It is an interesting observation that during my day to day consultation with my patients I have found every third person to be suffering from Diabetes and almost every alternate patient has got somebody in their family who is suffering from Diabetes. This extremely high prevalence of Diabetes is evident only in our country.
The management of Diabetes is getting eased off over last few decades due to immense research work which is being done in the discipline of Diabetes throughout the globe. In spite of so much of development, hurdles remain profound in managing Diabetes. These hurdles are ignorance and ill –information regarding Diabetes among citizens and foremost of all are the misconceptions regarding Diabetes.
I can presume that whichever Physician a patient consults, he gets quite a bit of information regarding management of Diabetes and in most of the cases it is quite unlikely that there will be any difference of opinion. The problem remains in dedication of adequate time to explain each and everything about Diabetes which is hardly given by any physician nowadays. Even I take 45 mins to examine and give adequate consultation to a Diabetic patient. All the physicians want their patient to keep on doing well without any ups and downs. But even then, be due to inadequate sharing of information from the physicians part or due to negative typecasting of the doctor fraternity by the media, it is hard to find a patient to sustain his/her treatment with a single Physician. The trust never develops and that is quite unfortunate. If one does not have adequate confidence on the qualification and credibility of the doctors’ management skills then the overall treatment gets a hard beating.
The motto behind authoring this Diabetes Manual is quite simple. It is to make things very clear and lucid regarding Diabetes.
The size of the manual is quite large and it is being delivered with basic information regarding Diabetes. The adverse events of Diabetic Medicines have been incorporated and also I have ensured that the Targets in management of Diabetes is also well elucidated which is a very important information. Facts and facets regarding Insulin should be very clear. Most of the people are afraid of Insulin. The two most important reasons behind this fear is first of all it is in injectable form and most of us are afraid of injections and secondly a myth is imbibed among the common people that usage of insulin is a tell-tale sign of end stage of Diabetes which is actually a big negative idea. Even it took pains to break the ice while initiating insulin to my mother who is a 12 year long diabetic and that now when her blood glucose is under control, she is disbelieving the laboratory reports.
Whatever, I have immense faith in the readers of this article as I hope to incorporate correct information regarding diabetes and break the myths. It is strongly recommended that you should consult your physician and Diabetologist for proper management of Diabetes and in case of any discrepancy of information provided in this composition.
FEW FACTS ABOUT DIABETES:
- 4,09,00,000 diabetics were there in India in 2007
- By 2025 , 80% of World’s Diabetics will be in India
- One person is dying due to diabetes every 10 seconds in this world.
- Every 10 seconds, two new cases of Diabetes are being detected.
- Diabetes in the most common cause of non-traumatic lower limb amputation.
- Almost 1 out of 2 patients will be found suffering from Diabetes related complications at the time of Diagnosis of diabetes for the first time.
WHAT IS DIABETES?
Diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is broken down into glucose, or sugar, which are oxidised by our tissues to produce energy. The pancreas, an organ that lies near the stomach, secretes a hormone called insulin. Insulin pumps in glucose from our blood into the cells of our bodies. When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin well as it should. This causes sugar to build up in your blood.
Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. There is no diabetes cure developed so far.
HOW BLOOD SUGAR IS NORMALLY CONTROLLED IN OUR BODY?
The Blood Sugar is tightly regulated between 70 to 110mg/dL in fasting state and 100 to 140mg/dL in post meal state. At any random state Blood Sugar is maintained below 180 mg/dL. This is done by the balanced action of some hormones; some of which tend to increase blood sugar while some tend to decrease.Hormones that increase blood sugar are Glucagon, steroids, Adrenaline, Somatostatin, Thyroid hormones, Growth Hormone etc.
The only hormone that reduces blood sugar is the INSULIN. Whenever there is a tendency of the blood sugar to rise above the permissible level, Insulin is secreted from the pancreas and the sugar from the blood is pushed inside the cells by insulin and the balance is achieved.
WHAT IS INSULIN?
Insulin is a protein hormone secreted from Pancreas. It is released from pancreas in two patterns.A constant secretion of insulin takes place throughout the day irrespective of meals which ensures that blood sugar in fasting state is under limits. This continuous Insulin secretion pattern is called the BASAL insulin.
On the top of this whenever there is any intake of food, Insulin senses the transient rise in blood sugar and is secreted in a pulsatile manner with each meals to bring down the post meal rise in blood sugar. This pulsatile pattern of Insulin release is called PRANDIAL Insulin.
When the doctors treat patients with insulin, they always try to match the above mentioned pattern of Insulin levels in the blood which is often difficult.
WHAT ARE MY RISKS FOR DEVELOPING DIABETES?
Roughly it can be extrapolated from researches on Diabetic genes that,
- If your mother is Diabetic: You have 19% chances to develop diabetes
- If your father is Diabetic: you have 14% chances to develop diabetes
- If both the parents are Diabetic: You have 25% chances to develop diabetes
- If your sister or brother is Diabetic: You have 75% chances of developing diabetes
- If your twin is Diabetic: You have 99% chance of developing diabetes.
WHAT ARE THE SYMPTOMS AND SIGNS OF DIABETES?
People who think they might have diabetes must visit a physician for diagnosis. They might have SOME or NONE of the following diabetes symptoms
- Frequent urination
- Excessive thirst
- Unexplained weight loss
- Extreme hunger
- Sudden vision changes
- Tingling or numbness in hands or feet
- Feeling very tired much of the time
- Very dry skin
- Sores that are slow to heal
- More infections than usual.
- Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of insulin-dependent diabetes, now called type 1 diabetes.
WHAT ARE THE TYPES OF DIABETES?
Type 1 diabetes, which was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, may account for about 5% of all diagnosed cases of diabetes.
Type 2 diabetes, which was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, may account for about 90% to 95% of all diagnosed cases of diabetes.
Gestational diabetes is a type of diabetes that only pregnant women get. If not treated, it can cause problems for mothers and babies. Gestational diabetes develops in 2% to 10% of all pregnancies but usually disappears when a pregnancy is over.
Other specific types of diabetes (like diabetes insipidus) resulting from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses may account for 1% to 5% of all diagnosed cases of diabetes.
WHAT ARE THE RISK FACTORS FOR DIABETES?
Risk factors for type 2 diabetes include
- Older age,
- Family history of diabetes,
- Prior history of gestational diabetes,
- Impaired glucose tolerance,
- Physical inactivity, and
- Race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes.
- Any history of Polycystic Ovarian Disease in females (PCOD)
- History of stress
Risk factors are less well defined for type 1 diabetes than for type 2 diabetes, but autoimmune, genetic, and environmental factors are involved in development of this type of diabetes.
Gestational diabetes occurs more frequently in African Americans, Hispanic/Latino Americans, American Indians, and people with a family history of diabetes than in other groups.
Obesity is one of the associated causes of diabetes with higher risk . Women who have had gestational diabetes have a 35% to 60% chance of developing diabetes in the next 10–20 years. Other specific types of diabetes, which may account for 1% to 5% of all diagnosed cases, result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses.
WHAT ARE THE COMPLICATIONS OF DIABETES?
Most of the complications of Diabetes are chronic. High blood Glucose tends to damage numerous enzymes and proteins of our body necessary for important functions and hence many organs are ultimately damaged. We called this as TARGET ORGAN DAMAGE (TOD).
The important target organs are Kidneys (Both), Eyes, Heart, Brain, Nerves and Arteries.
Here are a few terrifying facts regarding Diabetes related complications.
- Diabetes is the commonest cause of non-traumatic lower limb amputation.
- A diabetic may suffer heart attack without any pain (Silent Myocardial Infarction).
- Diabetics suffer heart attack 10 years younger than their peers.
- Diabetes aggravates the process of deposition of fats and lipids in arterial walls causing accelerated atherosclerosis resulting in arterial blockade. This sudden arterial blockade may occur in brain circulation causing stroke, in Heart Circulation causing heart Attack or in Peripheral arterial system causing gangrene.
- Diabetes affects long and thin nerves of the legs there by causing tingling and results in numb limbs.
- Diabetes slowly damages both the kidneys resulting in dependence on Haemodialysis and Renal Transplant.
- Diabetes is one of the leading causes of blindness either due to premature cataract or retinopathy.
- Most importantly, these complications remain completely asymptomatic in early stage and manifest only at a later stage when options of treatment are limited.
- Any infection, ulcer, bacterial infestation, wounds do not heal easily in diabetics not only due to excessive bacterial multiplication but also due to poor quality of tissue which had already been damaged by uncontrolled blood sugar.
HOW DO I KNOW IF I HAVE ALREADY DEVELOPED ANY COMPLICATION DUE TO DIABETES?
Usually complications do not alarm you when they start developing. They manifest only when they have already caused considerable irreversible damage.
a. If your eyes are involved:
i. Dimness of vision
ii. Frequent eye infections
iii. Frequent change of spectacles
iv. Coloured hallows around light
b. If your nerves are involved:
i. Tingling or numbness of soles of feet
ii. Instability or sense of imbalance while walking
iii. Sense of walking over a cotton surface
iv. Pain and burning sensation of legs
v. Weakness while getting up from seating position or breaking stairs.
vi. Slippage of slippers from feet
vii. Development of painless ulcer over any part of foot especially pressure points.
c. If your Kidneys are involved:
i. Unintentional weight gain
ii. Swelling of both lower legs especially early morning
iii. Decrease in urine output
iv. Swelling of face and often whole body
v. Loss of appetite and distaste to food
d. If your heart is involved:
i. Shortness of breath
ii. Breathlessness while exertion
iii. Chest pain
v. Sudden shortness of breath at mid of night (paroxysmal nocturnal dyspnoea)
vi. Progressive swelling of feet
e. If your brain is involved:
i. Sudden black out
ii. Sudden loss of sensorium or syncope
iii. Sudden onset weakness of any part of the body or slurring of speech
f. If your arteries are involved:
i. Pain while walking but relieved on rest
ii. Development of leg ulcers
iii. Pain while elevating the legs above bed
iv. Change of colour of the legs.
It is worth mentioning that if these complications are identified early in their course, they can be well managed and the progress can be arrested, delayed and even in some cases reversed. So it is important to get a diabetes test if you notice any of the symptoms.
To summarise, I would like to convey a very simple message to everybody who is suffering or living with a person of Diabetes that one should be alert, well educated and oriented and never ever disregard the importance of maintenance of optimum control of diabetes. Remember, if diabetes goes out of control, one will never feel any change in their day to day lifestyle but one should be very careful about the payback of the poor control even before the old age sets in. And that is going to hit very hard inside one's mind, pocket and health.
Note: Another article on Treatment of Diabetes with detail of drugs used is in pipeline.