Dr. Amitabh Khanna
President, Dwarka Diabetes Association
What is Diabetes?
Diabetes mellitus, commonly referred to as diabetes, is a medical condition associated with abnormally high levels of glucose (or sugar) in the blood (hyperglycemia).
• Glucose is a type of sugar found in certain foods such as honey and some, but not all, fruits. It is also the form of sugar that all sugary and starchy foods are converted to in the body after digestion. Glucose is used by the body to make energy.
• Normally, blood glucose levels are tightly controlled by insulin, a chemical signaling substance (hormone) that is produced by a gland near your stomach called the pancreas.
• Insulin lowers the blood glucose level because it stimulates the body to make use of glucose.
• When the amount of glucose in the blood increases, for example, after eating food, insulin is released from the pancreas to normalize the glucose level. However, in patients with diabetes mellitus, the elevated glucose levels cannot be normalized. This causes abnormally high levels of blood glucose, which ultimately leads to the presence of glucose in the urine (glucosuria).
What are the causes of Diabetes?
The various types of diabetes are different disorders with different causes:
Type 1 Diabetes This type of diabetes is an autoimmune disease. Your immune system turns on itself and destroys the insulin-producing cells in your pancreas. Although type 1 diabetes usually develops in childhood or teen years, it can appear later.
Type 2 Diabetes In this type, your pancreas makes some insulin, but not enough. Your cells also can become resistant to insulin’s effects, keeping insulin from escorting enough glucose into your body’s cells. Type 2 diabetes generally develops after age 40. However, doctors are seeing a rise in childhood type 2 diabetes that parallels the rise in obesity among youth. A form of type 2 diabetes, gestational diabetes, develops during 2 percent to 5 percent of pregnancies. In gestational diabetes, your body doesn’t effectively use the insulin you produce. The cause may be metabolic changes that occur due to the effects of hormones in pregnancy. Gestational diabetes usually disappears after pregnancy, but more than half of women who experience it eventually develop permanent type 2 diabetes.
How do you get Diabetes?
There are two main types of diabetes mellitus. These are known as type 1 and type 2.
• Type 1 diabetes mellitus used to be called insulin-dependent diabetes mellitus, or juvenile-onset diabetes mellitus, because it usually begins in childhood or adolescence.
• In type 1 diabetes mellitus, the pancreas releases no insulin at all because the body has destroyed the cells that produce it (islet cells). The patient therefore relies on treatment with insulin.
• Type 2 diabetes mellitus is the most common form of diabetes. It used to be called non-insulin dependent diabetes mellitus, or adult onset diabetes because it usually begins in adulthood.
• In type 2 diabetes, patients can still produce insulin, but they do not produce enough and/or their bodies cannot use it properly.
Another form of diabetes, known as gestational diabetes, occurs in some women during pregnancy. It is a temporary condition caused by pregnancy and usually occurs in the later stages, once the baby has formed but is still growing.
How serious is Diabetes?
The early symptoms of untreated diabetes mellitus are related to the elevated blood glucose levels. Excess glucose in the blood ultimately results in high levels of glucose being present in the urine (glucosuria). This increases the urine output, which leads to dehydration and increased thirst. Other symptoms include extreme tiredness, weight loss, blurred vision, itchy skin and repeated minor infections such as thrush and boils.
People with type 1 diabetes must be treated with insulin in order to stay alive.
If uncontrolled for many years, diabetes mellitus can lead to more serious health problems:
• Blood vessel damage within the eye (retinopathy). This can lead to blindness.
• Kidney disease (nephropathy) or kidney failure.
• Nerve damage (neuropathy) especially of the hands and feet, causing tingling, numbness and weakness.
• Narrowing of the blood vessels due to fatty deposits (atherosclerosis). This increases the risk of heart attack, stroke and poor blood flow in the legs.
Uncontrolled gestational diabetes can result in a large baby and a difficult birth. It can also increase the risk of developing type 2 diabetes later in life.
What are the symptoms of Diabetes ?
The symptoms are due to persistent high levels of sugar in the circulating blood. These symptoms are :
Frequent urination – When blood sugar is too high, your kidneys can’t absorb the excess glucose. The glucose leaks into urine, pulling water with it.
Extreme thirst – The process of dehydration makes you thirsty.
Blurry vision – High blood sugar may cause new blood vessels to form and may damage old blood vessels on the retina at the back of your eye.
Weight loss – To make up for the lost fuel, your body burns fat reserves, and you may lose weight.
Fatigue – When your cells don’t get enough glucose, their primary fuel source, fatigue results.
Hunger – Burning of fat reserves also may make you hungry
Treatment for Diabetes
As symptoms of diabetes tend to show up much later than the condition occurs in your body, it is advisable to have your blood sugar levels diagnosed periodically.
. Type 1 diabetes can be treated with exercise, insulin and a balanced diet. Type 2 diabetes is first treated with weight reduction, a diabetic diet and exercise. Weight reduction and exercising increases the body’s sensitivity to insulin, thus controlling blood sugar elevations.
When these methods fail to lower the blood sugar levels, oral medications are used. If oral diabetes medications are insufficient and do not help lower the glucose levels in blood, insulin treatment is used.
Exercising regularly can help regulate the blood sugar levels and lose weight. A heavy workout is not necessary and a walk or a moderate workout of 30 minutes would do. People who are under oral medications and insulin therapy must check their blood glucose levels before and after exercising. While doing heavy workouts, check the sugar level every 15 minutes. Also, if the sugar level becomes low during the exercise session, take a light snack to compensate for it. Use fruits or salads instead of snacks.
Diet plays a vital role in controlling diabetes. Avoid junk food as it contains lots of fat building materials and the sugar content in such foods will always be high. Always maintain a balanced diabetes diet, increasing the intake of low-glycemic foods. Such foods include fruits such as apples, oranges and pears; grains like oatmeal, barley, peanuts and granola; and vegetables such as broccoli, asparagus, green leafy vegetables, beans and peas.
A balanced diet low in fat, carbohydrates and cholesterol is ideal for diabetes. High-glycemic foods like potatoes, pasta and white bread which are rich in carbohydrates, must be avoided, as they easily enter the bloodstream and get converted to glucose very fast. For the required carbohydrates intake, diabetic patients can depend on foods like chicken, turkey and sea foods which are low in starch. Salads are a good way to get the required vitamins.
Try eating 4-5 small meals a day than three large meals and drink at least 8 glasses of water a day to flush out those harmful toxins from your body and to keep your body healthy.
Varying combinations of medications also are used to correct abnormally elevated levels of blood glucose in diabetes. As the list of medications continues to expand, treatment options for type 2 diabetes can be better tailored to meet an individuals needs. Not every patient with type 2 diabetes will benefit from every drug, and not every drug is suitable for each patient. Patients with type 2 diabetes should work closely with their physicians to achieve an approach that provides the greatest benefits while minimizing risks.