Diabetes | Know it Better for a Healthy Life

HELP YOURSELF AND HELP OTHERS IN THE JOURNEY OF HEALTH

Diabetes is a treatable chronic illness. Diabetes is a metabolic disorder, its medical name is DIABETES MALLITUS. For common man understanding  Diabetes is characterised by increased blood sugar levels. This high blood sugar level is either due to the inability of pancreas to secrete insulin or due to the resistance of body to insulin as a result of which level of sugar in the blood is increased. All of these two affects, we will discuss further below in detail.

Diabetes is the major cause of blindness, kidney failure, heart attacks, strokes and lower limb amputation. If diagnosed early one can able to live his / her life in a better way.

Diabetes is as easy to diagnose as with a single blood drop but it is extremely difficult to treat when get complicated.

SAY NO TO DIABETES BY EARLY SCREENING

We can avoid or delay the onset of Type 2 diabetes by:

• Eating Healthy diet.
• Regular physical activity (In the form of walk or exercise)
• Maintaining a normal body weight
• Avoiding tobacco / smoking
• Regular follow ups with medical physician

Before jumping into the further details of DIABETES just have a look on some statistics of Diabetes below.

STATISTICS OF DIABETES

Diabetes prevalence has been rising more rapidly in middle and low income countries. The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014 according to WHO report. In 2016, an estimated 1.6 million deaths were directly caused by Diabetes. Almost half of all of the deaths are due to high blood sugar before the age of 70 years. According  to WHO statistics Diabetes is the seventh cause of death and 80 million people are affected by diabetes in 2014.

14^TH November is celebrated as WOLRD DIABETES DAY internationally. It has grown from humble beginnings to become a globally celebrated event which increases awareness about diabetes. World Diabetes Day is internationally recognised and is an official United Nations Day. Its logo is blue circle. The theme for World Diabetes Day 2019 is  “THE FAMILY AND DIABETES”   

Diabetes can be treated and its effects / consequences avoided or delayed by adopting healthy lifestyle, a balanced Diet, physical activity, medication and treatment for complications. Good control of Diabetes has a positive impact on a person s life.

WHAT IS DIABETES?

Diabetes is a metabolic disorder which can be treated or it can be prevented or delayed with appropriate screening. By definition Diabetes is defined as elevated levels of blood glucose (hyperglycaemia). This increases blood levels is either due to a faulty pancreas or body itself.

In some cases pancreas is unable to secret insulin or secrete insufficient insulin. On the other hand sometimes there is resistance of body itself to insulin.

This is all the story of insulin which is a polypeptide (amino acid) secreted by Beta cells of pancreas.

TYPES OF DIABETES MALLITUS

The underlying cause of diabetes varies by type.  But no matter what type of diabetes one has, it can lead to excess sugar in your blood . High blood sugar can lead to serious health problems.

Chronic diabetes broadly divided  into

• Type 1 Diabetes
• Type 2 diabetes

Both type has different risk factors and needs different line of management.

Type 1 DIABETES

10% of the people with diabetes are diagnosed with type 1 diabetes. Type 1 is the most common form of diabetes in people who are under age 30. It is also known as insulin dependent or juvenile onset diabetes. It happens usually in early childhood but it can occur at any age. Type 1 Diabetes occurs because the insulin producing cells of pancreas (beta cells) are damaged as a result of which   pancreas is unable to secrete insulin or secrete very little insulin. Persons affected with type 1 diabetes they must have to use Insulin injections to manage/control the blood glucose levels. Your risk of getting diabetes type 1 increases if parent s or sibling has type diabetes. Certain countries such as Finland and Sweden ,have higher rates of type 1 diabetes.

Type 2 DIABETES

In Type 2 Diabetes pancreas is making insulin but either the insulin is not enough or the insulin does not work properly. 9 out of 10 people with diabetes are affected by type 2 diabetes. it develops usually in middle age most often in the people who are over 40 years old but it can occur even in childhood if risk factors are present.

Predisposing factors or risk factors are:

• Obesity especially central obesity.
• Being overweight
• High blood pressure.
• Sedentary lifestyle .
• Abnormal cholesterol and triglycerides level .
• Having family history of diabetes.
• Use of certain medications, including steroids.
• Having history of gestational diabetes.
• Having history of given birth to a baby weighing more than 9 pounds (4kg)
• Certain races- including African American, Hispanics, Native Americans, American Indians, Asian Americans, Pacific islander or ethnic background are at higher risk.

Type 2 diabetes may sometime be controlled with a combination of Diet, Weight management and Exercise. However, treatment also may include Oral- glucose lowering medications (taken by mouth) or insulin injections.

Potentially reversible diabetes condition include

• Pre-diabetes: It is a condition when blood sugar levels are higher than normal, but not high enough to be classified as diabetes . It can be reversed by weight management regular physical activity & by lifestyle changes.

• Gestational Diabetes: Gestational diabetes occurs during pregnancy and it usually resolves after the delivery of baby. It happened because of increase hormonal status during pregnancy as a result of which body cells become resistant to insulin. If anyone has gestational diabetes in one pregnancy her chance to have gestational diabetes in subsequent pregnancies are increased and if someone has gestational diabetes she is prone to diabetes type 2 so proper follow ups must be done in future to screen diabetes type 2.
  • Pregnant women who have a greater risk of developing gestational diabetes include those who are:

• • •  Above 35 years of age.
    • Overweight
    • Having family history of diabetes
    • Having history of polycystic ovarian syndrome.

Blood glucose level usually return to normal after childbirth but proper follow ups to be done in future to avoid the risk of developing type-2 diabetes.

“ DIABETES INSIPIDUS IS NOT A TYPE OF DIABETES MALLITUS. It should not be confused with DIABETES MALLITUS. DIABETES INSIPIDUS IS A SEPARATE DISEASE. It is an uncommon Disorder that causes an imbalance of fluids in the body.”

SYMPTOMS OF DIABETES

The symptoms of Diabetes vary from person to person usually it depends upon how much the level of blood sugar elevated in the blood . Some people especially with pre-diabetes and diabetes type-2 , may not experience any symptom initially. In type-1 diabetes symptoms tend to come on quickly and be more severe, some of the sign and symptoms of diabetes are:

• • Increased thirst
  • Increased hunger (especially after eating)
  • Frequent urination
  • Dry mouth
  • feeling fatigued ( getting tired easily)
  • Numbness or tingling in the hands or feet
  • Slow -healing ulcers or sores
  • Unexplained loss of weight (despite eating lot of food)
  • Blurring of vision
  • Presence of ketone bodies in urine (ketones are a byproduct of muscle and fat breakdown and it happened when there is not sufficient insulin available in body)
  • Irritability
  • Increase yeast infections or urinary tract infections
  • Dry and itchy skin
  • Presence of frequent infections such as gums or skin infections and vaginal infections.

DIAGNOSIS OF DIABETES

In order to make a diagnosis about any disease one has to follow certain screening tests or has to undergo a series of follow ups. For type 1 diabetes the symptoms usually appear early and suddenly so the diagnosis can be made early. But unfortunately the symtpms of diabetes type 2 and pre-diabetes come on gradually and may not be evident at all. American Diabetes Association (ADA) has recommended certain screening guidelines. We will have a quick look over these guidelines, according to ADA the following people must be screened for Diabetes Mallitus.

• Anyone with a body mass index greater than 25 (23 for Asian Americans), regardless of age, who has additional risk factors such as high blood pressure, family history of diabetes, abnormal cholesterol levels, a sedentary lifestyle, a hirtory of polycystic ovary syndrome, having heart disease need to be screened.
• Anyone who has been diagnosed with prediabetes is advised to be tested every year.
• Anyone older than age 45 is advised to do an initial blood sugar screening and than if results are normal is advised to be screened every three years thereafter.
• Any women who has had gestational diabetes, is advised to be screened for diabetes every year.

SCREENING TESTS FOR TYPE-1 AND TYPE-2 DIABETES AND PREDIABETES

Glycated haemoglobin (HbA1C )test 

It is a random blood test which means you can give this test at any time of day. Fasting is not required for this test. It indicates average blood glucose for the past three months. It is easy and helps in early diagnosis of diabetes. It determines glucose level on the surface of red blood cells. If you have diabetes or have border line diabetes/pre-diabetes levels of HbA1C is repeated after every 3 months . It is used to determine blood glucose control in the body over three months.

• The normal value of HbA1C is 4% to 5.6%.
• If HbA1c level falls between 5.7% and 6.4%, it means you are having higher chance of getting diabetes and you are categorised under the heading of Pre-diabetes.

• Levels of HbA1C  6.5% or higher on two separate tests means you have Diabetes.

So if you are having family history of diabetes or having  obesity, over weight, sedentary lifestyle, high blood pressure, smoking or have increased belly fat screen yourself with HbA1C.

Remember: Diabetes is a treatable chronic illness and Even in some cases type 2 diabetes can be prevented or delayed by adopting healthy lifestyle and with simple handy measures. Sometimes it is not feasible to measure HbAIC levels such as

• The results levels are not consistent
• Test is not available
• Or there is certain conditions that can make the HbAIC test inaccurate such as
  • Pregnancy.
  • Having an uncommon form of haemoglobin (known as haemoglobin variant) .

In that case there are certain other blood tests to diagnose Diabetes Mallitus. These tests are as follows.

FASTING BLOOD GLUCOSE TEST

This blood test is done after an overnight fast (atleast 8 to 10 hour fasting is required to obtain the result). A fasting blood sugar level less than 100 mg/dL (5.6mmol/L) is considered normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9mmol/L) is considered Prediabetes. If fasting blood sugar is 126mg/dL (7mmol/L) or higher on two separate tests , one has Diabetes.

RANDOM BLOOD GLUCOSE TEST

This blood test can be done at a random time regardless of when you last ate. A random blood glucose level of 200mg/dL ( 11 mmol/L) or higher suggests Diabetes.

ORAL GLUCOSE TOLERANCE TEST

For this test overnight fasting is required and fasting blood sugar level is measured.(at least 8 hours of fasting is required but not more than 16 hour) than one has to drink a sugary liquid and blood sugar levels are measured periodically for the next two hours. This test requires almost three hours to complete but it varies from laboratory to laboratory accordingly.

• A blood sugar level less than 140mg/dL (7.8 mmol/L) is normal.
• A level of more than 200mg/dL(11.1 mmol/L) after two hour indicates diabetes.
• A reading between 140 and 199mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates pre-diabetes.

For type-1 diabetes urinary ketones are also checked. Autoantibodies also checked in case of diabetes type-1.

TEST FOR GESTATIONAL DIABETES

Following criteria are followed in case of investigating gestational diabetes.

1. Your gynaecologist will likely to evaluate your risk factors for gestational diabetes early in your pregnancy, you are at high risk of gestational diabetes, for instance if you are:
   • Obese at the start of your pregnancy.
   • Having family history of diabetes.
   • Have a child with diabetes.
   • History of having gestational diabetes during previous pregnancy.
2.  You are at average risk of having gestational diabetes,  in case your doctor advised you a screening test for gestational diabetes during your second trimester of pregnancy that is usually  between   24 and 28 weeks of pregnancy.

Following screening tests are used for screening of gestational diabetes.

1. INITIAL GLUCOSE CHALLEGE TEST
2. FOLLOW UP GLUCOSE TOLERANCE TEST

Management of Diabetes Mallitus

Before jumping into detail of medical management there is a combined format of “healthy diet and execicse plan” that work for management of all type of diabetes. This is the most important part of managing Diabetes Mallitus. Through healthy diet and mild to moderate physical activity(as allowed by your doctor) one can spend life with diabetes with comfort and joy.

Your understanding what and how much to eat can be a challenge. With the help of a registered nutritionist /dietitian you can create your own meal plan that fits your food preferences,health goals and lifestyle. It will likely include carbohydrate counting especially if you have type 1 diabetes.

For different types of diabetes different regime of medical management is required. It is explained briefly in a simple form for common man understanding below.

For Type-1 diabetes medical management insulin is the only solution. There is no escape from insulin injection but the need to live life with insulin injection is courage and proper follow ups because mostly victims of type 1 Diabetes is under the age of 30 so with courage and determination one can live a better life.

Many types of Insulins are available long acting,intermediate acting and short acting. Your doctor may prescribe your insulin type and dosage according to the need of your body. Insulin is delivered either through pen like device or with ultra fine needles. It can be delivered by your ownself. Besides you have to keep monitor your blood sugar levels and make a record as advised by your doctor.

For Type-2 diabetes line of management is of many steps. It consist of

1. lifestyle changes ( that include healthy diet plan and physical activity (as allowed by your         doctor/health care)
2. Medications (oral medication in form of tablets or injectable in the form of insulin). Some diabeteic oral medications stimulate your pancreas to produce and screte more insulin. Others inhibit the production and release of glucose from your liver which means your insulin need in the body is decreased. Some block the action of stomach or intestinal enzymes that breakdown the carbohydrates or make your body tissues more sensitive to insulin. METFORMIN is generally the first medication prescribed for type 2 diabetes. Insulin as described earlier is of many types . Some person may need only oral diabetic medication only some need both oral and insulin in a mix regimen to ontrol their diabetes. Your doctor/health care is the one who will decide your treatment plan according to your blood glucose level.
   • monitoring your blood sugar levels . you have to check your blood sugar and jolt it down to make arecord according to the advise of you health care provider .
   • One has to admit the fact that to live a life with diabetes lifetime management is required. Strong willpower and dedication is needed to fight the disease because it is a lifelong journey.

For gestational diabetes, control of blood sugar is essential to keep your baby healthy and to avoid complications during pregnancy and delivery. In addition to

1. Monitoring blood sugar levels
2. Healthy diet
3. Physical activity (as allowed by your doctor) ,
4. you may need insulin injections to lower your blood sugar
5. Also an important part of treatment plan is close observation of baby as well to avoid the risk of complications

Your doctor will also monitor your blood sugar levels during labor. If your blood sugar rises your baby may release high levels of insulin which can lead to low blood sugar levels right after birth of baby.

Your blood sugar levels are also monitored 6 to 12 weeks after delivery. If your tests are normal(as most have) you will need to assessed you diabetes screening at-least after every 3 year.

But if fall under the category of diabetes or pre-diabetes discuss with your doctor about increasing your prevention efforts or to follow a diabetes management plan.

Treatment for pre-diabetes

If you are diagnosed with pre-diabetes, healthy lifestyle adaptation can help you either

a. bringing your blood sugar back to normal levels.

OR

b. at-least keep it from rising towards the levels seen in type 2 diabetes.

Healthy lifestyle include healthy diet and physical activity (either in the form of walk or exercise) at-least 150 minutes a week or 30 minutes 5 days a week. And also losing about 7% of your body weight may prevent or delay type 2 diabetes.

Once you are diagnosed with diabetes there is no escape but with proper follow up one can get  through the phases of life with comfort and happiness.

DISCLAIMER:

This article is for general information purpose only. In case of you are struggling with diabetes or health issues follow the plans your of doctor/health care. Remember self medication is dangerous. Any questions or comments are welcomed . you can ask any question at drfatimahina@gmail.com                 All copyrights reserved.