The theme of WHO day this year (2016) is ‘Beat Diabetes’ to draw the attention of the world towards diabetes. Diabetes is spreading its tentacles world wide. It is emerging as a major cause of death and disabilities. India has approximately more than 62 million people suffering from Diabetes Mellitus (DM) followed by China (20.8 million) and United States (17.7 million). By 2030 diabetes will afflict up to 79.4 million individuals in India, 42.3 million in China and 30.3 million in the United States. In 2012 diabetes killed 1.5 million people. As per projections by WHO, diabetes will be the 7th leading cause of death in 2030. Diabetes, once contracted is a life long association.
One can beat diabetes by healthy life styles. Knowledge is the first step to beat diabetes. A diabetics should know what will happen to him after 10 years? During informal talks with the patients admitted to hospitals, I have observed that the patients were neither clear about the disease, its complications and possible consequences nor very serious about the control of blood sugar. In this article I will discuss about the causes, effects and strategies to beat diabetes.
Know Diabetes to Beat Diabetes
Our food contains carbohydrates, fats, proteins vitamins and minerals. The food is broken down and later absorbed from intestines in form of simpler substances. Proteins are broken down and absorbed as amino acids, carbohydrates as glucose & fats as fatty acids. Each substance has its own set of mechanisms to control its level in the blood. In diabetes, the regulation of glucose is deranged.
How glucose is regulated in the blood?
Blood glucose level increases after food. Excess of glucose is removed from the blood by a hormone called insulin (secreted by a gland called pancreas). Insulin transports excess glucose from blood to cells, where it is stored for later use. If glucose level is low, it is transported back from cells to blood by another hormone called glucagon. When insulin secretion is absent or reduced, removal of glucose from blood is affected causing high level of glucose in the blood all the times. Excess level of glucose in blood is responsible for large number of complications affecting various organs like kidneys, eyes, limbs etc. For details refer to our post on Complications of diabetes.
Types of Diabetes
Based upon the onset, three common types of DM are recognized.
- Type-1 or Early Onset DM or Insulin Dependent Diabetes Mellitus (IDDM)
- Type 2 or late onset DM or Non Insulin Dependent Diabetes Mellitus (NIDDM)
- Gestational DM or diabetes due to pregnancy.
IDDM affects children & adolescents. It accounts for approximately 5 percent of all diagnosed cases of diabetes.
NIDDM affects adults. In India, Diabetes Mellitus has been reported in people below thirty years of age. NIDDM comprises of 90% of all diabetics. In NIDDM the insulin production is normal or excess. The disease is due to inability of insulin to remove glucose from blood (insulin resistance) caused by various factors.
Gestational diabetes or diabetes occurring during pregnancy.
Symptoms of Diabetes Mellitus
Type 1 diabetes, affecting children & adolescent, generally has an acute onset. The child may present with pain abdomen, shortness of breath, vomiting, dehydration or frequent urination. This condition is called as ketosis, a dreaded complication of diabetes. It is often misdiagnosed as gastroenteritis. Ketosis is an emergency. Some children may present with weight loss, excessive thirst and increased frequency of urination. A child who was normal earlier and now gets up frequently for urination and drinking water at night may be suffering from diabetes.
NIDDM or Type 2 or Adult form of diabetes is symptomless. Often it is detected by blood test done during routine medical examination. Some times it may present with the classical features of Diabetes as under:-
- Excessive thirst
- Increased appetite
- Frequent urination
- Loss of weight
- Easy tiredness
- Slow healing of cuts and wounds
Individual having above symptoms should get his blood checked to rule out diabetes. At times first indication of diabetes may be its complications.
Diagnosis of Diabetes
The diagnosis is confirmed by estimation of blood sugar. Blood sample is taken after overnight fasting. For fasting sample, one should not take anything except water after 10 o’clock in the night, otherwise the readings may be wrong. After giving the fasting sample, the person takes his/her breakfast. Blood sample is again taken after 2 hours (also called as post prandial or PP sample).
Diagnosis of diabetes is confirmed if:-
- Fasting blood sugar value is more than 120 mg/100 ml of blood (or 120 mg%)
- Post prandial value (2 hours after food or PP) is more than 180 mg/100 ml (or 180 mg%).
- Fasting values more than 120 mg%, but PP value between 120-180 mg%, is diagnosed as impaired glucose tolerance (IGT). It indicates that the person has not developed full fledged diabetes yet, but may develop it later if risk factors continue.
HbA1c estimation is now available which gives a good estimation of blood sugar control over 2-3 months. Non diabetics have HbA1c level of less than 6%. For good control, level below 7% is desirable. A level of above 7% means that person is heading for complications. Diabetes can also be diagnosed by a urine test, but blood sugar estimation is confirmatory. Now a days, glucometer strips are available in market for estimation of blood sugar.
Causes of Diabetes Mellitus
Type -1 DM is primarily due to some viral infection which causes irreparable damage to pancreas. Gestational DM occurs in 1% cases during pregnancy and subsides after delivery. In some cases it may develop into Diabetes Mellitus even after pregnancy. Gestational diabetes has its own effects on pregnancy. No exact cause of NIDDM has been discovered. Family history of DM, obesity and sedentary life increase the risk of diabetes. Diabetes affects rich, middle class and poor people equally.
Risk Factors For DM
How DM Harms Our Body
DM damages almost every part of body viz kidney, eyes, nerves, heart and so on. For details refer to our post on complications of diabetes
What should I do to beat diabetes
The main cause of complications is the poor control of blood sugar (glycemic control). To beat DM, the ultimate goal is to keep blood sugar levels as normal (fasting less than 110mg% and post prandial less than 130mg%) as possible by weight maintenance, diet, exercise, medicines, and self care. At stage of IGT and mild diabetes, weight maintenance, diet & exercise will revert back you to normal. Drug will be required if diabetes cannot be controlled by diet and exercise. To beat diabetes one should include following changes in life style:-
Regular physical activity forms an important part of strategy to beat diabetes. Exercise lowers the blood glucose level. It also protects against heart diseases. A diabetic must dedicate one hour per day for exercise. Better to do half hour morning and evening. Brisk walking is good. Yoga is a complete exercise package. One has to create exercise programme to suit his requirement. No tailor made solutions can be given at this juncture. The exercise session should start with warming up for five minutes and close with cooling down for five minutes. One must keep sugar with him during exercise which can be taken if symptoms of hypoglycemia develop. One should remain hydrated and should not overdo.
By modifying Diet, a diabetic can easily beat diabetes. For information on diet for diabetics, please refer to article on diabetic diet.
Weight Control, A Must
Overweight/obesity predisposes to diabetes. Controlling weight is the first step to beat diabetes. A diabetic must maintain his weight as per expected standards. The BMI should be kept below 25 and ideally it should be 22. Weight loss improves insulin resistance and reduces the requirement of anti-diabetic drugs. Most diabetics are obese due to combination of high calorie diet and inactivity. Combination of diet and exercise will lead to gradual weight reduction. For weight control strategies please refer to post on Loose weight and Live healthy.
Self Care : Key To Success
Self Care forms an integral aspect of diabetic management. Read our self care tips for diabetes.
I have observed that people are ignorant about various precautions to be taken for fighting the disease. People are not only ignorant about the diseases, but also not serious about the consequences. They think a tablet or some medicine is enough to cure their diabetes. In addition media, internet is full of claims and counter claims for magic remedies. For most of people, taking a occasional leisurely walk, quantifies for regular exercise and physical activity. During festive seasons, some people eat to glory causing persistent rise in blood sugar level. They avoid blood test and going to doctor. They go to doctor only when the blood sugar reports come back to near acceptable limits, to fool themselves.
Patients must understand that fluctuations in blood sugar levels are harmful and bring them nearer to the early onset of complications. It best to prevent Diabetes by adopting healthy life styles. The diabetics should be well informed about the disease process its complication and precautions.
Is future of diabetics bad?
After reading the above description or relevant articles in the blog, it may appear that future of a diabetic is not bright. However it is not so. Diabetes will compel an individual to adopt a healthy lifestyle. Healthy lifestyles in turn will help to reduce risk factors for other disease as well. Complication/abnormality will be detected at the earliest. He will be under constant medical supervision. With lifestyle management and medical supervision most of the diabetics will have a good, productive and healthy life. So, all diabetics must cheer up. With knowledge and power of your dedication, you can beat diabetes and be a winner.
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