November 14, 2013

(World Diabetes Day)

Fast growing life, work-place concerns and little time for recreation is killing us softly. As a nation, India is soon going to be the world’s diabetic capital. Those diagnosed with diabetes are only the tip of the iceberg. Those undiagnosed are like a ticking time bomb.

The word diabetes mellitus was originally coined by Apollonius in 230BC as Diabetes meaning honey and Mellitus meaning to pass through. However, the famous Indian physician Sushruta coined the word “Madhumeha” which means the passage of sweet urine after he had observed the attraction of ants over the urine of a patient with diabetes. Diabetes is a chronic disease caused by either insulin deficiency (Type 1) or a combination of insulin deficiency and insulin ineffectiveness which is called Type 2. Type 1 is commonly seen in children and young adults whilst Type 2 is commonly seen in older people. Type 2 diabetes comprises about 90% of people with diabetes worldwide. Diabetes as a disease is becoming increasingly common and it is increasing at an alarming rate amongst Indians. Today it is estimated that there are about 61-63 million people with Diabetes and it is estimated that this will rise to about 100 million by the year 2030. Originally it was thought that Diabetes was a disease of the rich but it is now found in everyone including children and young adults.

There are various reasons for the increasing prevalence of diabetes. There is certainly improved diagnosis of the disease due to raised awareness and improved diagnosis. The Indians have a particular genetic susceptibility to diabetes. However, increasing life expectancy, better economic conditions, a sedentary lifestyle and changes in nutritional habits of Indians have all led to the increase in diabetes. Diabetes can present with increased need to urinate, excess thirst, extreme tiredness and increased hunger, slow healing of wounds, irritability and blurred vision. But if you feel you have suddenly started drinking water more than usual, passing urine more than usual, then let the warning ring in your mind.

The diagnosis of Diabetes is a combination of patient history, clinical symptoms and blood tests. The diagnosis of diabetes is established when the fasting blood glucose is greater than 126mg/dl or the two hour post prandial blood glucose after a 75g glucose load is greater than 200 mg/dl or HBA1 is greater than 6.5% especially if this is repeated twice. A random blood glucose of greater than 200mg/dl is also strongly suggestive of diabetes.

People suffering from diabetes are susceptible to various complications. They are either due to damage to small blood vessels (microvascular) or due to damage to large blood vessels (macrovascular). Diabetes affects virtually every part of the body but the main complications are:

Diabetic retinopathy, when it affects the small blood vessels of the eyes. It is one of the most common causes of blindness in adults. Diabetics should have their eyes checked regularly as it does not produce symptoms in the early stages and can only be detected through check ups. Diabetic nephropathy is when it affects the kidneys. It starts with the leaking of minute quantities of protein (microalbuminuria) in the urine and if not treated may lead to renal failure. It is therefore important to check for microalbuminuria in the early stages. Diabetes is one of the commonest causes of dialysis in adults. Diabetic neuropathy is when diabetes affects the nerves. It affects about 70% of diabetics in some point in their lives. Sometimes it results in pain and on occasions no sensation at all. Diabetes also causes symptoms like erectile dysfunction, abnormal sweating and loss of control over the bladder.

Heart disease is one of the most important causes of death in diabetics. It is important to remember that in some diabetics it may not present with the classical symptoms of chest pain which may delay diagnosis and treatment. Strokes are at least three times commoner in diabetics leading to death or significant disability in those who survive. It is therefore important that good control of the blood glucose is maintained and regular check ups are undertaken to minimize the risk of complications.

Combating diabetes is a necessity and the patient himself is responsible for his well-being, a strict protocol diet in combination with what they are being maintained on either, oral drugs or insulin injections has to be followed with. It is important for every diabetic to look at their diet and nutritional requirements and their levels of physical activity such as exercise. Increasingly we have become used to a sedentary lifestyle and the eating of low fibre high fat diets.

Lifestyle management complemented by oral drugs and or insulin is the cornerstone of treatment of diabetes. Insulin and oral hupoglycaemic drugs should be started on the advice of a doctor. When it comes to food, Ideally the diet should be customized taking into account factors such as age, gender, weight, height, physical activity and the needs of the individual. However, foods with a low glycaemic index, high in fibre, low in fat are preferable. Animal protein such as meat often contains a higher quantity of saturated fat. Vegetable protein like beans, legumes, nuts and seeds are encouraged. Fish being a good source of omega 3 fatty acids is also good. It is important for diabetics to take meals/snacks at regular intervals avoiding both over eating and under eating. Smaller portions are always better than larger ones.

It is important to exercise as it helps in controlling the blood glucose. Regular exercise such as brisk walking, swimming, cycling or any other forms of exercise that keeps you moving for at least 30 minutes of moderate intensity five times a week is ideal. It is important that if you have not done any exercise in the past you start gently and build up gradually. There is no particular time of doing the work-out, you can do it when you are comfortable, either in the mornings or during the evenings.

The moral of the story is simple, we live in times where we do have treatment options for diabetes to maintain you for life. There are now newer drugs and different types of insulin available. But we do not have a cure for Diabetes. To what extent the disease progresses or to what extent you remain healthy is a question best you can answer. Proper control of blood glucose with lifestyle modifications and regular check ups is important. Patients with diabetes should be empowered to take control of their management of diabetes with the help of health professionals. Always remember to have a personal life untouched by work-place concerns. When the workload increases, see that you prioritize what you need from what you want. In that way you can not only add years to life but life to years.