Diabetes and its consequences

Diabetes

What is Diabetes?

Diabetes has many definitions and descriptions . It can be categorized as a Chronic disease which occurs when pancreas doesn’t produce enough insulin, or when pancreas cannot effectively use the insulin it produces.

Diabetes is also known as Hyperglycemia. In some severe cases it can lead to damage of nerves and blood vessels and also lead to blindness, amputation & kidney failure.

Unfortunately there is no cure for Diabetes. All the above listed complications that result from Diabetes can only be managed effectively by managing diet and lifestyle i.e. Therapeutic Lifestyle Change.

Diabetes in lay man terms also means that blood glucose (blood sugar) is too high. There are two main types of diabetes.

Type 1 diabetes – the body does not make insulin. Insulin helps the body use glucose from food for energy. People with type 1 need to take insulin every day.

Type 2 diabetes – the body does not make or use insulin well. People with type 2 often need to take pills or insulin. Type 2 is the most common form of diabetes.

Gestational diabetes – may occur when a woman is pregnant. Gestational diabetes raises her risk of getting another type of diabetes, mostly type 2, for the rest of her life. It also raises her child’s risk of being overweight and getting diabetes.

Diabetes is serious.You may have heard people say they have “a touch of diabetes” or “your sugar is a little high.” These words suggest that diabetes is not a serious disease. That is not correct. Diabetes is serious, but you can learn to manage it!

All people with diabetes need to make healthy food choices, stay at a healthy weight, and be physically active every day.

Taking good care of yourself and your diabetes can help you feel better. It may help you avoid health problems caused by diabetes such as:

  • heart disease and stroke.
  • eye problems that can lead to trouble seeing or going blind.
  • nerve damage that can cause your hands and feet to feel numb. Some people may even lose a foot or a leg.
  • kidney problems that can cause your kidneys to stop working.
  • gum disease and loss of teeth.

When your blood glucose (blood sugar) is close to normal you are likely to:

  • have more energy.
  • be less tired and thirsty and urinate less often.
  • heal better and have fewer skin, or bladder infections.
  • have fewer problems with your eyesight, feet, and gums.

All about Diabetes, its consequences, tests and some precautions

Global Diabetes Endemic

Diabetes is spreading at a very fast across the world. According to IDF Atlas data, there are more than 371 million people in the whole world that have diabetes ( Nov 2012). According to another study done by WHO more than 80% of people suffering from Diabetes are living in low- and middle-income countries. This comes as shock to few who have all this time believed that it is a disease of Rich People. WHO also projects that deaths due to diabetes will double between 2005-2030 making Diabetes as one of the leading causes of Death in the world.

India in Specific is second only to China with an estimated 63 million Diabetics by end of 2012 with china having around 92.3 million. What is alarming is the pace at which number of Diabetics are rising in India. It is again claimed that India would become the Diabetes Capital of the world in near future overtaking China which is not a good pole position.

Cost of Diabetes

Lifestyle Disease like Diabetes comes with its own costs. It is estimated that in India some of the low income families may spend up to 25% of family income devoted to diabetes care for one person. Although medicines for Diabetes are not expensive but associated problems and complications require treatment that makes Diabetes an expensive medical disease.

Apart from these Costs there are a number of Intangible costs like pain, anxiety, lower quality of life etc. People are always afraid of a disease which is going to accompany them for life.

It is estimated that Medical costs for those with diabetes are 2.3 times higher than for those without Diabetes.

Types of Diabetes

Type 1 Diabetes results from ß-cell destruction, usually leading to absolute insulin deficiency. This type of Diabetes is less common and only 5-10% of all cases of diabetes are Type 1. This type was also known as insulin dependent diabetes mellitus (IDDM) or juvenile-onset diabetes

Type 2 Diabetes results from progressive insulin secretary defect on background of insulin resistance. Almost 90-95% of all cases of diabetes are Type 2 Diabetes. This type of Diabetes was known as non-insulin dependent diabetes mellitus (NIDDM) or adult-onset

Diagnosis

Historically Doctors have used fasting plasma glucose (FPG) or 2-hour value in 75-g oral glucose tolerance test (OGTT) to diagnose / confirm Diabetes. In 2009: International Expert Committee recommended use of HbA1c with threshold of ? 6.5% to understand Diabetes. This is a much better test in comparison to the initially used test as HbA1c gives an estimate of last 3 months of a person’s blood sugar levels which makes it impossible for a person to manipulate results. In other tests it is easy not to comply with the guidelines and medical recommendations throughout the period of medication and still be able to manipulate the results of the tests by changing lifestyle before the test.

Tests for Diabetes along with Threshold limits

HbA1C higher than 6.5%
FPG higher than 126 mg/dL (7.0 mmol/L)—fasting is 8 hrs
OGTT 2-hour plasma glucose ? 200 mg/dL (11.1 mmol/L) 75 gm glucose dissolved in water
Random Random plasma glucose ? 200 mg/dL with classic symptoms of hyperglycemia or hyperglycemic crisis

What is Prediabetes ?

Pre diabetes is a condition wherein people don’t meet the criteria for diabetes but at the same time have glucose levels too high to be considered normal. PreDiabetes can be equaled to high risk of Diabetes.

  • Not clinical factors by itself, but risk factor for failure diabetes and CVD
  • Prediabetes is associated with obesity (abdominal or visceral), dyslipidemia, higher TG, HTN, lower HDL

Diagnosing Prediabetes

HbA1C 5.7-6.4%
FPG Impaired Fasting Glucose (IFG) if fasting plasma glucose is 100-125 mg/dL (5.6-6.9 mmol/L)
OGTT Impaired Glucose Tolerance (IGT) if 2-hr value after OGTT is 140-199 mg/dL (7.8-11.0 mmol/L
WHO Define cutoff for IFT at 110mg/dL (6.1 mmol/L)

Risk of Acquiring Diabetes

Following category of people are at high risk and should get themselves tested for Diabetes frequently.

All adults who are overweight (BMI ? 23) and who have 1 or more of the following:

  • Physical Inactivity
  • First – degree relative with diabetes
  • Women who delivered a baby weighing more than 3 Kg or who were diagnosed with Gestational Diabetes
  • People who have High Blood Pressure – Hypertension (blood pressure greater than 140/90 mmHg or on therapy for hypertension )
  • HDL less than 35 mg /dL (0.90mmol/L) and / or TG greater than 250 mg /dL (2.82 mmol/L)
  • Women with PCOS
  • A1C greater than or equal to 5.7% IGT, or IFG on previous testing

What is Gestational Diabetes

Gestational Diabetes Mellitus (GDM) : Diabetes diagnosed during pregnancy that is not clearly overt diabetes. Pregnant women without previous known diabetes, screen for GDM at 24-48 weeks’ gestation

Physical Activity and Weight in Diabetes

It is a known fact that overweight / weight gain leads to increased insulin resistance. Weight loss toward healthy weight helps increase insulin sensitivity

Diabetes Prevention Program

In one of the first large-scale trial to Assess 2 techniques in preventing or delaying development of Type 2 Diabetes (published in 2002), a large sample of overweight adults were randomly subjected to either of following regimens I.e.

  • Lifestyle Change including changes to Diet and including exercise (150 min/ week)
  • Medication – Metformin
  • Placebo

Results of the study proved what doctors have been recommending for a while now i.e. less number of people in the group with lifestyle change developed DM in comparison to the other groups. Metformin was also found to be helpful to delay onset of Diabetes Mellitus. ( Kindly seek advise from your Physician before starting any medicine )

5% body weight loss is associated with decrease in insulin resistance, improved glycemia and lipemia and lower BP. AHEAD (Action for Health in Diabetes) 1 year result show that at average 8.6% weight loss from intensive lifestyle intervention group had lower BP, lower TG, higher HDL & overall better diabetes and CVD risk factor profile

Recommendations for people diagnosed with Pre-Diabetes (high risk for developing diabetes ) include following:

  • Structured program that emphasize lifestyle changed, that include:
  • 7% body weight loss
  • Regular physical activity (150 min / week)
  • Reduced Calories and reduced fat intake

Physical Activity Recommendations

People with diabetes should perform moderate-intensity physical activity for at least 150 min/week. Exercise should be spread over at least 3 day / week and during the workout 50-70% maximum heart rate should be reached. No more than 2 consecutive day without activity

Target Heart Rate is calculated using following formula

Maximum age – related heart rate: 220 – age in yr

Physical Activity Recommendations

People with type 2 diabetes should do resistance training at least twice per week. All the training and strenuous exercise should be discussed with ones doctor before making it a routine. Structured exercise interventions of at least 8-week in duration have found to Lower A1c by average 0.66% in those with type 2 even if there is hardly any visible change in BMI
Regular exercise has been shown to Improve blood glucose control and well-being and also reduce CVD risk factors and promote weight loss.

Hypoglycemia

For those on insulin or insulin secretagogues, Physical activity can cause hypoglycemia if medication dose or carbohydrate consumption is not altered. Carbohydrate should be taken if preexercise glucose levels are <100 mg /dL (5.6 mmol/L)
Hypoglycemia rare in diabetic individuals not rerated with insulin or secretagogues – no preventive measure for them

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