, your doctor may tell you to do these things before you exercise:
  • Check your blood sugar
  • Adjust your insulin dose
  • Eat a snack
He may also suggest checking your pee for ketones, a sign that your blood sugar is too high. Avoid hard exercise when they are present.

Should You Get Pregnant?

Let your doctor know if you plan to have a baby. If your diabetes isn’t well controlled, it can cause complications, including birth defects. Good control of blood sugar before you get pregnant lowers your odds for these problems and for miscarriage. Your risk of eye damage and dangerous spikes in blood pressure will go down, too.

 
Diabetes, Infographic, Children's Hospital, Los Angeles
Source: Children's Hospital, Los Angeles

Type 2 Diabetes

Type 2 diabetes (formerly called non-insulin-dependent or adult-onset diabetes) is caused by the body’s ineffective use of insulin. It often results from excess body weight and physical inactivity.  Type 2 diabetes comprises the majority of people with diabetes around the world.

Symptoms may be similar to those of Type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen.

When you have this disease, your body does a poor job turning the carbohydrates in food into energy. This causes sugar to build up in your blood. Over time it raises your risk for heart disease, blindness, nerve and organ damage, and other serious conditions. It strikes people of all ages, and early symptoms are mild. About 1 out of 3 people with type 2 diabetes don't know they have it. 

What Will You Notice First?

People with type 2 diabetes often have no symptoms. When they do appear, one of the first may be being thirsty a lot. Others include dry mouth, bigger appetite, peeing a lot -- sometimes as often as every hour -- and unusual weight loss or gain.

Later Symptoms

As your blood sugar levels get higher, you may have other problems like headaches, blurred vision, and fatigue.

Signs of Serious Problems

In many cases, type 2 diabetes isn't discovered until it takes a serious toll on your health. Some red flags include:
Cuts or sores that are slow to heal
  • Cuts or sores that are slow to heal
  • Frequent yeast infections or urinary tract infections
  • Itchy skin, especially in the groin area


It Can Affect Your Sex Life

Diabetes can damage blood vessels and nerves in your genitals. This could lead to a loss of feeling and make it hard to have an orgasm. Women are also prone to vaginal dryness. About 1 in 3 who have diabetes will have some form of sexual trouble. Between 35% and 70% of men who have the disease will have at least some degree of impotence in their lifetime.

Risk Factors You Can Control

Some health habits and medical conditions related to your lifestyle can raise your odds of having type 2 diabetes, including:
Being overweight, especially at the waist
  • Being overweight, especially at the waist
  • A couch potato lifestyle
  • Smoking
  • Eating a lot of red meat, processed meat, high-fat dairy products, and sweets
  • Unhealthy cholesterol and triglyceride levels 

Risk Factors You Can't Control

Other risk factors are out of your control, including:
  • Race or ethnicity: Hispanics, African-Americans, Native Americans, and Asians are more likely to get it
  • Family history of diabetes: Having a parent or sibling with diabetes boosts your odds.
  • Age: Being 45 and older raises your risk of type 2 diabetes.

The more risk factors you have, the more likely you'll get type 2 diabetes.

Risk Factors for Women

You're more likely to get type 2 diabetes later on if you:

  • Had gestational diabetes when you were pregnant
  • Delivered a baby that weighed over 9 pounds
  • Had polycystic ovary syndrome

How Does Insulin Work?

In a healthy person, insulin helps turn food into energy. Your stomach breaks down carbohydrates into sugars. They enter the bloodstream, prompting your pancreas to release the hormone insulin in just the right amount. It helps your cells use the sugar for fuel.

Metabolism Mishaps

In type 2 diabetes, your cells can’t use sugar properly. That means there's a lot of it in your blood. If you have a condition called insulin resistance, your body makes the hormone, but your cells don’t use it or respond to it like they should. If you’ve had type 2 diabetes for a while but haven’t treated it, your pancreas will make less insulin.

How Is It Diagnosed?

Your doctor will take some blood and do an A1c test. It shows your average blood sugar level over the past 2-3 months. If you already have symptoms, he might give you a random blood glucose test, which shows what your current level is.

Your Diet Makes a Difference

You can control blood sugar levels by changing your diet and losing extra weight. That will also cut your risk of complications. Carefully track the carbs in your diet. Keep amounts the same at every meal, watch how much fat and protein you eat, and cut calories. Ask your doctor to refer you to a dietitian to help you make healthy choices and an eating plan.

Exercise Is Important

Regular exercise, like strength training or walking, improves your body's use of insulin and can lower blood sugar levels. Being active also helps get rid of body fat, lower blood pressure, and protect you from heart disease. Try to get 30 minutes of moderate activity on most days of the week.

Relaxation Is Key

Stress can boost your blood pressure and blood sugar. Some people don't do anything for it. Others turn to food to cope with it. Instead, practice relaxation techniques like deep breathing, meditation, or visualization. Talking to a friend, family member, counselor, or a religious leader could help. If you can’t beat it, reach out to your doctor.

Heart and Artery Troubles

If you don't treat diabetes with a healthy diet and exercise, you're more likely to  get plaque in your arteries than people who don't have it. This sticky substance slows blood flow and increases your risk of clots. It leads to hardening of the arteries (called atherosclerosis), which makes you more likely to have a heart attack or stroke. About 2 of 3 people with diabetes die of heart disease.

Check out our article about Heart Disease

Kidney Complications

The longer you have diabetes, the greater the chance you’ll get chronic kidney disease. Diabetes is the leading cause of kidney failure. It's to blame for about half of new cases. Controlling your blood sugar, blood pressure, and cholesterol can lower your risk for this complication. Yearly tests and medications can slow the disease and keep your kidneys healthy.

Eye Problems

High blood sugar can damage the tiny blood vessels that bring oxygen and nutrients to the retina, a critical part of your eye. This is known as diabetic retinopathy, and it can lead to vision loss. It’s the leading cause of new cases of blindness in people between the ages of 20 and 74. Pools of blood, or hemorrhages, on the retina of an eye are visible in this image.

Diabetic Nerve Pain

Over time, uncontrolled diabetes and high blood sugar can cause nerve damage.  Symptoms include tingling, numbness, pain, and a pins and needles sensation -- often in your fingers, hands, toes, or feet. The damage can’t be reversed, but there are treatments. Controlling your diabetes can help prevent further harm.

Foot Injuries Can Take a Toll

Diabetic nerve damage can make it hard to feel your feet. You might not notice wounds. At the same time, hardening of the arteries reduces blood flow to the area. Even a small injury can cause foot sores and gangrene. In severe cases, infections can result in an amputation.

Teeth and Gums Are Targets

High blood sugar levels can feed the bacteria that make plaque. Plaque buildup leads to cavities, tooth decay, and gum disease. Severe gum disease can cause tooth loss. It weakens gums and the tissues and bones that hold teeth in place. That makes it easier to get an infection, too.

Can It Be Prevented?

One of the most surprising things about type 2 diabetes is that you can avoid it.  Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. 

To help prevent type 2 diabetes and its complications, people should:
  • achieve and maintain healthy body weight;
  • be physically active – at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control;
  • eat a healthy diet, avoiding sugar and saturated fats intake; and avoid tobacco use – smoking increases the risk of diabetes and cardiovascular diseases. 
  • Talk to your doctor about being tested for prediabetes.
People with prediabetes can avoid getting diabetes with lifestyle changes and medication.




Diabetes, Infographic, CDC
Source: CDC


Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly frequently in children.



Diabetes, Infographic, Children's Hospital, Los Angeles
Source: Children's Hospital, Los Angeles

 

Gestational Diabetes

Gestational diabetes is hyperglycaemia that is first recognized during pregnancy. 

Gestational diabetes is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes, occurring during pregnancy. Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. 

They and their children are also at increased risk of type 2 diabetes in the future.

Gestational diabetes is diagnosed through prenatal screening, rather than through reported symptoms. 



Impaired glucose tolerance and impaired fasting glycaemia

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at high risk of progressing to type 2 diabetes, although this is not inevitable.






Source: WHO


WHO designed these posters for use around the world during this year's World Health Day on 7 April. The campaign will focus on the rising tide of diabetes worldwide.

Halt the rise

More and more people are getting diabetes around the world. The increase is in great part driven by rising levels of overweight and obesity and physical inactivity, including among children.


World Health Day 2016, Poster, WHO
Souces: WHO

Be active

Being physically active – through at least 30 minutes of regular, moderate-intensity activity on most days – can help prevent Type 2 diabetes and its complications, as well as help people to better manage Type 1 and Type 2 diabetes if they have it.


World Health Day 2016, Poster, WHO
Souces: WHO

Eat healthy

A healthy diet high in fruits and vegetables and low in sugar and saturated fats can help prevent Type 2 diabetes, and also help people to manage Type 1 and Type 2 diabetes if they have it.


World Health Day 2016, Poster, WHO
Souces: WHO

If in doubt, check!

Symptoms for diabetes include thirst, hunger, weight loss, fatigue and blurred vision. However, many people who have diabetes do not have symptoms. If people think they might have the disease, consulting a health-care professional is recommended.


World Health Day 2016, Poster, WHO
Souces: WHO

Follow medical advise

A range of treatments exists to manage diabetes and control blood glucose, including through eating healthy, being active, taking prescribed medication, controlling blood pressure, and avoiding tobacco use. People with diabetes can live well if they follow a treatment plan developed together with their health-care provider.


World Health Day 2016, Poster, WHO
Souces: WHO

World Health Day 2016, Poster, WHO
Souces: WHO

World Health Day 2016, Poster, WHO
Souces: WHO
     


You could download the poster in high resolution from the following link below:




 Source: WHO


For More...

You could read about Global report on diabetes here.

You could also read about Diabetes country profiles 2016 and check your country profile here.




Diabetes, Infographic, CDC
Source: CDC






Let's take the diabetes quiz to test your knowledge about diabetes.
Is one quiz not enough? Here is another one for you to test about Myths and Facts About Type 2 Diabetes




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