Diabetes: Don’t close your eyes

Ignoring diabetes doesn't make it go away


When Jayrath, a 42-year-old IT manager, felt weak during a meeting, he ignored it as exertion. The uncomfortable sensation continued and he landed in the hospital with a heart attack.

Jayrath was diagnosed with diabetes three years back. Still, he was overweight, he smoked and never took his diabetes treatment seriously.

He suffered from a silent heart attack. Like him, many people underestimate diabetes and get controlled by diabetes, instead of controlling it.

What happens in uncontrolled diabetes?

  • People with diabetes are 2 – 4 times more likely to have a heart attack and stroke. Studies show that about 50 % of people with diabetes die of cardiovascular disease.
  • Diabetic neuropathy [damage to the nerves] affects up to 50 % of diabetics. Combined with reduced blood flow and neuropathy in the feet, uncontrolled diabetes also increases the chance of foot ulcers, which may eventually lead to limb amputation.
  • Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. Research shows that after 15 years of diabetes, approximately 2 % of people become blind and about 10 % develop severe visual impairment.
  • Diabetes is among the leading causes of kidney failure and affects 10 – 20 % of diabetics.

How can one control diabetes?

Type-2 diabetes can be controlled with appropriate medications, regular monitoring and a healthy lifestyle. It is essential to visit the doctor regularly to evaluate the effectiveness of medicines.

Medications used in diabetes work on different mechanisms involved in glucose metabolism. For example, some oral medications lead to increased secretion of insulin from beta cells, some act on liver to minimise glucose production and some slow down the absorption of the starches one eats.

However, as type-2 diabetes is a progressive disorder, there is an increased destruction of the insulin-producing beta cells over time. This typically leads to the addition of medications every few years, and in most people, eventually results in the need for insulin therapy.

Incretin-based therapies today represent a new class of treatment for type-2 diabetes. People with type-2 diabetes lack a key incretin hormone, GLP-1 [Glucagon-like peptide 1], which is a natural hormone released from the intestine during digestion of food.

GLP-1 has the ability to lower HbA1c, systolic blood pressure, lipid levels and body weight without inducing hypoglycaemia. This offers a good alternative to people with type-2 diabetes to control diabetes and reduce their risk of complications.

However, note that, depending upon age, weight, and blood sugar levels, different people may need different medicines, which only an expert can decide.

Regular blood glucose monitoring helps the doctor understand how food, exercise and insulin or medicine affects your sugar levels. Along with self-monitoring of blood glucose level, one must also get the HbA1c [glycosylated haemoglobin] blood test done, every three months.

The higher the HbA1c, the greater is risk for developing complications. [In people with diabetes, HbA1c is aimed at less than 7 %.]

Along with glucose monitoring, a diabetic should also undergo the following tests to prevent complications: blood pressure monitoring, lipid profile, urine microalbuminuria, serum creatinine, eye fundus and foot examination.

While environmental factors like sedentary lifestyle, stress, increased obesity certainly play a major role in diabetes, it usually occurs more because of genetic susceptibility.

Various studies prove that Indians are genetically predisposed to diabetes at a younger age [at least 10 years earlier than our European counterparts].

Thus, do not wait for an emergency to start taking diabetes seriously. It is necessary to understand diabetes and its complications and take measures to prevent them. It may sound serious and tough, but controlling diabetes is pretty simple. With proper care and treatment, you can live a long and healthy life. There are many people with diabetes who are doing so.

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Vijay Panikar
Dr Vijay Panikar, MD, DNB, FCPS is a diabetologist associated with Lilavati Hospital & Research Centre.


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