World Health Day 2016 : Beat diabetes

Dr Chakshu *

According to International Diabetes Federation's diabetes atlas, seventh edition 2015, approximately 415 million adults have diabetes; by 2040 this will rise to 642 million. The greatest number of people with diabetes are between 40 and 59 years of age. 1 in 2 (46%) people with diabetes are undiagnosed. Diabetes caused 5 million deaths in 2015; every six seconds a person dies from diabetes.

What is diabetes ?

Diabetes, often referred to by doctors as diabetes mellitus (DM), refers to a group of metabolic disorders or diseases that disrupt the normal process of converting food to energy and it causes hyperglycemia or high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Insulin is made in the pancreas, an organ located behind the stomach.

Insulin is a hormone that helps your body to control the level of glucose (sugar) in your blood. Without insulin, glucose builds up in your blood instead of being used for energy. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).

There are three types of diabetes.

Type 1 diabetes: The body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes. People usually develop type 1 diabetes before their 40th year, often in early adulthood or teenage years. Approximately 10% of all diabetes cases are type 1. Type 1 diabetes is caused by a lack of insulin due to the destruction of insulin-producing beta cells.

In type 1 diabetes — an autoimmune disease — the body's immune system attacks and destroys the beta cells. Patients with type 1 diabetes will need to take insulin injections for the rest of their life to keep blood sugar levels under control. As with other forms of diabetes, nutrition and physical activity and exercise are important elements of the lifestyle management of the disease.

Type 2 diabetes: The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance). Approximately 90% of all cases of diabetes worldwide are type 2. Some people may be able to control their type 2 diabetes symptoms by losing weight, following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels. However, type 2 diabetes is typically a progressive disease – it gradually gets worse – and the patients will probably have to take insulin, usually in tablet form.

Gestational diabetes: This type affects females during pregnancy. Some women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all of the glucose into their cells, resulting in progressively rising levels of glucose. Diagnosis of gestational diabetes is made during pregnancy.

How to diagnose diabetes? Whether a person is suffering with diabetes or not can be ruled out through a urine test, which finds out whether excess glucose is present. This is normally backed up by blood tests commonly known as Random Blood Sugar (RBS), Fasting Blood Sugar (FBS) and two hours post meal or Postprandial (PP) blood sugar. The person will be considered to be a diabetic patient if he or she has symptoms of diabetes and RBS is equal to or greater than 200 mg/dl or FBS is equal to or greater than 126 mg/dl or PP is equal to or greater than 200 mg/dl.

A complete diabetes check includes the following tests like fasting blood sugar, postprandial blood sugar, HbA1c or glycated haemoglobin to check the control of blood sugar levels, lipid profile to check cholesterol level, kidney function test, urine for microalbuminuria to detect early signs of kidney damage in people who are at risk of developing kidney disease, HBsAg to rule out hepatitis B infection, ultrasound examination of the abdomen, ECG, Chest X-ray, complete physical examination and consultation with a physician. Based on the findings your physician will refer you to other healthcare professionals like eye specialist, nephrologist as and when required.

Risk factors for diabetes:

The risk factors for type 1 diabetes are still being researched. However, having a family member with type 1 diabetes slightly increases the risk of developing the disease. Environmental factors and exposure to some viral infections have also been linked to the risk of developing type 1 diabetes.

Risk factors for developing type 2 DM include high cholesterol levels, high BP, high fat diet, high alcohol consumption, sedentary lifestyle, overweight, giving birth to a baby weighing 9 pounds and above. The risk of developing type 2 diabetes is also greater as we get older. Experts are not completely sure why, but say that as we age we tend to put on weight and become less physically active.

Men whose testosterone (a powerful hormone, with the ability to control sex drive, regulate sperm production, promote muscle mass, increase energy, and even influence human behaviour) levels are low have been found to have a higher risk of developing type 2 diabetes. Researchers from the University of Edinburgh, Scotland, say that low testosterone levels are linked to insulin resistance.

Risk factors for gestational diabetes include excess weight. You are more likely to develop gestational diabetes if you are significantly overweight with a body mass index (BMI) of 30 or higher. The risk also increases if you have pre diabetes or if a close family member has type 2 diabetes. For reasons that are not clear, women who are black, Hispanic or American citizens who are descendants of the peoples of the Spanish speaking countries of Latin America, American Indian and Asian are more likely to develop gestational diabetes. Scientists from the National Institutes of Health and Harvard University found that women whose diets before becoming pregnant were high in animal fat and cholesterol had a higher risk for gestational diabetes, compared to their counterparts whose diets were low in cholesterol and animal fats.

Symptoms of DM:

It is possible to have diabetes with only very mild symptoms or without developing any symptoms at all. Such cases can leave some people with diabetes unaware of the condition and undiagnosed. This happens in around half of people with type 2 diabetes.

A condition known as pre-diabetes that often leads to type 2 diabetes also produces no symptoms. Pre-diabetes refers to blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes.

Type 1 diabetes can go unnoticed but is less likely to do so. Symptoms of type 1 diabetes are often dramatic and come on very suddenly in childhood often in association with some illness like nausea, vomiting, stomach pains, viral infection or urinary tract infections. The most common signs and symptoms of diabetes are frequent urination, disproportionate thirst, intense hunger, weight gain, unusual weight loss, increased fatigue, irritability due to lack of energy, blurred vision, cuts and bruises don't heal properly, more skin infections, itchy skin, frequent gum disease/infection, sexual dysfunction among men, numbness or tingling especially in hands and feet. Women may experience genital itching.

Complications of DM

DM ultimately leads to hyperglycemia or high blood sugar level. Over a long period of time, it may lead to the following complications.

Short term complications – Hypoglycemia or low blood sugar occurs from time to time in most people with diabetes who are on treatment. It may result from over treatment, missing a meal, doing excessive exertion, any acute illness. Common symptoms are headache, dizziness, poor concentration, tremors of hands and sweating.

Diabetic ketoacidosis is a serious acute complication in which uncontrolled hyperglycemia causes build up of waste products called ketones in blood which can cause nausea, vomiting, altered mental state or even weakness of whole body. It is precipitated by infection, stress, trauma, and other medical emergencies like stroke or heart attack. Hyperosmolar hypergly-cemic non ketosis syndrome is also an acute complication associated with very high level of blood glucose with severe dehydration which may lead to seizures, coma and eventually death.

Long term complications – Diabetic neuropathy (nerve damage): Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves. This can lead to facial paralysis, tingling, numbness, burning or pain (increased at night) that usually begins at the tips of the toes or fingers and gradually spreads upward, difficulty while getting up from sitting position, calf muscle weakness, paralysis of bladder leading to urinary tract infections, erectile dysfunction, light headedness or syncope or passing out when suddenly standing up or stretching, diabetic foot (wounded foot ulcer) which is the leading cause of foot and leg amputation.

Cardiovascular disease (conditions caused by narrowed or blocked blood vessels): affects the heart and blood vessels and may cause fatal complications such as coronary artery disease (leading to heart attack) and stroke. Cardiovascular disease is the most common cause of death in people with diabetes.

Infections: Diabetes increases susceptibility to various types of infections. The most common sites of infection in diabetic patients are the ear, nose and throat infections, urinary tract infections, skin and soft tissue infections and hepatitis-B. Gastrointestinal tract complications: Since diabetes mellitus affects every organic system, it affects gastrointestinal tract as well.

Oral candidiasis (fungal infection of the mouth), oral or mouth ulcer, dysphagia (difficulty or discomfort in swallowing), heartburn or awful burning sensation in your chest or throat due to acid reflux from stomach, gastroparesis or delayed gastric emptying (a disorder that occurs when the stomach takes too long to empty food), nausea, abdominal pain on and off, cholecystitis (inflammation of the gall bladder), anorectal dysfunction also known as pelvic floor dysfunction (a disorder causing abnormalities of bowel storage and bowel emptying, as well as pelvic pain) are some of the gastrointestinal tract complications due to long standing DM. Eye complications: DM over a long period of time damages the retina of the eye (diabetic retinopathy), which is the leading cause of blindness.

Other complications include glaucoma (a condition of increased pressure within the eyeball, causing gradual loss of sight), stye (small, painful lump on the inside or outside of the eyelid), dry eyes and refractive errors.

Diabetic nephropathy (diabetic kidney disease): is a complication of type 1 or type 2 diabetes caused by damage to the kidneys' delicate filtering system. In severe cases it can lead to kidney failure. Sexual dysfunction is also more common in diabetes patients. Undiagnosed or uncontrolled gestational diabetes can raise the risk of complications during childbirth. The baby may be bigger than he/she should be.

How to prevent diabetes? Changing your lifestyle could be a big step toward diabetes prevention — and it's never too late to start. Making a few simple changes in your lifestyle now may help you avoid the serious health complications of diabetes down the road, such as nerve, kidney and heart damage. There is no proper way to prevent type 1 DM.

When it comes to type 2 diabetes — the most common type of diabetes — prevention is a big deal. It's especially important to make diabetes prevention a priority if you're at increased risk of diabetes, for example, if you're overweight or have a family history of the disease.

Type 2 DM can be prevented by controlling weight, regular daily exercise for 30 minutes, quitting smoking and alcohol, decreased oil consumption and following a balanced and nutritious diet.

Treatment for diabetes: Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease. Type 1 diabetes is managed with insulin as well as dietary changes and exercise. Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes. The majority of gestational diabetes patients can control their diabetes with exercise and diet. Between 10% to 20% of them will need to take some kind of blood-glucose-controlling medications.

Diabetes is a serious disease that you cannot treat on your own. Your doctor will help you make a diabetes treatment plan that is right for you — and that you can understand. You may also need other health care professionals on your diabetes treatment team, including a foot doctor, nutritionist, eye doctor, nephrologist, gastroenterologist, neurologist, urologist, dermatologist, physiotherapist and ENT specialist etc.

Treatment for diabetes requires keeping close watch over your blood sugar levels (and keeping them at a goal set by your doctor) with a combination of medications, exercise, and diet. By paying close attention to what and when you eat, you can minimize or avoid the "seesaw effect" of rapidly changing blood sugar levels, which can require quick changes in medication dosages, especially insulin. If a patient has complications of diabetes, it should be dealt accordingly.

The skin should be taken care to avoid sores and cracks that can become infected. See a dentist regularly to prevent gum diseases. The feet should be washed and examined daily looking for small cuts, sores or blisters that may cause problems later. If you or someone you know already has diabetes, your focus should be on preventing the complications. Don't forget to monitor blood sugar regularly and most importantly regular follow up with your physician.