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Diabetes Mellitus

Diabetes is a group of chronic diseases in which blood sugar (Glucose) level are very high in blood. This may result from body’s inability to properly use blood glucose

There are two major types of diabetes.

Type 1 diabetes Mellitus

It was previously known as juvenile-onset or insulin-dependent diabetes. In this form of diabetes the body completely stops producing insulin (Hormone produce by pancreas that enables the body to lower glucose found in foods). People with type 1 diabetes have to take lifelong daily insulin injections to survive. This form of diabetes usually develops in children or young adults, but can occur at any age.

Type 2 Diabetes Mellitus

It was previously called adult-onset or non-insulin-dependent. It occurs when the body doesn’t make enough insulin or is unable to use insulin properly (insulin resistance) or both. This form of diabetes is responsible for more than 90%-95% cases of diabetes. Type 2 Diabetes usually seen in obese person with family history of diabetes.

Other types of diabetes are

  • Gestational Diabetes- Diabetes during Pregnancy
  • Pancreatic Diabetes- It occurs as a result of damage to the pancreases. Fibrocalculus Pancreatic Diabetes (FCPD) , is a one of the type of pancreatic diabetes which is commonly seen in southern part of India, particularly in Kerala
  • LADA-latent autoimmune diabetes of Adult
  • Diabetes as a result of drugs or other endocrine diseases like Acromegaly, Cushing’s syndrome etc.
  • Genetic disorder causing diabetes like Maturity Onset Diabetes of young (MODY) etc.
  • The initial phase of diabetes patient may have borderline elevation in blood glucose level and patient may not have any obvious symptoms. But, this sugar levels are sufficient to damage your body systems. That’s why diabetes is often called as silent killer. As disease advances, blood glucose increases further and patient start developing symptoms. The common symptoms of diabetes are:

  • Excessive thirst ( A desire to drink lot of water)
  • Excessive hunger ( A desire to eat even after proper meal)
  • frequent passage of urine
  • weight loss
  • Fatigue
  • vision problem
  • irritability
  • tingling or numbness in the hands or feet
  • frequent infections( skin, urine, throat)
  • non healing of wound
  • Diabetes can occur in anyone. However, certain people have increased risk of developing type 2 diabetes. These includes people with obesity, sedentary life style (physically inactive), and people with family member having diabetes, and having high blood pressure. People who have close relatives with the disease are somewhat more likely to develop it. Diabetes is more common in our Asian ethnicity. Also, women who develop diabetes while pregnant (a condition called gestational diabetes) and who have polycystic ovary syndrome are also more likely to develop diabetes later in life.

    It is very important to control blood glucose level because high glucose level start damaging your body’s organ like Kidney, Eyes, Heart, and Nerves etc. A long term uncontrolled diabetes can lead to serious complication like, blindness, Kidney failure, heart attack, paralysis, impotence in male.

    Life style modification is most vital part of diabetes management and it is applicable to all patients with diabetes, whether type 1 or type 2 diabetes. It includes diet plan and physical activity/ exercise.

    Few basic principle of diet plans:

  • Diabetic patient should not take large meal at a time. Rather than that small frequent meals/snacks, may be 6-7 times in a day is advisable.
  • Interval between two meals/snacks should not be more than 4 hours and less than 2 hours.
  • Feasting and fasting should be avoided as far as possible.
  • Avoid watching TV and conversation while eating
  • Avoid visible fat of animal or vegetable origin like Dalda, Ghee, Butter, Margarin.
  • Avoid oily and fry food like samosa, chips, bhujiya
  • Use deliberately green leafy vegetable, salads (cucumber, tomato, carrot, cabbage, lettuce leaves), pulses, and citrus fruit.
  • Avoid using bakery products (biscuits, white breads, tosts, pav) ,sweets, chocolates, sago, white bread, cakes, pastries, fruit juices, honey, jiggery, condensed milk
  • Exercise.

    Exercise has a key role in the management of diabetes.Regular physical activity helps to lower blood sugar. Apart from lowering blood glucose level it also lowers blood pressure and cholesterol level, reduce the risk of heart disease and stroke, helps to loose or maintain weight and relieves stress

    Recommendations of American diabetes association for exercise in diabetes patient

  • Adults with diabetes should be advised to perform at least 150 min/week of moderate-intensity aerobic physical activity (50–70% of maximum heart rate), spread over at least 3 days/week with no more than 2 consecutive days without exercise.
  • In the absence of contraindications, adults with type 2 diabetes should be encouraged to perform resistance training at least twice per week.
  • All individuals, including those with diabetes, should be encouraged to reduce sedentary time, particularly by breaking up extended amounts of time (>90 min) spent sitting
  • Children with diabetes or prediabetes should be encouraged to engage in at least 60 min of physical activity each day.
  • Most of the patient with type 2 diabetes patient required oral medication to control blood glucose level.Some people with type 2 diabetes can manage their diabetes without medication by appropriate meal planning and adequate physical activity.

    While, all patient with type 1 diabetes will required insulin to control blood sugar level.

    Every diabetic patient requires surveillance for the complication. They should have periodic evaluation of kidney, eye and foot examination. They should also check their cholesterol level regularly at 3 to 6 months interval.