General Medicine - Anticipation to a meal

6 important questions on General Medicine - Anticipation to a meal

What is the prevalence and mortality of diabetes? Differences between low and high income?

108 million in 1980
422 million in 2014 (10% of the global population)

Prevalence has been rising more rapidly in low- and middle-income countries than in high-income countries. In 2019, an estimated 1.5 million deaths worldwide were directly caused by diabetes.

What is the role of insulin in the body?

The amount of glucose in your bloodstream is tightly regulated by the hormone insulin. Insulin is produced by the beta cells in the pancreas. Insulin is always being released in small amounts by the pancreas. When the amount of glucose in your blood rises to a certain level, the pancreas will release more insulin to push more glucose into the cells. This causes the glucose levels in your blood to drop.

What are the risk factors for type 1 diabetes?
And for type 2?

Type 1:
  • family history (genetics - activation of several genes)
  • diet (especially low vit D intake)
  • infections/illnesses which can damage the pancreas

Type 2:
  • ageing
  • obesity (80-85% of the overall risk)
  • diet (especially saturated fat)
  • physical inactivity
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What are complications of diabetes?

  • Blindness
  • kidney failure
  • heart attacks
  • stroke
  • lower limb amputation

Adults with diabetes have a two- to three-fold increased risk of heart attacks and strokes.
Furthermore, neuropathy (nerve damage) in the feet, combined with reduced blood flow, increases
the chance of foot ulcers, infection and eventual need for limb amputation. Moreover, diabetes is
among the leading causes of kidney failure. Another complication is diabetic retinopathy (damage to retina of the eyes), which is an important cause of blindness. It occurs as a result of long-term accumulated damage to the small blood vessels in the retina. Diabetes is the cause of 2.6% of global blindness.

How can diabetes be diagnosed?

  1. Fasting plasma glucose test: after 8 hours fasting, a blood test will be done to test the sugar levels. The results are:
    1. normal: < 100 mg/dL (5.5 mmol/L)
    2. prediabetes: 100-125 mg/dL
    3. diabtes: >126 mg/dL
  2. Oral glucose tolerance test (OGTT): drinking beverage with glucose and then haing you blood tested every 30-60 minutes for 3 hours.
    1. diabetes: > 200 mg/dL at 2 hours

How can diabetes be treated?

Diet and physical activity along with lowering of blood glucose and the levels of other known risk factors that damage blood vessels.

A healthy diet, regular physical activity, maintaining a normal body weight and avoiding tabacco use are ways to prevent or delay type 2 diabetes.

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