Health issues, dealing with Diabetes. Now I thought I would write about this subject, mainly because it is so important and so common. Did you know that about 10% of Indians are diabetic? Big deal, so what, you say. after all its just a little more sugar in the blood, isn't it? WRONG! Diabetes Mellitus(Pronounced Die- *, appropriate, huh?- *ay- bee- tees, Mell-eye-tus) is one of the most deadly diseases you can have. It messes up your eyes, heart, kidneys and your brain. And what is worse, it does so silently, like a Ninja in a Lustbader novel, it kills you silently.and surely.
Diabetes is more about blood sugar. Its more about what docs like to call'Target Organ Damage'It targets you main organ systems and before you know it you have stroke, heart attacks, Kidney failure and blindness. Not to mention foot ulcers, amputations, diabetic comas and what not. OK, so now thats clear. Diabetes is a deadly disease.
How do you detect it?
Most obese Indian men are usually insulin resistant. Yes, oddly, Type 2 Diabetes mellitus(DM) is not due to less insulin in the body, but due to ineffective insulin, so you have to make it effective or add more. if your waist size is more than 40 inches, or if you have family history. I suggest a fasting blood sugar. If it is more than 126 mg/dl you have DM. if it is above110 you have impaired fasting glucose and you are a potential recruit for the DM Army.
Symptoms of diabetes are the 3 Ps: Polyuria: Too much urine, despite the climate being warm(you do pass more urine if it is colder as you sweat less); Polydipsia: Increased thirst; Polyphagia: Increased appetite. Plus frequent infections, non healing ulcers, etc. If you have these, just get your sugars checked.
Type 1 is rarer maybe see in 10% of diabetics and needs even more rigorous care. as most are Insulin dependant patients. and it occurs at an earlier age.
All adults above 25 should have a fasting sugar and a lipid profile a least once
If your FBS is less than 110, you are Ok, but you still could have insulin resistance, or the metabolic syndrome(more about that some other time)
You can detect this using your fasting insulin levels and response to a glucose load. Normal fastings are less than 20u. I suggest this only of you have a waist more than 40 in and a family history
How do you manage it?
Well you manage the sugar AND you manage to prevent target organ damage.
Blood sugar: I recommend a glucometer. It cost only 2600 nowadays. your FBS should be 70-110 max 120. The post meal one should be 150-160. Regular checks are essential
HBA1C:But even regular blood checks are just snapshots. you could still miss out. The HbA1C is more like a 24 hour surveillance video vs the snapshot. It should be below 7. have one every 3 months to assess you overall sugar control.
Target Organ checks:
Eye check up for retinopathy: Annually, at least
Urine microprotein: Ditto for Kidney involvement
Sensation check ups: Monthly and always wear footwear, even inside the house.
Check your feet every nightfor cuts and skin loss. A diabetic may not recognise an ulcer till its too late. as he/she can't feel pain that well. Foot care is thus, very important for a diabetic
Cardiac: Lipid Profiles, Stress tests annually might be a good idea, as chest pain is often absent in diabetics due to nerve involvement
Diet:
Very important: Avoid large heavy meals that cause the blood glucose to surge. Take several mini meals. Prefer complex carbs over refined. more vegetables and less maida. Fruit juices are best avoided, go for the natural fruit instead. Which fruit? Take them only if your sugar is under good control. see above. and prefer fibrous fruits. oranges and Musambis are such. Any fruit is OK, if your sugars are under control.Go for foodstuffs with lower gycemic indices. they are absorbed slower.
Diet was the only way of treating DM before insulin was isolated. and it is really important. Ask your dietician for details, there are quite a few, including the data given above.Avoid heavy meals, high glycemic loads such as sweets, refined flour, sugar etc. all cause the insulin to spike and wear the pancreas out further.
Take more fibre and low glycemic foodstuffs.There really is a review on diet. no space here.
Exercise:
Also very important. Helps to reduce insulin resistance and metabolize the sugar. But let it be graded never sudden as it can lower you blood sugar dangerously, if not monitored and if done without adequate glucose in the blood.
Exercise keeps your blood vessels lining(endothelium healthy and thats really important!
Hypoglycemia:
Very dangerous. This is low blood sugar, usually <60, which can lead to unconsciousness and even death. Can be due to excess insulin, diabetic drug dosage, excess exercise, less intake, diarrhea etc all culiminating in less sugar in the blood. So all diabetics should try for regular meals and regular exercise. And carry glucose/sweets for use in emergencies, in addition to a medical card, in case they become unconscious
Medicines:
This is beyond this review, but all diabetics should ensure that they are on an ACE inhibitor/ARB and a statin, in addition to their blood sugar medication, unless there is a reason not to. Ask your doctor. These drugs prevent the dreaded Target organ damage to a great extent. ACE inhibitors have interestingly been shown to prevent the onset of diabetes in people who are prone to develop it!
So in summary:
Check for it, Keep monitoring your body and be proactive. You can beat it
