Diabetes & its Prevention
What is Diabetes? Diabetes mellitus (DM) also known as simply diabetes, is a group of metabolic diseases in which there is a high blood sugar level for a prolonged period. This high blood sugar produces symptoms like frequent urination, increased thirst, and increased hunger. Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. There are three main types of diabetes mellitus:
- Diabetes Mellitus Type I results from the body’s failure to produce enough insulin. This form was previously referred to as “Insulin-Dependent Diabetes Mellitus” (IDDM) or “Juvenile Diabetes”. The cause is for this is unclear.
- Diabetes Mellitus Type II begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses a lack of insulin may also develop. This form was previously referred to as Non-Insulin-Dependent Diabetes Mellitus (NIDDM) or “Adult-onset Diabetes”. The primary cause is a sedentary lifestyle, bad eating habits, excessive body weight and not enough exercise.
- Gestational Diabetes, is the third main form and occurs when pregnant women without a previous history of diabetes develop a high blood glucose level.
What are the common symptoms?
Common symptoms are
a) Increased hunger and weight loss
b) Increased thirst and frequency of passing urine. Often patients wake up at night to void the
c) Lethargy and fatigue
d) Recurrent infections and delayed wound healing
e) Decreased libido
Patients often don’t realize they have Diabetes because initial symptoms are vague and often not severe enough to cause any worry. Either a blood test or a sudden sickness brings attention to high blood glucose. Unfortunately for most, the damage to eyes, kidneys, heart, etc has already begun much before the diagnosis is made.
Who all are at risk?
According to a study, India will have the maximum number of Diabetics by the year 2020. Worldwide, an alarm of this pandemic has already rung and nations are working and struggling towards making their populations disease-free. In India however, awareness regarding the problem is still very low. It is surprising to note that people often think that Diabetes is bound to happen in old age and instead of fighting against falling sick, they simply accept their sickness.
People above the age of 40 should get regular blood tests done yearly even if they have normal sugar levels. It becomes even more important for those who have a family history of Diabetes, so that any changes can be monitored, controlled and prevented for as long as possible.
Also, people who are overweight, pregnant women and people with other endocrinological disorders like thyroid diseases, PCOD, etc should go through regular blood tests for sugar and insulin levels.
How is the diagnosis made?
Diabetes Mellitus is characterized by recurrent or persistent high blood sugar and is diagnosed by demonstrating any one of the following:
- Fasting plasma glucose level ≥ 7.0 mmol/l (126 mg/dl)
- Plasma glucose ≥ 200 mg/dL two hours after a 75 g oral glucose load as in a glucose tolerance test
- Symptoms of high glucose levels and random plasma glucose of greater than 200 mg/dl
- Glycated hemoglobin (Hb A1C) ≥ 6.5%.
A positive result, in the absence of unequivocal hyperglycemia, should be confirmed by a repeat of any of the above methods on a different day. It is preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test. According to the current definition, two fasting glucose measurements above 126 mg/dl is considered diagnostic for diabetes mellitus.
People with fasting glucose levels ranging between 110 to 125 mg/dl and plasma glucose above 140 mg/dL but not over 200 mg/dL, two hours after a 75 g oral glucose load are considered to have an impaired glucose tolerance. Of these two prediabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus, as well as cardiovascular disease. However, Glycated hemoglobin is better than fasting glucose for determining risks of diabetes and it’s complications.
1) What are the complications of diabetes and what can be expected if sugar levels are not controlled?
— Diabetes Mellitus can lead to organ damage because of starvation being caused by a lack of insulin or resistance to insulin.
All forms of diabetes increase the risk of long-term complications. These typically develop after many years(10–20) but maybe the first symptom in those who have otherwise not received a diagnosis before that time.
Diabetes doubles the risk of heart diseases. The major long-term complications relate to damage to blood vessels and about 75% of deaths in diabetics are due to coronary artery disease.
Diabetic Retinopathy The small blood vessels also get involved, damage the retina of the eye and can result in gradual vision loss and potentially blindness.
Diabetic Nephropathy Damage to the kidneys can lead to tissue scarring, urine protein loss and eventually chronic kidney disease, sometimes requiring dialysis or kidney transplant Diabetic Neuropathy The most common complication of diabetes. Damage to the nerves of the body causes numbness, tingling, pain and altered pain sensation which can lead to damage to the skin. Diabetes-related foot problems such as diabetic foot ulcers may occur and can be difficult to treat, occasionally requiring amputation. Additionally, proximal diabetic neuropathy causes painful muscle wasting and weakness. There is a link between cognitive deficit and diabetes. Compared to those without diabetes, those with the disease have a 1.2 to 1.5-fold greater rate of decline in cognitive function.
2) Can diabetes be prevented?
— Diabetes can be prevented. Simple lifestyle changes can go a long way in improving our health and preventing LIFESTYLE DISEASES and also their complications.
It is also not necessary to suffer from the complications for if the blood glucose levels are maintained within normal range organ damage can be minimized and even reversed.
3) How can Diabetes be treated?
— Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal as possible, without causing a drop in glucose levels. This can usually be accomplished with diet, exercise, and the use of appropriate medications (insulin in the case of type 1 diabetes; oral medications, as well as possibly insulin, in type 2 diabetes). The goal of treatment is an HbA1C level of 6.5%, but should not be lower than that, and maybe set higher.
Attention is also paid to other health problems that may accelerate the effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise. Specialized footwear is widely used to reduce the risk of ulceration, or re-ulceration, in at-risk diabetic feet. Evidence for the efficacy of this remains equivocal, however.
4) How can Diabetes be Prevented?
— Unfortunately, there is no known preventive measure for Type 1 Diabetes Mellitus. However, blood sugar levels can be managed very well with proper diet and lifestyle counseling.
Type 2 Diabetes Mellitus can often be prevented by maintaining normal body weight, physical exercise and following a healthy diet. Dietary changes are known to be effective in helping to prevent diabetes include a diet rich in whole grains and fiber, and choosing good fats, such as polyunsaturated fats found in nuts, vegetable oils, and fish. Limiting sugary beverages and eating less red meat and other sources of saturated fat can also help in the prevention of diabetes. Active smoking is also associated with an increased risk of diabetes, so smoking cessation can be an important preventive measure as well.
4) How can Diabetes be Prevented?
— Unfortunately, there is no known preventive measure for Type 1 Diabetes Mellitus. However, blood sugar levels can be managed very well with proper diet and lifestyle counseling. Type 2 Diabetes Mellitus can often be prevented by maintaining normal body weight, physical exercise and following a healthy diet. Dietary changes are known to be effective in helping to prevent diabetes include a diet rich in whole grains and fiber, and choosing good fats, such as polyunsaturated fats found in nuts, vegetable oils, and fish. Limiting sugary beverages and eating less red meat and other sources of saturated fat can also help in the prevention of diabetes. Active smoking is also associated with an increased risk of diabetes, so smoking cessation can be an important preventive measure as well.