Diabetes is a metabolic disease characterized by elevated blood glucose levels (hyperglycemia) due to a defect in insulin secretion or action. Insulin is a hormone produced by the β cells of the pancreas, which helps lower blood glucose levels, among other functions. Chronic hyperglycemia in diabetes can lead to damage, dysfunction, and failure of various organs. It is particularly the eyes, kidneys, nerves, heart, and blood vessels. Therefore, it is a condition that can result in numerous complications if left untreated, making early detection crucial. Diabetes can occur at any age and requires continuous treatment.
We have two main types of diabetes.
Type 1 diabetes, commonly referred to as insulin-dependent one, occurs when the β cells of the pancreas are destroyed, primarily due to an autoimmune process or, in some cases, an unknown cause. This destruction usually results in absolute insulin-deficiency, meaning that a hormone in your body that lowers the amount of glucose in your blood must be administered externally, which is why it is labeled as insulin-dependent.
The development of this autoimmune disease often begins with the presence of anti-islet antibodies, which target various fragments of the β cells that produce a hormone in your body that lowers the amount of glucose in your blood. These antibodies can appear many months or even years before any symptoms of this condition arise.
Type 2 diabetes is the most common form of this condition, accounting for approximately 80% of cases. It occurs when there is a progressive impairment of insulin secretion in the context of insulin resistance, meaning that the body's tissues become less sensitive to a hormone in your body that lowers the amount of glucose in your blood. While genetic factors—often due to polygenic inheritance—can play a role, environmental factors are crucial. Among these are obesity (especially abdominal obesity) and low physical activity. An excess of visceral fat significantly contributes to the development of this condition, even in individuals who may not be classified as obese based on body mass index (BMI).
This type of diabetes is sometimes referred to as non-insulin-dependent diabetes because, in the early stages of the disease, patients typically do not require insulin-treatment. This type of diabetes is sometimes called non-insulin-dependent. That's because at the beginning of the disease, patients usually do not need to take a hormone in your body that lowers the amount of glucose in your blood. Moreover, treatment consists of lifestyle modification (reducing body weight, appropriate physical activity) and taking oral medications.
We have some rare forms of this condition:
In addition, there are so-called hybrid forms of diabetes, i.e., slowly developing autoimmune diabetes in adults (instead of LADA) and type 2 diabetes with a tendency to ketosis. If the diagnosis of diabetes is ambiguous, we talk about unclassified diabetes.
Gestational diabetes or diabetes in pregnancy is hyperglycemia first detected during pregnancy. The increased concentration of hormones that act oppositely to a hormone in your body that lowers the amount of glucose in your blood during pregnancy leads to insulin resistance (reduced tissue sensitivity to insulin), increased demand for this hormone, and increased availability of glucose for the developing fetus – as a result of these adaptive changes, the risk of carbohydrate metabolism disorders increases in previously healthy women.
Typical symptoms of diabetes (indicate the possibility of this condition with significant hyperglycemia) include:
Typical symptoms of diabetes may also occur in other diseases, and many people with this condition have no symptoms at all. Diabetes cannot therefore be diagnosed based on symptoms alone and appropriate tests must be performed. Therefore, if you are concerned that you may have this condition, you should contact your doctor.
Diabetes tests are not only performed on people who have symptoms but are also recommended to be performed regularly in so-called risk groups. For example, people who are more likely than others to develop diabetes.
Typical symptoms of diabetes are more commonly observed in type 1 diabetes than in type 2 diabetes. It is primarily because type 1 diabetes develops rapidly, leading to a swift destruction of the β cells in the pancreas and a quick onset of insulin-deficiency. Common symptoms of type 1 diabetes in children, adolescents, and adults include the typical symptoms associated with diabetes.
In children and adolescents, the rapid depletion of insulin-producing β cells can result in a sudden onset of the disease. It can lead to complications such as acidosis and ketoacidosis coma. Symptoms may include intense nausea, vomiting, severe abdominal pain, dehydration, rapid breathing, and a distinctive fruity smell of acetone on the breath. These metabolic disturbances can impair consciousness and lead to coma. Without timely treatment, this condition can be fatal.
In adults, the onset of type 1 diabetes tends to be less abrupt and may occur over a longer period. But the symptoms can still be similar.
Type 2 diabetes is the most common form of diabetes and is caused by progressive impairment of insulin-secretion in conditions of insulin-resistance, i.e. reduced tissue sensitivity to a hormone in your body that lowers the amount of glucose in your blood. It may be genetically determined (most often polygenic inheritance). However, environmental factors play a decisive role – obesity (especially abdominal) and low physical activity. An excess of so-called visceral fat tissue has a significant impact on the development of this condition. Moreover, also in people without obesity defined on the basis of the body mass index.
Symptoms of type 2 diabetes usually appear only when blood glucose levels increase significantly. Initially, the disease may be asymptomatic.
In type 2 diabetes, characteristic symptoms include:
Gestational diabetes usually does not cause any symptoms, which is why screening tests are performed during pregnancy – blood glucose level, as well as an oral glucose tolerance test. Gestational diabetes leads to many complications, including miscarriage, and fetal macrosomia.
In this condition, recurrent infections of the skin and mucous membranes are sometimes observed:
In addition, in the case of type 2 diabetes, so-called acanthosis nigricans can be observed, i.e. symmetrically located, dark brown skin discoloration, accompanied by excessive keratosis. It is most often located on the neck (the so-called dirty neck symptom), in the armpits, on the elbows, and knees.
Type 2 diabetes quite often does not cause any symptoms in the initial period, but also at this stage it leads to the development of complications. This condition is a disease that affects many organs, hence there is a multitude of symptoms that it can potentially cause.
In addition to the classic triad of symptoms (increased urination, increased thirst, weight loss), this condition may be indicated by, among others, recurrent infections of the skin and mucous membranes and intimate infections, visual impairment, difficulties with wound healing, in children, including bedwetting, apathy, irritability and related problems at school.
Especially in the case of type 2 diabetes, it sometimes happens that the first symptom noticed by the patient is a complication of a long-term disease.
The primary test used to diagnose diabetes is a blood glucose (glycemia) test. A normal fasting blood glucose level is less than 5.6 mmol/L (100 mg/dL). If the result falls between 5.7 and 6.9 mmol/L (100 to 125 mg/dL), the doctor will refer the patient for an oral glucose tolerance test (OGTT). A fasting glucose level of 7.0 mmol/L (126 mg/dL) or higher indicates a diagnosis of diabetes.
The oral glucose tolerance test (OGTT), often referred to as a blood sugar curve, is used to diagnose this condition or impaired glucose tolerance. This test involves taking a blood sample after fasting. It is followed by another blood sample taken two hours after the patient drinks a solution containing 75 g of glucose dissolved in 300 mL of water. During the two-hour period between consuming the glucose solution and the second blood draw, the individual should remain at rest in the same location where the test is performed. The test should be done 8 to 14 hours after the last meal, following a night of sleep, and after three days of eating a typical diet with normal carbohydrate content.
Many cases of this condition are asymptomatic, which is why screening tests (fasting glucose or OGTT) are recommended every year in groups at increased risk of developing type 2 diabetes:
Another significant test is the value of glycated hemoglobin (HbA1c). This is a glycemia indicator used to assess diabetes treatment in people with already diagnosed diabetes or to interpret it. This value reflects the concentration of glucose in the blood that was maintained for 3 months before the test.
In addition, the doctor may order other tests, such as:
This condition is diagnosed in the following situations:
In addition, there are two prediabetes states, i.e. states of increased risk of developing diabetes – impaired fasting glycemia and impaired glucose tolerance.
Prediabetes, which indicates an increased risk of developing diabetes, is diagnosed in two situations:
Treatment of diabetes is comprehensive and usually requires the use of several methods at the same time. These include:
In type 1 diabetes, taking a hormone in your body that lowers the amount of glucose in your blood is necessary.
Type 2 diabetes is a progressive disease, so over time the treatment must be modified: initially, metformin (oral treatment) is used, and then, when the treatment is no longer effective, additional, individually selected drugs are added, if they are ineffective, then as the disease progresses, the doctor will recommend insulin-therapy. All therapeutic decisions regarding the treatment of diabetes, regardless of its type, are made by the doctor in consultation with the patient.
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