Diabetes

Diabetes an Overview

Types

Symptoms

Management

Myths & Realities

Introduction

On being initially diagnosed to have diabetes, a person often reacts with anxiety, confusion and fear. This feeling of anxiety is a normal response as it could mean a restricted life-style, and fear of diabetes related serious complications.

'Diabetes mellitus' is a disease known from ancient times. Around 500 AD in Indian Vedic literature this disorder was recognized as Madhumeha meaning honey-urine.In the second century AD Greek physician Aretaeus, was the first in Europe, to give a vivid picture of the nature of diabetes.He gave this disease its name,diabetes, from a Greek word diabetos meaning a siphon, because in this disease fluids are not retained by the body. Mellitus comes from Latin, meaning honey. During the 19^th century, a remarkable progress has been made in the knowledge and understanding of diabetes.Today worldwide there are millions of men, women and children who suffer from diabetes and lead a near normal life. This of course requires slight adjustment in their life style.

As diabetes mellitus is a disorder in which blood levels of glucose (a simple sugar) are abnormally high because the body does not release or use insulin adequately, the most important factor is the proper control of blood sugar levels. If proper control of blood sugar levels is not achieved, diabetes can be life threatening. You can control the blood sugar level by eating a balanced diet, with regular and controlled exercise, and if required with oral medication and/or insulin as advised by your doctor.

Thus all it takes is some proper awareness, some lifestyle adjustments, which might seem difficult in the beginning, but these changes quickly become routine.

Without insulin, glucose accumulates in the blood -- a condition called hyperglycemia ("hyper", too much, "glycemia", glucose in the blood). It is this hyperglycemia that causes intense thirst, the need to urinate frequently, blurred vision, fatigue, and other symptoms. If not controlled in time, high blood glucose can cause very serious medical problems.

Types Of Diabetes

Type 1 or Insulin-Dependent Diabetes Mellitus (IDDM)

People with Type 1 diabetes do not produce insulin. They need their entire requirement from external sources to keep their blood glucose levels normal. Usually Type 1 diabetes is seen to occur before the age of 30 years. Only about 0.2% -15% of all diabetic persons belong to Type 1 diabetes.

Type 2 or Non Insulin Dependent Diabetes Mellitus (NIDDM)

The vast majority of diabetic persons belong to this category.

85% - 99% of people suffer from Type 2 diabetes. In this type insulin is produced but the cells in the bodies of such people are "insulin resistant" i.e. they do not respond properly to the hormone, so glucose accumulates in their blood. Insulin resistance increases as weight increases and physical activity decreases. Many people with Type 2 diabetes are seen to have sedentary lifestyles, and are obese (fat), they weigh at least 15 - 20% more than what is recommended for their height and build. Some people with Type 2 diabetes may require insulin injections, but most can control the disease through a combination of weight loss, exercise, and prescription oral diabetes medication as per the doctor's advice.

Gestational diabetes

In the third trimester of pregnancy about 5% pregnant women develop a form of diabetes called gestational diabetes. The blood glucose levels return to normal on its own after delivery. But studies have shown that about 40 percent of women with gestational diabetes go on to develop Type 2 diabetes within 15 years. All pregnant women should be tested for diabetes between their 24th and 28th weeks of pregnancy.

Symptoms Of Diabetes

If the following symptoms are seen to persist it is necessary to have the blood sugar levels tested:

The need to urinate more than usual

• Constant thirst
• Unusual weight loss
• Feeling weak or tired
• Blurred vision
• Tingling or numbness in hands or feet
• Cuts and bruises that are slow to heal
• Extreme hunger
• Feeling nauseous and vomiting
• Frequent and recurring infections such as urinary tract, boils, fungus
• Erection impairment in men, and unusual vaginal dryness in women

Management Of Diabetes

A well balanced diet (within permissible caloric limits), proper exercise, oral medication and/or insulin injection, forms an integral part of any good diabetic management.

Diet

A proper controlled diet helps to reduce blood sugar levels and thereby reduces the risks of complications such as high blood pressure, heart problems etc. Dietary therapy also helps you to keep your weight under control and thereby reduces the problems associated with obesity.

A diabetic can eat balanced food within the permissible caloric limits. It is best to distribute the daily requirements of food between meals. Fibre rich diet and restriction of oil and sugar is advisable.

Exercise

A regular controlled exercise not only helps to increase glucose utilization but also helps to maintain desirable weight. Exercise tones up the body, improves circulation, helps to build stamina and provides a sense of well being.

Role of medicines in diabetes

(Here we would like to warn the reader, that under no conditions should they attempt any form of unprescribed, self-medication. It could be fatal).

Oral medications for controlling blood sugar are broadly divided into three types :

• sulfonylurea drugs
• acarbose
• biguanides

All these classes of drugs help to reduce blood glucose levels. They work by different mechanisms. They lower glucose levels by different amounts. Your doctor would be the best person to advice which is the most suitable for you.

Insulins

As persons with Type 1 diabetes are unable to produce insulin they require insulin injections. In Type 2 diabetes there may be certain periods when oral medication may have to be replaced by insulin treatment e.g. during illness, surgery or pregnancy.

At the time of initiation, it is necessary to plan not just when to take insulin, but how much and what kind. This is to ensure optimum insulin coverage through the day and night.

The kinds of insulin are:

• rapid - acting,
• intermediate-acting, and
• premixed biphasic.

Each takes a different amount of time to start working (onset), to reach maximum strength in the blood (peak), and to remain in the blood (effective duration).

Please consult your doctor periodically and seek his advice about diet, exercise and medication to keep your blood sugar under control.

Monitoring of Blood Glucose

The amount of glucose in the blood changes throughout the day. If the level rises too high or falls too low, there are chances of some potentially serious complications.

Irrespective of the type of diabetes, Type 1 or Type 2, the best way to manage is to monitor the amount of sugar (glucose) in the blood. It may be necessary to monitor the blood sugar level several times a day.

It will help to remember (without being alarmed) there are no magic formulas to tell how an individual's blood glucose level responds to food, insulin, exercise, illness and other stress.

Diabetes educators say that keeping a diabetes diary will help you fine tune your glucose control and help your doctor to figure out what is wrong should your glucose levels fluctuate. The patterns in your blood glucose readings provide clues about your diabetes control. The only way to see the patterns is to record the results.

Blood Glucose : What Raises & Lowers It?

Any of the following could be responsible for raising the blood glucose levels :

• Food & diet, stress, illness, exercise, dawn phenomenon, menstruation, pregnancy, certain medications

Similarly some of the following could be responsible for lowering the blood glucose levels:

• Insulin, oral diabetes medication, exercise, alcohol, menstruation, sex

Diabetes and some of its complications

It is well established that neglecting medicines and other measures of controlling blood sugar can, and does lead to long-term complications.

These long term complications are completely disabling and irreversible. Once the long-term complications set-in they are difficult to be corrected. Maybe the more severe onset can be delayed. It is therefore very necessary to do everything possible to avoid these. Some helpful hints:

• Do not change the type or dose of the medicines your doctor has prescribed for you
• Monitor your sugar level and keep proper records. Report any unexplained rise or lowering (maybe even 2 to 3 time a day) of blood sugar levels
• Stop smoking and do not consume alcohol or alcoholic beverages
• Observe strict control over diet
• Continue the daily exercise regimen
• Go for regular check-ups. Not just for the glucose levels, but also for any early signs of long-term complications. Initially at least once a year, slowly increasing to 2-3 times a year

However unfortunate, it is true. Long-term complications of diabetes, sometimes also referred to as the triology of diabetic complications, result in serious consequences. The person may suffer a stroke, total loss of vision or kidney failure.

In keeping tight control over sugar, there is a possibility of undergoing hypoglycaemia. This is when the level of sugar falls below the normal. Hypoglycaemia can be mild or severe. Severe hypoglycaemia can lead to coma.

Some of the symptoms of hypoglycaemia are hunger, sweating, dizziness, headache, light-headedness, irritability, shakiness, blurred vision, nausea, confusion tingling or numbness in the lips or tongue.

It is advisable for diabetic persons to carry some glucose powder or hard-boiled sweets with them. In case of an approaching hypoglycaemic attack, some sugar can quickly avert the crisis.

Diabetes and the heart (Cardiovascular disease)

The extra glucose contributes to the clogging of the arteries that nourish the heart (coronary arteries). This clogging of the arteries is the underlying cause of heart disease. Several other matters that further complicate the issue are smoking, high blood pressure, and high cholesterol.

Diabetic persons SHOULD AVOID smoking.

A low-fat diet and regular moderate exercise form the backbone of healthy lifestyle recommendations for diabetics because they also help reduce blood glucose levels. Hypertension (high blood pressure) damages the coronary arteries and forces the heart to work harder than it should. High blood pressure can also cause changes in the eyes, nerves, and kidneys.

Diabetes and Stroke (Cerebrovascular Disease)

Compared with non diabetics, people with diabetes are far more likely to suffer strokes.

There are two types of strokes -- haemorrhagic and ischaemic. In the haemorrhagic stroke, a blood vessel supplying blood to the brain (or its part) bursts. This causes internal bleeding and clotting. It could be fatal or lead to impairment of some of the body functions controlled by that part of the body - paralysis. Whereas in the ischaemic stroke, the thickening of some of the arteries, may reduce or completely be unable to reach blood to some cells in the brain. Once again the result could be paralysis or death.

Diabetes and the eye diseases ( retinopathy, cataracts, glaucoma)

Uncontrolled (high) blood sugar levels can over a period of time can lead to eye diseases like retinopathy, cataracts and glaucoma. It is not that people without diabetes do not suffer such eye problems. But the chances of a diabetic person getting them are far in excess of others. These long-term complications of diabetes can lead to loss of vision, either partial or it may even cause total blindness.

Diabetics and kidney (disease) - nephropathy

The kidneys filter wastes out of the blood. Kidneys are richly endowed with tiny blood vessels (capillaries). As the blood passes through them, the organ draws wastes out and produces urine. In people with nephropathy, these capillaries become blocked and leaky. Wastes stay in the blood, and protein, which should remain in the blood, leaks into the urine.

The first sign of kidney complication is small amounts of protein in the urine (microalbuminuria). As the years pass, the protein content of the urine continues to increase, and with it, kidney function declines. After 25 to 30 years of diabetes, kidneys can no longer function.

Infections

Compared with people who do not have diabetes, those who do are at increased risk for all manner of infections from head to toe: gum disease, skin infections, tuberculosis, pneumonia, bladder and kidney infections, vaginal yeast infections, incisional infections after surgery and foot infections.

Diabetic foot

Not all "ulcers" occur in the stomach or intestine. An ulcer is an open sore, and diabetics with nerve damage are especially prone to foot ulcers that may become infected. Feet should be examined regularly. If this is a problem, use a mirror or have someone else do it, or examine socks for red or brown stains. They are likely to be caused by blood, signalling an ulcer. A foot ulcer if not detected and managed in time may end in amputation of the leg.

Sex and diabetes

Impotence or loss of ability to have erections may develop in men after many years of diabetes because the nerves to the penis are damaged. However, there could be many other causes of impotence (including psychological). However embarrassed you may feel, you must consult your doctor, if you have sexual difficulty. You cannot assume that it is permanent or due to diabetes - it is quite likely that it may be neither.

(ALL VISITORS TO THIS SITE ARE CAUTIONED, NOT TO ATTEMPT ANY SELF-MEDICATION OR CHANGE OF MEDICINE/DOSAGE WITHOUT CONSULTING THEIR DOCTOR)

Myths And Realities About Diabetes And Insulin

There are a lot of myths about the role and the use of insulin in managing Type 2 diabetes.

Some of the more common ones being:

Once on insulin, always on insulin

This is a myth which arises from an incorrect understanding of Type 2 diabetes. It is true that in Type 2 diabetes a person requires exogenous insulin (that is insulin from an external source) but it is incorrect to think that in such cases the body no longer produces insulin. This never occurs in clinical practice. On the contrary, in Type 2 diabetes, the capability of the body to produce insulin may be reduced because of hyperglaemia ( i.e. excess of glucose in the blood) and not because of external insulin. External insulin helps in reducing hyperglycaemia and controls glucotoxicity.

Use of insulin increases the risk of hypoglycaemia

Any intervention to control the sugar level in the body is capable of bringing about hypoglycaemia - whether it is because of insulin or because of oral medicines. It is like saying "driving causes accidents so it is better to walk then to drive". Research has established that the risk of hypoglycaemia with insulin in patients with Type 2 diabetes is not significantly greater than with some oral medicines. However in tight control of diabetes, whether with oral medicines or with insulin therapy, hypoglycaemia remains an unresolved issue which can at best be avoided, but cannot be wished away.

Insulin should be the last resort

To an extent there may be an initial resistance to the commencement of insulin therapy. A few days trial period often is the answer to such resistance. With improved control and the experience of a better quality of life, most people do not find self-injection as intimidating as they would have believed in the initial stages. With increasing awareness and the availability of newer (virtually painless) delivery devices, the resistance to insulin therapy has reduced even further.

Avoid insulin therapy because it results in weight gain

There may be weight gain due to improved metabolic control. Insulin also stimulates appetite. Weight gain can be avoided with appropriate dietary control and should not be the reason to withhold insulin.

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