"Is Diabetes Preventable" ..... Yes!!!
INTRODUCTION TO DIABETES
WHAT IS DIABETES?
Diabetes mellitus is a chronic metabolic disorder characterizes by elevation of the lood glucose concentration and caused by a relative or absolute deficiency of nsulin. Diabetes not only causes profound abnormalities of carbohydrate metabolism, but also affects protein and fat metabolism. If left untreated, diabetes will ultimately lead to a state that may be best described as 'metabolic chaos'.
Although sugar (glucose) is needed to provide energy for the body, when in excess, it can lead to complications in various organs. Carbohydrates in the food are igested and converted into glucose, which is carried in the blood stream to all the body cells. The cells use glucose as a source of energy. Persons with diabetes have excess sugar in blood because they have deficient supply of insulin. Insulin is a substance produced by pancreas, an organ situated behind the stomach. Insulin enables sugar (glucose) to enter the cells. It is as if insulin is a key, which opens the doors of the cell? to allow sugar to enter. When insulin is absent, or isdeficient, sugar cannot enter the cells and remains in blood in high amounts.
SYMPTOMS OF DIABETES
Most symptoms of diabetes are related to the fact that the body tissues cannot utilize glucose due to lack of insulin. When glucose does not enter body cells, it accumulates in blood. After it reaches a certain limit, it starts appearing in urine. Normal urine does not contain glucose. When glucose appears in urine, it draws out more water with it and hence there is excessive urination. Because of excess urination and loss of water there is excessive thirst
Although there is exceeds glucose in the blood, there isn't enough in the cells (because insulin is lacking).The cells are 'starved' of glucose. This causes loss of weight and tiredness. When glucose levels are very high, some people become irritable. Sometimes very high blood glucose levels can lead to coma-Also there is a greater risk of developing infections. Not all diabetes have these symptoms and some people don't have any symptoms at all; they are just discovered on routine examination.
ESTABLISHING THE DIAGNOSIS
Diabetes must always be diagnosed by measuring blow glucose and demonstrating its unequivocal elevation. The following symptoms in a person shows alert a physician to look for diabetes.
A) Excessive Hunger, B) Excessive Thirst, C) Excessive Urination, D) Loss of Weight, E) Tiredness, F) Irritability G) Itching in the genitals H) Delayed wound healing
DIAGNOSTIC CRITERIA FORDIABETES
(Non-Pregnant)
Venous plasma glucose (mg/dl)
| |
Normal |
Impaired Glucose tolerance |
Diabetes |
| Fasting |
110 |
140 -199 |
|
| Two hours after |
|
|
126 |
| 75g glucose load |
140 |
200 |
|
Note: Based on WHO recommendations. Values for whole blood capillary samples will be slightly lower.
TYPES OF DIABETES
Type I diabetes
Patients with Type I diabetes are usually severely insulin deficient and are dependent on exogenous insulin for life. Both genetic and environmental factors contribute to its etiology. If one parent has the condition, the risk of a child developing Type I diabetes, though increased, is still on about 1 -4 percent It is thought that certain environment factors-such as a viral infection-may precipitate the onset of diabetes in a genetically prone individual. Clinical diabetic usually presents when about 90 percent of the insulin producing beta cells have been destroyed. The patient usually young and complains of the classical symptoms listen in Tablet.
Type 2 diabetes
Hereditary factors are stronger in Type 2 diabetes. Th main environmental factor in the etiology of Type 2 diabetes is food: diabetes is commoner in the obese, although only minority of obsess people develop Type 2 diabetes. Thus, as Type I diabetes, a combination of genetic and environment factors probably causes the disease. Another relevant environmental factor is stress: many patients report that the diagnosis of diabetes was made following a stressful event such as an accident or bereavement.
A number of defects may lead to the development of Type 2 diabetes:
- Reduced insulin secretion by the beta cell
- Altered handling of glucose by the liver
- Insulin resistance at the cellular level
Patients often present with some of the symptoms listed above though the symptoms tend to be milder and longer duration. However, many patients have no symptoms whatsoever and are found to have diabetes at a medical examination.
SECONDARY DIABETES:
Diabetes may occasionally develop as a consequence other disease or drug therapy.
Some causes of secondary diabetes:
- Pancreatic disease (pancreatitis, surgery, carcinoma)
- Endocrine disease (acromegaly, Cushings)
- Drugs (steroids, contraceptives, diuretics).
- Genetic syndromes (many described-all extremely rare).
GESTATIONAL DIABETES:
Diabetes that develops during pregnancy. The mother's blood glucose rises due to hormones secreted during pregnancy, and the mother cannot produce enough insulin to handle the higher blood glucose levels. Although gestational diabetes usually goes away after pregnancy, about 60 per cent women who've had gestational diabetes eventually develop type 2 diabetes.
RISING PREVALENCE OF DIABETES IN INDIA
Studies done among the migrant Indian population settled in UK, South Africa. Singapore, Fiji etc., had shown that Indian migrants have a high prevalence of diabetes compared to their co-habitants. These studies proposed that Indians have a genetic tendency to develop diabetes. Studies done at the Diabetes Research Centre, Chennai by Dr A. Ramachandran and his colleagues have shown that there is an increasing prevalence in diabetes in the urban population.
Studies have shown that the prevalence of diabetes has increased from 5.2 per cent in 1986 to 8.2 per cent in 1990 and 11.6 per cent in 1996 in Chennai. At present, it is calculated that there are about 20-25 million and by the year 2000 we will have 30-35 million people with diabetes in India. In other words, India will have the largest number of diabetics in the world and one out of every four diabetics in the world will be an Indian.
Ramachandran's studies showed that there is a peculiar type of fat distribution in Indians called central adiposity. In this condition fat seems to accumulate more in the abdominal area in Indians, giving a pot belly or apple shaped figure. This particular central distribution of fat gives high risk not only for diabetes but also for heart disease.
DIABETES IN INDIANS
Research studies done at Diabetes Research Centre had found that diabetes occurs at a young age in Indians compared to the western population. Moreover, Type 2 diabetes occurs much more commonly in people below 25 years of age particularly those who have strong family history (Maturity onset of diabetes in the young: MODY). |
