Diabetes

Diabetes mellitus is a serious chronic disease characterized by abnormalities in the metabolism of carbohydrate, protein and fat. Persons with diabetes have bodies that do not produce or respond to insulin, a hormone produced by the beta cells of the pancreas that is necessary for the use or storage of body fuels. Without effective insulin, hyperglycemia (elevated blood glucose) occurs and can lead to both short-term and long-term complications of diabetes mellitus

Types of diabetes

There are two types of diabetes i.e Type I (IDDM-Insulin dependent diabetes mellitus), and Type II (NIDDM-Non insulin dependent diabetes mellitus)
Type I diabetes mellitus (Insulin Dependent Diabetes Mellitus - IDDM, or Juvenile Diabetes):
Type I diabetes results from autoimmune destruction of insulin-producing beta cells of the pancreas. The subsequent lack of insulin leads to increased blood and urine glucose.

Signs and Symptoms:

The classical symptoms are frequent urination, increased thirst, increased hunger, weight loss and fatigue

Causes:

Autoimmune Response

Type I diabetes is usually a progressive autoimmune disease, in which the beta cells that produce insulin are slowly destroyed by the body's own immune system.

Genetic Factors

A family history of diabetes is also one of the causes for type I diabetes. If a first-degree family member, such as a parent or sibling, has diabetes, then it shows a slightly greater risk of having diabetes.

Viruses:

Among the viruses, scrutiny are enteric viruses. It  is the cause of incidence of type I diabetes.

Type II diabetes mellitus (Non-Insulin-Dependent Diabetes Mellitus - NIDDM or Adult-onset Diabetes):
Type II diabetes is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency

Signs and symptoms

The classic symptoms of diabetes are frequent urination, increased thirst, increased hunger, fatigue and weight loss. Type II diabetes has been associated with an increased risk of cognitive dysfunction and dementia (loss of brain function)

Causes:

Type II diabetes is due to a combination of lifestyle and genetic factors. Recently, intrauterine growth restriction (IUGR) or prenatal under nutrition (macro and micronutrient) was identified as another probable factor

Complications of Diabetes:

  • Diabetes can affect many major organs in our body, including heart, blood vessels, nerves, eyes and kidneys. Keeping blood sugar level close to normal, most of the time can dramatically reduce the risk of many complications. Long-term complications of diabetes develop gradually, over years. These complications are even life-threatening
  • Heart and blood vessel disease - Diabetes dramatically increases risk of various cardiovascular problems, including coronary artery disease with chest pain , heart attack, stroke, narrowing of the arteries  and high blood pressure.
  • Nerve damage (neuropathy) - Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood sugar could cause to eventually lose all sense of feeling in the affected limbs. Damage to the nerves that affect the gastrointestinal tract can cause problems with nausea, vomiting, diarrhea or constipation
  • Kidney damage (nephropathy) - The kidneys contain millions of tiny blood vessel clusters that filters waste from blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant
  • Eye damage - Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma
  • Foot damage - Nerve damage in the foot or poor blood flow to the foot increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections. Severe damage might require toe, foot or even leg amputation.
  • Skin and mouth conditions - Diabetes may leave more susceptible to skin problems, including bacterial and fungal infections. Gum infections also may be a concern, especially if you have a history of poor dental hygiene.
  • Osteoporosis - Diabetes may lead to lower bone mineral density than the normal, increasing  risk of osteoporosis
  • Pregnancy complications - High blood sugar levels can be dangerous for both the mother and the baby. The risk of miscarriage, stillbirth and birth defects are increased when diabetes isn't well controlled. For the mother, diabetes increases the risk of diabetic eye problems , pregnancy-induced high blood pressure
  • Hearing problems - Hearing impairments occur more often in people with diabetes
  • Alzheimer's disease - Diabetes may increase the risk of Alzheimer's disease and vascular dementia.  Diabetes could contribute to dementia by blocking blood flow to the brain or causing strokes. Other possibilities are that too much insulin in the blood leads to brain-damaging inflammation, or lack of insulin in the brain deprives brain cells of glucose.

Compare your values with normal values

Diagnosis                                                                   Criteria

Diabetes                                              FPG ≥126mg/dl (≥7.0 mmol/L)
                                                              CPG≥200mg/dl(≥11.1 mmol/L) Plus symptoms
                                                              2hPG≥200mg/dl(≥11.1 mmol/L)
Pre – diabetes                                      
Impaired fasting glucose                FPG ≥100-125mg/dl (5.6-7.0 mmol/L)
Impaired glucose tolerance           2h PG 140-199 mg/dl (7.8 -11.0 mmol/L)           
                    
Normal                                                 FPG <100mg/dl (<5.6 mmol/L)
                                                              2h PG < 140mg/dl (<7.8 mmol/L)     

CPG –Casual plasma glucose; FPG, Fasting plasma glucose; 2h PG,2-hour plasma glucose level (measured 2 hours after an oral glucose tolerance test with administration of 75g of glucose)      

Hypoglycemia
Hypoglycemia is a condition that occurs when blood sugar (glucose) is too low. Blood sugar below 80 mg/dl is considered as low level.

Causes:
Hypoglycemia occurs when:

  • Body's sugar (glucose) is used up too quickly
  • Glucose is released into the bloodstream too slowly
  • Too much insulin is released into the bloodstream

The most common causes of low blood sugar in people with diabetes are:

  • Taking insulin or diabetes medicine at the wrong time
  • Taking too much insulin or diabetes medicine by mistake
  • Not eating enough during meals or snacks after taken insulin or diabetes medicine
  • Skipping meals
  • Waiting to eat meals
  • Exercising more or at a different time than usual
  • While consuming alcohol skipping the meals.

Symptoms
Symptoms when blood sugar gets too low include:

  • Double vision or blurry vision
  • Fast heartbeat
  • Feeling cranky or acting aggressive
  • Feeling nervous
  • Headache
  • Hunger
  • Shaking or trembling
  • Sleeping trouble
  • Sweating
  • Tingling or numbness of the skin
  • Tiredness or weakness
  • Unclear thinking
    Sometimes blood sugar may be too low, even if we do not have symptoms. If blood sugar gets too low, may:
  • Faint
  • Have a seizure
  • Sometimes it leads to coma stage too.

Treatment
Treatment depends on the cause.
If we have diabetes, first we should check blood sugar level whenever we have symptoms of low blood sugar.
One Should eat 15 grams of carbohydrates that to simple sugar. Examples are:

  • 3 glucose tablets
  • A 1/2 cup (4 ounces) of fruit juice or soda
  • 5 or 6 hard candies
  • 1 tablespoon sugar, plain or dissolved in water
  • 1 tablespoon honey or syrup
    We should wait about 15 minutes before eating anything else. We should be very careful not to over-treat by eating too much. This can cause high blood sugar and weight gain.

Hyperglycemia
Hyperglycemia, or high blood glucose (sugar), is a serious health problem for those with diabetes. Hyperglycemia develops when there is too much sugar in the blood. In people with diabetes, there are two specific types of hyperglycemia that is:

  • Fasting hyperglycemia is defined as a blood sugar greater than 90-130 mg/dl (milligrams per deciliter) after fasting for at least 8 hours
  • Postprandial or after-meal hyperglycemia is defined as a blood sugar usually greater than 180 mg/dl. In people without diabetes postprandial or post-meal sugars rarely go over 140 mg/dl but occasionally, after a large meal, a 1-2 hour post-meal glucose level can reach 180 mg/dl. Consistently elevated high post-meal glucose levels can be an indicator that a person is at high risk for developing type II diabetes.

Causes of Hyperglcemia:

  • Skipping or forgetting  insulin or oral glucose-lowering medicine
  • Eating too many grams of carbohydrates for the amount of insulin administered or just eating too many grams of carbohydrates in general
  • Eating too much food it gives more calories
  • Infection
  • Illness
  • Increased stress
  • Decreased activity or exercising less than usual
  • Strenuous physical activity

Symptoms:
A high blood sugar level itself is a symptom of diabetes. However, an individual experiencing hyperglycemia may have no symptoms.
Common symptoms can include:

  • High blood glucose
  • High levels of sugar in the urine
  • Frequent urination
  • Increased thirst
  • Dry mouth
  • Urination during the night
  • Blurry vision
  • Dry, itchy skin
  • Fatigue or drowsiness
  • Weight loss
  • Increased appetite
    If hyperglycemia persists for several hours and leads to dehydration, other symptoms may develop, such as:
  • Difficulty breathing
  • Dizziness upon standing
  • Rapid weight loss
  • Increased drowsiness and confusion
  • Unconsciousness or coma

Treatment
Treatment of hyperglycemia requires elimination of the underlying cause. Acute hyperglycemia can be treated by direct administration of insulin in most cases and with oral hypoglycemic therapy and lifestyle modification. It is important that one has to follow the meal plan, which should be worked out with a dietitian or health care professional

Nutrition Management:
Diabetic Food Pyramid

Carbohydrates:
50 – 60% of carbohydrate can consume. The type carbohydrate to be used, simple or complex has to be considered. Simple carbohydrates are mono and disaccharides and the complex one is polysaccharides. The disaccharide, sucrose is excluded as a sources of carbohydrate in any diabetic diet because it is readily hydrolyzed and absorbed in the gastrointestinal tract, especially when consumed without other foods, & has an adverse effect on blood glucose level.
Low Glycemic foods should be included such as:

  • Ragi
  • Bajra
  • Wheat bran
  • Barley
  • Oats
  • Wholegrain
  • Whole wheat
  • Fruit
  • Lentils
  • Soybeans
  • Flax seeds
  • Baked beans
  • Frozen Green Peas
  • Frozen Sweet Corn
  • Raw Carrots
  • Broccoli
  • Cauliflower
  • Cabbage
  • Mushrooms
  • Tomatoes
  • Chilies
  • Green Beans
  • Red Peppers
  • Onions.

Protein:
12% to 20% of the total calories should be derived from protein. 1g/kg of bodyweight of protein is needed in order to meet the protein requirements. While selecting the protein sources it should be high biological value protein such as

  • Egg (100% biological value)
  • Soy bean
  • Whey concentrate
  • Meat
  • Chicken
  • Fish
  • Milk
  • Pulses.

Fat:
Low fat diet increases insulin binding and reduces LDL (Low density lipoprotein) and VLDL (Very Low density lipoprotein) levels and reduces the incidence of atherosclerosis which is more common in diabetics. Fat content in the diet should be 15 – 25 % of total amount of calories and higher in polyunsaturated fatty acids. A mixture of oils is preferred than single oil. Poly unsaturated fatty acids and monounsaturated fatty acids in vegetable oils are preferred (sunflower oil, corn oil, ground nut oil, gingelly oil) than animal fat and hydrogenated fat which contain more saturated fatty acids. Fish and chicken are preferred than red meat and egg.

Vitamins and Minerals:
Vitamin supplementation may be helpful to overcome oxidative stress and deficiency. Diets rich in all vitamins and minerals particularly Vitamin C and Vitamin E present in fruits and vegetables and also Magnesium and Zinc are very good for health..
Foods to be avoided:
Simple sugars

  • Glucose
  • Honey
  • Syrup
  • Sweets
  • Dried fruits
  • Cake
  • Candy
  • Fried foods
  • Alcohol
  • Nuts (rich in fat)
  • Jaggery
  • Sweetened juices

Foods to be included in moderation:

  • Fats
  • Cereals
  • Pulses
  • Meat
  • Egg
  • Nuts roots
  • Fruits
  • Artificial sweeteners

Foods to be included:

  • Green leafy vegetables
  • Fruits except bananas
  • Lemon
  • Clear soups
  • Onion
  • Mint
  • Spices
  • Salads
  • Skimmed milk
  • Butter milk