DESCRIPTION OF TYPE 2 DIABETES -MELLITUS

TYPE 2 DIABETES MELLITUS

DESCRIPTION OF TYPE 2 DIABETES -MELLITUS

Type 2 diabetes (also known as non-insulin dependent diabetes or adult onset diabetes) is a disease in which the blood glucose levels in the body stay consistently above normal. Insulin is the hormone which regulates blood glucose levels. Insulin is produced in the body by the pancreas. It regulates glucose levels in your blood by numerous mechanisms. In case of diabetes, the body may have a deficiency of insulin or resistance to action of insulin at the tissue level, or both.

Causes and Risk Factors

Common causes and risk factors of Type 2 diabetes are:

1. Genetic factors: You are at an increased risk of suffering from diabetes if either of your parents, grandparents, or siblings has it.

2. Factors present at birth: Low birth weight is associated with type 2 diabetes later in life.

3. Age: As you age, the chances of suffering from diabetes also increases, especially after 45 years.

4. Fat distribution: Increased fat stores in abdominal area, increases your risk of Type 2 diabetes.

5. Obesity: Increased weight is a major risk factor for diabetes.

6. Lack of exercise: Inactivity leads to weight gain and increased fat storage in your body and thus increases the risk of diabetes.

7. Smoking

8. Diet: A low fiber, high fat, and sugary diet can lead to weight gain and eventually, diabetes.

9. Stress

Signs and Symptoms

The common signs and symptoms of diabetes include:

1. Increased frequency and quantity of urination

2. Increased thirst

3. Weight loss

4. Blurred vision

5. Fatigue

6. Skin Infections

Investigations

Investigations include:

1. Blood sugar fasting and post lunch: Blood glucose levels checked on empty stomach, i.e., overnight fasting for about 8 to 12 hours and then 2 hours after lunch. This forms the basic routine check for diabetes in any patient.

2. HbA1C (glycosylated hemoglobin): Is the test that gives you an average estimate of blood glucose levels over the span of last 3 months.

3. Glucose tolerance test: It helps in diagnosing diabetes in patients who have fasting glucose on higher side. This test measures body’s ability to utilize the given amount of glucose when consumed orally.

Other investigations that might be done are urine for protein, complete blood count, urea and electrolytes, lipid profile and liver function test.

Treatment

There are various drugs available in the market to treat type 2 diabetes. They depend upon the cause of diabetes, severity of the disease, and presence or absence of any other diseases your doctor would prescribe you drugs like oral hypoglycemics or insulin.

Complications and When Should You See

You must regularly visit your doctor, follow the treatment as prescribed and get all the investigations done whenever advised, for timely diagnosis of various complications of type 2 diabetes.

1. Cardiovascular (heart) diseases

2. Diabetic nephropathy: Uncontrolled diabetes disrupts the functioning of the kidneys. Severe damage to kidney can result in kidney failure or irreversible kidney damage.

3. Diabetic neuropathy: Persistent high blood glucose levels injure the nerves, especially of the legs and arms. This is termed as diabetic neuropathy. This results in tingling, numbness, burning, or pain beginning from tip of the toes or fingers and slowly spreads upward. This is therefore called ‘socks and gloves’ pattern. Uncontrolled diabetes can ultimately result in loss of different types of sensation, like temperature, pressure, pain, vibration sensation, etc. in the affected limbs.

4. Diabetic retinopathy: Diabetes damages the blood vessels of retina which if not treated in time can result in blindness.

5. Foot damage: Foot damage due to nerve damage and reduced blood supply to the lower limbs is called diabetic foot. It is the result of uncontrolled diabetes and can ultimately lead to amputation of affected toe or foot.

6. Infections

   

Frequently Asked Questions about Type 2 diabetes

Q. Does beer cause diabetes?

Beer is an alcoholic beverage which is consumed avidly since long worldwide. Beer contains alcohol, though in less quantity (about 5%), which amounts to about 150 calories. A 350 ml bottle of beer contains 13 grams carbohydrates. The excess intake of alcohol reduces the sensitivity of body towards insulin. In the presence of alcohol, the hormone insulin does not perform its activity of breaking down glucose, resulting in elevated blood sugar levels. A persistent rise leads to diabetes. Moreover, alcoholism also causes chronic pancreatitis and the patients suffering from chronic pancreatitis show diabetes as a common adverse effect. Therefore, alcohol/ beer directly as well as indirectly leads to development of diabetes in the long run. A moderate quantity of beer to consume by women of all ages and men under the age of 65 is one drink a day; for men 65 and above, two drinks a day should be the limit.

Q. Can eating yogurt prevent diabetes?

Yes, eating yogurt can reduce the risk of diabetes. A recent research from Harvard School, Boston suggested that eating yogurt daily reduces the risk of developing diabetes. Yogurt is a pro-biotic, i.e., it has helpful and healthy bacteria, which are good for our intestines and help in digestion. These bacteria also help in the reduction of injury to the intestines (caused by harmful bacteria and faulty diet) and they help in the production of vital hormones which are required for the better digestion of food. Some of these hormones, even help in controlling appetite and help in maintaining body weight. Thus, when yogurt is taken, it helps in maintaining a healthy body weight as well as helps in digestion, in turn preventing diabetes. Apart from that, yogurt is high on calcium and can help fulfill the dietary need of calcium too. It is important to know the amount of yogurt that needs to be taken. Roughly 1–2 serving of roughly 75–100 grams in a day is sufficient to be beneficial (higher amounts have not been shown to be harmful).

Q. Is sugarcane juice good for diabetes patients?

A diabetic patient can enjoy sugar cane juice. The most important aspect to consider when choosing a food in diabetes is its glycaemic index. The glycaemic index is a measure of how rapidly the blood sugar levels rise after consuming a particular food. Sugar cane is considered as a healthy drink for diabetic people due to its low glycemic index. i.e. 43 units. It contains natural sugars which are not responsible for worsening the blood sugar levels in patients of diabetes. Rather, it prevents the steep increase in blood glucose levels after consumption, despite the sweet taste and high content of sugar. Studies have reported that drinking of sugarcane juice by a diabetic patient does not significantly alter the blood glucose levels. However, patients suffering from type 2 diabetes cannot consume large quantities of sugarcane juice. Their consumption should be moderate, that too with the prior consultation with a doctor.

Q. Is banana healthy for pre diabetes patients?

Yes, banana is healthy for pre-diabetics and is one of the recommended fruits for them. Apart from carbohydrates (sugar), banana contains dietary fiber, protein, vitamin B3, vitamin B6, manganese, vitamin C, vitamin A, iron, folate, and potassium. Banana even has a very a low amount of saturated fats and cholesterol. American Diabetes Association suggests that bananas of various sizes provide a range of carbohydrates, a small banana gives 23 grams of carbohydrates, a medium banana gives 27 grams of carbohydrate, whereas a large banana gives 31 grams of carbohydrate, which is a large quantity of sugar and might be risky for pre-diabetics. Since it also has dietary fiber that holds the sugar in the intestines and prevents it from getting immediately absorbed, it prevents sharp spikes in blood sugar levels, which makes it safe to consume. Being a rich source of dietary fiber, potassium and Vitamin B6 with Vitamin C, bananas are considered to be a good mid-meal fruit for pre-diabetics, but it should be taken in moderate quantities, i.e., 1–2 servings of a medium sized banana per day would be sufficient.

Q. How long would it take to become diabetic if you drink over two litres of cola a day?

Colas have a very high quantity of carbohydrates (sugars, mostly artificial), and thus, are very high in calorie count. Two liters of cola usually gives around 808 calories, which when taken over a long duration can make you gain weight (tremendously and quickly). Thus, regularly taking cola can rapidly make you obese which is a major risk factor for diabetes. Colas also raise sodium levels, which makes it easier for the sugar to get absorbed and assimilated. Diabetes has several predisposing (causative and contributive) factors, and one of the strongest factors is obesity. Obesity not only worsens an already hampered sugar metabolism, but also dampens cholesterol metabolism. Thus, obesity can lead to the development of diabetes. Although, it is nearly impossible to predict how many days, months, or years will it take to develop diabetes, the eventual development of diabetes is certain . It would be advisable to consume colas as an occasional treat, not as a substitute for water.

Q. Is it true that men with diabetes suffer from erectile dysfunction?

Yes, it is true that men with diabetes may suffer from erectile dysfunction. Erectile dysfunction is a condition where the person experiences difficulty in attaining or maintaining erection during sex. The normal male sexual erection is the result of a mix of vascular, nervous, hormonal, and psychological responses, which means that it requires healthy blood vessels, intact and functioning nerves, adequate level of male hormones, and a sound mind. When a person has long standing diabetes, his blood vessels start getting damaged, this reduces the blood flow to the corpus cavernosum (a part of penis). Diabetes also damages the nerves (diabetic neuropathy) that help in bringing about excitation (erection). Along with these two, a usual complication, i.e., obesity also plays a negative psycho-physical role in attaining as well as maintaining erection. All the aforementioned factors play an important role in developing erectile dysfunction in a diabetic male. Keeping diabetes under control is a surer way to averting the risk of erectile dysfunction.

Q. What are the most useful herbs for the treatment of diabetes?

In recent years, more precise studies have been done over controlling diabetes with herbs and herbal medicines. The herbs that help are Jamun Seeds: Powder of jamun seeds can be taken with water or buttermilk Fenugreek (methi): methi seeds are taken with water 15-20 minutes before each meal. Methi has soluble fibers that slowdowns the digestion and absorption of glucose Bael Leaves: Fresh juice is taken along with a pinch of pepper Bitter gourd (Karela): Raw as well as cooked can be taken. It reduces blood sugar levels as well as prevents diabetic complications of eyes and nerves Cabbage: It has insulin like effects. It can be taken raw as well as cooked Cinnamon (Dalchini): It helps in improving sugar as well as cholesterol level. Its powder is taken with water Amla: concentrated amla juice along with bitter ground juice is taken. It helps in releasing more insulin Isabgol: It is taken before meals with a glass of water. It has high amount of fibers, thus slowing down digestion and absorption of sugar Ginger: Ginger extracts are taken along with water. It stimulates muscles to take more glucose, thus reduces blood glucose levels Beans: Beans are cooked and taken. Beans have high fiber and dietary carbohydrates that stimulate pancreas to make more insulin Aloe vera: Juice of aloe vera is to be taken once a day. It has multiple effects; reduces blood glucose as well as cholesterol levels. However, these herbs help in controlling blood glucose, but they do not replace medicines completely.

Q. Will honey cause diabetes?

No, intake of honey or any other sweet food products, does not cause diabetes. On the contrary, honey is used as a sweetener, but in moderate quantity, for diabetics. Honey as compared to regular table sugar, has glucose and fructose. It has a lesser glycemic index than sugar. Honey also has a lesser concentration of sugar than table sugar. Certain other micro-nutrients such as calcium, iron, vitamin C, vitamin B (B2, B3, B6 and B9), magnesium, phosphorus, zinc, and potassium are present in minute quantities in honey. These instead have numerous health benefits. Honey also has a good amount of anti-oxidants, which is effective against several diseases. If somebody is diabetic, with poorly controlled diabetes or fairly controlled diabetes, but is over-weight, he should not be taking honey. But if he has well controlled diabetes then honey can be taken as a replacement for table sugar also.

Q. Can you eat sweets without getting fat or diabetes?

A very common misconception is that eating sugar or sweets causes diabetes. This is not entirely true. Type 1 Diabetes occurs when the body’s immune system attacks the insulin producing cells in the pancreas and destroys them. It occurs mostly at a very young age. Type 2 Diabetes is more common and usually occurs in adulthood. In Type 2 Diabetes, the body isn’t able to use insulin in the right way. This is called insulin resistance. As type 2 diabetes gets worse, the pancreas may make less and less insulin leading to insulin deficiency. Eating sugar or sweets has nothing to do with developing Type 1 Diabetes. Intake of sugary drinks should be limited to help prevent Type 2 diabetes. One of the biggest risk factors for Type 2 Diabetes is being overweight, and a diet high in calories from any source contributes to weight gain. It is the high calorie content and not the sugar that leads to insulin resistance and diabetes. When taking sweets, remember that all sweets are not alike. Some have sugar alone and hence contain lesser calories and are safe to eat. Sweets containing high khoya content, ghee or oil are high in calories and hence more fattening. These sweets are more likely to result into insulin resistance in long term leading to diabetes. Sweets are bad because of calories contained in them. Serving sizes make a huge difference. When you include sweets in your meal, have one chapatti instead of two or have a smaller serving of rice.

Q. Why is immunity suppressed in diabetic patients?

Patients with uncontrolled diabetes have decreased immunity due to the negative effect of high blood sugar on the immune system. High blood sugar impairs the overall immunity in many ways. High blood sugar for a prolonged period of time leads to acidosis which impairs the effectiveness of immune system. Chronic high blood sugar levels also impair the flow of blood through blood vessels which leads to nerve damage. This causes the skin to be less responsive to trauma and inflammation. Therefore, impaired sensations may cause the patients with diabetes to ignore minor injuries and bruises till they become infected. This is why skin infections are so common in diabetics. High glucose levels also limit and deregulate neutrophil synthesis, which is essential in the immune system to attack a foreign object. High blood sugar levels also cause other impairments in the immune system such as decreased complement response, leukocyte adherence and bactericidal activity. Bacteria find it easier to grow in the presence of high blood sugar levels and the body finds it difficult to respond to antibiotics.

Q. What causes neuropathy in diabetes patients?

1. Is any of the nerve damage reversible?!The exact cause of Diabetic neuropathy is not clear. There are many factors that are known to contribute towards this condition, the most important being high blood sugar levels. Causes include: 1. Reduced blood flow: Diabetes causes reduced blood vessel relaxation leading to impaired flow to nerves 

2. Damage to nerve proteins: Depletion of myelin proteins which are important for nerve conduction. Glycosylation of structural nerve proteins leading to decreased nerve conduction 3. Oxidative stress: Increased production of oxygen free radicals producing oxidative stress and damage 4. Accumulation of sorbitol and fructose in nerves. Risk factors include: 1. Poor blood sugar control 2. Alcohol intake 3. High blood pressure

4. Smoking 

5. High cholesterol levels

6. Obesity 

7. Older age

8. Family history 

9. Duration of diabetes Depending on the extent of damage and the function that is impaired due to nerve damage, it is sometimes possible to reverse or slow down the damage by medications and lifestyle changes.

Q. Why are diabetic patients thirsty?

Patients with diabetes often experience excessive thirst due to excessive urination which leads to loss of fluids and hence increased thirst. This happens because in diabetes, when excess sugar accumulates in the blood, kidneys fail to reabsorb the sugar from the glomerular filtrate back to the blood stream. This increases the osmotic pressure of the filtrate, thereby pulling out more fluid from the body. This leads to excessive urination and loss of body fluids and eventually excessive thirst.

Q. Is diabetes transferable?

Type 1 Diabetes is not an inherited diseases but there is a genetic link . This means that a first-degree relative ( example: sister, brother, son, daughter) of someone with type 1 diabetes has about a 6 in 100 chance of developing type 1 diabetes. In Type 1 Diabetes, the body does not produce enough insulin. It is usually diagnosed in children and young adults. There is no known way to prevent it. Giving Insulin injection is the only treatment. But only 5% of people with diabetes have this form of the disease. Type 2 diabetes has a stronger link to family history than type 1. But there are environmental factors as well that determine whether a person will develop type 2 diabetes. Studies conducted on twins show that genetics play a very important role in the development of type 2 diabetes. Also having an unhealthy lifestyle like lack of exercise, obesity and eating processed food can predispose a person to diabetes. Studies show that it is possible to delay or prevent type 2 diabetes by eating right, exercising and losing weight.

Q. Is it true that high blood pressure medicine can cause diabetes?

No. High blood pressure and diabetes are commonly found together in patients. Each is a risk factor for the other. Blood pressure reducing medications do so by acting at various levels in the body. Earlier it was thought that beta blockers and thiazide diuretics, a class of high blood pressure reducing drugs, could lead to diabetes. These thiazide drugs, increased the excretion of water from the body by increasing urine output. This ultimately led to reduction in high blood pressure. However, plenty of studies thereafter have shown that neither beta blockers, nor thiazides increase the risk of diabetes or cause diabetes. However, it must be noted that untreated high blood pressure can increase the risk of diabetes type 2 in the long run. High blood pressure should be controlled well and checked regularly.

Q. Which diabetes is more dangerous? Type 1 or type 2?

Type 2 Diabetes is much more common that Type 1. Both type 1 and type 2 diabetes have their own set of complications, but with current treatment modalities, patients with either of the two types can live a healthy and fulfilling life. India has the largest number of diabetics in the world. Around 6.2 crore people in India suffer from diabetes. Many patients of diabetes in India are still undiagnosed. Here are some important facts about diabetes that you should know. Type 2 diabetes is the most common type Diabetes is a disease in which the blood glucose levels in the body stay consistently above normal. Insulin is the hormone which regulates blood glucose levels. Type 1 Diabetes: In this type of diabetes body does not produce enough insulin. It is usually diagnosed in children and young adults. There is no known way to prevent it. Giving Insulin injection is the only treatment.But only 5% of people with diabetes have this form of the disease. Type 2 Diabetes: It results from the body’s ineffective use of Insulin. It is usually diagnosed in age group of 35-45. It is the most common form of diabetes. It can be prevented by healthy diet and exercise. Type 2 diabetes is managed by oral medications. Type 2 diabetes may have no symptoms Many cases of type 2 diabetes have no or very mild symptoms. The typical symptoms of diabetes are frequent urination, excessive thirst and hunger, extreme fatigue and delayed healing of cuts and other injuries. Type 2 diabetes is preventable Regular moderate physical activity coupled with healthy diet can significantly reduce the risk of type 2 diabetes. Losing even 5-7 % of weight can prevent diabetes. Early detection of diabetes can prevent complications Large numbers of diabetes patients in India are undiagnosed. This may lead to complications of heart, kidney, eyes and nerves. Early detection and control can prevent all these complications.

Q. Is there any products on the market that test blood sugar levels without a blood sample?

Yes. Testing blood and urine samples are two ways to look for high blood sugar levels and diagnose diabetes. Apart from testing blood, testing a urine sample is the only way to confirm diabetes. This is done by collecting a fresh sample of first urine passed in the morning. Care should be taken that the sample is collected without touching the skin. Some initial urine should be allowed to pass off before beginning collection. The sample should be collected in a sterile container obtained from the laboratory and sent for analysis immediately. Using the dipstick method and other chemical reagents, the urine is assessed for presence of glucose in it. Presence of glucose in urine is abnormal and indicates diabetes. A blood test of Fasting blood sugar and Postprandial blood sugar should be done to confirm it.

Q. Is potato responsible for causing type 2 diabetes?

No. Potatoes do not cause diabetes. Diabetes type 1 is an inherited genetic disorder that is marked by lack of production of insulin in the body. This cannot occur by eating or avoiding any food substance. If you have the gene for diabetes type 1, you will manifest the symptoms despite avoiding potatoes, or even sugar. Next, Diabetes type 2 is marked by resistance of the body cells in using naturally produced insulin by the body. This has multiple risk factors including family history of diabetes, being overweight or obese, sedentary lifestyle, etc. So if you have any of these risk factors, your chance of being diagnosed with diabetes type 2 at some point in life is high. Now, nutritionally, 100g potatoes contain 158kcal energy, 2.75g protein, 5.48g fat, 25.55g carbohydrates, 2 g fiber and 0.37g sugars. None of these will produce insulin resistance. However, eating excessive amount of potatoes can lead to obesity in the long run when coupled with lack of activity. Obesity and a sedentary life are both leading risk factors for diabetes type 2. So indirectly, you might land up having diabetes. Even so, potatoes must not be blamed, it’s the lack of activity that needs to be corrected.

Q. What kind of foods are known for lowering blood sugar?

In diabetes, usually foods that are rich in sugars and fats should be avoided to prevent spiking of blood sugar levels. In case of obese patients, a weight loss diet is recommended because weight loss naturally reduces blood sugar. However, recent studies suggest that following food items might help in actively reducing blood sugar naturally Avocados Chia seeds Bitter gourd (Karela) Cinnamon (daalchini) Vinegar (Sirka) Olive oil Cherries Blue berries (Nilabadri) Some of the above food items help in reducing weight as well. Most importantly, a balanced diet along with these foods will help in managing blood sugars efficiently. These foods have been thought to help reduce blood sugar, but more research is needed to confirm their benefits.

Q. How do you cure diabetes naturally without medication?

Diabetes can never be cured per se, but blood sugar levels can be kept under control, naturally without medicines. The best way to do the same is to Reduce weight if you are overweight or obese and maintain ideal weight for your height Eat in moderation (following a balanced diet, which has low sugar, low fat, moderate carbohydrates and high protein Eat small but frequent meals Avoid sugar in any form (sweets, chocolates, sweet fruits, syrups artificial sweeteners etc.) Exercise 45 minutes to 1 hour, every day (this includes walking, skipping, swimming, cycling and aerobics; avoid excessive muscle training) A balanced lifestyle of good diet and exercise helps in managing the sugar levels naturally and keeps it under control, without medicines.

Q. Why is that diabetic people are always recommended to keep their legs and feet clean and free from bruises?

Diabetic patients of long duration (suffering from diabetes for more than 10 years), tend to have damaged nerves in their leg because of persistent high blood sugar levels. The damaged nerves are the reason for sensations in the feet in diabetics i.e. they often don’t realize if the footwear has slipped off while walking, or if they have a splinter sticking in their foot. In such a state of poor sensations, if they get hurt or injured, they won’t be able to feel the pain following the injury. As the injury will go unattended till noticed visually, this injured area might develop into an ulcer and get infected. Due to the high blood sugars in diabetics, the infections and ulcers don’t heal as quickly as they do in non-diabetics and respond slower to treatment too. If this continues, then the infection may spread deeper inside the foot and infect the bone and into the blood stream leading to sepsis. In extreme cases, the non-healing wound might lead to amputation of the infected and gangrene affected limb. Hence, diabetic people are always recommended to keep their legs and feet clean and free from bruises. They should inspect their feet each night before retiring and attend to the smallest of the injuries immediately by visiting a doctor before they worsen.

Q. Can diabetes type 2 be cured completely by Ayurvedic treatment?

Diabetes type 2 can’t be cured by any mode of treatment- allopathic or ayurvedic. However, it can be kept under control. Controlling blood sugar levels is the best mode of treatment. It possibly can be done using Ayurvedic treatment. Ayurvedic treatment includes health management with the help of herbs, which are in a dried-powder form or as capsules or extracts. This is accompanied by diet and lifestyle alterations. Diet includes a standard diabetic diet, i.e., avoidance of sugar in any form (sugar, sweets, candies, ice cream, chocolates, etc.); eating small meals regularly; reducing weight to the ideal weight (weight as per height). Adding exercise in the daily routine and exercising for 45 minutes to 1 hour every day is essential to control diabetes, irrespective of the mode of the treatment being followed. In Ayurvedic medicine, after all these changes in diet and lifestyle are carried out, then diabetes can be kept under control without any complications.

Q. Can surgery cause increased blood sugar in non-diabetics?

Yes. Surgery can lead to high blood sugars even in non-diabetics. As part of evolution, a surgery is identified as a physical stress for the body. The body gears up for a speedy recovery and during this period, our body mobilizes energy i.e. glucose to overcome this stress. Certain hormones too are released to overcome this stress. Amongst many others like cortisol, these hormones include insulin and glucagon, both of which work in combination to maintain our blood sugar levels within the normal range. This increased mobilization of glucose as a ‘stress response’ and increased release of hormones can result in an imbalance of sugar level and thus, increase blood sugars (especially in non-diabetics). This is usually managed without medicines, as glucose levels come down within the normal range in a few hours to days. But, in case of diabetic patients’ insulin needs to be administered for controlling it.

Q. Is eating a few large meals each day rather than more small meals bad for blood sugar levels?

Yes, eating a few large meals each day is bad for blood sugar. Usually, when we eat a meal, our body breaks down the food into its constituent sugars like fructose, glucose, etc and eventually converts them all into usable energy i.e. glucose. Hence, after a meal, glucose levels of blood increase, and this lasts for about 2 hours; during this time insulin is released from pancreas to bring the glucose level down and maintain it within normal range. When we eat a large meal, more amount of glucose is released in blood in the hours following the meal. This requires more amount of insulin to control this surge of glucose and bring it down. If this is repeated again and again (i.e. large meals are taken all day, instead of small meals) the pancreas are over burdened by making more insulin to keep blood sugar under control. Eating small and frequent meals stimulates pancreas to secrete small amounts of insulin to control the moderate spike of glucose that happens after a small meal. The pancreas and insulin can then work efficiently and prevent the blood sugars from shooting too high.

Q. Why insulin injections are given for type 2 diabetes mellitus despite insulin resistance?

Insulin injections are given to type 2 diabetic patients, when the duration of suffering is longer than 15 years (or in diabetics with uncontrolled blood sugar, longer than 5-10 years). In diabetes, blood glucose levels remain high and to combat this, the pancreas have to produce more and more insulin. In diabetes type 2, the body cells are ‘resistant’ to the circulating insulin in the blood stream and fail to use it to bring the blood sugars under control. Thus, despite of adequate insulin in the body, the person lands up with diabetes. Some diabetes medicines stimulate our body cells and make them sensitive towards insulin so that they utilize more glucose from the blood and help in lowering the blood sugar. When these patients are given insulin injections, their blood’s glucose level remain can be brought back down to within range.

Q. Are diabetic patients at risk of getting strokes?

Yes, diabetic patients are at a higher risk of getting strokes. Many studies report that diabetes patients have a higher risk of heart diseases and stroke. It has been seen that a diabetic patient is 2-4 times more likely to face a stroke as compared to a person with normal glucose levels. In cases with normal glucose level, the arteries act as a bypass to overcome the deficiency of oxygen. However, a person with a high glucose level does not respond in the same manner in case of a stroke. It has been observed that diabetic patients contain higher quantity of glucose in blood which deposits in the form of plaques or clots of fats which blocks the blood vessels of the brain, leading to a condition called as atherosclerosis. This results in narrowing the vessels space, thereby, restricting the supply of blood to the brain which causes a stroke.

Q. Can diabetes cause kidney failure?

Yes, diabetes can cause kidney failure. In the long run, diabetes affects kidneys, eyes and nerves, leading to conditions called diabetic nephropathy, retinopathy and neuropathy respectively. Diabetic nephropathy is a condition which is a major cause of kidney failure in diabetics. It has been reported that 1/3 of diabetic patients suffer from diabetic nephropathy. In Type 1 diabetic patients, kidney dysfunctioning is generally observed after 10 years from diagnosis, whereas in Type 2 diabetes, people are generally diagnosed with kidney diseases much earlier. Usually, the waste products released after digestion are small enough to pass the filters present in kidney. However, the big molecules (proteins and red blood cells) do not pass through the filter and stay in the blood. In diabetic patients, the filters of kidney get damaged due to high levels of blood sugar. This results in weakening of filters, followed by loss of proteins in urine (albuminuria). As the filtering ability of kidneys is reduced and progressively worsens, the kidneys eventually fail. This is called as kidney failure and they cannot produce normal quantities of urine. This can only be treated through dialysis or kidney transplant.

Q. What is role of protein in diabetes?

Proteins are one of the major energy providers among all macronutrients. Besides, being the building blocks of human body, proteins release energy as they can be broken down into glucose. Unlike carbohydrates, the process of metabolism of proteins into glucose is much slower. Therefore, the release of energy usually takes a few hours after consumption. Thus, the spike in blood sugar levels might occur after a few hours when you are on a high protein diet. Patients with type 1 or type 2 diabetes need to keep a check on their protein intake. Many studies support the association of intake of high protein diet (containing red meat) and development of type 2 diabetes. Moreover, consumption of processed red meat increases the chances of developing diabetes. Therefore, one should limit the consumption of high amounts of protein if he/ she is diabetic.

Q. What is the best way to self-monitor blood sugar?

The best way to self monitor sugar is by using a home blood sugar checking meter. Many electronic devices are available in the market today for this purpose. A self monitoring blood glucose device is a small, portable, durable and reliable machine which helps a diabetic patient to measure and monitor his/ her blood glucose level. These devices can be used by a caregiver or the patient himself. Just a small drop of blood needs to be placed on an electronic strip. This strip is inserted into the glucose meter which then measures the amount of glucose in the sample. A small screen on the meter displays the result. Most devices also display if the reading is higher or lower than the normal range. There are many benefits of using a glucose meter. One of the major benefits is that one can assess the effect of any food item or activity on blood glucose by monitoring the sugar level at appropriate time, in the convenience of home. Moreover, one can check his glucose level anywhere, anytime. The fluctuation in blood glucose levels during the day and night can also be easily detected by glucometers. Lastly, one can keep a detailed daily record of his /her sugar levels and the effect of medications on it.

Q. Why does diabetes cause weight loss in some people and weight gain in some others?

When a person becomes diabetic, the absence of insulin results in increase of glucose in your blood. Thus, the cells that are starved for energy without the glucose, start burning fats and muscle to get fuel (glucose). This is what leads to uncontrolled weight loss in some diabetics. This often occurs in patients of diabetes type 1. On the other hand, some people with diabetes are known to experience weight gain on becoming diabetic. This especially happens in patients with diabetes type 2. Patients who acquire diabetes type 2, tend to put on wight because of insulin resistance i.e. the body is producing insulin, but the cells are resistant to it. Thus, the excessive glucose from food keeps getting accumulated in the body as fat. This leads to weight gain and then to diabetes. A person with diabetes should have a well balanced, healthy diet and physical activity in addition to medications to control the blood sugar in consultation with their physician.

Q. Which fruits should I add to my diet to reduce my cholesterol level and blood sugar?

Fruits are rich source of minerals, fiber and vitamins. They can contribute in reducing the cholesterol and blood glucose levels. The fruits which are rich in fibers are considered best for diabetics as they do not elevate blood sugars too much. The low glycemic index of food fibers slows down the glucose absorption and is good for diabetics. Moreover, they also lower serum cholesterol, resulting in anti- lipid activity. The fruits such as beans, brussel sprouts, oranges, pears, peaches, plums, strawberries, apricots, apples, carrots, sweet potatoes, peas, broccoli and asparagus, etc. are rich in soluble fibers. Chromium is a mineral found in many fruits such as broccoli, orange or grape juice, potatoes, garlic, basil, green beans, apples and bananas, etc. is good for diabetic and hyperlipidemic patients. It is considered beneficial as it helps in decreasing blood sugar and cholesterol levels. It has also been reported that a healthy adult needs about 25-35 micrograms of chromium per day, whereas, a diabetic needs about 200 to 1,000 micrograms per day.

Q. Will eating fruits cause diabetes?

No, eating fruits cannot cause diabetes. Diabetes type 1 is a genetic disorder marked by severe deficiency or absence of insulin production from the pancreas. Eating fruits cannot lead to this form of diabetes. Similarly, diabetes type 2 is marked by resistance of the body to insulin. No natural fruits can produce insulin resistance on consumption. Hence, diabetes type 2 also cannot be induced by eating any fruits. However, there are some fruits which are rich in sugars and should be avoided by people who are already diabetic, as eating these fruits increases blood sugar levels and can result in weight gain. Some of the fruits that should be avoided are banana, custard apple, chikoo, sweet melon, grapes which are known to have very high levels of sugars. Along with these packed fruit juices, sugar or fruit syrups, jams and jellies must be avoided as they increase blood sugar levels. Some fruits that are very useful in diabetes are Jamun, Guava, Star fruit, Pine apple, Papaya, Oranges, water melon and pomegranate. These can be consumed in small proportions of 100-200 grams each day.

Q. Can you lose a limb from diabetes?

Yes. Limb loss is a possible reality as a result of unmanaged diabetes. Foot ulcers are a precursor to amputation in nearly 80% amputations that are without any major trauma. One of the commonest complications of diabetes is diabetic neuropathy, which means loss of sensation, especially of legs (nerves of the feet get damaged due to long standing, uncontrolled or poorly controlled diabetes). Due to this nerve damage and loss of sensation, a person is unable to feel pain even if he has suffered a cut or wound on his foot. Due to diabetes, wound healing is slower than usual, and this wound then often turns into an ulcer. If not aggressively treated even at this stage, it may get infected and cause pus formation. This infection slowly spreads deeper within the tissues where it damages not only muscles, but may also affect the foot bones. This deep injury is difficult to manage and often leads to death of tissue i.e. gangrene. To prevent spread of infection or ulcers to other body parts, it is preferred to amputate the limb. Hence, a person can lose a limb from diabetes and nearly 15% diabetics experience foot ulcers at some point. Therefore, diabetics are always recommended to keep their legs and feet clean and check them each day.

Q. What should be one's lifestyle to prevent getting diabetes?

Diabetes can be prevented by following a balanced diet, exercising regularly, and with lifestyle modifications. Some of the techniques that help to prevent getting Diabetes are as follows: - Reduce weight (if over weight) - Eat right food (follow a balanced diet, which has low carbohydrate, low fat, and high protein) - Eat small but frequent meals - Drink plenty of water, at least 2-3 litres - Consume plenty of fresh, raw fruits and vegetables of all colours - Avoid excessive sugars (sweets, chocolates, sweet fruits, syrups artificial sweeteners, etc.) - Have an adequate sleep of 6-8 hours - Exercise for 45 minutes to 1 hour every day (this includes walking, skipping, swimming, cycling, and aerobics; avoid gym and muscle training) Once diabetes is diagnosed, it can be just kept under control and never be cured. Thus, the old saying holds true prevention is better than cure.

Q. Can a type-2 diabetic donate blood?

Yes a diabetes type 2 person can donate blood. One can donate blood if he/she meets the following criteria: Well controlled blood sugar levels If you are not receiving insulin Having a good general health state Blood pressure is below 150/100 mmHg Optimum level of hemoglobin Blood banks usually ask to fill up a quick questionnaire to assess the general state of health. If all answers suggest that you are eligible, than you can donate blood. However, there are certain things one must keep in mind before donating blood: Have an adequate meal before donating blood to avoid fainting due to hypoglycemia Drink plenty of fluids Eat iron rich food (like spinach, dates, green leafy vegetables) Avoid caffeine-rich beverages

Q. Myth: Being on insulin means you did not take proper care of your diabetes?

At the time of diagnosis, mostly the blood sugar is controlled adequately by diet, exercise, and/or oral medications that help the body absorb glucose. However, with time the pancreas may stop producing enough insulin. At this point, insulin injections are added to the treatment plan. This is the natural progression of the disease.