Diabetes mellitus is a disorder affecting protein, fat and carbohydrate metabolism and not just “Sugar”. When we eat, the digested carbohydrates in the form of glucose and similar simple sugars flood the blood, along with other nutrients. That sugar must then enter INSIDE individual cells of the muscles, heart, brain and all other organs to get utilized to release their stored energy. When the glucose cannot enter the cells due to various reasons, that state is called Diabetes, and the hapless sugar left behind in blood causes raised blood sugar to cause diabetes. The cells must overcome their starvation to remain alive. So they burn out all the fats and proteins inside them irrespective of the consequences. This all round cellular deficiency state causes the many complications of diabetes.
4. Other Hormone Effects: There is an old saying in Hindi, “Sari khudai ek taraf aur joru ka bhai ek taraf” meaning the entire world on one side and wife’s brother on the other side!! That is the state with Insulin. While insulin alone lowers blood sugar, every other hormone of the body raises blood sugar. They include all steroid hormones (cortisone, sex hormones, mineralocorticoids, etc), growth hormone, thyroid hormone, adrenaline, nor-adrenaline, plus any drug mimicking their action. Anything that causes excess production of any of these hormones or use of allied drugs, can overcome the sugar-lowering effect of insulin to cause diabetes.
5. Genetic Disorders of pancreas development or insulin receptor development and actions.
Hypo-glycemia: A condition arising due to low blood glucose in the patient takes Insulin injection but forgets to eat
Hyper-glycemia: A technical term for high blood glucose
Polyuria: Excessive urination
Polydipsia: Excessive Thirst
Hyper-Lipidemia: Excessive fats and cholesterol in blood due to their non-utilisation
Hypo-Lipidemia: Lack of insulin starves body of glucose, body begins metabolizing fatty acids as energy source.
Polyphagia :Excessive Hunger
Glycosuria: Presence of Sugar in the urine
Ketoacidoses: When cells starve and burn stored fats, a byproduct is Ketones that build up in blood, making it very acidic with dropping Ph, which may be life-threatening.
Ketonuria: Ketones in urine
Macular degeneration: Degeneration of specific parts of the visual layer (retina) due to diabetes
Type 1 diabetes can occur at any age but usually appears between infancy and the late 30s, most typically in childhood or adolescence. Males and females are equally at risk. Studies report the following may be risk factors for developing type 1 diabetes:
Being ill in early infancy
Having a parent with type 1 diabetes (the risk is greater if a father has the condition)
Having an older mother
Research suggests that vitamin D may be protective against type 1 diabetes. However, early drinking of cow’s milk — a common source of vitamin D — has been linked to an increased risk of type 1 diabetes.
Having a mother who had preeclampsia during pregnancy
Having other autoimmune disorders such as Grave’s disease, Hashimoto’s thyroiditis (a form of hypothyroidism), Addison’s disease, multiple sclerosis (MS), or pernicious anemia
Very high blood sugar (glucose) level can develop quite quickly – over several days. If left untreated this causes lack of fluid in the body (dehydration), drowsiness, and serious illness which can be life-threatening.
In case of long-term complications, If the blood glucose level is higher than normal, over a long period of time, it can have a damaging effect on the blood vessels. Even a mildly raised glucose level which does not cause any symptoms in the short term can affect the blood vessels in the long term. This may lead to some of the following complications (often years after diabetes is first diagnosed):
Furring or hardening of the arteries (atheroma) which can cause problems such as angina, heart attacks, stroke and poor circulation.
Eye problems which can affect vision. This is due to damage to the small arteries of the retina at the back of the eye.
Kidney damage which sometimes develops into kidney failure.
Damage to the pancreas itself due to gluco-toxicity
Foot problems. These are due to poor circulation and nerve damage.
Impotence. Again, this is due to poor circulation and nerve damage.
Other rare problems.
Glycated hemoglobin (HBA1C) test. This blood test indicates the average blood sugar level for the past three months. It works by measuring the percentage of hemoglobin, the oxygen-carrying protein in red blood cells, attached to by blood sugar and denatured. The degree of denaturation depends on the level of blood sugar at the moment the RBC was released from bone marrow into peripheral circulation. The higher the blood sugar levels, the more the level of denatured hemoglobin. An HBA1C level of 6.5 percent or higher on two separate tests indicates the diabetes.
Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when the patient last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst.
Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it’s 126 mg/dL (7 mmol/L) or higher on two separate tests, indicates diabetes.
Insulin Injection : In most cases of type 1 diabetes, patient need to have insulin injections. Insulin must be injected because if it were taken as a tablet, it would be broken down in stomach, just like food, and would be unable to enter the bloodstream. Insulin injections are either given with a syringe or an injection pen, which is also known as an insulin pen or auto-injector. Most patient need two-to-four injections a day.
Insulin Pump Therapy: Insulin pump therapy is an alternative to injecting insulin. An insulin pump is a small device that holds insulin. The pump is attached to the patient by a long, thin piece of tubing, with a needle at the end, which is inserted under the skin. Most people insert the needle into their stomach, but it could also insert into hips, thighs, buttocks or arms.
The pump allows insulin to flow into the bloodstream at a rate that patient can control. This means patient no longer need to give themselves injections, although they will need to monitor their blood glucose levels very closely to ensure the right amount of insulin going to their body.
– Cardiac risk reduction is the most important management issue for diabetes patient.
Glucose Control :
Lifestyle modification and nonpharmacologic options include eating healthy diet that spreads carbohydrate throughout the day
Find a balance between food intake and physical activity.
Get at least 30 minutes of moderate -intensity physical activity on most days
No smoking and drinking alcohol
Type 2 is the most common form of diabetes used to be known as adult-onset diabetes, because it used to be most frequently diagnosed in adults. However, now kids are regularly diagnosed with type 2 diabetes as well. About 90-95%, the overwhelming majority, of people with diabetes have type 2 diabetes. In type 2 diabetes, the pancreas makes some insulin but it is not ale to attach to its receptors on the cell wall in order to work effectively. With type 2 diabetes, the sugar stays in the bloodstream, where it builds up and becomes too high.
Symptoms of type 2 diabetes may include the symptoms of type 1 diabetes, such as
– Increased thirst and hunger
– Frequent urination
– Initially, there is moderate to severe weight gain. After the pancreas fails, there is weight loss.
– Blurry vision
– Feeling very tired
– Infections of the skin, gums, or bladder
– Scrapes or bruises healing slower than usual
– Tingling or numbness in the limbs
A family history of diabetes. If a parent or sibling in your family has diabetes, your risk of developing type 2 diabetes increases.
Age over 45. The chance of getting type 2 diabetes increases with age.
Race or ethnic background. The risk of type 2 diabetes is greater in Hispanics, African-Americans, Native Americans, and Asians.
Metabolic syndrome (also called insulin resistance syndrome).
Being overweight. If you are overweight, defined as a body mass index (BMI) greater than 25, you’re at higher risk of type 2 diabetes. Also, fat around the waistline as opposed to fat in the buttocks and legs is a risk factor.
Hypertension. High blood pressure increases the risk of developing type 2 diabetes.
Abnormal lipid levels. HDL (“good”) cholesterol levels under 35 mg/dL (milligrams per deciliter) and/or a triglyceride level over 250 mg/dL increases your risk of type 2 diabetes.
History of gestational diabetes. Getting diabetes during pregnancy or delivering a baby over nine pounds can increase your risk of type 2 diabetes.
Impaired glucose tolerance. A fasting blood glucose over 100 mg/dL may indicate the impaired fasting glucose tolerance (IFT) while a blood sugar level 140 to 180 mg/dL indicates impaired glucose tolerance (IGT). Left untreated, 70 percent of people with IFG or IGT (pre-diabetes) will progress to diabetes. A fasting blood glucose of 126mg/dL and above on two occasions indicates diabetes. Random blood glucose value of 200mg/dL or more is indicative of diabetes.
Women who have gestational diabetes during pregnancy also have a greater risk of developing diabetes in later life.
1. Basic Requirements: Balanced diet, good micronutrient support, regular exercise totaling 150 minutes per week in at least five installments, total abstinence from tobacco in any form, and avoidance of alcohol (as it interacts with many anti-diabetic agents, besides being harmful).
2. Metformin: This drug enhances the attachment of insulin to its receptors, and is the sheet anchor of all therapies except in advanced liver or kidney disease and severe stress.
3. Pioglitazone: Again a re-sensitizer for insulin receptors, but heart and blood related side effects in certain populations have limited its usage.
4. Sulfonylureas: These drugs force the pancreas to release its stores of pro-formed insulin. Some are too long acting and are not preferred today. Some are excreted by liver (e.g. glimipride) and hence are a better choice in kidney disease and vice versa (e.g. gliclazide). The selection depends on the doctor.
5. Alpha-glucosidase Inhibitors: These drugs (e.g. acarbose and voglibose) reduce the rate and degree of glucose absorption in the gut, and may help in obese patients and those just won’t follow a restricted diet.
6. DPP-IV Inhibitors: These drugs (e.g. gliptins) help to gradually increase the mass of insulin producing cells in the pancreas, and also make the insulin work more efficiently. Though of lower efficacy, they thus perform a vital function to restore blood sugar control.
7. Incretin-mimetic Injections: These drugs (e.g. exenatide) also increase insulin producing cell mass in pancreas, lower release of glucagon: a hormone with the opposite action, and enhance the activity of insulin to control blood sugar. Its exorbitant cost is a very big limiting factor.
8. Insulin Injections: Insulin is now made with the help of specific micro-organisms whose DNA has been altered to make them manufacture human insulin, which is then extracted from the culture liquid. Addition of various side chemicals makes the insulin work from 6 to 24 hours or more, to suit individual patient requirements. In times of stress, or when the pancreas is too far damaged due to long standing diabetes, Insulin remains our only answer.