Types of Diabetes

Diabetes requires constant monitoring and regular check-ups as it is an acute and long-lasting condition with its share of additional health complications. Many things may go wrong in the prediabetes stage which can lead to the patient developing diabetes in the future. The most common forms of diabetes are type 1 and type 2. However, there is another form of diabetes known as gestational diabetes that affects women during their pregnancy.Fortis Hospital, Mumbai is a leading centre for diabetes management and is able to offer comprehensive treatment in the following areas of care:

  • Prediabetes:

Prediabetes is the stage before a patient develops type 2 diabetes. This is the case with the majority of patients. During the prediabetes stage, the glucose levels rise but are not high enough to be categorised as diabetic. This is the time where the cells in the body start building their resistance to insulin.

Research supports the fact that even in the prediabetes stage, the circulatory system and possibly the heart may suffer some extent of damage.

  • Type 1 Diabetes:

Type 1 diabetes mostly develops in children and young adults of any age and therefore is popularly known as ‘juvenile diabetes’. This is a more severe form of diabetes, where the affected is dependent on insulin to manage the condition.

Researchers are not absolutely sure of the reason why, but in type 1 diabetes, the body’s immune system strikes the pancreas. The action is out of the ordinary as the pancreas is a part of the body’s immune system too. However, during type 1 diabetes, the insulin producing cells from the pancreas are mistaken as foreign objects by the immune system and therefore tries to destroy them. This continued attack on the pancreas by the immune system of the body is known as ‘auto-immune disease’.

The ‘islets’ or cells that are present in the blood stream possess the capability to sense the sugar levels. Therefore, as a response mechanism, these cells start producing the required amounts of insulin to get the sugar levels within their normal range.

The ‘key’ to opening the body’s cells lies with the insulin. It permits the sugar to enter which is turn is used to generate energy in the body. If the insulin is not present, then the ‘key’ is lost. In such a situation, the glucose or sugar remains and begins building up in the blood stream. Due to the lack of glucose in the body, the cells begin to starve. If the condition is not identified at the right time and subsequently treated, the high blood sugar levels can cause additional damage to the eyes, kidneys, nerves, heart and potentially lead to coma and death.

The treatment path available to a patient with type 1 diabetes is by taking insulin injections. The insulin received in to the body now serves as the ‘key’ and allows the glucose to enter the body’s cells. However, it is imperative that one monitors the insulin quantity that is being injected, with periodic reviews of the patient’s diabetic condition by the consulting healthcare provider.

  • Type 2 Diabetes:

Type 2 diabetes or non-insulin dependent diabetes is the most common form of this chronic condition that affects adults. It typically develops in both men and women beyond the age of 35 and above. But, in recent times, more and more younger adults are now being affected by this serious health hazard too.

Insulin can be produced in limited quantities by patients diagnosed with type 2 diabetes. However, the quantities produced are not adequate and even though the insulin may try to serve as the ‘key’ to get into the body’s cells, in most cases it does not work. This leads to another condition known as insulin resistance.

The risk of developing type 2 diabetes is higher in those people who are overweight and obese, in comparison to those having a healthy body weight. Those having an excess of visceral fat or central obesity, belly fat or abdominal obesity are also at an increased risk. The body releases chemicals that can lead to destabilization of the body’s cardiovascular and metabolic systems as a result of being overweight or obese.

Apart from the weight factor, there are supplementary elements such as being physically inactive, eating unhealthy food that contribute to the risk of developing type 2 diabetes. Research suggests that by drinking a can of soda raises the risk of developing this serious condition by 22%.

Age too becomes a contributing factor and increases the risk of type 2 diabetes in adults. As one gets older, there is more tendency to put on weight. Along with that, physical activities too become limited. If there is an existing family history of diabetes, the chances of developing the disease is greater. With low testosterone levels, men too may be at a higher risk of developing type 2 diabetes.

The treatment for this condition largely depends on lifestyle and dietary changes along with physical exercise such as walking. Oral medications may be recommended by your consulting healthcare provider if the glucose levels remain higher than the normal range. Insulin injections are the last resort to control the condition.

  • Gestational Diabetes

Many women during their pregnancy develop another temporary form of blood sugar known as gestational diabetes. The blood sugar levels tend to increase drastically and so their bodies are unable to generate adequate amounts of insulin in order to transport the glucose to in to the body’s cells. In due course of time, this leads to rising levels of sugar in the body.

Gestational diabetes can be controlled and managed throughout the pregnancy period with the right diet and exercise. 10% to 20% of pregnant women with gestational diabetes may require some form of blood sugar controlling medicines. If the condition remains undiagnosed, it may put the child at risk during the birthing process.

Type 1 and type 2 diabetes brings with it several long-term effects that manifests gradually. If the blood sugar is not controlled properly, the risk of additional complications is much higher. Some of these complications may also lead to life-threatening conditions. Some possible complications resulting from diabetes include:

  • Cardiovascular disease:

The risk of heart problems and related conditions increases manifold with diabetes. Possible complications may include coronary artery with angina, cardiac arrest, stroke and atherosclerosis.

  • Nerve Damage or Neuropathy:

An increase in the glucose levels in the body can also cause harm to the walls of the capillaries that protect and nourish the nerves in the body, particularly in your legs. Symptoms that may indicate that the nerves are being damaged include a tingling sensation, a feeling of numbness, burning or pain sensation that starts at the tips of the toes or fingers and eventually spreads upwards. If treatment is not provided at the right time, there may be a loss of sensation in the affected limbs. Other signs of nerve damage are digestion problems, nausea, vomiting, diarrhoea and constipation. It may also lead to erectile dysfunction in men.

  • Kidney Damage or Nephropathy:

Millions of blood vessels make up the kidney that help to filter out waste materials from the blood. Diabetes may cause injury to the filtering system. Kidney failure or irreversible end-stage kidney disease is not uncommon if diabetes leads to severe kidney damage. Treatment options include dialysis or a kidney transplant.

  • Eye Damage or Retinopathy:

The blood vessels in the retina may be impaired and may potentially result in loss of vision. This condition is known as diabetic retinopathy. Lesser complications of the retina include cataracts and glaucoma.

  • Foot Damage:

This is also the result of the injury caused to the nerves that leads to poor blood flow to the feet. This increases the risk of a number of foot complications. Simple cuts and blisters may turn into serious infections that may require an amputation if not treated at the right time.  

  • Skin Conditions:

Diabetes may make the patient more prone to skin problems including fungal and bacterial contagions.

  • Hearing Impairment:

People who develop diabetes are susceptible to hearing impairments too.

  • Alzheimer’s Disease:

Diabetic patients are vulnerable to conditions such as dementia and Alzheimer’s disease. With little control on the glucose levels, the risk of developing dementia or Alzheimer’s disease is potentially greater.

  • Depression:

Diabetes management can be hard as it requires several lifestyle changes. For those who have type 1 and type 2 diabetes, it may lead to depression.

  • Hypertension:

This is a common complication in patients with diabetes. This can additionally increase the risk of developing kidney, retina, cardiovascular diseases such as heart attack and stroke.  

  • Gum Disease:

Gum disease is common with those who already have been diagnosed with diabetes.

  • Gastroparesis:

Diabetes may lead to gastroparesis where basically the abdominal muscles stop functioning properly.

  • Ketoacidosis:

The body may start accumulating ketone bodies or acidity in the blood as a result of diabetes.

  • HHNS or Hyperosmolar Hyperglycemic Nonketotic Syndrome:

This is an emergency condition where the glucose levels shoot up suddenly and no ketones bodies are present in the blood or urine.

  • PAD or peripheral arterial disease:

Diabetic patients may be prone to peripheral arterial disease. Common symptoms are pain in the leg, tickling and having difficulty walking.

  • Healing of Wounds:

It takes longer for simple cuts and lesions to heal if one is diabetic.

Gestational diabetes too can bring along certain complications. While most women with gestational diabetes give birth to healthy babies, if the condition remains untreated, the sugar levels may spiral out of control causing further problems for the baby and the mother. Some of problems that the child can encounter if the mother has been diagnosed with gestational diabetes are:

  • Excess Growth:

With the excessive glucose that reach the baby through the placenta, it may trigger the baby’s pancreas to produce additional insulin. As a result, the baby grows bigger in size, a condition known as macrosomia. If the baby is considerably bigger, then a natural birth is out of question and the mother would have to undergo a C-section.

  • Low Blood Sugar:

Low blood sugar or hypoglycaemia can develop in babies shortly after birth if the mother had been diagnosed with gestational diabetes during pregnancy. The blood sugar levels can be returned to normal levels through administering intravenous glucose solution and prompt feedings.

  • Type 2 Diabetes:

Babies who are born to mothers with gestational diabetes are more susceptible to developing type 2 diabetes later in life.

  • Death:

If the mother does not receive any treatment towards gestational diabetes during the pregnancy, it may lead the baby towards a fatality, either in the womb or shortly post-delivery.

The mother too can be prone to added health complications as a result of gestational diabetes. These conditions include:

  • Pre-eclampsia:

This condition is distinguished by overabundance of protein in the urine, high blood pressure and inflammation in the legs and feet. This can result in grave and life-threatening situations for the baby and the mother.

  • Subsequent gestational diabetes:

If the mother has had gestational diabetes during one pregnancy, chances are that she would have gestational diabetes in subsequent pregnancies too. In the future, the possibility of developing type 2 diabetes is also greater.

At Fortis Hospital, Mumbai, the objective of our care team is to empower our patients. Through a series of consultations and counselling, we help our patients to control and manage their diabetic condition. Our trained dieticians can help our patients to self-manage their diabetes through nutritional therapy. With recommendations that are based on the latest guidelines to combat diabetes, therapy is tailored to suit the patient’s current medical condition, dietary choices and personal preferences.

Our care team at Fortis, Mumbai will perform an assessment of your current diabetic state and additionally distinguish any pattern of unhealthy food consumption. An individualized meal plan will be prepared that our patients are suggested to strictly follow. Our trained counsellors will also advise your family members and loved ones on how to adapt to the challenges brought on by diabetes.