Dr Saheb Sahu, FAAP
What is diabetes?
The term diabetes refers to a group of diseases that affect the way your body uses blood glucose, commonly called blood sugar. Glucose is the body’s main source of fuel. If you have diabetes–no matter which type–it means you have too much glucose in your blood. And too much glucose can lead to serious problems. Around the world, 537 million adults (1 in 10)are living with diabetes (2021). The number will increase to 643 million by 2030. Diabetes is a national epidemic in India and 1 in 2 is undiagnosed.
The different types
Type1 diabetes
Type1 diabetes develops when your pancreas makes little if any insulin. Insulin is a hormone which metabolizes your blood sugar. Without insulin circulating in your bloodstream, glucose can’t get into your cells, so it remains in your blood. Type1 diabetes, also called juvenile diabetes, most often develops in children. Adults can also develop type1 diabetes, although it is less common.
Type 2 diabetes
Type 2 diabetes is by far the most common form of diabetes. It is also called the adult- onset diabetes. In type 2 diabetes, your pancreas still produces insulin, but the ‘lock and key’ interaction between insulin and the cell’s insulin receptor no longer works properly. This causes glucose to build up in your blood stream (high blood sugar).
Gestational diabetes
Gestational diabetes is the name for diabetes that develops only during pregnancy. This happens in about 5% of pregnant women. About half of the women who experience gestational diabetes develop type 2 diabetes later in life.
Pre-diabetes
A person with pre-diabetes has a blood sugar level higher than normal, but not high enough for a diagnosis of type 2 diabetes. Without lifestyle changes 15% to 30% of people with pre-diabetes will develop type 2 diabetes within five years. Research shows that by losing 5% to 10% of your body weight and getting 150 minutes of physical activity per week, you will be able to prevent or delay developing type 2 diabetes.
Diabetes warning signs
Whether you have type 1 or type 2 diabetes, the classic signs and symptoms are:
- Excessive thirst
- Increased urination
- Other signs and symptoms may include:
- Constant hunger
- Weakness and fatigue
- Unexplained weight loss
- Blurred vision
- Slow –healing wounds
- Tingling or loss of feeling in hands and feet
- Recurring bladder or vaginal infections
- Recurring infections of the gums or skin
Are you at risk of type 2 diabetes?
Researchers don’t fully understand why some people develop diabetes and others don’t. Recent studies are showing that multiple genes may be involved but not one particular gene. Certain risk factors do appear to increase a person’s risk of type 2 diabetes. They are:
- Parent, brother or sister with type 2 diabetes (mother or father, relative risk 5% to 20%, parents 25% to 50%, brother/sister 25% to 50%, identical twin 60% to 75%).
- Over weight
- Carry excessive weight around the waist or upper body (apple shape) rather than hips and thighs (pear shape)
- Older than age 45
- Being Asians, African American, Latinos and Pacific Islanders
- Given birth to a baby who weighed more than 9 pounds (more than 4 kg)
- Developed diabetes when pregnant (gestational diabetes)
Tests to detect diabetes
Many people learn they have diabetes through blood tests done for another condition or part of a physical exam. The international Diabetes Federation recommends that type 1 and type 2 testing include four tests.
A1C test
This blood test indicates your average blood sugar level for the past 2 to 3 months. It is the best among the tests. An A1C level of 6.5% or higher on two separate tests indicates you have diabetes. Result of less than 5.7% is normal and between 5.7% and 6.4% is prediabetes.
Fasting blood sugar
The preferred way to test your blood sugar is after you have fasted overnight or at least for eight hours. A fasting blood sugar level between 70 and 99 mg/dl. is within the standard range. If the result of two separate tests shows a level between 100 and 125 mg/dl, you have what is known as prediabetes. Prediabetes should not be taken lightly. It is a sign that you are at high risk of developing diabetes. You should see your doctor and make life-style changes as early as possible. Reading of 126mg or higher on two separate tests indicate diabetes.
Random blood glucose test
This test may be a part of the routine blood work done during a physical exam. Even if you’ve recently eaten before the test, your blood sugar level should not be above 200mgs per deciliter. If it is higher than most likely you have diabetes.
Oral glucose tolerance test
This test is rarely used today because other tests are easier and less expensive.
Low blood sugar (hypoglycemia) – a medical emergency
Blood sugar that is too low or too high can quickly become a medical emergency that requires immediate attention. Low blood sugar- a level below 70mg /dl- is called hypoglycemia. This condition basically results from too much insulin and too little glucose in your blood. If your blood sugar drops too low- for example below 50mg/dl- this could result in confusion, seizures or loss of consciousness, a condition sometimes called insulin shock or diabetic coma. It can also occur in people taking oral diabetic medications that enhance the release of insulin. The reason for hypoglycemia may include: too much diabetic medications, not eating enough or postponing or skipping meal, too much exercise or drinking too much alcohol. If you think you are having hypoglycemic attack, check your blood sugar if you can and drink four ounces of fruit juice or one tablespoon of regular sugar, jelly or honey or four glucose tablets (you should have it in your purse). Your friends and family members should know that you have diabetes and you are on medications.
Metabolic syndrome and diabetes
Metabolic syndrome is a cluster of metabolic disorders that makes you more likely to develop type 2 diabetes, heart disease and stroke. You may have metabolic syndrome if you have three or more of the following risk factors:
- Large waist (for Asian more than 31 inches (78cm) for women and more than 35-inches (88cm) for men)
- High triglyceride- a level more than 150mg/dl
- Reduced “good” (HDL) cholesterol. Lower than 50mg/dl for women and lower than 40mg/dl for men
- Increased blood pressure. Top number (systolic)130mmHg or above or bottom number (diastolic) of 85 mm Hg or above, or drug treatment for high blood pressure
- Elevated fasting blood glucose. A level 100 mg/dl or higher, or drug treatment for high blood glucose
Medical treatment
A healthy diet and regular exercise are an essential part of diabetes treatment. And for many living with type 2 diabetes, they may be the only measures needed-at least early on. Managing blood sugar (glucose) is the key. Very high glucose levels – higher than 300mg per deciliter (mg/dl) can cause dehydration and life –threatening complications. Diabetes increases the risk of serious long-term complications, such as kidney failure, blindness and amputations. It almost doubles the risk of heart attack and stroke. All these complications are largely preventable through optimal management of diabetes. These include not only glucose management but also the management of cholesterol, blood pressure and body weight as well as regular exercise, healthy eating and not using tobacco. When diet and exercise aren’t enough, oral or injectable medication may be prescribed. Many times, people need a combination of oral medication and injections. Talk with your doctor about the pros and cons of each drug. Have regular medical checkup with your physicians.
Long- term complications of diabetes
- Heart and blood vessel disease (cardiovascular disease)
- Stroke
- Kidney disease
- Nerve damage (neuropathy)
- Eye damage (retinopathy).
- Sexual dysfunction (erectile dysfunction)
- Other complications- high blood sugar impairs the ability of your immune cells to fight infections. Your mouth, gums, lungs, skin, feet, bladder and genital area are the common infection sites.
The good news is that you can prevent most of these complications or at least minimize them by keeping your blood sugar, blood pressure, blood cholesterol, triglyceride under control.
Preventing diabetes
Research has shown 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-Body Mass Index of 24 or less. Lose your belly fat.
- Increase your physical activity-at least 30 minutes of moderate-intensity physical activity on most or all days.
There is no “diabetic diet”. Consume a heart-healthy diet- more fruits, vegetables, whole grains, beans, fish, poultry, less fat, low in sugar and salt. Eat in moderation, three meals a day. Limit your intake of alcohol, sweets and sweetened beverages.
- Do not smoke.
- If you have risk factor or factors get your blood sugar checked.
Conclusion
Diabetes is a chronic and a progressive disease. It can affect many parts of your body: blood vessels, heart, kidneys, brain, nerves, eyes and your immune system. It is a major cause of disease, disability and death around the world. You can prevent or at least minimize it’s complications by controlling your blood sugar, eating a heart-healthy diet, being physically active, maintaining an ideal body weight, not using tobacco and following your doctor’s(s) advice. Diabetes itself may not kill you but many of its complications will.Please take your diabetes diagnosis seriously and get it under control.
Source
- M.Regina Castro, M.D. Mayo Clinic The Essential Diabetes Book. The Mayo Clinic Press: Rochester, 2022.
- Centers for Disease Control and Prevention. www.cdc.gov/diabetes/index.html
- International Diabetes Federation. www.idf.org