According to modern medicine, diabetes is a diverse group of metabolic disorders characterised by long-term hyperglycemia or elevated blood sugar. High blood sugar levels are the result of a dysfunction in the pancreatic production of insulin and/or a weakened effect of insulin. The most dangerous characteristic of diabetes is its lack of symptoms; most cases are diagnosed during a regular health check-up to the surprise of the patient. The disease was historically called ‘honey urine’ due to the fact that physicians noted the elevated sugar levels in the urine of diabetic patients. Today, we know that the disease is a much more extensive disorder of the overall energy metabolism system and can be connected to a poor cholesterol balance and an elevated risk of cardiovascular diseases.
Diabetes has traditionally been divided into two types: type 1 diabetes, i.e. juvenile or insulin-dependent diabetes, and type 2 diabetes, i.e. so-called adult onset or non insulin-dependent diabetes. Type 1 diabetes results from a pancreatic failure to produce insulin, whereas type 2 diabetes is characterised by insulin resistance, in other words insufficient responsiveness of tissues to insulin. However, in light of modern science, these two types of diabetes are only the extremes of a wide spectrum. Between the extremes, there are many forms of the disease with characteristics placing them somewhere between these two types.
Type 2 diabetes is growing more and more common in Finland and around the world. Type 1 diabetes is more common in Finland than anywhere else in the world. The most common type is type 2 diabetes which has become a national disease in Finland. There are about 300,000 known cases of type 2 diabetes in Finland. In addition, about 150,000 Finns are estimated to have type 2 diabetes unknowingly. There are about 50,000 type 1 diabetic patients in Finland. The treatment for diabetes should begin as early as possible, and a healthy lifestyle plays a key role in the treatment.
Symptoms of diabetes
Type 2 diabetes usually starts with little to no symptoms, which is why it often comes as a surprise. The symptoms of diabetes develop slowly over time, enabling the body to get used to them. Most patients receive a diabetes diagnosis by chance at, for example, a regular health checkup organised by their occupational healthcare provider after years of having the disease. An average delay of five years is estimated between the onset of the disease and the diagnosis due to the lack of symptoms. In insulin-dependent diabetes (type 1), the symptoms develop faster. If they are not addressed in time, the patient develops ketoacidosis.
Typical symptoms of diabetes:
- Increased thirst
- Increased amounts of urine
- Inexplicable weight loss
- Susceptibility to infections
In addition to high blood sugar levels, diabetes is often connected to elevated blood pressure, cholesterol values and blood clotting, which expedites vascular calcification and stenoses. Compared to people not suffering from diabetes, diabetics are much more likely to have a heart attack or stroke or suffer from intermittent claudication. Smoking considerably increases the above risks for all people and especially for diabetics.
The treatment of diabetes should be started as early as possible instead of monitoring the situation. If the sugar levels are elevated but not yet at the diabetes limit, taking action by adopting a healthier lifestyle is very important. Successful lifestyle changes, if conducted as early as possible, can delay the onset of diabetes for several years and possibly even prevent the onset altogether if the type of diabetes is very mild.
Risk factors of diabetes
The risk factors of diabetes include:
- Overweight, especially abdominal obesity
- Metabolic syndrome
- Diabetics in the family
- Even slightly elevated blood sugar level diagnosed at any point
- Gestational diabetes
- Elevated blood pressure, heart disease or circulatory disease, such as coronary artery disease, stroke or a disease causing vascular stenoses in the lower limbs
- Smoking, insufficient exercise or lack of sleep
You can find out whether you are at risk of diabetes by completing the Risk Test by the Finnish Diabetes Association (in Finnish, also available as a risk assessment form in English), which covers questions such as genetic factors, age, waistline and lifestyle. If you are at an elevated risk of diabetes, we recommend contacting the Diabetes Clinic of Mehiläinen for tests.
Complications related to diabetes
Diabetes is often connected to complications that develop slowly over the years. Complications related to diabetes include:
- Kidney disease or nephropathy
- Damage to the eyes or retinopathy
- High cholesterol
- Myocardial or cerebral infarction
- Artery diseases
- Damage to the nerves or diabetic neuropathy
- Foot problems and ulcers
- Dental and oral diseases
Compared to people not suffering from diabetes, diabetics are much more likely to have a heart attack or stroke. The treatment of diabetes includes regular screening of kidney disease, damage to the eyes and foot problems. The blood pressure and cholesterol levels are monitored regularly. Diabetics often suffer from numbness of legs due to damage to the nerves. Other foot problems and ulcers are also typical for diabetics. A poorly healing foot ulcer is a usual symptom for diabetics and may, at worst, require partial amputation of the leg.
Children with diabetes
Diabetic children usually suffer from insulin-dependent diabetes, i.e. so-called type 1 diabetes. Type 2 diabetes is also possible but distinctly uncommon in children. The symptoms of children’s diabetes are characterised by sudden ketoacidosis, in other words insulin deficiency, which develops rapidly and requires emergency care. Diabetic children are usually treated and monitored in specialised healthcare.
Gestational diabetes is a glucose metabolism dysfunction occurring for the first time during pregnancy and fixing itself after childbirth. However, gestational diabetes indicates a latent susceptibility, meaning a clearly elevated risk of developing type 2 diabetes later in life. Elevated blood sugar levels in pregnant women expose them to elevated blood pressure or pre-eclampsia, an increased risk of a large foetus and hypoglycemia in the newborn.
A healthy lifestyle plays a key role in the treatment of gestational diabetes and the prevention of diabetes after the pregnancy. By working on a healthy weight, diet and exercise, you can significantly reduce your risk of developing type 2 diabetes later in life. If the genetic susceptibility is minor, the onset of diabetes may even be completely avoided by keeping your lifestyle in check and your weight within the normal limits. Gestational diabetes is monitored at the maternity clinic. After childbirth, the blood sugar level is examined with a glucose tolerance test. If the results are normal, the glucose tolerance test must be repeated after three years and then regularly throughout life.
The risk of diabetes can be assessed without laboratory tests but a diagnosis requires a blood sugar test. If you are prone to excess weight gain in the abdomen and someone in your immediate or close family is a diabetic, we recommend having your blood sugar levels checked and discussing the matter with a physician during an occupational health appointment or a regular health check-up, for example.
Even if your fasting glucose or glycohaemoglobin levels are normal, individual tests of said levels do not rule out diabetes. The best way to discover the status of the glucose metabolism is the glucose tolerance test. It can also discover milder glucose metabolism dysfunctions up to years before the onset of diabetes. Simply testing the fasting glucose is not a reliable way to rule out the risk of diabetes. Glycohaemoglobin, in turn, indicates the average of blood sugar levels over three months and is not, therefore, sufficiently accurate for diagnosing early or mild forms of diabetes. Once diabetes is diagnosed, medication should be started and it is not advisable to wait and monitor the situation. Once successful lifestyle changes start to be reflected in the blood sugar levels, the medication can often be reduced.
If you suspect you might have diabetes, you can book an appointment with a general practitioner or an occupational health physician or directly with a diabetes nurse at the Diabetes Clinic of Mehiläinen who will collect the necessary information before your appointment with a physician. Book an appointment at Mehiläinen by using our online booking system and searching for ‘Diabetes Clinic’ or Diabetesklinikka’ or by calling us.
Treatment of diabetes
Diabetes is treated with both medication and lifestyle changes. By nature, diabetes is a progressive illness that progresses at an individual rate; faster for some, slower for others. Therefore, it is not advisable to wait for the symptoms of high blood sugar levels or potential complications to appear but to treat the disease proactively.
Taking action and changing your lifestyle plays a key role in the treatment of diabetes; the patient’s efforts are decisive in the success of the treatment. The lifestyle changes should be slow and carried out in small steps rather than making major changes at once as small steps are easier to adhere to. To ensure successful self-care, a diabetic requires information, guidance, support and tools provided by the multiprofessional team treating the patient. The tools include providing information on examinations, analysing individual risks, supporting lifestyle changes and planning the required medication.
The medicinal treatment of diabetes has considerably developed over the past few years. Medication is available in both injection and tablet form. In insulin-dependent diabetes, insulin remains the key medication, but in other types of diabetes, it is no longer usually used as the primary option. The diabetic discusses with the physician to select the suitable medication from a wide range of options. Today, the medicinal treatment aims to impact not only the blood sugar levels but also cholesterol, blood pressure and metabolic factors. Aspirin is no longer recommended for all diabetics as preventive medication; it is recommended based on an individual risk assessment if a vascular disease has already been diagnosed or there is a considerably elevated risk of a vascular disease. Lifestyle treatment can reduce the amount of required medication.
Diabetes, diet and exercise
Even losing a small amount of weight considerably improves the general state of health and is very effective in the prevention and treatment of type 2 diabetes. The current nutrition recommendations form an excellent basis for any person’s diet, including diabetics.
Physical exercise plays a major role in the prevention and treatment of diabetes. According to research, regular exercise hinders the onset of diabetes. It is also highly important in type 1 diabetes, particularly for weight control and the prevention of complications.
The Diabetes Clinic operates at the following Mehiläinen clinics:
Expert consulted for the article Tove Laivuori, Licentiate in Medicine, Specialist in General Practice
Sources: Current Care Guidelines, Health Library