Diabetes

Diabetes

Diabetes (Diabetes mellitus) is a metabolic disease that is characterized by higher blood sugar (glucose) levels. The food ingested by human is converted into glucose that enters into each cell of the body to generate energy for various activities. This function is mainly under the effect of insulin, a hormone that regulate glucose levels in the blood. Insulin is produced from pancreas which is an important organ into the abdomen for various digestive functions. There could be complete lack of insulin or its relative deficiency. Accordingly, diabetes is broadly classified into two categories i.e. Type 1 and Type 2. Type 1 diabetes is due to complete absence of insulin in the body due to pancreatic dysfunction which leads to high blood glucose levels. The immune system of the body destroys the insulin producing cells in the pancreas. Type 1 diabetes is found in 10-15% of the population and affect adolescents or early age groups. Type 2 diabetes which is seen in about 85% of the population is a major public health issue that is due to relative deficiency of insulin or even normal insulin with abnormal effect. Type 2 diabetes may have both features as inadequate insulin production and also lack of its effect on the cells (insulin resistance). The risk factors for Type 2 diabetes are increased body weight (Obesity), family history (diabetes in parents, siblings), age above 45 years, smoking, alcohol, pregnancy, sedentary life style, and lack of physical exercise.

Most of the patients do not have any symptoms of this disease and diagnosed only after a general health checkup. Further early onset of disease has very few symptoms. But damage to eyes, heart, kidney and nerves already begins once patient develop high blood sugar level. However, the patient may have following symptoms:

Increased hunger

Increased thirst

Frequent urination

Unexplained weight loss

Fatigue

Slow healing of wounds

Dry, itchy skin

Tingling or numbness of hands or feet

Frequent bacterial or fungal infection

Vision impairment.

The patient of diabetes may have concomitant illness like high blood pressure (hypertension), high cholesterol, or other metabolic disorders. It is important to investigate for these problems in any patient who is diagnosed with diabetes.  

Diagnosis:

Diabetes is diagnosed by measuring blood glucose levels in fasting and postprandial (after meals) conditions. The usual limits for fasting is upto 126 mg/dl while postprandial value should be below 200 mg/dl. The higher levels during fasting and after meals suggest diabetes. Further blood sugar level any time during the day (random blood glucose) higher than 200 mg/dl along with symptoms like excessive hunger (polyphagia, excessive thirst (polydipsia) and excessive urination (polyuria) confirms the diagnosis of diabetes. A laboratory test known as HbA1c (glycosylated hemoglobin) is also an important test to know the status of average blood glucose levels in last 3 months. A value higher than 6.5% is indicative of diabetes and require detailed evaluation of the disease.                 

Treatment:

  1. Diet control and exercise is the mainstay of the management of diabetes. Patient should limit the intake of sugar, carbohydrates, excess salt and fatty foods. A help of qualified dietician can help select the food suitable for patients with diabetes. Further, all patients of diabetes should go for physical exercise in form of yoga, brisk walking, aerobic or resistance exercise. Before starting any exercise program, patient should discuss the suitability of each with treating doctor based on his overall health and if there is any other concomitant illness. 
  2. The patients with Type 1 diabetes are treated only with Insulin injections as there is complete absence of this hormone. Type 2 diabetes which is most common in general population is treated by oral drugs (Oral antidiabetics) and may require Insulin only if oral drugs are inadequate to control the blood glucose levels. Almost all patients with Type 2 diabetes respond to oral treatment in the early stage of the disease. However, few patients may require Insulin with or without oral antidiabetic drugs during the course of their disease.

Some of the common oral Antidiabetics:

  1. Drugs to increase insulin secretion from pancreas: Glimiperide, gliclazide, glipizide
  2. Drug to increase insulin usage in the body: metformin
  3. Drugs that mimics the action of insulin: sitagliptin, teneligliptin, vildagliptin, linagliptin.       
  4. Drugs that reduce the absorption of sugar/carbohydrate from the meal: Acarabose, voglibose 
  5. Drug that enhances the sensitivity of insulin: Pioglitazone.
  6. Drug that increases the excretion of glucose through urine (Empagliflozin, Cangliflozin)      

There are other oral drugs as well that are used depending on the need of individual patient. These drugs are used either as single agent or usually in combinations.

Insulins:

Insulin is an injectable drug (subcutaneous, intravenous) that is taken before or after meals. There are several types of insulins depending on its duration of action. Insulin is self-administered as directed by the doctor.  

GLP-1 analogues:

These are new class of drugs that mimic their action like an endogenous hormone. They are administered by daily or weekly injections and used only in certain patient. The drugs are exenatide and liraglutide.   

Complications of Diabetes:

Diabetes is a chronic disease that persists almost life long and require regular treatment to control blood glucose levels. Patient is advised to adhere to his treatment as directed by his doctor to prevent or delay any future complications. The following complications can develop in patients with diabetes.

  1. Hypoglycemia (fall in blood glucose below 60 mg/dl). Immediate attention is required to control any serious complication mainly neurological. Patient should immediately be given oral or IV glucose to increase the blood sugar level and prevent any major clinical complications.        
  2. Diabetic ketoacidosis (Very high levels of blood glucose usually more than 300 mg/dl with associated metabolic complications). It is a medical emergency and require immediate hospitalization.
  3. Kidney dysfunction: high protein excretion in urine, raised creatinine in blood.
  4. Eye disorders: Patients can develop blurring of vision due to cataract, retinal problems.
  5. Heart dysfunction: myocardial infarction (heart attack), heart failure, 
  6. Nervous dysfunction: neuropathy, stroke
  7. Gut disorders: diarrhea, constipation 

Patients are advised to go for periodic check up for kidney, eye, heart and nervous system to respective doctors.