Introduction to Diabetes
For reasons of genetics and lifestyle changes, Indian’s already form the world’s largest diabetic population. In urban areas, 12% of adult population suffers from diabetes, compared to 6% in US. In 2000, India had 31.7 million diabetic patients and the number is expected to rise to 79.4 million by 2030.
The main symptoms of diabetes are: increased thirst, frequent urination - especially at night, extreme tiredness, weight loss, genital itching or regular episodes of thrush, blurred vision. Two major types of diabetes are:
Type 1 diabetes develops when the insulin-producing cells in the pancreas have been destroyed. Nobody knows for sure why these cells have been damaged but the most likely cause is an abnormal reaction of the body to the cells. This may be triggered by a viral or other infection. This type of diabetes generally affects younger people. Both sexes are affected equally. Type 1 diabetes develops much more quickly, usually over a few weeks, and symptoms are normally very obvious.
Type 2 diabetes results from insulin resistance, a condition in which the body fails to properly use insulin, combined with relative insulin deficiency. Of patients diagnosed with diabetes, over 90% suffer from type 2 diabetes. Having type 2 diabetes increases your risk for many serious complications. Some complications of type 2 diabetes include: heart disease (cardiovascular disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy). Learn more about these complications and how to cope with them.
Checking for Diabetes
In order to determine whether or not a patient has pre-diabetes or diabetes, health care providers conduct a Fasting Plasma Glucose Test (FPG). With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes
Can type 2 be prevented?
Pre-diabetes is a serious medical condition that can be treated. The good news is that people with pre-diabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. They may even be able to return their blood glucose levels to the normal range.
Often, you can lower your blood glucose level by exercising. Cutting down on the amount of food you eat might also help. What you eat is closely connected to the amount of sugar in your blood. The right food choices will help you control your blood sugar level. Specifically, cutting down of simple carbohydrates such as wheat, rice, sugar, potatoes, helps control blood sugar level significantly.
People in risk of type 2
People with a family history of diabetes, people between age group of 45 and 65 of Asian origin, overweight people and people with sedentary lifestyle, people who have ischaemic heart disease, cerebrovascular disease, peripheral vascular disease (problems with circulation, including heart attack or stroke) or hypertension (high blood pressure), women who have had diabetes during pregnancy are at most risk of developing type 2 diabetes.
Symptoms of Diabetes
Hypoglycemia: Hypoglycemia, sometimes called an insulin reaction, can happen even during those times when you're doing all you can to manage your diabetes. So, although many times you can't prevent it from happening, hypoglycemia (low blood glucose) can be treated before it gets worse.
The quickest way to raise your blood glucose and treat hypoglycemia is with some form of sugar, such as glucose, 1/2 cup of fruit juice, or 5-6 pieces of hard candy.
Hyperglycemia: Hyperglycemia is the technical term for high blood glucose (sugar). High blood glucose happens when the body has too little, or not enough, insulin or when the body can't use insulin properly.
It's important to treat hyperglycemia as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn't have enough insulin. Without insulin, your body can't use glucose for fuel. So, your body breaks down fats to use for energy. When your body breaks down fats, waste products called ketones are produced that build up in your blood. This can lead to ketoacidosis. Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include: shortness of breath, breath that smells fruity, nausea and vomiting, a very dry mouth.
Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS): HHNS, is a serious condition most frequently seen in older persons. HHNS can happen to people with either type 1 or type 2 diabetes, but it occurs more often in people with type 2.
In HHNS, blood sugar levels rise, and your body tries to get rid of the excess sugar by passing it into your urine. You urinate more often. Later urination frequency is reduced, but urine becomes very dark. If you don't drink enough liquids at this point, you can get dehydrated. If HHNS continues, the severe dehydration will lead to seizures, coma and eventually death. HHNS may take days or even weeks to develop. Know the warning signs of HHNS. The best way to avoid HHNS is to check your blood sugar regularly.
Treatment options for type 1
People with Type 1 diabetes need injections of insulin for the rest of their lives and also need to eat a healthy diet that contains the right balance of foods. Insulin cannot be taken by mouth because it is destroyed by the digestive juices in the stomach. People with this type of diabetes commonly take either two or four injections of insulin each day.
Treatment options for type 2
The first treatment for type 2 diabetes is often meal planning for blood glucose (sugar) control, weight loss, and exercising. Sometimes these measures are not enough to bring blood glucose levels down near the normal range. The next step is taking a medicine that lowers blood glucose levels.
All diabetes pills sold today are members of six classes of drugs : sulfonylureas, meglitinides, nateglinide, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors. These six classes of drugs work in different ways to lower blood glucose levels.
Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in side effects, how often they are taken, and interactions with other drugs.
Meglitinides & Nateglinides are drugs that also stimulate the beta cells to release insulin. You should know that alcohol and some diabetes pills may not mix. Occasionally, they can interact with alcohol to cause vomiting, flushing, or sickness. Ask your doctor if you are concerned about any of these side effects.
Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by the liver. A side effect of metformin may be diarrhea, but this is improved when the drug is taken with food.
Thiazolidinediones help insulin work better in the muscle and fat and also reduce glucose production in the liver. Although effective in lowering blood glucose levels, thiazolidinediones can have a rare but serious effect on the liver. For this reason, your doctor will perform blood tests regularly to monitor the health of your liver.
Alpha-glucosidase inhibitors help the body to lower blood glucose levels by blocking the breakdown of starches, such as bread, potatoes, and rice in the intestine. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood glucose levels after a meal. They should be taken with the first bite of a meal. These drugs may have side effects, including gas and diarrhea.
Carbohydrates and Diabetes
The right food choices will help you control your blood sugar level, lower total calorie intake naturally and aid in maintaining a healthy digestive system. Carbohydrates form a very large part of Indian vegetarian diet. So, know your carbohydrates. Did you know there are three main types of carbohydrate? There are starches, sugars, and fiber. Foods high in starch include: starchy vegetables like peas, corn, and potatoes, legumes, grains like wheat, barley, and rice.
The grain group can be broken down even further into whole grain or refined grain. A grain, let's take wheat for example, contains three parts. The parts are the bran, germ, and the endosperm. The bran is the outer hard shell of the grain. It is the part of the grain that provides the most fiber and most of the B vitamins and minerals. The germ is the next layer and is packed with nutrients including essential fatty acids and vitamin E. The endosperm is the soft part in the center of the grain. It contains the starch. Whole grain means that the entire grain kernel is in the food.
If you eat a whole grain food, it contains the bran, germ, and endosperm so you get all of the nutrients that whole grains have to offer. If you eat a refined grain food, it contains only the endosperm or the starchy part so you miss out on a lot of vitamins and minerals. Because whole grains contain the entire grain, they are much more nutritious than refined grains.
Sugar is a simple or fast-acting carbohydrate. There are two main types of sugar: naturally occurring sugars such as those in milk or fruit, added sugars such as those added during processing such as fruit syrup or sugar added to make a cake or biscuit.
In the past, people with diabetes were warned to avoid sugar. Experts thought that eating sugar would rapidly increase blood glucose, resulting in levels that were too high. Some people even thought that eating sugar caused diabetes, an idea that we now know isn't true. Research has shown that sugar has the same effect on blood glucose levels as other carbohydrates such as bread or potatoes. Calorie for calorie, sugar raises blood glucose about the same amount as other simple carbohydrate. Eating a piece of cake made with sugar will raise your blood glucose level. So will eating potatoes, white rice, or refined wheat. So you can eat foods with sugar as long as you work them into your meal plan as you would for other simple carbohydrate-containing food.
Fiber comes from plant foods so there is no fiber in animal products such as milk and other dairy products, eggs, meat, poultry, and fish. Fiber is the indigestible part of plant foods, including fruits, vegetables, whole grains, nuts, and legumes with skin. When you consume dietary fiber, most of it passes through the intestines and is not digested. Adults need to try to eat 25 to 30 grams of fiber each day.
Soluble and insoluble fibers make up the two basic categories of dietary fiber. Insoluble fibers - cellulose, hemicellulose and lignin - are responsible for increased stool bulk and help to regulate bowel movements. Soluble fibers - gums, pectins, and mucilages - become gummy in water. When eaten, these fiber sources actually slow the passage of food through the digestive system. Some researchers believe this action helps to regulate cholesterol and glucose (sugar) levels in the blood by affecting absorption rates.
Since fiber is not digested, it does not count towards carbohydrate calories. Presence of fiber slows down the carbohydrate to sugar conversion in the body. Additionally, fiber contributes to digestive health by keeping you regular. It also helps to make you feel full and satisfied after eating thus reducing total number of calories consumed. Other health benefits, of a diet high in fiber include significant reduction in incidents of colon cancer.
To control blood sugar, eat more of the whole grain and fiber and avoid refined carbohydrates and simple sugars.
National Diabetes Information Clearinghouse: NDIC was established in 1978 to increase knowledge and understanding about diabetes among patients, health care professionals, and the general public. (more)
International Diabetes Federation: IDF is a global advocate for people with diabetes and their healthcare providers. (more)