Diabetes

Diabetes is a lifelong condition which occurs when your blood glucose levels are high. What is that? When you eat, your body turns those foods into glucose. Glucose is a type of simple sugar formed in the body during digestion. Insulin helps in proper utilization of glucose. This insulin helps the glucose to get into your cells and use it for energy. 

Types of Diabetes 

Type 1 Diabetes

Type 1 diabetes is an autoimmune disease, caused due to a disturbed immune system which attacks the beta cells of the pancreas (beta cells of the pancreas secrete insulin). This destroys the beta cells of the pancreas and thereby leads to a deficiency of insulin (deficiency of insulin causes an increase in blood sugar).

The duration of symptoms of type 1 diabetes is usually short, but the destruction of beta cells starts long before the symptoms appear. The common symptoms of type 1 diabetes are dry mouth, increased thirst and frequent urination, increased hunger, weight loss, patches of dark skin, and fatigue or excessive tiredness. Delay in diagnosis or treatment in a person with type 1 diabetes can cause a life-threatening diabetic coma. It is known as diabetic ketoacidosis (characterised by highly elevated blood sugar levels, the presence of ketone compounds in the blood and urine, and dehydration).

Type 2 Diabetes

This is the most common type of diabetes. Type 2 diabetes mostly affects older people. Some of the risk factors of developing Type 2 diabetes are obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and race. However, lately Type 2 diabetes is increasingly being diagnosed in children and adolescents.

Gestational Diabetes 

Gestational diabetes is the type of diabetes that develops during pregnancy (high blood glucose levels are first diagnosed during pregnancy). It affects about 4% of all pregnancies and mostly resolves after the baby is born. In gestational diabetes like type 1 and 2 diabetes, glucose is not properly utilized by the cells of the body and it leads to high blood glucose levels. Hormonal changes during pregnancy and the increased demand for insulin as pregnancy advances can result in gestational diabetes.

Gestational diabetes indicates the type of diabetes that pregnant women develop. The risk of type 2 diabetes in the future is increased in women with a history of gestational diabetes.

Diabetes should be diagnosed as early as possible because the disease causes several complications and can be deadly if not detected in time. It is important to be aware of the early warning signs of diabetes as the condition does not cause noticeable symptoms in most of the cases.

Early Warning Signs of Diabetes 

Increased Thirst and Frequent Urination

Do you feel that you spend most of the day going to the toilet? These could be symptoms of diabetes. Increase in the blood sugar level causes fluids to move out from your cells. This makes you feel thirsty and you drink more water which in turn leads to frequent urination. The high blood glucose levels cause loss of glucose in urine, which will take water from your blood and causes your bladder to fill up and finally result in frequent urination.

Increased Hunger

People with diabetes feel hungry as their body cannot use the glucose in the blood because the hormone, insulin is not doing its function properly. So the cells of the body are depleted of energy and you feel hungry more frequently.

Weight gain

If you are obese, you are at greater risk of diabetes. Also, weight gain is one of the complications of diabetes. Addition of pounds in the midsection is directly related to insulin resistance and pre-diabetes.

Unusual Weight Loss

This is more common in people with type 1 diabetes as the inability of the body to use glucose leads to tissue breakdown (fat and muscle break down). This causes weight loss.

Increased Fatigue

Even though there is abundant glucose in the blood. The cells starve as your body cannot use the glucose in the blood due to lack of insulin and don’t get their essential energy. So you feel tired and fatigued.

Blurred Vision

Elevated glucose levels in the blood lead to a loss of fluid from the lenses of your eyes. This can affect your ability to focus and see clearly. If diabetes remains untreated or uncontrolled, blindness or prolonged vision problems can occur.

Slow-healing Sores or Frequent Infections

If your cuts and bruises take a much longer time than usual to heal then get your blood sugar tested. It can be because of diabetes. Elevated blood sugar (glucose) impairs the ability of your body to heal and can lead to frequent infections. The incidence of bladder and vaginal infections in women increases considerably.

Other Symptoms

Sexual dysfunction among men over 50 years of age can experience frequent or constant erectile dysfunction. This caused due to damage to the nerves due to high blood sugar. A diabetic person with severe hyperglycaemia or severely elevated glucose levels for a long time (several hours or days) can have other symptoms.

• Dehydration
• Difficulty in breathing
• Giddiness on standing
• Weight loss
• Drowsiness, stupor and confusion
• Loss of consciousness or coma

If you have symptoms suggestive of elevated glucose levels, get your blood sugar levels tested. Even though the signs and symptoms of diabetes seem harmless initially, an early diagnosis of diabetes improves the overall prognosis and decreases the chances of serious complications due to diabetes.

Some of the factors which increase the risk of developing diabetes are modifiable while others are not modifiable. Factors that increase the risk of diabetes include:

Obesity

Obese people are more likely to develop type 2 diabetes. Obesity increases insulin resistance, as fat affects the body's ability to use insulin. Obesity increases the risk of diabetes in children as well.

Sedentary Lifestyle

A sedentary lifestyle is responsible for the problem of type 2 diabetes. Regular exercise or any other physical activities is considered adequate for healthy living. Physical activity decreases insulin resistance, thereby lowers blood sugar levels and helps in maintaining healthy body weight.

Unhealthy Eating Habits

Eating unhealthy foods leads to obesity. Eating a healthy and balanced diet which has a variety of foods from each major food group, can prevent diabetes or control blood sugar in diabetes patients.

Family History and Genetics

The exact contribution of heredity or genetics in diabetes is not well understood. But it is well known that certain genetic variations are responsible for an increased risk of developing diabetes. People with a family history of diabetes are at a higher risk of development of diabetes. But changes in lifestyle can decrease your risk of developing diabetes even if you have a persistent family history of diabetes.

Increased Age

It is true that the risk of diabetes increases with age. However, by adopting a healthy lifestyle you can decrease your risk of developing diabetes with an increase in age.

High Blood Pressure and High Cholesterol

Both these conditions increase the risk of several diseases such as heart attack, stroke and diabetes. By adopting a healthy lifestyle and healthy eating habits, you can decrease high blood pressure and high cholesterol and thereby prevent the risk of diabetes.

Type 1 Diabetes 

Glycated haemoglobin (A1C) test

This is the test which shows the average blood sugar level for the past two to three months. The test is conducted by measuring the percentage of blood sugar attached to haemoglobin, which is the oxygen-carrying protein in red blood cells. The higher your blood sugar levels go, the more haemoglobin will be attached to your sugar. When there is an A1C level of 6.5 percent or higher on two separate tests, then that would indicate that you have diabetes.

Random blood sugar test

For this test, your blood sample will be taken at a random time. Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher will suggest that you have diabetes. The suspicion will increase if the result is coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst.

Fasting blood sugar test

There is another sort of blood sugar test that is taken by collecting the sample of your blood after an overnight fast. If your fasting blood sugar level is less than 100 mg/dL (5.6 mmol/L) then it is normal. If your fasting blood sugar level is somewhere from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes, and if it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.

Type 2 Diabetes 

If you experience symptoms similar to those of type 2 diabetes, make sure that you visit your general physician. After asking certain questions pertaining to your family history and symptoms experienced, he/she will recommend further tests to arrive at a confirmed diagnosis.

Blood and Urine Tests

When it comes to testing for diabetes, the doctor looks for the presence of glucose in the blood or urine. In diabetics, the glucose can overflow from the kidneys into the urine. If your doctor sees that your urine sample has glucose in it, he/she will further ask you to undergo a specialised blood test, referred to as the glucose tolerance test. This test can finally confirm if you have diabetes or not.

Glucose Tolerance Test

A glucose tolerance test is also called an oral glucose tolerance test, which can show whether one’s body is going through problems processing the glucose or not. Before you undergo the test, it is important that you avoid eating or drinking certain types of fluids for at least 8-12 hours. If you take medications for any other medical problem, you will have to tell your doctor about it. This is critical because certain medications can dilute the urine.

Before the test is done, a blood sample is taken to measure the level of glucose present in it. Post this you will be given a glass of glucose drink followed by another measurement of the glucose level present in your blood after two hours.

Gestational Diabetes 

Fasting Blood Glucose or Random Blood Glucose Test

For the fasting blood glucose test, your doctor will advise you to fast for at least 8 hours (which means that you have nothing to eat or drink except water for at least 8 hours). In random blood glucose test your blood glucose is tested at any time during the day. Both these tests can detect gestational diabetes in some women, but your doctor may recommend other tests to be sure that diabetes is not missed.

1-hour Glucose Tolerance Test

The 1-hour glucose tolerance test is done on pregnant women to screen for gestational diabetes. Unlike the 3-hour glucose tolerance test, you will not be advised to fast prior to this test. For this test, you will be given 50 gm of glucose solution to drink. The solution has to be consumed within 5 minutes. Some women may feel nausea after drinking the solution as it is very sweet. The blood sample for glucose testing is taken after 1 hour. Based on the results of the 1-hour glucose tolerance test the following diagnoses may be made:

Normal screen: if the blood sugar level is <140 mg/dL (7.8 mmol/L)

Abnormal result: If the blood sugar level is >140 mg/dL (7.8 mmol/L) (OGTT is recommended)

3-hour glucose tolerance test: The 3-hour glucose tolerance test is considered as the gold standard for making the diagnosis of type 2 diabetes but it is presently most often done to diagnose gestational diabetes. If the result of the 1-hour glucose tolerance test is abnormal, the 3-hour glucose tolerance test is recommended to confirm the diagnosis of gestational diabetes.

You will be advised to fast overnight (at least 8 but not more than 16 hours) before the 3-hour glucose tolerance test. The next morning, a sample for fasting plasma glucose level is taken.  After this, you will be given 75 grams of glucose (100 grams for pregnant women) solution to drink. Then blood samples are taken to measure the blood glucose. In the classic test blood glucose level is measured five times over a period of 3 hours.

Gestational diabetes is diagnosed based on 3 hour glucose tolerance test if any two of the following after 100g OGTT is positive:

• Fasting plasma glucose > 95 mg/dl.
• 1-hour glucose > 180 mg/dl.
• 2-hour glucose level > 155 mg/dl.
• 3-hour glucose level > 140 mg/dl.

Glucose tolerance test can help in early diagnosis of gestational diabetes. Early diagnosis and appropriate management can help to prevent the gestational diabetes-related complications both in the mother and baby.

Treatment of Diabetes 

This is a serious disease that cannot be treated on its own; you will need a doctor’s assistance. You must keep a watch on your blood sugar levels along with taking medications, exercising and eating a healthy diet. 

Natural Ways to Treat Diabetes 

It is not easy to eradicate the disease from your system but with a combination of medication with some natural ways can help treat the problem. 

Healthy diet 

Many studies have recommended that patients with type 1 diabetes should adhere to a low-glycemic index diet for better control over soaring blood glucose levels. Foods with low glycemic index, such as oats, whole wheat, fruits (apple, grape, grapefruit, pears and coconut) and vegetables (carrots, cabbage, cauliflower, beans and peas) should form a major portion of a diabetic’s diet.

Exercise 

Regular exercise can slow down the progression of diabetes. Even moderate physical exercise such as brisk walking, dancing, swimming or jogging can help you with the disease. 

The treatment generally aims to keep blood sugar levels between 80 and 120 mg/dL (4.4 to 6.7 mmol/L) in the daytime and between 100 and 140 mg/dL (5.6 to 7.8 mmol/L) during the night. Therefore, you must understand that the treatment of diabetes is basically a lifelong commitment to taking insulin, exercising regularly, maintaining a healthy weight, eating healthy foods and monitoring the blood sugar levels.