Articles on diabetes mellitus type 2

Treatment and Prevention of Type 2 Diabetes

Dr. Anirban Chakraborty, Internal Medicine
‘Beat Diabetes’ by Prevention and Better ManagementWorld Health Day 2016 is about prevention and better management of diabetes. Type 2 Diabetes, which is around 90% of all Diabetes, is a largely preventable condition that is rapidly increasing throughout the world; mostly among the affluent in countries like India and in the economically deprived sections of the developed world. Obesity, poor diet and lack of exercise are the main reasons for this rise.Simple lifestyle measures including doing regular exercise, eating healthy diet and maintaining normal body weight have been shown to be effective in preventing or delaying the onset of type 2 diabetes by up to 50%.If a patient has developed diabetes, then the emphasis should be on better management of their condition by early diagnosis, regular check-up of various organ dysfunctions and appropriate treatment to prevent complications of diabetes. Treatment of type 2 diabetes can be inexpensive if international and national guidelines are followed, and the total initial monthly cost of effective first line treatment can be as low as under Rs. 50 per month.Reduce risk of developing Type 2 DiabetesThere are three main ways to reduce risk of developing diabetes: Not being overweight, having a healthy diet and exercising regularly.Healthy WeightTry to keep your Body Mass Index (BMI) under 25 if you are overweight. Waist measurement should be kept under 80cm (31.5inches) for Women and 90cm (35inches) for Indian men to be within the healthy range.Eat fewer calories and burn more energy through physical activity to achieve these targets.Balanced DietTry and achieve a balanced healthy diet over a day or even a week incorporating the following principles in your diet:Eat at least five portions of a variety of fruit and boiled or steamed vegetables a day.Drink plenty of water between 3 and 4 litres a day during summer.Keep total volume of carbohydrate intake under 1/3rd of your total daily food portion.Choose low-fat and low-sugar option of dairy or dairy alternatives (e.g. yoghurts)Regularly have beans, pulses, fish, eggs, meat and other protein in moderation.Choose unsaturated oils and spreads and eat in small amounts.Eat foods high in fat, salt and sugar like chocolate, cakes, biscuits, sugary soft drinks, butter, ghee       and ice cream less often and in very small amounts.Avoid comfort snacking if you are stressed, having late nights or watching TV or reading books.Avoid eating out frequently. One full meal at a restaurant can have more than a whole day’s recommended calorie intake. Order smaller portions only and have either starters or desserts, but not both. To compensate for the excess calorie intake, try and be more active and avoid high calorie foods for the next few days.ExerciseAn easy way to exercise is to make activity part of everyday life, like walking to work, taking stairs or cycling to get around, doing household chores like washing clothes by hand, dusting or mopping the floor (moderate intensity activities). Participating in sports including swimming or exercising in a gym (vigorous intensity activities) are even better – try and combine these two types of activities over a week to total at least 150 minutes.Avoid excessive sedentary behaviour like watching TV and using a computer or smartphone for long hours. If you have exercising equipment at home, try to use it regularly while watching your favourite programme on TV.Better Management of Type 2 DiabetesEarly DiagnosisEarly diagnosis of type 2 diabetes is very important to prevent organ damage and further complications. If you have risk factors including being overweight, sedentary, over 25, having a close family member (parent, brother or sister) who has type 2 diabetes etc or you have symptoms suggestive of diabetes like excessive urination, excessive thirst, blurring of vision, tiredness, wound infections etc, you should get tested immediately.In the early stages, lifestyle changes can be sufficient and you may not need any medication to treat your condition.Better TreatmentYou may eventually need to take medication to help control your blood glucose levels. Initially, this will usually be in the form of tablets, and can sometimes be a combination of more than one type of tablet. The cost for vast majority of patients should be low if they are on the recommended medications. Doctors should follow National and International guidelines in prescribing medicines. That will keep cost and medical complications low and will help patients in long term.To reduce the risk of developing other serious health conditions, patients may be advised to take other medicines, including medicines to control high blood pressure and high cholesterol, low-dose aspirin to prevent stroke and other medications if you have the early signs of diabetic kidney disease. Your doctor should be able to tell you your risk of developing heart attack and stroke and prescribe medicines accordingly.If you have type 2 diabetes, you will need to take a reading of your average blood glucose level about every two to three months by the HbA1c test to help guide your treatment. You may need other tests depending on your condition and medications used.Remember, ‘prevention is better than cure’, and it is very true for type 2 diabetes. Together we can beat diabetes by prevention and better management.

Bend Your Knees to Mend Your Diabetes

Dr. Sachin Chittawar, Endocrinologist
Exercise  leads to opening of a current of channels in your body which leads to consumption of sugar by our cells without requiring insulin. The magic of exercise is extended further when a diabetic who has got less insulin or insulin resistance  does exercise. Exercise brings the blood sugars to a normal level and helps diabetics to achieve their sugar targets.On this auspicious day of World Yoga Day  we should exercise yoga to part away our sugar troubles. Yogic asanaas are known to create a divine milieu of physical, mental and spiritual well being. Stress leads to high sugars, lack of exercise leads to weight gain which also increases your blood sugars, spiritual inclination takes you towards the frugality of worlds materialistic things , you achieve spiritual solace.Learning of yoga requires a systematic approach and have fixed set of rules for breathing pattern and has got a schedule of giving rest to your body after a particular set of positions. The chances of a muscle pull, cramps, sprains which are the main roadblocks in our exercise schedule are less in Yoga. Yoga and diabetes is a matter of interest for researchers and there is good data favouring yoga. Yogic positions are to be learnt under supervision of a master teacher  and preferably are to be done in groups. When we exercise in a group we do exercise comfortably in a flow and find it much easier and the monotony doesn’t takes its toll. A diabetic should choose his exercise plan as per his /her choice  and should stick to it on regular basis. You may require medicines with exercise and some of you may require insulin also. Requirement of medicines to control diabetes doesn’t mean that yoga is ineffective. Exercise will help you in controlling weight, sugars and will make you more comfortable with yourself in whichever state of illness you are in. Rationalise your thinking and make yourself aware of the fact that exercise is not a substitute for medication. Exercise and treatment should go hand in hand for better results, good control and less complications in future.Happy Yoga day.

Does Eating Too Much Sugar Cause Diabetes? Here Is What You Need to Know!

Ms. Swati Kapoor, Dietitian/Nutritionist
Sugar can be toxic at some point of time but it doesn’t mean that it is the only food group that leads to diabetes. Anyone can get diabetes who is obese, having high cholesterol, bad eating habits, less workout, too much stress or it can even be genetic. Lets focus more on this: ”Does sugar cause diabetes?”The 2 most common types of diabetes are - Type 1 and Type 2 diabetes. In type 1 diabetes, the insulin producing cells from pancreas are destroyed by your immune system. Anything in your lifestyle can cause type 1 diabetes. With type 2 diabetes, sugar doesn’t directly causes type 2 diabetes, you are more likely to get if you are overweight. You gain weight when you take more calories than your body actually requires. Sugary drinks contain more calories and also products which claim added sugar, certainly prove to be more detrimental, further worsening the conditionSo should I stop eating sugar completely?It doesn't mean you have to cut down sugar completely. Sugar is present in fruits and vegetables. Do include them in your diet in day to day routine. Having said that, it’s added sugar we need to cut down. Check out the insulin pump therapy. It’s not just obviously about the sweet things like cookies, chocolates, biscuits. It’s the hidden sugar like sauces, packaged products like juices, chips that needs to be avoided .How can I reduce my sugar intake?Replace intake of chocolates, cakes with a bowl of  fruitsInstead of fizzy drinks, opt for lemon water, coconut water, fruit smoothiesLimit the usage of ketchup while cooking as well as with the side dish. As an alternative, go with homemade green chutney, salsa sauceTry to avoid the usage of artificial sweetenersFor grocery shopping, read the labels thoroughly and avoid the products that contain added sugar

How to Manage Type 2 Diabetes

Ms. Swati Kapoor, Dietitian/Nutritionist
Type 2 diabetes is caused due to resistance developed by our body cells towards insulin produced by the body. This leads to a rise in blood glucose level as the cells natural tendency to absorb insulin as much reduces, preventing the body from using glucose effectively, resulting in excess sugar levels in the body. Type 1 diabetes is genetic but Type 2 diabetes is a lifestyle disease most commonly caused by obesity. The good news is that because Type 2 diabetes is not genetic and can be controlled, managed and sometimes even be reversed completely.Recent study on diabetes suggests that you could reverse your diabetes to normal. That means you could balance you blood sugar levels in the body. The study by Newcastle Magnetic Resonance Centre at Newcastle University in England says that eating less calories about 600 per day for three months could reverse the diabetes. In the study, 11 people with type 2 diabetes for four years were put on a 600 calorie diet with leafy green vegetables and liquid diet which reversed the diabetes of 7 people.We believe that you dont have to go on such a strict low calorie diet that can damage your daily nutrition intake. Read here to understand what is a  balanced diet and how it is essential for our healthy well being. Diabetes Type 2 can be controlled and managed through healthy diet and exercise without reducing the calorie intake to such low levels. A person diagnosed with Type 2 diabetes needs a special diet chart that ensures that mostly food with low glycemic index should be included. Here is a list of foods that you must include and also avoid.5 High GI Foods                                              5  Low GI FoodsPotatoes                                                            Green VegetablesRice                                                                    LentilsSweets                                                               Fruits (Citrus)Packaged Juice                                                    OatsPasta                                                                   Brown Rice

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

Female Sexual Dysfunction & Diabetes

Dr. Sharmila Majumdar, Sexologist
Causes of FSD in DiabetesVascular damage can affect blood slupply to the vagina and clitoris which can cause problems with dryness and arousal.Neuropathy can reduce sensitivityDiabetes can also lead to low oestrogen levels which can also affect the lubricationDepression can lead to FSD in a diabetic women and can affect relationships.FSD in the Diabetics Assessed in a SurveyFemale sexual response cycle is a complex non linear progression from desire to arousal and orgasm.Diabetes particularly affects arousal with decreased genital sensation and lubrication.Vaginal dryness & infections may lead to dyspareunia.Sexual functioning can be affected by Vaginitis caused by yeast infection and cystitis often result of a UTI.Predictors of sexual dysfunction in women include depression.Neither age, duration of diabetes, glycemic control nor complications in predict sexual dysfunction in women as they do in men.Low androgens and possibly estrogens may be etiologic, as may numerous medications used by patients with diabetes.Recognition of the high prevalence of FSD (up to Results show that women with type one diabetese, depression and marital status are the main predictors of FSD, whereas glycaemic control & complications were not associated with FSD.Further studies are needed to elucidate the mechanisms underlying these differences.Considering that FSD can have an important negative effect on quality of life and partner relationships, the sexual difficulties of women with diabetes warrant more attention in both research & practice.50%) & potential increase, in tandemwith that of diabetes, is needed.In. The absence of definitive treatment, psychosexual counselling, relationship & sex therapy, DHEA supplements, vaginal lubricants, Flibanserin, low doses of estrogens or androgens, and Vitamin T(touch) have been used toRelieve the personal distress of  FSD.Conclusion- FSD is more frequent in diabetic than in control women, but it is still poorly understood; low Female Sexual Function Index is associated with high BMI.Sexual functioning of women with diabetes, has received far less attention in research, and results are less conclusive than those of studies in men. Further studies are necessary to better understand the risk factors for FSD in diabetic women.

Dont' Lose Sleep Over Type 2 Diabetes

Dr. Nishant Singh, General Physician
The famed American activist and author Michael Pollan termed obesity as an epidemic.With close to 400 million people having diabetes in the world, are we not losing this battle?Closer home, it is estimated that India has 67 million diabetic patients. Add to it, another 30 million in the pre-diabetes group (blood sugar level is higher than normal, but still not as high to be classified as Type 2 Diabetes), we are staring at a dark future. If media reports are to be believed, India will overtake China and become the diabetes Capital of the world by 2030.You can still go on with your lifeA diagnosis of Type 2 Diabetes brings in a wave of panic. What to do and what not to do and what to eat and still worse, what not to eat – the list of instructions handed over by our well-wishers seem to be a long one. General Physicians are of the view that a mere diagnosis of Type 2 diabetes should not make you stop enjoying your life.However, doctors give the following set of advice for diabetic patients to lead a healthy life.Walk the pathNothing can beat the benefits of daily physical activity. The fact that you are diabetic should make you more enthusiastic about your daily dose of exercise. Incorporate simple physical activities like walking, swimming, jogging or running in your daily routine.Cut the flab outMost of the Type 2 diabetic patients are obese too. So, it assumes utmost importance that you keep a close check on your body weight. Doctors say that even losing a few kilos work wonders for your body.Savour that bar of chocolateThe old timers may say that a diabetes patient should stay away from sweets and chocolates. However, this is not true. The key is to eat in moderation which applies to non-diabetic patients as well. A diabetic patient should concentrate more on eating healthy and nutritious food.Here are few things a Type 2 Diabetes patient should keep in mind regarding healthy eating:Evenly space your meals in a dayNever ever skip your breakfast (Foregoing breakfast can increase blood glucose levels)Have more of whole grains, fruits and non-fat dairy foodsDon’t overeat.Do pop-in those pillsIf you are diabetic, never neglect your medication, irrespective of whether they are insulin injections or oral medications. And remember, medicines will have to be supported by your lifestyle changes too, like adequate exercise and healthy eating habits.Observe itDoctors advise diabetic patients to monitor their blood glucose level at regular intervals. When to do it and how frequently should it be done depends on your previous blood glucose readings and your general health. Usually, the blood glucose levels are checked before you have a meal or a couple of hours after you have had a full meal.Do check with your physician as to how frequently your blood glucose readings have to be taken and do follow it without fail. In case, you see abnormal readings, do not hesitate to seek professional help.Kick the buttSmoking increases blood sugar levels and leads to insulin resistance, things a diabetic patient should be wary of. Doctors say that individuals who gave up smoking have been found to have increased insulin sensitivity.Do you smoke? If so, cut down on your smoking and still better, give it up.My diabetes is such a central part of my life. It did teach me discipline, it also taught me about moderation. I’ve trained myself to be super vigilant, because I feel better when I am in control – Sonia Sotomayor, Associate Justice of the Supreme Court of the United States of America.Take control of your life and in turn, stop diabetes in its track. 

Home Remedies To Stop Type 2 Diabetes

Dr. Nikhil Prabhu, Diabetologist
Approximately 95% people suffer from type 2 diabetes, which is primarily obesity & lifestyle related diabetes and can be prevented by diet modification & exercise. We normally diagnose diabetes when fasting blood sugar is more than 125 mg/dl, which is primarily affected by hours of fasting and quantity & quality of carbohydrate meal consumed at dinner last night. Also, 2 hours post prandial blood sugar depends on what we consume at breakfast or lunch. More than 200 mg/dl is diagnosed as diabetes. Majority of obese people, who are in the range of fasting sugars 100-125 mg/dl and/or post lunch sugars in range of 140-200 mg/dl, are about to develop diabetes in succeeding years are termed as Prediabetic. Diabetes can be reversed at Prediabetes stage with lifestyle modification (diet & exercise).Home remedies can help you a lot to control blood sugars at Prediabetes stage to prevent its progress to Diabetes.Now, we have a more reliable test called HbA1c ( Glycated Hemoglobin), which shows an average of blood sugars over last 3 preceding months which is not affected by hours of fasting and quality of food consumed. Normal person has a HbA1c value of 5.7% or less. Prediabetic person ranges between 5.7 -6.4 % of HbA1c , 6.5 % & above is diagnosed as Diabetes.(HbA1c value is also affected by certain rare conditions like blood loss, hemoglobinopathies, adminstration of certain drugs like aspirin, Vitamin C, etc.)Type 2 Diabetes is a progressive disease. When diabetes develops approximately 60% of pancreatic beta cells are dead and eventually over the time beta cells keep on diminishing and finally a stage arrives when exogenous insulin is necessary to control blood sugar.Natural home remedies are fruits and vegetables which helps to lower sugar by reducing carbohydrate absorption from gut, delaying gastric emptying or preserving and promoting beta cell function.In prediabetic stage these home remedies can help a lot to prevent its progress to diabetes. Also, in case of already developed diabetes these home remedies along with medication, can help to keep sugar under control. In diagnosed diabetes patients it is not an alternative to medication but adjunct to medication.Commonly used Natural home remedies includes :Fenugreek (Methi): Methi seeds can be soaked in water overnight and can be consumed in morning along with water or powdered methi seeds can be consumed along with milk or water. Normally two tablespoon is an appropriate quantity.Bitter gourd (Karela): Drinking karela juice daily on an empty stomach helps to lower sugarCinnamon (Dalacini): Adding dalacini to beverages and food helps to lower blood sugar to some extent.Indian Goosebery (Amla): Amla is a rich source of Vitamin C. Drinking small quantity of amla juice daily helps to lower sugars.Black Plum (Jamun): Powdered dried seeds of Jambul can be consumed along with water on empty stomach daily or jambul fruits can be consumed directly.Other Natural home remedies includes consumption of guava, powder of mango leaves with water, black coffee without sugar, green tea, okra, aloe vera, cloves, peas etcAll these home remedies are effective only if they are consumed daily for atleast 2-3 months. In known diabetes patients already on insulin or certain medication, occasional or sudden use may induce Hypoglycemia. In such a case, it is advisable to consult your diabetologist before starting such home remedies.Other Home remedies includes:Lifestyle modification with diet & exercise.Daily high quality sleep to minimize stress.Avoid smoking & tobacco.Avoid excessive consumption of alcohol.Staying lean with healthy diet & regular exercise is key to prevent diabetes.If you like this article , Please share it with your friends & family.Awareness is Prevention!

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.