Diabetes

Estimates by WHO show that Diabetes (Diabetes Mellitus) affects 57 million people in India. A sedentary lifestyle and faulty diet have not helped matters. Statistics show that  by 2025, India will have the largest number of diabetics in the world. The information below will provide you with a better understanding of the disease and how you can prevent diabetes by adopting a healthy lifestyle.

What is Diabetes?

All of us need energy for our bodily functions. For this, we need glucose or sugar which is derived from the food that we eat. For the body to utilize this sugar, a hormone called Insulin is necessary. This is secreted by the Pancreas, which lies close to the stomach. In Diabetes, either the Pancreas is not able to produce sufficient insulin, or the body is not able to utilize the insulin properly, resulting in a raised level of sugar in the blood.

What are the types of Diabetes Mellitus?

Diabetes may be of two types:

Type I diabetes (IDDM or Insulin Dependent Diabetes Mellitus) This is common in children and in young people under the age of 30. In this type, the pancreatic cells, which produce insulin, are gradually destroyed and lose their ability to provide sufficient amounts of insulin that the body needs. In most people with this type of diabetes, anti-pancreatic cell antibodies are found even before the symptoms develop and up to two years after they do. Type II diabetes (NIDDM or Non-Insulin Dependent Diabetes Mellitus) This condition is when the body's response to insulin decreases and insulin becomes less efficient. This is the type of diabetes that is more common in people over the age of 40, people who are obese and those who have a strong family history. Obesity, pregnancy, liver diseases, stress and immobility can be responsible for this type of Diabetes. In fact there is a condition called Syndrome-X which is characterized by Obesity, Hyperlipedmia (increased amount of cholesterol in the blood) and Hypertension.

There is also a condition known as Gestational Diabetes Mellitus, which affects some pregnant women. It develops during pregnancy and then disappears. Sometimes, Diabetes may develop in some other conditions such as when the pancreas are removed, or when there are other problems of the pancreas. Some drugs may also induce diabetes.

What are the symptoms of Diabetes?

Here are some symptoms, which a person with diabetes may have. But absence of these symptoms does not mean a person is not suffering from Diabetes.           - Excessive thirst           - Frequent urination           - Weight loss that cannot be explained           - Extreme hunger           - Exhaustion           - Wounds or sores taking a long time to heal           - Bacterial or Fungal skin infections           - Sudden changes in vision           - Tingling or numbness in the feet or hands           - Nausea, vomiting or pain may accompany a sudden onset of Type I or Insulin dependent diabetes.

How is Diabetes diagnosed?

A doctor will first take the medical history and find out whether the person has any of the common symptoms of diabetes like excessive thirst, frequent urination and so on. A positive family history of diabetes will also be useful. Then the doctor will perform a physical examination to find out whether there are any indications of complications due to diabetes. The following tests are the most common ones that the doctor may request for.

1. Test to measure the level of glucose in the urine: Usually, glucose is not secreted in the urine. But when the amount of glucose in the blood increases, the kidneys are not able to prevent glucose from getting into the urine. An increased urine sugar level indicates an increased blood sugar level. 2. Tests may be done to find out the fasting blood glucose and the post-prandial blood glucose levels. The test to find out the post prandial level is done usually one and half hours after breakfast. 3. Glucose Tolerance Test is done to find out how well the body responds to 75g of glucose. This is a very useful test for early detection of diabetes. Values in Glucose Tolerance Test   Fasting Glucose 2 hours after Glucose load Normal GTT 100mg% 120mg% Impaired GTT 120mg% 120-180mg%

What is the treatment for Diabetes?

The treatment for diabetes is by oral anti-diabetic medication, insulin, diet and exercise. The dosage values of oral drugs and insulin have to be tailored to suit each person. Whatever the dosage, these are the guidelines for treating diabetes:

- The main aim of a good diet for diabetics is to cut the simple carbohydrates like sugar, glucose and honey. The carbohydrate requirement (55-60%) should come from complex carbohydrates like whole grains, vegetables and fruits. Protein forms about 15-20% of our diet, the remaining being from fats. Most of this fat should come from plants (polyunsaturated fats). - Losing excess weight can itself control the need for anti-diabetic medication. The most important tip is to not eat too much at one time, but in small amounts more often (for example: 3 light meals for breakfast, lunch and dinner with 2 snacks). The total quantity of food must also be reduced. - The food should be eaten slowly. If a person feels hungry between meals, a vegetable like tomato or carrot can be taken. - Butter, Cheese, Cream, Red meat (mutton), chips, and nuts with high fat content have to be avoided. - Smokers should quit the habit. It is ideal to avoid alcohol. - Animal protein should be replaced with plant proteins (mushrooms, beans, peas, lentils, soya beans). - Food increases the level of blood glucose, while insulin brings it down, by acting on the sugars. The aim of treating diabetes with insulin, or drugs that induce the pancreas to secrete insulin, is to maintain optimal blood glucose levels by combining these with a proper diet. There are many varieties of insulin available including short acting and long acting insulin. The doctor will decide which type of insulin is most suited for a person and the dosage required. Oral hypoglycemic drugs are those that reduce the blood sugar by inducing the pancreas to produce more insulin. Examples are sulphonyluria derivatives and biguanides. - Exercise: Physical effort increases the body’s response to insulin and decreases blood glucose levels. Low serum glucose levels (hypoglycemia) may occur, a few hours after exercise. A person with diabetes should consult the doctor before starting an exercise program, because it may cause hypoglycemia or low blood sugar, which could be serious. Diabetics should also keep with them, a glass of fruit juice, or something sweet that they can have, if they develop symptoms of hypoglycemia. There is no doubt that exercise is very essential and helpful for a diabetic. It only needs to be monitored and done under the guidance of a doctor.

What are the complications of uncontrolled diabetes?

The Macrovascular complications include hypertension, coronary disease, stroke, or peripheral vascular disease due to atherosclerosis. The Microvascular complications include changes that may develop in many organs but are most often seen in the kidneys, eyes and the nervous system. Renal complications: In the early stages of renal impairment there may be an excretion of small amounts of proteins (30-300 mg of albumin) called microproteinuria. These changes are reversible if diabetes is well controlled. If the diabetes is not controlled properly, it may lead to renal failure. Diabetic Retinopathy: Diabetes may affect the retina and may lead on even to blindness. Diabetics should undergo an eye check-up once a year. Diabetic Neuropathy: This increases with age and duration of diabetes. Peripheral neuropathy is characterized by tingling sensations or burning pain and hypersensitivity. There may be autonomic dysfunction seen as rapid heart rate, orthostatic hypotension (lowering of BP according to posture), impaired intestinal motility (diarrhea and constipation), impaired digestion and impotence.

People with diabetes should take extra care of their feet to avoid Diabetic Foot which is characterized by ulceration and necrosis in the toes, heel and sole of the foot, which may be painless. When uncontrolled diabetes causes serious infections of the limbs, gangrene may set in, with a need for amputation. That is why it is very important to get even the smallest of infections and sores treated immediately. It must be mentioned, that with the number of home-monitoring facilities now available, all diabetics must have their sugar levels in their urine monitored regularly and a blood sugar test done at least once in six months. With a proper diet, exercise and appropriate medication, there is no reason why a diabetic cannot lead a healthy and happy life.