DIABETES

After you eat, various foods are broken down in your gut into sugars,the main sugar is called glucose. After you eat, the level of a hormone called insulin produced from pancreas should also rise. Insulin works on the cells of your body and makes them take in glucose from the bloodstream. Some of the glucose is used by the cells for energy, and some is converted into glycogen or fat (which are stores of energy). When the blood glucose level begins to fall (between meals), the level of insulin falls.

KEEPING YOUR BLOOD GLUCOSE LEVEL AT NORMAL LEVELS

You can usually reduce the level of your blood glucose and HbA1c if you:

  1. Eat a healthy and balanced diet. The diet is the same as recommended for everyone. The idea that you need special foods if you have diabetes is a myth. Basically, you should aim to eat a diet low in fat, salt and sugar and high in fibre and with plenty of fruit and vegetables.Important is to see the glycaemic index or starch content of food. Eat smaller portions of certain foods with higher starch content.
  2. Lose weight if you are overweight.
  3. Do some physical activity regularly. A minimum of 30 minutes’ brisk walking at least five times a week is advised. Swimming, cycling, jogging, dancing are good activities.

TO REDUCE OTHER RISK FACTORS

Keep your blood pressure down

If you smoke – now is the time to stop!

Smoking is a high risk factor for complications. medication or nicotine replacement therapy (nicotine gum, etc) may help you to stop.

Lower cholesterol.

You will usually be advised to take a drug to lower your cholesterol level. This will help to lower the risk of developing some complications such as heart disease, peripheral vascular disease and stroke.

TO DETECT AND TREAT ANY COMPLICATIONS PROMPTLY.

Checking for early signs of complications, for example:

  1. Eye checks – to detect problems with the retina (a possible complication of diabetes) which can often be prevented from getting worse. Glaucoma is also more common in people with diabetes and can usually be treated.
  2. Urine tests – which include testing for protein in the urine which may indicate early kidney problems.
  3. Foot checks – to help to prevent foot ulcers.
  4. Other blood tests – these include checks on kidney function and other general tests. It is important to have regular checks, as some complications, particularly if detected early, can be treated or prevented from getting worse.

FAQs

What does immunisation mean?

You should be immunized against flu (each autumn) and also against the pneumococcus bacteria (just given once). These infections can be particularly unpleasant if you have diabetes.

Can diabetes be cured?

Currently, there is no cure for type 2 diabetes.

How is diabetes diagnosed?

A simple ‘dipstick’ test may detect glucose in a sample of urine. However, this is not sufficient. A fasting and a post prandial sugar done two hours after meals maybe done. More precisely, a glucose tolerance test with 75gram glucose maybe done. Glycosylated haemoglobin(HbA1c)is a test which gives you the average of blood sugar for the past 3 months.

In many cases diabetes is diagnosed during a routine medical or when tests are done for an unrelated medical condition.

What are the possible complications of diabetes?

Short-term complication – a very high blood glucose level

A very high blood level of glucose can cause dehydration, drowsiness and serious illness which can be life-threatening.

Long-term complications

If your blood glucose level is higher than normal over a long period of time, it can gradually damage your blood vessels. This may lead to some of the following complications often years after you first develop diabetes:

  • Atheroma or hardening of blood vessels due to deposition of cholestetol. This can cause problems such as angina, heart attacks, stroke and poor circulation.
  • Kidney damage which sometimes develops into kidney failure.
  • Eye problems, which can affect vision.
  • Nerve damage.
  • Foot problems (due to poor circulation and nerve damage).

The type and severity of long-term complications vary from case to case. You may not develop any at all. In general, the nearer your blood glucose level is to normal, the less your risk of developing complications.

Complications of treatment

Hypoglycaemia (which is often called a ‘hypo’) occurs when the level of glucose becomes too low. A hypo may occur if you have too much diabetes medication, have delayed or missed a meal or snack, or have taken part in unplanned exercise or physical activity.

Symptoms of hypoglycaemia include: trembling, sweating, anxiety, blurred vision, tingling lips, paleness, mood change, vagueness or confusion. To treat hypoglycaemia you should take a sugary drink or some sweets. Then eat a starchy snack such as a sandwich.

What are the aims of treatment?

Although diabetes cannot be cured, it can be treated successfully.

Therefore, the main aims of treatment are:

  • To keep your blood glucose level as near normal as possible.
  • To reduce any other ‘risk factors’ that may increase your risk of developing complications. In particular, to lower your blood pressure if it is high, and to keep your blood lipids (cholesterol) low.

To detect any complications as early as possible. Treatment can prevent or delay some complications from getting worse.

How is the blood glucose level monitored?

You can self monitor blood sugar with a glucometer. The HbA1c test measures a part of the red blood cells. Glucose in the blood attaches to part of the red blood cells. This part can be measured and gives a good indication of your average blood glucose level over the last 3 months.Treatment aims to lower your HbA1c to below a target level . The target level is usually somewhere between 6.5% and 7.5%. If your HbA1c is above your target level then you may be advised to ‘step up’ treatment to keep your blood glucose level down.

Lifestyle – diet, weight control and physical activity

What is Type 1 diabetes?

In Type 1 diabetes the beta cells in the pancreas stop making insulin. The illness and symptoms develop quickly (over days or weeks) because the level of insulin in the bloodstream becomes very low. Type 1 diabetes used to be known as juvenile, early onset, or insulin-dependent diabetes. It usually first develops in children or in young adults. Type 1 diabetes is treated with insulin injections and diet.

What is Type 2 diabetes?

Type 2 (formerly called ‘adult-onset’ or ‘non insulin-dependent’) usually occurs in people who are over 40 years of age, overweight, and have a family history of diabetes, although today it is increasingly found in younger people. It occurs because:

  • You do not make enough insulin for your body’s needs,
  • The cells in your body do not use insulin properly. This is called insulin resistance.
  • A combination of the above two reasons

Type 2 diabetes is much more common than Type 1 diabetes.

Who gets Type 2 diabetes?

The incidence of diabetes in India is increasing so fast, that it may have the maximum number of diabetes in the world in the next decade. Other risk factors for Type 2 diabetes include:

  • Having a first-degree relative with Type 2 diabetes. (A first-degree relative is a parent, brother, sister, or child.
  • Being overweight or obese.
  • Having a waist measuring more than 31.5 inches (80 cm) if you are a woman or more than 37 inches (94 cm) if you are a man.
  • Having impaired glucose tolerance. (Impaired glucose tolerance is when your blood glucose levels are higher than normal but not high enough to have diabetes.

Having diabetes or impaired glucose tolerance when you were pregnant.

What are the symptoms of Type 2 diabetes?

People with type 2 diabetes frequently experience certain symptoms. These include:

  • being very thirsty
  • frequent urination
  • blurry vision
  • irritability
  • tingling or numbness in the hands or feet
  • frequent skin, bladder or gum infections
  • wounds that don’t heal
  • extreme unexplained fatigue

The reason why you make a lot of urine and become thirsty is because glucose leaks into your urine which ‘pulls out’ extra water through the kidneys.

How is type 2 diabetes treated?

Type 2 diabetes is often treated with oral medication because many people with this type of diabetes make some insulin on their own. The pills people take to control type 2 diabetes do not contain insulin. Instead, medications such as metformin, sulfonylureas, alpha-glucosidase inhibitors and many others are used to make the insulin that the body still produces more effective.

Some people with type 2 diabetes are treated with insulin. Insulin is either injected with a syringe or pen device several times per day, The goal of insulin therapy is to mimic the way the pancreas would produce and distribute its own insulin, if it were able to manufacture it. Taking insulin does not mean you have done a bad job of trying to control your blood glucose-instead it simply means that your body doesn’t produce or use enough of it on its own to cover the foods you eat.

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