Diabetes: Are you at Risk?

Diabetes spares no one. It has no gender bias; no racial, or cultural, barriers. It can affect anyone, including you and me

DiabetesRohit Verma [32], a busy executive, is feeling giddy, sweaty, extremely thirsty, and awfully uneasy for a while. He knows there is something wrong. His wife too senses that something is amiss, albeit she is clueless. She opts for the best possible option and rushes her hubby to a nearby hospital. Tests are ordered in a jiffy, and the results are startling. Verma has very high blood sugar levels. He is diagnosed with diabetes - something he's blissfully unaware of, until now.

This could happen to you, me, or anyone else, without warning!

Imagine you are totally unaware that you are diabetic today and tomorrow you are diagnosed with diabetes! Your life changes dramatically. Ask a diabetic - s/he does live a normal life, but it's a life with constraints that s/he'd prevent if s/he could. So, prevent diabetes; you will do yourself a big favour.

Estimates say about 80 million Indians are pre-diabetic. In other words, they do not have symptoms of diabetes, but their blood glucose is at a level that warrants medical attention. You could be one of them. It is, therefore, important for each of us to get a diabetes check-up done, educate ourselves about diabetes, and work actively towards its prevention.

What is pre-diabetes?

Pre-diabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes. It has no apparent symptoms.

If I have pre-diabetes, is it a cause for concern?

American Diabetes Association says people with pre-diabetes have a 1.5-fold risk of cardiovascular disease compared to people with normal blood glucose. People with diabetes have a 2-4-fold increased risk of cardiovascular disease.

If I have pre-diabetes, is it inevitable that I will get diabetes?

No, there is hope. Experts say that diet, exercise and behaviour modification can be used to avoid developing diabetes. Also, pre-diabetes can be prevented from developing into full-blown diabetes, if only you address it. However, without adequate attention, pre-diabetes increases the risk of diabetes greatly.

The Indian Journal of Medical Research says the number of people with diabetes in India is currently around 40.9 million. This is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken. Experts also say that we have a propensity to certain ethnic factors, which makes us [Asian-Indians] more prone to diabetes.

Why are high blood sugar levels bad?

Excessive glucose in the blood stream damages the blood vessels. First, the capillaries get affected, because they are the smallest blood vessels.

  • If blood vessels in the eye get damaged, it can lead to blindness [retinopathy]
  • If blood vessels in the kidney get damaged, it can lead to kidney failure [nephropathy]
  • Nerve damage can cause numbness/pain in areas away from the heart, e.g., foot [diabetic foot].

Am I at risk for Diabetes?

Yes, if:

  • You are often thirsty
  • You go to the bathroom frequently to pass urine
  • You lose weight without knowing why
  • You do not have enough energy
  • You can't see well [blurred vision]
  • You get more infections than usual
  • You have cuts and bruises that heal slowly
  • You feel tingling or numbness in your hands or feet.

The body gives us signals that something is awry. It is important that we heed to its call and take appropriate, corrective measures. In our busy schedules and hectic lifestyles, we seem to disregard signals the body gives us. Diabetes is too big a price to pay for such laxity.

Can I relax if I do not have such symptoms?

Not really. The Indian Journal of Community Medicine states that, "[A] family history of diabetes, obesity, sedentary life style, urbanisation, stress, smoking and alcohol consumption were identified as the important risk factors for [Type-2] diabetes."

You need to also consider:

Excess Weight: According to the World Health Organisation [WHO], a Body Mass Index [BMI] of 18.5-22 kg/m2 is considered as healthy for the Asian population. BMI = [Weight in Kg]/[Height in metre x Height in metre]. If you have a BMI value greater than the recommended value, you are overweight and, hence, at risk of diabetes.

Family history: Having your mother alone as a diabetic puts you at more risk of diabetes than having just your father as a diabetic. Having both parents diabetic, you are at even greater risk of diabetes.

Age: As we cross our teens, our risk for Type-2 diabetes statistically increases. It is recommended that everybody above the age of 45 should certainly get a diabetes check-up done. Though this age limit is being pushed down, cases of diabetes are being detected at ages below 40.

Stress: Stress can cause excess weight. This may lead to diabetes.

What should I do if I have diabetes symptoms?

If you tend to have symptoms of diabetes, visit your physician. You may also want to be ready with answers to the following questions:

  • What are your symptoms?
  • When did they begin?
  • How often do your symptoms occur?
  • Under what circumstances do symptoms occur?
  • Are they constant, or do they come and go?
  • Have you had any of these symptoms before? When?

If I do develop diabetes, can I be cured?

No. Diabetes is not curable; it is a manageable disease. Proper understanding, timely medications, lifestyle modifications, diet control, and exercise are essential in managing the disorder and leading an active life.

How does it feel to have diabetes?

There are a host of emotional factors that come into play when one gets diabetes.

  • Fear. There is a constant fear that on contracting diabetes you are doomed to suffer terrible complications.
  • Depression. People with diabetes are twice as likely to experience depression as those without diabetes. Depression leads to sadness, apathy, loss of energy, irritability, guilt of being good-for-nothing, sleep problems, lack of concentration, among other problems. Each can contribute to loss of control in sugar level leading to a vicious cycle.
  • Denial. It is a natural response. "I will not think about diabetes any more." But, a lack of attention to signs and symptoms of aggravating diabetes can cause long-term complications.
  • Guilt. "I am a bad, irresponsible person who developed diabetes." Or, "I am so bad I did not exercise today." Such thoughts are common among diabetics.

It is important to keep your spirits, confidence high.

Diabetics are, at times, unable to control blood sugar level. This can lead to two kinds of situations

  • Hyperglycaemia. When the blood sugar becomes abnormally high.
  • Hypoglycaemia. When the blood sugar becomes abnormally low.

These are conditions that, at times, get hilarious and equally embarrassing. Having hypoglycaemia hit you at the wrong time can do weird things to you. From boarding the wrong bus and dancing up and down the aisles, getting unconscious to blurting to oneself while watching TV.

Are there professions diabetics can't continue with?

No, there is no reason why diabetics should lose their jobs on account of diabetes. However, efforts are needed to ensure that diabetic emergencies like hyperglycaemia and hypoglycaemia can be taken care of. With proper precautions and discipline on part of the diabetic, adverse effects of diabetes on workplace productivity can be managed.

What can one do on the health insurance front?

For Type-2 diabetics, there are two insurance policies. One is from ICICI Pru Life Insurance and the other from Star Health.

What can I do?

You can seek better facilities, better co-ordination, and better information about diabetes. You can start by stressing on the need for para-medical staff like a diabetes nurse. A role called "Diabetes Educator" is virtually absent in India. With want of accurate information about diabetes - along with myths that surround it to complicate matters - it is important that a diabetes education programme on a large scale be organised.

A National Diabetes Education Programme is in existence since July 2001. There are also organisations like the Diabetes Association of India, Research Society for the Study of Diabetes in India, Delhi Diabetes Research Centre, and M V Hospital for Diabetes & Diabetes Research Centre, Chennai, that are doing good work. The best thing to do is to start with ourselves, get checked, and educated about diabetes.Diabetes is a disease that arises from the body's inability to maintain normal levels of sugar [glucose] in the bloodstream. You can control it.

Types of diabetes

There are two main forms of diabetes.

Type-1 diabetes [previously called Insulin Dependent Diabetes Mellitus {IDDM}], is a condition where patients do not produce their own insulin. Insulin is required for the uptake and processing of sugar by the body's cells. Type-1 diabetes is said to strike children and young adults. Occasionally, it may present for the first time in the middle aged, or the elderly. However, there is more to it than what meets the eye.

Earlier called juvenile onset diabetes, this form of diabetes is believed to be caused by an auto-immune reaction with the subsequent destruction of the Islet cells in the pancreas, responsible for insulin production. The form is evidenced to be triggered by acute or chronic pancreatitis [inflammatory disease of the pancreas], genetic disorders, infection, or injury. Said to be the more risky of the two forms, Type-1 diabetic patients require daily insulin injections. However, these patients now have the option of using pen-like devices containing insulin, or insulin pumps. Inhaled insulin and oral insulin are other newer delivery forms which are likely to be available for diabetic patients in the near future.

In Type-2 diabetes [Non-insulin Dependent Diabetes Mellitus {NIDDM}], the cells in the body become resistant to the action of insulin. Also, the pancreas produces too little insulin as it gets exhausted due to continuous demand. Type-2 diabetes generally develops in adults at age 40, or older. Called "adult-onset" diabetes, researchers now suggest that more and more people are developing the Type-2 form of the disease at a much younger age [even teenagers!]. This type is known to be closely associated with obesity, increased stress, advancing age, inactivity, and genetic tendency.

Type-2 diabetes accounts for almost 95 per cent of all cases of diabetes. It has a tendency to run in families. Certain ethnicities such as Asians, Latin Americans, and African Americans, have very high rates of Type-2 diabetes, owing to dietary and/or genetic factors. The astounding rise in diabetes today has also been attributed to an increased number of obese adults and adolescents, thanks to lack of physical exercise. Researchers suggest that when the body's cells are exposed to excessive amounts of dietary calories, they often react by reducing or down-regulating insulin.

There is also another form of diabetes. It is called gestational diabetes. It occurs in approximately 3-5 per cent of pregnancies. Every pregnant lady should have her blood sugar checked at least once during her pregnancy to rule out this condition. It lasts for the duration of the pregnancy. Glucose control usually normalises following delivery. However, these women [who develop gestational diabetes] have a greater risk of developing Type-2 diabetes later in life.

Diabetes may also develop in individuals following long-term use of certain drugs [steroids], hormonal disturbances [thyroid disorders], chronic liver, or kidney disease, or other genetic disorders.

What happens in diabetes?

  • You have too much sugar in your blood
  • Your body does not make enough insulin
  • Your body does not use the insulin properly.

Think of a lock-and-key. The cell has a lock that only insulin can open for glucose to enter. If there is no insulin key [as in Type-1 diabetes], the cell cannot be unlocked. If the insulin key is defective, [as in Type-2 diabetes] the cell cannot be unlocked. If the glucose cannot enter the cells, they starve. And the glucose stays in the bloodstream.

Dangers

Every organ in the body from head to toe can be affected by diabetes. Kidney, heart, eyes, nerves, foot, and blood vessels are most commonly affected in diabetics. The risk is increased in those who have high blood pressure [hypertension]. So, controlling diabetes is simply not just getting your blood sugar close to normal and sustaining it - it is much more than that.

Type-1 diabetes may sometimes lead to a potentially dangerous condition called diabetic ketoacidosis [DKA]. The condition is characterised by nausea, vomiting, abdominal pain, confusion, and a fruity breath. It can also lead to what is famously called diabetic coma. It may be mentioned here that it is not uncommon for symptoms of DKA to be confused with acute alcoholism, thanks to the patients fruity breath. The breath may smell like fruit brandy!

Tests for Diabetes

Routine blood sugar screenings at annual check-ups can often help identify and treat diabetes early. A fasting blood sugar in excess of 126 mg per cent, or post-prandial sugar of more than 200 mg per cent, indicates that diabetes is present.

What is normal?

  • A fasting glucose [sugar] level less than 100 mg per cent
  • A post-prandial [after meal] sugar level less than 140 mg per cent.

A fasting sugar between 100 and 126 mg per cent and post-prandial sugar between 140 and 200 mg per cent are now termed as pre-diabetics.

The good news is - patients who are identified as pre-diabetic can modify their lifestyles and opt for proper medical treatment in order to prevent the progression of the disease.

One best long-term measure as to how much excess glucose is circulating in the blood stream and causing harm is the HbA1c [glycosylated haemoglobin] test. This test is ideally repeated every three months, in order to measure the effectiveness of treatment. A level of six per cent or below is excellent. However, levels of seven per cent, and above, suggest major problems. Levels over 9-10 per cent express serious trouble.

Managing diabetes

Healthy eating is a must. Eat 5-6 small meals spread over the day so that your blood glucose levels do not swing from one extreme to the other. Eat also more of highly complex carbohydrates [cereals] and high-fibre [vegetables], but cut down on refined sugars and fat intake. 1-2 fruit helpings are permissible in well-controlled diabetics. Alcohol should be best avoided, or taken occasionally, in small quantities.

  • Exercise, especially walking, is good for you
  • Medications, pills and/or insulin injections, are part of your treatment plan. Take them regularly, on your doctor's advice
  • Tobacco, in any form, including smoking, is strictly not allowed for diabetics
  • Skin and foot care are extremely important. A cut or a bruise can lead to delayed healing, and can cause dangerous infections, or complications. So, take good care of your feet
  • Blood sugar monitoring and control are a must
  • A regular visit to your family doctor is also a must to detect early damage to the eyes, nerves, blood vessels, or teeth
  • Carry an identity card that you are diabetic at all times.

Your doctor will tell to you about how and when to test your blood, or urine, for glucose. The tests results will enable him/her to see what effect your treatment is having on your health, or whether it needs to be changed. If your diabetes is treated with tablets or insulin, you may use testing strips for either urine or blood. These tests are easy-to-do at home.

There are other tests which are used to get a complete picture of your overall diabetes status, control, and general health. Your doctor may check your blood pressure at regular intervals and evaluate your blood fats for long-term diabetes control. Your doctor will also tell you about the significance of these tests, and what the results mean to you.

As a matter of fact, studies have shown that simple, consistent physical activity and a healthy diet can reduce a person's risk of developing Type-2 diabetes by nearly 60 per cent. Is this not enough reason for you to keep the diabetic wolf away from your door?

Long-term complications

Heart disease. The arteries in long-term diabetes can become blocked and narrow. This can lead to high blood pressure, strokes, heart attacks and poor circulation, particularly in the legs.

Nephropathy is another complication. It causes damage to the kidneys. Early detection helps in treating the condition.

Retinopathy is damage to the back of the eye. It can lead to blindness. Diabetics should have their eyes examined by an eye specialist every year.

Neuropathy is damage to the nerves. The condition can affect the body and produce weakness, numbness and burning, particularly in the feet and legs. The best thing to do is take care of your feet.

Smoking. Smoking puts you at a higher risk of heart attacks, angina [chest pain], strokes and poor circulation. If you smoke, it is time you gave up the habit, in consultation with your doctor.

It must be mentioned here that not everyone with diabetes develop complications. Yet, it is important to know the long-term effects of the condition.

It is also imperative for one to know that eating a balanced diet, doing regular exercises, taking medication and keeping your blood glucose, blood pressure and blood cholesterol well controlled, can help reduce the chance of developing complications.

Try yoga

Yoga reduces stress and helps stabilise blood glucose levels. Relaxation and breathing exercises, including meditation, are also useful. Ayurveda, homoeopathy, herbal and other therapies, have also been suggested to be useful. Some supplements, like chromium, have been found to be useful too. Speak to a qualified therapist in the relevant field to know correct dosages.

Medical treatment

People with Type-1 diabetes need insulin injections. People with Type-2 diabetes need tablets, insulin, or a combination of both. Some tablets help to produce more insulin. Others help the body to make better use of the insulin that is produced. Diabetes tablets work by lowering your blood glucose levels. Your doctor is the best judge to decide which tablets, or insulin, is going to work best for you. Your doctor will also tell you how to monitor your blood glucose levels alongside a given treatment plan.

Diabetics' Walk Primer

By Rajgopal Nidamboor

A regular walking programme is more than indispensable for diabetic individuals. Walking, on a regular basis, helps to keep your sugar levels in check.

  • Go for a walk, as and when time permits. The best thing to do is to go for a 30-minute regular walk, set at a good pace, not too fast or not too slow, 4-5 times a week
  • Walking is the best, simple, and safest form of exercise. Mahatma Gandhi called walking the "queen of all exercises." Science attests to the view in equal measure, and more too
  • If you can't, for whatever reason walk at one "go," break your walk into three 10-minute sessions at different times of the day; it will cumulatively add up to 30 minutes walk
  • Walking burns calories, exercises your respiratory muscles, increases oxygen uptake, and boosts the production of the "feel-good" hormone - endorphins. What's more, it does not require any special equipment, or gear
  • Hold your head high. Swing your arms gently as you walk. To do this correctly, bend your arms at a 90-degree angle, and swing them naturally, back and forth
  • Most important, walking can be done anywhere. When you walk, you will also feel close to nature and with yourself.

There are a few things you'd need to incorporate to derive the best possible benefits from your walking schedule.

Warm up

You need to warm up before a walking session.

  • To start with, walk slowly for 2-3 minutes. Take a couple of minutes to stretch all the major muscles you will be using when walking
  • Hold each stretch for 10-20 seconds
  • Never jump while stretching
  • Your warm up should last 5-10 minutes. This will help to slowly increase your heart rate and deliver blood to areas of the body that are about to work, when you walk.

Cool down

You need to cool down after a walking session.

  • Allot the last five minutes of your walk to cool down
  • Also, slowly reduce your pace of walking. This lowers your heart rate; your heart will come closer to your resting heart rate [This is a person's heart rate at rest]. A resting heart rate [60-80 times per minute] denotes your basic fitness levels. It can be measured by the number of heart beats per minute when you are at complete rest.
  • Duplicate the stretching exercises you did to warm up. But, don't extend this beyond five minutes
  • This routine will increase your flexibility and reduce muscle soreness. You will also now be more relaxed and focused.

Know your heart rate

Place first two fingers over the radial artery located in your wrist directly in line with the thumb. Feel the artery pulsations to record your heart rate. Count the beats for a full one minute, or count for six seconds, and add a zero at the end. If you felt your heart beats 14 times in six seconds, the number would be 140 for a full 60 seconds. Counting for only six seconds is a convenient method. However, it is more accurate to count for full 60 seconds.

Target Heart Rate [THR]

To get the most health benefits from your walking plan, your heart, while exercising, should be in the range from 55 per cent to 90 per cent of your Maximum Heart Rate [MHR]. Subtract your age from 220 [226 for women] to calculate your MHR.

You can now easily find your Target Heart Rate [THR]. It should be in the range of 50-60 per cent of your MHR.

Try to start at the lower end of the range. As you become more accustomed to the schedule and more fit, try to aim for a higher heart rate, while staying within the range.

How to use THR

The range from low [55 per cent] to high [90 per cent] is your THR. Feel your pulse at your wrist for 10 seconds. Count your pulse for 10 seconds, several times during your walk. If you fall below your THR, walk faster. If you are above your THR, slow down.

Footwear

Wear the right type of shoes. They should fit you well and feel comfortable. They should be well-designed and able to absorb shock. This is very important to prevent foot problems, such as blisters. Remember that diabetes slows down your natural healing process. Hence, getting the right fit in a walking shoe is an important part of foot care and wound prevention.

Wear the right type of socks. This will again help prevent blisters. It is best not to wear your favourite cotton socks! You won't believe this. But, the fact is: cotton binds sweat. This can lead to blisters. Choose a synthetic fabric that does not hold sweat. This will help keep your feet dry, which is good for you.

— With inputs from Rahul Baji and Ashwini Ranade

Control Diabetes in 6 Steps

  1. Have a positive attitude, and be appreciative of what you have. Solicit positive support from your family and friends. Also, give up what you may like the most - chocolates and other sweets. A positive attitude will help you combat difficulties that crop up during the process of managing diabetes
  2. Educate yourself. Know what is necessary for your diabetes treatment, such as your blood glucose levels, as well as administering insulin when needed
  3. Create a time-table for yourself. Schedule your meals and also your physical exercise
  4. Keep a diary. Maintain a list of your activities, the diet you followed, how you felt after eating certain foods, and your general overall wellbeing. This can help your doctor determine whether a change in treatment is needed at any point in time
  5. Ask your doctor the best insulin/medicine regimen that suits you and your needs best, including laboratory tests that you need to undergo from time to time
  6. Know your body and its signals. Keep a watch on your nutrition. A good nutrition and a balanced diet plan, along with regular physical activity, not only helps prevents diabetes, but it also allows you to lead a fit and vibrant life.

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