What is Diabetes?

Ans. Diabetes is a condition characterized by elevated blood glucose level which develops due to absolute or relative deficiency of insulin. Insulin is a hormone, secreted from the pancreas, which is needed to move glucose (blood sugar) from the blood into the cells. The cells of the human body need glucose for energy. Without insulin, the glucose remains in the blood. Therefore, on one hand, the body does not receive fuel for energy and on the other hand the high blood glucose leads to complications.

Type 1 diabetes is a disease that develops when the pancreas stops producing insulin. It usually appears in children and young adults. It is also called juvenile diabetes or insulin–dependent diabetes mellitus (IDDM). Type 1 diabetics need insulin for survival. Type 1 diabetes is thought to comprise about 5% of all diabetes.
Type 2 diabetes was previously called non–insulin–dependent diabetes mellitus (NIDDM) or maturity–onset diabetes. Type 2 diabetes accounts for more than 95% of all diagnosed cases of diabetes. It usually begins as insulin resistance, in which the body cells are unable to use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it. A combination of insulin resistance and insulin deficiency leads to Type 2 diabetes.

What is the cause of diabetes?

Ans. Type 1 diabetes is an autoimmune disease. It occurs when the body’s immune system does not recognize the beta cells of the pancreas as its own part, and mistakenly attacks them, as if they were foreign elements. Genetics predisposes to type 1diabetes, and viral infections or other unknown environmental factors may precipitate the disease.

Type 2 diabetes is caused either because the body no longer responds to the insulin it produces – a condition known as insulin resistance – or it fails to produce enough insulin. In either of the two conditions of a reduced insulin effect the body is unable to convert the glucose into energy, causing the excess sugar to remain in the bloodstream. It typically occurs in adults, and can often be managed by lifestyle measures and oral drugs, although insulin may be required sometimes. Obesity and family history are the most powerful risk factors for type 2 diabetes.

Types of Diabetes?

Ans. Type 1 diabetes is an autoimmune disease. It occurs when the body’s immune system does not recognize the beta cells of the pancreas as its own part, and mistakenly attacks them, as if they were foreign elements. Genetics predisposes to type 1diabetes, and viral infections or other unknown environmental factors may precipitate the disease.

Type 2 diabetes is caused either because the body no longer responds to the insulin it produces – a condition known as insulin resistance – or it fails to produce enough insulin. In either of the two conditions of a reduced insulin effect the body is unable to convert the glucose into energy, causing the excess sugar to remain in the bloodstream. It typically occurs in adults, and can often be managed by lifestyle measures and oral drugs, although insulin may be required sometimes. Obesity and family history are the most powerful risk factors for type 2 diabetes.

Type 3 GDM: Gestational diabetes mellitus or diabetes onset during pregnancy affects more than 10% pregnant Indian women. This form of diabetes develops during 6th to 7th month of pregnancy and usually goes away post delivery. If left untreated it can lead to complications both in mother and child. The recommended treatment for this is multiple injections of insulin. If the treatment is followed strictly with regular monitoring of sugars it is possible to have a healthy baby and no complications for the mother. Such women are more likely to get diabetes later on in life and need regular checks and preventive measures.

Prediabetes: If a non diabetic person has fasting blood sugar values between 100 and 125mg/dl and/or 2 hours post glucose sugar values between 140 and 200mg/dl then the individual is in prediabetic state. These individuals are prone to develop overt diabetes. Lifestyle measures are the key in management and can prevent or delay development of diabetes. Drugs like metformin and acarbose can be used occasionally.

What are the symptoms of diabetes?

Ans. The signs of type 1 diabetes may include excessive thirst, increased urination, increased appetite and unexplained weight loss. Sometimes fat breakdown in the body results in excessive production and accumulation of ketones and can lead to an emergency called diabetic ketoacidosis, which can result in coma.The signs of type 2 diabetes can be similar, but there is usually no ketoacidosis. Lack of energy, blurred vision, frequent infections, cuts/bruises that are slow to heal, tingling/numbness in the hands/feet, recurring skin, gum, or bladder infections are common presentations. Almost half of type 2 diabetics may have no symptoms and are detected incidentally, or when complications have actually occurred.

What are the complications caused due to diabetes?

Ans. Microvascular (small vessel) complications– eye (retinopathy, glaucoma, cataract), Kidney – protein leak, kidney failure, nerves– neuropathy.

Macrovascular (large vessel) complications– heart attacks, feet– gangrene.

In the worst case scenario, eye complications can lead to blindness and kidney failure may necessitate dialysis or transplantation. Leg amputations are the dreaded complication of diabetic foot involvement.

Which treatment is more effective (tablets or insulin)?

Ans. Both are effective, but there is much greater capacity to adjust insulin doses– there is no upper limit to insulin unlike in tablets. Often combinations of insulin and tablets are used. When diabetes is very long standing, tablets may not work, and insulin may be required. In certain special situations like kidney disease, pregnancy, infections, surgery or any acute illness, insulin is the preferred method of treatment.

Is there any side effect of using Insulin injection for longer time?

Ans. No, insulin is very safe for long term use. Some individuals may gain weight gradually. Occasional low blood sugar reactions may be seen, especially if patient is erratic about meals and meal timings.

What are the different ways to control it?

Ans. Lifestyle– diet and exercise.

Oral medications –metformin, suphonylureas (glimeperide, gliclazide. glibenclamide), DPP4 inhibitors (sitagliptin, vildagliptin)Glitazones– pioglitazone, rosiglitazone, Alpha glucosidase inhibitors – acarbose, voglibose, miglitol,Insulins– human and analogs, short and long acting.

The choice of medication depends on the patient profile. Metformin is the typical drug for initiating therapy. Others are added on as need arises. Sometimes two drug combinations are used even initially. Insulin can be introduced at any stage.