Diabetes mellitus, usually known as diabetes is a leading cause of morbidity and mortality across the world and also expected to continue as a major health issue owing to its serious complications including nephropathy (end-stage renal disease), retinopathy( blindness) and diabetic neuropathy. Again don’t confuse with the term diabetes insipidus- a hormonal abnormality causing salt and water imbalance. However, symptoms like more thirst and frequent urination may overlap in both disorders.
Diabetes mellitus is the most common metabolic disorder generally marked by a prolonged increase in blood glucose levels with disturbance of carbohydrate, fat and protein metabolism usually believed to be associated with insufficient insulin production or insulin resistance.
Across the world, the Highest prevalence are observed in countries like India, china, US, Indonesia and Japan. In India, as per the National Diabetes and Diabetic Retinopathy Survey, conducted by the All India Institute of Medical Sciences’ Rajendra Prasad Centre for Ophthalmological Sciences, About 161 million people are estimated with diabetes mellitus mainly due to genetic susceptibility meld with lifestyle of low activity high calorie diet.
Types of Diabetes Mellitus:
- TYPE-1 DIABETES MELLITUS:
10% of the cases are found to be of type -1 , which generally displays at early age of below 35 years and the patients are not obese but usually have continuous weight loss. The basic phenomenon is destruction of β-cells of pancreas may be caused due to genetic vulnerability, autoimmunity, and environmental factor. And these people are more prone to develop ketoacidosis and hypoglycaemic episodes.
Blood glucose levels marks in the range of 260-600mg/dl.
Symptoms: frequent urination, increase thirst and hunger, vomiting, abdominal pain, shortness of breath, and confusion.
It can be treated with insulin administration and diet changes along with exercise.
- TYPE-2 DIABETES MELLITUS:
80%of existing diabetic cases are of type -2 . Mostly seen in obese and older people aged between 45-60 and above.
- Genetic factor – 80% probability to develop diabetes in the other identical twin if one of twin get affected and 40% risk of getting diabetes if both parents have diabetes.
- Constitutional factors: Hypertension, obesity and level of physical activity.
- Insulin resistance- lack of responsiveness of peripheral tissues to insulin and also Liver synthesises glucose.
- Improper insulin secretion.
–Symptoms: generally asymptomatic when diagnosed on the basis of increase blood glucose levels or may present with frequent urination and more thirsty.
- Urine test – urine is tested for presence of glucose or ketone bodies. However is obsolete and may be false-positives and false-negatives since this can occur even in certain other conditions like many metabolic disorders , starvation, intracranial lesions (brain tumour, haemorrhage and head injury), renal glycosuria and alimentary glucosuria.
- Fast glucose test: recommended for all individuals aged above 45 years and obese in every 3 years since type -2 diabetes mellitus can be underdiagnosed as it is asymptomatic.
The fasting plasma glucose level exceeding above 126mg/dl (>7 mmole/L) indicates diabetes.
- Oral Glucose Tolerance Test: For patient diagnosed positive in Fasting Glucose Test , value ranging between 100-140 mg/dl. The patient is scheduled to eat high carb diet 3 days prior to test and overnight fast on the day of test (for at least 8 hours). After drawing fasting blood sample patient is provided with 75gm of glucose dissolve din 300 ml of water to drink and then blood glucose is measured. If it reads above 200mg/dl then are labelled as diabetic.
- Screening for diabetes associated complications- such as dyslipidaemia and thyroid dysfunction.
- Glycosylated haemoglobin (HbA1C) : degree of glycaemic control is better monitored by measuring the HbA1C levels. More than 6.5% indicates diabetes.
- DIET: The food you eat has a major impact on your body. Over decades it has been believed that six meals plan(less quantity but frequently eating) helps control blood sugar levels, but it causes weight gain and ultimately making difficult to manage the glycaemic levels. According to recent studies , it has been found that three meals plan will have maximum benefit in diabetic patient overcoming the weight gain issue
Let say it as a triangle meal plan.
- Never skip breakfast: it is considered to be essential meal of the day. Having healthy breakfast keeps you energetic entire day thereby controlling your appetite and prevents you from eating high caloric snacks. Hence, no extra calories and thus weight management.
- Eat lunch in moderation. Avoid much whites like white rice, white flour, white sugar in your diet. Go green with fresh fruits and vegetables.
- Taper your dinner. Eat less in night to balance your blood glucose level.
- Prefer dark chocolate to munch your carve to eat.
- Water, milk and green tea should be your primary choice of beverage.
- Prefer direct fruit to canned fruit juices.
- Avoid fatty food: say no to junk foods, street foods, and fatty foods like noodles, burger as they can cause spike to your cholesterol level increasing the risk of cardiovascular diseases. Instead replace your snacks with salad.
- Add fibre rich diet like oatmeal, whole grain bread, soy, green leafy vegetables and low carb diet.
- Add herbs like aloe Vera ( juice or capsule), spice up with cinnamon (insulin sensitizer)and ginger , bitter melon, Fenugreek.
- Avoid sedentary life style: Healthy diet with physical exercise is good for everybody and more beneficial for diabetic patient for weight management. Prefer aerobic exercise for atleast 15-30minutes.
- Enjoy the bask: vitamin D acts as a insulin sensitizer and helps in maintaining blood glucose level.
- Avoid stress.
- Quit smoking and alcohol right away.
- Sleep – a better healer.
- Medication – most commonly used drug is metformin, which is recently come up with a benefit in increasing your life span. Even doctor may prescribe you for injecting insulin.
Follow medication regimen properly prescribed by your physician.
- Monitor your blood glucose levels regularly.
- GESTATIONAL DIABETES: It comprises of 4% of diabetic cases and is reversible. Usually developed during pregnancy due to metabolic changes or after giving birth to a child weighing more than 4Kg. However, after delivery it revert back to normal but these women are at high risk to develop DM later in life after two to three decades.
- SECONDARY DIABETES MELLITUS: it contributes to 10% of cases caused due to
– mutations in β- cells
-pancreatic diseases- chronic pancreatitis, pancreatic tumours, post pancreatectomy.
-endocrine disorders- Acromegaly, Cushing syndrome, pheochromocytoma
-drug induced- few medications like steroids, thyroid hormone, thiazides and β-,blockers may induce diabetes.
– infections- congenital rubella, cytomegalovirus infections
– immune mediated- these are uncommon but caused due to stiff man syndrome or anti insukin receptor antibodies.
-other genetic syndrome- down syndrome, klinefelter’s syndrome, Turner’s syndrome.
Globally, About 352 million individuals are estimated to be prediabetic .the right way to prevent yourself from falling into the category of diabetic or prediabetic ,take a step right now. Get the awareness about the diseases, eat healthy and exercise well. Keep check on your weight. Avoid stress. Stay healthy.