Understanding Diabetes to 'Be at ease'
There are many ways to describe Diabetes. That it's a metabolic disorder or that it's an endocrinological disorder. That it's a lifestyle disease or that it's the most dreaded of all the noncommunicable diseases. However you put it, Diabetes Mellitus is a life-changing diagnosis therefore it is of paramount importance for one and all to be clearly acquainted with what it is. It could help you deal with it and manage it better if you or a loved one has been given a diagnosis of Diabetes. If you are fortunate enough to be non Diabetic, knowing more about it could help you change your life on your own terms so that it doesn't show up and change your life for you!
Diabetes is characterised by consistently high levels of sugar in the blood and urine. Excess sugar(glucose) in the blood simply means that the rest of the body (the cells of the muscles, tissue and the brain) isn't getting adequate glucose consistently to meet its requirement. The pancreatic hormone insulin plays a vital role in the uptake of glucose from the blood to the cells that need it. Simply put, Diabetes occurs when insulin fails to do its job.
There are two main types of chronic Diabetes:-
Type 1 Diabetes Mellitus
Type 1 DM is an autoimmune condition wherein one's own body (through antibodies) attacks its own insulin insulin-producingn the pancreas. It constitutes 8% of all diabetic cases. This type of Diabetes is characterized by its quick and early onset, and it can manifest during childhood or early teenage years. The medical community to this day remains in the dark as to what causes this type of Diabetes or what cures it. The only way to manage type 1 DM is by taking lifelong insulin injections.
Type 2 Diabetes Mellitus
It is the more common type of Diabetes that we mostly see around us and it is this type of diabetes that qualifies as a lifestyle disease (though not in all cases). As opposed to type 1 DM, in which the insulin producing cells of the pancreas get destroyed, type 2 DM is characterised either by decreased production of insulin in the pancreas or the inability of the adequately produced insulin to carry out its functions in the body (glucose uptake from the blood to the cells). Unlike type 1 DM, type 2 has plenty of risk factors as well as mitigating factors. It occurs in one's late thirties or early forties although it could appear as early as at 25 years for South Asians who are at risk. Though there is no cure for type 2 DM as well, it can be controlled in more ways than type 1 which include but aren't limited to insulin injections and medications. There is evidence now suggesting that it can even be forced into remission with a combination medicine, diet, exercise and lifestyle modifications.
Despite its differences in pathophysiology and onset, both type 1 and type 2 diabetes result in elevated blood sugar levels and have some common presenting symptoms. That being said, it would be worthwhile to note that symptoms of type 2 DM are easier to miss due to their delayed and slow onset.
Symptoms of Diabetes Mellitus
The trademark symptomatic triad of Diabetes Mellitus consists of the three P's - Polydipsia, Polyuria and Polyphagia.
Polydipsia refers to increased unnatural thirst. Polyuria is an increase in the frequency of urination, especially at night. Polyphagia simply means increased appetite. Constant fatigue is another telling sign of Diabetes. A sudden and apparent loss of weight along with the three P's is a classic sign of type 1 Diabetes whereas the onset of type 2 DM is harder to distinguish as mentioned before.
Diabetes may also present with one or a few localized symptoms such as periodontal infections (gum disease), thrush ( fungal infections on the tongue), genital itching, wounds and ulcers that take longer to heal, tingling sensation in the extremities or blurred vision.
If you or your loved one has been experiencing any of the aforementioned symptoms, it would be wise to get yourself tested for Diabetes. Although it is easy to monitor our blood sugar levels at home now with a store-bought blood glucose monitor, the glycated hemoglobin (HbA1c) test and the Glucose Tolerance Test remain the gold standard for diagnosing Diabetes Mellitus. The HbA1c test is especially useful in revealing one's mean plasma glucose level over the previous three months and whether the subject is pre-diabetic. Prediabetes is characterized by high blood sugar levels that can be reversed with diet and exercise and cannot yet be diagnosed as Diabetes Mellitus.
What causes Diabetes?
The exact cause of most cases of Diabetes is unknown but the general consensus is that both type 1 and type 2 diabetes may be caused by a combination of genetic and environmental factors. The family members of people suffering from type 1 (autoimmune) DM could get themselves tested for the presence of auto-antibodies as the presence of it indicates an increased risk of getting the disease. The primary distinction between the two types is that type 2 is many a time a lifestyle-related disease and develops over time in the presence of certain risk factors. Some of these risk factors include:
- Genetics - A parent or a sibling with type 2 DM
- Ethnicity - South Asians, Asian Americans, Blacks, Hispanics and Pacific Islanders unfortunately are more prone to get type 2 DM than others.
- Obesity/ High Triglyceride levels over a long time can render insulin ineffective in glucose uptake. This is also true in the case of low HDL (good) cholesterol and high LDL (bad) cholesterol.
- High Blood Pressure - High Blood Pressure is often associated with type 2 DM and it goes without saying that a life of undue stress could eventually precipitate Diabetes.
- Sedentary lifestyle: People who tend to be inactive for prolonged periods of time in a day tend to have impaired insulin function.
- Age - most cases of type 2 DM manifests after 40 years of age although the trends have been disturbing as of late, with type 2 DM choosing to appear much earlier (around 25 years), especially among South Asians.
Effects and Complications of Diabetes
It is understood that any chronic long-lasting illness will, to an extent, cause a certain amount of emotional trauma. One shouldn't be quick to judge or divulge unsolicited advice to a diabetic patient. It is important to be empathetic towards them as we would towards anyone who would be suffering. As mentioned before, any number of factors could cause Diabetes and it's not just lifestyle alone. Just like how the cause of Diabetes could be vague, the effects of this dreadful disease are manifold. Only the common symptoms have been mentioned above but glucose in the blood running uncontrolled could cause damage anywhere in the body.
Some of the psychologically damaging symptoms of Diabetes include wasting of muscles in men, vaginal yeast infections in women and decreased sex drive in both.
Apart from these, there are 6 long-term complications that could ensue from uncontrolled Diabetes over time:-
- Cardiovascular diseases including but not limited to atherosclerosis, coronary artery disease and heart attacks
- Kidney damage (nephropathy)
- Eye damage that could lead to eventual blindness (retinopathy)
- Poor wound healing may lead to sores and ulcers in parts of the body that may go unnoticed till it becomes painful and difficult to manage (Diabetic foot ulcer)
- Nerve damage (neuropathy) that starts as tingling at the extremities and then spreads. The resulting numbness of neuropathy often contributes to the development of foot ulcers going unnoticed.
- Periodontitis - Destructive disease of the gums that could result in total and premature loss of teeth.
Prevention of Diabetes - Be at ease!
The silver lining is that type 1 Diabetes is rare and type 2 Diabetes could be prevented with some smart lifestyle choices:-
- If diabetes runs in your family, make sure you run too! Adequate physical exercise, especially the aerobic kind, at least 30 minutes a day, goes a long way in keeping Diabetes at bay.
- You are what you eat! Indulge excessively in simple sugary foods and you become a walking cauldron of sugar yourself. Try to have a balanced diet rich in fiber with plenty of grains, fruits and vegetables and restrict carbohydrate intake to a necessary minimum.
- Keep your weight in check. If your BMI is above normal, losing as less as 7% of body weight can significantly decrease your risk of getting diabetes.
It is also important to be vigilant and remember to screen your blood sugar levels every now and then. A self-operable glucometer is a handy investment which you could use to monitor your stats well as your family.