The term diabetes or more often referred to as diabetes mellitus by doctors, is getting popular among people nowadays. This disease has affected many people from all around the world. A survey was conducted by National Health and Morbidity Surveys (NHMS). It is found that the prevalence of diabetes in Malaysia was 15.2% in 2011. The population of Malaysia in 2011 was 29.2 million, which means that 4.4 million of the population was affected by diabetes.
Graph of prevalence of diabetes in year 2007 and 2011.
Diabetes is a chronic disease where a person has a high sugar level in blood, commonly due to a low production of insulin in their body. The most frequent and obvious symptoms of diabetes are frequent urination (polyuria), increased thirst (polydipsia) and increased hunger (polyphagia). It is also observed that the urine of the diabetes patients is sweet and attracts ants.
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This disease, diabetes mellitus (DM), is basically divided into three main types, which were named as Type 1 DM, Type 2 DM and gestational diabetes mellitus respectively.
Type 1 DM was previously known as insulin-dependent diabetes mellitus or juvenile-onset diabetes. The development of this type of diabetes is due to destroy of pancreatic beta cells by the body's immune system. Pancreatic beta cells are the only cells in the body that produce insulin that is important in regulating the blood glucose level.
The non-insulin-dependent diabetes mellitus or adult-onset diabetes, which is known as Type 2 DM these days, is caused by the insulin resistance where the cells do not use the insulin in a proper way.
Gestational diabetes mellitus occurs during pregnancy, where the body of the pregnant mother is intolerant of glucose. During 24-28weeks of pregnancy, pregnant women are usually advised by doctors to conduct a test on diabetes. Doctors often advise the patients to exercise and manage their diets in order to control their diabetes.
Type 2 DM
Type 2 DM can be spotted by the common symptoms of diabetes, including frequent urination, decreased vision, etc. However, some Type 2 DM patients have no symptoms for years during the early stage as Type 2 DM occurs slowly over time. As the blood sugar level rises, the development of the symptoms begins.
Symptoms of Type 2 DM are as follow:
Frequent urination and increased thirst.
The most common symptom is polyuria, where they urinate more often. Often related to the increased thirst, the excess sugar in the bloodstream pulls fluid from the tissues. With lesser fluid in the body, you feel thirsty and you may drink more. This leads to an increase in urination.
Diabetic retinopathy is a disease where the retina of the eye is damaged by diabetes. High amounts of blood sugar will damage the blood vessels in the retina, which may reduce your vision. If critical, it may lead to blindness.
Infections and healing.
An individual with Type 2 DM usually have slow-healing wounds or cuts. They are also more prone to illness. The permeability of the blood vessels is reduced by the high blood glucose levels. This then reduces the amount of oxygen and nutrients reaching the site of the wound, slowing the healing rate.
When the insulin is inadequate, the glucose transported into the cells reduces. The cells have not enough energy and start breaking down alternative sources like fats for energy. As a result, you feel hungry and you will seek for food.
Discovery of diabetes
Pancreas and diabetes
In 1889, Oskar Minkowski, a German physiologist, who was nominated six times for Nobel Prize, together with a German physician, Joseph von Mering, have accidentally discovered the relationship between the pancreas and diabetes. This discovery was said to be an accident because the experiment was conducted to evaluate the absorption of fat following pancreatectomy instead of diabetes.
In his experiment, he removed the pancreas from a dog by conducting a surgery. With its pancreas removed, the dog exhibited disorder similar to human diabetes. This observation made Oskar Minkowski to realize that the pancreas produces a substance that plays a role in regulating the blood glucose level. However, he did not manage to discover what the substance was.
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In 1920, Dr. Frederick Banting conceives an idea on insulin after reading an article in the journal by Moses Barron, an American pathologist. He then confronted Professor John Macleod, who was also studying on diabetes in Canada, convincing him that his idea on insulin worth a try. Macleod then provided Banting with a laboratory with minimum equipment and ten dogs. Charles Best was assigned as his assistant.C:\Users\Goh- Family\Desktop\3_best_banting.jpg
By conducting experiments on the depancreatized dogs, he finally came to the discovery of the insulin, which was firstly named as "Isletin" when the extract was first injected into Dog 410.
Banting and Best then started extracting insulin from pancreases from cattles. The dogs which were weaken by diabetes seemed healthier after receiving the
extracts. Macleod then gave them more funds and moved them to a laboratory with better working conditions.
In late 1921, Dr. James Bertram Collip joined them in the research. He was assigned to purify the insulin so that the humans can receive them safely.
Testing on humans
Banting and Best were the first humans to be tested with the extracts. They did not feel well at first but they were not harmed by the extracts.
In January 1922, a test on insulin was conducted on a 14-year-old boy named Leonard Thompson. Surprisingly, this boy who was in critical state due to diabetes recovered rapidly. The team then tested the insulin extracts on the other prevalence and they recovered, too. This marked the success in the hard work of the team in looking for a way to keep humans with diabetes alive.
The Nobel Prize
The discovery of insulin was one of the biggest discoveries in medicine. In year 1923, Banting and Macleod were awarded the Nobel Prize in Physiology or Medicine. Best and Collip were not awarded. However, Banting decided to share his cash award with Best while Macleod shared with Collip.
Contributions of scientists to physiology
Oskar Minkowski published the concept where the pancreas produces a substance which was named as insulin later. He discovered that the pancreatic substance is responsible in controlling the blood glucose level.
Furthermore, Oskar Minkowski proved that the pancreas is also responsible in producing bile pigments as well as site for uric acid formation.C:\Users\Goh- Family\Desktop\1_pancreas.png
His discovery was a marvel to the medical and physiology field, advancing the understanding of people in their body functions, specifically the pancreas. By doing so, it inspires the younger scientists to deepen their knowledge on the pancreas.
Without these foundations, scientists nowadays will not be able to discover so much more things regarding pancreas.
Dr. Frederick Banting
The discovery and extraction of insulin by Dr. Frederick Banting and his team was also a great achievement in medical field. He contributed to physiology field in the sense where he successfully demonstrated the function of the insulin to reduce the blood glucose level, or in other words, being able to prolong the lives of the diabetes prevalence.
His great achievement in the extraction of insulin saved many people who had diabetes from dying by injecting insulin into their bodies. This discovery gave the diabetes patients hope to survive, or at least prolonging their lives, other than improving the knowledge in both medical and physiology fields on the functions of hormone insulin and pancreas.
Type 2 DM is developed when the pancreas produces insufficient insulin to the body or when the body has insulin resistance. Researches have been going on for years to find out the causes of diabetes in order to cure this disease. Other than the genetic issue, it is also believed that human culture lifestyle is one of the causes to diabetes mellitus.
High-fat and carbohydrate diet.
Carbohydrates have a great influence on the blood sugar levels. It is advised not to consume high-fat food as it may cause obesity, which is one of the main causes of diabetes.
It is known that the beer and sweet wine contain carbohydrates which may raise the blood sugar levels. Furthermore, it may also affect the effects of insulin in the body. Failure of the insulin function will lead to diabetes.
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Exercising can increase the use of insulin in the body while it helps to burn excess body fat. With that, the weight of the body can be controlled and the risk of getting diabetes can be reduced too.
Many patients of the Type 2 DM are obese. A theory was published that being overweight may lead to insulin resistance, a condition where the cells do not respond normally to insulin. Less glucose is taken into the cells and thus excess glucose is present in blood, leading to a high glucose levels in blood.
There are currently few types of diagnosis available. Experts from American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation recommended people who suspect themselves getting diabetes to go for the tests below:
Glycated hemoglobin (A1C) test.
In this test, blood sample will be taken and analysed. Average blood sugar level for the past few months can be revealed. The percentage of blood sugar attached to haemoglobin is measured.
5.7% - 6.4%
Random blood sugar test.
In this test, the blood sugar levels are in milligrams per decilitre (mg/dL) or millimoles per liter (mmol/L). Blood sample is taken at random time.
> 200 mg/dL (11.1 mmol/L)
140 mg/dL (7.8 mmol/L) -
199 mg/dL (11.0 mmol/L)
< 140 mg/dL (7.8 mmol/L)
Fasting blood sugar test.
This test requires an overnight fasting before taking the blood sample. The units of blood sugar levels are similar with the random blood sugar test.
> 126 mg/dL (7.0 mmol/L)
101 mg/dL (5.7 mmol/L) -
125 mg/dL (6.9 mmol/L)
< 100 mg/dL (5.6 mmol/L)
Oral glucose tolerance test.
An overnight fasting is also required. Blood sample with fasting blood sugar level will be taken, and then a sugary liquid will be given. Blood sugar levels are tested at intervals for few hours.
> 200 mg/dL (11.1 mmol/L)
141 mg/dL (7.9 mmol/L) -
199 mg/dL (11.0 mmol/L)
< 140 mg/dL (7.8 mmol/L)
* Prediabetes indicates that an individual has a high risk of developing diabetes.
Type 2 DM occurs when the pancreatic beta-cells dysfunction and produces less insulin. As insulin is the regulator of blood glucose levels, a decrease in the amount of insulin present affects the regulation of blood glucose level. Inadequate amount of insulin leads to high blood glucose level as the ability to regulate is reduced.
Insulin resistance is when the body cells do not respond normally to hormone insulin. At this point, the body requires more insulin than usual to move the glucose into the body cells. Insulin resistance alone does not cause to develop diabetes. However, when it occurs together with pancreatic beta-cells dysfunction, diabetes mellitus develops. The pancreas could not produce sufficient amount of insulin required by the body for transportation of glucose into body cells and not all excess glucose is converted into glycogen. Thus, the glucose in the bloodstream remains and accumulates, causing an increase in blood glucose level.
When the blood glucose level reaches a percentage, an individual is considered to have developed diabetes mellitus.
Type 2 DM usually starts developing when the beta-cells in the pancreas dysfunction. Beta-cells dysfunctions occur gradually. Beta-cell is one of the types of cells found in the islets of Langerhans, where islets of Langerhans are the regions in pancreas where endocrine cells of pancreas are found.
Beta-cells are involved in storing and releasing the hormone insulin which regulates the blood glucose level. A failure in production of insulin by beta-cells reduces the ability of the insulin to regulate the blood glucose level as inadequate insulin is present to transport the glucose into body cells. At the same time, excess glucose could not be converted into glycogen. As a result, the blood contains more glucose than it should have. Thus, the blood glucose level increases to a high level.
Simplified diagram for pathophysiology of Type 2 DM.
Insulin resistance is when the body cells do not react normally to insulin, or is said to have resistance to insulin. Therefore, more insulin is required in order to transport the glucose molecules into the cells. The amount of glucose transported into the cells to be stored as energy is greatly reduced. The body detects this change and assumes that the body has insufficient glucose. Signals are transmitted to the liver to convert the glycogen in it into glucose which is then released into the bloodstream. The increase in Hepatic Glucose Production (HGP) further increases the amount of glucose present in the blood, leading to high blood glucose level - diabetes.
However, for the Type 2 DM to develop, both the insufficient insulin production and insulin resistance must exist together.
Diabetes mellitus has no cure but there are ways to reduce the impacts from diabetes. The main goal to prevent problems from diabetes is to reduce the blood glucose level. The most popular and effective ways are to exercise regularly and managing one's diet.
An individual with Type 2 DM needs to focus more on their weight control as most patients of Type 2 DM are obese. Doctors and nutritionist often advise their clients with Type 2 DM to reduce their calories intake and consuming an even amount of carbohydrates at the same time. Healthy monosaturated fats can be consumed to substitute carbohydrates food.
Exercising has always been a good way to lead a healthy life. By exercising, the blood glucose level drops naturally as your heart beats more and you breathe more other than improving the blood flow. Moreover, exercising can help to burn fats that may help one in managing their weight.
In some cases, doctors may prescribe some medications to be consumed to help the body to regulate the blood glucose level. For example, alpha-glucosidase inhibitors, biguanides, etc. These medications are sometimes given together with insulin.
Injection of insulin.
The more common form of treatment is the injection of insulin. Approximately 40% of Type 2 DM prevalence requires injection of insulin. By injecting insulin into the body, glucose in the body will be converted into glycogen in the liver, thus lowers the blood glucose level.
Diabetes is a slow killer with none curable treatments, yet. However, it is need not to be afraid as the impacts can be reduced by proper treatment. If not treated properly, complications may happen, leading to blindness, kidney damage and heart attack. Therefore, it is very important to keep one's blood glucose level at normal level to avoid unwanted complications.