What is Diabetes?
Diabetes mellitus is a metabolic disorder in which the body's capacity to utilize glucose, fat and protein is disturbed due to insulin deficiency and/or insulin resistance.
In people with diabetes there is insufficient insulin activity in the body. Insulin is a hormone produced by beta cells of islets of Langerhans in the pancreas.
Action of Insulin on the food
Most of the food we eat is broken down into glucose and other simple sugars. Glucose gets absorbed into the blood stream which enters into the cells and is used for energy. As the blood glucose rises, insulin is released from the pancreas. Cells have receptor sites on the outside. When insulin attaches to the receptor sites, a passage is made and glucose enters into the cell. This insulin regulates the blood glucose level.
When there is insulin deficiency, glucose cannot enter into the cells and remain in the blood which leads to high blood sugar levels.
Normal Blood Glucose Levels
Fasting 80 – 120 mg/dl
Post Prandial 120 – 160 mg/dl
Insulin deficiency may be relative or absolute and may be due to
Symptoms of Diabetes
Risk Factors for Diabetes
Big baby (over 3.5 kg at birth)
Classification of Diabetes
Diabetes refers to a condition in which there is elevated blood sugar. It is a chronic disorder of metabolism where the body is not able to effectively utilize the blood sugar. Diabetes can be classified as follows:
There are other rare conditions of diabetes associated with genetic syndromes. Drugs and toxic metabolites can also induce secondary diabetes. The other specific types of diabetes are:
Type 1 Diabetes (IDDM)
This type of diabetes results from complete destruction of beta cells of the pancreas due to auto immunity which results in the absence of insulin secretion. Such patients need insulin treatment for their survival. On withdrawal of insulin, they end up with high blood sugar finally resulting in diabetic ketoacidosis.
Type 1 diabetes is generally found in young children, adolescents and adults under the age of 40 years. The onset of symptoms is usually sudden, and the major symptoms observed are:
In some cases, patients present with keto-acidosis or coma especially during recurrent illness or surgery.
Genetic factors, autoimmune and environmental factors play a role in the causation of this kind of diabetes.
Type 2 Diabetes ( NIDDM)
This type is very common and is widely known as Non- insulin Dependant Diabetes. It develops in later stages of life. Often patients are overweight, (some may be lean due to loss of weight because of uncontrolled diabetes) and have family history of diabetes. They may respond to diet, exercise and oral hypoglycemic drugs. Their symptoms develop gradually and many have insulin resistance.
Differences between Type 1 and Type 2 Diabetes
Gestational Diabetes (GDM)
GDM is a condition where the diabetes sets in during pregnancy. The assessment for GDM should be undertaken at the first prenatal visit. Women with obesity, previous history of GDM, glycosuria or family history of delivering big babies should undergo a spot random glucose screening. If they are found to have elevated blood sugars during the initial screening, they should undergo a glucose tolerance test. If they are normal, they can be retested between 24 and 28 weeks of their gestation.
Patients can be treated with diet control in mild cases and insulin may be needed if the sugars are high. Oral hypoglycemic drugs are contraindicated during pregnancy 5 % of patients may continue to have diabetes after delivery.
Impaired Glucose Tolerance (IGT)
The term IGT refers to a metabolic stage intermediary between normal glucose tolerance and diabetes. IGT is more frequent in obese than in non-obese persons. They may be associated with an increased frequency of hypertension, hyperlipidemia, obesity and fasting hyprinsulinemia. About 3-5 % of the patients with IGT progress to diabetes every year. Those with IGT are advised to be on diet control, exercise and adopt life style changes to prevent diabetes.
Fibrocalculous Pancreatic Diabetes (FCPD)
This is an unique secondary type of diabetes occurring due to pancreatic stones. The whole pancreatic gland is shrunken due to pancreatitis and hence the insulin producing cells are damaged, resulting in diabetes. These patients are usually very lean, malnourished and may present with severe abdominal pain prior to developing diabetes. They usually require insulin to control their diabetes.
Who is to be tested?
Exercise and Diabetes
What exercise dose for the heart?
Smart and safe exercise
How often, How much and How long
Try to do exercise every day, minimum of 5 days a week.
Intensity ….. moderate intensity.
Time should last for at least 30 minutes going up to one hour if possible. There should be a warm up and cool down period of exercise for each session.
Prepares body for vigorous activity; helps Prevent strains and injuries to muscles. It should last for 5-10 minutes.
Helps restore circulation to normal levels, prevents cramps, sore muscles and post – exercise dizziness. This should last for 5 to 10 minutes.
Choose Your Exercise
Walking, running, cycling, swimming, playing team games, dancing, jogging, brisk walking, tennis choose whatever suits your personality, but stick to it.
Risks and Precautions
Tips for increasing exercise in daily life
When should you stop exercise
Remember the Principle "Pain – No Gain"
Energy Need for Different Activities
Holidays and Travel
Having diabetes does not mean you have to restrict your holiday or travel plans. As with everything else, a little pre-planning makes things easier. Here is some basic information you need to know.
Car travel usually means (traffic jams permitting) you can stop when you like, but do make sure you have some food available in the car. Start your day early so that you can arrive at your destination early. Always have some form of sugar in the car with you because hypoglycemia is particularly dangerous when you are driving. Choose something that won't melt and mess up the upholstery in your car.
Train travel means you may be subject to delay. Again, carry food and drinks with you. Bread, biscuits (sugar free biscuits are now available) and fruits would stay longer and hence can be had during travel.
Most airlines provide food very frequently, but do carry extra in case of delays. Since you will not be doing much exercise and will probably be more stressed than usual, you could be slightly sugary for few days. This will do you no harm and at least you can be fairly confident that you will not become hypoglycemic particularly on long journeys. It is wise to request the cabin staff to provide some food if you feel meals are getting usually delayed.
If you are on a package tour, please note that the travel insurance is likely to exclude "pre-existing conditions" which means, diabetes in your case. For customs purposes, particularly in exotic places, a letter from your clinic explaining why you are carrying syringes and needles is also a good idea. Please note that some of the pen injectors show up on the metal detector at airports. You are likely to have to take it out and explain that it is not a weapon.
Prevention of Diabetes
The prevalence of Diabetes Mellitus in the Indian population now ranks first in the world even ahead of China. In the last twenty years there has been a three fold increase in the prevalence of diabetes and today it is estimated that there are over 20 million people with diabetes in India.
The problem in diabetes is that very often it is silent. The symptoms of diabetes such as increased thirst and urination, etc., occur only when the diabetes is severe. In early stages it can remain totally asymptomatic. Moreover after 10-15 years duration of diabetes, the prevalence of all diabetes related complications increase markedly. These include Retinopathy leading to blindness, Nephropathy leading to kidney failure, Heart attacks, Gangrene of the feet, Stroke and even less known complications like Impotency, and sexual weakness. Thus diabetes is a serious threat to public health and this shows the need for prevention of diabetes.
Primary prevention refers to the prevention or the postponement of diabetes itself in those who are susceptible to diabetes. Early detection is the key to prevent and control diabetes. As diabetes is largely asymptomatic, regular screening for diabetes is most important.
Why should you be screened for Diabetes?
Positive Family History
It is a well known fact that diabetes is caused mostly due to hereditary factors. Hence it is clear that screening of diabetic families would be the first priority.
Risk of diabetes based on family history: Risk
If both parents are diabetic 99%
If one parent is diabetic 50%
If any other relative is diabetic 20%
One parent diabetic and any other relative
of the non-diabetic parent is also diabetic 75%
Hence it is clear that anyone who has positive family history should be screened for diabetes.
At what age the screening should be started?
The onset of diabetes is earlier in Indians i.e., around 20-30 years of age. If the family history is strong, e.g., members of more than two generations in the family have diabetes, the first screening could be done even by 20-25 years of age and thereafter on a yearly or two yearly basis.
Obesity causes resistance to Insulin. Your body makes insulin but the extra weight prevents it form using the insulin the way it should be. For this reason, obesity is another risk factor for diabetes.
What test to be done?
The Glucose Tolerance Test (GTT) is the confirmatory test since it helps to diagnose even the early stage of diabetes. Most people check only Fasting, Postprandial or Random Blood Sugar which may not reveal diabetes until it is at a more advanced stage. Even if the GTT results show normal values at the time of testing, it does not mean that the person will never develop diabetes. Such individuals should have an annual GTT done if the family history of diabetes is very strong.
Secondary Prevention refers to the prevention of complications once diabetes set in. This can be achieved by good control of diabetes with the help of diet, exercise, medication and regular monitoring of blood sugars. Blood sugars can be checked even on daily basis with help of blood sugar meters which facilitates quick determination of blood sugars. Since blood sugars tend to fluctuate a lot, from day to day or hour to hour, HbA1C (Glycosylated haemoglobin) test should be done to assess the blood sugar for the previous 2-3 months.
Tertiary prevention refers to the rehabilitative measures once the complications have set in. For example, for Diabetic Retinopathy, the technique of Laser Photocoagulation will help to prevent or reduce the incidence of blindness. Laser photocoagulation helps to seal leaking blood vessels in the retina and thus prevent visual loss.
It is recommended that at least once a year every diabetic individual should do a complete checkup of all complications especially the eyes, kidneys, heart and feet in order to reduce the morbidity due to diabetes.
LEVELS OF PREVENTION IN DIABETES
Symptoms of Diabetes
In both types of diabetes, signs and symptoms are more likely to be similar as the blood sugar is high, either due to less or no production of insulin, or insulin resistance. In any case, if there is inadequate glucose in the cells, it is identifiable through certain signs and symptoms. These symptoms are quickly relieved once the Diabetes is treated and also reduce the chances of developing serious health problems.
Diabetes Type 1
In type 1, the pancreas stop producing insulin due to autuimmune response or possibly viral attack on pancreas. In absence of insulin, body cells don't get the required glucose for producing ATP (Adenosin Triphosphate) units which results into primary symptom in the form of nausea and vomiting. In later stage, which leads to ketoacidosis, the body starts breaking down the muscle tissue and fat for producing energy hence, causing fast weight loss. Dehydration is also usually observed due to electrolyte disturbance. In advanced stages, coma and death is witnessed.
Diabetes Type 2
Types of diabetes
There are three main types of diabetes:
Type 1 diabetes
Is sometimes called insulin-dependent, immune-mediated or juvenile-onset diabetes. It is caused by an auto-immune reaction where the body's defence system attacks the insulin-producing cells. The reason why this occurs is not fully understood. People with type 1 diabetes produce very little or no insulin. The disease can affect people of any age, but usually occurs in children or young adults. People with this form of diabetes need injections of insulin every day in order to control the levels of glucose in their blood. If people with type 1 diabetes do not have access to insulin, they will die.
Type 2 diabetes
Is sometimes called non-insulin dependent diabetes or adult-onset diabetes, and accounts for at least 90% of all cases of diabetes. It is characterised by insulin resistance and relative insulin deficiency, either of which may be present at the time that diabetes becomes clinically manifest. The diagnosis of type 2 diabetes usually occurs after the age of 40 but can occur earlier, especially in populations with high diabetes prevalence. Type 2 diabetes can remain undetected for many years and the diagnosis is often made from associated complications or incidentally through an abnormal blood or urine glucose test. It is often, but not always, associated with obesity, which itself can cause insulin resistance and lead to elevated blood glucose levels.
Gestational diabetes (GDM)
Is a form of diabetes consisting of high blood glucose levels during pregnancy. It develops in one in 25 pregnancies worldwide and is associated with complications in the period immediately before and after birth. GDM usually disappears after pregnancy but women with GDM and their offspring are at an increased risk of developing type 2 diabetes later in life. Approximately half of women with a history of GDM go on to develop type 2 diabetes within five to ten years after delivery.
Tests related to Diabetes
The main diagnostic test for diabetes is taking a blood test to measure glucose, either when you have been fasting or at other times of the day. Diagnostic tests are also used routinely done during pregnancy to identify gestational diabetes.
High blood sugar levels harm the body
The hormone insulin helps to move blood sugars (glucose) into cells and convert glucose into energy. Diabetes is a condition characterized by abnormally high levels of glucose in the blood. This occurs because, either not enough insulin is made, or the cells don't respond to the hormone.
Accuracy of test results
Depending on the test used, the level of blood glucose can be affected by many factors including:
Most diabetes tests require blood samples. Generally, a band is tightened around your upper arm to slow blood flow and cause the veins below the band to stand out. The intended needle site is swabbed with alcohol. The hypodermic needle is inserted into the vein and the blood is directed into a collection tube. The band may be removed from your arm while the blood is being taken.
Types of tests
Tests to diagnose diabetes include:
The most common test for diagnosis of diabetes is the fasting blood glucose test. Glucose tolerance tests are used when the results of the fasting blood glucose are borderline. They are also used to diagnose diabetes in pregnancy (gestational diabetes).
Immediately after the procedure
The fasting blood glucose test will confirm that the person has diabetes if it shows that the level of glucose in their blood is higher than normal when they are fasting.
Possible complications of diabetes testing include:
What is Juvenile Diabetes?
Diabetes is a chronic metabolic condition caused by the body's inability to break down glucose (sugars) and store them properly. When an individual's system is unable to efficiently process glucose, it will back up in the person's bloodstream creating multiple health problems.
What are the symptoms?
Type 2 Diabetes symptoms include:
Without adequate medical treatment and supervision, serious health problems can arise. Long term complications include heart attacks, blindness, nerve damage that can ultimately cause loss of limbs, and kidney failure. It is crucial to follow your physician's treatment plan to avoid serious side effects.
Diabetes and Pregnancy
The prevalence of Type-2 diabetes mellitus is higher in women, partly related to obesity. The Type-2 diabetes typically doubles the coronary heart disease risk in men and triples in women.
Indications for detection of diabetes in pregnant women
To prevent excess spontaneous abortion and congenital malformations in infants of diabetic mothers, diabetes care and education must begin before conception. There are no contraceptive methods that are specifically contraindicated in women with diabetes. The selection of a method should focus on its proven high degrees of effectiveness. Once patient achieves stable sugar control then contraception can be discounted and hence, plan for a pregnancy.
Management during pregnancy
What Is Prediabetes?
People with prediabetes have glucose levels that are higher than normal but not high enough yet to indicate diabetes. The condition used to be called borderline diabetes. Most people with pre diabetes don't have symptoms, but they are considered to be at high risk of developing heart disease.
Normally, your body produces a hormone called insulin to help your cells use the energy (glucose) found in food. With diabetes, either your body doesn't make enough insulin or doesn't efficiently use the insulin it does produce. When glucose builds up in the blood, it can damage the tiny blood vessels in the kidneys, heart, eyes, and nervous system.
With prediabetes, the subtle balance between glucose and insulin has been thrown off. The pancreas may not be able to produce enough insulin after a meal to "clear" the incoming glucose from the blood. Or cells may be insulin resistant. When cells are insulin resistant, they won't allow the insulin to escort glucose from the bloodstream into them. Too much glucose in the blood is also called high blood sugar or hyperglycemia. A low blood sugar level is called hypoglycemia.
If you have pre diabetes, you're at high risk of developing type 2 diabetes as well as the serious medical problems associated with diabetes, including heart disease and stroke. With prediabetes, you are at a 50% higher risk of heart disease and stroke than someone who does not have prediabetes.
How is prediabetes diagnosed?
To determine if you have prediabetes, your doctor can perform one of three different blood tests – the fasting plasma glucose (FPG) test, the oral glucose tolerance test (OGTT) or the Hemoglobin A1C (or average blood sugar) test.
How is the fasting plasma glucose test (FPG) done?
The fasting plasma glucose test can be done after an overnight fast or after an eight-hour fast during the day. It is a relatively easy, inexpensive test. After the fast, a simple blood test measures glucose levels before you eat again. The test results indicate whether your blood glucose level is normal or whether you have prediabetes or diabetes:
In most cases, your doctor will repeat any abnormal test before confirming the diagnosis.
How is the oral glucose tolerance test (OGTT) done?
The OGTT usually requires that you have the fasting glucose test first. Then you take a dose of high-sugar (glucose) solution to challenge your body to clear the glucose from your blood. After two hours, another blood glucose test is done. The final test results indicate whether you have a normal level of blood glucose or may have prediabetes or diabetes:
Once we have crossed the reversible stage of pre diabetes and enter diabetes stage, certain changes start developing in our body. These changes occur due to high blood sugar level with instability in the hormones as well as blood vessels and nerves. When these changes become permanent in the body it develops into serious Diabetes Complications and body indicates these changes by steady symptoms.
Symptoms of the Diabetes Complications
When alarming symptoms given by the body are ignored and the same status is maintained, it starts damaging body organs, such as heart, kidney, eye, feet, and skin. The physiology for each and every affected organ is explained one by one.
Diabetes Diet and Food Tips
What is Dietetic?
Diabetes is on the rise, yet most cases are preventable with healthy lifestyle changes. Some can even be reversed. Taking steps to prevent and control diabetes doesn't mean living in deprivation. While eating right is important, you don't have to give up sweets entirely or resign yourself to a lifetime of bland "health food". With these tips, you can still enjoy your favorite foods and take pleasure from your meals without feeling hungry or deprived.
Diabetes and Fitness
Life Style Management
Lifestyle clinic is a regular exercise area for the members. The package includes fitness testing, fitness counseling, diet counseling, posture correction, stretching, aerobics, circuit, strength training exercises on one month membership subscription. We schedule exercises based on the measurements of fitness testing, set goal and give personalized training to reach the specified goal. At the end of each month, fitness testing is done again and exercises are re-scheduled accordingly by increasing intensity or changing the pattern to reach the goal more effectively.
At DMDSC, we counsel the patient coming for fitness consultation and explain them the importance of exercise and the effects of exercise on reducing hba1c level. By giving tips, we motivate them to do regular exercise. We teach basic exercise for new patient and incase of any complication we will customize the exercise according to their condition. We issue pamphlet in 4 languages for the basic exercise taught to the new patients. We do phone follow-up after 1 month of fitness consultation to check whether they are doing exercises regularly, if they have any doubt we clear it through phone or we tell them to come for review. Exercise schedule card is given to follow them and exercise DVD & Books also available in this Portal and our pharmacy. Exercises are reviewed during next visit by increasing the intensity and scheduling strength training exercises.
Obesity and Weight Management
In obesity clinic, we customize, schedule and teach exercise to the patient based on the body composition test done. The exercises taught are mentioned in a schedule card and given to client to work out in home and advised to come for review after a month. Later we do phone follow-up to check whether they are exercising regularly. When they come in for review, measurements are taken to see results of regular exercises and the new exercises are scheduled accordingly.