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What is Diabetes?
Diabetes is a metabolic disorder characterized by high blood sugar but also accompanied with increase in blood fats. (cholesterol and triglycerides).

Why become diabetic?
Diabetes occurs when organ called "Pancreas" located at the rear wall of stomach fails to produce sufficient "insulin" or effect of produced insulin reduces (insulin resistance) or due to occurrence of both cases at the same time.

What is insulin?
Food nutrients we take with meals, especially carbohydrates are converted into glucose to meet the energy of our body. Glucose is taken inside the cell due to insulin hormone and is used in energy production or is stored in liver in the form of glycogen. Glucose access is not allowed in sufficient amount to cells as a result of failure of secretion of this insulin hormone or reduction of its effect and glucose not accessing inside the cell remain in bloodstream. In this way, while blood sugar level increases (hyperglycemia), our cells experience "absence in presence". 

How is diabetes diagnosed?
It is very easy to diagnose diabetes. Blood sugar level of non-diabetes persons does not exceed 100 mg/dl after at least 8 hours of fasting. It does not exceed 140 after 2 hours of meal. 

"Fasting blood sugar" or "oral glucose tolerance test" is applied for finding out whether there is a diabetes in a person. In case fasting blood sugar is over 126 and more in minimum 2 different measurement, diabetes is diagnosed.

Sometimes, while fasting blood sugar is normal, there may be diabetes suspicion. In this case, oral glucose tolerance test (OGTT) is recommended. In oral glucose tolerance test, a 75 gr glucose is melted in water and drunk by this person on an empty stomach in the morning and after 2 hours, blood glucose level is examined. In second hour, if blood sugar is 200 mg/dl or more, diabetes is diagnosed.

In recent years, diabetes is diagnosed with Hemoglobin A1c measurement. If HbA1c level of a person is 6.5 or more, diabetes can be diagnosed. However, since this method may yield inaccurate results such as anemia, this method is not recommended.

What latent diabetes?
If fasting blood sugar of a person is between 100-126 mg/dl or when sugar loading (OGTT) is made, 2nd hour blood sugar level is between 140-220 mg7/dl, "latent diabetes" or "prediabetes" can be diagnosed. Latent diabetes is not an innocent situation and most of latent diabetes cases can turn into diabetes unless measures are taken such as change in life style and increase in physical activity.

What are the types of diabetes?
Roughly, diabetes can be classified as type 1, type 2, pregnancy diabetes and other specific types. 80-95 % of all diabetes incidents are type 2 and the remaining 5-10 % is Type 1 diabetes.

What is Type 1 diabetes?
Former name of this disease is also known as "insulin dependent diabetes" or "juvenile diabetes". This occurs as a result of destruction of beta cells secreting insulin on pancreas gland as a result of attack of immune system of the body. Most of the incidents may be seen in childhood/youth and it can be seen in every age. Only insulin is used in its treatment.

What is Type 2 diabetes?
This is the most common types of diabetes.  This is also known as insulin resistance diabetes or adult-onset diabetes.  In this disease, reduction of insulin effect (insulin resistance) can be mentioned rather than lack of insulin in at least onset period of this disease. Once disease progresses, insulin secretion also declines. Most of the patients are over-weight and obesity itself leads to insulin resistance. Excessive fat accumulation especially in belly area can be mentioned in non-obese patients. Most of the incidents are adults and type 2 diabetes is frequently encountered in childhood ages in our time as a result of increase of obesity in children. This can be treated with incretin mimetics drugs subcutaneously as well as drugs such as agents for insulin resistance in therapy, insulin secretagogues and DPP-IV inhibitors and various methods can be benefited from in insulin treatment.

What is gestational diabetes (GDM)?
This is defined as glucose tolerance disorder when pregnant women without a previous history of diabetes develop a high blood glucose level. Obesity seen in women in childbearing age in our time may also play a role in this phenomenon. 

How is gestational diabetes diagnosed? 
FBG in case of presence of any of the following in loading test made with 75 gr glucose in random time in 24th-28th weeks of pregnancy (   :  ≥92 mg/dL, 1st hour Blood Glucose: ≥ 180 mg/dL, 2nd hour Blood Glucose ≥ 153 mg/dL) gestational diabetes is diagnosed.

What are the risk factors for gestational diabetes? 
The risk factors can be listed as obesity, presence of gestational diabetes in a previous pregnancy, having giving birth to large baby (over 4 kg), having a stillbirth with no known reason, being over 35 years of age, family history of diabetes and/or hypertension and hunger blood glucose over 105 mg/dl and postprandial glucose over 120 mg/dL.  In case of presence of such risk factors, glucose loading test should be conducted without waiting for 24th-28th weeks.

What should we do?
Once it is diagnosed, assistance should be sought from nutritionist(dietician). A regular nutrition program is not only required for people with diabetes but for everyone. We would love to use term of "healthy nutrition" rather than using the terms of "diet" or "regimen". The drugs recommended by the doctor should be taken regularly according to the type and stage of diabetes. A follow-up book should be obtained at all times and blood pressure measurement and whether there is protein leakage in the urine (microalbuminuria) (microalbuminuria) should be conducted as well as periodic blood sugar, cholesterol levels and A1c control. Especially diabetes using insulin should have a diabetes card with the telephone number of following doctor with them and they should have a piece of sugar with them in case of drop of blood sugar.  Smoking must be avoided and alcohol must be abstained from as much as possible. Daily exercise program should be a part of our lives. Exercise should not be heavy and activities such as brisk walking activities should be preferred. In addition, evaluation in terms of cardiac and respiratory system should be conducted at all times in advance.  Control is a must periodically in terms of eyes, kidney, heart and neuropathy in diabetes follow-up.  Substances with no specific content and promising miracle, prepared from herbs and included frequently in written and visual media in recent time must be strictly avoided.

Are we to fear from diabetes?
Diabetes is never a scary condition. Checks should be conducted on regular basis, when treatment condition is good, care should be given to nutrition and almost everything remains normal with a regular exercise program and perhaps we will have more quality and longer life thanks to diabetes. Bear in mind that diabetes is not a temporary condition and its follow-up should be all the time. 

What are the acute complications of diabetes?
Low blood sugar (hypoglycemia): In case of low blood sugar, a person cannot maintain his/her normal functions. (too much insulin, too much exercise or insufficient energy intake) Hypoglycemia rapidly recedes when you take sweetened fruit juice, cube or powder sugar.

Ketoacidosis: Ketoacidosis called diabetic coma is a serious condition depending on insulin absence. Mainly, this is frequently seen in people with type 1 diabetes.

Lactic acidosis: Lactic acidosis is lactic acid build-up in the body. When cells use non-glucose fuel as energy, they generate lactic acid. If too much lactic acid stays in the body, balance is disrupted and people begin to feel uncomfortable. This less frequently encountered case mainly affects type 2 diabetes people.

Bacterial-fungal (fungus) infections: The persons with diabetes are more vulnerable to infections with bacterial and fungal origin in all organs as frequently on skin and nails.

What are the chronic complications of diabetes?
High blood sugar lasting for a long time destroys large and small vessels and nerves. Problems may arise according to the organ of which destruction affects it.

Cardiovascular disease: In many countries, cardiovascular disease or circulatory system disease is the foremost cause of death among the people with diabetes. Cardiac disease or stroke risk is 2-5 times more in the people with diabetes. Vessels in legs are affected and this may lead to amputation with neuropathy.
Retinopathy (eye damage): This is prevalent cause of blindness and visual impairment in adults. 2 % of the persons with uncontrolled sugar and with diabetes for 15 years become blind and severe visual impairment develops in 10 % of them.
Nephropathy (kidney damage): This is a major threat for the people with diabetes. Severe kidney disease which may require dialysis and/or kidney transplant when they reach 50 years of age may develop in 40 % of the people with uncontrolled type 1 diabetes.
Neuropathy (Nerve damage): It affects at least half of people with diabetes. Diabetic nerve disease may lead to loss of sense in legs and feet and this may result in feet wound or leg amputation. Unfortunately, diabetes ranks as the leading in non-accident causes in leg amputations. Diabetic nerve disorders may also result in impotence.