Diabetes mellitus is a chronic disease characterized by high levels of glucose in the blood. It’s an increasingly common condition affecting millions of people worldwide (yes, including children).
In this article, we delve into the causes, symptoms, diagnosis, and treatment of diabetes mellitus, providing useful information for prevention and management of this condition.
What is Diabetes Mellitus?
Diabetes mellitus is a metabolic disorder in which the body doesn’t produce enough insulin or doesn’t respond adequately to the insulin produced.
Insulin is a crucial hormone that regulates blood glucose levels by allowing it to enter cells, where it’s used as an energy source.
When this mechanism doesn’t work correctly, glucose accumulates in the blood, causing hyperglycemia.
In the long term, chronic hyperglycemia can damage various organs and tissues, leading to serious complications.
Main Types of Diabetes Mellitus
There are two main forms of diabetes mellitus:
Type 1 Diabetes: this is an autoimmune disease where the immune system attacks and destroys the insulin-producing cells in the pancreas. As a result, the body produces little or no insulin. It usually affects children and young adults.
Type 2 Diabetes: this is the most common form, representing about 90% of cases. In this type, the body becomes resistant to insulin or doesn’t produce enough. It typically develops in adulthood and is often associated with being overweight and a sedentary lifestyle.
There’s also a transient form called gestational diabetes, which can occur during pregnancy.
Age of Onset of Type 1 Diabetes in Children
Type 1 diabetes can develop at any time during childhood, even in the first years of life.
Generally, type 1 diabetes appears between 4 and 6 years or between 10 and 14 years.
By age 18, 1 in 300 children has developed type 1 diabetes.
In recent years, there has been an increase in cases of type 1 diabetes onset in children under 5 years old.
So, type 1 diabetes mellitus, the most common form of diabetes in pediatric age, can occur in the very early years of life, although the typical onset is between 4-6 years or 10-14 years.
Cases of type 1 diabetes in children under 5 are increasing, and the causes are linked to diets excessively rich in fats and sugars.
Causes and Risk Factors
The causes of type 1 diabetes are not entirely clear, but it’s believed that genetic and environmental factors play an important role. As for type 2 diabetes, the main risk factors include:
- Being overweight or obese
- Age over 45
- Family history of diabetes
- Sedentary lifestyle
- Diet rich in sugars and fats
- High blood pressure and high cholesterol
- Ethnic origin (higher risk in some populations)
Symptoms of Diabetes Mellitus
Diabetes symptoms can develop gradually, especially in type 2. The most common signs include:
- Increased thirst and urination frequency
- Excessive hunger
- Fatigue and weakness
- Blurred vision
- Slow wound healing
- Tingling or numbness in hands and feet
In type 1 diabetes, symptoms tend to appear more rapidly and can be more severe, with possible development of an acute condition called diabetic ketoacidosis.
Diagnosis of Diabetes
The diagnosis of diabetes is based on measuring blood glucose levels. The main tests are:
- Fasting Blood Glucose: Measurement of blood glucose after at least 8 hours of fasting. Values above 126 mg/dL indicate diabetes.
- Oral Glucose Tolerance Test: Measures blood glucose 2 hours after consuming a sugary solution. Values above 200 mg/dL are diagnostic.
- Glycated Hemoglobin (HbA1c): Reflects average glucose levels over the past 2-3 months. A value of 6.5% or higher indicates diabetes.
In some cases, continuous glucose monitoring through wearable or portable devices may be useful.
Complications of Diabetes
If not adequately controlled, diabetes can lead to serious complications over time that involve various organs and tissues:
- Cardiovascular diseases (heart attack, stroke)
- Diabetic nephropathy (kidney damage)
- Diabetic retinopathy (vision damage)
- Diabetic neuropathy (peripheral nerve damage)
- Diabetic foot (foot ulcers and infections)
- Increased susceptibility to infections
Good glycemic control from the onset of the disease is crucial to prevent or delay the onset of these complications.
Treatment of Diabetes Mellitus
The treatment of diabetes aims to keep blood glucose levels as close to normal as possible. Disease management is based on several pillars:
Pharmacological Therapy
In type 1 diabetes, insulin administration is always necessary, through subcutaneous injections or insulin pumps.
In type 2 diabetes, treatment usually starts with oral medications like metformin.
If not sufficient, other drugs or insulin may be associated. New drug classes like GLP-1 agonists and SGLT2 inhibitors offer additional therapeutic options.
Diet
A balanced diet is fundamental in managing diabetes. It’s recommended to:
- Limit simple sugars and refined carbohydrates
- Prefer complex carbohydrates with a low glycemic index
- Increase fiber consumption
- Reduce saturated fats
- Control portions
An expert dietitian can help develop a personalized meal plan.
Physical Activity
Regular physical exercise helps improve insulin sensitivity and glycemic control. It’s advised to practice at least 150 minutes per week of moderate aerobic activity, combined with resistance exercises.
Self-Monitoring
Regular blood glucose monitoring via glucometer is essential to evaluate treatment effectiveness and prevent hypo and hyperglycemia. The frequency of checks varies based on the type of diabetes and therapy.
Therapeutic Education
Learning to manage diabetes in daily life is fundamental. Educational programs help patients acquire the knowledge and skills necessary for self-management of the disease.
Prevention of Diabetes
While type 1 diabetes cannot be prevented, it’s possible to significantly reduce the risk of developing type 2 diabetes by adopting a healthy lifestyle:
- Maintain a normal body weight
- Follow a balanced diet rich in fiber and low in sugars and fats
- Practice regular physical activity
- Avoid smoking
- Limit alcohol consumption
In high-risk subjects, such as those with prediabetes, adopting these behaviors can reduce the probability of developing overt diabetes by up to 50%.
Living with Diabetes
Diabetes is a chronic disease that requires constant commitment in daily management. However, with good control, it’s possible to lead a normal and active life. It’s important to:
- Strictly follow the prescribed therapy
- Regularly monitor blood glucose
- Perform periodic medical check-ups
- Pay attention to diet and physical activity
- Learn to recognize and manage hypo and hyperglycemia
The support of family, doctors, and patient groups can be very helpful in facing the challenges posed by the disease.
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SOURCES
Goyal R, Singhal M, Jialal I. Type 2 Diabetes. [Updated 2023 Jun 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available here: https://www.ncbi.nlm.nih.gov/books/NBK513253/