What Is Diabetes?

Diabetes Mellitus has become a common condition that has grown into pandemic levels in recent times. While information about diabetes is more readily available today, it is essential to consult a specialist considering the long-term and progressive nature of this disorder.

Diabetes Mellitus is a chronic metabolic condition in which the carbohydrate metabolism is defective, resulting in high sugars. All of the cells in the body need glucose to function normally. It enters into the cells with the help of a “key” hormone called insulin. Insulin is synthesized in special cells called beta cells in the pancreas. These cells secrete insulin in response to glucose in body. If there is not enough insulin, or if cells in the body don't respond normally to insulin, sugar builds up in the blood.

The pancreas is a gland in the abdomen with critical endocrine and exocrine functions; some of the products are released directly into the blood like insulin. However other products i.e. enzymes are released into the digestive system. Enzymes, or digestive juices, that are secreted by the pancreas into the small intestine, helps to break down complex food molecules to simple forms, so that it can be absorbed into blood.

We no-longer use the word “diabetic” to address a patient who has diabetes, instead we refer them as person with diabetes (PWD)

Symptoms Of Diabetes

AClinical symptoms and presentation might vary based on type of diabetes(type 1 and type 2).

Fatigue:  Insulin is necessary to help absorb the glucose in the blood. Diabetes is a state of starvation among excess, as cells are deprived of nutrients. While the blood sugar levels are high in such patients, they tend to suffer fatigue since the cells have little glucose uptake.

Hunger: Despite eating larger quantities, patients with diabetes are likely to suffer hunger pangs since the body does not register the nutrition due to a lack of processing of the sugar and loss of sugar in the urine. People with diabetes are very often hungry and tired despite regular meals, and this is an indication of a lack of insulin function in the body.

Frequent urination and increased thirst: Polyuria occurs when the blood glucose concentration rises significantly way beyond kidney threshold for glucose reabsorption, which leads to increased urinary glucose. This glucose in the urine drags along water and electrolytes, which in turn can lead to increased thirst. Patients who replace this losses with concentrated sugar drinks, like colas and fruit juices will worsen their sugar levels.

Dry mouth: Dry mouth and bad breath, gingival infections are often associated with Diabetes.

Dry skin: Flaky or itchy skin that is not moisturized despite topical ointments may be caused due to some involuntary nervous system dysfunction in long standing diabetes.

Blurred vision: Long-term effects of diabetes include vision problems. Persistent high sugars can cause change in shape of the the lens thereby effecting vision. In long standing diabetes, cataract and retinopathy is well known complication.

Weight loss: Despite regular meals, the body may be unable to utilise nutrition and may start to burn fat in the absence of sugar. It can lead to unhealthy weight loss problems and is often seen in insulin deficient patients with diabetes.

Causes Of Diabetes

The hormone insulin facilitates entry of sugar from the blood into the body's cellular storage, which is broken down by these cells to derive energy for the body's everyday tasks. In the case of diabetes, the body is either deficient in insulin or is unable to effectively use the insulin made in the pancreas, leaving a high residual amount of sugar in the blood, causing hyperglycemia and symptoms of diabetes. Hyperglycaemia, if left untreated, causes severe damage to almost every organ system in the body.

Different types of diabetes have other causes.

For example, in Type 1 diabetes, the pancreas's insulin-producing cells are destroyed through autoimmune activity, leaving the body incapable of handling sugar. In Type 2 diabetes, the body may become resistant to the effects of insulin at a cellular level, with the cells unable to absorb sugar from the bloodstream. Pregnancy-related hormonal changes may also cause diabetes in some people.

Type 1 diabetes is caused due to genetic factors, and the onset is usually witnessed in children. It can occur usually after 1-2 year of age or beyond adolescence though peak presentation is during puberty and childhood (3-5y).

Type 2 diabetes is prompted by poor lifestyle and diet concerns, and multiple genes are attributed to it.

Risk Factors Of Diabetes

Factors that put a person at higher risk of diabetes can be divided into modifiable vs non modifiable risk factors.

Modifiable

Obesity
Sedentary lifestyle and a lack of exercise
Distribution of fat
Smoking
Alcohol consumption
sleep (quality) and sleep related breathing problems
dietary pattern
micronutrient deficiencies

Non modifiable

Family history of type 2 diabetes
Previous history of gestational diabetes
High blood pressure
High cholesterol or triglycerides
Polycystic ovary disorder (PCOD)

A large population today is at risk of diabetes. Across the growing economies, the disease is becoming more and more common, affecting up to a quarter of the geriatric population. People with diabetes are at risk of other health disorders as well, thus making them more vulnerable in terms of health. The above risk factors should be considered during regular check-ups to prevent the disease.

Steps To Prevent Diabetes

Research has shown that higher levels of insulin may likely cause insulin resistance and set off the development of type 2 diabetes in a patient with genetic propensity. Prevention of diabetes is suggested through the management of both diet and lifestyle, and a diet low in carbohydrates is the primary step suggested to avoid further complications of diabetes to reduce the levels of hyperglycaemia in the body. Exercise to specifically lower blood sugar levels and prevent obesity may also prevent type 2 diabetes.

Some significant steps to the prevention of diabetes would be:

Weight loss upto 7 to 10 % of current weight
Exercise programs, including regular cardiovascular and strength training activities
Regular walks in case of situations where sitting long hours is part of the occupation, particularly after food intake
Restriction of food items with high sugar content, including, but not limited to, sweets and aerated drinks and avoiding processed foods
Sequencing of food intake with more fibre and salads and protein rich food in the beginning and then a smaller portion of carbohydrates help in reducing the glucose surge
Smoking and alcohol cessation

A change in diet is the primary means of preventing diabetes. No amount of activity can undo the hormonal damage after the onset of the condition, although it may help control it. Diets high in refined sugar and highly processed foods require the body to produce higher amounts of insulin to help absorb the increased blood sugar.

Exercise has been shown to increase the insulin sensitivity of cells, helping the body utilize the hormone more efficiently to absorb sugar from the bloodstream. However, care must be taken not to counteract the effect of exercise through erratic food patterns.

Diagnosis Of Diabetes

HbA1c: This test measures the reflects the average glucose exposure integrated over the half-life of hemoglobin in the red blood cell, which is approximately 60 to 90 days. Its not affected by recent fluctuation in sugars. A1C levels of 6.5% or above on two tests performed on two separate days indicate diabetes. HbA1c levels in the ranging from 5.7 to 6.4% indicate pre-diabetes. Below 5.7% in an A1C test is considered normal.

Fasting blood sugar test: This is performed on an empty stomach without calorie intake for at least eight hours. Regular fasting blood sugar is less than 100 mg/dl. Diabetes is diagnosed if blood sugar levels are higher than 125 mg/dl, and pre-diabetes ranges fall between 100-125 mg/dl.

Random blood sugar test: Regardless of fasting, a blood sample suggesting blood sugar levels higher than 200 mg/dl of blood on two separate test occasions in the presence of symptoms of high blood sugar, indicates diabetes.

Oral glucose tolerance test: This is a gold standard test for diagnosing diabetes mellitus. It is more applicable in special conditions like pregnancy, various types of anemias where HbA1c is not reliable. It requires overnight fasting, after which fasting blood sugar levels are measured. Then, a glucose liquid is consumed, and blood sugar levels are tested periodically for the next two hours. A blood sugar level under 140 mg/dl is normal, while levels above 200 mg/dl after two hours indicate diabetes. A reading between 140 and 199 mg/dl indicates pre-diabetes. We have now recognised that the one-hour value after the glucose load can predict diabetes better and a value greater than 155 strongly predicts future progression to diabetes and a value >209mg/dl is indicative of diabetes.

Treatment Of Diabetes

Different types of diabetes require different treatment approaches. The methods are often customized depending on the family history of diabetes, the patient's overall health, dietary, exercise patterns and social support. Diet and lifestyle changes, in addition to medication, are a major part of the regimen required for the treatment of diabetes. The treatment is incomplete without exercise, overall lifestyle changes and dietary modification. Any type of diabetes requires frequent monitoring blood sugar levels to ensure steady levels. Monitoring can be through Glucometer at home, laboratory measurements or continuous glucose monitoring devices. Your doctor can decide which is suitable in your case.

Treatment of diabetes also requires continued monitoring of blood sugar levels and keeping them to levels recommended by a medical specialist, along with lifestyle changes. Maintaining proper diet helps to maintain steady glucose levels. If a doctor suspects type 1 diabetes, it means that the pancreas is unable to produce enough insulin, hence shall need insulin to be taken through injections, insulin pens or via insulin pump. Various regimens may be used depending upon patient profile- rapid-acting, regular (short-acting), intermediate-acting, long-acting or ultra-long-acting insulin doses.

IN patients with Type 2 diabetes, the medicines work in different ways, including those that increase insulin production in the pancreas, decrease sugar absorption in the intestines, increase insulin efficiency, decrease sugar production by affecting liver function, and prevent sugar reabsorption by the renal system or synthetic insulin injections. A combination of these drugs is often used to treat diabetic conditions in patients, and several drugs are available in each of the above categories.

Diabetes Complications

If left untreated, diabetes is a very severe condition that may cause multiple organ failures and eventual death. Some of the complications arising from diabetes include:

Heart disease: Cardiovascular function is impacted by the prolonged rise of blood sugar levels in the body, and people with diabetes are more prone to heart disease than the average person including heart attacks and heart failure

Kidney disease: High blood sugar levels, as in the case of diabetes, can cause irreversible damage the nephrons in the kidney, or to vasculature. It may require dialysis or a kidney transplant if the kidney disease has progressed to an advanced stage.

Nerve damage: Numbness in the extremities or the feet indicates nerve damage due to untreated diabetes. The condition adversely affects capillaries in the nerves, leading to tingling sensations, spasmodic pains or numbness. Men may be affected by erectile dysfunction.

Retinopathy or glaucoma: Eye conditions such as retinal damage or cataracts and glaucoma are exacerbated by diabetes.

Skin conditions: autonomic neuropathy leaves skin dry, itchy, and vulnerable to bacterial and fungal infections, including eczema.

Mental health conditions: Depression or low mood is closely associated with diabetes.

Fatty Liver disease: Patients with Diabetes can have fatty liver disease and liver fibrosis and end up with shrunken liver called cirrhosis and liver failure and this may lead to liver cancer

Gestational diabetes, or diabetes occurring especially due to hormonal changes during pregnancy, may result in a few complications:

Bigger babies: Extra glucose passing through the placenta into the baby/s system stimulated baby’s pancreas to secrete more insulin. Insulin being an anabolic agent increases growth resulting in big babies.

Hypoglycemia in babies: Some children of mothers with diabetes may be born with lower blood sugar since their insulin production may be higher. It can be treated through glucose solutions and regular feeding and may not require further treatment.

The development of type 2 diabetes later in the adult life of children whose mothers have diabetes is debatable subject. Avoiding excessive weight gain, maintaining healthy diet and physical activity can help prevent/ prolong the onset of diabetes.

Road To Recovery And Aftercare

Lifestyle changes are a significant part of recovery from diabetes. Most of these changes require regular check-ups with a doctor to ensure they have the necessary effect on the patient. In addition to increasing dietary intake of fresh fruits, raw vegetables and nuts, regular physical exercise is recommended. A temporary break from work or a career change may sometimes be necessary. Reducing weight around the belly is essential, especially for patients with diabetes, and overall weight loss is also recommended.

Diet For Diabetes

In addition to fruits and vegetables, a balanced diet including fatty fish such as salmon and anchovies is advised. Mediterranean diet is found to benefit patients with uncontrolled diabetes. Leafy greens, nuts and seeds, anti-inflammatory foods such as turmeric and certain varieties of cinnamon, and fermented foods such as yoghurt, kefir and berries are a part of any healthy diet. They are especially recommended for people with diabetes. In addition to the consumption of specific foods, it becomes essential to exclude some foods from diets including but not limited to Sugary drinks, White bread, pasta and other goods using refined flour, Flavoured yoghurt and packaged juices; these usually contain very high levels of sugar, Flavoured cereals, French fries.

Sequencing of food intake with more fibre and salads and protein rich food in the beginning and then a smaller portion of carbohydrates help in reducing the glucose surge. Plate method is useful for portion control wherein a plate is divided into 4 quadrants- half with non starchy vegetables, 1/4th with protein, 1/4th with carbs.

Exercise Regimen For Diabetes

Depending on the progression of diabetes, patients are recommended an exercise regimen which may include one or a combination of some of the below exercises:

Walking
Swimming
Cycling
Aerobics
Yoga
Resistance band exercises
Weight lifting

Cardiovascular activity is a regular exercise regimen for diabetics and helps prevent further complications.