Dr VK Abichandani is in conversation with a newly diagnosed person with Type 2 Diabetes
Recently a male patient, newly diagnosed with Diabetes, consulted me for the first time. Mr Shah was diagnosed only a week prior to this conversation. He had visited his local physician to seek treatment for a severe bout of common cold. His doctor asked him to undergo a random blood sugar test. The glucometer showed a reading of 232 mg/dL. The doctor then advised him to avoid intake of carbohydrates from his diet for a week and repeat the blood test in a pathology laboratory. These readings were also high – fasting sugar was 170 mg/dL and 2-hour post lunch sugar: 266 mg/dL.
When Mr Shah came to see me regarding his diagnosis of Type 2 Diabetes, he had a whole list of pertinent questions which I feel will benefit all people newly diagnosed with Diabetes. The following is my conversation with him.
I am just 34 years old and do not remember if either of my parents had Diabetes. I would like to know what Diabetes is.
Diabetes mellitus is defined as elevated blood sugar, which means there is too much sugar in one’s blood stream. Diabetes is diagnosed if:
- The plasma glucose level before breakfast (fasting) is 126 mg/dL or higher.
- The plasma glucose is 200 mg/dL or higher after an oral glucose tolerance test.
- The random blood sugar value is more than 200mg/dL with symptoms that accompany Diabetes which include but are not limited to unexplained weight loss, excessive fatigue, thirst, appetite, increased frequency of urination, blurring of vision, erectile dysfunction, nausea and vomiting.
There are different types of Diabetes:
- Type 1 Diabetes is caused by an autoimmune destruction of the insulin producing cells in the pancreas.
- Type 2 Diabetes is characterized by inadequate insulin production, and diminished insulin action.
- Other types of Diabetes are caused by surgical removal of pancreas, injury to insulin producing cells in the pancreas, genetic mutations, and gestational Diabetes i.e. Diabetes detected for the first time ever, during pregnancy.
Type 2 is the most common form affecting more than 90 per cent of people diagnosed with Diabetes. Type 2 Diabetes is the most common form of Diabetes worldwide. It has multiple causes. It is strongly familial. It has a range of treatments that may include following a diet and getting more exercise, using one or more kinds of pills and being treated with insulin or other injectable therapies.
People can develop Type 2 Diabetes because they are overweight or obese, lead an inactive lifestyle, have a family history of Type 2 Diabetes, are diagnosed with high blood pressure, or have high fats (triglycerides and LDL) as detected via blood tests and are diagnosed with prediabetes or elevated blood glucose in the past. Women with a history of delivering overweight babies (over 3.5 kg of birth weight) or those who have had gestational Diabetes are also at a risk of developing Type 2 Diabetes. When left untreated, Diabetes can adversely affect the eyes, heart, kidneys, the feet and even the brain.
Is there any other test which can confirm or rule out Diabetes?
A test called HbA1c reflects average blood sugars of previous 3 to 4 months. A value greater than 6.5 per cent is considered diagnostic of having Diabetes.
What is prediabetes?
Prediabetes is diagnosed when fasting plasma glucose is between 100-125 mg/dL and the 2-hour (75 g) oral glucose tolerance test result is between 140-200 mg/dL.
What is Type 1 Diabetes?
Type 1 Diabetes is most frequently diagnosed in younger individuals; however it can develop at any age. It requires management with insulin and is usually caused by autoimmune destruction of the insulin-producing beta cells present in our pancreas. It is associated with an increased risk of excess ketone (a product of abnormal fat breakdown in our body) formation.
What is an autoimmune disease?
An autoimmune disease develops when our immune system, which defends our body against disease, decides our healthy cells are foreign. As a result, our immune system attacks healthy cells. Depending on the type, an autoimmune disease can affect one or many different types of body tissue.
I feel sad after my diagnosis, what do I do?
It is important to understand that you should not hold yourself responsible for getting Diabetes. I would also recommend a few counselling sessions to help alleviate any feelings of anger, sadness or depression.
How important is Diabetes education?
Diabetes education programs have different philosophies, contents and approaches. Also, there may be newer treatments and technologies. Attending education classes is an excellent way to stay up-to-date on new developments.
Why do people with Type 2 Diabetes whose Diabetes is under control require insulin?
There are several reasons why people with Type 2 Diabetes require insulin, even if they hadn’t needed it before. Short term insulin usage is advised during pregnancy, surgery, broken bones, cancer or steroidal medicines (like prednisone). Long term insulin usage is required if the pancreas is unable to produce enough insulin. This happens frequently with aging and longer duration of diagnosed Diabetes. People can also become insulin resistant due to weight gain or chronic emotional or physical stress. Simply put, pills can no longer control Diabetes. They would also require Insulin injections. However, non-adherence to diet, exercise and oral drug prescription might result in high blood glucose levels that only insulin can control.
How should people with Diabetes plan for an overseas trip, especially if they are on insulin?
If you are planning a trip, please make sure you have enough medicines and blood glucose test strips for the entire trip and unforeseen delays. It is important to know how to count carbohydrates for the foods you will be eating. You must also be aware where the nearest medical facility is.
When travelling with friends on insulin it is necessary to carry extra insulin supplies, in case they get lost or damaged. It is important to understand how to protect the insulin from unsafe temperatures. Wearing a medical identification that states he/she has Diabetes also helps. It is necessary to speak with his/her doctor about how to adjust his insulin doses for time zone changes. At times, it could help to bring a packed meal on the flight because the food provided may not be part of his/her dietary plan.
While travelling, it is a good idea to check blood glucose more often because:
- Foods can be unfamiliar, and you’re not sure how your blood glucose will respond.
- Blood glucose can be lower than usual because of unexpected spurts of activities, like carrying luggage and extra walking in the terminals or stations.
- Blood glucose can be higher than usual from sitting for long periods of time during travel.
One of my relatives has Diabetes and is on oral medication. He gets vaccinated periodically. What are these vaccinations?
This is a very important question. We hear a lot about vaccination shots for children, but it turns out that adults need vaccinations as well. Getting vaccinations is even more important for people with all forms of Diabetes as they are more likely to be more susceptible to flu and pneumonia.
Adults with Diabetes should be given with three different types of vaccinations. The most important yearly vaccination is the flu shot. Influenza (flu) can range from a mild illness – not much worse than a bad cold – to a really serious winter virus that can make you very sick. Flu should not be taken lightly; it affects the bronchial tubes and lungs, causing inflammation that can then lead to bacterial pneumonia.
Pneumococcal refers to the bacteria that are the most common cause of the lung infection known as pneumonia. The vaccine against these bacteria is often called the pneumonia vaccine. But the vaccine also protects one from bloodstream infections and is caused by pneumococcal bacteria. People with Diabetes are more likely to become infected with pneumococci, even when their blood glucose is under control. In this case, only a single dose of the vaccine is needed. For those who are 65 and older, a second dose of vaccine is recommended if it has been five years or more since the first dose.
Hepatitis – B vaccine protects against hepatitis B virus infection, which can cause liver disease and liver cancer. It is currently recommended for adults up to age 59, and can be considered occasionally for those 60 and older by the treating physician.
What advice would you give people newly diagnosed with Type 2 Diabetes?
I would like to urge everyone who has Diabetes to avoid an unhealthy diet (salty, fatty and sugary foods), physical inactivity, tobacco and alcohol drinking. You must adopt a healthy and active lifestyle habits and continue to follow your doctor’s recommendations and guidelines. This will help you better manage Diabetes and allow you to live a happy, healthy life free of medical complications.
I also want to commend you in taking onus of your diagnosis and seeking answers to questions that affect people with Diabetes every day. Always remember to discuss any issues related with your treatment with your physician. This will ensure that you take charge of Diabetes and never allow it to control you.
Dr VK Abichandani is a Diabetes and Endocrine Physician in Ahmadabad.