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Diabetes mellitus

Diabetes mellitus is a disease in which blood glucose levels are increased to such an extent that it can damage different organs of the body (kidney, eye, heart, nerves, etc.). Pre-Diabetes is a state in which blood glucose levels are increased to such an extent that risk of developing diabetes mellitus is increased.
Patient with mildly elevated sugars may not have any symptoms. Many patients are diagnosed incidentally on routine health check up during some illnesses (myocardial infaction, stroke or urinary tract infection) or as a part of periodic routine health check up. Hence, screening for diabetes is very important (especially if you are at risk of developing diabetes), irrespective of presence/absence of symptoms. Usual symptoms of diabetes are: frequency of urine, excessive thirst, increased/decreased apatite, weight loss, burning feet, generalized weakness, body ache, lethargy, etc. Majority of the patients with Type 1 diabetes are diagnosed with symptoms of diabetic ketoacidosis (nausea, vomiting, abdominal pain, giddiness, convulsions, altered consciousness, etc.).
Diagnosis of diabetes is confirmed by fasting/postprandial sugars or HbA1c. Fasting glucose ≥ 126 mg/dl or postprandial (post OGTT) glucose ≥ 200 mg/dl or HbA1c > 6.4% is called ‘Diabetes mellitus’. Random glucose > 200 mg/dl in presence of symptoms of diabetes can also confirm the diagnosis of diabetes. Fasting glucose 100-125 mg/dl or postprandial (post OGTT) glucose 140-199 mg/dl or HbA1c 5.6-6.4 % is called ‘Pre-Diabetes’.
HbA1c is a better reflection of sugar control than fasting or postprandial sugars, because it is an average of last 3 months blood glucose levels. Hence, every diabetic patient should do HbA1c testing at least 2-3 times per year to accurately predict sugar control.
Type 1 diabetes, type 2 diabetes, diabetes in pregnancy & other types. Majority (90-95 %) of the patients with diabetes have Type 2 diabetes.
Insulin is a hormone which is produced from beta cells of the pancreas. It is secreted as and when required (based on blood glucose levels) to keep glucose level in normal range.
Type 1 diabetes is an autoimmune disorder, wherein beta cells of the pancreas are destroyed and insulin secretion is decreased leading to high blood sugar levels. It occurs mostly in children and younger adults, though rarely it can occur even in older age groups. Insulin is required for sugar control as well as for the survival in type 1 diabetes.
Anti GAD65 antibody, anti insulin antibody, anti IA2 antibody, anti ZnT8 antibody and anti islet cell antibody can be useful for the diagnosis of type 1 diabetes. After few years of onset of diabetes, these tests may not remain as useful as in the early stages of onset of diabetes.
Type 2 diabetes is the result of insulin resistance ± defective insulin secretion. Insulin resistance is a state wherein insulin is not able to control the sugar level and hence higher than normal amount of insulin is required for sugar control. Insulin resistance is the result of genetic defect and/or obesity. Type 2 diabetes tends to run in families. Sedentary lifestyle and unhealthy dietary patterns are responsible for type 2 diabetes.
In Type 2 diabetes, sugars can be controlled with oral drugs for many years & Insulin is required in few patients only. In Type 1 diabetes, Insulin is always required for sugar control and stopping of insulin can lead to death.
Not directly. In fact, eating too much calories in form of carbohydrate/fat in presence of sedentary lifestyle (physical inactivity) can lead to obesity. Obesity leads to insulin resistance (inability of insulin to control sugars) and hence diabetes. Not everyone with high intake of sugars/sweets develops diabetes, especially if they don’t have a family history of diabetes, they are very active and weight is under control.
Those who are overweight (BMI > 23 kg/m2) or obese (BMI > 25 kg/m2) or have family member with diabetes are at risk for type 2 diabetes. Females with history of diabetes in pregnancy or PCOS (polycystic ovary syndrome) are also at increased risk of developing diabetes. Diabetes can occur in anyone without any of these risk factors because we Indians are already at high risk of developing diabetes.
Uncontrolled diabetes can cause damage to eyes (diabetic retinopathy), kidney (diabetic nephropathy) & nerves (diabetic neuropathy). It can lead to stroke or heart diseases. It can also increase the risk of infections and diabetic foot problems. Hence, it is very important to control the sugars.
No. But, sugars can be controlled with diet, lifestyle modifications and weight loss in some patients with type 2 diabetes at least in the initial few years after onset of diabetes.
No. There is no permanent cure for the diabetes. But, you can control the sugar levels by weight loss ± medicines. By controlling sugar levels you can prevent complications of diabetes.
Prediabetes state means you are at high risk of developing diabetes. Hence, you need to change your dietary patterns and modify your lifestyle. You need to control your weight. Try to avoid sedentary habits and be as much active as possible. You can postpone the onset of diabetes for few years by lifestyle modifications/weight loss alone.
No. Medicines used to treat diabetes don’t damage the kidney. But, uncontrolled diabetes can certainly damage the kidney and many other organs in the body. ‘Medicines (for diabetes) damaging kidneys’ is a common misconception and without any basis.
Diet, exercise & weight loss helps in controlling sugars. If you don’t follow diet exercise & weight loss, you will need higher dose of medicines to control sugars and you may even require insulin in the early years after onset of diabetes. So, weight loss can help you in postponing onset of diabetes, postponing insulin requirement and better sugar control with fewer medicines.
Physical activity is the most important aspect of management of diabetes. At least 30 minutes of walking/day is advisable. You can do as much exercise as possible and suitable for your health. Avoid prolonged (>90 minutes) sitting. Avoid watching TV or using Laptops continuously for a long time. Exercise helps in controlling sugars and reducing weight. It also helps in lowering blood pressure and cholesterol levels and reducing the risk of heart disease or stroke.
You need to avoid calorie/carbohydrate rich food and prefer low calorie/carbohydrate containing food items. Avoid: sugar, sweets, butter, ghee, cheese, honey, bakery products (Khari/toast/buiscuits/bread/pav/pastries/cakes), potato, sweet potato, fried items, fastfood, junkfood, packaged food, fruit juices & oily foods Limit: rice, roti & wheat. Prefer: salads (cucumber/tomato/carrot/onion/cabbage/capsicum), green leafy vegetables, pulses, sprouts, citrus fruits, low fat milk & buttermilk.
Most of the fruits (except mango, banana, chikoo & clustered apple) are advisable in diabetes. At least 2-3 fruits per day are recommended. It is always better to eat whole fruit than fruit juice.
You can have 5-6 pieces of almonds/walnut per day.
Fasting glucose < 130 mg/dl, postprandial glucose < 180 mg/dl and HbA1c < 7 %. HbA1c is a better indicator of sugar control than fasting/postprandial glucose. Ideally, HbA1c should be done every 3 monthly to know actual sugar control.
Laboratory sugars are more reliable as compared to glucometer sugars. But, when you are on Insulin or you have pregnancy induced diabetes/infection, you need to monitor sugar levels more frequently (sometimes on a daily basis). It is nearly impossible to check lab sugars so frequently. So, you can use glucometer sugar reading for day to day monitoring. Glucometer sugar readings may help you in identifying the hypoglycemia at home/during night time and give you the convenience of measuring sugars at anytime as per your wish.
Measuring glucose level by glucometer as well as by the lab simultaneously at regular intervals will help you in measuring the accuracy of glucometer readings.
A patients with diabetes needs to be monitored for eye, kidney & foot problems at regular intervals. Creatinine, urine albumin/creatinine ratio, lipid profile (cholesterol levels) and fundus (retina) examination should be done once in a year. Blood pressure should be measured at every visit.
Other than hypoglycemia (low sugars), there are no major side effects of Insulin. Insulin (high doses) doesn’t damage your kidneys. If you can change your lifestyle and reduce your weight, your insulin requirement will go down.
Insulin injection site needs to be changed repeatedly. Frequent usage of same syring/niddle should be avoided. You need to check your sugars more frequently, so as to prevent hypoglycemia and control the sugars. Sometimes, you need to change (increase/decrease) Insulin dose based on carbohydrate content of your diet as per the advice of your doctor.
Yes. Tablets containing sucralose (e.g., Natura sugar free) can be used (2-3 times per day).
Hypoglycemia (blood glucose levels > 70 mg/dl) can happen if you are on Insulin/glimiperide. You need to be aware of symptoms of hypoglycemia (giddiness, palpitation, sweating, desire to eat some food). If you get any symptoms of hypoglycemia, check your sugar level with Glucometer to confirm the hypoglycemia and then you can take 15 gms of glucose (3-4 glucose tablets) to treat hypoglycemia.