Chapter – 10
Diabetes
Lose the inches lower your risk. Tell diabetes. Not me. -Unknown
Diabetes is a disease in which blood glucose (sugar) levels are above normal. A hormone called insulin, produced by the pancreas, helps blood glucose get into the cells to provide them with energy.
There are 3 kinds of diabetes.
Type-I or Juvenile Diabetes
Type-1 or Juvenile diabetes is mainly occurs in children. In type-1 diabetes, the pancreas loses its ability to produce insulin. Children with type-1 diabetes require insulin (by injection) replacement every day to stay alive. They cannot be treated with oral medications.
Gestational diabetes:
Gestational diabetes is a type of diabetes that develops only during pregnancy (gestation). After the baby is born, the high blood sugar gradually returns to normal. However, mother who develop gestational diabetes have much higher risk of developing type-2 diabetes many years later.
Pre-diabetes
A person with pre-diabetes has a blood sugar level higher than normal, but not high enough for a diagnosis of diabetes. He or she has a higher risk for developing type- 2 diabetes. Without lifestyle changes to improve their health, 15% to 30% of people with pre-diabetes will develop type-2 diabetes within five years. If you have pre-diabetes, research shows that doing just two things: losing 5% to 10% of your body weight and getting at least 150 minutes of physical activity per week can help you prevent or delay type- 2 diabetes.
Diagnosis of diabetes
The best way to diagnose diabetes is by measuring blood sugar level. Blood sugar level can be measured with fasting or not fasting (random). Fasting is better. Fasting or random blood sugar reflects the blood sugar level when the sample was drawn. There is another and better test called Hemoglobin A1C or simply A1C. It reflects average blood sugar levels over 3-4 months, is not much affected by the food you ate night before.
Pre-diabetes vs. Diabetes
Test Healthy Range Pre-diabetic Diabetic
A1C < 5.6% 5-7 to 6.4% > 6.5%
Fasting Blood Sugar < 100mg/dl. 100-125 mg/dl. >126 mg/dl.
Blood sugar not fasting < 140 mg/dl 140-199 mg/dl. > 200 mg/dl.
Source – American Diabetic Association, 2017.
Risk Factors for Type-2 Diabetes
- Being over 45 years of age.
- Being overweight or obese.
- Having parents, brother, or sister with diabetes.
- Being Asian, Pacific Islander, Hispanic, African- American.
- Having prior history of gestational diabetes (high blood sugar during pregnancy) or birth of a baby weighting more than 4 kg. (9 lbs.)
- Having high blood pressure measuring 140/90 or higher.
- Having abnormal blood cholesterol, higher than 240 mg/dl. or triglyceride level 200 mg or higher.
- Being physically inactive.
What are the symptoms of diabetes?
- Frequent urination.
- Excessive thirst.
- Unexpected weight loss.
- Extreme hunger.
- Sudden vision changes.
- Tingling or numbness in hands and feet.
- Feeling tired much of the time.
- Sores those are slow to heal.
- More infections than usual.
- Very dry skin.
Preventing Diabetes
Research studies have found that moderate weight loss (5% to 10%), and exercise can prevent or delay type 2 diabetes among adults at high risk of diabetes. Steps you can take are:
- Keep your weight under control-
– BMI of 25 or less. Lose your belly (abdominal) fat.
- Increase your physical activity – at least 30 minutes of moderate – intensity physical activity on most or all – days of the week.
- Consume a healthy diet – more fruits, vegetables, fiber, whole grains, beans, fish, poultry, less fat, low sugar, low salt diet.
- Do not smoke.
- If you have risk factor or are in doubt get your blood sugar or A1C level check. Early diagnosis and treatment will minimize your complications from diabetes. It may also save your life.
Complications of Diabetes
- Heart disease.
- High blood pressure.
- Kidney failure.
- Vision problem –diabetic retinopathy.
- Nerve damage (diabetic neuropathy).
- Delayed wound healing – ulcers.
- Gum disease.
- Sexual dysfunction (erectile dysfunction).
- Frequent illnesses, cold, flu.
- Mood change.
Preventing Complications of Diabetes
Diabetes is a bad disease. It can affect many parts of your body – blood vessels nerves, eyes, heart, brain, kidneys. The good news is that you can prevent most of these complications or at least minimize them by keeping your blood sugar, blood cholesterol, triglyceride and blood pressure under control, being physically active and maintaining normal or close to normal body weight. Diabetes causes peripheral nerve damage and poor blood flow to skin and various organs. People with nerve damage do not feel pain from their sores and cuts. They should wear properly fitting shoes and check daily for sores and cut in their feet.
Diabetes is a progressive disease. It damages multiple organs. It is a major cause of disease and disability and death. Please take it seriously and get it under control.
Saheb Sahu, M.D., F.A.A.P., MPH.