Types of Diabetes

Diabetes, Why Bother Typing?

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What is Diabetes?

Diabetes is a chronic metabolic disorder with high levels of glucose in the blood. A gland in the tummy named pancreas secretes a hormone called Insulin, which controls blood glucose.

When we eat, glucose is absorbed from the stomach and enters in the blood. The glucose must enter into the cells to make energy and insulin helps glucose to enter the cells.

Diabetes is the result of inability of the pancreas to produce normal amount of Insulin or Insulin becoming ineffective to do its’ job.

How do we diagnose Diabetes?

The normal blood glucose in the morning before taking any food (fasting) is less than 100 mg. There are four ways we diagnose Diabetes. If there is no symptom, we need a repeat test. Urine glucose is not reliable for diagnosis.

  • Fasting blood glucose 126 mg or more is diagnostic of Diabetes; value in-between 100 mg to 125mg is borderline.

  • A random blood glucose sample taken anytime of the day more than 200 mg is also diagnostic of Diabetes. In doubtful cases sample is taken after a glucose drink, called glucose tolerance test (GTT- blood sugar is measured at fasting and after 120 min of oral glucose)

  • HbA1C – Hba1c 5.9 to 6.4 is pre-Diabetes and more than 6.4 is current definition of Diabetes

What are the types of Diabetes?

There are two main types: type 1 or Insulin deficient and type 2 or Insulin resistant or adult onset Diabetes.

In type 1 Diabetes pancreas does not produce Insulin and you cannot survive without Insulin. This happens because body produces antibody to Insulin producing cells and they get destroyed.

In type 2 Diabetes, pancreas does produce Insulin but it is insufficient and/or less effective. Diabetes can manifest for the first time in pregnancy, called gestational Diabetes.

Certain medications like steroids in high doses can cause diabetes, another cause of Diabetes is Pancreatitis (acute or chronic) – they are called secondary diabetes.

Tests done to differentiate Type 1 from 2 Diabetes (AUTOIMMUNE DIABETES PROFILE)                                        

Test Normal Value How does it help?
Insulin Auto-Antibody (IAA) <30  IU/ml Elevated levels of IAA confirm a diagnosis and Predict the risk for
Developing type-I Diabetes
GAD – 65 Antibody <30  IU/ml The presence of GAD-65 autoantibody (most common autoantibody) also Confirms the autoimmune nature of Diabetes, i.e , type-I Diabetes.
Estimated Average Glucose (eAG) 70 – 115(mg/dl) Estimated Average Glucose is calculated by converting the A1c number (a percent) to equivalent glucose level(mg/dl)
C-Peptide 0.81 – 3.85 (ng/ml) C-Peptide test is used to monitor insulin production, It helps to determine how much insulin a person’s pancreas is still producing.
Heamoglobin A1C <5.9 (%) Heamoglobin A1c is the part of total haemoglobin that has glucose attached to it. High A1c levels are caused by high levels of blood glucose over the preceding 3 months
Heamoglobin A1C <5.9 (%) Heamoglobin A1c is the part of total haemoglobin that has glucose attached to it. High A1c levels are caused by high levels of blood glucose over the preceding 3 months

What way this autoimmune profile help us in treatment?

Adult can have type 1 Diabetes just as it presents in the children,autoimmune profile can help in typing the Diabetes and correct treatment can be started.

There is another type of Diabetes interestingly where autoimmune profile helps, it is called LADA– Latent autoimmune Diabetes of Adults, where the process of autoimmunity is slow and they do not present as classic type 1 Diabetes,initially they respond to diabetes tablet,but after some time they become dependant on insulin.

The other place where the autoimmune profile tests can be helpful is children and adolescent with type 2 Diabetes.

Modernisation, lack of exercise,easy availability and palatability (!) of fast food all are to share the responsibility along with the change of the environmental pollution etc.Typically the chid is obese and has family history of type 2 Diabetes(they are born with the gene).  They will respond to healthy eating,regular physical exercise and a tablet called Metformin.

To see the pancreatic reserve of insulin at Diagnosis – C-Peptide test is a good indicator, it also helps us to differentiate type 1 from type 2 Diabetes. Type 1 diabetes will have less c-peptide reserve.

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