Thursday, December 27, 2012

What is diabetes mellitus?

Firstly, diabetes mellitus and diabetes is one and the same thing, expect that colloquially we say diabetes. Diabetes mellitus is a condition where the blood glucose or sugar level is high. In some cases of a diabetes mellitus patient, the pancreas fails to produce insulin that carries the glucose to the cell which in turn produces energy. In other cases the person going through diabetes mellitus does not use insulin well.

Type of diabetes

There are two types of diabetes mellitus:

Type 1 diabetes mellitus - Here diabetes mellitus is hereditary. It is known as insulin-dependent or childhood-onset diabetes, which is characterized by a lack of insulin production.

Type 2 diabetes mellitus - This is caused by lifestyle changes like regular consumption of unhealthy food plus sedentary life and increase in weight. It is also called non-insulin-dependent or adult-onset diabetes. Diabetes mellitus is caused by the body's ineffective use of insulin.

What is gestational diabetes?

Gestational diabetes is a kind of diabetes that comes on during pregnancy. It is often diagnosed on screening tests done between weeks 24 and 28 of pregnancy. According to the American Diabetes Association gestational diabetes affects 4% of all pregnant women. While doctors aren't sure what causes gestational diabetes, it is believed that hormones from the placenta may block the action of insulin in the mother, leading to abnormally high levels of sugar in your blood.

What is pre-diabetes?
Dr. Shalini Jaggi, Senior Consultant with Action Diabetic Centre explains the term pre-diabetes, "When one's sugar levels are higher than normal but not as high to be treated as diabetes that is known as pre-diabetes. People who have a fasting plasma blood glucose in the 100-125 mg/dl range are defined as having impaired fasting glucose and a post prandial blood sugar between 141-199 are defined as having impaired glucose tolerance. These together are defined as pre-diabetes."

Causes of diabetes: 

The symptoms of pre-diabeties are:

- Feeling hungry often
- Weight loss or weight gain
- Slow healing of wounds, weakness, and blurry vision
- Infection of the gums, skin, vagina and bladder

Diet tips to fight pre-diabetes

Dr. Shalini says, "Since pre-diabetics are at a risk of developing diabetes, they should also take appropriate measures when it comes to their diet. They should have small meals, eat moderately, have foods that are low in fat and carbohydrate content. Further, in addition to the diet, they should indulge in some kind of daily exercise or outdoor activity."

Are there any sugar substitutes for diabetics?

Yes, there are a few ways one can replace sugar and still control blood sugar levels. Honey, figs and raisins are sweet and healthy. Diabetics can also try out jaggery but watch out; you don't want to go overboard with jaggery. It should be consumed in moderation.

Should you avoid rice if you are diabetic?

The good news is, Indians with diabetes can consume rice. But it has to be two kinds of rice, Swarna and Mahsuri rice. 'In fact, two types of rice commonly consumed by India's middle classes have now been found to have the lowest Glycemic Index (GI) — the measure of its ability to raise blood sugar levels after eating - when compared with 233 other types of rice consumed around the world'. What is food without rice!

A word of caution for women

It's a known fact that men with diabetes are most likely to be impotent. But latest research reveals that women with diabetes are on the cutting board too. 'Based on a survey of nearly 2,300 California women aged 40 to 80 years, researchers found that more than a third of those on insulin treatment said they were "moderately" or "very" sexually dissatisfied.' These women complained about lack of lubrication and orgasm.
Can cosmetics spike diabetes?

Apparently it is true; according to recent study, cosmetics can spike diabetes. The biggest culprit is phthalates, an endocrine disrupting chemical present in different cosmetic products. 'Researchers found that women with higher levels of phthalates in their urine were more likely to have diabetes.' Researchers have scratched the surface on this latest find, wonder what the next step in this field have for us.

Diabetes and its treatment

Diabetes is a condition that causes high blood sugar. It cannot be completely cured but it can definitely be managed. There are basically two types of diabetes, the first being Type 1 diabetes, wherein the body's immune system destroys the insulin producing cells in the pancreas. Due to low insulin level, it is treated with daily insulin injections and a healthy diet. The second type is Type 2 diabetes, here the pancreas does not produce enough insulin or does not use insulin efficiently. It is treated by implementing a diet modification, exercise plan or oral medication.

Time-to-time medication

Medicines and injections are very important to manage your diabetes level. Whichever medicines your doctor prescribes for you, take detailed information about its dosage, and follow it the way advised by your doctor. Whenever you make any appointment with any healthcare professional, take the list of all the medicines you have been advised to manage your diabetes level, to avoid any medicinal complications.

Diet for diabetes

Dr. Sanjiv Bhambani, Endocrinologist and Diabetologist with Moolchand Medcity shares the pillars of good health for diabetics, "Disciplined and responsible eating habits can help a diabetic control their blood sugar levels. There is no real harm with snacking when you are hungry but the key is to snack on healthy alternatives. A diabetic diet should be high on fiber, must contain milk without cream, buttermilk, fresh seasonal fruits, green vegetables, etc."

List of dos and don'ts for diabetics

- Drink tomato juice with salt and pepper ever morning on an empty stomach.
- Per day calorie intake should be between 1,500-1,800 calories with a proportion of 60:20:20 between carbohydrates, fats and proteins, respectively.
- Artificial sweeteners can be used in cakes and sweets for diabetic people (in moderation).
- Keep a check on over-intake of dry fruits.
- Diabetics should eat 3 meals in a day with a good meal plan.
- Have lots of fluid.
- Have at least two seasonal fruits and three vegetables in a diet plan.
- Limit intake of alcohol.
- One teaspoon of methi seeds soaked overnight in 100 ml of water is very effective in controlling diabetes.
- Intake of 6 almonds (soaked overnight) is also helpful in keeping a check on diabetes.

How is diabetes linked to feet and leg problems?

Dr. Sanjeev says, "Foot problems in diabetics result from poor circulation, nerve damage and decreased resistance to infection. High blood sugar level over a long period may affect blood vessels and nerves. There are various conditions that affect people with diabetes that may result in leg and foot problems."

What are the signs of tissue and skin damage?

He says, "In diabetic patients blood glucose is high and body loses fluid. Due to insufficient fluid skin gets dry. Dry skin tends to crack or split more easily and wounds heal more slowly in diabetics. Thus skin conditions should be treated as soon they're noticed, to prevent them."

There are various signs of tissue and skin damage, which can be categorized as:

Dry skin is one of the most common symptoms among diabetes due to loss of body fluid and frequent urination. 

Itchy skin could be another prior symptom which can be triggered by poor blood flow. Itching can be confined to one spot or may occur in many parts of the body especially in lower legs and feet. 

Digital Sclerosis due to excess production of collagen among Type 1 diabetic patient results in waxy, tight skin on toes, fingers and hands. Dryness, burning, numbness and skin ulcers could be due to neuropathy when nerves are damaged. Patient suffers from pain in the lower extremities, burning and numbness. As a result, nerves in the legs and feet may not release sweat which is required to keep skin soft and moist."

What is the link between morbid obesity and diabetes?

This is a question that has several obese people worried; Dr. Sanjeev makes the link between obesity and diabetes: "Obesity is defined as having a BMI greater than 27 (as per Indian body structure). Approximately two-thirds of adults with Type 2 diabetes are obese. Diabetics are at higher risk for cardiovascular disease, and obesity further increases this risk. Obesity also increases other diabetes complications including end-stage kidney disease. Other complications may include sleep apnea syndrome, arthritis and fatty liver disease."

Stats on the cases of diabetes and limb amputations...

The picture is unflattering; here's what the diabetologist reveals, "All over the world in every 30 seconds, a leg is lost to due to diabetes. 15% of the total diabetic population develops foot ulcers. All over, 85% of all diabetes-related amputations are preceded by foot ulcers. Thus it is advisable that patients should daily inspect their feet and consult the doctor as soon as they find an ulcer or an infection in the foot."

What is retinopathy?

Prolonged uncontrolled blood sugars produce changes in the blood vessels all over the body. The damage caused to blood vessels of the retina is called Diabetic Retinopathy. It is a microvascular complication of diabetes, which if not diagnosed and treated early, can lead to blindness."

Signs and symptoms of diabetic retinopathy

So how do we spot it?  "Unlike other common eye problems, there are no presenting signs or symptoms of diabetic retinopathy in the early stages. So, the patient may not even be aware that he is developing changes in the retina, unless he gets his fundus (retina) specifically checked by his ophthalmologist," says the doctor.

Important test for diabetes prevent and control

- First, get your blood pressure checked - your risk of developing high blood pressure doubles if you have diabetes. The ideal number: Below 130/80

- A foot exam: Pressure sores, cuts or ingrown nails can lead to infections and gangrene. Left untreated, an infection may lead to amputation. Daily self-exams are recommended.

- Every three to six months, depending on your type of diabetes and how well you're controlling your blood sugar levels, have:

- A glycosylated haemoglobin (or haemoglobin A1C) test: This measures how well you have maintained blood sugar control for the last two or three months.

Once a year, have:

- A urine microalbumin test: This measures the amount of protein (albumin) in your urine, which indicates kidney damage.

- A blood fat (lipid) profile: Lipids are the cholesterol and triglycerides in your blood. Triglycerides are another type of fat in the blood. If you have raised cholesterol and raised triglycerides you have an increased risk of CVD.

- Dilated Eye Exam: If you have diabetes, your ophthalmologist or optometrist should perform a dilated eye exam, in which the pupils are widened with drops, to check for signs of diabetic retinopathy.

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