All there is to know about Diabetes and how Oral GGT helps detect

The Big D and GGT

Diabetes mellitus, which means honey-sweet in Greek, is a disease that arises from high levels of blood glucose, or blood sugar, in the body. Under normal circumstances, blood sugar is the main energy source of the different parts of the human body, which is derived from the various foods we eat every day.

The World Health Organization posits that the global prevalence of diabetes for adults over 18 years of age has gone from 4.7 percent in 1980 to 8.5 percent in 2014. The number of people afflicted with the illness has been rising more rapidly most especially in middle- and low-income countries.

The year 2015 saw 30.3 million people in the United States suffering from diabetes, which is 9.4 percent of the population. More than a quarter of those afflicted do not know that they have the disease. About 90-95 percent of cases in adults in the US are type 2 diabetes.

Back in 2017, data from the International Diabetes Federation (IDF) shows that the disease has affected 6.2 percent of the adult population in the Philippines, which translates to roughly 3.7 million people living in the country.

Diabetes is most commonly tied with the hormone insulin and resistance to its effects. Made in the pancreas, the hormone helps blood glucose get into the cells of the body to be used for energy. Diabetes is a condition characterized by too little or a total lack of insulin in the body or resistance to it. This allows excessive sugar to stay in the blood, a condition referred to as hyperglycemia. If left untreated and uncontrolled, this leads to serious damage to the body, especially the nerves and blood vessels.

It currently has no cure. However, with proper management and a healthy diet, diabetes and the multitude of complications it brings can be kept at bay.

Numbers from the American Diabetes Association (ADA) say that diabetes was the seventh leading cause of death in the US in 2015.

There also exists prediabetes, a condition that is indicative of higher than normal blood glucose levels but is not excessive enough to be diabetes. However, prediabetes can progress to diabetes if not managed properly.

Almost 34 percent of US adults aged 18 and above have prediabetes back in 2015. Nearly half of these are aged 65 or older.

Beyond insulin resistance

Diabetes is mainly divided into three types, Type 1, Type 2, and gestational diabetes. Each has a different underlying cause and present different problems regarding insulin production and use in the body.

Type 1 diabetes is a condition in which the body is unable to produce insulin at all. People with this type of disease need to take insulin every day for the rest of their lives, hence earning the name insulin-dependent diabetes.

While the cause of this type is still uncertain as per the WHO, it is believed that Type 1 is an autoimmune disorder. The person’s immune system attacks the insulin-making cells in the pancreas called beta cells, rendering them useless and unable to produce said hormone. Other experts believe that a genetic predisposition to the disease may also cause people to have Type 1.

This was also once called juvenile or childhood-onset diabetes since it is mainly diagnosed in children and young adults before. Yet, the disease can come up at any point in a person’s life.

Type 1 presents the classic diabetic symptoms, which include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger (polyphagia), and weight loss. Patients may also experience vision changes and fatigue. These symptoms may occur suddenly.

Other symptoms of diabetes include the presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there’s not enough available insulin), slow-healing sores, and frequent infections, such as those of the gums, skin, or vagina.

Type 2, formerly called non-insulin-dependent, or adult-onset, happens when the body’s use of insulin is ineffective primarily because of insulin resistance. This type of diabetes is found in the majority of patients in the world. It is estimated that 95 percent of diabetes cases are Type 2.

While Type 1 is autoimmune, Type 2 could be a direct result of lifestyle choices. The pancreas can produce insulin, yet the body is unable to utilize it properly.

Excessive weight and physical inactivity are believed to be the main reasons behind Type 2. It is also possible that your genes could be predisposed to have insulin resistance.

Other causes could include another metabolic syndrome, such as high blood pressure, high cholesterol, and triglycerides. Some people’s livers may also have problems managing the release and storage of glucose storage.

Some patients’ pancreatic beta cells may also malfunction, producing the wrong amount of insulin and releasing them at the wrong time.

For others, there could be problems with communication between the body’s cells, setting off a chain reaction leading to Type 2 diabetes.

Until recently, this is the type of diabetes that starts during adulthood. However, more and more children are diagnosed with this.

This is the type strongly linked to childhood obesity. Once thought to only affect adults, Type 2 is becoming more and more frequently present with children and young adults.

Type 2 exhibits the same symptoms as Type 1, polyuria, polydipsia, and polyphagia. However, these are less seen and felt by patients, hence diagnosis is usually delayed. It is only when complications occur that patients find out they have Type 2.

Patients are usually treated with oral medications and advised to make changes to their lifestyle. However, if left untreated, Type 2 patients would have to take insulin every day as well, just like Type 1 patients.

Gestational diabetes occurs is hyperglycemia during pregnancy, as carrying a child may trigger insulin resistance to some women. While blood sugar levels are not high enough to be considered diabetes, gestational diabetes poses risks to women during pregnancy and delivery. Furthermore, women and their eventual children are put at risk of getting Type 2 in the future. The National Institutes of Health (NIH) reports that up to 10 percent of women who had gestational diabetes develop Type 2 later in life.

Figures from the NIH state that gestational diabetes happens somewhere between 2-10 percent of pregnancies. It usually goes away after pregnancy.

Causes, risk factors, and complications

Some causes of diabetes are pretty straightforward. In Type 1, as mentioned, is believed to be caused by the body’s immune system attacking cells at the pancreas. Gestational diabetes only happens during pregnancy.

However, with Type 2 diabetes, the causes are not clear. There is a lifestyle component to it, such as obesity and sedentary living, yet research has shown that there could be other factors as well.

A family history of diabetes puts you at risk of getting the disease in the future. Furthermore, a low, high-density lipoprotein (HDL) cholesterol level may contribute to increasing your risk of diabetes.

Family history or personal history of high blood pressure, heart disease, and/or stroke puts you at risk as well.

As mentioned earlier, women who had gestational diabetes may acquire Type 2 later on. Giving birth to a child more than 9 pounds in weight may mean increased risk. Women who have polycystic ovary syndrome (PCOS) are also at risk for Type 2 diabetes.

A person’s ethnicity may also affect their chances of acquiring diabetes. People of African-American, Native American, Latin American, or Asian-Pacific Islander descent are more commonly afflicted with diabetes.

Age can also be a factor, as people over the age of 45 are at risk of developing this chronic illness.

Having acanthosis nigricans, a skin condition in which your skin becomes dark and thick, especially around your neck or armpits, may also mean there is an increased risk of getting diabetes.

Smoking can also affect your chances of developing diabetes.

Diabetes can lead to complications to almost any part of the body, starting from the skin and even the tiniest blood vessels in your eyes.

Uncontrolled, high blood sugar levels lead to a host of nasty conditions that may affect the quality of life.

Heart diseases are common complications found in diabetics, especially those who have problems with their blood lipids and blood pressure. It is the number one cause of death in people with Type 2 diabetes. Diabetes can exacerbate existing cardiovascular conditions that can lead to illnesses.

Stroke risks are increased many times in people with diabetes. Diabetes makes it harder for the body to respond to a stroke by clogging or hardening blood vessels that would have served as bypass due to the clot that formed in the brain.

Kidney disease is also a common complication of diabetes. The extra blood sugar overworks the kidneys, and over time, may cause them to fail. This is called diabetic nephropathy. One of the telltale signs of diabetes is the presence of sugar in the urine.

Diabetes also causes damage to the nerves. Excess blood glucose hampers nerve function, leading to numbness in numerous parts of the body, most commonly in the hands and feet.

The numbness in the feet, that may give diabetics ulcers, cuts, and injuries that go unnoticed. These can progress to conditions that may require amputation.

The nerves affected may also be those found in the stomach. This may lead to a condition called gastroparesis, which causes the stomach to have a hard time emptying itself.

Vision impairment is also one of the complications of the disease. Most known of these conditions is called diabetic retinopathy. Diabetic retinopathy is an eye condition that causes the blood vessels in the retina of the eyes to swell, leak fluid, or bleed, which affects the function of the eyes. If untreated, diabetic retinopathy can permanently scar and damage the retina, leading to blindness.

Skin infections may take longer to heal in diabetics due to increased blood sugar.

Their oral health may also be compromised, as diabetes can cause dental and gum diseases, as white blood cells are weakened by high blood glucose.

Men with diabetes are also at risk for erectile dysfunction. Nerve and blood vessel damage may hamper a man’s ability to get his member up, leading to sexual dissatisfaction.

Knowing if you are too sweet, anatomically speaking

A blood test is usually done to check for diabetes and prediabetes. There are different blood tests available and each has a unique way of looking at blood glucose levels in the body.

The most common test conducted is the fasting plasma glucose (FPG) test. The FPG blood test measures your blood glucose level at a single point in time. The results would be most accurate if the test is done in the morning after 8 hours of fasting. Fasting means having nothing to eat or drink except sips of water. Non-diabetics have a blood sugar reading of 99 milligrams per deciliter (mg/dL) or less. A result of 100-125 mg/dL may indicate prediabetes. Diabetics usually have a blood glucose level higher than mg/dL.

Another test used to diagnose diabetes is the A1C test. Sometimes called the hemoglobin A1C, HbA1c, glycated hemoglobin, or glychemoglobin test, the A1C test uses hemoglobin in the blood to check blood glucose levels. This is because blood sugar attaches to hemoglobin in the blood. Hemoglobin is the component of blood that allows red blood cells to carry oxygen to the cells.

Therefore, the higher the sugar present in the bloodstream, the more of it attaches to the hemoglobin. The A1C test measures the amount of hemoglobin with the attached glucose.

The A1C test result is reported as a percentage. A normal A1C level is below 5.7 percent. Prediabetic A1C levels range from 5.7 to 6.5 percent. Anything beyond 6.5 is indicative of diabetes.

A person may also be tested through a random plasma glucose (RPG) test. This can be taken anytime without the need for fasting. A reading of 200 mg/dL or more may mean a person has diabetes.

Pregnant women can be tested in one of two ways. A glucose challenge test would mean drawing out a blood sample from a patient an hour after giving them a sweet drink. If the reading is high, the woman would be asked to take a fasting oral glucose tolerance test (OGTT).

A healthcare professional will draw the patient’s blood. Then, she will be asked to drink a glucose-laced liquid. For diagnosing gestational diabetes, blood will be taken every hour for 2 to 3 hours.

High blood glucose levels at two or more blood test times during the OGTT—fasting, 1 hour, 2 hours, or 3 hours—indicate gestational diabetes. This may also be used to diagnose prediabetes and Type 2 diabetes to non-pregnant patients.

GGT: Predictor of Diabetes

Gamma-glutamyl transferase (GGT) is an enzyme that is found in many places in the body. However, it is mostly found in the liver. Elevated GGT levels in the blood mean there is damage to the liver or the bile ducts, yet this has to be confirmed by other tests that look at other enzymes, like alkaline phosphatase (ALP), in the body.

GGT’s function is not clear but experts do know that it is responsible for breaking down, changing, and moving proteins and other molecules in your body.

A high GGT reading may mean any of the following: overuse of alcohol, chronic viral hepatitis, lack of blood flow to the liver, liver tumor, cirrhosis, or scarred liver, overuse of certain drugs or other toxins, heart failure, diabetes, pancreatitis, or fatty liver disease.

Since the discussion above is focussed on diabetes, the connection between GGT and diabetes would be further explored, particularly just how good the levels of the enzyme are at predicting the disease.

A 2005 study published in Germany found that the higher the GGT levels in the body, the greater the chances of acquiring Type 2 diabetes. This is study a study based on 1851 men and 1836 women (aged 25-64 years) who participated in the first Monitoring Trends and Determinants on Cardiovascular Diseases (MONICA) Augsburg Survey 1984/1985 and was monitored for more than a decade for the study.

Another 2005 study in Finland stated the same thing, that serum GGT levels are good predictors of diabetes. It studied 20,158 Finnish men and women aged 25-64 yr who participated in cardiovascular risk-factor surveys for ten years. The higher the GGT levels in the body, the more likely patients will develop diabetes.

A 2005 study in Mexico City tested the hypothesis that enzymes associated with liver dysfunction like GGT and ALP may predict diabetes. They found out that of the four enzymes they studied, GGT is the only reliable predictor of Type 2 Diabetes.

A 2009 Korean study also found out that not only GGT but ALP may also be a reliable predictor Type 2 diabetes for people without fatty liver or any form of liver dysfunction.

It is believed that the presence of elevated levels of GGT is indicative of oxidative stress in the body. Oxidation is a normal and necessary process that takes place inside a person. Oxidative stress occurs when there is an imbalance between free radical activity and antioxidant activity. Free radicals can wreak havoc on fatty tissue, DNA, and proteins, the building blocks of the human body. Damage to these may cause diseases like cancer, atherosclerosis, hypertension, and of course, diabetes.