Diabetes And Its Management

by Akash Mishra web designer

For thirty-four-year old Rekha, the symptoms began with excessive thirst and hunger. She paid this no heed, believing it to be nothing more than a change in her eating and drinking habit. Frequent urination followed this. Rekha tossed it aside by applying simple logic. The more she will drink the more she will feel like going to the washroom.

It was not until she began feeling tired and losing weight, Rekha started to think about something else at work. She became irritable. Her eyes blurred every now and then. Soon skin infections and slow healing wounds joined on the list of her problems. Rekha couldn't take it anymore and she quickly visited a doctor. The doctor diagnosed her with diabetes.

What is diabetes?

The term diabetes is the reduced version of the full name diabetes mellitus. Diabetes is a type of condition in which the body fails to utilize the ingested glucose properly. There could be two reasons for this: Lack of hormone insulin. Because the insulin which is available is not working effectively.

Diabetes is the fastest growing long term disease that almost affects millions of people all around the world.

When food is taken, our body breaks it down to smaller components. Sugars and carbohydrates are thus broken down into glucose for the body to utilize them as an energy source. The liver is also able to manufacture glucose.

In normal persons, the hormone insulin, which is made by the pancreas, regulates how much glucose is in the blood. When there is excess glucose, insulin stimulates cells to absorb glucose from the blood. Insulin secreted by pancreas also stimulates the liver to absorb and store any excess glucose. Insulin release is triggered after a meal. This time period when there is a rise in blood glucose. When blood glucose levels fall, insulin levels fall too.

Glucagon is a second hormone manufactured in the pancreas opposite. It stimulates the liver to release glucose when necessary.

Symptoms of diabetes

The main symptoms of diabetes are polydipsia, polyphagia, and polyuria, meaning increased thirst, increased hunger and increased frequency of urination.

Other symptoms are:

l Weight loss or gain

l Fatigue

l Irritability

l Blurred vision

l Slow-healing wounds

l Nausea

l Skin infections

l Darkening of skin in areas of body creases

l Breath odor that is fruity or sweet

Types of diabetes

There are two major types of diabetes. These are type 1 and type 2 diabetes. The other types of diabetes are less common. They include gestational diabetes or pregnancy-induced diabetes.

Type 1 diabetes

Here the body's immune system destroys the beta cells of the pancreas. These cells are responsible to produce insulin. This results in a severe lack of insulin. Without insulin, the blood glucose levels rise uncontrollably. This can go on to damage the body's organs.

It is often known as insulin-dependent diabetes. It starts in children and in the young. Hence it is also termed juvenile diabetes or early-onset diabetes. Type 1 is less common than type 2. About 10% of the diabetic population has type 1 diabetes.

Treatment for this type of diabetes is insulin injections that are needed for the rest of the person’s lifetime.

Type 2 diabetes

Type 2 diabetes is where the pancreas does not produce enough insulin to meet the body's own needs.

It usually develops gradually over time. Most people with the condition may be unaware of their disease. This is especially true at early stages as there may be no specific symptoms. Type 2 diabetes is often associated with obesity. Obesity-related diabetes is referred to as maturity-onset diabetes. This is because it is more common in older people.

Gestational diabetes or diabetes during pregnancy

Some women may develop high blood sugar during their pregnancy. Their pancreas fails to produce enough insulin to absorb all of it. This is known as gestational diabetes. It affects around 4 to 5% of pregnant women.

Pregnant women with this type of condition may or may not have pre-existing type 1 or type 2 diabetes. In most cases, gestational diabetes develops during the second trimester of pregnancy and disappears after the baby is born.

This type of condition can increase the risk of health problems developing in an unborn baby. Thus it is important to detect it early. Treat it appropriately.

Treatment of gestational diabetes is usually the regular insulin injections as oral pills.

Secondary diabetes

Around 1 to 2% of all diabetics may develop this condition. This could be caused due to a pancreatic disease like chronic pancreatitis, pancreatectomy, cystic fibrosis, or pancreas cancer. Some drugs such as thiazide diuretics, corticosteroids, atypical antipsychotics, protease inhibitors used in HIV infection may raise the risk of diabetes.

Diagnosis

Doctors diagnose diabetes by performing a blood test. The test usually reveals high blood glucose.

Management

Diabetes is characterized by high and uncontrolled blood sugar and a lack of insulin. There are several approaches to managing diabetes.

Type 1 diabetes

These patients respond only to insulin injections. There is no cure for type 1 diabetes. Symptoms can still be eliminated by adequate physical exercise and by adopting a healthy diet. Insulin needs to be taken at regular intervals to keep the blood glucose level steady.

Insulin cannot be taken orally. The digestive juices would damage it if taken orally. Injections these days have become simple and painless. Some people need it twice a day. Some need it three times a day.

These individuals need a healthy diet. Diet should be free of all kinds of simple sugars and saturated fats. The aim is to maintain healthy body weight. Regular exercise also stimulates insulin release.

Alcohol contains excess simple sugars and hence should be taken in a restricted manner.

Type 2 diabetes

The primary advice in the initial stages is diet, weight management, and regular activity. It will first be managed with a drug called Metformin.

There are now several other drugs used for this type such as sulphonylureas, thiazolidinediones and other newer agents like Vildagliptin. Eventually, some type 2 diabetics will end up needing insulin therapy. This is because this is a progressive disease.

Diabetes in those undergoing surgery and pregnant women

Pregnant women with diabetes undergoing surgery or illness cannot be managed by oral anti-diabetic drugs. They need to be given insulin injections.

Among pregnant women the oral anti-diabetes drugs are not given as they may lead to damage to the unborn fetus.

For effective management always reach out to a good endocrinologist or diabetologist such as Dr. Ambrish Mithal who is an expert in diabetes management.