1. What is diabetes?
Diabetes is a chronic disease characterized by raised blood sugar levels which leads to damage of the body's systems, especially the nerves and blood vessels. There are two main types of diabetes, namely type 1 diabetes and type 2 diabetes. Type 1 diabetes (previously known as insulin-dependent diabetes or childhood-onset diabetes) usually has a sudden onset in children, adolescents or young adults and is characterized by deficient production of insulin by the pancreas. Insulin therapy is essential for the survival of the patient suffering from type 1 diabetes.
Type 2 diabetes (formerly called non-insulin-dependent diabetes or adult-onset diabetes) results from the body's inability to effectively use the insulin. As a result, glucose cannot be used by the body's cells as a source of energy and consequently the levels of glucose in blood continue to rise. Type 2 diabetes generally occurs among people aged 40 years or more. It is treated with diet, exercise and oral medication. Insulin therapy is given only if blood sugar levels are too high and not controlled by oral medication.
2. What are the risk factors for diabetes and actions to be taken to reduce the chance of getting diabetes?
People with a strong family history of either type of diabetes (i.e. history of diabetes in a parent or sibling) are at increased risk of developing diabetes. People who are overweight or obese and physically inactive are at risk of developing Type 2 diabetes. Women who develop diabetes during pregnancy (gestational diabetes) are at greater risk of type 2 diabetes later in life.
The risk factors for diabetes include the following:
• obesity or overweight
• physical inactivity
• family history of diabetes in a parent, brother or sister
• having a disease of heart or blood vessels
• high blood pressure
• high density lipoprotein (HDL - good cholesterol) level below 35 mg/dL or a triglyceride level above 250 mg/dL in blood
• history of having given birth to a child weighing more than nine pounds (about 4.1 kg) or diagnosed with gestational diabetes le chances of developing diabetes can be reduced by a high-risk individual through diet modification, exercise, weight reduction and stress management.
3. When should diabetes be suspected for seeking medical attention and what are the self care measures to be undertaken by diabetes patients?
It should be remembered that many patients with diabetes, particularly type 2 diabetes may not have any symptoms till the disease is well advanced. The common symptoms in diabetes are increased frequency of urination, increased thirst, extreme hunger, unusual weight loss, increased fatigue, irritability, giddiness, blurry vision, tingling or numbness in the hands and feet, frequent skin, gum or urinary infections, wounds that do not heal and itching in genital areas. If one experiences any of these symptoms, blood sugar should be checked as soon as possible.
Even if symptoms are not present, overweight and obese adults should get their blood sugar tested for diabetes if they have one or more of the risk factors mentioned above. Those individuals without any risk factor should also get tested for diabetes, starting from the age of 45 years. If results are normal, the testing should be repeated at least once in three years.
Long standing and untreated diabetes can damage the heart, blood vessels, eyes, kidneys and nerves. The most common causes of death in diabetic patients are cardiovascular disease - heart attacks and strokes - and kidney failure.
Damage to nerves (diabetic neuropathy) along with reduced blood flow to the foot may result in development of ulcers and eventually even in amputation of the limb. Long-term damage to the blood vessels of retina of eyes (diabetic retinopathy) is an important cause of blindness.
Diabetes patients should take the following action to keep their blood sugar at normal levels and thus prevent complications. A diet with low amounts of sugar and fats but with plenty of vegetables is appropriate for diabetes patients, even though there is no need for total avoidance of sugar.
Food with high sugar content such as honey, jellies, candy, syrup and soft drinks, fruits like mango and grapes should be avoided. Sugar intake may be reduced by alternative use of sweeteners such as saccharin, aspartame, acesulfame potassium and sucralose available in the market. With proper diet planning, a diabetes patient can still enjoy a wide variety of their favourite foods.
Diabetes patients should do regular daily exercise to keep themselves FIT: i.e. frequency, intensity and timing.
• Frequency - exercise at least 5 times a week
Intensity - exercise enough to burn sufficient calories
• Timing - exercise for minimum 45 minutes to 1 hour walking
Patients can get their blood sugar test done at a laboratory or even at home using test strips or a blood glucose meter. Not only is testing important, but a chart of the sugar levels should be kept, which will be useful to the doctor to adjust the medication.
Patients taking insulin injections should never skip meals as this can lead to dangerously low levels of blood sugar (hypoglycaemia) which can be life threatening. The symptoms of hypoglycemia include drowsiness, headache,
slurred speech, confusion, excessive sweating, hunger and pounding of the heart. Attacks of hypoglycemia should be promptly recognized and treated by taking sugar mixed in fluids such as tea, coffee or even water.
If the patient does not respond, he/she should be taken immediately to a doctor for administering glucose through a vein. Diabetes patients should always carry a card which gives details of their disease and treatment so that hypoglycaemia can be easily recognized and treated.
4. How is diabetes diagnosed and treated in the health system?
Diabetes is ideally diagnosed by the oral glucose tolerance test. The test is usually performed in the morning after a minimum 8 hours of overnight fasting. The individual drinks a glass of water in which 75 grams of glucose has been dissolved.
A blood sugar level of 200 mg/dL or above in the sample taken after two hours indicates that the person has diabetes. If the blood glucose level is between 140 and 199 mg/dL, it indicates a pre-diabetic condition called impaired glucose tolerance (IGT).
A fasting plasma glucose (FPG) test alone will miss some cases of diabetes or IGT; fasting level of between 70 and 100 mg/dl is normal; between 100 to 125 milligrams per deciliter (mg/dL) indicates IGT and 126 mg/dL or above confirmed by repeating the test on another day, means that the person has diabetes.
Glycated hemoglobin test is a newer test that has become the "gold standard" in the management of diabetes. The test is done to find out whether plasma glucose levels are under control over long periods - say two to three months. Good control goes a long way in preventing the complications of diabetes.
Diabetes is commonly treated with diet control and use of only oral drugs; insulin injections may be required only in patients in type 1 diabetes and some patients of uncontrolled type 2 diabetes. An insulin pump is now available, which is a computerized device that can be worn to deliver a continuous amount of insulin.
The amount of insulin delivered can be regulated by the user depending on factors like exercise, activity level, and sleep.
(Source : WHO country office for India)