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Diabetes is a group of metabolic disorders characterized by high blood sugar levels due to insufficient or ineffective secretion of insulin and/or insulin resistance, leading to disturbances in the metabolism of carbohydrates, proteins, and fats. The typical clinical manifestations of diabetes include polydipsia, polyuria, polyphagia, weight loss, high blood sugar, and presence of glucose in the urine. Prolonged diabetes can lead to multi-organ damage, causing progressive chronic impairment and failure of tissues and organs such as the eyes, kidneys, nerves, heart, and blood vessels. In severe cases or during stress, it can lead to acute and severe metabolic disorders. Diabetes is a major cause of cardiovascular diseases, mortality, amputations, blindness, renal failure, and heart failure.
Type 1 Diabetes
This type is less common and often occurs in children and adolescents, accounting for less than 1% of diabetes patients in China. It can be caused by immune-mediated factors or be idiopathic (mechanism unknown). The main pathogenesis is the destruction of pancreatic β-cells, leading to an absolute deficiency or significant reduction in insulin.
Type 2 Diabetes
This type is more common, accounting for over 95% of diabetes patients in China. Causes include insulin resistance, progressive insulin secretion deficiency, or a combination of both.
Special Types of Diabetes
Diabetes due to genetic defects in β-cell function
Rare, often with a family history. Genetic mutations lead to defects in β-cell function, resulting in reduced insulin production.
Diabetes due to genetic defects in insulin action
Rare, may have a family history. Abnormal insulin receptor genes lead to insulin resistance where insulin cannot function properly.
Diabetes secondary to diseases of the exocrine pancreas
Rare, occurs as a result of pancreatic diseases or systemic metabolic diseases, such as hemochromatosis. It is often seen after trauma, pancreatic resection, pancreatitis, pancreatic tumors, or pancreatic islet damage or loss due to metabolic diseases.
Diabetes secondary to other endocrine diseases
Rare, occurs as a result of other endocrine diseases. It is often seen in conditions such as acromegaly, glucagonoma, or pheochromocytoma, where excessive production of hormones with hyperglycemic effects leads to diabetes.
Diabetes due to drug or chemical-induced factors
Rare, associated with the side effects of certain medications. Many drugs such as corticosteroids or PD-1 inhibitors used in cancer treatment can lead to elevated blood sugar or impaired pancreatic secretion function.
Diabetes due to infections
Rare, some diabetic patients may have had viral infections before the onset of the disease. In susceptible individuals, certain viral infections can lead to damage to pancreatic islet cells, possibly contributing to the development of diabetes, particularly in the immune-mediated type 1 diabetes.
Other immune-mediated diabetes
Rare, more common in females and may be accompanied by other autoimmune diseases. It may be related to the production of islet cell antibodies in autoimmune processes.
Other genetic syndromes associated with diabetes
Many genetic syndromes are accompanied by diabetes, such as hemochromatosis, malnutrition-related diabetes syndrome, etc. The causes of most of these conditions are unknown.
Gestational Diabetes
High blood sugar first detected after 24 weeks of pregnancy in women without diabetes prior to pregnancy. The main causes are increased insulin resistance and relative insulin deficiency after pregnancy, leading to high blood sugar.
Genetic Factors
Genetic factors play an important role in the onset of type 1 diabetes, with over 50 genetic variations found to be associated with the genetic susceptibility to type 1 diabetes. The occurrence of type 2 diabetes is also related to genetic factors, with over 400 genetic variations found to be associated with the risk of type 2 diabetes or hyperglycemia. It is important to note that genetic background only confers a certain degree of susceptibility to the disease and is not sufficient to cause the disease. Generally, under the influence of environmental factors, the combined effects of multiple genetic abnormalities lead to the onset of diabetes.
Environmental (Extrinsic) Factors
The environmental factors related to the onset of type 1 diabetes are unclear, but viral infections may be one of the environmental factors leading to type 1 diabetes. These include viruses such as rubella, mumps, coxsackievirus, etc., which can directly damage pancreatic β-cells and initiate further autoimmune reactions leading to β-cell damage. Some chemical toxins such as rodenticides like picolinic acid and urea can also cause destruction of pancreatic β-cells, triggering type 1 diabetes. In recent years, with the widespread use of programmed cell death protein 1 (PD-1) inhibitors in cancer treatment, the number of type 1 diabetes patients caused by these drugs has also increased significantly. Environmental factors are particularly important in the onset of type 2 diabetes, including factors such as aging, modern lifestyle, excessive nutrition, and lack of physical activity. The most important environmental factor increasing the risk of developing type 2 diabetes is the adverse lifestyle formed by the social environment.
Defects in the Autoimmune System
Under the combined action of environmental and genetic factors, the immune system attacks the insulin-producing islet cells, leading to autoimmunity, which results in damage and disappearance of pancreatic β-cells and ultimately leads to reduced or deficient insulin secretion.
Patients should strictly adhere to the prescribed medication, control their diet, engage in appropriate exercise, conduct regular self-monitoring, and undergo regular medical check-ups.
Family members should supervise, remind, and take care of the patient, and actively contact the doctor in case of any special circumstances.
Diet
Due to the different individual conditions of diabetes patients, we recommend regular visits and timely personalized dietary guidance from doctors or nutritionists. In general, a diversified dietary plan is needed, focusing on grain-based foods, high fiber intake, and low salt, low sugar, and low-fat consumption.
Diet Recommendations:
- Quantitative and as-needed consumption of staple foods such as rice, flour, and various grains under the guidance of a doctor or nutritionist.
- Whole grains and legumes should account for one-third of the staple intake.
- Fresh vegetables should be included in every meal, prepared in a suitable manner to avoid excessive oil intake.
- Daily vegetable intake should be around 500g, with dark-colored vegetables accounting for more than half.
- Choose low glycemic index fruits in moderate amounts between meals and consume them at appropriate times.
- Regular consumption of fish and poultry, moderate intake of red meat, and limited consumption of fatty meat, with no more than one egg per day.
- Daily intake of 300ml of liquid milk or an equivalent amount of dairy products. For yogurt, choose plain yogurt without added sugar or honey.
- Emphasize the intake of soy and its products and consume a moderate amount of nuts, such as pistachios and almonds, with a daily intake of about 30-50g.
- Drink plenty of water, and consume moderate amounts of unsweetened tea or coffee, while avoiding sugary drinks.
- Meals should be consumed at regular intervals and in appropriate portions, with a recommendation to consume vegetables before staple foods.
Dietary Restrictions:
- Alcohol consumption is not recommended as it can induce hypoglycemia, especially on an empty stomach.
- Cooking should involve minimal oil and salt, and the use of high-sodium condiments or foods such as soy sauce, chicken essence, monosodium glutamate, and pickled foods should be limited.
- Limit the consumption of smoked, baked, or cured meat products.
Exercise
Exercise therapy is particularly important for type 2 diabetes patients with obesity and should be undertaken under the guidance of a physician, with a recommended 150 minutes of moderate-intensity exercise per week.
- Focus on individuals at high risk for diabetes, including those over 45 years of age, obese individuals (especially those with central obesity), those with a family history of diabetes, individuals with high blood lipids, and those with hypertension and/or cardiovascular diseases.
- Planned and monitored pregnancy is essential for women with diabetes.
- Individuals who are not suitable for exercise therapy include those with severe insulin deficiency in type 1 diabetes, those with extremely unstable blood sugar, those with systolic blood pressure greater than 180mmHg, those with blood sugar levels exceeding 14mmol/L, individuals with severe heart disease, cerebrovascular insufficiency, kidney complications, and those with acute infections.
Complications:
- Hypoglycemia is a serious complication that may occur during diabetes treatment, particularly in elderly patients, those with impaired kidney function, and those with severe microvascular and macrovascular complications. Severe hypoglycemia and recurrent hypoglycemia should be promptly addressed by seeking medical attention.
- Government, health departments, and the community should collaborate in diabetes prevention, education, and healthcare plans. Promoting healthy lifestyles and diabetes prevention knowledge among the general population, conducting diabetes screening in high-risk populations, and advocating active and healthy living for pre-diabetic individuals through diet and exercise are essential preventive measures.
