Greetings,
Today in the 3rd & final episode of the diabetes series we will talk about how to diagnose diabetes properly and which kind of complications could go with it – so lets round up the whole topic!
Diabetes Type 1 & 2: a head to head comparison
Let's start with a quick & clean overview:
| Information | Diabetes Type 1 | Diabetes Type 2 |
|---|---|---|
| RELATIVE FREQUENCY | 10 – 20 % | 80-90 % |
| PATHOGENESIS | absolute lack of insulin | initially insulin resistance due to excess nutrition |
| PHYSIQUE | asthenic – slim & fragile | adipose/obese |
| BEGINNING | initially acute between the age of 14 – 24 | slowly starting from the age of about 40 |
| METABOLISM | unstable & deficient | stable |
| THERAPY | insulin dose always mandatory | First life style schooling, then drugs, lastly insulin |
Diagnostics
Irrespective of the exact type of diabetes there are 3 ways to diagnose glucose metabolism problems:
- HbA(1c) ≥ 6,5 %
- Fasting blood sugar ≥ 126 mg/dl [7,0 mmol/l]
- Orale Glucose Tolerance Test: blood sugar ≥ 200 mg/dl [11,1 mmol/l]
HbA(1c)
The HbA(1c) is one of the most reliable markers for diabetes.
To explain this marker, we need to get a little bit of background knowledge: in our blood we have red blood cells 🩸 – the red colour of these cells is based upon the molecule haemoglobin, which is also the one transporting oxygen in our blood.
If we have high blood sugar levels [e.g. as a diabetes patient] it is more likely for the glucose to interact spontaneously with the haemoglobin of the red blood cells [so-called erythrocytes] – so they get connected to each other and they will stay like that until the cells get degraded by the body.
This marker is stable und correlates with the blood sugar levels meaning it is proportional to the approx. blood sugar levels of the past 3 months - there are a lot of nice charts!
Fasting blood sugar
This one is pretty obvious – you test the blood sugar level after the patient has not eaten of a set amount of time. This will reveal a deficient glucose metabolism.
The follow-up to this is usually the orale glucose tolerance test
Orale Glucose Tolerance Test
After measuring the fasting blood sugar level, the patient drinks a glass of 75 g of glucose dissolved in water. After 1, 2 & 3 hours you test the blood sugar levels. If it is ≥ 200 mg/dl [11,1 mmol/l] after 2 h it is almost certain that the glucose metabolism respectively insulin system is not functioning correctly.
If it is ≤ 140 mg/dl after 2 hours you have nothing to worry about – everything in between is not to be ignored as well as not as dramatic.
Complications
Diabetes Type 1
The most common acute complication of diabetes type 1 is usually the first time it presents itself: the diabetic coma – due to the lack of insulin, high levels of sugar in the blood and the incapacity of transporting the glucose into the cells, where it is needed [especially in the brain!], people pass out. In addition, the body acidifies due to the high fat metabolism building ketones – normally the insulin would inhibit the lipid catabolism [the degradation of fat for energy production].
Due to the fast emergence of the disease it is almost impossible to be caught of guard by creeping, long-term complications before getting diagnosed. Still one of the most common ones is the diabetic retinopathy [Diseases of the eye]
Diabetes Type 2
There is also a chance of being hit by the diabetic coma, but other than the diabetic ketoacidosis of type 1 diabetics there is no acidification of the body – due to the inhibitory effect of the insulin which is still being produced by the body.
Most worrying are all the possible, creeping long-term problems. Therefore it is important be checked by a Doc regularly!🩺
You could write a whole episode about each one of those secondary diseases, but to keep it short there are high chances to permanently damage your liver, heart, eye & neurological system – just by having a chronic increase of blood sugar!
One of the most iconic ones is the diabetic foot 👣 which can lead up to an indication for amputation – if you are brave enough you can google it and look at some extreme pictures!
Nevertheless, the biggest cause of death 💀 among diabetics is the heart attack 💔⚡️ followed by kidney failure.
Therapy
One of the most important goals is to keep the HbA(1c) ≤ 7 % - reducing the cardiovascular risk [risk of e.g. a heart attack or occlusion of arteries] massively. To give an overview about all target values:
- Fasting blood sugar: 70 – 130 mg/dl
- Oral Glucose Tolerance Test: < 180 mg/dl after 2 hours
- LDL-Cholesterol: < 100 mg/dl
- Nicotine abstention ❌🚬
Keep that in mind🧠: It is always a compromise of the risk of hypoglycaemia [too low blood sugar] & the risks of consequential diseases!
For type 1 diabetics it is fundamental to apply insulin 💉– they get a special, individual schooling for that.
For type 2 diabetics the first stage would be to establish a healthier life style [🍎🤸♂️] which is the most effective & riskless method.
The 2nd Stage would be to prescribe oral anti-diabetics 💊 which is a group of drugs that help to lower blood sugar levels on a lot of different ways [e.g. reducing the absorption of sugar in the intestinal tract or supporting the body own insulin production & effects – the most common drug here is Metformin].
The 3rd Stage would be to establish an insulin therapy💉, eventually in combination with oral anti-diabetics.
Thanks for bearing with me trough all three episodes of the diabetes series – I hope you enjoyed it!
I already prepared the next series – stay tuned!
Checklist
By now ...
✅ you can distinguish Diabetes Type 1 from Diabetes Type 2 **
✅ you know how to diagnose Diabetes**
✅ you know aspects of the therapy for Diabetes Type 1 & 2
Also do not forget to follow in order to not miss out on new content!
See you soon!
Noogie 👨⚕️
Disclaimer
The content shown here is no alternative to consulting a doctor – if you have any kind of health issues bothering you, firstly consider visiting a health-expert. This is just meant to feed your personal interests. All the information given are related to the German standards