What is diabetes?

What is diabetes?
Diabetes is a disease in which the blood sugar content is higher than normal. If you are untreated, the elevated blood sugar can be fatal in certain cases and can cause serious and debilitating sequelae.

What types of diabetes excists?
There are two main types of diabetes, which is Type 1 diabetes, typically found in kids, adolescents and young adults. Then Type 2 diabetes which is mainly found in middle-aged adults, but with a tendency for the disease to be found in increasingly younger people.

Other types of diabetes:

• Type 1 1/2 diabetes: This type has features in common with both type 1 and type 2 diabetes. Observed in adults.
• Gestational diabetes: This type, which occurs during pregnancy and disappears after birth, is also called gestational diabetes. Gestational diabetes is most similar to type 2 diabetes, and about one in two women who have had gestational diabetes will develop type 2 diabetes later in life.

• Secondary diabetes: These are different types that occur as a result of another disease or treatment. Can, among other things, come after pancreatitis, pancreatic cancer or other glandular diseases. Secondary diabetes can also occur in connection with certain medical treatments, such as treatment with adrenal cortex hormone or cancer treatment in the form of immunotherapy.

• Hereditary diabetes: This type is also called MODY (maturity-onset diabetes of the young). These are forms of diabetes that are caused by a single gene and are inherited directly from the parents. The disease is most often diagnosed before the age of 25, but most frequently resembles type 2 diabetes.

Why do you get diabetes?
The hormone insulin, which is produced in the pancreas, has an absolutely decisive role for the sugar metabolism in humans and thus for the maintenance of normal blood sugar. In all forms of diabetes, an altered production or effect of insulin is important.

Type 1 diabetes
Type 1 diabetes occurs when most of the insulin-producing cells in the pancreas have died. For reasons that are not entirely clear, these cells are destroyed. It happens in a complicated interaction between the immune system, hereditary and environmental factors. The disease is hereditary, so people with siblings or parents who have type 1 diabetes have an approximately 10-fold increased risk of getting the disease.
The process that leads to type 1 diabetes occurs most often in the younger years, especially around puberty, but can be seen at any age. What causes the immune system to react against its own cells is not known, but various viruses and proteins are suspected.

Type 2 diabetes
In type 2 diabetes, several things are wrong. Inside the body, especially the muscles and the liver, have a reduced sensitivity to insulin. This reduced sensitivity means that sugar is not absorbed normally into the body’s cells. The pancreas initially tries to produce even more insulin, but eventually cannot keep up. Blood sugar will slowly begin to rise and without treatment, insulin production will decrease further and blood sugar will become even higher. Other conditions are also important, such as the gut hormone GLP-1, which normally supports the effect of insulin in connection with meals, and which works to a lesser extent when you have type 2 diabetes.

The causes of insulin resistance and insufficient insulin production are not known in detail, but it is known that both hereditary and environmental factors play a role. Thus, the risk of getting type 2 diabetes is approximately 40% if one of your parents has type 2 diabetes and up to 80% if both parents have type 2 diabetes. The disease is also strongly linked to obesity and reduced physical activity. That is why it is also called a lifestyle disease.

Type 1½ diabetes
This type of diabetes is also called LADA (Latent Autoimmune Diabetes in Adults). The disease is considered a subtype of type 1 diabetes or a type of slowly developing type 1 diabetes. It is believed that the destruction of the insulin-producing cells in the pancreas occurs in the same way as in type 1 diabetes, but this process is just much slower.
Often people with this type of diabetes are misdiagnosed as having type 2 diabetes. In the beginning, they can also be treated with tablets, but after a few years they will need insulin treatment.

What is the difference between type 1 and type 2 diabetes?
In type 1 diabetes, the pancreas produces virtually no insulin. People with type 1 diabetes are therefore dependent on being supplied with insulin from the outside in order to survive. The disease develops quickly, and you get many symptoms. If you are not treated with insulin daily, the person with type 1 diabetes will, within days to a few months, become seriously ill and end up in a coma and possibly die. People with type 1 diabetes, blood sugar can fluctuate despite insulin treatment, and there is a risk of low blood sugar.

In type 2 diabetes, the pancreas produces too little insulin in relation to the body’s needs. Many people with type-2 diabetes have a great need for insulin, as the body’s sensitivity to insulin is reduced (insulin resistance), and their lifestyle is also characterized by a large intake of fat, sugar and carbohydrates and not enough exercise.

Insulin resistance in type 2 diabetes is strongly linked to the degree of obesity. Approximately 80 percent of all people with type 2 diabetes are overweight. The disease develops insidiously, and it is far from everyone who has symptoms of the high sugar level in the blood. Often it is symptoms of diabetes complications that make the person go to the doctor.

In the beginning, you rarely need insulin treatment, but you can usually cope with tablet treatment, or even simply with dietary changes and increased physical activity, which can lead to weight loss. Later in the course, most people with type 2 diabetes need more medication, a combination of different types of medication and possibly insulin treatment. Thus, over half of all people with type 2 diabetes are on insulin treatment after 15 years of diabetes.

What can occur as a result of diabetes?
Due to the high blood sugar, diabetes can cause dangerous sequelae, which in the worst case can be debilitating.
After eating carbohydrates in particular, the level of sugar in the blood begins to rise. This causes the pancreas to start releasing more insulin, which takes care of converting the sugar into energy or storing the sugar in the body as a sugar depot or as fat.

If the pancreas does not produce enough insulin, or if the body’s cells cannot use the insulin sufficiently, the sugar will remain in the blood and you will have a constantly elevated blood sugar. At the same time, there is a lack of sugar and thus energy in the cells.
The constant elevated blood sugar is a problem, as the sugar is transported around with the blood to all organs, and slowly it can cause damage and consequential diseases in particular to the eyes, kidneys and nervous system etc.

In the worst case, the sequelae of diabetes can be:
• Impaired vision, possibly blindness.
• The kidneys can be damaged and in some cases have difficulty excreting waste products, which may require dialysis treatment.
• Risk of foot ulcers and, in rare cases, gangrene, which may necessitate amputation.
• Diabetic nerve damage which can cause pain, erection problems and other problems.

What are the symptoms of diabetes?
When blood sugar rises, you will often get some classic symptoms, which are primarily due to the sugar starting to be excreted in the urine. The typical symptoms of diabetes are 1) thirst, 2) frequent urination, 3) fatigue, 4) decreased appetite and weight loss, 5) itching around the genitals and 6) infections in the skin and mucous membranes.

What can you do to help yourself?
First of all you have to get a healthy lifestyle with great food combines with exercise and not too much stress.

You must learn to measure your own blood sugar and learn to manage diabetes treatment in everyday life. A thorough and practical education in treatment with GLP-1 or insulin treatment is essential for those who are in this treatment. The general practitioner has the option of referring you to a municipal service or the nearest health centre, where you can take part in a course or diabetes school, and learn about both medical treatment and lifestyle changes.

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