Diabetes

Although there are several types of Diabetes, Diabetes is a metabolic disorder that involves the release of insulin from the pancreas and its use in the body in order to process and store Glucose (sugar) within the body.  Glucose is an important source of energy, however, too much can negatively impact health.

Types of Diabetes include:

• Type 1
• Type 2
• Gestational
• Prediabetes (Mayo, 2018)

In Type 1 Diabetes, an individual's immune system destroys the cells of the pancreas that produce insulin.  This greatly reduces the amount of insulin being produced.  Without insulin or very little insulin, the amount of blood sugar in the body increases (Mayo, 2018).There is a genetic proponent to Type 1 Diabetes.  Prediabetes is a step to developing Type 2 Diabetes.  In Prediabetes, cells within the body become increasingly resistant to insulin.  Regardless of how hard the pancreas works, it cannot make enough insulin to counteract the insulin resistance (Mayo, 2018).  This leads to blood glucose increasing instead of being used by cells for energy.  At this point, someone has developed Type 2 Diabetes.  There is also a genetic aspect to  Type 2 Diabetes.  Increased weight is also linked to developing Type 2 Diabetes (Mayo, 2018).  Gestational Diabetes occurs due to hormones, produced by the placenta, causing cells to be resistant to insulin.  There are instances where the pancreas is unable to produce enough insulin to counteract the resistance (Mayo, 2018).  Typically, Type 1 Diabetes is diagnosed in children and younger adults, but can be diagnosed at any age.  Type 2 Diabetes is typically diagnosed in adulthood, but  can be also diagnosed in children as well.  Gestational Diabetes is diagnosed during pregnancy (NIH, 2016).

There are approximately 50.2 million people, 18 years or older, in the United States with Diabetes, either diagnosed or undiagnosed (MNT, 2020).  This equates to almost 10% of the population.  More than 25% do not know that they have Diabetes (NIH, 2016).

Symptoms of Diabetes (including Gestational) include:

• Extreme hunger
• Fatigue
• Increased urination
• Increased thirst
• Dry mouth
• Itchy skin
• Blurred vision
• Impotence/Erectile dysfunction

Symptoms of Type 1 Diabetes include:

• Unexplained weight loss
• Nausea
• Vomiting
• Velvety dark skin changes of neck, armpits, and groin (Acanthosis Nigricans)
• Decreased vision

Symptoms of Type 2 Diabetes include:

• Yeast infections
• Slow healing sores or cuts
• Pain or numbness (Mayo, 2018)(WebMD, 2019)

Complications from Diabetes can arise.  Diabetes can play a part in developing conditions such as:

• Heart disease
• Stroke
• Kidney disease
• Eye problems
• Dental disease
• Nerve disease
• Foot problems
• Hearing impairment
• Alzheimer's disease
• Depression (Mayo, 2018)(NIH, 2016)

With Gestational Diabetes, complications that can occur include:

• Excess growth (Large baby)
• Baby more likely to develop Type 2 Diabetes later in life
• Low blood sugar
• Death (Mayo, 2018).

There are many risk factors for Diabetes.  They include:

• For Type 1:
• Family history
• Environmental factors
• Presence of damaging immune system cells (autoantibodies)
• Geography
• For Prediabetes/Type 2:
• Family history
• Weight
• Physical inactivity
• Race
• Age
• Gestational diabetes
• Polycystic Ovary Syndrome
• Hypertension
• High Cholesterol
• Gestational
• Age
• Family history
• Personal history
• Weight
• Race (Mayo, 2018).

With the symptoms occurring rapidly with Type 1 Diabetes, screening tests for Diabetes are often warranted.  With Type 2 Diabetes and Prediabetes, there are guidelines set forth by the American Diabetic Association to prompt screening for Diabetes including:

• BMI >25, regardless of age
• 45 years old or older
• Any woman that had Gestational Diabetes during a pregnancy
• Diagnosis of Prediabetes (Mayo, Diagnosis, 2018).

Tests used to diagnose Diabetes include:

• Glycated Hemoglobin (A1C) test
• Random blood sugar
• Fasting blood sugar
• Oral glucose tolerance test
• Urine checked for ketones, if Type 1 is suspected 
• Glucose challenge test, used to diagnose Gestational Diabetes

There are several treatments that can be used with Diabetes.  These treatments include:

• For Type 1
• Insulin
• Injections
• Insulin pump
• Blood sugar checks
• Carbohydrate Counting
• For Type 2
• Lifestyle changes
• Exercise
• Weight loss
• Well-balanced diet
• Minimal alcohol 
• Medications
• Metformin
• SGLT2 inhibitors
• GLP-1 receptor agonists
• Bariatric surgery (Mayo, 2018).

With all types of Diabetes, an individual should be aware of the symptoms of hypoglycemia, hyperglycemia, Diabetic Ketoacidosis, and Hyperglycemic Hyperosmolar Nonketotic Syndrome as they all can constitute an emergency. Individuals with Diabetes should be aware of the symptoms of each of these conditions.   Hypoglycemia, or low blood sugar, occurs when someone's blood sugar falls below a target level.  Hyperglycemia occurs when blood sugar raises above a target level.  Diabetic ketoacidosis occurs when the body breaks down fat for energy producing ketones.  Hyperglycemic Hyperosmolar Nonketotic Syndrome occurs with Type 2 Diabetes when the blood sugar level becomes so high that an individuals' blood thickens (Mayo, 2018).

Symptoms of Hypoglycemia include:

• Sweating
• Shakiness
• Weakness
• Hunger
• Dizziness
• Headaches
• Blurred vision

Symptoms of Hyperglycemia include:

• Frequent urination
• Increased thirst
• Dry mouth
• Blurred vision
• Fatigue
• Nausea

Symptoms of Diabetic Ketoacidosis include:

• Loss of appetite
• Weakness
• Fever
• Numbness
• Stomach pain
• Sweat, fruity breath

Symptoms of Hyperglycemic Hyperosmolar Nonketotic Syndrome include:

• Blood sugar 600 mg/dL or higher
• Fever
• Dry Mouth
• Extreme thirst
• Drowsiness
• Confusion
• Vision loss
• Hallucinations (Mayo, 2018).

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For more resources on Diabetes, visit the American Diabetic Association website at https://www.diabetes.org/resources

Mayo Clinic. (2018)  Diabetes.  Mayo Clinic.  Retrieved from https://www.diabetes.org/resources

Medical News Today. (2020) Diabetes: Symptoms, treatment and early diagnosis.  Medical New Today.  Retrieved from https://www.medicalnewstoday.com/articles/323627

NIH. (2016) What is Diabetes?  National Institute of Diabetes and Digestive and Kidney Diseases.  Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes

WebMD. (2018) Early Signs and Symptoms of Diabetes: How To Tell If You Have It.  WebMD.  Retrieved from https://www.webmd.com/diabetes/guide/understanding-diabetes-symptoms

Depression

Depression is a mood disorder that is also known as Major Depressive Disorder or Clinical Depression.  Because depression is comprised of a persistent feeling of sadness and a loss of interest in activities it is more than feeling sad for a couple days (Mayo, 2020).  The symptoms of depression can affect and individual's feelings, thoughts, and daily activities (NIH, 2020).

The symptoms of depression can fluctuate in severity.  An individual can have episodes of symptoms.  The episodes last at least two weeks but can last for months or years (MNT, 2020).  Symptoms of depression include:

• Persistent feelings of sadness, anxiety, hopelessness, worthlessness.
• Feelings of irritability or angry outbursts.
• Loss of interest in activities.
• Decreased energy or fatigue.
• Difficulty concentrating, remembering or making decisions.
• Sleep disturbances such as difficulty sleeping, early morning awakening, oversleeping.
• Appetite and/or weight changes (increased or decreased).
• Aches or pains not explained by other conditions.
• Increase in purposeless physical activity (pacing back and forth, etc).
• Slowed movements and speech.
• Suicidal ideations or suicide attempts (Mayo Clinic, 2020)(APA, 2017)(NIH, 2018).

About 6.7% of adults are affected by depression in any given year and 16.6% of people experience depression during their lifetime.  (APA, 2017).  Also in any given year, 16.1 million people in the United States are affected by depression (MNT, 2020).  Women are about twice as likely  to experience depression than men and about one third of women experience an episode of depression in their lifetime (APA, 2017)(MNT, 2020).

Risk factors of depression include:

• Genetics
• Brain chemistry
• Environmental factors
• Psychological and social factors
• Hormones
• Personality
• Acute stress
• Lack of coping strategies
• Some medications
• Recreational drugs
• Head injury
• Chronic condition
• Persistent pain (MNT, 2020)(APA, 2017)(Mayo Clinic, 2020).

Depression is most often first seen in adulthood, although depression can occur at all ages.  In adults, depression can occur along with other medical conditions.  Medications for these conditions may impact depression (NIH, 2018).

In order to diagnose depression, several things should be done including:

• Physical exam
• Lab tests
• Psychiatric evaluation
• The Hamilton Depression Rating Scale
• The Beck Depression Inventory
• Use of DSM-V (Diagnostic & Statistical Manual of Mental Disorders, 5th edition) (MNT, 2020)

According to the DSM-V, five or more symptoms must be present during a two week period, as well as be a change in prior functioning with one of the symptoms being either a depressed mood or loss of interest in activities or pleasure (FMHI, 2018).

Treatments for depression include:

• Support
• Psychotherapy
• Medications
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Monoamine Oxidase Inhibitors (MAOIs)
• Tricyclic antidepressants
• Atypical antidepressants
• Selective Serotonin & Norepinephrine Reuptake Inhibitors (SSNRIs) 
• Electroconvulsive therapy  
• Transcranial Magnetic Stimulation (MNT, 2020)(APA, 2017)(Mayo Clinic, 2020)-.

There are forms of depression that are somewhat different from Major Depressive Disorder.

• Persistent Depressive Disorder:  also known as Dysthemia and is less severe and more chronic as it lasts for at least two years.
• Postpartum Depression: occurs during pregnancy or after childbirth.
• Psychotic Depression: consist of severe depression and a form of psychosis (delusions or hallucinations).
• Major Depressive Disorder with Seasonal Pattern:  onset is during winter months with less natural sunlight.
• Bipolar Depression:  Depression fluctuates with mania (extreme high euphoria).
• Cyclothymic Disorder:  involves symptoms that are milder than Bipolar Depression.

If you are experiencing depression, find support and seek medical attention.  If you are considering suicide, find support, seek medical attention or contact the National Suicide Hotline at 1-800-273-8255.

Watch Youtube video below.  Click like, share and subscribe.  Also, in blog, at right of articles, click follow for updates on articles.

APA. (2017) What is Depression?  American Psychiatric Association.  Retrieved from https://www.psychiatry.org/patients-families/depression/what-is-depression

FMHI. (2018) DSM-5 Criteria: Major Depressive Disorder.  Florida Mental Health Institute. Retrieved from  http://www.medicaidmentalhealth.org/_assets/file/Guidelines/2017-
2018%20Treatment%20of%20Adult%20Major%20Depressive%20Disorder.pdf

Mayo Clinic. (2020) Depression (Major Depressive Disorder)  Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013

MNT. (2020) What is Depression and What Can I Do About It?  Medical News Today.  Retrieved from https://www.medicalnewstoday.com/articles/8933#triggers

NIH. (2018) Depression.  National Institue of Health.  Retrieved from https://www.nimh.nih.gov/health/topics/depression/index.shtml