Describe insulin and what it does in the body?

Insulin is a hormone released by the pancreas in response to increased levels of blood sugar or glucose in the blood. When we eat, our bodies break food down into organic compounds, one of which is glucose. The cells of our bodies need glucose as a source of energy for movement, growth, repair, and other functions. But before the cells can use glucose, it must move from the bloodstream into the individual cells. Insulin facilitates the process of blood sugar moving into the cells.

Insulin allows glucose from the food we eat, to get into our cells for energy. Without insulin, glucose and other nutrients from food cannot be used properly and glucose levels rise in the blood. Insulin steps up the uptake of glucose into peripheral tissue, thereby lowering blood glucose concentrations.

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What is diabetes and what are its types?

Diabetes or diabetes mellitus is a disorder characterized by a reduced ability of the body to handle blood glucose. Insulin is essential for glucose to move from the blood to the inside of the cells. Unless glucose gets into cells, the body cannot use it for energy. Excess glucose not utilized by the body, remains in the blood, and is then removed by the kidneys.

In normal health, blood glucose level is maintained at a comparatively constant level, although it does vary a little. Blood glucose level is controlled largely by the action of insulin, a hormone produced in the pancreas. Insulin facilitates the uptake of glucose, amino acids and fat from the blood into the tissues for use. Insulin also promotes the storage of excess blood glucose in the liver and muscles in the form of glycogen. By this mechanism, insulin prevents the glucose level becoming too high in the blood. If the body produces less insulin or the body becomes insensitive to insulin, the condition is called diabetes.

Types of diabetes:

• Type 1 diabetes in which body does not produce adequate amounts of insulin hence requires total insulin replacement. Also called as insulin dependent diabetes (IDDM) or juvenile diabetes, the condition affects mostly at young age. In this form of diabetes, the beta cells of the pancreas are destroyed by body's immune system and are incapable of producing insulin.
• Type 2 diabetes is related to lack of the ability of the body to respond to insulin appropriately, a condition called as insulin resistance. Initially the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. This type of diabetes, well known as non-insulin dependent diabetes is seen mostly in obese people with sedentary lifestyle.
• Gestational diabetes, which occurs during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is prone to develop type 2 diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or by a shortage of insulin

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Who gets diabetes and what are its symptoms?

Diabetes does not affect everybody. Factors which increase the risk of developing diabetes are:

• Overweight or obesity
• Age greater than 45 years
• Family history of diabetes
• Race/ethnicity- African-Americans, Hispanic-Americans, and Native Americans all have high rates of diabetes
• High blood pressure
• HDL cholesterol of less than 35 and/or triglyceride level of greater than 250
• History of gestational diabetes
• Sedentary lifestyle

Symptoms of diabetes
People at risk of developing diabetes should look for the following symptoms:

• Frequent urination or polyuria
• Excessive thirst or polydypsia
• Unexplained weight loss
• Extreme hunger or polyphagia
• Sudden vision changes
• Tingling or numbness in hands or feet
• Fatigue
• Very dry skin
• Slow healing sores
• Increased frequency of infections
• Erectile dysfunction in men

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What are the tests available for diabetes?

People manifesting with any of the symptoms indicating diabetes should contact their doctor. Basic blood tests are done to diagnose diabetes. These diagnostic tests are:

• Fasting plasma glucose (FPG) test : The FPG is the preferred test for diagnosing diabetes due to convenience and is most reliable when done in the morning. It measures your blood glucose after you have gone at least 8 hours without eating. A level of 126 mg/dL or above, confirmed by repeating the test on another day, means that you have diabetes.
• Oral glucose tolerance test (OGTT): The OGTT requires you to be empty stomach for at least 8 hours before the test. The person is made to drink a liquid containing 75 grams of glucose dissolved in water and the plasma glucose is measured immediately before and 2 hours after it. A 2-hour glucose level of 200 mg/dL or above, confirmed by repeating the test on another day, confirms diabetes.
• Random plasma glucose test : In a random plasma glucose test, blood glucose is checked irrespective of the meal timing. A random blood glucose level of 200 mg/dL or more, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes.

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What are the complications of diabetes?

High blood sugar is harmful for the body. Diabetes if uncontrolled for many years, may eventually damage the organs leading to serious health problems.

• Retinopathy - High blood sugar damages the blood vessels within the eye. It is one of the major causes of blindness.
• Nephropathy - Diabetes can interfere with the function of kidney, in due course of time leading to kidney failure.
• Neuropathy- Abnormally increased blood glucose levels inflict nerve damage particularly of the hands and feet, causing tingling, numbness and weakness. If not taken care, non healing sores may develop.
• Atherosclerosis - Diabetes accelerates fatty deposits in the blood vessels, thereby narrowing it. This process called as atherosclerosis raises the risk of heart attack, stroke and poor blood flow in the legs.

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What happens if there is poor blood sugar management?

Poor blood sugar management is harmful to invariably all parts of the body. Excess of glucose is risky for the body functions.

Heart and blood vessels - Unutilized glucose in the blood is converted into fats that gets deposited in the blood vessels. Over a period of time, it can decrease the lumen of the blood vessels, blocking the blood supply. This blockade is the root cause of heart attacks, strokes and problems arising out of shortage of blood supply to the legs.

Eyes - Diabetes is injurious to the retina and lens of the eye resulting in many problems of the vision.

Kidney - Kidney is a vital body organ that can get damaged by high blood sugar. The kidneys may no longer be able to filter the blood and excrete toxins out of the body.

Nerves - Damaged nerves, as a complication of high blood sugar, may decrease sensation in feet and hands making them prone for injury. As the blood supply is also compromised, the injury may worsen to non healing ulcers.

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What is diabetes during pregnancy and how to manage it?

Diabetes during pregnancy, also called as gestational diabetes is presence of high blood glucose during later stages of pregnancy. This state of abnormal blood glucose subsides after the baby is born; however, it increases the risk of developing diabetes later in life.

During pregnancy, glucose is delivered to the baby for nourishment through placenta. The other function of the placenta is to produce certain hormones that help the baby develop. Some of these hormones are anti-insulin hormones and prevents utilization of insulin by the body. During later stages of pregnancy, the placenta increases its production of these anti-insulin hormones. Increased levels of these hormones can hamper the process of glucose moving from bloodstream into the cells. The pancreas may not be able to keep up with the state of insulin resistance. As a result, too much glucose builds up in the bloodstream, causing gestational diabetes.

High blood glucose is detrimental for the mother and the baby too. It is found more often now because more women have babies after age 35, more women are overweight and more women are tested for diabetes. It is recommended that all pregnant women should have a blood test to check for gestational diabetes between the 24th and 28th weeks of pregnancy.

Managing diabetes during pregnancy
Diabetes during pregnancy should be managed properly to protect the mother and baby from its harmful effects. For this it is very important to keep blood sugar levels as normal as possible. Gestational diabetes can be managed through the following steps:

• Daily blood glucose monitoring- Pregnant women with gestational diabetes should learn to check their blood sugar and your urine for ketones regularly.
• Taking insulin- If the blood sugar is not controlled with diet and exercise, insulin may be needed to metabolize excess sugar in blood.
• Following a special diet- Eat plenty of fruits, vegetables and grains because they are healthy and help prevent constipation. Eat three small meals and two or three snacks spread out over the day. Don't skip meals or snacks. Eat a small breakfast. Blood glucose is most likely to be high first thing in the morning. Pregnant ladies should have foods high in iron every day.
• Following an exercise program
• Learn a relaxation or meditation technique.
• Be positive.

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What is hypo and hyperglycemia?

Hypoglycemia is a condition marked by lower than normal level of sugar in the blood; characterized clinically by sweating, trembling, palpitation, hunger, and weakness; may result from excessive production of insulin by the pancreas or excessive administration of insulin to a diabetic.

Hyperglycemia is a condition of too high level of glucose in the blood. It is a sign that diabetes is out of control. Many things can cause hyperglycemia. It occurs when the body does not have enough insulin or cannot use the insulin it does have to turn glucose into energy. Signs of hyperglycemia are a great thirst, a dry mouth, and a need to urinate often. For people with insulin-dependent diabetes, hyperglycemia may lead to diabetic ketoacidosis.

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What is low blood sugar?

Low blood sugar or hypoglycemia refers to a pathologic state produced and usually defined by a lower than normal amount of sugar glucose in the blood. Hypoglycemia can produce a variety of symptoms and effects but the principal problems arise from an inadequate supply of glucose as fuel to the brain, resulting in impairment of function. Derangements of function can range from vaguely feeling bad to coma.

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