ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

An Overwiew of Diabetes - What you need to know

Updated on August 15, 2011

Diabetes is a metabolic disorder characterized by hyperglycemia due to an absolute or relative lack of insulin or a cellular resistance to insulin. It is a multifactorial disorder caused by diminished insulin action since it affects basically the whole body. In older classification there were two main types of diabetes i.e. type 1 and type 2 but the newer classification is as follows;

Type 1: immune mediated or idiopathic

Type 2: insulin resistance /insulin deficiency

Type 3: genetic syndromes, drug induced, hormonal, malnutrition related

Type 4: gestational diabetes

Type 1 diabetes is a disease of insulin deficiency. The immune-mediated form of the disease is common in the West compared to the East. Type 1 diabetes is prominent as a disease of childhood, reaching a peak incidence around the time of puberty, but it can present at any age.

Type 2 diabetes is relatively common in all populations enjoying an affluent lifestyle. The four major determinants are increasing age, obesity, ethnicity and family history. It is becoming a global health problem. It is estimated that 15.7 million people around the world are affected and among those 10.3 are diagnosed while 5.4 are undiagnosed. Overall prevalence within the UK is 2–3%, and the lifetime risk is around 15%. It is 2–4 times as prevalent in people of South Asian, African and Caribbean ancestry who live in the UK, and the life-time risk in these groups exceeds 30%.

Diabetes can present in many ways; there can be an acute presentation with polyuria (excessive passage of urine), thirst and weight lost lasting for 2 to 6 weeks or a chronic presentation with non specific fatigue, malaise, visual blurring, and genital candidacies. Nonetheless certain individuals directly present with complications related to diabetes since it is a multisystem disorder like staphylococcal skin infections, retinopathy noted during a visit to the optician, a polyneuropathy causing tingling and numbness in the feet, erectile dysfunction, arterial disease, resulting in myocardial infarction or peripheral gangrene.

Sometimes patients can be completely asymptomatic and can be found to have elevated blood glucose or glycosuria which is found as an incidental finding. Sometimes patients do present with emergencies related with diabetes such as diabetic ketoacidosis and non-ketotic hyperosmolar coma.

For diagnosing diabetes there is a criteria defined by WHO as stated below;

·         Fasting plasma glucose > 7.0 mmol/L (126 mg/dL)

·         Random plasma glucose > 11.1 mmol/L (200 mg/dL)

·         One abnormal laboratory value is diagnostic in symptomatic individuals; two values are needed in asymptomatic people.

The glucose tolerance test is only required for borderline cases and for the diagnosis of gestational diabetes.

The glucose tolerance test – WHO criteria


Normal <7.0 mmol/L  

Impaired glucose tolerance <7.0 mmol/L

Diabetes Mellitus >7.0 mmol/L

2 hours after glucose

Normal <7.8 mmol/L

Impaired glucose tolerance 7.8–11.0 mmol/L

Diabetes Mellitus ≥11.1 mmol/L

Impaired glucose tolerance (IGT) is not a clinical entity but a risk factor for future diabetes and cardiovascular disease. Obesity and lack of regular physical exercise make progression to frank diabetes more likely. Individuals with IGT have the same risk of cardiovascular disease as in frank diabetes but do not develop the specific microvascular complications.

Most important thing to know in a patient with diabetes mellitus is that there are a lot of complications related to the long term control of the disease. The complications are of two types namely macrovascular complications and microvascular complications.

The pathogenesis of each group of complications is different and difficult to explain but there are several described mechanisms.

1.      Non-enzymatic glycosylation of a wide variety of proteins, e.g. haemoglobin, collagen, LDL and tubulin in peripheral nerves. This leads to an accumulation of advanced glycosylated end-products causing injury and inflammation via stimulation of pro-inflammatory factors, e.g. complement, cytokines.

2.      Polyol pathway. The metabolism of glucose by increased intracellular aldose reductase leads to accumulation of sorbitol and fructose. This causes changes in vascular permeability, cell proliferation and capillary structure via stimulation of protein kinase C and TGF-β.

3.      Abnormal microvascular blood flow impairs supply of nutrients and oxygen. Microvascular occlusion is due to vasoconstrictors, e.g. endothelins and thrombogenesis, and leads to endothelial damage.

4.      Other factors include the formation of reactive oxygen species and growth factors stimulation (TGF-β) and vascular endothelial growth factor (VEGF). These growth factors are released by ischaemic tissues and cause endothelial cells to proliferate.

5.      Haemodynamic changes, e.g. in kidney.

 Atherosclerosis mainly attributes in causing macrovascular complications. It affects coronary vessels causing increase in incidence of ischemic heart disease, cerebral vessels causing cerebrovascular accidents (CVA) and peripheral blood vessels causing peripheral vascular disease (PVD).

Microvascular complications affect small vessels in the whole body but effects are apparent in three particular sites giving serious effects i.e. retina causing retinopathy, renal glomerulus causing nephropathy, nerve sheaths causing neuropathy. Here the strict glycaemic control can delay both these complications yet it cannot be prevented entirely.

Treatment of diabetes is based on;

1.      Lifestyle modifications including diet and exercise

2.      Treating with oral hypoglycaemic agents

3.      Insulin therapy

Management is aimed at controlling hyperglycaemia and preventing hypoglycaemia; delaying or treating complications; improving wellbeing of the patient. Patient should be informed regarding all the complications related to the disease and also regarding adverse effects related to treatment. They should also be aware of the symptoms and signs of hypoglycaemia and emergencies.  It is very important to have the patient compliance and give psychological support to the patient since management lasts throughout the lifetime of the patient.


    0 of 8192 characters used
    Post Comment

    • Nadeeshan301 profile imageAUTHOR

      Chathurika Dhanasekara 

      6 years ago from Kandy - Sri Lanka

      Thank you for the comment Denise Handlon!!

    • Denise Handlon profile image

      Denise Handlon 

      6 years ago from North Carolina

      Wonderful hub filled with useful information and well written.

    • Nadeeshan301 profile imageAUTHOR

      Chathurika Dhanasekara 

      6 years ago from Kandy - Sri Lanka

      Dear Binaya.Ghimire,

      Thank you for the comment! Glad that the hub was useful!!

    • Nadeeshan301 profile imageAUTHOR

      Chathurika Dhanasekara 

      6 years ago from Kandy - Sri Lanka

      Dear Apostle Jack,

      I think you are asking about how diabetes is inherited. Diabetes is a multi-factorial, polygenically inherited disease. So, it is not possible to predict whether the disease will be transmitted to the next generation, although the risk of developing diabetes (type 1, 2 and 4) is high in an individual with a 1st degree relative diagnosed to have diabetes.

      As it is multifactorial genes are only one factor determining the acquisition of the disease. Other factors such as diet and exercise are also important.

      However, there are forms of diabetes known as LADA and MODY which are inherited due to mutations in single genes. These have autosomal dominant and recessive forms and therefore in some the risk of seeing diabetes in the next generation is as high as 50%.

      Thank you for the question and you are always welcome for comments and question!!

    • profile image


      6 years ago

      Diabetes is very common these days, thanks for this useful advice.

    • Apostle Jack profile image

      Apostle Jack 

      6 years ago from Atlanta Ga

      What are the traits of diabetes?


    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at:

    Show Details
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the or domains, for performance and efficiency reasons. (Privacy Policy)
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)