Diabetes

Diabetes is a chronic disease that affects how the body processes blood sugar, or glucose. It is a growing global health issue that affects millions of people worldwide, including in Georgia. The increasing number of patients is caused by lifestyle, genetics, and other health-related factors.

There are several main types of diabetes: diabetes mellitus, diabetes insipidus, and gestational diabetes. Diabetes mellitus is further divided into Type 1 and Type 2.

Type 1 diabetes is an autoimmune disease in which the immune system attacks the insulin-producing cells in the pancreas, leading to insulin deficiency. Type 2 diabetes, the most common form, develops when the body becomes resistant to insulin or does not produce enough of it.

Diabetes insipidus is a completely different condition and is not related to blood sugar levels. It results from the body’s inability to regulate fluid balance and occurs when kidney function or vasopressin (the antidiuretic hormone) is impaired. This hormone is responsible for fluid regulation.

Gestational diabetes develops during pregnancy when the mother's body cannot effectively regulate blood sugar levels. It usually disappears after childbirth but increases the risk of developing Type 2 diabetes later. This form of diabetes requires special attention, as it can affect both the mother’s and baby’s health.

Is Diabetes Curable?

A common question arises — is diabetes curable? The answer is not straightforward because different types of diabetes require different management approaches.

How to Recognize Diabetes?

As with any disease, the first question we ask is: how do we recognize diabetes? Whether it's gestational, diabetes insipidus, or diabetes mellitus — it’s essential to know the symptoms and undergo proper diagnosis.

Each type of diabetes presents with different symptoms.

Let’s review diabetes mellitus symptoms:

• Excessive thirst – a constant need to drink, even after consuming large amounts of water.

• Frequent urination – the body tries to eliminate excess sugar through urine.

• Rapid weight loss – despite normal or increased appetite, the body breaks down fat and muscle due to lack of energy.

• Fatigue and lack of energy – sugar does not enter cells properly, causing ongoing tiredness.

• Nausea and vomiting – uncontrolled diabetes can lead to diabetic ketoacidosis (DKA), a toxic condition.

• Blurred vision – high blood sugar damages small blood vessels in the eye.

• Slow wound healing – poor circulation leads to delayed skin healing.

• Tingling or numbness in hands and feet – diabetic neuropathy, often affecting lower limbs.

Gestational diabetes symptoms often resemble those of Type 2 diabetes.

Diabetes insipidus, since it's unrelated to blood sugar, presents with symptoms like:

• Excessive thirst

• Urine output ranging from 3 to 20 liters a day

• Signs of dehydration (dry skin, low blood pressure)

• Fatigue and drowsiness
  

Diagnosis and Testing

Early detection and identification of the type of diabetes are essential for proper management. Diagnosis usually begins with identifying the type of diabetes, as each requires a specific treatment plan.

For diabetes mellitus (Type 1 and Type 2), the main tests are:

• Fasting glucose test – performed after 8 hours of fasting; values above 126 mg/dL indicate diabetes.

• Oral glucose tolerance test (OGTT)

• HbA1c (glycated hemoglobin) – shows the average blood glucose level over the past 2–3 months, especially useful for diagnosing Type 2 diabetes.
  

Gestational diabetes is diagnosed between the 24th and 28th weeks of pregnancy with the OGTT. After consuming a glucose-rich drink, blood sugar is measured. If it exceeds 200 mg/dL two hours after drinking, gestational diabetes is diagnosed.

For diabetes insipidus, diagnosis involves assessing fluid balance, since the condition affects water retention, not sugar levels.
A vasopressin test may also be done to evaluate whether this hormone is produced and if kidneys respond to it properly.

How to Manage Diabetes?

Once diagnosed, patients often ask: is diabetes reversible or manageable? The answer depends on the type.

In general, diabetes management includes:

• A balanced diet rich in proteins and vegetables

• Regular physical activity

• Medication such as insulin or oral drugs

• Continuous blood sugar monitoring
  

Technological advancements, like glucose monitoring devices and insulin pumps, have made diabetes management easier and more precise. Patients need to monitor blood sugar regularly.

When to check blood sugar levels:

• In the morning, before eating or drinking

• Before meals

• Two hours after meals

• Before bedtime

• Before and after physical activity (if advised by a doctor)
  

Target Blood Sugar Levels

For those with diabetes mellitus, typical target ranges are:

• Before meals: 80–130 mg/dL

• Two hours after meals: below 180 mg/dL

However, individual targets may vary based on age, health conditions, and doctor recommendations. Regular consultations are essential.

Hypoglycemia and Hyperglycemia

• Hypoglycemia = blood sugar below 70 mg/dL

• Hyperglycemia = blood sugar above normal levels

Both conditions require attention and proper response.

Treatment and Reversal Possibilities

• Type 1 diabetes is considered irreversible since insulin-producing cells are permanently damaged.

• Type 2 diabetes can enter remission through weight loss, healthy eating, and exercise. However, remission is not a cure — ongoing control is necessary.

Diabetes Insipidus

This condition includes two main types:

• Central diabetes insipidus – due to a lack of vasopressin

• Nephrogenic diabetes insipidus – kidneys don't respond to vasopressin

Treatment aims to:

• Prevent dehydration

• Maintain fluid balance

• Reduce symptoms
  

Central diabetes insipidus is effectively treated with desmopressin (DDAVP), a synthetic form of vasopressin. It helps the body retain water and reduce urination. Dosage must be adjusted to avoid hyponatremia (low sodium levels).

Nephrogenic diabetes insipidus is harder to treat, since kidneys don’t respond to the hormone. Management includes:

• Dietary changes

• Use of thiazide diuretics and anti-inflammatory drugs

• Reducing salt and protein intake to reduce kidney load

Patients must stay well-hydrated and monitor urine output, body weight, and general condition. Regular medical supervision and therapy adjustment are crucial for quality life.

Gestational Diabetes

Management includes:

• Healthy eating

• Physical activity

• Insulin therapy, if needed

Regular blood sugar monitoring and controlled carbohydrate intake help avoid sharp glucose changes.

If lifestyle changes are not enough, insulin may be prescribed — safe for both mother and baby. The goal is to ensure a healthy pregnancy and avoid complications. In most cases, blood sugar returns to normal after childbirth, but the risk of Type 2 diabetes remains, so a healthy lifestyle must be maintained.

Conclusion

Diabetes is a complex and multifaceted disease that requires proper management and continuous control. The different types — diabetes mellitus, diabetes insipidus, and gestational diabetes — present differently and require specific diagnostics and treatments.

• Type 1 is currently incurable, but manageable with the right therapy.

• Type 2 can be managed and sometimes enter remission with lifestyle changes, though not fully cured.

• Gestational diabetes often resolves after birth, but increases future risk.

• Diabetes insipidus, linked to fluid imbalance, requires specialized therapy and medications.
  

Timely diagnosis and appropriate treatment are key to managing diabetes effectively. Blood sugar monitoring, balanced diet, physical activity, and doctor consultations are critical in preventing complications. While still incurable, modern medicine and a healthy lifestyle allow people with diabetes to lead normal, active, and fulfilling lives.