DIABETES MELLITUS-THE COMPLETE PICTURE

• Diabetes mellitus is a very common disease, one of the most widespread chronic health conditions in the world. At least 50% of all diabetics are unaware of their condition; and in some countries, this figure may reach 80%. Upto 11% of India’s urban population and 3% of the rural population above the age of 15 have diabetes. But, the good news is that upto 80% of type-2 diabetes cases can be prevented by lifestyle changes like adopting a healthy diet and increasing physical activity. This article is aimed at creating awareness among the readers with our expertise in the medical field for a healthy and happy life.
• In type1 diabetes, the cells in the pancreas that produce insulin are lost or damaged whereas in type2 diabetes, the pancreas cannot produce adequate insulin and the cells become resistant or less sensitive to the insulin that is produced.
• Type 2 diabetes usually occurs gradually. Most people with the disease are overweight at the time of diagnosis. However, type 2 diabetes can also develop in those who are thin, especially the elderly.In the initial stages, typically before you exhibit the type2 diabetes symptoms, the pancreas may produce more insulin to try and manage the increased levels of glucose in the blood. But, ultimately the additional insulin stops conversion or working, then the glucose levels in the blood continues to increase. This can lead to severe health problems
• Type2 diabetes is the most common form of diabetes, also known as non-insulin dependent diabetes mellitus (NIDDM) or adult-onset diabetes.Type2 diabetes symptoms vary from person to person. Sometimes, it becomes very difficult to recognize type 2 diabetes symptoms.
• Although at times you exhibit few or no symptoms, type2 diabetes can be diagnosed using a plasma glucose test where you can find the level of glucose in the blood stream. Your doctor can perform this test.
• Normally, the food in the stomach is changed into glucose. This glucose then enters into the blood stream and the pancreas produces insulin that allows the glucose to enter the cells of the body and be used for energy.So, when the pancreas does not produce enough insulin or when the body is unable to make use of it properly, there will be no conversion of glucose into energy and too much glucose remains in the blood.

Symptoms

People with type 2 diabetes frequently experience certain symptoms. These include:

• being very thirsty
• frequent urination
• blurry vision
• irritability
• tingling or numbness in the hands or feet
• frequent skin, bladder or gum infections
• wounds that don’t heal
• extreme unexplained fatigue

Causes and Risk factors

Family history and genetics play a large role in type 2 diabetes. Low activity level, poor diet, and excess body weight (especially around the waist) significantly increase your risk for type 2 diabetes.

Other risk factors include:

• Age greater than 45 years
• HDL cholesterol of less than 35 mg/dL or triglyceride level of greater than 250 mg/dL
• High blood pressure
• History of gestational diabetes
• Polycystic ovarian syndrome
• Previously identified impaired glucose tolerance by your doctor
• Race/ethnicity (African Americans, Hispanic Americans, Native Americans and now Indians all have high rates of diabetes)

Signs and tests

Type 2 diabetes is diagnosed with the following blood tests:

• Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on two occasions.
• Hemoglobin A1c test -- this test has been used in the past to help patients monitor how well they are controlling their blood glucose levels. In 2010, the American Diabetes Association recommended that the test be used as another option for diagnosing diabetes and identifying pre-diabetes. Levels indicate:
  • Normal: Less than 5.7%
  • Pre-diabetes: Between 5.7% - 6.4%
  • Diabetes: 6.5% or higher
• Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours.
• Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic symptoms of increased thirst, urination, and fatigue (this test must be confirmed with a fasting blood glucose test).

Warning Signs

• If other members of your family have Type 2 diabetes, this increases your risk of getting the condition.
• If you are overweight you will significantly increase your risk of developing Type 2 diabetes. Almost all those affected by this condition are overweight. Your waist measurement is a good yardstick of your weight.
• If you have high blood pressure or increased amounts of lipids (fat) in the blood.
• If you've had a blood clot in the arteries supplying the heart (coronary thrombosis) or a stroke.
• If you're on certain types of medications, especially corticosteroids or diuretics.

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  Possible complications

  
  
  
  
  
  
  
  • Atherosclerosis (hardening of the arteries) can lead to poor circulation in the legs, stroke and heart attack.
  • Diabetic nephropathy (diabetes-related kidney disease).
  • Diabetic retinopathy (diabetes-related eye disease).
  • Diabetic neuropathy (degeneration of the nerves).
  • Ulcers and infections of the feet.
  • Susceptibility to infections, eg urinary tract infections.

  
  

  Management

  
  
  
  
  
  Type 2 diabetes can usually be controlled with the right diet and tablets.
  If you keep a close eye on the disease and your blood glucose levels, you can greatly minimise the risk of further complications.
  As the disease progresses, many people need insulin injections.
  Because diabetes increases the likelihood of complications such as hardening of the arteries and heart disease, it's important to try and reduce your risk.
  Controlling blood pressure and lowering cholesterol levels with drugs known as statins significantly improves the long-term outlook for everyone with diabetes.

  
  

  Some useful information

  
  
  
  
  
• Keep an eye on your weight and blood pressure. If you're overweight, try to lose weight.
• Do all you can to keep your arteries and circulation healthy. If you smoke, now would be a good time to quit.
• Pay attention to the amount of cholesterol in your blood.
• Eat a healthy balanced diet with fibre, carbohydrates and not too much fat.
• Keep an eye on your disease - especially signs of either high or low glucose levels.
• Learn how to measure your glucose levels and do it as regularly as your doctor advises.
• If you need insulin injections, learn how to adminster them yourself.
• See your doctor on a regular basis for your health checks.
• See your doctor early on if you become unwell, because this might cause extra problems with your diabetes.
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Diabetic Tips

Don't keep changing your diabetologist. You may take a second opinion at times if you are suspicious about something.

If you feel extremely weak and drowsy, begin to sweat, or start breathing very fast, rush to your doctor.

If you develop a fungal infection in your genital region, there is a major possibility that your blood sugar has shot up drastically.

Drinking raw pumpkin juice has been found to be good for diabetics, probably by virtue of its alkaline properties.

If you are on any new hypoglycemic drug, and you develop some unusual symptoms, consult your doctor immediately.

Diabetics should never get into the habit of binging on junk food and then popping in a pill to keep their blood sugar under control.

Boiling or baking vegetables is better than frying them, especially for people suffering from diabetes.

Eating raw onions works against diabetes because of its diuretic and digestive properties.

Flax seeds, a source of Omega 3 fatty acids, helps control diabetes by facilitating insulin secretion and glucose uptake by cells.

Fibers help to empty the stomach and trigger satiety, thereby helping Type 2 diabetics to achieve weight loss goals.

The fiber in fruits and vegetables soaks up excess bile acids in the intestines and prevents their conversion into blood cholesterol.

Roughage slows down the digestion and absorption of nutrients, resulting in a slow rise in blood glucose after meals.

Boil cinnamon in water and drink this daily to promote glucose metabolism and reduce cholesterol.

Include antioxidants like vitamins C and E, selenium, and zinc in your diet to reduce the possibility of diabetic complications.

Stick to your daily schedule for exercising and taking your medicines to avoid wide fluctuations in your blood sugar levels.

DIET AND WEIGHT CONTROL

People with type 2 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugar from becoming extremely high or low. Meal planning includes choosing healthy foods, eating the right amount of food, and eating meals at the right time. You should work closely with your doctor, nurse, and registered dietitian to learn how much fat, protein, and carbohydrates you need in your diet. Your meal plans should fit your daily lifestyle and habits, and should try to include foods that you like.

Managing your weight and eating a well-balanced diet are important. Some people with type 2 diabetes can stop taking medications after losing weight (although they still have diabetes).

Physical activity

Regular exercise reduce the problem of insulin resistance,and so tackles the root cause of Type 2 diabetes.

If you need to take insulin, you may need to adjust your insulin dose according to the amount of exercise you 

do. Too much insulin and exercise may lower your blood sugar level and lead to hypoglycaemia

MEDICATIONS TO TREAT DIABETES

If diet and exercise do not help maintain normal or near-normal blood glucose levels, your doctor may prescribe medication. Since these drugs help lower your blood sugar levels in different ways, your doctor may have you take more than one. These drugs may also be given along with insulin, if needed.

Some of the most common types of medication are listed below. They are taken by mouth or injection.

• Alpha-glucosidase inhibitors (such as acarbose) decrease the absorption of carbohydrates from the digestive tract to lower after-meal glucose levels.
• Biguanides (Metformin) tell the liver to produce less glucose and help muscle and fat cells and the liver absorb more glucose from the bloodstream. This lowers blood sugar levels.
• Injectable medications (including exenatide, mitiglinide, pramlintide, sitagliptin, and saxagliptin) can lower blood sugar.
• Meglitinides (including repaglinide and nateglinide) trigger the pancreas to make more insulin in response to the level of glucose in the blood.
• Sulfonylureas (like glimepiride, glyburide, and tolazamide) trigger the pancreas to make more insulin. They are taken by mouth.
• Thiazolidinediones (such as rosiglitazone and pioglitazone) help muscle and fat cells and the liver absorb more blood sugar when insulin is present. Rosiglitazone may increase the risk of heart problems. Talk to your doctor.

If you continue to have poor blood glucose control despite lifestyle changes and taking medicines by mouth, your doctor will prescribe insulin. Insulin may also be prescribed if you have had a bad reaction to other medicines. Insulin must be injected under the skin using a syringe or insulin pen device. It cannot be taken by mouth.

Insulin preparations differ in how fast they start to work and how long they work. Your healthcare provider will determine the appropriate type of insulin to use and will tell you what time of day to use it.

More than one type may be mixed together in an injection to achieve the best blood glucose control. Usually injections are needed one to four times a day. Your doctor or diabetes educator will show you how to give yourself an injection.

Some people with type 2 diabetes find they no longer need medication if they lose weight and increase activity. When they reach their ideal weight, their own insulin and a careful diet can control their blood glucose levels.

It is not known whether hypoglycemia medications taken by mouth are safe for use in pregnancy. Women who have type 2 diabetes and take these medications may be switched to insulin during pregnancy and while breastfeeding.

MEDICATIONS TO PREVENT COMPLICATIONS

Since those with diabetes have a much higher chance of developing heart disease, kidney disease, and other medical problems, they may need to take certain medicines to treat these problems or prevent them from happening.

An ACE inhibitor (or ARB) is often recommended:

• As the first choice medicine for treating high blood pressure in persons with diabetes
• For those who have signs of early kidney disease

ACE inhibitors include captopril (Capoten), enalapril (Vasotec), quinapril (Accupril), benazepril (Lotensin),ramipril (Altace), perindopril (Aceon), and lisinopril (Prinivil, Zestril).

Statin drugs are usually the first choice to treat an abnormal cholesterol level. Aim for LDL cholesterol level less than 100 mg/dL (less than 70 mg/dL in high-risk patients).

Aspirin to prevent heart disease is most often recommended for persons with diabetes who:

• Are 40 or older
• Have a history of heart problems
• Have a family history of heart disease
• Have high blood pressure or high cholesterol
• Smoke

FOOT CARE

People with diabetes are more likely to have foot problems. Diabetes can damage nerves, which means you may not feel an injury to the foot until a large sore or infection develops. Diabetes can also damage blood vessels.

In addition, diabetes affects the body's immune system. This decreases the body's ability to fight infection. Small infections can quickly get worse and cause the death of skin and other tissues. Amputation may be needed.

To prevent injury to the feet, check and care for your feet every day.

Please Note

Call your doctor immediately if you have:

• Chest pain or pressure
• Fainting or unconsciousness
• Seizure
• Shortness of breath

These symptoms can quickly get worse and become emergency conditions (such as convulsions or hypoglycemic coma).

Call your doctor also if you have:

• Numbness, tingling, pain in your feet or legs
• Problems with your eyesight
• Sores or infections on your feet
• Symptoms of high blood sugar (being very thirsty, having blurry vision, having dry skin, feeling weak or tired, needing to urinate a lot)
• Symptoms of low blood sugar (weak or tired, trembling, sweating, feeling irritable, unclear thinking, fast heartbeat, double or blurry vision, feeling uneasy)

Regular Check Up

You should see your doctor every 3 months. At these visits, you can expect your doctor to:

• Check your blood pressure
• Check the skin and bones on your feet and legs
• Check the sensation in your feet
• Examine the back part of the eye with a special lighted instrument called an ophthalmoscope

The following tests will help you and your doctor monitor your diabetes and prevent complications:

• Have your blood pressure checked at least every year (blood pressure goals should be 130/80 mm/Hg or lower).
• Have your glycosulated hemoglobin (HbA1c) checked every 6 months if your diabetes is well controlled; otherwise every 3 months.
• Have your cholesterol and triglyceride levels checked yearly (aim for LDL levels below 70-100 mg/dL).
• Get yearly tests to make sure your kidneys are working well (microalbuminuria and serum creatinine).
• Visit your ophthalmologist at least once a year, or more often if you have signs of diabetic retinopathy.
• See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.