Diabetes Mellitus is a metabolic disorder, which caused by inadequate insulin production by pancreas or ineffectiveness of the insulin actions that lead to a very high blood glucose (sugar) level. Glucose is the simplest form of sugar, which is the energy source for the body’s cells. When the food is being digested, the carbohydrates are broken down into glucose. Glucose will be absorbed into bloodstream to transport to the whole body’s cells. However, the body’s cells cannot absorb glucose without insulin. Insulin is a hormone produced by beta cells (insulin-producing cells) of the islet of Langerhans in pancreas, which will be released into bloodstream once glucose enters the bloodstream.  When there is no or too less insulin production, glucose will accumulate in bloodstream. Then the excessive glucose will pass out from body through urine, causes sweet urine in diabetic patients.

Type 1 Diabetes Mellitus (T1DM)

Type 1 Diabetes Mellitus (T1DM) is also known as insulin-dependent diabetes. It is an autoimmune disease, which the immune system attacks the beta cells, causes destruction of beta cells and lead to little or no insulin production. This condition normally occurs on childhood or adolescence, but may occur on adult too.

Signs and symptoms

There are some similarities between the symptoms of T1DM and T2DM. However, symptoms of T1DM appear more quickly and might be severe. The common symptoms of T1DM are excessive sugar in urine (glycosuria), excessive urination volume (polyuria), excessive thirst (polydipsia), extreme hunger (polyphagia) and weight loss. The symptoms of T2DM may include frequent urination, extreme thirst and hunger, sudden weight loss, blurred vision, slow wound healing, vaginal infection, fatigue and always tired.

These symptoms just let you know that you are possibly having diabetes. To determine your blood glucose level, you can check it through a blood glucose meter or blood glucose monitoring devices. You should visit a doctor for diabetes diagnosis if you found yourself have the symptoms of diabetes or your blood glucose level is higher than normal.

The blood glucose reading indicates the concentration of glucose in blood, which is measured in millimoles per litre (mmol/L; UK standard), sometimes it is measured in milligrams per 100 millilitres (mg/dL; US standard).  Blood glucose level can be measured in the morning after at least 8 hours fasting, or 2 hours after meal.

Besides measuring your blood glucose using a blood glucose meter, doctors or health care professionals will diagnose diabetes through other test, such as OGTT (oral glucose tolerance test), FPG (fasting plasma glucose) test, and HbA1c test. 

Risk factors

• Family history and the genetic. When you have family members (father, mother or siblings) with diabetes mellitus, you have higher risk to develop diabetes mellitus. Besides, people with the presence of autoantibodies in their bodies have increased risk as well. Autoantibodies are the antibodies that fight against self-antigens, which will damage and cause destruction to the beta cells and lead to T1DM.
• Sedentary lifestyle. People who are physical inactivity, little or no exercise, and sitting for most of the time every day, have the higher risk of developing diabetes mellitus. It is also a main factor that contributed to obesity and other chronic diseases.
• Unhealthy diet. Low fiber and high saturated fats diets; High saturated fats and high total fats diet will causes insulin resistance, which the cells are resistant to insulin, and the cells cannot absorb and use glucose effectively, causes high blood glucose level. High carbohydrates (especially refined and processed carbs) diet may also increase the risk of diabetes. High intakes of carbohydrates require more insulin for glucose metabolism, hence it causes burden on beta cells to produce more insulin, and this may accelerate the decline of insulin production. Besides, frequent intake of processed foods, soft drinks or other sugary beverages will increased risk of diabetes and other chronic diseases.
• Obesity and overweight. Most patients developed T2DM due to obesity. The excess body fats cause stress on the body’s cells and lead to insulin resistance.

Complications

Diabetes mellitus always co-exist with several complications especially when the patients did not manage their blood glucose level.

• High blood pressure is the most common complication that coexists with diabetes since their risk factors are similar. Diabetes may causes high blood pressure since it will increases the fluid concentration in the body, reduces elasticity of blood vessels and causes damage to cardiovascular system. This may further link to other cardiovascular disease, such as stroke and heart attack.
• Eye damage is also known as the diabetic retinopathy. Diabetic patients might have poor vision because diabetes mellitus can damages the small blood vessels in retina of the eyes. Also, this will increase the risk of developing cataract and glaucoma, and may cause blindness in diabetic patients.
• Foot complications often occur on diabetic patients. This is because diabetes can causes damage to blood vessels, lead to poor blood circulation and affect the nerve functions, especially at the lower limb of the body. When poor blood circulation occurs on leg or foot, it becomes prone to infection, which is hard to cure and require toe, foot or leg amputation.
• Wound healing process of a diabetic patient is very slow and more prone to some skin problems such as bacterial and fungal infections. A poor blood circulation due to diabetes mellitus causes limited amount of blood flow to the body’s cells especially at lower limb, hence this limited the amount of oxygen and nutrients deliver to cells and slow down wound healing.
• Nerve damage is also known as neuropathy. The excess glucose in blood can damages the blood vessels, and causes nerve damage, eventually loss the sense of touch at the limb parts, especially the lower limb, from toes to leg.
• Other possible complications including kidney damage (nephropathy), erectile dysfunction or male impotence, teeth and gum problems, hearing impairment and mental health disorder.

Manage and Control

• Increase physical activity. Physical activity is the bodily movement which requires energy, such as walking, running, swimming, climbing stairs and etc. Diabetic patients may carry out simple exercise such as walking about 10 minutes, 3 times a day; or other exercises such as yoga, jogging, cycling and etc. Just spend 30 minutes per day to do some exercises and this can help you to improve the control of your blood glucose level.
• Healthy diet. Food is the major concern for a diabetic patient. Diabetic patients should avoid eating foods high in saturated fats, trans-fat, sugar and salt content, such as fast foods, processed meat, canned foods, sugary beverages and etc. Increase dietary fiber intake by eating more vegetables, fruits and whole grains may help to reduce blood glucose level.
• Maintain healthy weight (BMI) and waist circumference (wc).
  
  1. Being overweight or obesity may increases the risk of diabetes mellitus. You can know your weight range by calculating your BMI (body mass index). BMI is an indicator of weight range, which is calculated using weight (kg) divided by square of height (m2).
     

     BMI	Asian	International
     Underweight	< 18.5	< 18.5
     Normal	18.5 – 22.9	18.5 – 24.9
     Overweight	23 – 27.4	25 – 29.9
     Obesity	≥ 27.5	≥ 30

  2. Waist circumference or waist-hip ratio has found to be a more accurate indicator for risk of diabetes mellitus. Waist circumference can be measured by using a measuring tape, measure at your waist where it is a point between bottom of your rib and top of your hip bone. Waist circumference measurement may help to estimate the excess fat, or the fat distribution in abdomen, which is the main cause of abdominal or visceral obesity. Below is a summarized table of waist circumference from Canadian Diabetic Association.
     

     	Central obesity define by waist circumference
     	Men	Women
     International	≥ 94 cm (37.6 inches)	≥ 80 cm (32 inches)
     Asian	≥ 90cm (36 inches)	≥ 80 cm (32 inches)

• Consume dietary supplement. Supplements can help to improve blood sugar level. Consider the supplements such as omega-3 fatty acids, alpha-lipoic acid, chromium, magnesium, coenzyme Q10 and etc. Besides, consuming herbal remedies such as garlic, ginseng, fenugreek seed, and bitter melon are able to maintain healthy blood glucose level. However, it is best to consult your doctor before start taking any health supplements.
• Check your blood glucose regularly. This may help you to monitor your blood glucose level better, but if the blood glucose level is consistently high and unable to lower down, please approach to your doctor for diagnosis and treatment.