Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

All rights reserved with siahmsr digital healthcare[siahmsr wellness]

Reviewed by SIAHMSR medical team.

Diabetes 

   Are you worried about diabetes? Are you aware that diabetes is manageable with a few medications, dietary modifications and physical exercise? If you already know it , you are right. To manage any disease effectively, you must have a good idea about its cause, type, progress, complications if proper treatment is not taken in time, the treatment options available etc. SIAHMSR physicians will give you a comprehensive information about diabetes and the prospects in its management.

What is diabetes?

  Diabetes is a condition that occurs when your blood glucose level rises beyond the normal limit. Blood sugar in normal amounts is present in the blood of all individuals and that is taken up by cells as source of energy. The insulin hormone produced by pancreas has great role in this process.

Glucose is a sugar that your body can produce and it also comes from the food you eat. Your body breaks down most of the food you eat into sugar (glucose) and releases it into your bloodstream.

 Diabetes is a disease state where either insulin hormone production by pancreas is low or insulin produced in the body cannot remove glucose from blood. This condition is called insulin resistance. This state predisposes to development of diabetes gradually.

What are the causes of diabetes?

Diabetes [diabetes mellitus] may arise from various causes.

·Genetics

 It has a strong genetic link.  Diabetes has strong family history with presence of diabetes in either or both of the parents.

Gene mutations also cause diabetes as in MODY [Maturity-onset diabetes of the young] and neonatal diabetes.

· Environment & lifestyle

In addition to genes, environment also play contributory role in the development of diabetes. The sugar you eat may not produce diabetes directly. However, it can cause obesity and eventually hormonal imbalances leading to diabetes happen. Stress and environmental factors also play some role.

· Autoimmunity

  It is  a condition in which body’s immune system works against pancreatic cells producing insulin and destroys them].Type 1 diabetes and LADA happen when your immune system attacks the insulin-producing cells in your pancreas.

·Pregnancy

Diabetes is associated with pregnancy in some women- it is known as gestational diabetes. In some women diabetes may persist after delivery.

·Infections

Certain infections raise blood sugar level and it persists lifelong in some group of people.

· Injury to pancreas

Surgery or injury to pancreas may adversely affect its capacity to make insulin, resulting in Type 3c diabetes.

 

Types of Diabetes

· Type 1 diabetes

     Type 1 diabetes is a state in which no insulin is produced by your body. The immune system of your body attacks and destroys the cells in your pancreatic islet cells which is the producer of insulin. Therefore type 1 diabetes is a condition of raised blood sugar as no insulin is produced.

   Type 1 diabetes usually occurs in children and young adults, although it can appear at any age.

It is important for type 1 diabetes patients to take insulin every day to stay alive.

 The most common complication of type 1 diabetes is diabetic ketoacidosis (DKA) which is life threatening complication if not addressed in time.

·Type 2 diabetes

  This is the most common type of diabetes found in majority of the people. In this type either insulin production by the pancreas is not enough or the insulin inaction happens. The insulin cannot take up glucose into cells and clear it from blood. This state is known as insulin resistance.

  Overweight, obesity, particularly central obesity of trunk predispose to type 2 diabetes and insulin resistance. 

As a consequence of obesity and high body mass index (BMI), there is resistance of the peripheral tissues to the action of insulin. The beta-cell in the pancreas continues to produce insulin, but the amount is not enough to oppose the resistance from cells and tissues.

 Family history of diabetes is another risk factor. However, you can modify your lifestyle through dietary modification, exercise programs to prevent and manage type 2 diabetes.

· Prediabetes

  Prediabetes is a state or condition in which blood glucose levels are higher than normal but not high enough to be diagnosed with type 2 diabetes.  Prediabetes enhances the risk of developing type 2 diabetes later. 

It also enhances the risk for infections and cardiovascular diseases [ diseases of heart and blood vessels]in future. In the United States, 96 million adults—more than 1 in 3—have prediabetes.

· Gestational diabetes

  This is persistently raised blood sugar level during pregnancy. After childbirth the blood sugar may become normal. However, some women become diabetic later in life. This is type2 kind of diabetes

 Other uncommon types of diabetes

·       Type 3c diabetes:  Any damage to pancreas (other than autoimmune attack), impairs the capacity of pancreas to produce insulin. Pancreatitis, pancreatic cancer, cystic fibrosis and hemochromatosis can cause pancreatic damage and may lead to diabetes. Pancreatectomy or surgical removal of pancreas also results in Type 3c.

· Latent autoimmune diabetes in adults (LADA):  Type 1 diabetes happens from autoimmune attack on pancreas; LADA also results from an autoimmune reaction, but the progression to diabetes is not as fast as in type 1 diabetes. Its course is progressive and occurs mainly in young populations above 30.

· Maturity-onset diabetes of the young (MODY):

  This type of diabetes results from an inherited genetic mutation that impairs production and usage of insulin by the body. There are around over 10 different types of MODY. This type of diabetes runs in families.

· Neonatal diabetes:

Diabetes that occurs within the first six months of life is called neonatal diabetes. The high sugar level may disappear within a few months of onset of diabetes [transient form]. However, it may reappear later in life. In about 50% of babies diabetes persists lifelong and it is called permanent neonatal diabetes mellitus.

·Brittle diabetes:

It is a rare form of Type 1 diabetes with frequent and severe episodes of high and low blood sugar levels necessitating hospitalization. 

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  Type 2 diabetes

 It is the most common type of diabetes found in majority of people across the globe. In this type either insulin production by the pancreas is not enough or the insulin inaction happens. The insulin cannot help take up of glucose into the cells and clear it from blood. This state is known as insulin resistance.

    Overweight, obesity, particularly central obesity of trunk predisposes to type 2 diabetes and insulin resistance.  As a consequence of obesity and high body mass index (BMI), there is resistance of the peripheral tissue to the action of insulin. The beta-cells in the pancreas continue to produce insulin, but the amount is not sufficient to oppose the resistance from cells.

Over time, type 2 diabetes can cause serious damage to the body, especially nerves and blood vessels. Therefore, early diagnosis is important to prevent the complications of type 2 diabetes.

More than 95% of people with diabetes have type 2 diabetes. Type 2 diabetes was formerly called non-insulin dependent, or adult onset. Of late, this type of diabetes is also occurring increasingly and frequently in children also.

 What are the Symptoms of type 2 diabetes?

·       Increased thirst

·       Increased frequency of urination

·       Blurred vision

·       Tiredness or fatigue

·       Unintentional weight loss

Over time, diabetes can damage blood vessels in the heart, eyes, kidneys and nerves and may cause various complications.

 

What are the Complicationso type 2 diabetes?

Acute complications

These are acute in onset and sometimes life threatening also if proper treatment is not given  in time.

· Diabetic ketoacidosis [DKA]

DKA happens when your body doesn’t produce sufficient insulin and your blood glucose remains high. Insulin is needed for glucose to be taken up by cells and converted into energy.

 If there’s no insulin or not enough insulin, your body starts breaking down fat for energy instead of glucose. Fat breakdown causes release of ketones into your bloodstream and urine.

Ketones cause your blood to become acidic, which is a life-threatening condition mostly associated with type 1 diabetes [ blood sugar above 250 mg/dl].

· Hyperosmolar hyperglycaemic state [HHS] 

 HHS happens when very high blood sugar leads to severe dehydration and highly concentrated blood (high osmolality), which are life-threatening. Commonly seen in people with type 2 diabetes with very high blood sugar levels[ higher than 600 mg/dl]

There is lack of insulin or insufficiency in HHS also, but the production of insulin is still enough to prevent the production of ketones in blood and urine. So, it is a different condition, which is life threatening due to dehydration and highly concentrated blood.

 Intense thirst, frequent urination and mental status changes - delirium, loss consciousness are the symptoms presenting in both conditions.

What are the factors triggering HHS in diabetic patients?

Infections in diabetic patients may trigger HHS state. About 50% to 60% of HHS cases are triggered by infections such as pneumonia, urinary tract infections and sepsis.

 Stroke, heart attack and myocardial infarction can also trigger a stress response which can also leads to HHS.

  Certain medications for other diseases such as thiazide diuretics, beta-blockers, glucocorticoids, and some atypical antipsychotics may trigger HHS.

Is Hyperosmolar hyperglycaemic state dangerous in diabetic patients?

This complication of uncontrolled diabetes, HHS may be life threatening. The death rate in HHS can be as high as 20%, which is about 10 times higher than the mortality seen in diabetic ketoacidosis.

That means, it is very important to see your doctor when feel excessive thirst, frequent urination, delirium and you are already diagnosed as diabetic. Most people do not maintain the regular intake of medications  and do not test their blood sugar regularly. Therefore awareness about these warning symptoms is crucial to avoid HHS related deaths.

It is important to manage diabetes right from the very beginning with proper medications to prevent these grave complications.

  Chronic complications of diabetes

·       Heart attack

·       Stroke

·       Chronic kidney disease or nephropathy

·       Nerve damage or neuropathy

·       Eye problems or diabetic retinopathy

·       Cancer– chronic inflammatory state associated with high blood sugar predisposes to cancer.

·       Infections

·       gum diseases

·       sexual problems – The nerve and blood vessel damages may cause decreased arousal and erection problems .

 

How can you find out if you are diabetic?

Diagnosis of diabetes is made through blood tests.

· Random blood sugar test [RBS]

 A blood sample will be taken at a random time [no fasting needed]

 a blood sugar level of 200 milligrams per deciliter (mg/dL) means diabetes.

·Fasting blood sugar [FBS]

  A blood sample will be taken after fasting the previous night [ at least 8 hrs of fasting]. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal.

 A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes.

If it's 126 mg/dL (7 mmol/L) or higher on two different tests means you have diabetes.

· Glucose tolerance test

 After fasting over night the fasting blood sugar level is measured in the morning. Then you drink a sugary liquid, and blood sugar levels are tested after the next two hours.

A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A value of more than 200 mg/dL (11.1 mmol/L) after two hours means you have diabetes.

 A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) means you have prediabetes.

· HbA1C test

It measures average blood sugar level for the past 2 to 3 months. That is, the percentage of blood sugar attached to haemoglobin, the oxygen-carrying protein in red blood cells. It's also called a glycated haemoglobin test.

If  A1C level of 6.5% or higher on two  different tests reports are found that means  you have diabetes. An A1C between 5.7% and 6.4% means that you have prediabetes. Below 5.7% is considered normal.

 

What is the Treatment for diabetes?

Your health care provider or doctor may prescribe medications of the following category for managing diabetes.

·       metformin

·       sulfonylureas

·       sodium-glucose co-transporters type 2 (SGLT-2) inhibitors

·       insulin injections or other medicines

 

Complementary and alternative medicine (CAM)

Homeopathic treatment

Only Type 2 diabetes may be managed by homeopathic medications.

A few medications are listed below:

Lycopodium

Phosphorus

Phosphoric acid

Uranium nitricum

Cephalandra Indica

Gymnema  Sylvestre

 

How to prevent diabetes?

   Diabetes is a disease which poses many serious health risks. Untreated diabetes may eventually lead to damage to blood vessels in the heart, eyes, kidneys and nerves and may cause various complications.  Prevention of diabetes and its complications is very important to improve the quality of life.

Obesity is one of the major risk factors for diabetes. Therefore  it is important to keep a healthy body weight.

Focus on your diet including more fruits, vegetables, lean proteins and whole grains. These foods are nutritious and rich in fiber and low in fat and calories. Fiber rich foods can lower blood sugar level as well as cholesterol in your blood.

Physical activity is very important to prevent obesity and related insulin resistance which lead to diabetes. Stay physically active with at least 30 minutes of moderate exercise each day.

Studies show that physical activity improves glycemic or sugar levels control and reduces the risk of cardiovascular diseases such as heart attack, stroke etc. and reduces death rate in patients with type 2 diabetes. Moderate to vigorous physical activity is recommended to manage diabetes.

Eat a healthy diet avoiding sugar and saturated fats. Include healthy unsaturated fats and healthy carbohydrates such as whole grains in your diet in moderation.

Avoid smoking.

How to prevent complications in patients having diabetes?

· Foot care in diabetic patients

 Keep your feet clean and tidy and consult a doctor if you have burning , numbness on feet and  must treat ulcers , callosities and blisters on foot very early.

· Diabetic nephropathy  early screening

 It is the leading cause of kidney disease in the United States, occurring in 20%-40% of patients with diabetes. Early screening and treatment for kidney disease is essential to prevent nephropathy or kidney failure as a complication of diabetes.

Do kidney function tests at fixed regular intervals to prevent complications. The earliest characteristic change is appearance of albumin protein in urine.

The recommended screening tests include checking albumin to creatinine ratio annually  and more frequent tests if indicated  are glomerular filtration rate and  urinary albumin test;

Control your blood sugar levels and keep a hemoglobin A1c goal of <7%.

·Do eye and vision tests to screen for diabetic retinopathy

   According to American academy of ophthalmology Duration of diabetes is a major risk factor, and is the main criteria utilized to decide when to begin DR screening.

After 5 years, approximately 25% of type 1 patients will have retinopathy. After 10 years, almost 60% will have retinopathy, and after 15 years, 80% will have retinopathy.

Guidelines for Diabetic retinopathy screening were released by the International Council of Ophthalmology (ICO) and American Diabetes Association (ADA) in 2018. Adequate visual acuity screening and retinal examination are the common tests done for screening.

The most important things to control diabetes and its complications include :

Proper medications

Diabetic diet

Exercise and physical activity

Stress management

Timely check up with your doctor

Testing blood sugar levels regularly & doing other tests if indicated.

Written by dr sanjana b[ copyright]

References

1.    https://www.who.int/news-room/fact-sheets/detail/diabetes

2.    https://www.cdc.gov/diabetes/basics/diabetes.html

3.    https://my.clevelandclinic.org/health/diseases/7104-diabetes

4.    https://www.cdc.gov/diabetes/managing/index.html

5.    https://ayushnext.ayush.gov.in/detail/writeUps/effectiveness-of-homeopathic-medicine-in-case-of-diabetes-mellitus

6.    https://pubmed.ncbi.nlm.nih.gov/15887451/#:~:text=Hyperosmolar%20hyperglycemic%20state%20is%20a,and%20little%20or%20no%20ketosis

7.    https://www.ncbi.nlm.nih.gov/books/NBK482142/

8.    https://www.mayoclinic.org/diseases-conditions/diabetes/diagnosis-treatment/drc-20371451

9.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4914832/

10.           https://www.cdc.gov/diabetes/library/features/healthy-feet.html

11.           https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171795/

12.           https://eyewiki.aao.org/Diabetic_Retinopathy_Screening