12-Nov-2023
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Dr Ksh Manglem Singh
World Diabetes Day is celebrated each year to draw attention to issues of utmost importance to the diabetes community. Millions of people with diabetes around the world do not have access to diabetes care. World Diabetes Day is celebrated on the birthday of Sir Frederick Banting, who discovered insulin with Charles Best in 1922.
Between 2021 and 2023, the theme is a subject close to our hearts: “Access to diabetes care”. The slogan for World Diabetes Day is “Know your risk, know your answer”. Our actions focus on the importance of knowing your risk of developing type 2 diabetes to delay or prevent the disease.
India has more than 69.2 million diabetics. Within two decades, this number will reach around 120 million. Diabetic patients are two to four times more prone to coronary heart disease (CAD). In a low-income family group in India, 25% of the family income goes towards diabetes care.
Diabetes is a disease in which the body is unable to produce or use insulin (a hormone released by the pancreas) properly, causing blood sugar levels to rise too high.
Two main types of diabetes:
Type 1 diabetes – The body completely stops producing insulin, a hormone that allows the body to use glucose. This form of diabetes usually develops in children or young adults, but can occur at any age. People with type I diabetes must take insulin daily to survive.
Type 2 diabetes: This occurs when the body does not produce enough insulin and/or is unable to use it properly (insulin resistance). This form of diabetes usually occurs in people over 30, overweight and with a family history of diabetes and in young people, especially obese adolescents.
Symptoms of diabetes: increased thirst and frequent urination, increased hunger, weight loss, fatigue, blurred vision, infections, slow-healing ulcers. In almost 50% of cases there are no symptoms, this occurs in type 2 diabetes. In this case, people can live for months or even years without knowing that they have diabetes. disease.
Risk factors for type 2 diabetes:
1 Obesity or overweight – The best predictor of type 2 diabetes is being overweight or obese. A body mass index (BMI) of 23 to 24.9 is considered overweight, a BMI above 25 is defined as obesity.
2 Abdominal (central) obesity carries a higher risk of developing type 2 diabetes.
3 Altered fasting blood glucose (FBG) indicates prediabetes (precursor to diabetes). It is a major risk factor for developing type 2 diabetes.
4 Insulin Resistance – When insulin resistance occurs, the pancreas (insulin-producing organ) has to work very hard to produce enough insulin so that cells can get the energy they need. This ultimately leads to type 2 diabetes.
5 Ethnic Indians are more prone to central obesity and are therefore more prone to diabetes.
6 Hypertension (high blood pressure) – Defined as 140/80 mmHg, is a major risk factor for diabetes.
7 Gestational diabetes (diabetes during pregnancy). The person is at high risk of developing type II diabetes later in life.
8 Sedentary lifestyle – Exercising less than three times a week makes you more likely to develop diabetes.
9 Family history – Having a parent or sibling diagnosed with diabetes increases your risk of developing type 2 diabetes.
10 Age Age increases the risk of developing type 2 diabetes, but diabetes can develop at any age.
Who should be screened?
Get screened for diabetes if:
1 You are 40 years or older
2 By age 30 under certain conditions such as: overweight or obesity, family history, high blood pressure, high cholesterol, inactivity, diabetes during pregnancy, history of heart disease or stroke, history of polycystic ovaries (PCO) in women.
Diabetes diagnosis:
1 Fasting blood sugar test: A blood sample is taken after an overnight fast (8 hours). A fasting blood sugar level between 100 and 125 mg/dl (more precisely 110 mg/dl) is considered prediabetes. If it is 126 mg/dl or higher on two separate tests, you will be diagnosed with diabetes.
2 2-hour plasma glucose test: 5 tablespoons (75 g) of glucose dissolved in 200 ml of water ingested orally. After 2 hours, a blood sample will be taken. A sugar reading of 200 mg/dl or more indicates diabetes.
3 Glycated hemoglobin (HbA1c) test: This blood test shows the average blood sugar level over the past three months. It measures the percentage of blood sugar linked to hemoglobin. An A1c level of 6.5% or higher indicates that you have diabetes, therefore if you are under treatment. this indicates that the diabetes is not well controlled.
Treatment of diabetes:
1 Proper Meal Planning
2 Physical activity – Exercise for 30 minutes at least 5 days a week. This can help the body use insulin better so it can convert glucose into energy for cells.
3 Anyone with type 1 diabetes and some people with type 2 diabetes also need to receive insulin injections.
4 Some people with type 2 diabetes take oral antidiabetic medications (OADs) with or without insulin injections.
5 Some people with type 2 diabetes can manage their disease without medication through proper meal planning and appropriate physical activity.
6 Everyone with diabetes should have the following tests at least once a year
i) Eye – To rule out eye diseases (retinopathy)
ii) Blood tests – For detection of kidney, liver and cardiovascular diseases, more tests advised by healthcare providers should be carried out.
7 People with diabetes should be aware of daily self-monitoring of blood sugar (SMBG). As a result, proper planning of meals, activities, and medications can be done.
Complications of diabetes mellitus:
If not properly controlled, diabetes affects the larger blood vessels (macrovascular) as well as the smaller blood vessels (microvascular) of important organs such as the heart, kidneys, eyes and nerves, leading to failure heart disease, kidney failure, blindness, neuritis (tingling, numbness, pain). in the limbs), foot ulcer, etc.
Diet:
Improving an individual’s diet in terms of nutritional composition and total energy content can improve health through several mechanisms.
Microvascular risk can be reduced by good control of blood pressure and blood sugar.
Macrovascular risk can be reduced by weight and lipid management.
A healthy and balanced diet, recommended for the general population, is suitable for people with type 2 diabetes mellitus. Because 90% of people with type 2 diabetes mellitus are overweight, high in calories, low in carbohydrate content and a low glycemic load.
Advice on diet and food choices:
Less or moderate consumption of starchy foods rich in fiber (complex carbohydrates) i.e. 50%, or less than half of the daily diet. Reduce daily salt consumption (5 g of common salt or 1.5 g of sodium); this is particularly important for hypertensive patients. .Increase fish consumption (especially oily fish) (one or two servings/week). Choose proteins (around 20% of total energy intake) preferably of plant origin because animal proteins contain a greater quantity of fats. Limit sugar and sweet foods. Eat three regular main meals or approximately every 4 hours.
Reduce fats (especially saturated fats) in the diet; choose monounsaturated fats (d » 30% of total energy intake)
People with diabetes mellitus have a greater need for antioxidants, increasing their consumption of fruits and vegetables (at least five servings per day).
Exercise:
• The goal of increasing exercise as part of a weight reduction program (including a low-calorie diet) is to increase energy production, which results in the mobilization of fat from tissue stores adipose.
• Daily aerobic physical activity (egbrisk walking for 30 minutes/day or active swimming for 1 hour three times a week) should be encouraged, but advice on physical activity should be tailored to the patient, with the goal being that regular aerobic exercise is enjoyable. , practical and, preferably sociable. Jumping type exercises are not recommended for overweight people.
• The health benefits of an initial weight loss of 5 to 10% should be emphasized.
• Increasing the level of aerobic exercise can improve diabetes control (improve insulin sensitivity, blood pressure and lipid profile) and slow disease progression.
• Age, sex, sedentary or active lifestyle, general health (foot problems) and the presence of possible chronic diseases (egischemic heart disease) are all factors to take into account when prescription of increased physical activity.
Diabetes prevention:
A healthy lifestyle can delay and even prevent type 2 diabetes. Just a few changes in your lifestyle will help you avoid serious diabetes-related health complications.
1 Get tested
Since you can have prediabetes and type 2 diabetes without any symptoms, simple blood tests are used to diagnose both.
Prediabetes Diabetes
Fasting blood sugar (mg%) 100-125 > 125
Random blood sugar (mg%) 140-200 > 200
HbA1c 5.6-6.4% > 6.4%
2 Exercise
Make every effort to keep yourself in good physical shape. A combination of aerobic exercise and resistance training is ideal.
3 Reduce weight
Losing weight can have health benefits: lowering blood sugar, reducing blood pressure, improving cholesterol, increasing energy, improving sleep, decreasing pressure on joints, and decreasing the risk of cancer.
4 Control food intake
This can be accomplished by reducing the portions per serving of rice, potatoes, etc. Replace high-calorie drinks with herbal teas (without milk or sugar) or lots of water.
5 Eat foods high in fiber
To get at least 25 to 40 g of fiber per day, you can eat fiber-rich whole grains, beans, vegetables, and fruits. Fiber can help lower blood sugar, and certain forms of starch improve insulin sensitivity.
