What is Diabetes?
When we eat, some of the foods are broken down into glucose (sugar), which then enters the blood. In order for this glucose to enter the cells of our body, we need insulin, which is made by the pancreas (an organ behind the stomach). Insulin causes glucose to travel from the blood into the tissues, such as the heart and muscle. The cells then use this glucose to create energy to survive. Diabetes occurs when there is not enough insulin in the body, which means glucose cannot enter tissues, and thus glucose remains in the blood for a long time and cells don't have the energy to survive.
Diabetes is a chronic disease with a myriad of possible complications. With the right education and motivation, it is a preventable disease.
Diabetes is a chronic disease with a myriad of possible complications. With the right education and motivation, it is a preventable disease.
What is prediabetes?
People with prediabetes have blood sugar levels that are higher than normal, but not high enough for a diagnosis of diabetes. They are at higher risk for developing diabetes and other serious health problems, including heart disease, and stroke.
Without lifestyle changes to improve their health, 15% to 30% of people with prediabetes will develop diabetes within 5 years.
Patients with prediabetes usually do not need to take any medication. But they must work hard to make sure that their prediabetes does not become diabetes
Without lifestyle changes to improve their health, 15% to 30% of people with prediabetes will develop diabetes within 5 years.
Patients with prediabetes usually do not need to take any medication. But they must work hard to make sure that their prediabetes does not become diabetes
What are the initial symptoms of diabetes/prediabetes?
- Having to urinate alot
- Being very thirsty
- Feeling tired or weak (especially after eating)
- Having pain, tingling, or numbness in your hands or feet
- Having blurry vision
- Loosing weight without trying
Symptoms of hyperglycemia (glucose levels above 200 mg/dL for many days):
- Headache
- Nausea and vomiting
- Fruity-smelling breath
- Shortness of breath
- Dry mouth
- Weakness
- Confusion
- Coma
- Abdominal pain
How to prevent prediabetes from becoming diabetes?
- Watch your weight! If you are overweight, try to lose weight. If you are not overweight, try not to gain weight.
- Be active! Try to exercise at least 30 minutes a day, 5 days a week.
- Eat healthy foods like fresh fruits, vegetables, and whole grains. Try not to eat too many foods high in fat. Do not overeat.
Research shows that modest weight loss and regular physical activity can help prevent or delay type 2 diabetes by up to 58 percent in people with prediabetes. Modest weight loss means 5% to 7% of body weight, which is 4.5 to 6.5 kilos for a 91 kilo person. Getting at least 150 minutes each week of physical activity, such as brisk walking, also is important.
Lifestyle change programs offered through the National Diabetes Prevention Program, which is led by CDC, can help participants adopt the healthy habits needed to prevent type 2 diabetes. Trained lifestyle coaches lead classes to help participants improve their food choices, increase physical activity, and learn coping skills to maintain weight loss and healthy lifestyle changes.
Do I have diabetes/prediabetes?
The test below is a good indicator to see if you could be diabetic/prediabetic:
Those with risk factors (see below) or those with symptoms must get screened for diabetes. A useful test is the Indian Diabetes Risk Score (IDRS) listed on the left. If you have a score greater than 60, it is recommended that you get screened.
Who should be tested for diabetes/prediabetes?
The above two tests are good indicators of your overall risk of diabetes/prediabetes. But those with the following risk factors are more likely to get diabetes and should get tested:
- People who are over 45 years old.
- People who are under 45 years old:
- Are overweight or obese
- Have a family member with diabetes
- Not physically active
- Have high blood pressure or high cholesterol
- Are African-American, Native-American, Hispanic, or Asian (Indian)
- Women who had diabetes while pregnant
- Women who had a baby weighing over 9 pounds
- Women who have Polycystic Ovary Disease (PCOD)
How to interpret blood test numbers?
- Fasting plasma glucose (FPG) test: This measures blood glucose in people who have not eaten anything for at least 8 hours. Fasting glucose levels of 100 to 125 mg/dL are diagnostic of prediabetes. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.
- Oral glucose tolerance test (OGTT): This test measures blood glucose after people fast for at least 8 hours, and two hours after they drink a sweet liquid provided by a doctor or laboratory. A blood glucose level below 140 is normal. A blood glucose level between 140 and 199 mg/dL means you have prediabetes. If confirmed by a second test, a 2-hour glucose level of 200 mg/dL or above means a person has diabetes.This test is better than the FPG test, but it is less convenient to administer.
- Random glucose test: A blood sample will be taken at a random time. A random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst. A level between 140 mg/dL (7.8 mmol/L) and 199 mg/dL (11.0 mmol/L) is considered prediabetes. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal.
- Hemoglobin A1c test: This test measures the amount of glucose that is on the red blood cells. Fasting is not necessary. An A1c value of 5.7% to 6.4% indicates prediabetes. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. Normal levels are below 5.7 percent.
*People whose test results indicate they have prediabetes should have their blood glucose levels checked again in 6 months to 1 year.
How often to check my blood glucose at home?
All diabetes patients should have a blood glucose meter (also called a home blood sugar meter, a glucometer, or a glucose meter). This can help you improve control of your blood sugar levels, and help your doctor make appropriate adjustments to your medicine, diet and/or level of physical activity.
If you are not using insulin or if you are taking insulin once a day:
(a) Test your blood 3 times each day:
a. When you wake up (before breakfast)
b. Before your biggest meal of the day
c. 2 hours after your biggest meal of the day
(b) Do this just 3 days per month. Write the numbers down in your log book so you can see your pattern (getting up, before biggest meal, 2 hrs after meal).
(c) Testing more often may be needed when you first start insulin or if your insulin dose is being changed.
If you are taking insulin two or more times a day:
(a) Test your blood:
a. Before each insulin dose, and
b. 2 hours after your biggest meal of the day. You have to do this every day.
(a) Make notes in your log book if you feel unusually sick or tired.
(b) You may need more frequent testing when you are starting a new insulin dose.
For all patients:
(a) Please bring your glucometer and log book to all diabetes clinic appointments.
(b) Test any time you think you may have low blood sugar, also known as being hypoglycemic ( shaky, sweaty, weak, fast pulse)
(c) Test any time you are feeling unusually sick or tired.
(d) Write down all of your blood sugar testing results! Changes to your medications are diabetes plan are based on the pattern of your blood sugar level
For many people who have diabetes, target levels are:
If you are not using insulin or if you are taking insulin once a day:
(a) Test your blood 3 times each day:
a. When you wake up (before breakfast)
b. Before your biggest meal of the day
c. 2 hours after your biggest meal of the day
(b) Do this just 3 days per month. Write the numbers down in your log book so you can see your pattern (getting up, before biggest meal, 2 hrs after meal).
(c) Testing more often may be needed when you first start insulin or if your insulin dose is being changed.
If you are taking insulin two or more times a day:
(a) Test your blood:
a. Before each insulin dose, and
b. 2 hours after your biggest meal of the day. You have to do this every day.
(a) Make notes in your log book if you feel unusually sick or tired.
(b) You may need more frequent testing when you are starting a new insulin dose.
For all patients:
(a) Please bring your glucometer and log book to all diabetes clinic appointments.
(b) Test any time you think you may have low blood sugar, also known as being hypoglycemic ( shaky, sweaty, weak, fast pulse)
(c) Test any time you are feeling unusually sick or tired.
(d) Write down all of your blood sugar testing results! Changes to your medications are diabetes plan are based on the pattern of your blood sugar level
For many people who have diabetes, target levels are:
- Before meals — between 70 and 130 milligrams per deciliter (mg/dL), or 4 and 7 millimoles per liter (mmol/L)
- One to two hours after meals — lower than 180 mg/dL (10 mmol/L)
- Fasting at least eight hours — between 90 and 130 mg/dL (5 and 7 mmol/L)
How to control my diabetes?
Weight loss is the most important goal once a person is diagnosed with diabetes. This can only be achieved by eating healthy and regular physical activity.
It is well known in the scientific community that the healthiest cuisine in the world is the Mediterranean diet (followed by nations surrounding the Mediterranean sea: Spain, Italy, Greece). People who follow this cuisine have lower cholesterol levels, lower number of strokes, lower number of heart attacks, and lower risk of diabetes.
It is well known in the scientific community that the healthiest cuisine in the world is the Mediterranean diet (followed by nations surrounding the Mediterranean sea: Spain, Italy, Greece). People who follow this cuisine have lower cholesterol levels, lower number of strokes, lower number of heart attacks, and lower risk of diabetes.
Key components of the Mediterranean diet:
The diet also recognizes the importance of being physically active, and enjoying meals with family and friends.
- Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts
- Replacing butter with healthy fats, such as olive oil
- Using herbs and spices instead of salt to flavor foods
- Limiting red meat to no more than a few times a month
- Eating fish and poultry at least twice a week
- Drinking red wine in moderation (optional)
The diet also recognizes the importance of being physically active, and enjoying meals with family and friends.
- Research has shown that replacing white rice with brown rice helped significantly reduce glucose levels and lower serum insulin. The study was conducted by Dr. V. Mohan, MD, FRCP PhD, DSc, FNASc, from the Madras Diabetes Research Foundation, World Health Organization Collaborative Centre for Non-Communicable Disorders, Chennai, India, at the International Diabetes Federation World Diabetic Conference 2013. Dr. Mohan found that Indians who replaced white rice with brown rice has their glucose cut by 20%, and insulin cut by 60%.
- To learn about 8 Indian Diet Habits that you can avoid to stay healthy, visit the following site: http://www.thehealthsite.com/fitness/8-indian-diet-habits-that-are-bad-for-your-health/
How many diabetics in India and why so many?
A 2004 WHO report initially listed India as the diabetes capital in the world, possessing the most number of diabetics in the world. It said India heads the world with over 32 million diabetic patients and this number is projected to increase to 79.4 million by the year 2030.
Surveys indicate that diabetes now affects a staggering 10-16% of urban population and 5-8% of rural population in India.
A later 2013 report by the International Diabetes Federation (IDF)found that India had the second largest number of diabetics in the world, a grand total of 65.1 million diabetics. It is commonly understood that diabetes in India is severely under-diagnosed, and bound to surpass china if the current trends are to remain.
The table on the left shows which nations have the highest diabetics.
The reason why diabetes is an epidemic in India is multifold. It includes:
Due to rapid urbanization, there is fewer labor intensive jobs. People are not getting nearly as much exercise as they should. The diet is built upon rice, which is essentially pure sugar. There is lot of misinformation about snacks and soft drinks. Fruits, vegetables, and whole grain do not receive the attention they deserve.
While diabetes is traditionally though of as a disease of the upper and middle class, new research has shown that the diabetes rates in rural areas is alarmingly high. This is because rural citizens have poor eating habits, and depend more on Ayurveda medicine than Allopathy. As such, their diabetes is poorly controlled, leading to higher complications.
Surveys indicate that diabetes now affects a staggering 10-16% of urban population and 5-8% of rural population in India.
A later 2013 report by the International Diabetes Federation (IDF)found that India had the second largest number of diabetics in the world, a grand total of 65.1 million diabetics. It is commonly understood that diabetes in India is severely under-diagnosed, and bound to surpass china if the current trends are to remain.
The table on the left shows which nations have the highest diabetics.
The reason why diabetes is an epidemic in India is multifold. It includes:
- Demographic transition
- Epidemiological transition
- Rapid Urbanization
- Industrialization
- Increasing income levels
- Changing lifestyles, values and culture
Due to rapid urbanization, there is fewer labor intensive jobs. People are not getting nearly as much exercise as they should. The diet is built upon rice, which is essentially pure sugar. There is lot of misinformation about snacks and soft drinks. Fruits, vegetables, and whole grain do not receive the attention they deserve.
While diabetes is traditionally though of as a disease of the upper and middle class, new research has shown that the diabetes rates in rural areas is alarmingly high. This is because rural citizens have poor eating habits, and depend more on Ayurveda medicine than Allopathy. As such, their diabetes is poorly controlled, leading to higher complications.
How aware are Indians?
A household study was conducted in 2010 in Tamaka Village (Karnataka). The subjects were adults and elderly age group people. The researchers created questionnaires to test their knowledge, and also blood test to check blood sugar levels.
They found that 10% of the 311 adults had hyperglycemia (elevated blood glucose levels). Only 50% of the population knew anything about diabetes. Close to 75% of them were not aware of the long term effects of diabetes and diabetic care. They believed that in order to avoid diabetes, one had to sweets, rice and fruits and to consume more ragi, millet and wheat chapattis.
This study and many others show that knowledge about diabetes is very poor in the rural population. Community level awareness programs have to be organized.
They found that 10% of the 311 adults had hyperglycemia (elevated blood glucose levels). Only 50% of the population knew anything about diabetes. Close to 75% of them were not aware of the long term effects of diabetes and diabetic care. They believed that in order to avoid diabetes, one had to sweets, rice and fruits and to consume more ragi, millet and wheat chapattis.
This study and many others show that knowledge about diabetes is very poor in the rural population. Community level awareness programs have to be organized.
Who are most likely to get diabetes?
Those with the following risk factors are more likely to get diabetes:
- Age ≥40 years
- First-degree relative with type 2 diabetes
- Member of high-risk population (people of Aboriginal, African, Asian Hispanic, or South Asian descent)
- South Asia includes the nations India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, and Maldives
- South Asia includes the nations India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, and Maldives
- History of prediabetes (see above)
- History of diabetes during pregnancy
- History of delivery of a macrosomic infant
- Presence of end organ damage associated with diabetes:
- Microvascular (eye disease, nerve disease, kidney disease)
- Macrovascular (heart disease, strokes), cerebrovascular, peripheral)
- Vascular disease:
- HDL cholesterol level <1.0 mmol/L in males, <1.3 mmol/L in females triglycerides ≥1.7 mmol/l
- Hypertension (elevated blood pressure)
- Overweight
- Abdominal obesity
- HDL cholesterol level <1.0 mmol/L in males, <1.3 mmol/L in females triglycerides ≥1.7 mmol/l
- HIV infection
- Obstructive Sleep Apnea (OSA; causes snoring while asleep)
- Use of the following drugs
- Glucocorticoids
- Atypical antipsychotics
- Highly Active Antiretroviral Therapy (HAART)
What are potential complications of diabetes?
Some of the potential complications of diabetes include:
- Heart and blood vessel disease: Diabetes dramatically increases the risk of various heart and blood vessel problems, including coronary artery disease with chest pain, heart attack, stroke, narrowing of arteries and high blood pressure. The risk of stroke is 2to 4 times higher for people with diabetes, and the death rate from heart disease is 2 to 4 times higher for people with diabetes than for people without the disease, according to the American Heart Association (AHA).
- Nerve damage (neuropathy): Excess sugar can injure the walls of the tiny blood vessels that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood sugar can eventually cause you to lose all sense of feeling in the affected limbs. Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.
- Foot damage: Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections. Severe damage might require toe, foot or even leg amputatio
- Skin and mouth conditions: Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections. Gum infections also may be a concern, especially if you have a history of poor dental hygiene.
- Osteoporosis: Diabetes may lead to lower than normal bone mineral density, increasing your risk of osteoporosis.
- Kidney damage (nephropathy): The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant.
- Eye damage: Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
- Alzheimer's disease: Type 2 diabetes may increase the risk of Alzheimer's disease and vascular dementia. The poorer your blood sugar control, the greater the risk appears to be. So what connects the two conditions? One theory is that cardiovascular problems caused by diabetes could contribute to dementia by blocking blood flow to the brain or causing strokes. Other possibilities are that too much insulin in the blood leads to brain-damaging inflammation, or lack of insulin in the brain deprives brain cells of glucose.
- Hearing problems: Diabetes can also lead to hearing impairment.
Highly Rated Sources:
- http://www.mayoclinic.org/diseases-conditions/type-2-diabetes/basics/complications/con-0031902
- http://www.cdc.gov/diabetes/prevention/factsheet.htm
- http://www.idf.org/worlddiabetesday/toolkit/gp/facts-figures
- http://www.diabetespartnership.org/what-is-diabeteshttp://guidelines.diabetes.ca/ScreeningAndDiagnosis/Screening
- http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/
- http://www.idf.org/worlddiabetesday/toolkit/gp/facts-figures
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859279/
- http://journals.lww.com/epidem/Fulltext/2010/09000/Diabetes_Mellitus_in_Rural_India.34.aspx
- http://www.medscape.com/viewarticle/819304
- http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801
- http://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628