Concept of Diabetes
Diabetes is a chronic condition that is difficult to cure, characterized by hyperglycemia and glycosuria caused by absolute or relative deficiency of insulin. Diabetes is classified into multiple types based on specific causes that lead to insulin deficiency. One type is called insulin-independent diabetes, which is characterized by relative insulin deficiency due to beta-cell defects in the pancreas or increased insulin demand in the body.
Insulin-independent diabetes accounts for the majority of diabetes cases in Koreans and is the most common form among various types of diabetes. Approximately 85-90% of these cases occur primarily after the age of 40.
The major pathological mechanisms of insulin-independent diabetes can be explained by impaired insulin secretion function in the pancreas and insulin resistance. In insulin-independent diabetes, the quantity and activity of beta cells in the pancreas are similar to those in normal individuals, but the amount of insulin secreted after stimulation by beta cells is lower compared to normal individuals. This indicates decreased insulin secretion function in the pancreas. The phenomenon where the serum insulin level in patients is normal or increased reflects reduced sensitivity to insulin, indicating impaired insulin receptor function or insulin-resistant characteristics due to defects in intracellular processes after receptor binding.
Insulin
Insulin is produced by clusters of cells called beta cells in our pancreas, and it helps us utilize glucose from the food we eat. In order for blood glucose to be transported into cells, insulin's assistance is required. It functions like a key that opens insulin receptors, which are present on cell membranes, allowing glucose to enter the cells. The occurrence of diabetes is mostly associated with absolute or relative deficiency of insulin, and the treatment of diabetes is directly or indirectly related to insulin.
Insulin is administered to patients with type 1 diabetes or childhood-onset diabetes who have impaired insulin secretion in the pancreas. It is also used in cases where dietary control does not effectively regulate blood glucose during pregnancy in diabetic patients, when oral hypoglycemic agents are ineffective for blood glucose control in adult-onset diabetes, during major surgeries, or in cases of hyperglycemic coma.
Blood Glucose
Blood glucose refers to the glucose supplied from the food we consume, serving as a source of energy within the body. In healthy individuals, after a meal, blood glucose levels increase, and insulin is secreted by the pancreas in response. The secreted insulin transports glucose from the bloodstream into cells, where it is utilized as energy. In diabetic patients, insufficient insulin secretion or impaired insulin function leads to elevated blood glucose levels. Normal fasting blood glucose levels are below 115 mg/dL, and 2 hours after a meal, it should be below 140 mg/dL.
Glycated Hemoglobin
Within human red blood cells, there is a protein called hemoglobin, which is necessary for oxygen transport and is referred to as hemoglobin A1c (HbA1c). When blood glucose (glycemia) rises, a portion of glucose binds to hemoglobin. This glucose-bound hemoglobin is called glycated hemoglobin or HbA1c.
The lifespan of red blood cells is approximately 120 days. In our bodies, some red blood cells break down daily, while new ones are produced, maintaining a constant level. However, once glucose is bound and glycated hemoglobin is formed, the red blood cell retains glycated hemoglobin until it reaches the end of its lifespan. Prolonged high blood glucose levels lead to an increase in glycated hemoglobin within red blood cells.
While blood glucose tests determine the amount of glucose present in the blood on a daily basis, glycated hemoglobin reflects the average blood glucose level over an 8-week period. Glycated hemoglobin provides an indication of how well diabetes has been controlled over the past few months. The normal range for glycated hemoglobin is less than 6%.
Treatment Methods for Diabetes
Since diabetes is a chronic condition with progressive advancement, consistent and continuous treatment is crucial. Failure to manage diabetes effectively can lead to various acute and chronic complications, making proper blood glucose control essential. To achieve efficient blood glucose management, medication therapy, dietary therapy, and exercise therapy are available, and appropriate treatment methods should be selected and adjusted based on individual symptoms. However, recent research suggests that diabetes knowledge, a positive attitude, family support, and stress management are also important.
Medication Therapy
The choice between oral hypoglycemic agents and insulin injections depends on the mechanism and cause of diabetes and the ability to produce insulin. Oral hypoglycemic agents are commonly used when dietary therapy alone is insufficient for diabetes management. These agents facilitate insulin secretion from the pancreas, thereby reducing blood glucose levels. Insulin injections, derived from animal pancreases such as pigs, are used when dietary therapy and oral medications do not sufficiently regulate blood glucose levels. The dosage of insulin depends on the type of insulin, its duration of action and peak effect time, the patient's condition, dietary habits, and blood glucose levels.
Dietary Therapy
Dietary therapy is essential for individuals with diabetes because it enables the intake and digestion of appropriate energy sources necessary for maintaining health. In order to maintain ideal body weight, diabetic patients need to determine the calorie intake of the required food. Typically, the method of determining ideal body weight is proportional to height. Subtracting 100 from one's height and taking 90% of that value gives an estimate of ideal body weight. Once ideal body weight is measured in this manner, the necessary calorie intake for the corresponding weight should be calculated to obtain an appropriate amount of energy.
Dietary therapy for diabetes does not involve rigid food restrictions or prohibitions, but rather adjusting the amount, type, and timing of food intake according to individual requirements. The goal of dietary therapy for diabetes is to suppress blood glucose elevation as much as possible. It aims to maintain appropriate blood glucose and lipid levels, balance insulin levels, sustain desirable body weight, and promote overall nutritional well-being.
Exercise Therapy
Exercise therapy is recognized as one of the most effective methods, along with dietary therapy, for managing diabetes. Exercise not only prevents aging of blood vessels and muscles but also promotes active glucose metabolism, especially in muscles, leading to a decrease in blood glucose levels. It also enhances the action of insulin and plays a significant role in preventing obesity. Exercise for diabetic patients does not refer to specific sports or exercises but rather physical activities in daily life, such as household chores, yard work, or walking. It encompasses any bodily movement or labor, and even activities like walking or doing housework can be considered exercise.
However, diabetic patients have abnormalities in various metabolic processes due to inadequate insulin secretion from the pancreas, so intense exercise can cause excessive lowering of blood glucose levels, resulting in hypoglycemic symptoms. Therefore, diabetic patients should engage in regular, moderate exercise suitable for their daily routine, rather than intense or partial exercises.
Complications of Diabetes
Complications caused by diabetes are more distressing to patients and can decrease their average lifespan compared to the disease itself. Diabetic complications are diverse, difficult to treat, and often associated with the duration of diabetes and blood glucose levels.
Diabetic complications can be categorized into acute and chronic complications. Acute complications occur due to excessively high or low blood glucose levels. Examples of acute complications include hyperglycemic coma, ketoacidosis, and hypoglycemia. Chronic complications affect various parts of the body and include cardiovascular diseases, kidney diseases, eye diseases, skin diseases, and oral diseases. Once chronic complications occur, they are difficult to treat, so prevention is crucial. Even if complications have already developed, maintaining normal blood glucose levels can slow down the progression of complications.
