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Insulin and Diabetes

Greetings everyone! Today we will discuss an important hormone called “insulin” and how it relates to diabetes.

Insulin is a hormone produced in the pancreas by special cells called beta cells, which regulate blood sugar levels. Insulin helps blood sugar enter the body’s cells so it can be used for energy, which in turn lowers blood sugar levels. There is usually a spike in insulin secretion when blood sugar rises, such as when we eat since the food contains sugar or glucose that gives us energy. The pancreas will produce more insulin to reduce blood sugar levels, which will keep increasing as we consume more sugar. As blood sugar levels in the bloodstream begin to fall, the pancreas reduces insulin release to maintain normal blood sugar levels.

Simply said, the time after eating a meal, snack, or anything that increases your blood sugar is when insulin is most released. It will be released in adequate quantities to lower blood sugar to a level that is safe for the body. Insulin secretion will be inhibited once it reaches that level. All of this is a typical bodily procedure.

People with insulin and pancreatic problems will have insufficient insulin production or function. This could lead to diabetes because their insulin secretion is insufficient for reducing blood sugar, or if the beta cells are damaged, the body may be unable to produce insulin at all.

As a result, insulin is the most prominent cause of diabetes, which is categorized into two categories.

Type 1 diabetes mellitus,also known as insulin-dependent diabetes, is most diagnosed in thin/skinny people under the age of 30. Type 1 diabetes has been diagnosed in less than 5% of the Thai population.

Type 1 diabetes happens when the pancreas makes little to no insulin. Even when the pancreas can produce insulin, it is ineffective because the stem cells are not normal, resulting in the lack of insulin to help blood sugar enter the body’s cells which would lower blood sugar levels. The lack of such leads to high blood sugar that makes diabetic patients feel tired and weak, lose weight quickly, get infections easily, feel more thirsty than usual, urinate a lot, feel irritable, and could cause diabetic ketoacidosis (DKA). This type of diabetes can be treated with insulin injections only.

The cause of this type of diabetes is still unknown. However, it is thought to be caused by an autoimmune reaction where the body attacks itself by mistake. In this case, it is thought the reaction destroys the beta cells in the pancreas, preventing it from producing insulin. Different factors, such as genetics, may cause type 1 diabetes as well.

Type 2 diabetes, also known as non-insulin dependent diabetes mellitus (NIDDM), can be found in children and adults, particularly those with obesity. However, it is more common in adults over the age of 40 years old. Type 2 diabetes is significantly more common than type 1 diabetes. Some women develop diabetes during pregnancy, which is called gestational diabetes. This type of diabetes affects up to 95% of the Thai population.

Type 2 diabetes often occurs because cells respond poorly to insulin, also known as insulin resistance (the origin of the name non-insulin dependent diabetes mellitus). As a result, cells take in less sugar, not receiving enough energy, leading to high blood sugar, which causes the body to produce more insulin in an effort for the cells to receive enough energy. However, over time, pancreatic cells would no longer be able to produce insulin. This type of diabetes is most commonly found in people who like to eat sweets or carbs. ^^

Type 2 diabetes symptoms are similar to those of type 1 diabetes but less severe, such as feeling thirsty all the time, having dry lips, urinating more than usual, feeling hungry often but losing weight quickly, and feeling tired all the time.

In the following article, we will discuss getting tests and diagnoses if you suspect diabetes.

We will discuss different tests you can take if you suspect diabetes, which are:

  1. Random Blood Sugar Test – This test measures your blood sugar when you’re tested. The name tells it all: you can take this test at any time and don’t need to fast (not eat) first. However, this test has the lowest accuracy. It is done through a blood test. If the result shows a blood sugar level of 200 mg/dL or higher, it indicates you might have diabetes, requiring an additional blood sugar test called FBS.
  2. Fasting Blood Sugar (FBS) Test – This test measures your blood sugar after six to eight hours of fasting (not eating). It also measures your blood sugar when you’re tested but has more accuracy than the first one. Fasting would help avoid false results, although not entirely, because consuming food with high carbs and/or sugar before the test would increase the blood sugar level. For this test, if the result shows a fasting blood sugar level of 126 mg/dL or higher, it indicates you have diabetes. (This test is the most popular as it is not too expensive and more accurate than the first test.)
  3. Hemoglobin A1C (HbA1c) Test – HbA1c is your average blood sugar level for the last two to three months, and this test would measure just that. There is no need to fast before the test as this test examines glucose (sugar) that binds to the hemoglobin in your red blood cells. Since the lifespan of red blood cells is about 120 days or 3 months, many people refer to it as the 3-month blood sugar level. If your HbA1c level is 6.5% or higher, you have diabetes.
  4. Glucose Tolerance Test – This test measures your blood sugar before and after you take a certain amount of sugar (typically around 75 g). There is no need to fast for this test. The process is to take the specified sugar, wait around 2 hours, and have your blood sugar level checked after that. If the result shows a blood sugar level of 200 mg/dL or higher, it indicates you have diabetes.

Q: Which one is better/more accurate, between finger prick tests with a small meter to indicate the blood sugar level and venous tests (using a needle to draw blood from a vein in your arm) and analysed by a bigger medical machine?

A: The venous tests are more accurate. However, venous tests cannot be done as often due to several limitations, such as the requirement of personnel specialized in taking blood and the use of specific machines. This rationale particularly applies to patients with type 1 diabetes, as they need to check their blood sugar levels regularly, typically many times per day. Therefore, they cannot travel to a clinic or hospital every time they take the test (otherwise, they might be shocked). Hence, it is best for them to use the finger prick tests and occasionally get the venous test.

If you notice any abnormality in your body and suspect it might be diabetes, it is best to take the test as soon as possible. If the high blood sugar level is detected early, it could be within the range you could address and lower it yourself. However, if you leave it for too long that it surpasses such a level, there are no other options except getting into treatment.

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