Having a history of Diabetes during pregnancy called gestational Diabetes
Having high blood pressure
Having unhealthy cholesterol
Being physical inactivity
Having unhealthy eating habits
Age, race, gender and family history of Diabetes and associated complications
Every individual is different and at times there is a possibility that you may experience no symptoms at all. However, it is necessary to keep the following points in mind:
Lack of interest and concentration
A tingling sensation or numbness in the hands or feet
Vomiting and stomach pain (often mistaken as the flu)
You know your body the best so if you do notice that something is amiss, do consult your doctor and check your blood sugar levels.
Type 1 Diabetes is an autoimmune disease i.e. some antibodies are being produced which damage the beta cells of the pancreas and the pancreas stop making insulin, so gradually the pancreatic function goes down. In such cases, C-peptide levels decrease and the blood sugar levels increase, hence the symptoms. Type 1 Diabetes cannot go undiagnosed for long as the child develops symptoms such as excess thirst (polydipsia), excess production of urine (polyuria), unexplained weight loss or sudden bedwetting in a normal child. If these initial symptoms are not caught on time then the child may develop diabetic ketoacidosis (a life- threatening condition in which the ketones levels are abnormally high).
Type 2 Diabetes is a condition that begins with insulin resistance (the cells fail to respond to normal levels of insulin). As the disease progresses, a lack of insulin may also develop. The primary cause for this is obesity, lack of exercise and unhealthy eating habits. This type of Diabetes is most common in people.
Type 2 Diabetes in obese people is a result of consumption of excess calories. The extra calories get converted in fat and deposited in various organs of the body of importance like liver and pancreas. Carbohydrate in the food is broken down into glucose which is utilised for energy. Excess glucose gets converted into glycogen and deposited in the liver. With the help of insulin, it also gets converted into fatty acid, circulated to different parts of the body and deposited as fat in adipose tissue.
When calorie consumption exceeds utilisation then the excess calories cause fatty acid flux. If the fat cells cannot expand rapidly enough to store this increasing fatty acid flow, then the excess released fatty acids begin to accumulate in other tissues such as the liver and skeletal muscles. This begins the process of lipotoxicity (fatty acid induced toxicity) which increases insulin resistance. Insulin resistance occurs when cells in your muscles, fat, and liver don’t respond well to insulin and can’t use glucose from your blood for energy. To compensate for it, pancreas makes more insulin. Over time, blood glucose levels rise.
Excess deposition of fat on the liver causes fatty liver disease which is one of the risk factors for Type 2 Diabetes and its progression. Fatty liver disease worsens insulin resistance which is the primary reason why Type 2 Diabetes occurs. So the primary aim to facilitate Type 2 Diabetes remission is to reduce this fat by losing weight.
Gestational Diabetes mellitus (GDM) is a type of Diabetes that is seen in pregnancy. The sugar levels usually return to normal after a delivery. Out of 1 in 10 pregnancies associated with Diabetes, 90 per cent are GDM. In India the incidence is 12-15 percent. Women are more likely to develop GDM if they have following problems, like:
Overweight or pre- pregnancy high Body Mass Index (BMI)
Family history of Diabetes Mellitus
Delivered previous big baby weighing >4 kg
Previous pregnancy GDM
Women who have been diagnosed with Polycystic Ovarian Disease (PCOS) prior to pregnancy.
Women are screened at 24-28 weeks of pregnancy with oral glucose tolerance test. This test involves fasting overnight for 8-10 hours. On the day of the test, fasting sugar test is done and then you will need to drink 75 g of sugar solution. Then the repeat blood test is done 1 hour and 2 hours afterwards.
If the values are above normal, GDM is diagnosed.
Criteria for GDM are as follows:
Fasting: 95 mg/dL
One hour after a meal: 140 mg/dL
Two hours after a meal: 120 mg/dL
A person is diagnosed to have prediabetes when blood sugar level tests repeated on two separate occasions show a higher than normal result but are not high enough for the individual to be diagnosed as having Diabetes mellitus.
Usually, people who have fasting plasma blood sugar level within the 100-125 mg/dL range are defined as having impaired fasting glucose. If your doctor gives you an oral glucose tolerance test (OGTT) and at two-hours, your blood sugar is 140-199 mg/dL, you are said to have impaired glucose tolerance (IGT). Either of this medical terminology denotes that you have prediabetes.
Prediabetes has no clear symptoms. Some people may experience conditions that are associated with insulin resistance, such as polycystic ovarian syndrome (PCOS) and acanthosis nigricans which involves the development of dark, thick and often velvety patches of skin. This discoloration usually occurs around the elbows, knees, neck, armpits and knuckles.
The HbA1c is a blood test which gives the average blood sugar levels of the past three months. It can never be overemphasised that people with Diabetes should regularly check his or her HbA1c level and maintain it at a level as advised by the doctor. If done every four to six months, it gives information regarding the blood sugar control in a person and indicates if the person has been regularly taking his or her medication.
One of the most important interventions in Diabetes treatment is early diagnosis and rapid corrections of blood sugar levels and more importantly, diagnosing the people with prediabetes (those with borderline blood sugar levels but not in diabetic range). The American Diabetes Association has recently recommended its use as a diagnostic criterion for Type 2 Diabetes. It has been shown in people with Diabetes whose HbA1c or also called A1c is as close to normal or at least less than 7 per cent have significantly fewer complications in terms of vision loss, kidney failure, stroke and heart attacks. HbA1c for diagnosing Diabetes is as follows:
Normal reading - lesser than 5.7 per cent
Pre diabetes - 5.7-6.4 per cent
Diabetes - more than 6.5 per cent
Diabetic retinopathy is a complication associated with Diabetes affecting the small blood vessels of the retina. The retina is a light-sensitive layer at the back of the eye that covers about 65 percent of its interior surface. The optics of the eye create an image of what is seen on the retina. This functions like the film in a single-lens reflex camera.
People who are at a higher risk of developing diabetic retinopathy are those who have:
poor blood sugar control
high blood pressure
Heart disease is amongst the most dreaded complications of Diabetes. People with Diabetes require specialised care to prevent, diagnose and treat heart disease. High blood sugar levels (Diabetes) and hypertension (high blood pressure) increase the risk of heart failure. Other factors like obesity, smoking and high blood cholesterol increase risk of heart failure in people with Diabetes.
Heart failure usually develops gradually when muscle of the heart become weak. Their reduced ability to pump blood causes fluid accumulation and congestion. Heart muscles thicken or enlarge to compensate the declining pumping action, which further weakens them. Symptoms of heart failure include shortness of breath, persistent cough, fatigue, weight gain, swelling of the feet, ankles and legs.
Silent heart attacks have either no symptoms or minimal symptoms or unrecognized symptoms. Uncontrolled diabetes is associated with inflammation of the inner lining of the arteries leading to damage and blockage of the artery resulting in heart attack. But unlike people without diabetes, people with diabetes may have such ‘attacks’ without any symptoms. When missed, the condition may lead to a major attack- which then is obviously symptomatic or even fatal.
Knowing what puts you on the path to a heart attack is half the prevention battle. People with Type 1 and Type 2 Diabetes should check and treat cardiovascular disease risk factors early and often. Some of these risk factors are:
Smoking - Smokers are two to three times more likely to develop coronary heart disease than non-smokers
Being overweight - Losing weight can help cut down your heart disease risk
Sedentary lifestyle - Getting more exercise may also help people with Diabetes reduce heart disease risk.
High blood pressure / cholesterol - Lowering blood pressure and cholesterol levels remains the greatest shield against heart disease
Diabetes Mellitus has been called a silent killer. Left untreated, it can damage the kidneys, nerves, eyes and heart. This damage may be silent. For instance, heart disease may be silent, without even chest pain till, one day the patient suffers a catastrophic heart attack. These silent fluctuations in the day or night can predispose to complications. Every person with Diabetes, whether the blood sugar levels are well controlled or not, should undergo an annual check-up to look for diabetic complications. Good control of Diabetes can prevent diabetic complications.
Many people with Diabetes believe that only when the complications occur, that they need to be treated. This is wrong. By the time a complication like a kidney failure or loss of vision occurs, they are virtually difficult to reverse. Therein lies the importance of screening for complications. If a person undergoes testing and a problem is detected in the pre-complication stage, the treatment may prove effective.
The tests mentioned below provide a fair understanding of the risks and complications that may arise, which otherwise are skipped during the normal screening. In addition to these tests, people with Diabetes must also undergo these routine tests for follow up:
Type of Test
Every 3 months
Lipid profile with measurement of fractions
like LDL and HDL cholesterol levels and triglyceride levels
Every 6-12 months
Every 12 months if normal and every 3-6 months if abnormal
Every year if normal and every 3-6 months if abnormal
Stress test, ECHO and cardiology consultation
Depending on the ECG test result
Every year if normal, every 6 months
if mild to moderate retinopathy and every
3 months for severe retinopathy or
if laser treatment is done
Neurovascular evaluation of foot
This involves testing for fine touch (by monofilament),
vibrations (by biothesiometry or tuning fork)
for evaluation of neurological sensation
and Ankle brachial index for the evaluation
of circulation in the feet. To be done at least
once every one year. If required, the doctor may advise doing a foot scan
every 6 months
Depending on the test results, doctors may advise the following tests for a more detailed evaluation:
Vitamins B12, D3
Thyroid function tests at least once every year after the diagnosis of Diabetes. In addition to the laboratory tests, Blood pressure and BMI are also checked.
Caring for feet is of utmost importance for people with Diabetes. Poor foot health can act as a gateway to several fungal infections. Very high blood sugar levels affect blood circulation in the feet and reduce sensitivity to any injury. People with diabetic neuropathy are easily prone to fungal infections. The other common foot problems are foot ulcers, charcot foot (deformity in the foot), calluses (hardened part of the soft tissue), athletes foot, bunion, blisters, plantar warts and ingrown toenails.
People with Diabetes in India commonly develop fungal infection between the toes because of the moisture and weather. Many people with Diabetes have a combination of bacterial and fungal infections. They are usually toe infections which further spread into the foot because of walking on the infection. People with Type 2 Diabetes are more prone to foot infections due to lowered immunity.
Foot infections, if not treated in time, can gradually spread to the entire body and the person starts developing multiple organ failure. It can cause septicaemia (infection in the blood). It can also affect other organs such as the lungs and the kidney and can cause complete renal shut down.
Kidneys are the waste filtration system of the body as millions of blood vessels filter blood to remove waste and leave protein in the blood. Overwork causes the filtering system to break down. This damages the kidneys and decreases its filtering ability and proteins like albumin can leak through into the urine. Symptoms of kidney damage include insomnia, poor appetite, upset stomach, weakness, vomiting, body swelling and decreased urine output. Early detection and treatment slows progression of kidney disease.
Bariatric or weight loss surgery involves reducing the size of the stomach with a band or through removal of a portion of the stomach or by resecting and re-routing the small intestines to a small stomach pouch. Although it is not specifically considered as a treatment for Type 2 Diabetes. You may be advised this procedure if you have Type 2 Diabetes along with a body mass index higher than 35 as you may benefit from this type of surgery. People who've undergone gastric bypass have seen significant improvements in their blood sugar levels.