Diabetes (high blood sugar)

What is diabetes?

Diabetes is a condition in which the sugar (glucose) in the blood stays too high. Glucose is the body’s main fuel, and a hormone called insulin, released by the pancreas, moves it into the cells. In diabetes, either there is too little insulin or none is made at all, or the cells do not respond to it well. The result is that sugar stays in the blood.

Type 1 is when the immune system destroys the insulin-making cells, and the patient needs insulin every day. Type 2 is the most common type (about 90 to 95 percent of cases) and can appear at any age. Gestational diabetes is a type that appears in pregnancy and usually ends after the birth, but raises the risk of type 2 diabetes in the future. Below you will read mostly about type 2. If you have diabetes and do not know which type, ask your doctor.

Over the years, high blood sugar damages the eyes, kidneys, nerves and heart. But high blood sugar does not always show itself.

Symptoms

The symptoms of type 2 diabetes usually appear gradually, and some people have no symptoms at all:

• Constant tiredness
• Needing to pass urine more than usual
• Constant thirst
• Losing weight without trying
• Blurred vision
• Cuts and wounds that heal slowly
• Itching or repeated infections of the genital area

These symptoms can also have other causes. Only a test can tell.

Diabetes and the rest of the body

Diabetes is not only a blood sugar issue:

• Heart and vessels: Diabetes can damage the vessels and lead to heart disease and stroke. To lower this risk, blood sugar, blood pressure and blood fats must be controlled together, and smoking must be stopped.
• Blood pressure: Diabetes is one of the conditions that raises the risk of high blood pressure.
• Blood fats: Type 2 diabetes is a risk factor for high blood fats.
• Kidneys, eyes and nerves: Kidney disease, eye disease that may lead to poor vision or blindness, and nerve damage (for example in the feet) are known complications.
• Feet: Nerve damage and poor blood flow mean that even a small callus or sore can turn into a problem or an infection.
• Mouth and teeth: Gum disease and a dry mouth are also seen.
• Liver: Fatty liver is common in type 2 diabetes. See the section “Digestion and fatty liver”.

How is it diagnosed?

Diagnosis is by blood test. These are the common tests and their usual numbers:

Test	Normal	Prediabetes	Diabetes
HbA1c (average blood sugar over the last 2 to 3 months)	Less than 5.7%	5.7 to 6.4%	6.5% or more
Fasting blood sugar (after an overnight fast)	99 mg/dL or less	100 to 125 mg/dL	126 mg/dL or more
Glucose tolerance test (blood sugar 2 hours after drinking glucose)	Less than 140 mg/dL	140 to 199 mg/dL	200 mg/dL or more
Random blood sugar (any time of day)			200 mg/dL or more

If a test was done outside a doctor’s office (for example at a screening or a pharmacy), it should always be followed up with a doctor. The doctor may repeat the test to be sure.

Prediabetes means blood sugar is above normal but has not yet reached the diabetes level. It often has no symptoms, but it raises the risk of diabetes and heart disease. Your care team can give advice about food, activity and other changes to lower the risk of reaching diabetes.

Treatment and management

Treatment of type 2 diabetes usually starts with lifestyle change, then medicine is added if needed, and if medicine is not enough, insulin may be required. The type and the plan are set by the doctor for each patient.

• Food: A balanced diet with vegetables, fruit, whole grains and pulses. Eat fewer processed foods high in salt and sugar. Do not start a very strict low-calorie diet without advice, especially if you take medicine or insulin.
• Activity: About 2.5 hours a week of walking or an activity that makes you slightly breathless.
• Weight and smoking: If the doctor has said to lose weight, do it gradually and with a plan. Stop smoking.
• Medicine: Sometimes one medicine is needed and sometimes a combination of several. Do not stop diabetes medicine without the doctor’s opinion. If you take medicine and have vomiting, diarrhoea or a very high fever, contact the doctor quickly.
• Education: Medical sources recommend that every patient with type 2 diabetes take an education course about the condition. Ask your doctor where it is held.

Follow-up and self-care

These follow-up checks are the advice of medical references, and your own plan is set by the doctor:

• HbA1c: Usually every 3 to 6 months.
• Blood pressure, blood fats, kidneys and weight: At least once a year.
• Foot check: Show your feet to the doctor every time you visit. Nerve damage and poor blood flow mean even a small callus can lead to pain or infection, so tell the doctor about any foot problem.
• Eyes: An eye examination with dilating drops. The references do not agree on the interval: one says “at least once a year” and another says “every one to two years”. The right interval is set by your eye doctor and your doctor.
• Teeth: See a dentist at least once a year, and brush twice a day.
• Sleep: If you have pauses in breathing during sleep, tell the doctor. Sleep apnoea raises the risk of diabetes and makes it worse.

Low blood sugar: when you take medicine

If you take insulin or some diabetes tablets, your blood sugar may fall too low. Eating late, going without food, heavy exercise and illness make it more likely. For many people, a blood sugar below 70 mg/dL counts as low, but your personal limit may be different. Ask your doctor for your own number.

Its symptoms are shakiness, hunger, tiredness, dizziness, confusion, irritability, a pounding heart, headache and blurred vision. If you have symptoms and your blood sugar is below 70, take 15 to 20 grams of fast-acting sugar, for example a tablespoon of sugar or honey, or half a glass of fruit juice or regular soft drink. After 15 minutes check your blood sugar again, and if it is still low, repeat. Get more explanation from your own doctor.

When to get help

Call 115 (Iran’s emergency number) immediately if:

• A person with diabetes has lost consciousness or had a seizure. A very low blood sugar is dangerous and must be treated at once.
• You have thirst and a lot of urine, abdominal pain, nausea or vomiting, deep and fast breathing, a fruity or acetone-like smell on the breath, drowsiness or confusion. This could be diabetic ketoacidosis, a complication seen mostly in type 1 patients and in people with diabetes who inject insulin.
• You have sudden chest pain or pressure that does not go away, or that comes with shortness of breath, sweating and nausea.

Talk to your doctor if you have thirst, a lot of urine, tiredness and weight loss, a foot sore that heals slowly, blood sugar that is repeatedly high or low, or a new symptom after starting a medicine.

Every patient’s treatment plan is different. Ask your doctor about your own situation.