Diabetes

Diabetes mellitus is an endocrinological disorder affecting the ability of the body to properly absorb glucose, the main energy source of all cells. This can come from an inherent loss of insulin (type 1 diabetes, loss of pancreatic function) or an inability for cells to respond to insulin (type 2 diabetes). Both forms can be diagnosed in adults, but type 2 is more commonly seen with older age.


The way diabetes is diagnosed is by one of three ways:

  • Checking the hemoglobin A1C (most common)- normal is < 5.7, pre-diabetes is 5.7-6.4, and > 6.4 is considered diabetes

  • Checking a fasting blood glucose

  • Any non-fasting blood glucose greater than 200


There are many deleterious complications that arise from poorly controlled diabetes:

  • Vascular disease- poorly controlled diabetes causing all arteries to become easily clogged with plaque, increasing the risk for heart attack, stroke, and peripheral vascular disease that can lead to amputations of extremities

  • Neuropathy- nerves are damaged with prolonged exposure to elevated glucose levels. Initially, the light sensory is lost on the feet, leading to an inability to sense when one is having a foot injury- this can lead to severe infection. In the later stages of neuropathy, the extremities can be extremely painful, having dysfunctional nerves that continuously send pain signals to the brain

  • Kidney disease- the ongoing elevated glucose causes damage to the intricate filtration systems of the kidneys, leading to protein loss and accelerated kidney disease, leading to end stage renal disease and dialysis

  • Vision loss- retinopathy, or damage to the retina, leads to loss of vision. These changes are permanent and treatment is limited

  • Suppressed immune system- the white blood cells in the body become sluggish due to the increased levels of glucose. This leads to an ineffective response to bacterial and viral infections, leading to greater risk of complications from pneumonia, kidney infections, skin infections, bone infections, and infections of the blood stream


The fastest, most efficient way to get control of poorly controlled diabetes (A1C > 9) is by using insulin. Not all patients require insulin as the initial treatment, nor is insulin the only treatment. If your A1C is more than 9, it is extremely important to get your glucose well controlled (A1C 6.5-7.5), in order to reverse/avoid the above complications.


After getting good control, or if starting non-insulin treatment, there are several medications available.