Diabetes mellitus: symptoms, treatment and complications

Diabetes mellitus, also called diabetes, is the most common metabolic disorder. The disease is characterized by too much glucose in the blood. There are two main types, these are known as type 1 and type 2. What are the causes and symptoms? How can diabetes be treated, what are the complications and what is the prognosis? What is gestational diabetes? In 2020, work is being done on an artificial pancreas for people with type 1 diabetes.

Article content

  • Metabolism
  • Diabetes mellitus/diabetes
  • Glucose and insulin
  • Types of diabetes mellitus
  • Gestational diabetes
  • Causes of diabetes mellitus
  • Diabetes mellitus type 1
  • Diabetes mellitus type 2
  • Symptoms of diabetes mellitus
  • Ketoacidosis (seek immediate medical attention)
  • Complications of diabetes mellitus
  • Short-term complications
  • Long-term complications
  • Diagnosis diabetes mellitus
  • Treatment of diabetes mellitus
  • Diabetes mellitus type 1
  • Diabetes mellitus type 2
  • Prognosis diabetes mellitus
  • Dutch artificial pancreas

Metabolism

Metabolism: all chemical processes that take place in the body. Nutrients are absorbed from the intestines, substances are made by the body, substances are broken down by the body, waste products are excreted. Many of these processes are controlled by hormones. Metabolic disorders can be caused by over- or underproduction of a certain hormone .

Diabetes mellitus/diabetes

Diabetes mellitus, also called diabetes mellitus, is one of the most common chronic diseases . In the Netherlands, approximately six percent of the population has diabetes mellitus. The body cannot use glucose sufficiently as a source of energy because there is a deficiency of the hormone insulin and/or the body has become insensitive to insulin. This means that the glucose level in the blood is increased .

Glucose and insulin

Glucose is the energy source for the body. It is absorbed from food during meals or it is made by the body itself during fasting. The hormone insulin ensures that glucose is absorbed into various cells of the body. Insulin also ensures that the blood glucose level does not become too high. Insulin is made by the pancreas. In people with diabetes who have not been treated, glucose accumulates in the blood. This causes complaints and organs can be damaged. The body also does not get enough energy to survive. The glucose is excreted in the urine, which is manifested by excessive urination and severe thirst.

Types of diabetes mellitus

There are two main types of diabetes mellitus, they are known as type 1 and type 2.

  • Type 1 : this type occurs when the pancreas produces far too little or no insulin. Diabetes mellitus type 1 usually develops over a short period of time, in childhood or adolescence. But it can also occur later in life. Type 1 is treated with insulin.
  • Type 2 : this type is much more common than type 1. The pancreas does produce insulin, but the effect of the insulin is reduced. The body’s cells have become resistant to insulin. The pancreas tries to solve the problem by producing more insulin. At a certain point this is insufficient and the blood glucose level becomes too high. Type 2 mainly occurs in people over forty years of age and overweight people (including young people). The condition develops slowly and is often noticed late.

Gestational diabetes

Diabetes can develop during pregnancy and is usually treated with insulin to keep mother and child healthy. Gestational diabetes usually disappears after giving birth. Women who have had gestational diabetes are more likely to develop type 2 diabetes later .

Causes of diabetes mellitus

Diabetes mellitus type 1

Diabetes mellitus type 1 is usually caused by an abnormal body reaction, the immune system destroys the cells of the pancreas that produce insulin. The remaining tissue of the pancreas is not affected. It is unknown what causes this, possibly a viral infection. In some people, the cells that produce insulin are destroyed after inflammation of the entire pancreas. Heredity can also play a role. A child of someone with type 1 has a slightly increased risk of developing type 1. However, most children with diabetes do not have a parent with the condition.

Diabetes mellitus type 2

In diabetes mellitus type 2, obesity, little exercise and heredity are important factors. About one in three people with the condition has a family member who also has it. Diabetes mellitus 2 is a growing problem in affluent countries. People are eating and sitting more and more. It can also be caused by the use of corticosteroids or because the body produces too much corticosteroid (Cushing’s syndrome). It inhibits the action of insulin.

Symptoms of diabetes mellitus

The symptoms of diabetes mellitus 1 and 2 are similar, but type 1 usually develops more quickly and the symptoms are often more pronounced. They may resemble complaints of old age. With type 2, the symptoms do not have to be so obvious, as they sometimes only become apparent during a medical check-up.

Symptoms of types 1 and 2

  • Increased urination, often at night;
  • Thirst and dry mouth;
  • Fatigue, a lack of energy.

Even more symptoms that can occur with type 1

  • Weight loss;
  • Sometimes ketoacidosis.

Ketoacidosis (seek immediate medical attention)

Sometimes this is the first sign of diabetes mellitus type 1. It is a result of insulin deficiency in the body, causing toxic substances, ketones, to accumulate in the blood. Ketones are produced when body tissues cannot absorb glucose from the blood because insufficient insulin is produced and must use fat for energy. It can also occur if people with diabetes mellitus type 1 have used too little insulin or, for example, temporarily needed more insulin due to an additional illness. In case of ketoacidosis, seek immediate medical attention! Otherwise, dehydration and coma may occur. In the hospital, fluid and insulin are administered through a vein.

Symptoms

  • Nausea, vomiting, sometimes abdominal pain;
  • A deep breath;
  • On the breath you smell the smell of acetone;
  • Confusion.

Complications of diabetes mellitus

Diabetes mellitus can cause complications in both the short and long term. Short-term problems are usually easy to combat, long-term problems are more difficult.

Short-term complications

  • Type 1 can lead to ketoacidosis;
  • Hypoglycemia occurs as a complication in both types. This is an abnormally low glucose level in the blood, which means that body cells do not receive glucose. Without treatment, hypoglycemia can lead to unconsciousness and seizures.

Long-term complications

A blood glucose level that is as normal as possible reduces the risk of long-term complications. But complications can also occur in people who have the condition well under control. Early recognition of the complication is very important, which is why all people with diabetes should see their doctor for regular check-ups. People with diabetes have an increased risk of cardiovascular disease . This includes arteriosclerosis in the large arteries resulting in a heart attack or stroke, increased cholesterol levels are more common, increased blood pressure, and damage to smaller blood vessels. Also an increased risk of eye diseases (such as diabetic retinopathy, cataracts). Blood vessels of the nerves can become damaged, which can lead to a slow loss of sensation in the feet, legs, hands and forearms. When standing, a person can become dizzy, and impotence can occur in men. Legs and feet can be more prone to ulcers and gangrene due to the loss of sensation. The small blood vessels in the kidneys can also become damaged, which can lead to a decrease in kidney function. Sometimes lifelong kidney dialysis or a kidney transplant is required.

Diagnosis diabetes mellitus

A blood test can reveal too high a glucose level.

Treatment of diabetes mellitus

The aim of the treatment is to achieve and maintain blood glucose levels that are as normal as possible. It can be done through dietary adjustments, a combination of an adjusted diet and insulin injections or an adjusted diet and pills that lower the glucose level in the blood. The treatment is usually lifelong. Diet and medication must be adjusted every day.

Diabetes mellitus type 1

Diabetes mellitus type 1 is almost always treated with insulin injections. Insulin is available in different forms: fast-acting insulin, slow-acting insulin or a combination of the two. The insulin is usually administered using a type of pen. A diabetes nurse will teach you how to inject yourself. If the disease is difficult to control, you may be given an insulin pump. A pancreas transplant is the only way to cure this type of diabetes mellitus. This surgery is rarely offered because the body may reject the new organ and you will need to take lifelong anti-rejection drugs.

Diabetes mellitus type 2

Many people with diabetes mellitus type 2 can get the glucose level in the blood back to reasonably normal through more exercise, an adjusted diet and by losing weight if they are overweight. If this is not possible, a doctor can prescribe medication.

Prognosis diabetes mellitus

Advances in determining blood glucose levels combined with a healthy lifestyle have made it easier to control diabetes mellitus. People with diabetes can lead normal lives. Diabetes mellitus can lead to premature death, especially due to cardiovascular disease.

Dutch artificial pancreas

In the Netherlands, the company Inreda Diabetic is working on the artificial pancreas (which works with insulin and glucagon) together with the AMC (Amsterdam). Research was conducted with the handy device in 2019. The results were so positive that Inreda received the CE mark for the artificial pancreas in February 2020. CE marking means that the product complies with the applicable rules within the European Economic Area. The device may be brought onto the market, but many steps are still required. Consider further development to make the artificial pancreas smaller, more user-friendly and suitable for children. Production needs to be scaled up, setting up a training center and customer service. Also important: discussions need to be held about the reimbursement of the artificial pancreas. Together with insurers, it must be examined whether reimbursement can come from basic insurance. What form will the reimbursement take, but also whether there is a personal contribution. A ruling could take a few years.

Eligibility for an artificial pancreas
The artificial pancreas is now (2020) only available in the context of research projects. If you want to participate in a project, you must register with Inreda . There is a registration form on the website. If Inreda does a project at your hospital and you have registered with Inreda, Inreda will inform you. Together with you and your doctor, we will then determine whether you can participate.