Across all studies, diabetes is most accurately defined as a complex disorder that focuses on the presence of hyperglycemia (high blood sugar). This occurs as a result of the altered metabolism of carbohydrates, fats, and proteins.
In simpler terms, it is the condition that affects the normal metabolism of the body leading to alterations in the processing of the main compounds that help the normal development of the body. It should be noted that although hyperglycemia is often mentioned in the definition of diabetes, it may not be present in the early stages of the condition.
Normal pancreas function
In order to better understand this disease, we must first understand the normal functioning of the pancreas and how blood sugar is metabolized.
The pancreas is located in the abdominal cavity, between the duodenum and the spleen. It is the only organ that has an endocrine function (hormone secretion) and exocrine (enzymes). It produces enzymes necessary for digestion, but also insulin and glucagon with a role in regulating blood sugar.
Among the enzymes of the pancreas, we mention trypsin – the enzyme produced by the pancreas, which breaks down proteins into aminoacids. Chymotrypsin – the enzyme that plays a role in protein metabolism and which is secreted in the pancreatic level (chymotrypsinogen) being activated in the duodenum by trypsin, this is very important because the pancreas has in its structure some proteins that if they come in contact with chymotrypsin would start to be metabolized leading to pancreatitis, other enzymes are pancreatic amylase with a role in carbohydrate metabolism and lipase with a role in lipid metabolism.
For laboratory tests in the detection of pancreatic diseases, lipase has a much higher specificity for the pancreas compared to amylase.
The two functions of the pancreas also have a morphological correspondence. So, regarding the structure of the pancreas, it can be divided into two main components:
a) the acinar component with exocrine function
b) the island component with endocrine function. At the level of the island component, there are changes that lead over time to the onset of diabetes.
The pancreatic islets contain four cell types:
a) alpha cells in the proportion of 30 40%, which have a role in the secretion of the hormone glucagon involved in the catabolism of glucose. The action of this hormone leads to increased blood glucose levels.
b) 40%-50% beta cells have a role in the secretion of insulin, a hormone with a role in the storage and distribution of glucose to cells where it is used as an energy source for the maintenance of various physiological processes. Affecting these cells is a prerequisite for diabetes.
c) delta cells in the proportion of 10%, have a role in the secretion of somatostatin is a hormone that has the role of regulating the activity of other hormones secreted by the pancreas.
d) F cells – which secrete a pancreatic polypeptide whose function is uncertain, but which appears to maintain local homeostasis
Diabetes is a disease
Both genetic factors (genetic predisposition of the individual to get the disease) and environmental factors (diet, daily activity, physical activity, pollution, etc.) are involved in the genesis of diabetes. The importance of environmental factors has been shown by the fact that in a population with a genetic predisposition to diabetes, only certain individuals have diabetes.
Other data that support the importance of environmental factors in the genesis of diabetes were represented by the increase in the number of diabetics in Eastern Europe after 1989 at an accelerated rate, differences in genetically related populations, damage to monozygotic twins by 50%, etc.
The main environmental factors involved in diabetes are viral factors (enteroviruses, rotaviruses, retroviruses, rubella virus, cytomegalovirus, etc.) and food / nutritional factors (vitamin D deficiency, zinc deficiency, nitrates, nitrites, nitrosamines, introduction early feeding of cow’s milk, etc.).
Two pathological processes underlie the onset of diabetes:
- Insulin resistance
- Low insulin secretion
Insulin resistance – in the body’s cells we find glucose receptors. These receptors should be seen as a gateway to the cell, and insulin produced by the pancreas as a key. In order for the cell to perform its functions, it needs energy obtained from glucose consumption. Thus insulin acts on the receptors by activating them and thus helps to load the cell with glucose.
It should be noted that glucose passes from the blood into the cell resulting in a decrease in the concentration of glucose in the blood.
Insulin resistance is defined as the resistance of the cells of an organ, more precisely of the cellular receptors to the action of insulin. Therefore, insulin cannot sensitize the receptors enough to accept glucose, and the concentration of the latter increases blood pressure causing hyperglycemia, which diabetes is most accurately defined as.
This insulin resistance is caused on the one hand by the decrease in the number of glucose receptors and on the other hand by the low concentration of insulin in the blood.
Low insulin secretion occurs after the destruction of beta cells in the pancreatic islets. As a result of alterations in the immune system, there is an altered immune response directed against beta cells that leads to their destruction; the decrease in the number of beta cells and the alteration of the function of the remaining ones leads to the appearance of a low secretory function which has as a consequence the decrease of the insulin concentration in the blood.
This alteration of the cells is irreversible, eventually leading to their complete disappearance. The speed with which this process comes to an end depends on the degree of altered immune response and the time of occurrence of the phenomena during life. A low amount of secreted insulin will not be able to sensitize the receptors enough and thus a large part of the glucose remains in the blood causing hyperglycemia, which is what diabetes is most accurately defined as.
Diagnosis of diabetes (diabetes is most accurately defined as)
Over time, the diagnostic criteria for diabetes have undergone a number of changes depending on the importance of the diagnosis at that time. The American Diabetes Association (ADA) established the following criteria that a patient must meet in order to be suspected of suffering from diabetes:
a) the concentration of glycosylated hemoglobin (HbA1c) in the blood is above 6.5% – measured under standardized conditions;
b) the value of fasting blood glucose (fasting, at least 8 hours) 126 mg / dL;
c) blood glucose value (after two hours from the glucose tolerance test) is above 200mg / dL; The glucose tolerance test involves ingesting 75 grams of glucose dissolved in water and monitoring your blood sugar.
d) a blood glucose value of 200 mg / dL or above, determined in a patient who has a hyperglycaemic crisis or who has classic symptoms of hyperglycemia.
Signs and symptoms of diabetes
Diabetes has a number of signs and symptoms, some typical and some less typical. Among the most well-known signs are represented by the three P: polyuria (frequent and important quantitative urination), polydipsia (high water consumption, significant thirst), polyphagia (high food consumption) and weight loss.
In order to understand the reason for weight loss, it must be understood that insulin is also known as a fattening hormone, which has anabolic storage actions. This manifestation of diabetes occurs in 25% of cases of diabetes.
Other forms of diabetes can lead to complications of diabetes. Among these, we mention diabetic eye disease which is represented by decreased visual sense, diabetic kidney disease (diabetic nephropathy) – which is described by impaired renal function and last but not least diabetic neuropathy – represented by decreased sensory capacity (perception of pain, cold, of heat, are altered), pain, limb paresthesias, etc. these complications represent the onset of 30% of diagnosed cases of diabetes.
Diabetes can also be diagnosed by seeing a doctor for other coexisting conditions. Thus, the patient may present with symptoms of ischemic coronary heart disease, stroke, kidney disease that eventually prove to be the cause of diabetes.
Over time, diabetes can lead to disabling complications that can greatly affect the patient’s quality of life. Disabling complications in diabetes occur as the disease progresses and due to low treatment compliance.
Disabling complications include lower limb amputations that occur due to altered nerve and vascular components, consequent blindness of diabetic eye disease, infarction following vascular atheromatous damage due to diabetes and poor nutrition of the heart muscle, consequent renal failure of diabetic kidney disease, and last but not least, the stroke that occurs as a result of heart and vessel damage to the brain.
In conclusion, diabetes is most accurately defined as high blood sugar, a disorder in the metabolism that needs immediate attention from the your doctor.