Did you know that diabetes has been around for at least 3500 years. Evidence was discovered in the Ebers papyrus. In these documents there are descriptions of symptoms of extreme thirst and increased urination. Further evidence is seen in the 1st century CE, the Greek physician Aretaeus of Cappadocia provided one of the most detailed early descriptions of diabetes. He emphasized the excessive passage of urine by people with the disease.
It wasn't until the 19th and 20th centuries that significant advancements were made in understanding diabetes. In 1889, German physicians Paul Langerhans discovered the pancreatic islets, the areas of the pancreas containing beta cells responsible for producing insulin. Then, in 1921, Frederick Banting and Charles Best discovered insulin, the hormone responsible for regulating blood sugar levels. This groundbreaking discovery revolutionized diabetes treatment and transformed the prognosis for people with Type 1 diabetes.
Since the discovery of insulin, researchers and medical professionals have continued to deepen their understanding of diabetes, leading to the classification of Type 1 and Type 2 diabetes, along with other types such as gestational diabetes. Today, ongoing research and advancements in diabetes management aim to improve the quality of life for millions of people living with diabetes worldwide.
Part of that research played a role in identifying the various stages of type 1 diabetes and type 2 diabetes.
Type 1 Diabetes
A chronic autoimmune disorder in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. Insulin is a hormone that regulates the amount of sugar in the bloodstream, and without it, glucose cannot enter the cells to provide energy. Type 1 diabetes can develop at any age despite the outdated nomenclature of Juvenile Diabetes.
Genetic Predisposition and Autoimmune Activation
The first stage of Type 1 diabetes begins with a genetic predisposition. Certain genes are associated with an increased risk of developing the condition. However, having these genes does not guarantee that someone will develop diabetes. Other environmental triggers play a critical role in the progression of the disease. For example, during the cold and flu season there is an increase in diagnosis of type 1 diabetes. Viral illness is one trigger for the autoimmune response. During this stage, the immune system starts to malfunction and may produce autoantibodies that target the beta cells in the pancreas. These autoantibodies are a key indicator that the immune system is attacking the insulin-producing cells, leading to the destruction of beta cells over time.
Stage One: Asymptomatic Pre-diabetes
In this stage, there may be no noticeable symptoms, but the autoimmune process is already underway, resulting in the gradual destruction of beta cells. Blood glucose levels may be slightly elevated, but not high enough to diagnose diabetes. However, specific autoantibodies can be detected through blood tests, signaling an increased risk of developing Type 1 diabetes in the future. Identifying pre-diabetes is crucial as it provides an opportunity for early intervention and close monitoring to delay or prevent the onset of diabetes.
Stage Two: Symptomatic Onset and Diagnosis
At this stage, a significant number of beta cells have been destroyed, leading to a considerable reduction in insulin production. As a result, glucose accumulates in the bloodstream, causing hyperglycemia. This leads to the onset of classic symptoms such as excessive thirst, frequent urination, unexplained weight loss, fatigue, and increased hunger. A diagnosis of Type 1 diabetes is typically confirmed based on the presence of symptoms, elevated blood sugar levels, and the detection of specific autoantibodies in the blood.
Initial Diabetes Management: After diagnosis, individuals with Type 1 diabetes need immediate treatment to manage their condition effectively. The cornerstone of treatment is insulin therapy, as the pancreas can no longer produce sufficient insulin. Insulin may be administered through injections or an insulin pump. Blood glucose monitoring becomes a routine part of managing diabetes, helping individuals adjust their insulin doses and manage their diet and exercise to maintain stable blood sugar levels.
Managing Type 1 diabetes is a lifelong commitment. It involves consistent blood sugar control to prevent both short-term and long-term complications. Uncontrolled diabetes can lead to acute complications like diabetic ketoacidosis and hypoglycemia, which can be life-threatening if not managed promptly. Long-term complications of Type 1 diabetes include cardiovascular issues, neuropathy, nephropathy, retinopathy, and foot ulcers. However, with diligent diabetes management, the risk of complications can be minimized.
Ongoing Research and Advancements:
Research in diabetes continues to advance, seeking better treatment options, improved insulin delivery methods, and potential cures. Advancements in technology, such as continuous glucose monitoring systems and closed-loop insulin delivery systems, have significantly improved the quality of life for those living with Type 1 diabetes.
Type 2 Diabetes
Type 2 diabetes is a metabolic disorder characterized by insulin resistance, where the body's cells do not respond effectively to insulin, and relative insulin deficiency, where the pancreas does not produce enough insulin to meet the body's needs. It is the most common type of diabetes and is often associated with lifestyle factors such as obesity, sedentary behavior, and poor dietary habits.
Prediabetes:
The early stage of Type 2 diabetes involves insulin resistance. When this occurs the body's cells do not respond well to insulin's actions. As a result, glucose uptake into the cells is impaired, leading to higher blood sugar levels. The pancreas compensates by producing more insulin to maintain normal blood sugar levels. During this stage, blood glucose levels are higher than normal but not high enough for a diabetes diagnosis. People with prediabetes have an increased risk of developing Type 2 diabetes and may also experience other metabolic changes, such as abnormal lipid levels.
Symptomatic Onset and Diagnosis:
As insulin resistance worsens, the pancreas may struggle to produce enough insulin to overcome the resistance. Leading to the blood glucose levels rising above the normal range, resulting in symptoms similar to Type 1 diabetes, such as excessive thirst, frequent urination, fatigue, and blurred vision. A diagnosis of Type 2 diabetes is confirmed through blood tests, typically measuring fasting blood glucose levels or conducting an oral glucose tolerance test.
Lifestyle Modifications and Oral Medications:
Following a Type 2 diabetes diagnosis, lifestyle modifications become crucial in managing the condition. These modifications include adopting a balanced diet, engaging in regular physical activity, and achieving and maintaining a healthy weight. Lifestyle changes aim to improve insulin sensitivity and glucose control.
Healthcare providers may prescribe oral medications to help lower blood sugar levels. These medications work in various ways, such as stimulating insulin release, reducing glucose production in the liver, or increasing insulin sensitivity in the cells. Always consult your physician before making any big chances to your plan of care.
Insulin Therapy and Additional Medications:
Over time, the pancreas's ability to produce insulin may decline further, necessitating the addition of insulin to the treatment plan. Insulin injections help to control blood sugar levels and may be used in combination with oral medications. In some cases, healthcare providers may also prescribe other injectable medications, such as GLP-1 receptor agonists or SGLT-2 inhibitors, to improve blood glucose control and support weight management.
Advanced Diabetes Management:
As Type 2 diabetes progresses, managing blood sugar levels becomes more challenging. Regular monitoring, adherence to medications, and lifestyle adjustments are critical to preventing acute complications like hyperglycemia and hypoglycemia. Long-term complications of Type 2 diabetes can affect various organs and systems, including the heart, blood vessels, kidneys, eyes, and nerves. These complications may include cardiovascular disease, diabetic nephropathy, diabetic retinopathy, neuropathy, and foot ulcers.
Ongoing Research and Treatment Advancements:
Researchers continuously explore new treatment options and interventions to improve the management of Type 2 diabetes. Advances in medical technology, such as continuous glucose monitoring (CGM) systems and closed-loop insulin delivery (artificial pancreas), have provided additional tools to help individuals manage their condition more effectively.
Understanding the different stages of Type 1 and Type 2 diabetes is essential for early detection, proper management, and minimizing the risk of complications. For individuals with Type 1 diabetes, early intervention, regular medical check-ups, and a proactive approach to diabetes management can empower them to lead healthy and fulfilling lives. On the other hand, comprehending the stages of Type 2 diabetes is crucial for early detection, appropriate management, and the prevention of complications. Adopting a balanced diet, engaging in regular exercise, and undergoing regular medical check-ups, in close collaboration with healthcare professionals, are key to effectively managing Type 2 diabetes and promoting better overall health and well-being, particularly for those with prediabetes.
All the love,
Trisha BSN, RN
The Diabetic Diabetes Nurse
References
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