Rapid urbanization and industrialization have produced advancement on the social and economic
front in developing countries like India. This has resulted in dramatic lifestyle changes leading to
lifestyle related diseases. The transition from a traditional to modern lifestyle, consumption of diets
rich in fats and calories, combined with a high level of mental stress has compounded the problem further.
Various studies and programs in the west have shown that a modification in lifestyle and proper
medication can delay and prevent diabetes in high risk groups. These studies also reported a blood
sugar level reduction among the obese people who reduce their weight.
But, the results of the studies are not applicable to the Indian population because, Indians differ
in anthropometric (human body measurement) and biochemical features that increase the risk of diabetes.
Indians are relatively non-obese but highly insulin resistant. The onset of diabetes in Indians is
significantly at a young age compared to their Western counterparts.
Unveiling Diabetes : Know, Identify, Tame
To understand diabetes, it is important to first understand the normal process by which food is
broken down and used by the body for energy.
Several things happen when food is digested:
- A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
- An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream
into muscle, fat, and liver cells, where it can be used as fuel.
- People with diabetes have high blood sugar. This is either because, their pancreas do not make enough
of insulin (autoimmune) or the body cells do not respond to insulin produced insulin resistance)
Insulin acts just like a key, opening the way for glucose coming from the food we eat to enter the cells
where it will be transformed into energy.
Without insulin, glucose will not be able to enter the cells and will remain in the blood stream. As a
result, glucose level in the blood will rise.
Types of Diabetes
Type 1 diabetes
This is known as 'Juvenile diabetes' in which autoimmune destruction of insulin producing cells (beta cells
of pancreas) occur which results in the production of little or no insulin. The exact cause is unknown but genetics,
viruses, and autoimmune problems are suggested to play a role. Usually it is diagnosed in childhood or in teenage.
Symptoms of Type 1 diabetes
1. Fatigue
2. Nausea
3. Vomiting
4. Blurred vision
5. Increased thirst
6. Increased appetite
7. Increased urination
8. Weight loss in spite of increased appetite
Type 2 diabetes
Type 2 diabetes is far more common than type 1. It makes up most of the diabetes cases. It usually
occurs in adulthood, but reports show that the diagnosis rate among young people has increased.
In type 2 diabetes, body cells (fat, liver, muscle) do not respond correctly to insulin, showing insulin
resistance. As a result blood sugar does not enter into the cells and remains in the blood itself causing
'hyperglycemia'. Many people with type 2 diabetes are not aware they have it, although it is a serious
condition. Type 2 diabetes is becoming more common due to increasing obesity and lack of exercise.
Symptoms of Type 2 diabetes
1. Gradual weight gain
2. Increased appetite
3. Increased thirst
4. Increased urination
5. Irritability & fatigue
6. Poor wound healing
Gestational diabetes
Pregnant women who never had diabetes before but, have high blood sugar (glucose levels during pregnancy
are said to have gestational diabetes. Gestational diabetes affects about 4% of all pregnant women. It may
precede the development of type 2 diabetes (or rarely type 1).
Symptoms of Gestational diabetes
Usually there are no symptoms, or the symptoms are mild and are not life threatening to the pregnant
woman. Often, the blood glucose level returns to normal ranges after delivery.
Risk Factors
Type 1 diabetes
Type 1 diabetes is believed to be an autoimmune disorder. The body's immune system attacks the
cells of the pancreas that produce insulin.
- A predisposition to develop type 1 diabetes may run in families, but the genetic causes (a positive
family history) is much more common for type 2 diabetes.
- Environmental factors, including common unavoidable viral infections,may also contribute.
- Type 1 diabetes is slightly more common in men than in women.
Type 2 diabetes
Type 2 diabetes tends to run in families. Several genes have been identified and more are under study,
which may relate to the causes of type 2 diabetes. Risk factors for developing type 2 diabetes include
the following:
- High blood pressure
- High blood triglycerides (fat) levels
- Gestational diabetes or giving birth to a baby weighing more than 4 kgs
- Consuming high-fat diet
- Chronic alcoholism
- Sedentary lifestyle
- Obesity or being overweight due to ethnicity, particularly when a close relative had type 2 diabetes or
gestational diabetes
- Aging: Increasing age is a significant risk factor for type 2 diabetes. Risk begins to rise significantly
from about the age of 45 years, and rises considerably after age of 65 years.
Diabetes Causing Different Conditions
Indian culture is unique and diverse, yet, one thing that predominates our culture is the significance
that sweets have in our festivities and celebrations, Sweets are an ineluctable part of our life. We love
to relish the taste of sweets, preferably home made and if not available in any form of sweets that we
can devour for that matter. But, does everyone get to enjoy this joy throughout their life? This question
reminds us about the ghost that haunts all the sweet lovers...the fear of Diabetes! The unfortunate part
of diabetes is that it not only affects glucose levels in the blood, but can also affect various other metabolic
processes in our body. It is a disorder characterized by increased blood sugar levels resulting from defects
in insulin secretion or insulin action or a combination of both.
1) Diabetes and Thyroid
Disturbed thyroid functions are more commonly seen in type 1 diabetic patients as compared to type 2
diabetic patients. Thyroid disorders are observed in 13.4% of the diabetic individuals and also, female
diabetic patients are found to be more affected (31.4%) as compared to males (6.9%). Also, 30% of the
female with type 1 diabetes have thyroid disease.
Thyroid disorders and diabetes mellitus are two of the most common endocrine disorders which are
known to mutually influence each other. Dysfunction of thyroid gland can adversely affect glucose control
in diabetics. Raised thyroid hormone levels (hyperthyroidism) increases the absorption of glucose from
the gastrointestinal tract. It can also cause greater resistance to insulin, increasing the rate of insulin
degradation (breakdown), thereby leading to a rise in blood glucose levels. Decreased level of thyroid
hormone (hypothyroidism), has a reverse effect, thus causing reduction in blood glucose level and complicating
diabetes management in thyroid patients. Type 1 diabetic patients have a higher prevalence of autoimmune
thyroid disorders compared to normal population.
Common Risk Factors for Thyroid Disorder and Diabetes
- Age
- Gender
- Change in body mass index-BMI (weight)
- Genetic factors
- Family history of the disorder
- Smoking
- Pregnancy
Symptoms of hypothyroidism (less thyroid hormone/under active) include weight gain, constipation, dry
skin and sensitivity to cold. Overactive thyroid may lead to symptoms such as weight loss, excess sweating,
chest pain, cramps, diarrhea and nervousness.
2) Diabetes and Osteoarthritis
A published report based on studies conducted on adults ranging from 18-64 years has shown the
prevalence of arthritis to be 52% in type 2 diabetes patients as compared to 27% in those without diabetes.
Both Diabetes and osteoarthritis are the leading cause of disability, especially in obese individuals. Diabetes
can lead to serious complications like kidney failure, amputation of lower limbs, heart disease and stroke.
Whereas, osteoarthritis can affect the overall productivity and activities of an individual due to severe pain
and stiffness of the joints. It can result in loss of flexibility, a sensation of bone rubbing together, weight gain,
stress fractures, deterioration of ligaments around joints and bone death.
Common Risk Factors for Osteoarthritis and Diabetes
- Age
- Overweight or Obesity Risk factors needing further studies
- High blood pressure
- Dyslipidemia (Increased blood cholesterol)
- Impaired glucose tolerance (pre-diabetic state)
The two conditions are common among aging population and people suffering from type 2 diabetes. Diabetic
individuals at the same time has an increased susceptibility of developing osteoarthritis. The reason for this
is still not entirely clear but, both have certain common risk factors like obesity and age. According to experts,
osteoarthritis is also associated with systemic Metabolic disturbances which is majorly seen in type 2 diabetes.
This suggests that diabetes can influence the pressure onset of osteoarthritis even in the absence of obesity
or aging
3) Diabetes and Non Alcoholic Fatty Liver Disease (NAFLD)
Studies indicate that up to 70% of the patients with diabetes show presence of NAFLD. A diabetic condition
indicates some degree of relative insulin deficiency. Any degree of insulin insufficiency, especially in obese
individuals, will result in increased breakdown of stored fat. This further will lead to elevated levels of circulating
free fatty acids (FFAs) which are products of fat breakdown, thus resulting in their increased uptake by the liver.
Majority of the NAFLD cases has underlying links to type 2 diabetes mellitus (T2DM) and obesity.
Common Risk Factors for NAFLD and Diabetes
- Obesity
- Lack of physical activity
- Genetic factors
- Hyperlipidemia (Increased lipids in blood)
- High triglycerides
- Smoking and life style
In the early stages of the disease symptoms such as fatigue, weight loss and weakness begin to appear.
Once the disease progress and enters a more advanced stage, cirrhosis (scarring) develops. An individual
with cirrhosis may develop fluid retention, decrease in muscle mass bleeding from the intestine and
eventually liver failure.
4) Diabetes and Obesity
Studies indicate that 85.2% of people with Type 2 diabetes are overweight or obese. When examined on
the basis of BMI, diabetes was found to be more prevalent among those who were obese (18.0% to 20.1%),
suggesting a link between diabetes and obesity.
Obesity and diabetes are complex conditions caused due to a spectrum of factors and they significantly
raise the risk for cardiovascular diseases (CVD) and stroke. Obesity has been successfully correlated to
diabetes. In obese individuals, insulin sensitivity and B-cell (insulin secreting cells of the pancreas) function
decreases whereas, resistance to insulin increases. Other risk factors associated with obesity include
musculoskeletal disorders and cancers involving certain parts like endometrium, breast, ovaries, prostate,
liver, gallbladder, kidney and colon. It has also been reported that increasing body weight in young age
groups increases the risk of developing type 1 diabetes.
Common Risk Factors for Obesity and Diabetes
- Low physical activity
- Sedentary life style
- Genetics
- pregnancy
Weight gain usually happens over time. Most people know when there is an increase in weight. Some
of the signs of overweight and obesity are clothes becoming tight or needing a larger size, extra fat around
the waist, higher body mass index and increased waist circumference.
Diabetes is the root cause of various other disorders affecting numerous organ systems and the overall
metabolism of the body. It can be managed with proper awareness, healthy diet, active lifestyle and good
exercise. Hence, say "No" to diabetes and bid goodbye to the associated maladies it brings in.
Complications of Diabetes
Both forms of diabetes ultimately lead to high blood sugar levels, a condition called hyperglycemia.
Over a long period of time, hyperglycemia damages the retina of the eye, the kidneys, the nerves and
the blood vessels.
- Diabetic retinopathy (damage to the retina from diabetes) can cause blindness.
- Kidney damage due to diabetes (diabetic nephropathy) leads to eventual kidney failure.
- Impairment to the nerves due to diabetes (diabetic neuropathy), results in foot wounds and ulcers,
which frequently lead to foot and leg amputations.
- Damage to the nerves of the autonomic nervous system can lead to paralysis of the stomach
(gastroparesis), chronic diarrhea and an inability to control heart rate and blood pressure during
postural changes.
- Diabetes accelerates atherosclerosis (the formation of fatty plaques inside the arteries) which can
lead to blockages or clot formation (thrombus).
Such changes can then lead to heart attack, stroke and decreased circulation in the arms and legs
(peripheral vascular disease)
- Diabetes predisposes people to high blood pressure and high cholesterol and triglyceride levels.
These conditions independently and together with hyperglycemia increase the risk of heart disease,
kidney disease & other blood vessel complications.
- Many infections are associated with diabetes, which are frequently more dangerous in these affected
people because the body's normal ability to fight infections is impaired. To compound the problem,
infections may worsen glucose control, which further delays recovery from an infection.
- Hypoglycemia, or low blood sugar, occurs from time to time in most people with diabetes. It results from
taking high dosage of diabetes medication or insulin (sometimes called an insulin reaction), missing a
meal, doing more exercise than usual, drinking too much alcohol or taking certain medications for other
conditions. It is very important to recognize hypoglycemia and be prepared to tackle it at all times.
Headache, feeling dizzy, poor concentration, tremors of hands and sweating are common symptoms of
hypoglycemia. A person can even faint or have a seizure, if the blood sugar level gets too low.
- Diabetic ketoacidosis is a serious
condition (mostly seen in type 1 diabetes mellitus) wherein uncontrolled hyperglycemia (usually due to lack
of insulin) over time creates a buildup of the acidic waste products called ketones in the blood. High levels
of ketones can be very harmful. This typically happens to people with type 1 diabetes who do not have good
blood glucose control. Diabetic ketoacidosis can be precipitated by infection, stress, trauma, missing
medications like insulin, or medical emergencies like stroke and heart attack.
Hyperosmolar hyperglycemic nonketotic syndrome is a serious condition (mostly seen in type 2 diabetes
mellitus) in which the blood sugar level gets very high(>100). The body tries to get rid of the excess blood
sugar by eliminating it in the urine. This increases the amount of urine significantly and often leads to
dehydration; so severe that it can cause seizures, coma, and even death. This syndrome typically occurs in
people with type 2 diabetes who are not controlling their blood sugar levels, who have become dehydrated,
or who have stress, injury, stroke, or are taking certain medications, like steroids.
Various Tests for Diabetes
1. Fasting and post prandial blood glucose level
In this test, a blood sample is taken after over night fasting (10 to 12 Hrs). Blood sugar level ranging from 100 to
125 mg/dL is considered as prediabetes, which is sometimes also referred as impaired fasting glucose.
Whereas, blood sugar level <100 is considered as non diabetic and sugar level above 126 is an
of diabete
2. Oral glucose tolerance test
In this test, blood sugar levels from 140 to 199 mg/dL is considered as predibetes. If glucose level is
2 200 mg/dL, a diagnosis of diabetes is made and if it is <140 the patient is considered as non diabetic.
The patient is asked to take glucose drink and blood glucose level is measured before and after 2 Hrs of
the intake of sugary drink. (This test is used more for type 2 diabetes and to detect gestational diabetes.)
3. Random (non-fasting) blood glucose level
Diabetes is suspected if blood glucose level is 200 mg/dL and is accompanied by the classic diabetes
symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)
4. Urine glucose / sugar
Typically, there is very little or no sugar (glucose) in urine, but when blood sugar
levels in the body are too high, excess sugar can be detected in the urine. This can be seen incase of
gestational diabetes, a form of diabetes that only develops during pregnancy. It occurs when pregnancy
hormones disrupt the body's ability to use insulin, an enzyme (chemical) that converts blood sugar
(glucose) into energy.
5. HbAlc test
HbAlc,also known as Alc is the glucose bound to hemoglobin molecule (glycated hemoglobin).
It is a reliable biomarker that evaluates chronic hyperglycemic condition by measuring the percentage of
glycosylated hemoglobin in blood. The test indicates cumulative glycemic history over 2-3 months (as
lifespan of RBC is around 120 days). The results are equally efficient for diagnosing and monitoring type
1 and type 2 diabetes.
6. Fructosamine test
It is a marker of glucose control that reflects the average glycaemic level of preceding 2-3 weeks. Results
of this test represents glycaemia which may be beneficial to monitor rapid metabolic alterations or changes
in diabetic patients. It is also proposed as a suitable parameter to screen gestational diabetes, as HbA1c
level drops due to physiological changes during pregnancy
7. Blood and Urine Ketones
When fat is broken down for energy instead of carbohydrates, the results are acidic byproducts known as
ketones. Its buildup can be measured by checking ketone levels in blood and urine. However, testing of
blood ketones gives a clearer picture, as it can detect all types of ketone bodies. Presence of large quantities
of ketones in urine or blood indicate ketoacidosis, which can lead to diabetic coma.
8. Serum Insulin
Insulin is a hormone produced by beta cells of the pancreas. It helps to transport glucose into the cells
and maintain blood glucose levels. For hearty functioning of the body, insulin and glucose should be in
balance. Abnormal results in serum insulin test indicate Type 1 diabetes or Type 2 diabetes. It may be
done when an individual has insulin resistance and also, to diagnose hypoglycemia, This test is generally
suggested to people with diabetes, polycystic ovary syndrome (PCOS), prediabetes, obesity, heart disease
and metabolic syndrome.
A urine test alone does not diagnose diabetes. They are less accurate and are difficult
to understand, and also, levels of sugar in the blood required to produce sugar in the urine changes from
person to person. A person can have elevated blood sugar levels without having sugar in the urine.
Above all the tests, the most important tests to determine diabetes are 'Hemoglobin Alc' (Hba1c)
and fructosamine.
