Diabetes is a chronic disease that occurs when the pancreas is no longer able to produce insulin or when the body cannot make good use of the insulin it produces. Diabetes is the condition that occurs when the level of glucose in blood rises above the normal range. The term Diabetes Mellitus was derived from the Greek words meaning ‘passing through’ and ‘sweet as honey’. It was the English physician Thomas Willis (1675) who first used the words to describe this condition. In India the first mention of diabetes occurs in about500 B.C. The famous Ayurveda physicians of ancient India, Charaka and Susruta had noted this disease and named it as ‘Madhumeha’ meaning ‘rain of honey’.
Glucose – source of energy
Our body needs glucose to produce energy for our day to day activities. Energy is very essential for the normal functioning of all our organs. Energy is obtained mainly from carbohydrates, proteins and fat which is present in the food we consume. During the digestion process, they are broken down, ultimately producing glucose. Glucose is used as fuel for energy by the body. Normally when we consume food, it is converted within the body into glucose which is a form of energy. Cells use glucose as a source of energy. Insulin regulates the level of glucose in blood and also helps in utilizing and storing glucose in the body.
Insulin is a hormone which is secreted by the beta cells in the pancreas. As result of food consumption blood glucose level rises and it signals beta cells to secrete insulin. Insulin helps the glucose which has entered the blood in the intestines to reach the blood cells in the body and keeps the blood sugar at normal levels. Insulin is the hormone that functions as the key opening the door for the glucose to reach the cells. If for some reason insulin fails in functioning normally or if the amount produced is less, it results in glucose not reaching the cells, and remaining in the blood. This condition is known as diabetes. Diabetes develops from defects in insulin secretion, insulin action or both. In other words, body is unable to make appropriate use of foods consumed due to insufficient insulin.
The normal range of glucose in blood is between 70mg/dl and 100mg/dl. When tested in the mornings, on an empty stomach, a reading above 126 mg/dl indicates a diabetic condition.
Before developing diabetes many people will have “Pre Diabetes”. It is a stage where blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes. If the reading is between 100mg/dl and 126mg/dl it relates to a pre-diabetic condition. If a person has pre diabetes, he is at risk of eventually developing type 2 diabetes. He is also at risk of developing heart disease, even if he doesnt develop diabetes.
Risk Factors of Diabetes
Several risk factors have been associated with Diabetes which include:
Unhealthy dietary habits.
Physical inactivity and sedentary life.
Family history of Diabetes Mellitus.
Age above 40
Women who have given birth to infant weighing more than 4 Kg.
Severe mental stress.
History of gestational diabetes.
Poor nutrition associated with pregnancy.
Signs and Symptoms of Diabetes
Signs and symptoms of diabetes will be different in different persons and sometimes there may be no signs. Some of the signs commonly experienced include:
A tingling sensation or numbness in the hands or feet
Vaginal infection in women.
Vomiting and stomach pain
The development of type 1 diabetes is usually sudden and dramatic while the symptoms can often be mild or absent in people with type 2 diabetes, making this type of diabetes hard to detect.
Types of Diabetes
There are three main types of Diabetes.
Type 1 Diabetes
Used to be called juvenile-onset diabetes or as insulin dependent diabetes mellitus, it is usually caused by an auto-immune reaction where the body’s defence system attacks the cells that produce insulin. People with type 1 diabetes produce very little or no insulin. The disease may affect people of any age, but usually develops in children or young adults. Only 0.02% of people have type 1 diabetes in India. People with this form of diabetes need injections of insulin every day in order to control the levels of glucose in their blood. The only treatment for type-1 diabetes is insulin therapy and with insulin treatment the affected people can lead a normal life.
Type 2 Diabetes
Type 2 diabetes is the most common form of diabetes. Type 2 diabetes is also known as non insulin dependent Diabetes Mellitus or adult onset diabetes. In Type 2 diabetes either the body does not produce enough insulin or the cells do not use insulin properly. In the later case we say, it is insulin resistance .People can develop type 2 at any age, even during teenage.Being overweight and inactive also increases the chance of developing type 2 diabetes. Management include diet, exercise, medicine or insulin etc.Type 2 diabetes may remain undetected for many years and the diagnosis is often made when a complication appears or a routine blood or urine glucose test is done.
Many women develop diabetes during pregnancy and it is called Gestational Diabetes Mellitus (GDM). This form of diabetes usually gets normal after the baby is born. But a woman with GDM, is more likely to develop Type 2 diabetes, later in life. If a mother does not seek treatment and control this condition during pregnancy, the baby may have problems with excess body fat and insulin at birth, which can increase the risk of breathing problems and diabetes later in life.
Gestational diabetes is mainly caused by the hormones of pregnancy or due to shortage of insulin. GDM develops in one in 25 pregnancies worldwide and is associated with complications to both mother and child. Diagnosis of GDM does not mean that the person had diabetes before she conceived or she will have diabetes after the baby is born.
Screening for GDM is usually performed at 24 to 28 weeks of gestation. But it is agreed worldwide that it should be done at the time of first visit of the patient to the doctor. If a person is being tested for gestational diabetes, the doctor will consider the results of each blood glucose test. If two or more of the tests are higher than normal, the person will be diagnosed as having gestational diabetes.
Normal fasting blood glucose level is lower than 95 mg/dL (5.3 mmol/L).
One hour after drinking the glucose solution, normal blood glucose level is lower than 180 mg/dL (10 mmol/L).
Two hours after drinking the glucose solution, normal blood glucose level is lower than 155 mg/dL (8.6 mmol/L).
Three hours after drinking the glucose solution, normal blood glucose level is lower than 140 mg/dL (7.8 mmol/L).
Symptoms of GDM
Usually there won’t be symptoms or symptoms may be mild. Usual symptoms are:
Frequent infection in bladder, virgin and skin.
Increase thirst and urination.
Nausea and vomiting.
Weight loss in spite of increased appetite.
Diagnosis of Diabetes
Diabetes is usually diagnosed based on laboratory values. But it is usually recommended to repeat the test on the second day of diagnosis.
Laboratory tests for diagnosis of Diabetes
Fasting Blood Sugar:- Test measures blood glucose in a person after a fasting of at least 8 hours.
Normal -- Less than 100 mg/dl
Pre diabetes -- 100 – 125 mg/dl
Diabetes -- 200 mf/dl or Higher
Oral glucose tolerance test:- Measures blood glucose after a fasting of 8 hours and 2 hours after the person drinks 75 gram of glucose containing liquid.
Normal -- blood glucose level lower than 140 mg/dL (7.8 mmol/L)
Prediabetes -- between 140 mg/dL and 199 mg/dL (7.8 and 11 mmol/L)
Diabetes -- blood glucose level of 200 mg/dL (11.1 mmol/L) or higher
Random plasma glucose :- Measures blood glucose with out considering time of taking food.
Diabetes -- 200 mg/dl or Higher
Glycated hemoglobin ( HbA1c) measure your average blood glucose for the past 2 to 3 months.
Normal -- Less than 5.7 %
Pre diabetes -- 5.7 % to 6.4 %
Diabetes -- 6.5 % or Higher
Complication of diabetes
Complications of two types.
1. Short term complications and 2. Long term complications
Short term complications:
Hypoglycaemia (Low Blood Sugar)
When the sugar levels in blood drops it results in a condition called hypoglycaemia. Eating very less, not eating food, medicating oneself with high doses, too much of insulin, overwork, and over-exercising may cause a drop in blood sugar levels. The symptoms are quite sudden; fast and timely treatment is advisable.
Shivering, palpitation/ fast heart beat, Profuse sweating, tiredness, dizziness, hunger, diminishing eyesight, headaches.
Hyperglycaemia ( High Blood Sugar)
When the sugar levels in blood rises it leads to the condition called hyperglycaemia. Overeating, low intake of insulin, and not taking enough tablets. These are the reasons seen. This condition builds up slowly; and is alarming since it results in diabetic coma.
Acute thirst, tendency to urinate often; dry skin, extreme hunger, discomfort in stomach/ indigestion.
Diabetes, when uncontrolled, affects all the organs in the body.
Long term Complications:
Diabetes causes damage to the nerves throughout the body, when blood glucose and blood pressure are too high for long periods. Commonly affected areas are the extremities, especially the feet. Nerve damage in this areas is called peripheral neuropathy and can causes pain, tingling and lose of sensation.Patient with long run diabetes or uncontrolled diabetes may have altered vibration and sensation.
There are two type of Neuropathy.
Sensory neuropathy – leads of loss of pain and pressure sensation.
Autonomic neuropathy leads to increased dryness and fissuring of the skin.
Diabetes neuropathy is one of the commonest complications of type 2 diabetes. People with diabetes are twice likely to suffer a stroke than non diabetes. Peripheral neuropathy brings lots of risk for foot problems especially foot ulcer. Loss of feeling is particularly important because it can allow injuries to go unnoticed, leading to serious infections and possible amputations. People with diabetes carry a risk of amputation that may be more than 25 times greater than that of people without diabetes. However, with comprehensive management, a large proportion of amputations related to diabetes can be prevented. Even when amputation takes place, the remaining leg and the person’s life can be saved by good follow-up care from a multidisciplinary foot team. People with diabetes should regularly examine their feet.
Peripheral Vascular Diseases (PVD)
When the blood vessels carrying blood to the legs get narrow it leads to what we refer to as less blood flow or peripheral vascular disease. When this happens the area below the knee gets painful while walking, and such patients will tend to stop during their walks to rest their legs. Gradually the length of time of painless walking becomes lesser and lesser. Moreover, over time, even while sitting down the patient may experience pain. Uncontrolled blood sugar levels and smoking are the two main causes for peripheral vascular disease. This can contribute to poor or delayed wound healing and also may also cause gangrene. Such foot problem can result in amputations if not managed properly.
Most people with Diabetes will develop some form of eye problems causing reduced vision. The main complication to the eyes comes from diabetic retinopathy. The retina within our eyes is responsible for our sight. Problems relating to the blood flow and swelling and bleeding in the eye relate to diabetic retinopathy. To avoid this we should control the blood sugar levels in our bodies. In the beginning this goes undetected since the sight has not been affected yet. So the patients do not know and when the last stage arrives there will be bleeding and swelling within the eye. Blood clots occur and this affects eye sight; leading to blur in vision and even blindness.
The treatment for this is laser treatment. Laser treatment aims at preserving the eyesight we have now; and does not mean we regain our earlier eyesight. All diabetics should have their eye tested every year.
The other problem affecting diabetics is cataract. Diabetics are more prone to cataract. The remedy for this is surgery for the eye. Surgery can be done once the blood sugar levels are under control; and eyesight will be regained after the surgery.
Another complication is the pressure within the eye – referred to as intra-ocular pressure. When this increases it refers to the condition known as glaucoma. This can also be treated through medication and surgery. When the blood sugar is high it leads to the nerve in the eye – the optic nerve – getting swollen and this can lead to blur in one’s vision.
Micro albumin is considered as the early stage of Diabetic Nephropathy. About 20 % to 30 % people with Diabetes develop kidney damage. In a diabetic patient, kidney disease is clinically characterized by increased urine albumin excretion , which progress to micro albumin then macro albumin and finally the end stage is renal disease. It is caused by damage to small blood vessels in the kidneys leading to the kidneys becoming less efficient or end in total damage.
Maintaining near normal levels of blood glucose and blood pressure can greatly reduce the risk of kidney disease. The important fact for prevention of diabetic Nephropathy is early diagnosis and detection of risk factors and it management.
People with Diabetes have higher risk of heart attack or stroke. Coronary artery disease, also known as hardening of arteries, is due to narrowing of the blood vessels that supply blood to our heart muscles. Blood carries oxygen and other materials to our heart. If these vessels are partially or completely blocked by fatty deposits, then blood supply is affected. In this situation heart attack can happen. In heart failure the heart is unable to pump blood. In congestive heart failure, fluid, build up inside the body tissues such as lungs and the breathing is affected.
Cardiovascular diseases are most common cause of death in people with diabetes. High blood pressure, High cholesterol High blood glucose and other risk factors contribute to increasing the risk of cardiovascular complication.
Management of Diabetes
Diabetes is a lifestyle disease. So diabetes management demands lifestyle modification in one’s life. Diabetes management requires awareness regarding every aspects of diabetes and its complications.
Management of Diabetes
For proper control of blood sugar, a person should be aware of diabetes – the disease, its complications, how to monitor and how to keep blood sugar under control, the factors which raise blood sugar level, risks etc. For this patient education, group discussions, group counseling and individual counseling provided in hospitals are very helpful. Handbooks and pamphlets about various topics related to diabetes provided to patients from diabetes care centers are als very much helpful to the patients.
Healthy eating habits is the corner stone for healthy living. But people with diabetes should know how food affect their blood sugar levels. Following directions should be observed in this regard.
Meals should be balanced.
There should be moderation and portion control.
Understand healthy foods in diet.
Overall reduction in fat and salt in diet.
Have food at regular intervals.
Learn to eat slowly.
Physical inactivity or lack of exercise is one of the risk factors for diabetes. For diabetes control and management physical activity or exercise has as pivotal role. When we exercise our muscles use glucose for energy. Regular exercise also helps our body to use insulin more efficiently.
Blood sugar can be controlled by oral hypoglycemic agents as well as insulin. Your doctor prescribes you the best suitable medicine to control your diabetes. Once treatment is fixed follow the instructions strictly and adhere to follow up.
Regular monitoring as well as periodic follow up and recording is a must for proper diabetes control.
Positive attitude and mental strength can to do better control of diabetes. Sharing your frustrations and fears with people who can understand, or other support groups, can be of much help in this direction.
Inform your doctor about your stress, anxiety, anger etc. Otherwise it can lead on to depression. Yoga, regular exercise, breathing exercise, sharing etc. can do a lot in bringing back your mental health. Maintaining a healthy weight can also benefit diabetes better control.
Prevention of Diabetes
Peoples who are at risk of diabetes, can choose lifestyle modification and there by present diabetes in their future. There is a lot of evidence that lifestyle changes (achieving a healthy body weight and moderate physical activity) can help prevent the development of type 2 diabetes.
Always choose Healthy Foods
It is always better to select foods that are low in salt, fat, calories and high in fiber. In our daily foods, major portion should be whole grains and vegetables. Have plenty of water and also consume fruits instead of fried snacks or Jung foods.
Be Physically Active
Make physical activity a part of your life .Walk for 30 min or more daily whenever you get a chance or option, or physical activity, go for it. Use stairs instead of it, walk short distance instead of taking vehicle, plan for group exercise including family members etc.
Lose weight if you are overweight or obese: losing excess weight and maintaining normal or near normal weight, prevent diabetes.
Mental health is very important preventing diabetes. Controlling our emotions positively, positive talks and thought can do better for a healthy happy life. Yoga helps to coordinate our breath, mind and body to promote relaxation, develop breath awareness and provides a sense of inner strength or peace.There are many ‘asanas’- various body postures- breathing methods and meditation, which are all planned and designed to promote physical comfort and mental strength.
Many studies and researches confirm that yoga is help full in improving overall quality of life. Regular practice of yoga will help to reduce stress, lower blood pressure, lipids and improve overall wellbeing . It’s also supportive in weight lose programmes and also for maintaining normal weight
Smoking is a well-established risk factor for many chronic diseases, including diabetes and its complications. As well as other harmful effects, smoking increases abdominal fat accumulation and insulin resistance. All smokers should be encouraged to quit smoking. However, weight gain is common when quitting smoking and therefore dietary advice on avoiding weight gain should also be given.