Every Patient’s Dilemma

Every Patient's Dilemma

Spandana Birajdar shares with you the basics of Diabetes and what you need to know.

Most of us are in a fix once we are diagnosed with Diabetes. The toughest part is to come to terms with the condition as it is a life-long disease. While majority of the people are still in denial a small part are actually relieved that their symptoms will now lessen.

Defining Diabetes

Diabetes mellitus refers to a group of diseases that affect how your body uses blood glucose, commonly called blood sugar. Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel. If you have Diabetes, no matter what type, it means you have too much glucose in your blood and this in turn can lead to serious health problems.

There are two types of Diabetes Mellitus

• Type 1 Diabetes – is an autoimmune disease, in which the body's own cells destroy the beta cells (responsible for insulin production) of the pancreas, as a result of which the body is devoid of insulin. In such cases, the only treatment option is taking insulin injections. This type of Diabetes is usually seen in young adults and children.
• 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.

Gestational Diabetes – is a type of Diabetes that is seen in pregnancy. The sugar levels usually return to normal after a delivery, however, it puts the mother as well as the baby at high risk of developing Diabetes in the future.

Pre-Diabetes – implies that the blood sugar levels are high but high enough to be classified as Diabetes. However, if this this condition is not managed well then chances are that one may develop Diabetes in the future.

Secondary forms of Diabetes

This type of Diabetes occurs when the pancreas has been damaged or injured. This form of Diabetes usually results from an illness and if the illness can be treated then the Diabetes may disappear. In general, the reasons for this type of Diabetes may be hormonal, genetic, due to malignancies or caused by chemicals or drugs.

Drug induced – Many therapeutic agents can predispose to or precipitate Diabetes, especially when pre-existing risk factors are present, and these may cause glucose control to deteriorate if administered to those with existing Diabetes. They may act by increasing insulin resistance, by affecting the secretion of insulin, or both. Examples of such drugs include steroid, anti-psychotics and a range of immunosuppressive medications.

Drug induced – Many therapeutic agents can predispose to or precipitate Diabetes, especially when pre-existing risk factors are present, and these may cause glucose control to deteriorate if administered to those with existing Diabetes. They may act by increasing insulin resistance, by affecting the secretion of insulin, or both. Examples of such drugs include steroid, anti-psychotics and a range of immunosuppressive medications.

Pancreatectomy – is the surgical removal of the pancreas. This procedure is usually done when tumours, cancers and pancreatitis (inflammation of the pancreas) is seen. As a result the person develops Diabetes after the surgery due lack/insufficient amount of insulin.

Confirming Diabetes diagnosis

Type 2 Diabetes may take a while to detect as most symptoms get progressive over a period of time. However the American Diabetes Association recommends that the following people be screened for Diabetes

• People who have a body mass index higher than 25, regardless of the age – have additional risk factors, such as high blood pressure, a sedentary lifestyle, a history of polycystic ovary syndrome, having delivered a baby who weighed more than 9 pounds, a history of Diabetes in pregnancy, high cholesterol levels, a history of heart disease or having a close relative with Diabetes.
• People who are older than 45 years – is advised to receive an initial blood sugar screening, and then, if the results are normal, to be screened every three years thereafter.

To check whether you have Diabetes the doctor may advise you to do a

HBA1c test (glycated haemoglobin test) – is done to assess your blood sugar control over a period of 2-3 months. The advantage of this test is that it is does not require fasting and can be taken anytime during the day. The following are the results when A1c is being used to diagnose Diabetes:

• Normal (no Diabetes): Less than 5.7 per cent
• Pre-diabetes: 5.7-6.4 per cent
• Diabetes: 6.5 per cent or higher

Random blood glucose test – as the name suggest a blood sample will be taken. Regardless, of what time you ate a reading of 200mg/dl or higher would indicate that you have Diabetes.

Fasting blood glucose test – a blood sample will be taken after an overnight fast. A fasting blood sugar level between 100-125mg/dl indicates prediabetes, whereas levels >125mg/dl indicates that you have Diabetes.

Oral Glucose tolerance test (OGTT) – This test is done to assess how well your body breaks down glucose. You need to fast for 8 hours before the test is carried out. Also you cannot eat anything during the test. You will be asked to take a liquid containing 75 g of glucose, following which blood samples will collected after one, two or three hours (if needed) after ingesting the solution. The results are as follows:

• Normal response: If your two hour glucose level is less than 140 mg/dl and all values between 0 and 2 hours are less than 200 mg/dl.
• Prediabetes: If your fasting blood sugar level is less than 126 mg/dl and the two hour blood sugar level is between 140 and 199 mg/dl. This is also at times referred to as impaired glucose tolerance.
• Diabetes: You will be diagnosed with Diabetes when two diagnostic tests done on different days show that the blood glucose level is high. This implies that either the two hour level is greater than 200 mg/dl or the fasting blood sugar level is greater than 126 mg/dl.

Note: If Type 1 Diabetes is suspected your urine sample will be collected and tested for ketones (by-product produced when muscle and fat tissue are used for energy when the body doesn't have enough insulin to use the available glucose). In addition a c peptide level test (measures the ability of the pancreas to secrete insulin) may be suggested. C peptide levels are low in people with Type1 Diabetes but may be normal or even higher in people with Type 2 Diabetes.

Treatment

Blood sugar monitoring, insulin or medications may play a role in managing your Diabetes. However, maintaining a healthy weight through healthy diet and exercise plays a pivotal role in managing your condition.

Healthy eating – Your diet will be centred on fruits, vegetables and whole grains (foods that are high in nutrition and fibre and low in fat and calories. You will also need to make conscious efforts to cut down on sweets and refined carbohydrates. Depending on your blood glucose readings your nutritionist may allow you a sweet treat once in a while. A dietician will help you in developing a meal plan that fits your health goals, food preferences and lifestyle. Another concept called 'carbohydrate counting' may also be taught to you, especially if you have Type 1 Diabetes.

Physical activity – Exercise not only lowers your blood sugar level by transporting sugar to cells which is then used as energy but also reduces insulin sensitivity, i.e. the body requires less insulin to transport sugar to cells. It is best advised to get your doctors approval before starting any activity and if you haven't exercised in a while then to start slow and increase the intensity gradually.

Monitoring your blood sugar – Careful monitoring of blood sugar is the only way to ensure that your blood sugar levels remain within the target range. Despite a rigid meal plan the amount of sugar in your blood can change unpredictably. With the aid of your Diabetes health team , you will learn how to our blood sugar level changes in response to food, physical activity, medications, illness, alcohol, stress and — for women — fluctuations in hormone levels. In addition to blood test your doctor may advise you to do the HBa1c test

Treatment options

Oral or other medications – Sometimes oral or injected medications are prescribed as well. Some Diabetes medications stimulate your pancreas to produce and release more insulin. Others inhibit the production and release of glucose from your liver, which means you need less insulin to transport sugar into your cells. Still others block the action of stomach or intestinal enzymes that break down carbohydrates or make your tissues more sensitive to insulin. Insulin – Most people with Type 1 Diabetes require insulin to survive. In addition some people with Type 2 may also need insulin to survive. Often insulin is injected using a fine needle and syringe or an insulin pen — a device that looks like an ink pen, except the cartridge is filled with insulin. Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night. Bariatric surgery – This 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. However, the procedure's long-term risks and benefits for Type 2 Diabetes aren't yet known.