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Diabetes mellitus, commonly know as "Diabetes" is a group of metabolic diseases characterized by high levels of blood sugar(glucose). In normal cases,glucose levels in blood are controlled by insulin,which is a hormone produced by the pancreas. Insulin lowers the level of glucose in the blood. When the blood glucose level increases usually after food, insulin is released to bring the glucose level to normal. In diabetic people, there is an absence or insufficient production of insulin, wich results in excess glucose in the blood. Diabetes can be controlled but it lasts a lifetime.

We Indians are more prone to diabetes than almost any other population in the world! As the living conditions improved in India, we are increasingly following western dietary habits, not suited for our environment,adopting sedentary life style, and exposed to psycho-social stress. This has resulted in an unprecedented rise of diabetes during in our country. It is estimated that there are at least 20million diabetics in India, which is the highest ever reported number from anywhere in the world.Also,Indians tend to be diabetic at a relatively young age of 45years which is about 10 years earlier than in the west.

Causes of Diabetes

Insufficient production of insulin, defective insulin, or inabilityof cells to utilize insulin properly leads to high blood glucose levels and diabetes. Glucose provides energy for the body cells and needs insulin to aid in its transport into the cells.

Types of Diabetes

There are two main types of diabetes, type1 and type2.
Type1 diabetes is also known as insulin dependent diabetes mellitus(IDDM), or juvenile onset diabetes mellitus. Patients with type1 diabetes have to rely on insulin medication to survive.
Type2 diabetes is also called non-insulin dependent diabetes mellitus(NIDDM), or adult onset diabetes mellitus(AODM). In type2 diabetes, patients can produce insulin, but in relatively inadequate amounts for body`s needs. Sometimes insulin produced may also be defective. A good number of patients with type2 diabetes occurs mostly due to poor eating habits, higher body weight,and lack of exercise.

It is estimated that chances of developing diabetes doubles for every 20% increase over desirable body weight. Diabetes occurs more frequently in women with a previous history of diabetes that develops during pregnancy(getational diabetes), especially those who remain overweight after their delivery. Gestational diabetes usually resolves once the baby is born.

Sometimes elevated blood sugar levels may occur from another medical condition. This is called "secondary" diabetes.

The Symptoms

Initial symptoms of diabetes when untreated are high blood sugar levels, and loss of glucose through urine. High amounts of glucose in the urine causes increased urine output which leads to dehydration and hence increased thirst. Insulin deficiency ultimately will lead to weight loss in spite of an increased appetite. Sometimes patients complain of fatigue,nausea and vomiting. Patients with diabetes are likely to develop infections of the bladder, skin, and vaginal areas, blurred vision and even lehargy and coma in extreme cases.

The Fasting Blood Sugar(FBS) test is the preferred way to dianose diabetes. It is easy to perform and convenient. After fasting overnight (at least 8 hours), a single sample of blood is drawn and sent for laboratory analysis. This can also be done accurately using a glucometer. A Random Blood Sugar(RBS) test can also be used to diagnose diabetes. Oral Glucose Tolerance Test(OGTT) is a standard for dianosis of type2 diabetes also used for dianosing gestational diabetes.

Blood Sugar Check At Home

Home blood sugar (glucose) testing is important in contrlling blood sugar, in the normal range of 70 to 120 mg/dl before meals and below 140 mg/dl two hours after eating. Blood glucose levels are usually tested before and after meals,and at bedtime,by pricking a fingertip with a lancing device and applying the blood to a glucometer,which reads the value. Glucometers give patients some independence to manage their disease process.

Acute Complications of Diabetes

  • Highly elevated blood sugar levels due to complete lack or a relative deficiency of insulin.
  • Abnormally low blood sugar levels due to too much insulin or other glucose-lowering medications.

Lack of insulin also results in a condition called diabetic ketoacidosis(DKA). Without prompt medical treatment,patients with diabetic ketoacidosis can rapidly go into shock, coma, and even death.

In patients with type2 diabetes, severaly elevated blood sugar levels,accompanied by dehydration, can lead to coma. Immediate treatment with intravenous fluid and insulin is required.

Abnormally low blood sugar in diabetics is commonly caused due to excessive use of insulin or other glucose-lowering medications. Sometimes, low blood sugar can be the result of insufficient food intake or sudden excessive physical exertion. Untreated,severly low blood sugar can lead to coma, seizures, and even irreversible brain death.

Chronic Complications of Diabetes

Chronic complications relate to blood vessel diseases, such as those involving the eyes, kidneys and nerves(microvascular disease),and large vessel disease involving the heart and blood vessels(macrovascular disease). Diabetes can lead to coronary heart disease(heart attack), strokes, and pain in the lower extremities.

  • Eye complication called diabetic retinopathy occurs in patients having diabetes for at least five years, imparing vision. Eye diseases like cataract and glaucoma are also more common in diabetics.
  • Kidney damage called diabetic nephropathy can occur due to the accumulation of toxic waste products in the blood. This leads to need for dialysis.
  • Nerve damage called diabetic neuropathy also occurs in diabetics leading to numbness, burning, and aching of the feet and lower extremities.

The Treatment

The main aim in treating diabetes is to reduce elevation of blood suagr(glucose) without causing abnormally low levels of blood sugar. Type1 diabetes is treated with insulin,exercise,and diabetic diet while type2 diabetes is treated first with weight reduction, diabetic diet, and exercise. When these measures fail to control high blood sugar levels, oral medications are used. If oral medications are insufficient, treatment with insulin is considered.

A diabetic diet is a very important aspect in controlling high blood sugar. Weight reduction and exercise are also important in treatment of diabetes. Weight reduction and exercise increase the body`s sensitivity to insulin, thus helping to control blood sugar elevations.

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