Prevalence of Diabetes

The World Health Organization (WHO) has declared diabetes as a hidden epidemic, considering the statistics and the increasing trend worldwide, and has called on all countries to combat this epidemic since 1993. According to the International Diabetes Federation (IDF), one in every 12 people has diabetes, and one in every two diabetics is unaware of their condition. The number of people with diabetes in 2021 was 537 million, and it is predicted that this number will reach 783 million by 2045. In 2014, the medical costs associated with diabetes amounted to 612 billion dollars.

Iran is among the top 5 countries in terms of the number of diabetes patients in the West Asia region. According to IDF statistics, over 5.5 million people in Iran have diabetes in 2021. The prevalence of diabetes varies in different regions of Iran. According to studies conducted, the highest prevalence of diabetes is observed in Yazd city.

Types of Diabetes

Diabetes is generally classified into four types: Type 1 diabetes, Type 2 diabetes, gestational diabetes, and secondary diabetes.

Type 1 Diabetes

Type 1 diabetes, previously known as insulin-dependent diabetes, accounts for 5 to 10 percent of all diagnosed diabetes cases and is more commonly seen in individuals under 30 years of age (although it can occur at any age) and is due to the destruction of insulin-secreting cells, resulting in a lack of this hormone. Individuals diagnosed with this type of diabetes must supply their body's insulin needs through daily injections from the moment of diagnosis.

Type 2 Diabetes

Type 2 diabetes is more commonly seen in adults over 30 years old and in overweight and obese individuals, accounting for 90-95 percent of all diabetes cases. This type of diabetes was previously referred to as non-insulin-dependent diabetes (which will be discussed in detail later).

Gestational Diabetes

This type of diabetes is diagnosed during pregnancy in some women and occurs in approximately 7 percent of all pregnancies. This type of diabetes is usually transient and improves after pregnancy. Individuals with gestational diabetes are later at risk of developing Type 2 diabetes.

Secondary Diabetes

Diabetes resulting from specific genetic syndromes, certain surgeries, some medications (such as corticosteroids), malnutrition, certain infections, or other diseases.

Type 2 Diabetes

Type 2 diabetes results from the body's inability to produce enough insulin or its inability to optimally use the produced insulin, a condition known as insulin resistance. Many factors contribute to decreased cell sensitivity to insulin, many of which are still unknown. It is said that physical inactivity, obesity, poor dietary habits, stress, and psychological pressures are contributing factors.

Risk Factors for Type 2 Diabetes

The following factors increase the likelihood of developing diabetes:

Increasing age (over 40 years)

Sedentary lifestyle

Unhealthy dietary habits

Weight gain and obesity (especially abdominal obesity)

Dyslipidemia

High blood pressure

History of gestational diabetes

History of giving birth to a baby weighing over 4 kilograms

History of polycystic ovary syndrome

Insulin resistance syndrome

Use of certain medications such as corticosteroids

Smoking

Genetics

Diabetes factor

Symptoms of Type 2 Diabetes

Type 2 diabetes has a slow onset, and its most common initial symptom is actually asymptomatic. A significant percentage of individuals with Type 2 diabetes (almost half of them) are unaware of their condition, and only through testing can the disease be diagnosed. The most common symptoms include:

Thirst and excessive drinking

Hunger and overeating

Frequent urination (polyuria)

Unexplained excessive fatigue

Excessive weight loss

Diabetes symptoms

Prediabetes

Prediabetes is a stage where blood sugar levels are higher than normal but not yet high enough to be classified as diabetes. This stage, which exists in the natural progression of Type 2 diabetes, is referred to as glucose intolerance or prediabetes. Although most prediabetic individuals have no specific symptoms, some of the aforementioned symptoms may be observed in them. These individuals are actually at a higher risk of developing Type 2 diabetes than others. This stage can be easily diagnosed with simple diagnostic methods.

Individuals with prediabetes can significantly delay the onset of Type 2 diabetes by making lifestyle changes that include proper nutrition, weight loss, and regular physical activity.

Diabetes Screening

Healthcare professionals should encourage individuals to undergo regular screening for diabetes. This is especially important in groups that are at higher risk. Due to the significant increase in Type 2 diabetes among children, the ADA recommends screening in high-risk groups.

Diagnosis of Type 2 Diabetes

Standard methods for diagnosing diabetes include biochemical blood and urine tests. To diagnose hidden diabetes, a doctor usually prescribes two types of tests: fasting blood sugar (FBS or FPG) and oral glucose tolerance test (OGTT).

Fasting Blood Sugar Test

The oral glucose tolerance test (OGTT) measures blood sugar two hours after consuming 75 grams of glucose. Values above 200 mg/dl indicate diabetes. This method is costly and less effective.

Status of the glucose tolerance test (OGTT) result

Normal less than 140 mg/dl

Glucose intolerance between 140 mg/dl and 199 mg/dl

Diabetes more than 200 mg/dl

Blood Test

The hemoglobin A1C test measures the amount of hemoglobin attached to glucose, which is now used as both a diagnostic criterion and a control measure for diabetes. Values of 5.7 to 6.4 indicate prediabetes, and values above 6.5 indicate diabetes.

Complications of Diabetes

High levels of glucose in the blood can damage various parts of the body, especially the heart, blood vessels, kidneys, nervous system, reproductive system, and skin. Awareness of the complications of this disease helps individuals with diabetes, those at risk, and their surroundings to make greater efforts in monitoring and preventing the disease and to delay its complications.

Diabetes complications are divided into two groups: short-term and long-term:

Short-term (Acute) Complications of Diabetes

Hypoglycemia or low blood sugar

When blood sugar levels drop below normal (below 70 mg/dl), symptoms of low blood sugar appear, usually due to injecting too much insulin or taking certain blood sugar-lowering medications, or even drug interactions, increased physical activity or exercise, delaying meals, or skipping meals.

Warning signs include:

Feeling hungry

Trembling

Perspiration

Irritability and agitation

Rapid heartbeat and pulse

Trembling lips

Blurred vision

Some individuals may experience hypoglycemia while sleeping. Symptoms of nighttime hypoglycemia include: bad sleep, nightmares, screaming, excessive sweating, and high fatigue and irritability upon waking.

What to do in case of low blood sugar?

One should consume quick-acting sugary substances such as half a glass of juice, three sugar cubes, or one tablespoon of honey in half a glass of water or a few pieces of candy. If there is no improvement after 15 minutes, this should be repeated.

Always carry a sweet food item such as candy when outside to use in case of low blood sugar.

Hyperglycemia or high blood sugar

Hyperglycemia refers to a condition where blood sugar rises above 240 mg/dl and remains high. When hyperglycemia occurs, it indicates that the disease is out of control. Hyperglycemia develops slowly and usually does not pose an urgent problem, but if blood sugar remains high for an extended period, it can become dangerous. If this condition is not controlled, the signs that were present at the initial diagnosis of diabetes will be felt again by the individual.

Excessive food intake, especially sugary foods, forgetting to take insulin or oral medication, psychological stress, physical injuries, surgery, infections, and even common illnesses such as colds, flu, diarrhea, vomiting, and fever, as well as taking certain medications such as corticosteroids and diuretics can lead to hyperglycemia, which has dangerous long-term complications including cardiovascular problems, kidney damage, eye damage, etc.

Hyperglycemia can lead to diabetic coma, which is a very sensitive stage and is considered a medical emergency.

What to do in case of high blood sugar?

Try to drink plenty of non-sweet liquids and consult your doctor or nutritionist after measuring your blood sugar.

When to see a doctor?

Fever above 38 degrees Celsius for 24 hours

Persistent hyperglycemia with blood sugar above 300 mg/dl

Persistent diarrhea (more than 8 hours)

Vomiting and inability to consume liquids for more than 4 hours

Feeling unwell and malaise for more than 24 hours

Severe abdominal pain, difficulty breathing, or confusion

Long-term (Chronic) Complications of Diabetes

It has now been established that excess sugar in the body can be converted into other substances, which affect the walls of blood vessels and peripheral nerves, disrupting their normal functions. This condition occurs throughout the body, but its effects are more pronounced in the eyes, heart, kidneys, and feet.

Eye Problems

Blurred vision, cataracts, glaucoma, retinopathy (damage to the retina), and blindness

Diabetes is one of the four leading causes of blindness in the world.

Cardiovascular Diseases

Angina, heart attacks, and strokes

Diabetic patients with hypertension are much more at risk of cardiovascular diseases, kidney disorders, and strokes than others.

Nerve Damage

Diabetic foot (formation of ulcers on the foot), gastrointestinal disorders, and gastroparesis (stomach dysfunction), urinary problems, and sexual problems (erectile dysfunction in men and vaginal infections and painful intercourse in women)

It should be remembered that diabetic foot is one of the most serious complications of diabetes that can lead to amputation of the individual's foot; therefore, all patients should be regularly examined to detect high-risk conditions in the foot and receive necessary education on foot care.

Kidney Problems

Nephropathy and kidney failure

Blood sugar levels and blood pressure are involved in the occurrence of kidney complications. Therefore, the better the control of blood sugar and blood pressure, the lower the likelihood of these complications.

Skin Problems

Wounds, infections, skin lesions, and itching

Oral and Dental Problems

Gum infections, tooth decay, and loose teeth

Treatment of Type 2 Diabetes

The treatment of diabetes generally involves achieving normal or nearly normal blood sugar levels and preventing long-term complications of diabetes. It generally includes medication and nutritional therapy.

The five main pillars of diabetes treatment are: education, medication, nutritional therapy, physical activity, and daily blood sugar monitoring.

Medication

Diabetes medication includes the use of oral medications and injectable medications such as insulin.

Oral medications control blood sugar levels by stimulating insulin-producing cells in the pancreas, reducing the body's resistance to insulin, or slowing the absorption of sugar from the digestive tract. Usually, individuals diagnosed with diabetes are initially treated with dietary and lifestyle modifications if their blood sugar is not severely high, and then if blood sugar is not controlled, the use of anti-diabetic medications begins. The doctor may use a combination of several medications.

Glyburide

Metformin

Acarbose

Pioglitazone

Repaglinide

Glyburide reduces blood sugar by stimulating the production and release of insulin from the pancreas if the patient has some insulin production capacity. Metformin is effective in treating diabetes by reducing liver glucose production, delaying glucose absorption, reducing insulin resistance, and also by reducing appetite and stabilizing weight. Acarbose is also a medication that may sometimes be prescribed; this medication delays the absorption of digested carbohydrates and causes blood sugar to rise more slowly.

Take insulin and oral medications as prescribed by your doctor and avoid changing their doses without consulting your doctor or pharmacist.

Nutritional Therapy for Type 2 Diabetes

Perhaps the greatest concern and question for diabetic individuals relates to their diet. Medical nutritional therapy (MNT) is an integral part of all diabetes care and treatments. Various studies have examined the role of nutritional therapy in diabetes and proven its positive impact. One of these studies reported a 2 percent reduction in HbA1c levels in individuals with Type 2 diabetes due to nutritional therapy, which is equivalent to the effect of one of the strongest diabetes medications, Metformin.

One of the most important goals of nutritional therapy in diabetes is to align the diet with the dose of insulin or oral medication.

Nutritional therapy not only helps in better blood sugar control but also significantly aids in weight loss or maintaining ideal weight, controlling fat and blood pressure, and delaying other long-term complications of diabetes. Nutritional therapy is also important in preventing and treating short-term complications (hypoglycemia and hyperglycemia) of diabetes.

Considering all the aforementioned points, consulting a nutritionist to educate and implement appropriate changes in the individual's diet and eating habits for better diabetes control is very helpful.

It is noteworthy that proper nutrition plays a role in both the prevention and treatment of diabetes.

Exchange List

Some nutritionists use an exchange list to educate and organize their patients' meal plans. This list was initially designed for diabetic individuals who need to count their carbohydrate intake, but due to its extensive application, it was decided to use it comprehensively. In this system, foods are divided into six groups based on carbohydrates, proteins, and fats, and ultimately the calorie amount is calculated. The exchange list allows you multiple choices.

Dairy Group

Each unit from the dairy group (low-fat) contains an average of 12 grams of carbohydrates, 8 grams of protein, 5 grams of fat, and 100 kilocalories of energy.

Dairy One unit grams

Milk one glass 240 cc

Yogurt 2/3 glass 170 grams

Buttermilk and Kefir 2 glasses 480 cc

Dry Milk 1/3 glass 35 grams

Consume 2 to 3 units of low-fat dairy daily.

Vegetable Group

Each unit from the non-starchy vegetable group contains an average of 5 grams of carbohydrates, 2 grams of protein, 0 grams of fat, and 25 kilocalories of energy, which, if consumed in moderate amounts, are not counted in carbohydrate counting due to their negligible sugar content and high fiber content that slows down sugar absorption, and their consumption is considered free in the diet.

This category of vegetables includes: cucumber, carrot, tomato, spinach, lettuce, pepper, mushroom, okra, onion, eggplant, celery, cabbage, cauliflower, kohlrabi, broccoli, green beans, zucchini, artichoke, rhubarb, and various herbs.

One unit from this group is equivalent to 1/2 glass of cooked vegetables or vegetable juice and 1 glass of raw vegetables.

Starchy vegetables are categorized under the starch group due to their higher sugar content.

By consuming at least 3 to 5 units of fresh non-starchy vegetables daily, you not only significantly help control your blood sugar but also benefit from the miraculous properties and effects of this food group.

Type 2 diabetes; from zero to one hundred

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