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 is a disease state associated with raised blood glucose or blood sugar. Elevated blood glucose [sugar] levels are dangerously risky to various organs of the body in the long run. Untreated diabetes is associated with complications.

Glucose is the main source of energy in human body. The body can make glucose, and it can reach the body through the food we consume.Insulin is a hormone produced by the pancreas that helps to regulate glucose levels in the body. Insulin helps the cells to take glucose from blood and to use it for energy. Diabetes is a state in which the body doesn’t make enough insulin or use it for the uptake of glucose by the cells. This may lead to persistence of increased levels of glucose in the blood.

Diabetes if not diagnosed and managed properly it can damage the eyes, kidneys, nerves, and heart. Diabetes also enhances the risk to some types of cancer.

Early diagnosis and prevention of diabetes are the keys to reduce the complications of diabetes.

Healthy lifestyle practices including dietary changes and physical activity are important for the prevention as well as management of diabetes.                                                SIAHMSR 

Epidemiology 

   In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2019, diabetes was the direct cause of 1.5 million deaths and 48% of all deaths due to diabetes occurred before the age of 70 years. In 2019, diabetes and kidney disease due to diabetes caused an estimated 2 million deaths.

    In April 2021 WHO launched the Global Diabetes Compact, a global initiative aiming for sustained improvements in diabetes prevention and care, particularly in low- and middle-income countries.

  In May 2021, the World Health Assembly agreed a Resolution on strengthening prevention and control of diabetes. In May 2022 the World Health Assembly endorsed five global diabetes coverage and treatment targets to be achieved by 2030.

World Diabetes Day is observed globally on 14th November of the year for building awareness about diabetes and its life threatening complications. On the day, the healthcare sectors worldwide conduct surveillance of diabetes and its risk factors.

Causes

Diabetes [diabetes mellitus] has various causes.

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

B] Environment & lifestyle

 The sugar you eat may not produce diabetes directly. However it can cause obesity and eventually hormonal imbalances leading to diabetes. Stress and environmental factors also play some role.

C] Autoimmunity [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.

D] Pregnancy

Diabetes is associated with pregnancy in some women- gestational diabetes.

E] Infections

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

F] Injury to pancreas

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

                                                                               SIAHMSR

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 found in majority of 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 

                                                                                             SIAHMSR  

                                   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 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 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.

Symptoms of diabetes include:

· Increased thirst

· Increased frequency of urination

· Blurred vision

· Tiredness or fatigue

·  Unintentional weight loss

What are the complications or  impact of diabetes on health of a person?

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

People with diabetes have a higher risk of health problems including heart attack, stroke and kidney failure.

Chronic complications include:

·       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 .

Diagnosis and treatment

   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) is diagnosed as 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 overnight the fasting blood sugar level is measured in the morning. Then you drink a sugary liquid or food, and blood sugar levels are tested after 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.

· A1C test

It measures average blood sugar level for the past 2 to 3 months. That is, the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. It's also called a glycated hemoglobin test. A1C between 5.7% and 6.4% means that you have prediabetes.

If A1C level of 6.5% or higher on two different tests reports means  you have diabetes. A1C Below 5.7% is considered normal

Treatment

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.

Prevention of type2 diabetes

To help prevent type 2 diabetes and its complications lifestyle modifications are important.

· Maintain a healthy body weight

· Stay physically active with at least 30 minutes of moderate exercise each day

· Follow a healthy diet and avoid sugar and saturated fat

· Avoid smoking                                           SIAHMSR

 Health benefits of Mediterranean diet  in Diabetes

Research studies show that  Mediterranean Diet can lower your risk of cardiovascular diseases, obesity, diabetes and life style diseases. A dietitian can help you customize the diet to suit your individual needs. SIAHMSR wellness wellness consultants & nutritionist recommend Mediterranean diet for :

           ·        Lowering your risk of cardiovascular diseases like heart attack, stroke etc.

·        Help you maintain a healthy body weight.

·        Help reduce blood sugar, type 2 diabetes, blood pressure and cholesterol.

·        Lowering your risk of metabolic syndrome-[ high blood pressure, obesity and bad cholesterols ]

For  further reading on Mediterranean diet follow this link :

https://siahmsrwellness.in/obesity-diabetes-metabolic-syndrome-role-of-mediterranean-diet-yoga  

Reference
1.    https://www.who.int/news-room/fact-sheets/detail/diabetes#:~:text=Overview,hormone%20that%20regulates%20blood%20glucose.
2.    National diabetes statistics report, 2022. Centers for Disease Control and Prevention. Updated January 18, 2022. Accessed August 4, 2022. www.cdc.gov/diabetes/data/statistics-report/index.html
3.    https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes
4.    Davidson's Principles and Practice of Medicine –Diabetes.
5.     https://www.cdc.gov/diabetes/managing/index.html
6.     https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4914832/m
7.     https://www.cdc.gov/diabetes/library/features/healthy-feet.html
8.     https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171795/
9.     https://eyewiki.aao.org/Diabetic_Retinopathy_Screening

10.   https://siahmsrwellness.in/obesity-diabetes-metabolic-syndrome-role-of-mediterranean-diet-yoga