Types of diabetes

DIABETES- Long Story Short

     Whilst having a deadly potential, diabetes affects 537 million people worldwide, Romania’s fair share revolving around 2 million. The Covid-19 pandemic nonetheless ensued an alarming rise in type 1 diabetes, reaching almost 9 million worldwide and almost 10.000 in Romania. On the other hand, as a direct result of extra weight issues, type 2 diabetes is on the line for 40% of Romanian children; that is to say, 40 %  aged 0-18 are overweight. This means almost 1 in 2 children, that is, almost half are clinically obese and therefore, prone to type 2 later in life. Unfortunately, the pandemic made things worse, steadily increasing stats, up to the point of reaching 783 million cases in 2045, according to the International Diabetes Federation estimates.

Diabetes occurs when the pancreas ceases to release insulin or when our body cannot effectively handle or utilize insulin. Insulin is a hormone released by the pancreas which acts like a  key and allows the glucose found in the food we eat, to get through, from our blood stream, to our body cells, in order to produce energy. In other words, within our blood stream, the carbohydrates found in food turn into glucose and the insulin helps glucose go through to our body cells. The sheer inability to release insulin or to utilize it effectively determines predictably a steady rise in glucose levels (hyperglycemia)

Diabetes represents a complex chronic metabolic disorder, underpinned by an equally complex etiology which entails various risk factors spanning from social and genetic to behavioral and environmental.  Being unable to control one’s blood sugar is associated with severe complications affecting various organs or tissues, though early diagnosis and treatment can prevent or delay complications on the long run.

 TYPES OF DIABETES

     Type 1 diabetes (known as insulin-reliant, commonly with childhood on-set) is an autoimmune condition mainly characterized by a deficit in insulin production and requires daily insulin shots to keep the blood sugar under control. In case the insulin is unavailable, type 1 proves deadly and patients may lose their lives as a result.   What causes type 1 remains unknown for the time being and on the basis of what we do know so far, it can neither be prevented. It can affect all age groups, though it is a common occurrence in children or young adults.

Symptoms usually have a sudden on-set and may include: massive urine production (polyuria), enurezis, abnormal thirst or dry mouth (polidypsia), permanent hunger, unexplained rapid weight loss,  blurred vision, extreme tiredness and lack of energy, slow-healing wounds or recurrent infections, sweet smelling breath, abdominal pain, and last but not least, tingling, numbness in hands and feet or dry, itchy skin, as well.

     Type 2 Diabetes (also known as non-insulin reliant or with adulthood on-set) represents at least 90% of all diabetes diagnoses. Its specificity revolves around insulin-resistance or in other words, around the underlying moderate deficit of insulin, being most frequently associated with excess weight or obesity. As a matter of course, insulin-resistance develops despite the fact that the pancreas secretes enough insulin to lower the rising glucose in the blood. What happens though, is that the former does not get through in the system, being thus, unable to take its effect and act as it naturally should, due to its remaining ineluctably “stuck” within the fat cells. Consequently thereby, it is no wonder that high blood sugar as well as elevated insulin levels constitute the telltale signs for type 2 diabetes.

     Normally, right after we eat, foods break down and synthesize at our gut level, turning into glucose, entering next into the blood flow and raising thus blood sugars. By way of immediate consequence, it is the pancreas’ turn to intervene with its insulin input to lower the latter. Nonetheless, as far as the overweight are concerned, even though their pancreas is normal, both in terms of structure and functionality, the insulin input remains unable to produce its likely effects, all due to the insulin being stuck in the underlying excess fat. Differently put, the fact that the insulin gets stuck within fat cells puts in turn, immense pressure on the pancreas, to release even more insulin in order to lower glycemia. This concrete occurrence unfortunately only triggers elevated insulin levels in the body, and not blood sugar balancing, as expected.

     Also known as an urban lifestyle disorder, type 2 diabetes can be managed through oral medication and/ or insulin but most importantly and with great results, through diet, healthy nutrition and daily exercise. Symptoms can be similar to those specific to type 1, though less poignant. It may lay dormant for long periods of time, patients being diagnosed as a result of serious complications or in-depth blood and urine tests. Not until recently, type 2 used to take a toll only on adults, though nowadays, it is becoming increasingly common in children and teenagers as well.

     Gestational diabetes is a form of diabetes that entails hyperglycemia or elevated levels of glucose in the blood, during pregnancy. It occurs roughly once in every 25 pregnancies world-wide and presents associated risks for both mother and child. Usually, it goes away on its own at the end of pregnancy, though women as well as their children are at risk of developing type 2 diabetes later in life. That is to say, almost half of affected women will be prone to develop type 2, in the first 5 to 10 years after bearing their pregnancies. For gestational diabetes, the diagnosis comes much more often as a result of thorough prenatal screenings than through reporting specific symptoms.

     Type 3 Diabetes and Alzheimer’s on-set

     Not until recently, a new diagnosis concept has readily emerged, i.e. the type 3 diabetes. It is worth noting that it has nothing to do with diabetes mellitus as we know it, but with Alzheimer’s disease, getting associated by virtue of their underlying occurrence mechanisms that are somewhat similar. In other words, the insulin-resistance that causes type 2 has proved to be causally linked with the on-set of Alzheimer’s disease as well.

     As mentioned above, insulin-resistance occurs where there is excess weight or obesity. In any case, even though the pancreas secretes enough insulin to lower the blood sugar, the latter has trouble getting through because it gets stuck in fat cells; thus, it is virtually unable to act as it should and the patient ineluctably undergoes high blood sugar. What is more interesting and recent studies have shown, insulin-resistance also bears detrimental effects on the brain notwithstanding, with serious consequences on memory or other dementia-related issues, like it is the case of Alzheimer’s disease.

Differently put, we are already aware that type 2 occurs in patients with excess weight and associated hyperlipidemia (high levels of fats i.e. high cholesterol and high triglycerides due to unhealthy, processed- based diet consisting in refined carbs, saturated- trans fats, sugar etc). On the other hand, there has been shown that Alzheimer’s disease also occurs due to hyperlipidemia and unhealthy nutrition. Hence, the conclusion ensues: these unhealthy diets represent the common etiological factor to both type 2 and Alzheimer’s; nonetheless, by way of logical consequence, if type 2 is associated with hyperlipidemia and hyperlipidemia is linked to Alzheimer’s, then type 2 diabetes must get associated with Alzheimer’s disease.

     In the same context, another aspect draws our attention. From an etiological standpoint, dementia occurs as well due to the use of statins. These are fat or cholesterol-lowering drugs, frequently prescribed to patients with hyperlipidemia and diabetes to countervail cardio-vascular disease (heart attack or stroke).

     Statins are mostly prescribed not only to prevent cardiovascular episodes (primary prevention) but also to counteract the aftermath of such episodes (secondary prevention). For instance, as a result of a heart attack, the patient is advised to take statins for the rest of his life, regardless of how little or low their cholesterol gets. However, the brain needs constant feeding of both glucose and fat (healthy fats, that is) to form new synapses and if a patient takes statins and their fat levels stay low or very low, a brain suffering ineluctably gets underway; ergo, we are presented in this case not only with a predictable incapacity of the brain to form and perform new synapses but also concurrently, with a predictable Alzheimer’s dementia onset.

     Be that as it may, even though we pay heed to the clinical paradox that underlies these matters, we have no intention to advise against statins. By contrast, they have been shown to save lives and the treatment should not be interrupted under no circumstance, regardless whether it involves primary or secondary prevention. Indeed, at the end of the day, prevention is undoubtedly the best, but with healthy nutrition as our most efficient tool to achieve it.

     All in all, these are the reasons why type 2 diabetes gets associated with Alzheimer’s disease; the type 3 diagnosis-concept eminently defines an old-age brain disorder with underpinning specificity as well as etiological mechanisms, factually similar to those involved in type 2.

     MODY Diabetes (Maturity-onset Diabetes of the Young) is another type, commonly found among youngsters under 25. As opposed to other types of diabetes, MODY is mostly inherited, due to its stronger underlying genetics. Thus, genetic testing remains mandatory in order to pinpoint the diagnosis. Moreover, if a parent presents this genetic mutation, there are 50% chances their child inherits it, regardless whether the latter adopts a healthy lifestyle or not. As far as symptoms are concerned, MODY often resembles type 2; though, as far as excessive weight is concerned, this type of diabetes has nothing to do with obesity; that is to say, patients getting this diagnosis are almost never overweight. There are already 6 types of MODY established and there are high chances other types will emerge in the future. Its underlying severity may vary from one type to the other, though in most cases, it may manifest as a mild form of type 1 diabetes (with partial insulin input as well as normal insulin sensitivity) and treatment does not always entail insulin administration.

     In the same vein nonetheless, it is worth stressing one of the most common type of MODY, that is, the HNF1-alfa. This gene is responsible for roughly 70% of cases, determining the diabetes outbreak through lowering the insulin input stemming from the pancreas. Most frequently, the treatment does not require external insulin shots, just type 2 specific medication will suffice. On the other hand, as far as this gene is concerned, patients have low blood glucose right from birth, leaving them in need of specific medication and insulin treatment thereof.  Additionally, in case of HNF1-beta,  patients may develop not only renal cysts, uterine abnormalities and gout but also diabetes complications, its underpinning treatment requiring insulin administration as well as a proper, balanced diet and a healthy lifestyle altogether.

     All in all, regardless of the MODY type, the main priority in terms of prevention or treatment is no different than the one pertaining to other types of diabetes i.e. maintaining blood sugars within normal ranges, daily walking or exercising as well as insulin and/or oral anti-diabetes medication.

     LADA Diabetes (Latent Autoimmune Diabetes in Adults) is a different form of diabetes, with  the usual onset affecting adults over 35. Also known as type 1.5, LADA resembles type 1 insofar the autoimmune component is concerned, though it presents its own specificity. The outbreak can be very slow and intricate, spanning several years overall. Thusly, LADA presents positive antibodies, similarly to type 1, though its obliteration of the pancreatic beta-cells presents a much slower progress than in the case of the latter. In other words, in case of type 1, these beta cells get destroyed at a much faster pace, the insulin availability thusly stalling or becoming virtually impossible; in LADA case though, this process insidiously takes place over a long period of time, the pancreas decreasing the insulin input in slow motion, so to speak. Therefore, at the outbreak, patients require only oral diabetes medication as well as a healthy, balanced diet whereas towards the end of the aforementioned beta-cells obliteration process, insulin administration becomes a sheer must. It is worth noting that the LADA patient resembles the type 2 patient, though they are almost never overweight. In addition, it is worth mentioning that likewise type 1, LADA patients have high chances to develop associated autoimmune diseases, for instance, autoimmune thyroid, lupus, vitiligo, rheumatoid arthritis or coeliac disease.