Articles on complications of diabetes mellitus

All You Wanted to Know About Diabetes: A Scientific Elucidation

Dr. Tanoy Bose, Internal Medicine
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 2007By 2025 , 80% of World’s Diabetics will be in IndiaOne 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 diabetesIf your father is Diabetic: you have 14% chances to develop diabetesIf both the parents are Diabetic: You have 25% chances to develop diabetesIf your sister or brother is Diabetic: You have 75% chances of developing diabetesIf 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 symptomsFrequent urinationExcessive thirstUnexplained weight lossExtreme hungerSudden vision changesTingling or numbness in hands or feetFeeling very tired much of the timeVery dry skinSores that are slow to healMore 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 includeOlder age,Obesity,Family history of diabetes,Prior history of gestational diabetes,Impaired glucose tolerance,Physical inactivity, andRace/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 lightb. 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 foodd. If your heart is involved:   i. Shortness of breath   ii. Breathlessness while exertion   iii. Chest pain   iv. Palpitation   v. Sudden shortness of breath at mid of night (paroxysmal nocturnal dyspnoea)   vi. Progressive swelling of feete. 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 speechf. 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.

6 Common Myths About Diabetes

Sheetal Aversekar, Diabetologist
      1. ONLY OLDER PEOPLE GET DIABETESEarlier, diabetes occurring in children and youngsters was considered to be type 1 (juvenile/ insulin dependant) diabetes. However the scenario is fast changing nowNowadays, unhealthy lifestyles are causing a lot of youngsters to develop the more common variety of type 2 diabetes. Today, it is not uncommon for teenagers or people in their 20s and 30s to be detected as being  type 2 diabetic.        2. DIABETES MEDICINES SHOULD NOT BE TAKEN FOR LONG AS THEY DAMAGE KIDNEYSMany people stop their diabetes medicines once their blood reports are normal, fearing damage by long term usage of medicinesThe truth is that stopping medicines will again cause the blood sugar level to rise and an uncontrolled blood sugar may damage not only the kidneys, but also eyes, nerves, heart, liver in the long run     3. MY FASTING AND 2 HOUR POST LUNCH REPORTS ARE WITHIN NORMAL LIMITS, SO I SHOULD NOT WORRYYour sugar level at other times of the day or on other days may not be within limits. Hence, you need to do a blood test called as HbA1c every 3 months which will tell you if you are well controlled in general over the past 3 monthsApart from that, lipid profile, kidney function tests, liver function tests, eye examination, feet examination should be done at least once a year or in some cases, more frequently, to detect any complications of diabetes at an early stage        4. DIABETES AFFECTS ONLY THOSE WHO EAT MORE SUGARUnfortunately, all Indians have a  risk of developing type 2 diabetes ( we are genetically more prone). However, it is not only the sugar intake but an unhealthy lifestyle which decides whether you will develop diabetes or not. This includes irregular meal and sleep timings, over intake of fast food/ oily food leading to weight gain, lack of adequate exerciseHealthy habits need to be inculcated right from childhood. For all the mothers out there, a chubby child is NOT a healthy child!      5. A SPECIAL DIET IS REQUIRED FOR DIABETICSThis may be true in certain special cases as decided by your doctor. However, most diabetics need to follow a healthy dietary and lifestyle pattern which should be followed even by non-diabeticsWhat is more important is to have small frequent meals rather than 3 heavy meals, increasing fibre intake in the form of fresh fruits and vegetables, avoiding processed food( tinned/ready to eat meals/ bakery foods), increasing water intake, ensuring adequate sleep and having a brisk walk for 30-40 minutes daily with appropriate footwearCrash diets should not be attempted as they will do more harm than good      6. INSULIN WILL DAMAGE MY BODYInsulin is an injection which needs to be taken daily in some individuals with diabetes. Your doctor will prescribe it only if your diabetes cannot be controlled by tablets, either on a temporary or a permanent basisIt is the best medicine to control blood sugar levels and if taken in the right dose and if precautions are followed, it will cause no harmNowadays, better varieties of insulins and insulin needles with a very fine tip are available which make the injections almost painless

3 Symptoms of Diabetic Eye That You Must Know

Dr. Charu Tyagi, Ophthalmologist
India  has a huge population of  diabetics, and recently we were named as the diabetic capital of the world with the highest number of diabetics!Yet, only a few people are aware of its impact on eyes. Raised blood sugar levels have multi-fold impacts on eyes and can lead to progressive and permanent visual loss. It is very important for all diabetics to have a regular detailed eye check-up and dilated retina examination at least once a year with your eye specialist.BLURRING OF VISION Frequent change of glasses or blurring of vision with your recently corrected glasses is very common in diabetics, it is an indicator of fluctuating blood sugar levels leading to diabetic lens changes or damage to the retina. Vision in one eye may appear slightly blurred and distorted more for reading than at distance, or sudden black spots may be seen, these are all an indicator of retinal problems.WATERING- Mild watering in both eyes, one more than other is a common finding in diabetics. The tear film in eye is unstable in diabetics and they are also prone to higher and longer incidences of eye (conjunctivitis, meibomianitis) infections.REDNESS-Eyes may appear red and congested due to chronic dryness and infection. At times one of the eye may appear bright red, noticed by others without much discomfort. This is due to fragility of blood vessels seen in long-standing diabetics who may also have hypertension.

Can Diabetes Lead to Hearing Loss?

Mr. T. Kannan, Audiologist
Hearing loss is common in people with diabetes. As diabetes becomes more common, the disease may become a significant contributor to hearing loss.A recent study found that hearing loss is twice as common in people with diabetes as it is in those who don't have the disease.Also, of the 86 million adults in the U.S . who have pre-diabetes, the rate of hearing loss is 30% higher than in those with normal blood glucose. Research shows that people with uncontrolled type I or type 2 diabetes are twice as likely as others to experience hearing loss.In a large study of people ages 20-69, researchers from the National Institute of Diabetes and Digestive and Kidney diseases found a strong association between diabetes and hearing problems,emerging as early as age 30.It,s possible that the high blood glucose levels associated with diabetes cause damage to the small blood vessels in the inner ear,similar to the way in which it damages the eye and the kidneys.Diabetes may lead to hearing loss by damaging the nerves and blood vessels of the inner ear.Since it happens slowly, the symptoms of hearing loss can often be hard to notice. In fact, family members and friends sometimes notice the hearing loss before the person experiencing it.Signs of Hearing loss :Frequently asking others to repeat themselvesTrouble following conversation that involve more than two peopleA hearing problem frustrates you or triggers arguments when talking to family membersA hearing problem causes you to attend public events or services less often than you would likeThinking that others are mumblingProblems hearing in noisy places such as busy restaurantsTrouble hearing the voices of women and small childrenTurning up the TV or radio volume too loud for others who are nearbyHearing loss makes you feel depressed

Diabetes Increases the Risk of Stroke

Ms. Swati Kapoor, Dietitian/Nutritionist
Before we explain the link between diabetes and stroke, we need to understand diabetes and stroke, and the causes behind them.What is diabetes?Diabetes is a metabolic disorder in which blood glucose levels deviate from normal levels. There are two types of diabetes: Type 1 and Type 2. Type 1 diabetics are those who are diabetic from their childhood or young adulthood. Type 2 diabetics are those who are diabetic from their adult lives. Diabetics could be Insulin dependent or independent, depending on the state of the pancreas. There are many factors which lead to diabetes such as: Age, Heredity (family history) , Alcohol abuse, Drug abuse, lack of physical activity, poor diet etc.What is stroke?A stroke is the impairment of the brain function due to disturbance in the blood supply to the brain, especially when it occurs all of sudden. There can be many factors which lead to a stroke, such as Age, Heredity (family history), Race, Sex (gender), Prior stroke history, heart attack, Alcohol abuse, Drug abuse, etc. Hypertension is also one of the major factors which lead to a stroke.How is diabetes linked to stroke?People with diabetes are up to 4 times as likely to have a stroke as someone who does not have the disease. Many people with diabetes have health problems that increase their risk for stroke. Although a lot of research is being carried out on why people with diabetes are at a higher risk for having high blood pressure and brain stroke, researchers are yet to arrive at any definite answer. Uncontrolled high blood pressure, or hypertension, is a major risk factor and a leading cause of stroke. As many as 2 out of 3 adults with diabetes have high blood pressure. When it comes to preventing diabetes complications, normal blood pressure is as important as good control of your blood sugar levels.What Lifestyle Changes Can Prevent and Treat High Blood Pressure?To treat and help prevent high blood pressure, diabetes and stroke: • Control your blood sugar • Stop smoking • Eat healthy • Maintain a healthy body weight • Limit alcohol consumption • Exercise • Limit salt intake • Visit your doctor regularly • Be stress free. Minimize stress levels. • Give your body sufficient sleep

What Health Problems Can Diabetes Cause?

Dr. Narendra Mahara PT, Physiotherapist
You are in controlTaking care of yourself when you’ve been diagnosed with diabetes takes effort. You need to check your blood sugar, eat right, stay active, and take your medications. It makes a big difference; because it can help you avoid major problems throughout your body, even in places you might not expect. Stick to your treatment plan so you can help slow them down or prevent them altogether.Gum disease and cavitiesDiabetes makes you more likely to get infections inside your mouth, like gum disease or thrush, a fungal infection that can make painful white sores. Uncontrolled high blood sugar can also raise your risk of plaque and cavities. A 2015 study found that people with diabetes lose twice as many teeth as those without the disease. Make sure you tell your dentist about your condition, keep up with brushing, flossing, and rinsing with antiseptic mouthwash. Watch for bleeding gums or other symptoms of gum disease.Problem with visionDiabetes can lead to glaucoma (increased pressure in the eye) and cataracts (clouding of your eye’s lens). It also can damage the blood vessels in the retina at the back of your eye, a problem that doctors call diabetic retinopathy. All of these conditions can worsen your vision and even lead to blindness. By the time you notice your eyesight fading, serious harm may already have happened. So see your eye doctor regularly.Damaged nervesMany people with diabetes get nerve damage (neuropathy). It can happen anywhere in your body, but it most often affects your arms, legs, hands, and feet. Doctors call this peripheral neuropathy. Symptoms can include a tingling feeling, numbness, sensitivity, or pain. Another kind, called autonomic neuropathy, can affect urination, sex, digestion, and other body functions. It’s less likely if you aren’t overweight, and if you manage your blood pressure and blood sugar.Foot problemsIf diabetes damages your feet’s nerves, numbness can make you less likely to notice an injury or infection. Your condition can also make it harder for blood to flow in that area. Together, these problems can eventually cause so much harm that your toes or feet need to be amputated. Quit smoking and get exercise to make these problems less likely. Also, check your feet daily, keep them clean and moisturized, and wear shoes that fit well.Skin conditionsMany of these changes are due to infections, which diabetes makes more likely. Your skin may become itchy, it may feel thinner or thicker, or you may notice scaly or discolored patches. Circulation and nerve problems caused by diabetes can also affect your skin. It helps to stay at a healthy weight and keep your blood sugar under control. If you get sores or blisters due to an infection, your doctor may prescribe antibiotics, creams, or other medicine.StrokesThese happen much more often among people with diabetes, and they also tend to happen at an earlier age. A stroke happens when one of the vessels that sends blood to your brain becomes weakened, injured, or blocked. When brain tissue is deprived of blood, it can become permanently damaged within minutes. What can you do to prevent it? Watch your blood sugar, cholesterol, and blood pressure. High numbers can mean higher risk. Exercise, stay at a healthy weight, and most importantly, avoid tobacco smoke.Heart diseasesThe wear and tear on your blood vessels caused by diabetes means a lot of extra work for your heart. And people with the disease are more likely to be overweight or have other conditions, like high blood pressure and high cholesterol. All that adds up to a serious risk for heart disease. That's why it's key to follow a ticker-friendly lifestyle - exercise, eat a healthy diet, get regular cholesterol and blood pressure screening tests, and say no to smoking or second hand smoke.InfectionsDiabetes makes you more likely to get infections more often and to have complications. People with the disease face higher risks of getting gum disease, respiratory infections, the flu, pneumonia, urinary tract infections, yeast infections, and more. Make sure you stay up to date on vaccines, including immunizations for the flu and pneumonia.

An Apple a Day Keeps Diabetes Away

Dr. Sachin Chittawar, Endocrinologist
Fruits  are a necessary ingredient of our diet. They are rich in essential vitamins , minerals  and give us a gush of antioxidants. The essence of seasonal change is beautifully incorporated in the changing availability of fruits in our market. They are a healing touch to our body, soul, and the persona.Diabetes and Fruits-The diabetic enigma begins with a flurry of suggestions telling us what to  be or not to be eaten?. The soul of the advice gets lost in between  the newly found advising, newly generated anxiety, awareness, and the wrong perceptions. Diabetics are the ones who are being controlled in a remote controlled way by their wives, relatives, and children. Social fabric in India is different from the west, it is being beautifully driven by the sense of belongingness, concern and the real worry about  the coming doom. When a person gets diabetes even the maid of the  house starts taking care of the ailing individual. Extra care is good, but sometimes we are stuck up in between various suggestions and thoughts of our relatives. What to eat and what not to eat?.The three tenets of diabetes care are to restrict carbohydrates to 40-60% , restrict fat to 20%, proteins to 20% and have plenty of dietary fibre. This is like a plate full of chaat with miscellaneous ingredients and  the beauty of chaat is that the taste varies with individual to individual. You can have more of the green chutney or imli ki chutney, you can have more of sev , papdi  or the never ending list of spices. The taste varies with individual and the savory tickles the taste buds of everyone. This is what life is for, it gives us pleasure and self  containment.The treatment of diabetes and advice to a diabetic patient cannot be different. Advice to a  diabetic should incorporate the likes and dislikes of the patient who is receiving it, life will continue even if the patient is diabetic. The ingredients for the chaat personified as life of a diabetic cannot be without choices.Rationalisation of thoughts amongst the diabetics, relatives and friends is required, brakes to be applied when necessary.Fruits in Diabetes – Diabetic needs are not different from a non diabetic individual with an extra requirement of antioxidants, fiber and the balance in the three tenets. Fruits are  a rich source of  the recommended in diabetes.Is there an absolute no for a particular fruit? Myths shroud us and sometimes we are haunted by it. All fruits are good for diabetics, they should have all of them. They should know the fact that fruit sugars are not like the food sugar, it takes time in getting converted to glucose. We  have learnt the fact that if a food stuff  does not lead to a sudden increase in sugars i.e glucose, it is good for diabetics. The glycemic index of fruits is low.Which fruit should be taken?Fruits with the less  glycemic index like apple, papaya, guava, pomegranate are the preferred ones. Chikoo, banana, oranges, grapes, mangoes, litchis are the ones to be taken in moderation. Preference doesn’t mean that the others should never be taken. Balance the fruits in the diet as per season, availability and the three tenets of diabetes. Fruits are the necessary content of a diabetic diet, they reduce the oxidative stress and gives us the elixir of life. An apple a day keeps diabetes away.

Diabetes and Pregnancy - Your Lifestyle Matters!

Dr. Sujoy Dasgupta, Gynecologist/Obstetrician
India is nowadays considered the “Diabetic Capital” of the world. The rate at which diabetes is increasing in modern societies is, indeed, a matter of concern. Diabetes does not merely mean increased and sometimes uncontrolled blood sugar. It affects various organs and systems of our body , particularly affecting heart (coronary artery disease), brain (stroke), eye (retinopathy), kidney (nephropathy), blood pressure (hypertension), liver (fatty liver), nerves (neuropathy), increased risk of infection and even some cancers. Obesity and diabetes go hand-in-hand. So, the main control measures are life style changes (controlling weight, diet, exercise, avoidance of alcohol and smoking); drugs (oral drugs and insulin) and monitoring by physician.Sexual Dysfunction: Diabetes is a major cause of sexual dysfunction in both male and female. It can reduce the libido (sexual desire) by altering the sex hormone levels. In case of male, Erectile Dysfunction (ED) is sometimes the first symptom of diabetes. So, if a male suffers from ED, rather than taking drugs directly from medicine shops, the cause of ED must be evaluated, particularly diabetes. Often patients do not know that they are diabetic but when the cause of ED is investigated, diabetes is discovered incidentally. It can also affect the nerves and thus can worsen the sexual problems. In female, it can lead to decreased arousal leading to avoidance of sexual activity. In some cases, it is responsible for premature ejaculation (PE) in males. Thus any person with sexual problems, should be evaluated for diabetes. Control of diabetes often resolves the problem. Menstrual problems: Obesity and diabetes together can affect hormone balance leading to irregular menstruations ranging from periods occurring at every 2-3 months, sometimes too frequently (every 10-15 days), scanty flow and sometimes heavy flow. This is particularly true in case of polycystic ovarian syndrome (PCOS) which can affect various organs and systems of the body. In PCOS, insulin is there in the body but it cannot function properly and ultimately it leads to diabetes. In some cases, this high blood sugar may be responsible for appearance of excessive hair growth (male-like hairs) in females. Even in some cases, diabetes may be associated with increased thickening of the endometrium (the inner lining of the uterus). In the worst cases, these women may have cancers in endometrium. So, women with menstrual problem need proper evaluation. Reduction in weight and control of blood sugar help to control menstrual problems. Infertility: As mentioned above, PCOS is a common cause of infertility. Similarly, diabetes and obesity can lead to problems in ovulation and thus creates problems in having pregnancy. Control of weight and blood sugar lead to successful conception in most cases. Similarly in male, high blood sugar can affect sperm production and thus impairs male fertility. Sexual dysfunction can aggravate the problem. Infection also plays a important role.Infection: Diabetes is notorious for increasing susceptibility to infection and often interferes with eradication of infection. In female, the infections may lead to vaginal white discharge and even in severe cases can block the fallopian tubes leading to infertility permanently. In male, it can cause phimosis (tight foreskin) and sometimes infection of sperm conducting-passage leading to infertility. So, male and female with genital infection must be evaluated for diabetes. Proper control of blood sugar and antibiotics are needed to control these. Pregnancy problems: Women diagnosed with diabetes are encouraged to control blood sugar before pregnancy. Otherwise there will be problems for mother as well the baby. Diabetes can cause miscarriage, preterm labour and worsens maternal problems like hypertension, nephropathy and retinopathy in pregnancy. It can lead to sudden unexplained death of the baby inside the uterus. The baby can have excessive weight (that leads to its diabetes in later life) and other problems like low blood sugar at birth, problems in breathing, problems in brain and problems in heart etc. So, proper control of blood sugar is needed before pregnancy and should be continued throughout pregnancy. GDM: Some women may have normal blood sugar before pregnancy but may develop diabetes in pregnancy. This is called gestational diabetes (GDM). It is also associated with increased risk of complications to mother and baby. 50% women with GDM can develop diabetes in later life. So, women with repeated miscarriage, still birth and very large baby should be evaluated for diabetes. Treatment must be continued throughout pregnancy.To summarize, diabetes is not only responsible for diseases of heart and brain but it can affect your reproductive life, particularly sexual function, conception and pregnancy. So, if you suffer from these problems, do not hesitate to check blood sugar. If diabetes is detected, there is no need to worry as proper control will solve all these problems.