Introduction

If you just found out you have diabetes mellitus (in short diabetes), I am sure you have a lot of questions, doubts and may feel a bit uncertain. You are not alone. One among 10 adults in India might be suffering from diabetes. Most of these people lead a healthy productive life. What you can do best right now is to get more information on diabetes. In this article I will try to present a few basics about diabetes.

What is diabetes?

Diabetes is a disease in which your blood glucose, or sugar, levels are too high. It occurs when a person's body doesn't make enough of the hormone insulin or when the body does not respond to insulin properly. There are 2 types of diabetes. Type 1 diabetes occurs when your pancreas fails to produce insulin. Type 2 diabetes occurs when the pancreas either doesn't produce enough insulin or your body does not respond to insulin properly. Most people who are diagnosed with diabetes have type 2 diabetes.

What is type 1 diabetes?

Type 1 diabetes is also called insulin-dependent diabetes. About 10% of affected people have this type. It is sometimes called juvenile diabetes because it is usually discovered in children and teenagers, but some adults up to age of 40 years may also have it.

What is type 2 diabetes?

Type 2 diabetes occurs mainly in overweight persons and usually at an older age. It occurs when pancreas fails to cope up with increased need for insulin as the body cells do not respond properly to insulin.

Can children get type 2 diabetes?

Yes. In the past, doctors thought that only adults were at risk of developing type 2 diabetes. However, an increasing number of children worldwide are now being diagnosed with type 2 diabetes. This increase is possibly because more children are overweight or obese and are less physically active.

What is pre-diabetes?

Pre-diabetes occurs when blood sugar levels are higher than it should be, but not so high that you can be diagnosed to have diabetes. Pre-diabetes is becoming more common. It greatly increases the risk of developing type 2 diabetes.

The good news is that you can take steps to prevent or delay the onset of full-blown type 2 diabetes by making lifestyle changes, such as eating a healthy diet, reaching and maintaining a healthy weight, and exercising regularly.

Can I live a normal life with diabetes?

Yes, you can live a normal life. You can stay healthy if you do what it takes to control your diabetes and related problems like high blood pressure and cholesterol.

Symptoms

What are the symptoms of diabetes?

Symptoms vary from person to person. In the early stages , there may be no symptoms, so you may not know you have diabetes. Even without your knowing, damage may already be happening to your eyes, your kidneys and your heart and blood vessels even before you notice symptoms. A few symptoms of diabetes are:

• Excessive hunger

• Extreme thirst

• Frequent urination

• Unexplained weight loss

• Blurry vision

• Fatigue or drowsiness 

• Slow-healing wounds, sores or bruises

• Dry, itchy skin

• Tingling or numbness in the hands or feet

• Frequent or recurring infections of skin, gum, bladder or vaginal yeast infections

People who have type 2 diabetes may also show signs of insulin resistance, such as darkening and thickening of skin around the neck or in the armpits, high blood pressure,  abnormal cholesterol, and skipped or absent periods in teen girls and women.

 If your blood sugar levels become very high without treatment, a condition calleddiabetic ketoacidosis may develop. If this happens, you may experience shortness of breath, pain in the belly, vomiting, dry mouth, dehydration, and even coma and death if left untreated.

Causes & Risk Factors of Diabetes

What causes diabetes?

Pancreas

A gland called pancreas which is present below the stomach produces a hormone called insulin. This hormone controls the level of sugar in the blood by directing it’s storage in the tissues after intake of food. A lack of insulin in the body or resistance to its action causes diabetes. There is a  "traffic jam" for glucose to exit from the blood vessels (highway) into the tissues(cities). Though glucose is essential source of energy it is also a poison to our body. Hence our body keeps it's levels as low as safely possible. In diabetes too much glucose in the blood can lead to serious health problems that may damage the blood vessels, nerves, heart, eyes and kidneys.

Who are at risk for diabetes? Am I at risk? What can I do to about it?

Diabetes is commonly seen in those people with relatives having diabetes, those without physical exercise, unhealthy food habits, excessive body weight, high blood pressure (B.P.), old age, those with diabetes during pregnancy. Talk to your doctor about your risk factors for diabetes. You can make at least a few changes to significantly lower your risk.

Can you tell me more about the risk factors?

Age

The risk for type 2 diabetes increases with age, especially after 45 years of age. Although you can't change your age, you can work on other risk factors to reduce your risk.

Race/ethnic background

Indians are a high risk ethnic group for diabetes. We still do not exactly know why it it is so. You can't change your ethnicity but definitely reduce other risk factors to prevent or delay the onset of diabetes.

Family history

You can't change your family history, but it is important for you to let your doctor know if diabetes runs in your family. Your risk for diabetes is higher if your mother, father or sibling has diabetes. It's even higher if both parents, multiple members have diabetes. Tell your doctor if anyone in your family has diabetes.

Diet

This one you can modify unlike the ones we saw earlier. A diet high in fat, calories and cholesterol increases your risk of diabetes. A  diet is high in fiber and low in fat, cholesterol, can help in reducing diabetes risk. Also, remember to watch your portion size--how much you eat is just as important as what you eat. Eating till you feel full is not a good practice.

Exercise

Regular exercise and maintaining a healthy weight can reduce your risk of diabetes. Some physical activity is better than none, but we suggest that you try to exercise for 30 to 60 minutes at least five days a week. If you haven't exercised in a while or you have any health problems (eg. Heart disease), talk to your doctor before starting an exercise program.

Diabetes during pregnancy

Also called gestational diabetes. It means diabetes was diagnosed for the first time during pregnancy. Although this diabetes usually goes away after pregnancy, 40% to 60% of women develop type 2 diabetes within 15 years.

Even if they don't have diabetes during pregnancy, women who give birth to large babies who weigh more than 3.5 kg are more likely to develop type 2 diabetes later in life.

Polycystic ovary syndrome (PCOD)

Polycystic ovary syndrome occurs when an imbalance of hormone levels in a women's body. This causes cysts formation in her ovaries. Women with PCOS have increased risk of developing Type 2 diabetes.

Diagnosis

Is it important to prevent, diagnose and treat diabetes?

Yes because untreated diabetes causes blood sugar levels to rise further. This can lead to a number of serious health problems, like:

• Eye damage that can cause blindness

• Kidney failure

• Nerve and blood vessel damage that can lead to the loss of toes or feet

• Heart attacks

• Stroke and paralysis

• Impotence in men

• Problems with gums, including tooth loss

The longer your body is exposed to high blood sugar levels, the greater the risk that problems will occur. Keeping blood sugar levels very close to the recommended values can minimize, delay and, in some cases, even prevent the problems due to diabetes. Reputed studies have shown that better control of diabetes in the earlier days can go a long way in preventing future complications. Compare it to a long term investment in a bank. The earlier you start the better it is!

How can I get diagnosed if I have diabetes?

To check for diabetes, your doctor may request any of the following tests:

Fasting blood sugar testing: It is done usually after an overnight fast of 8 hours. If your blood sugar ≥126 mg/dL, the test may be repeated to confirm. A blood test showing blood sugar level of 126 milligrams per deciliter (mg/dL) or higher on 2 occasions means you have diabetes.

If it is between 100 mg per dL to 125 mg per dL it indicates prediabetes.

Oral glucose tolerance test:  During this test, you will be asked to 75 grams of glucose dissolved in water. Blood sugars are measured at intervals. If the blood sugar rises to 200 mg per dL or more then you have diabetes.

HbA₁C test: Testing is done on a sample of blood drawn at any time of the day. If the value is >6.5% it indicates diabetes, if you have any of the symptoms mentioned above. If not your doctor may ask for a repeat testing to confirm.

Random Blood sugar test: Not commonly done. However if it is >200mg/dL with any of the symptoms of diabetes (like excessive thirst,urination, unexplained weight loss) then it indicates diabetes. If no symptoms your doctor may order one of the other standard tests.

Fasting Plasma Glucose (FPG)		Oral Glucose Tolerance Test (OGTT)