Diabetes is a life long disease that is characterised by increased levels of sugar in the blood. It is either caused by lack of insulin, a hormone produced by the pancreas or your body’s inability to respond to it. High blood sugar levels caused by lack of this hormone is called type 1 diabetes. It develops due to faulty genes that make this chemical and affects mostly young adults and teenagers. When your blood sugar levels escalate due to the failure of response to this hormone, it is known as type 2 diabetes. It is a more common type of diabetes which mostly affects adults and is triggered mainly by lifestyle factors. Factors like unhealthy diet, sedentary lifestyle and obesity are the main contributing factors of type 2 diabetes. In fact, type 2 diabetes is one of the most common ‘lifestyle diseases’ which is plaguing people in the developed countries. It can also increase your risk of conditions like heart diseases and hypertension.
Some of the common symptoms of diabetes are excessive hunger, frequent urination and increased thirst. While type 1 diabetes is quite difficult to manage, type 2 can be controlled by making simple changes in your daily routine.
Types of diabetes
Diabetes affects millions across the globe and India is known as the diabetes capital of the world. Diabetes can be classified into 3 types:
Type 1 diabetes: Also known as juvenile-onset diabetes, it is caused by lack of insulin in the body. This is a genetic disorder.
Type 2 Diabetes: It is a more common type of diabetes, mainly triggered by lifestyle factors like unhealthy eating, sedentary lifestyle, stress, etc.
Gestational diabetes: During pregnancy, there is an increase in the blood sugar levels of the pregnant woman leading to diabetes.
Risk factors of diabetes
Diabetes has emerged as a major threat over the past few decades and is still spreading alarmingly all over the world. A number of factors are responsible for such a heavy burden of diabetes. Here are the top four risk factors of this condition:
Age: As a person ages, several physiological functions are impaired, one of them being your body's capacity to use insulin effectively.
Genes: Faulty genes can be responsible for causing type 1 diabetes. Having certain combination of genes may increase or decrease the risk of this form of diabetes. If your parents were diabetic, you should be extra careful about your lifestyle habits.
Obesity: A British health report has warned that adults with a big waistline are five times more likely to develop type 2 diabetes. According to the report, women with a waist circumference of over 88 cm (34.6 inches) are three times more likely to develop type 2 diabetes.
Smoking: While our dietary habits exert great influence on the development of diabetes, lifestyle factors do have an influence too, most notably smoking. One of the most dreaded complications that comes along with high blood sugar levels is cardiac ailment. The nicotine in cigarettes narrows down the blood vessels and makes them hard, increasing your risk of heart diseases. So, quitting smoking is an essential for everyone, and more so for people living with diabetes.
Causes of Diabetes
Our digestive system breaks down the food we eat into glucose. This glucose is absorbed by our blood with the help of a hormone called insulin produced by beta cells in the pancreas. Diabetes occurs when the body is not able to produce this hormone or is not able to use it effectively. Here are some of the reasons why this happens.
1. Autoimmune destruction of beta cells
Sometimes, our own immune system may recognise insulin-producing beta cells as antigens, and create antibodies to destroy them. Often, diabetes is diagnosed after most of the cells are destroyed. In that case, the patient then needs a daily dose of insulin to survive.
2. Lack of physical activity
Lack of exercise and obesity can be major causes of type 2 diabetes. Just 30 minutes of physical activity reduces the chances of you having diabetes by 30 per cent, suggest some studies. So, make sure you include activities like walking and cycling in your daily timetable. Here are some exercise tips for diabetics that might help.
3. Certain drugs
Certain medicines like nicotinic acid, psychiatric drugs, diuretics, etc. can destroy the beta cells that produce insulin or disrupt its absorption.
4. Pancreatic disease or injury
Since the beta cells are present in the pancreas – any injury or disease, like cancer, pancreatitis, etc. can stop beta cells from functioning and ultimately lead to diabetes.
Symptoms of Diabetes
In diabetes, the body is unable to absorb glucose which leads to a host of problems. Here are some of the symptoms that could indicate diabetes:
Excessive hunger: Diabetes hinders the entry of glucose into your cells from the bloodstream, making you hungry and tired too. This happens due the insufficient production of insulin or ineffective usage of this hormone.
Frequent urination: When blood sugar levels go up, your body makes more urine. This makes you pee more often. Another outcome: You feel thirsty.
Dryness: Overproduction of urine depletes your body of moisture. That is why you feel dehydrated.
Slow healing of injuries: Poor blood circulation caused by high sugar levels can lead to nerve damage. This, in turn, makes it difficult for your body to repair any sort of damage.
Yeast infection: Glucose helps yeast to thrive. So, people with long-term diabetes are likely to get this fungal infection.
Unexplained weight loss: This is typically one of the symptoms of type 1 diabetes. Lack of insulin doesn’t allow food to be broken down into glucose. So your body can’t rely on foods for energy. Instead, it uses your fat and muscles for energy. That’s how you end up losing weight without even trying.
Diagnosis of Diabetes
Diabetes is diagnosed with blood tests. The most important blood examinations used for detecting this condition are:
1. A1C test or glycohaemoglobin test
This test is used for diagnosing Type 2 diabetes. It measures a person’s average blood glucose levels over the past three months. An A1C level below 5.7%falls in the normal range. If it is between 5.7 to 6.4%, it indicates prediabetes which may lead to diabetes if appropriate measures are not taken on time. A person is diagnosed with diabetes if he/she has an A1C level of 6.5% or above.
2. Fasting Plasma Glucose (FPG) test
The Fasting Plasma Glucose test is the most common test used for diagnosing diabetes. It is performed by measuring a person’s blood sugar level, after he/she has fasted for at least 8 hours.
If a person has a fasting glucose level of 126 mg/dL or above, he or she has diabetes. It is advised to repeat the test on another day for confirmation. This test can be performed at home with a glucometer.
3. Postprandial Plasma Glucose Test
This blood test is performed to check how tolerant your body is to glucose. For this test you have to take 75g of glucose orally. Blood sample is drawn two hours after taking glucose. If the reading reveals 200 mg/dl or above, then you are diagnosed with diabetes. A reading between 140 mg/dl and 200 mg/dl indicates impaired glucose tolerance.
3. Oral glucose tolerance test (OGTT)
This blood test determines your body’s ability to metabolise sugar or carbohydrate. It helps to diagnose prediabetes, gestational diabetes and insulin resistance. One has to fast for 8-12 hours before the test. The first blood sample is taken on an empty stomach. The next blood sample is drawn 2 hours after you take a glucose drink. A person is diabetic if the fasting value of the test is over 7.0 mmol/L and the reading at 2 hours is 11.0 mmol/L.
Treatment of Diabetes
The four pillars of diabetes management include constant monitoring at home, oral medicines, insulin shots/pumps, well-planned diet and exercise.
Checking blood sugar levels at home is crucial to figure out your changing need of insulin or medicines. You need to monitor it several times a day at home. A device known as glucometer is used to do so. There are also more sophisticated devices like continuous glucose monitoring systems (CGMS) to help you keep a track of your blood sugar levels. This system can attached to your body to take blood sugar readings every few minutes.
Insulin shots or pumps
People with type 1 diabetes need to take insulin shots. In some cases, type 2 diabetes patients may also need it. The dosage is decided by your doctor based on your condition. There are five types of injectable insulin:
- Rapid-acting (starts working within a few minutes and lasting 2-4 hours)
- Regular or short-acting (starts working within 30 minutes and lasting 3-6 hours)
- Intermediate-acting (starts working in 1-2 hours and lasting up to 18 hours)
- Long-acting (starts working in 1-2 hours and lasting beyond 24 hours)
- Ultra-long-acting (starts working 1-2 hours and lasting 42 hours)
Apart from injectable insulin, there’s a computerised device known as insulin pump. Your doctor will help you set it, according to your requirement.
People with type 2 diabetes may need oral drugs. These medicines function in a number of ways to bring down blood sugar levels. While some increase insulin production by the pancreas, others bring down sugar absorption by the intestine. There are also drugs that improve your body’s insulin efficiency, reduce sugar production by the liver, so on and so forth. Your doctor may prescribe yet another type of drug--the ones that prevent your kidneys from reabsorption of glucose and help you excrete more of it through urine.
Sticking to a well-planned balanced diet is the cornerstone of diabetes management. Work closely with your doctor and nutritionists to plan a balanced meal. Your diet should be well-balanced between carbohydrates, proteins and fats. The quantity needs to be decided by your nutritionist on the basis on your blood sugar levels, body weight and personal preferences. If you are overweight, you may be advised a low-carb, low-fat, and low-calorie meal. Also, you need to avoid trans fats and high-sugar foods. The other food rules include high intake of fruits and vegetables, moderate consumption of alcohol, so on and so forth. Also, following proper mealtimes is essential for diabetics.
Regular workouts improve your body’s ability to use insulin. Exercising at least 30 minutes a day for 5 days a week is good for people living with diabetes. Regular workouts become all the more important if you are overweight. They improve blood circulation and reduce the risk of associated complications like heart diseases, nerve damage, etc.
Complications of Diabetes
Diabetes, if uncontrolled can lead to detrimental health complications.
1. Diabetic ketoacidosis (DKA): Associated with type 1 diabetes this condition occurs when your blood sugar is abnormally high and leads to the build-up of acidic substances called ketones. High levels of ketone can be fatal, if not managed on time. The symptoms of DKA include frequent urination, extreme thirst, high blood sugar levels, nausea or vomiting, abdominal pain, confusion, etc.
2. Diabetic retinopathy: This is an eye problem associated with diabetes.The early symptoms include blurred vision and double vision. It can also cause permanent loss of vision. Diabetes increases the risk of developing cataract and glaucoma too. If you are a diabetic, you need to follow certain eye care measures.
3. Diabetic nephropathy: High blood sugar levels affect your kidneys making them unable to perform their essential functions. This leads to toxin and fluid build-up in the body. If you notice swelling in your feet and legs or around your eyes, it could signal diabetic nephropathy. If you have hypertension (or high BP), your chances of developing this is even higher.
4. Diabetic neuropathy: High blood sugar levels lead to nerve damage, especially in your feet. In severe cases, this condition may need amputation. Uncontrolled diabetes can also affect nerves that control your heartbeat, blood pressure, digestion, blood flow to organs etc leading to diarrhoea, erectile dysfunction, loss of bladder control, vision changes, and dizziness.
5. Heart issues: If you are a diabetic who smokes, have high blood pressure, and are overweight, you have a greater risk of developing heart disease, strokes.
6. Erectile dysfunction: According to some estimate, up to 60-70% of men having diabetes will experience problems with erection in their lifetime. This is because high blood sugar levels affects blood to various parts of the body including your sex organs.
7. Hair loss: Diabetes negatively affects the body’s circulatory system, leading to poor blood circulation to the scalp too among other organs. Reduced blood flow to the scalp leads to the death of hair follicles triggering hair loss. Poor blood circulation may also prevent further hair growth.
Preventive measures for Diabetes
Type 1 diabetes is an autoimmune disorder associated with your genes. There is no way one can prevent it. The risk of type 2 diabetes, on the other hand, can be brought down by lifestyle modifications like healthy eating and regular workouts. You need to be extra cautious if you have a family history of this condition. Stress management is an important factor behind diabetes risk reduction. Practising yoga regularly can help you maintain emotional equilibrium.