World Diabetes Day every year is celebrated on 14th November, on the birth date of Sir Frederick Banting who discovered insulin along with his team in 1922. This year’s theme of world diabetes day is “access to diabetes care and education to protect tomorrow.” Therefore, it is important for general population and people with diabetes in particular to know more about diabetes. The following is an attempt to disseminate some education regarding diabetes.
When should we suspect diabetes?
Most of the times diabetes may have no symptoms. Symptoms appear if blood glucose increases markedly. The main symptoms because of very high blood glucose are excessive thirst, excessive urination, increased appetite and weight loss. Sometimes passage of urine during night may be a clue to diagnosis. Other symptoms, which may be related to high blood glucose, include blurring of vision (because of glucose induced temporary changes in focal length of lens). Impaired hearing and non-healing of wounds or infections. Sometimes if blood glucose increases markedly, person may become unconscious.
How is diabetes diagnosed?
Diabetes is diagnosed by documenting high glucose concentration in blood. In an asymptomatic individual, overnight fasting (at-least 10 hours overnight fast) should be more than 126 mgs/dl to diagnose. This level of high blood glucose has to be documented at least twice. However, if a person has symptoms as described above, random blood glucose of more than 200 mgs/dl also makes a diagnosis of diabetes; in such a situation a repeat test is not required for diagnosis. Once diabetes is diagnosed both doctor and the patient would like to know as to how long the diabetes in there. To answer the question, another test called HBA1c estimation is required. HBA1c level of >6.5% means diabetes of at least three months duration. Presence of glucose in urine may not mean diabetes.
What is prediabetes?
Overnight fasting blood glucose between 100 and 125 is known as prediabetes. Level <100 mgs/dl is normal and ≥126 mgs/dl means diabetes. As said, HBA1c measures average blood glucose level for the previous three months. An HBA1c of 5.7-6.4% also means prediabetes. Level of <5.7% means a normal and >6.5% means diabetes. Prediabetes is an intermediate stage between normal and diabetes; it means person with prediabetes has chance of developing diabetes in future. If precautions about diet and exercise are not followed properly.
Who is at risk for developing diabetes?
Any person can develop diabetes. People with following risk factors are more predisposed: People who are overweight or obese, have sedentary life style, have family history of diabetes in first degree relatives or have received some medications causing diabetes ( such as steroid drugs).
Diagnosis of diabetes during pregnancy
Pregnancy is a state with high predisposition for diabetes and most of the women during first antenatal check-up need to be screened for diabetes. After taking a fasting sample for blood glucose, 75 grams of glucose are given orally and blood glucose estimated at 1, 2 and sometimes 3 hours after oral glucose. Normal blood glucose values are: 92,180,153 and 140 at fasting, one hour, two hour and three hours respectively after oral glucose. Even a single glucose value exceeding these limits makes a diagnosis of diabetes during pregnancy.
Conditions associated with diabetes
Some other common conditions are commonly associated with diabetes like high blood pressure, abnormal lipids and uric acid. So a clinician may ask for these tests while someone is diagnosed with diabetes.
Is it important to control diabetes?
Control of diabetes is important to prevent immediate and long-term complications because of diabetes (such as neuropathy, eye disease, kidney and heart disease).
What are the ideal levels of blood glucose control?
Ideally, a person with diabetes should have a good control of diabetes to prevent complications. The targets for blood glucose control are: fasting or premeal blood glucose 70-130 mgs/dl; post meal (1-2 hour) less than 180 mgs/dl and HbA1c ideally less than 7%. In extremes of age (children and older population and those with other diseases), these targets can be relaxed and even an HBA1c of 8% is acceptable. Also in people who are committed and do not have any other co morbidity an attempt of HBA1c of 6.5% can be attempted.
Management of diabetes
Three things are important for control of diabetes: diet, exercise with or without drugs.
Role of diet:
It is the most essential part of management of diabetes. Traditional Kashmiri diet comprises of two major and two minor meals. All these four meals primarily comprising of roti and rice are high in carbohydrates. To start with, remove all the free sugars from your diet (like sugar added to tea); reduce all sugar containing eatables (like sweets, deserts, ice cream, soft drinks, junk foods and ready to eat foods) and finally reduce the quantity of usual daily routine foods like rice and chapatti. In addition, oil and salt content also need to be kept low. The concept of a healthy plate will further improve the diet. Plate Method is the easiest way to create healthy meals that can help manage blood sugar. Using this method, you can create perfectly portioned meals with a healthy balance of vegetables, protein, and carbohydrates. Fill half your plate with non-starchy vegetables. Non-starchy vegetables are lower in carbohydrate, so they do not raise blood sugar very much. They are also high in vitamins, minerals, and fibber, making them an important part of a healthy diet. Some of the non-starchy vegetables are: Cauliflower, cabbage, carrots, cucumber, eggplant, kale, collards (saag), mushrooms, okra (bindi), green beans, spinach, and all varieties of squash, peppers and tomatoes. Fill one quarter of your plate with lean protein foods. Examples of lean protein foods include: chicken, eggs, fish and cheese. Plant-based sources of protein include: beans, lentils, nuts. Fill one quarter of your plate with carbohydrate foods. Foods that are higher in carbohydrate include rice, bread, oatmeal, potatoes, dry beans and dried fruit. These foods have the greatest effect on blood sugar.
Limiting your portion of carbohydrate foods to one quarter of your plate can help keep blood sugars from rising too high after meals. These include:
A simple way to cut back on the amount of food you eat is to use a smaller plate. Same quantity of food looks larger in a smaller plate than in a large plate. The size of dinnerware influences how much you serve and consume during a meal. In a study, switching from 12-inch plates to 10-inch plates resulted in 22% less food consumption.
Role of exercise
Structured lifestyle interventions that include at least 150 min/week of physical activity and dietary changes resulting in weight loss of 5%–7% are recommended to prevent or delay the onset of type 2 diabetes in populations at high risk and with prediabetes.
Medications and Diabetes
Patients with diabetes if not controlled with diet and exercise may need medications to control their blood glucose. In addition, patients with diabetes are at increased risk of high blood pressure and abnormal lipids. They are also predisposed to coronary heart diseases. So common medications which most of the people with diabetes take are drugs for diabetes, blood pressure, lipids and prevention of heart disease.
Who requires insulin?
Some people who have very high blood glucose at presentation may need insulin for few months to control diabetes, after some time insulin can be withdrawn. However, people with diabetes of more than ten years may permanently need insulin for control of diabetes.
Summary
1. Diabetes is common and prevalence of diabetes is going to increase in future.
2. A blood glucose test after the age of 30 years can be done as a routine check-up.
3. If diabetes or prediabetes is diagnosed, attention needs to be paid towards lifestyle modification like diet and exercise.
4. It is required to have a good control of diabetes and its associated conditions in order to prevent diabetes related complications.
5. Finally, patient and family members need to be sufficiently educated about diabetes.
Prof. Bashir Ahmad Laway, Professor & Head, Department of Endocrinology Sher-I-Kashmir Institute of Medical Sciences, Srinagar
DISCLAIMER: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.