DIABETES

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Diabetes is a complex disease characterised by high blood glucose. The commonest form, type 2 diabetes, develops because either there is a deficiency of the hormone insulin or the body is resistant to insulin, or both.

What is OGTT (Oral glucose tolerance test)?

What are the symptoms of diabetes?

What is HbA1C and its importance?

What is gestational diabetes? How is it diagnosed?

What are the risk factors of Type II diabetes?

What are refined carbs?

How is diabetes treated?

What to eat if you are diabetic?

What you should not eat if you are diabetic?

What are hypoglycaemia and hyperglycaemia?

         ORAL GLUCOSE TOLERANCE TEST

OGTT is commonly carried out to confirm or exclude diabetes. The test is carried out after the subject has fasted overnight for 8 hours (water may be consumed during this period):1) A fasting blood sample is drawn and the glucose level evaluated: a level of 126 mg/dl or more confirms diabetes.
2) 75g of glucose dissolved in a glass of water is ingested.
3) A blood sample is taken 2 hours later and the glucose level assessed: a level of 200 mg/dl or more confirms diabetes.

Insulin plays a crucial role in maintaining the blood glucose concentration and delivering energy.

HbA1C

Blood glucose levels can vary quite a bit each day depending on the food consumed, physical activity, stress and other factors. HbA1c is a blood test which erases the day-to-day variation and reflects the average blood glucose level over the preceding 3 months. This test is a fairly reliable marker of the level of control of diabetes, a level of less than 6.5% indicating good control.

The weakness of HbA1c test is that it may not be accurate in people with chronic kidney disease, liver disease, and anemia.

Under its guidance, cells throughout the body absorb glucose from the blood and use it for energy. If there is a shortage of insulin or if it is ineffective, the cells are unable to take up glucose. The cells are thus deprived of energy even as glucose accumulates and builds up in the blood.

Like hypertension, diabetes is a treacherous disease which can seriously damage the heart, the brain, the eyes, the kidneys, and the arteries that carry blood to the limbs. Diabetes can render the limbs numb by injuring the nerves which carry sensation to and from the brain.

Diabetics who take care to control their blood glucose levels usually do not suffer any significant harm. Poorly controlled diabetes inflicts all the damage that the disease can wreck on the human body.

Symptoms of diabetes

  • Unexplained fatigue
  • Increased thirst
  • Increased urination
  • Unexplained weight loss
  • Boils and ulcers that do not heal
  • Blurred vision
CONFIRMING DIABETES
HbA1c (%) Fasting Blood glucose (mg/dl) Blood glucose measured 2 hours after ingesting 75 g glucose (mg/dl) Random Blood Glucose (mg/dl)
Normal less than 5.5% less than 100 less than 140 x
Prediabetes 5.5 to 6.4% Impaired fasting glucose: 100 to 125 Impaired glucose tolerance: 140 to 199 x
Diabetes (Diabetes is established when any one of these four conditions are met) 6.5% or more 126 or more 200 or more 200 or more, in a patient who has symptoms of diabetes
Diabetes develops gradually over time so test results can differ in the early stages of the disease: for example, the HbA1c may confirm diabetes but the glucose tolerance test may be normal.

                                                                      PRE DIABETES

A fasting glucose of 100-125 mg/dl (or a HbA1c of 5.5 to 6.4%) indicates the presence of pre-diabetes, also known as impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Prediabetes is a condition that almost always leads to full blown diabetes unless lifestyle changes are strictly implemented. These lifestyle changes include:

* regular physical exercise
* weight reduction if overweight or obese, and
* total avoidance of simple and refined carbs

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Types of diabetes

1) Gestational diabetes seen during pregnancy.

GESTATIONAL DIABETES

Gestational diabetes develops during the later stages of pregnancy because the patient is unable to meet the demand for increased insulin.

Gestational diabetes usually clears up after delivery but in some women it progresses to T2D (type 2 diabetes). Babies born of mothers with gestational diabetes are more likely to be obese and develop T2D. All women should be tested for gestational diabetes at 24 to 28 weeks of pregnancy.

Diagnosis of gestational diabetes – oral glucose tolerance test with 75 g glucose:
Fasting 92 mg/dl or above
1 hour after glucose drink 180 mg/dl or above
2 hours after glucose drink 153 mg/dl or above
Diagnosis is established if any one of the level is met

Treatment target: To maintain a fasting level of less than 95 mg/dl and a 2 hour aftermeal glucose value of less than 120 mg/dl (if it can be safely achieved).

2) Type 1 diabetes (T1D) is due to insulin deficiency and affects mainly the very young. In some cases it manifests right at birth. Insulin must be used to treat T1D and must be taken throughout life in order to control blood glucose. Type 1 diabetes is not very common.

3) Type 2 diabetes (T2D) is the commonest form, and is virtually raging as an epidemic. The sufferer usually has no deficiency of insulin in the early stages of the disease but is resistant to insulin circulating in the blood. To overcome the resistance, the pancreas produces large quantities of insulin. As a result, over the years, the pancreas runs out of insulin and insulin deficiency ensues.

In a sense, type 2 diabetes can be accurately described as a lifestyle disease. Patients who develop type 2 diabetes are:

*mostly overweight or obese
*sedentary, with very minimal or no physical activity, and
*consume excessive food-calories, and excessive simple and refined carbs

Risk factors for Type 2 diabetes

  1. Overweight
  2. Obesity
  3. Sedentary lifestyle
  4. Chronic stress
  5. Heart disease
  6. Hypertension
  7. Impaired fasting glucose or impaired glucose tolerance
  8. HDL-C less than 35 mg/dl and or triglyceride more than 250 mg/dl
  9. Gestational diabetes
  10. Metabolic syndrome
  11. Family history of diabetes
  12. Longterm oral steroids
  13. Sleep disorders like obstructive sleep apnea, chronic sleep deprivation and working night shift

REFINED CARBS (CARBOHYDRATES)

Carbs are macronutrients that are a vital part of our food chain. They provide energy (1g carb = 4 calories).

In their natural state, complex carbs come packaged with healthy micronutrients and fibre and are referred to as complex carbs, such as whole grain wheat, brown rice, and fruits.

In order to enhance the taste and palatability, complex carbs are often refined by stripping off and discarding the fibre. In the process, most of the micronutrients are also lost, turning refined carbs into “empty calories”.

REFINED CARBS INCLUDE:

*sugar
*white rice
*refined wheat flour (maida) and products such as pasta, momo, white bread and buns, biscuits, cookies, pizza, cakes and pastries
* fruit juice
*sugar substitutes like high fructose corn syrup (HFCS), and fruit juice concentrates

The term ‘wheat flour’ refers to refined wheat flour or maida. The term ‘wholewheat flour’ indicates that the flour is from unrefined whole grain wheat, and it contains all the natural fibre and micronutrients.

*** People generally tend to label blood reports inaccurate when the results do not match their expectation.

Many diabetics are able to control their blood glucose levels by eating an appropriate diet and do not require any medication. In such patients, even when several consecutive tests show normal blood glucose, it does not mean that diabetes has been ‘cured’. It just indicates that diabetes is under control.

Treatment of diabetes

The aim of treatment is to achieve and maintain good health by encouraging a nutritious, balanced diet in appropriate amounts which controls blood glucose, cholesterol and body weight. The blood glucose level should be in the range of 110-140 mg/dl with the absence of any abnormal surge or dip in glucose level at any time, and a Hb1c less than 6.5%. This is eminently achievable by careful attention to the following measures:

1) Achieving and maintaining a healthy body weight:

This best done by moderating food intake, by being physically active, and avoiding refined carbohydrates.

2) Physical activity:

Physical activity like walking, swimming requires energy (calories). Our body burns blood glucose to provide the energy – 1g glucose provides 4 calories. Depending on the level of exertion, a corresponding amount of glucose is used up and this helps control blood glucose.

Apart from controlling blood glucose, physical activity also improves the blood circulation across the entire body and the heart, strengthens the muscles, improves the mental health, and improves digestion.

It is important to walk at least 30 minutes every day. This may be replaced with swimming or workout in a gym. Besides this, it is vital to remain physically active throughout the day which leads to sustained expenditure of calories.

3) Food and beverages:

There is a very close relationship between food intake and control of diabetes: consume too much food or the wrong food, the glucose level will leap upwards; consume too little and the blood glucose can dip to dangerously low levels. Irregular intake of food can have the same effect. It is therefore important to eat meals and snacks at regular intervals and to eat the right foods.

A nutrient-dense diet will provide a rich array of micronutrients and also help moderate the calories consumed. The following food and beverages should be included in the diet:

  • Water
  • Beverages such as coffee, tea, lassi, sattu drink, coconut water
  • Unrefined whole grains and whole grain products such as brown rice, whole wheat atta, jowar, bajra, oats, corn and corn flour, besan, ragi
  • Dairy products like milk, butter, cheese, paneer, yoghurt
  • Soya products like soya milk, tofu
  • Dal such as rajma, masoor, moong
  • Eggs, chicken, fish, mutton, beef, pork
  • Fruits like apple, papaya, guava, banana, pineapple, melon, watermelon
  • Vegetables, particularly leafy green vegetables
  • Nuts and seeds

The foods and beverages that should be avoided:

  • All simple and refined carbohydrates such as sugar, white rice
  • Products made with refined wheat flour (maida) such as pasta, noodles, momo, white bread and buns, cakes, pastries, biscuits, cookies, pizza, naan
  • Food and beverages sweetened with sugar and sugar substitutes such as high-fructose corn syrup (HFCS), gur, honey, fruit juice concentrates, fruit nectar, fructose
  • Fruit juice and fruit drink
  • Soft drinks, sherbet, syrups

4) Medicines

A wide variety of effective medicines are available for the control of diabetes. Most cases of T2D can be controlled with pills but some may also require insulin. An endocrinologist will be the best person to advise. If insulin has been prescribed it is important to learn how to administer it and not be dependent on someone else to do it. Actually, with the availability of pre-loaded insulin syringes (called ‘pen’), it has become very easy to self-administer insulin.

When diabetes is well-controlled, it is a terrible mistake to stop or skip medication in the belief that the diabetes is cured and there is no need for continued medication – diabetes is never cured, it can only be controlled. Home remedies such as karela (bitter gourd) juice and methi (fenugreek) seeds do help in bringing the blood glucose a few notches down and can definitely be used in a supportive role, but the primary treatment with conventional medicines should be continued at the same time.

5) Regular meal time:

Meals and snacks should be taken at regular intervals. Haphazard consumption of food and beverages wrecks havoc in the control of diabetes. It is usual to take diabetic medication a few minutes before a meal. If the medication has been taken or insulin injected, the meal has to be eaten, even if an urgent task has suddenly emerged – not eating the meal or skimping on it could lead to hypoglycemia.

Hypoglycaemia (hypo)

In a diabetic, when the blood glucose drops to abnormally low levels (below 70 mg/dl), the condition is called hypoglycaemia or simply ‘hypo’. The symptoms of ‘hypo’ include anxiety, palpitations, intense hunger, sweating, palpitations, dizziness, severe weakness, confusion, and in extreme cases loss of consciousness and death.

It is absolutely vital that all diabetics understand ‘hypo’ and that they recognize it as soon as it appears. They need to take corrective action promptly by eating whatever is at hand, preferably a sugary drink. If a meal has been missed, it should be eaten as soon as possible.

Hypoglycaemia occurs because:

1) the diabetic medication was taken but either the meal was missed or only a portion of the meal was eaten

2) excessive and unusual physical exertion over prolonged periods

Hypoglycaemia could occur due to either of the above two situations or it could be due to a combination of both. Unusual excessive physical exertion calls for the consumption of an extra snack or two.

Hyperglycaemia

Hyperglycaemia refers to high blood glucose. In a diabetic, the blood sugar is usually persistently high because of excessive consumption of inappropriate food and beverages. It could also be due to inadequate or irregular medication. If the blood sugar remains persistently uncontrolled, the patient is well on the way to developing the complications that are associated with diabetes. Most of these complications are irreversible and degenerative. It is absolutely crucial to maintain control of blood glucose, and prevent complications from developing. Some of the prominent complications of persistently elevated blood glucose include:

  • Kidney disease, leading to renal failure
  • Heart disease, leading to heart attack
  • High triglycerides and low HDL-cholesterol, which leads to heart disease
  • Brain damage
  • Eye damage, with disturbance of vision and in extreme cases, blindness
  • Nerve damage, causing numbness in the limbs
  • Damage to the arteries in the limbs, which reduces the blood flow and results in cold limbs. In such a condition, accidental injury to the limbs can cause ulcers that prove difficult to heal. In extreme cases, gangrene can develop due to very poor blood flow, requiring amputation of the limb.

One does not need to be a rocket scientist to appreciate that hyperglycaemia, like hypoglycaemia, is an extremely unpleasant condition. Diabetes needs to controlled to prevent the disasters that accompany both hyperglycaemia and hypoglycaemia.

Diabetes is complex disease linked to the hormone insulin. It cannot be cured. It can be controlled with medication and lifestyle changes with excellent long-term result. Home remedies recommended by friends and well-wishers have a variable effect, if at all, on blood glucose and some of these remedies may prove dangerous. Magical cures promised by quacks with herbal drinks, tablets and powders are mostly based on total falsehood. Ingesting these false ‘cures’ can often lead to tragic consequences.

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