Background: Diabetes is the shared name of different diseases. The two major diabetes diseases by prevalence are Type 1 diabetes, named T1DM and type 2 diabetes, named T2DM. The approximate prevalence of T1DM is 0.5 % of the native population in Sweden (one of the highest worldwide). The prevalence of T1DM increases tenfold to 6 % with one parent having T1DM. T1DM is a genetic, autoimmune disease destroying the insulin producing cells of the pancreas. It occurs early in life and at present makes life-long insulin treatment necessary. The prevalence of T2DM is 7 % in Sweden. T2DM is the result of reduced sensitivity of the body to normal blood levels of insulin (insulin resistance). It develops slowly and occurs later in life, often together with obesity. The two types of diabetes are two different diseases that both present as lack of normal insulin effect and therefore present with similar initial symptoms i.e. increased levels of fasting glucose in blood and urine.
Symptoms: Early symptoms in diabetes are related to the abnormally high fasting blood sugar concentration: unexplained fatigue, increased urine production and thirst. With insufficient treatment and lasting abnormal elevation of blood sugar during months, early changes can be observed in the eyes. After several years of insufficient treatment, damages can be observed in the eyes, immune defense, kidneys, blood vessels, heart, intestines, and nerves.
Diagnosis: of diabetes is based on demonstration of elevated fasting blood sugar concentration, and preferably by a specific blood test (HbA1c) showing the blood sugar concentration during the preceding 6 weeks. Because of the 7% prevalence of T2DM, screening for diabetes is recommended for Caucasian people above the age of 45 who are without symptoms
Treatment:of T1DM requires life-long administration of synthetic insulin injected under the skin. T2DM may be postponed or even prevented by reduction of obesity. This lifestyle intervention is more effective than medical prevention. Treatment of overt T2DM is initially done by increasing the sensitivity of the body to insulin by oral medication and by stimulating lagging insulin secretion from the decompensating pancreas by administration of oral or injected medications. Synthetic insulin may eventually have to be administered in T2DM as in T1DM. The effect of the treatment is monitored by frequent blood sugar measurements done by the patient himself. By daily blood sugar measurements, the patient can determine the correct dose of insulin needed corresponding to his caloric intake and physical activity. This requires detailed patient education and understanding. Regular medical follow-up and adherence to a special diet is necessary to reduce the risk of complications. Continuous blood sugar measurements can be obtained via special sensors placed on the skin. They may transmit blood sugar measurements to an insulin pump that delivers insulin in response to the momentary blood sugar level in a closed loop servo system. Measurements of a patient’s blood sugar levels during a certain period may also be transmitted to his diabetes center for professional titration of treatment. A special and stable diet and an activity level that require few adjustments will improve the treatment. Diabetes of both types can be treated effectively to counter complications of the disease but it cannot presently be cured or long-term prevented.
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