What is Diabetes | Type 1 & Type 2 Diabetes; Symptoms, Causes

What is Diabetes | Type 1 & Type 2 Diabetes; Symptoms, Causes

What is Diabetes | Type 1 & Type 2 Diabetes; Symptoms, Causes

1) Diabetes - An Overview

A. Cappadocia first coined the term diabetes. And in 1675 Thomas Wills added the word Mellitus (which is a Latin word and means ‘honey’, and it has reference to the sweet taste of urine which has been noticed in the ancient times by the Greek/ the Chinese/ the Egyptians/ the Indians/ the Persians). The ancient test for diabetes was conducted by observing whether the patient’s urine attracted the ants. The Indian philosopher Sushruta identified diabetes and named it Madhumeha (sweet urine disease). In the ancient era, diabetes appeared to have been a death sentence. But in the modern era, diabetes is no longer a life-threatening disease, although it is a life long disease. Because diabetes is a disease, there is a chance to control it, although it cannot cure.  

 

Diabetes is a Group of Metabolic Diseases

Clinically known as Diabetes Mellitus in which the patient has high blood glucose (which comes from foods taken), either because the body does not produce enough insulin or because the cells do not respond to the insulin production. Insulin is a hormone produced by the pancreas. To be more specific, it is a peptide hormone produced by the ‘Beta cells’ of the pancreatic islets. Insulin is considered as the main anabolic hormone of the body and is responsible for preventing the blood sugar level in the body from getting too high, known as hyperglycemia, or too low, known as hypoglycemia.  Insulin is an important hormone that helps glucose to get into body cells to give them energy.  And hormone is a special chemical messenger in the human body.

The hormone controls most of the body functions from simple system hunger to complex system reproduction. Too much or too little hormone can be a serious health problem. And pancreas is a gland organ that lies between the stomach and the spine. The shape of pear like a thin, and about 6 inches long. The pancreas is a part of the digestive system that produces enzymes and other hormones in addition to insulin. The pancreas has an endocrine function because it releases juices directly into the bloodstream. And again it has an exocrine function because it releases juices into the ducts.

2) Blood Sugar Chart

Very dangerous, it needs emergency treatment within hours by I.V insulin injection  

3)Types

Identification of the type of disease is quite important that influences treatment procedure. Depending on the signs and symptoms, the type of diabetes also varies, and hence, the treatment procedure. There are 3 major types of diabetes: Type 1 diabetes/ Type 2 diabetes/ Gestational diabetes. Besides, there are two other diabetes:  DM (Diabetes Mellitus) and DI (Diabetes Insipidus)  

3.1) Type 1 Diabetes

Type 1 diabetes can be controlled but not cured.  So type 1 diabetes occurs when body’s immune system (the organs and the processes of the body provide resistance against infection and toxins, Organs include:  thymus/ bone marrow/ lymph nodes) destroys cells in the pancreas (known as beta cells). These are the cells that produce insulin. There are also people who have different type 1 diabetes, known as secondary diabetes. (it is similar to type 1 diabetes except that, the body’s immune system does not destroy the beta cells, The beta cells are wiped out by other reasons, such as disease or injury in the pancreas) In the case of type 1 diabetes, the damaging process caused to beta cells throws the pancreas off. In consequence, glucose does not move into the cells. Because insulin is not available there to perform the natural function. Instead, glucose is built up in the blood, and consequently, the cells starve.

Ultimately, the blood sugar level goes up, resulting in type 1 diabetes. Conclusively, type 1 diabetes is less common and requires insulin injection. Hence, it is also referred to as IDDM (Insulin Dependent Diabetes Mellitus). Further, research studies reveal the fact that  with type 1 diabetes, average life expectancy  is 66 years for men and 68 years  for women (as compared to the average life expectancy of 77 years for men and 81 years for women respectively without having a type—1 diabetes)  

3.2) Type 2 Diabetes

Previously type 2 diabetes was referred to as NIDDM (Non-insulin Dependent Diabetes Mellitus) or AODM (Adult onset Diabetes Mellitus). In type 2 diabetes, the patient can still produce insulin, But it is inadequate as compared to body’s needs, particularly in the face of insulin resistance (Insulin resistance occurs when the body produces insulin such that the body cells are resistant to the insulin and are unable to use insulin effectively leading to high blood sugar). A major feature of type 2 diabetes is the lack of insulin sensitivity to the body cells, particularly fat and muscle cells (insulin sensitivity implies how sensitive the body is to the effects of insulin. Someone having high insulin sensitivity will require a small amount of insulin to reduce blood glucose level and vice versa).

Type 2 diabetes is more common than other types of diabetes. Early symptoms include frequent urination/ increased thirst/ feeling tired and hungry/ vision problem/ delay in wound healing. Important risk factors are obesity/lack of exercise/ poor eating habits. Age is a less important risk factor for type 2 diabetes.  

3.3) Gestational Diabetes

It is also known as a condition displaying glucose intolerance or carbohydrate intolerance. Gestational diabetes occurs during pregnancy when a pregnant woman develops high blood sugar without having any diabetes. Gestational diabetes in general, involves a few symptoms, such as depression and preeclampsia (it is a serious condition when the woman develops high blood pressure on the one hand and has a high level of protein in urine on the other. Additionally, there are also swelling in feet/legs/ hands. Over and above, the patient had no high blood pressure before).

Causes include: Gestational diabetes occurs during pregnancy when the pancreas fails to produce enough insulin to handle the glucose built up. Additionally, the build-up of glucose in the blood is aggravated on account of hormones secreted by the placenta (it is an organ that develops in the uterus during pregnancy. The structure provides oxygen and nutrients to the growing baby and removes waste products from the blood of the body).  

Advice:

The diabetic test is essential during 6-12 weeks after the baby is born. Afterward, the test needs to perform once every 2-3 years. Caution: Untreated, gestational diabetes can cause serious health complications. If blood sugar level remains elevated, too much glucose can end up in the baby’s blood. When it occurs, the baby’s pancreas needs to produce more insulin in order o process extra sugar, and this can cause the baby to grow abnormally large known as macrosomia  (It is a term to denote a newborn baby significantly more significant than average size  that weighs more than 4 kg right after birth)  

3.4) DM (Diabetes Mellitus)

It is a group of metabolic diseases characterized by high blood sugar that results from defects in insulin secretion or defects in its action or both. Diabetes Mellitus or commonly referred to as diabetes is a disease associated with sweet urine. The elevated level of blood glucose (hyperglycemic condition) results in the leakage of glucose into the urine. Hence come the terms:  sweet urine and mellitus   (in Latin mellitus means honey).  

3.5) DI (Diabetes Insipidus)

Diabetes Insipidus is a condition characterized by a large volume of dilute urine and increased thirst. The reduction of fluid has little impact on the concentration of urine. Causes behind Diabetes Insipidus are the inability of the kidneys to concentrate the urine usually, and in consequence, a large amount of dilute urine is excreted. When Diabetes Insipidus is caused by the failure of the kidneys to ADH (Anti-Diuretic Hormone), the condition is called Nephrogenic Diabetes Insipidus.  

Diabetes Insipidus can be further classified into the following four subcategories.

  • 3.5.1) Central Diabetes Insipidus: diabetes occurs due to lack of anti-diuretic hormone (vasopressin), And this can be on account of genetics or damage to hypothalamus or pituitary gland.
  • 3.5.2) Nephrogenic Diabetes Insipidus: It happens when the kidneys do not adequately respond to vasopressin
  • 3.5.3) Dipsogenic Diabetes Insipidus: It is a syndrome of disordered thirst.
  • 3.5.4) Gestational Diabetes Insipidus: It is a rare disorder that occurs during pregnancy, notably in the 3rd trimester (28th- 40th week of pregnancy period). It is also known as water diabetes.                      

Conclusively, Diabetes Mellitus has two primary forms (Type 1 and Type 2 diabetes), which results from insulin deficiency or insulin resistance. But Diabetes Insipidus is quite different from Diabetes Mellitus.  

4) Causes and Risk Factors

Causes and risk factors are not synonyms. Reasons are the agents directly responsible for the occurrence of the disease. In most cases, it is not clear what causes the particular malignancy befalling the patient. A risk factor is not necessarily a cause. A risk factor may be anything that increases the likelihood for a patient to develop the disease. (For instance, age is a vital risk factor for most of the malignant disorders, but it cannot be a cause).  

4.1) Causes

Blood glucose is the body’s primary source of energy. Blood glucose can enter and support the body cells through the supply of energy only when there is sufficient insulin in the bloodstream. Without insulin, the cells would starve, and as such, after eating, blood sugar concentration would rise when instead of supplying energy to save a life, blood glucose rise may be life-threatening, if left untreated.  Just as, water is indispensable for a ship to sail. But when water enters the ship, it will sink the ship. Diabetes is such a chronic disease associated with an abnormally high level of glucose in the blood. Since insulin produced by the pancreas controls blood glucose, so absence or insufficient production of insulin, or inability of the body to use insulin, can raise blood glucose level excessively to cause diabetes.  

4.2) Risk Factors

Risk factors for type 1 diabetes are not well understood as those for type 2. Family history is known as the major risk factor for type 1 diabetes. Other risk factors for type- 1 diabetes include certain infections as well as disease of the pancreas. The following risk factors usually occur in case of type 2 diabetes  

4.2.1) Overweight and Obesity

Overweight and obesity is a global problem and a major risk factor for most of the fatalities, including diabetes. A healthy weight is measured by BMI (Body Mass Index) =W/ H2. (Where, W=weight in kg.  H2 =square of height in meters).    For instance, with a height of 1.7 meters

  • An ideal weight is indicated by BMI = (20- 25)
  • An overweight   is indicated by BMI = (25- 30)
  • An obese is indicated by BMI = (over 30)
  • Underweight is indicated by BMI = (below 18.5)

 

4.2.2) High Blood Pressure

High blood pressure also is a great risk factor for type 2 diabetes. The blood pressure (expressed in unit mm Hg) lying above normal and indicated by the range (120/80- 140/90) is considered high blood pressure. According to various research studies, about 25 % of patients having type 1 diabetes and 80% of patients with type 2 diabetes suffer from high blood pressure. In addition to diabetes, high blood pressure invites malignant diseases, such as heart failure, stroke, and kidney disease.  

4.2.3) High Level of Triglycerides and Low Level of HDL

Excess carbohydrate in the diet causes high triglycerides, which signal insulin resistance. Furthermore, this results in higher than normal blood sugar level. Again HDL (High-Density Lipoprotein) is good cholesterol for the health in general and heart in particular. Therefore, deficiency of HDL can become a great risk factor to develop diabetes. (Triglycerides are the most common type of fats in the body. Ideally, for an adult, normal level of triglycerides while fasting, is mg ml. 10- 190. However, depending on age and gender, the normal range may insignificantly vary.  

4.2.4) Pancreatic Disease

Patients with the diseased pancreas will have an inability or slow ability to make insulin. The diseased pancreas is also a great risk factor to develop type- 1 diabetes.  

4.2.5) Impaired Glucose Tolerance

Impaired glucose tolerance initially starts with pre-diabetes. It is, therefore, essential to regularly perform a blood test to avoid the risk of type 2 diabetes that may impact arriver mightily later on.  

4.2.6) Insulin Resistance

Risk of developing type 2 diabetes is higher in the case of people having body cells resistant to insulin. The implication is that the pancreas has o work harder to make enough insulin to meet the body needs.  

4.2.7)  PCOS (Polycystic Ovary Syndrome)

PCOS is a hormone imbalance that can cause irregular periods and unwanted hair growth in addition to type 2 diabetes among women.  

4.2.8) Aging

As people move along the age path without any pause, resistance power of the body (against the imminent attack by the various diseases and illness) diminishes and in consequence, aged people are more likely to develop a host of malignancies including diabetes. People of age 45 years and over having obesity, face greater risk.  

4.2.9) Family History

Those having diabetes among the parents/ brothers/ sisters, are at higher risk to develop diabetes (type- 1 or type 2).  

4.2.10) Ethnic Background

Various research studies reveal the fact that diabetes occurs more among the Americans/ Latin Americans / Native Americans (as compared to people living in other regions of the world.)  

4.2.11) Sedentary Lifestyle

Quiet, inactive life coupled with unhealthy food habits as well as lack of physical exercise, has more likelihood to develop diabetes.  

4.2.12) Stress

It is a common risk factor for all the malignancies, including diabetes. Stress is observed in the guise of shock/ anxiety/ trauma /mental agony/ suppressed anger etc. People under stress are usually found addicted to smoking and alcohol, or they may be found more addicted than before (when they were free of stress and anxiety) Conclusively, for the women have had gestational diabetes before, are likely to fall prey to type 2 diabetes later on.  

5) Complications

Diabetes invites a lot of problems, complications, and lifetime sufferings, which are enumerated below.  

5.1)  Cardiovascular Problem

Too high blood sugar in the wake of diabetes may invite coronary artery disease with chest pain, heart attack, stroke, and other malignancies.  

5.2)  Dehydration

When there is extra sugar in the blood, the patient passes urine frequently. That is the way the body gets rid of excess sugar. A large amount of water goes out during urination, thus causing the body to dry out.  

5.3) Weight Loss

On account of having diabetes, the glucose that goes out when one passes urine sheds calories in the process, and this is the reason why many diabetic patients having high blood sugar lose body weight. Dehydration is another reason why weight loss occurs in the case of diabetic patients.  

5.4) Vision Loss/ Blindness

Diabetic retinopathy involves changes to retinal blood vessels that can cause them to bleed or leak fluid, distorting vision. Among diabetic patients, diabetic retinopathy is the most common cause of vision loss or blindness.  

5.5) Kidney Failure

One cause of kidney failure is diabetes mellitus- a condition characterized by high blood sugar. Over time, the high blood sugar damages millions of tiny filtering units within each kidney; this eventually leads to kidney failure.  

5.6) DKA (Diabetic Ketoacidosis)

If the body can’t get enough glucose for fuel or energy, it breaks down the cells instead. This creates chemicals (known as ketones, which is an organic compound containing a carbonyl group). This releases the sugar stored to help out. But the body fails to use it without insulin. So, the sugar is built up in the blood along with acid ketones. The built-up combination is known as ketoacidosis. which can be life-threatening, if not treated well in time.  

5.7) Atherosclerosis

High blood sugar can gradually harm each part of the body by affecting nerves, small blood vessels in the eyes/ kidneys/ heart. The problems arising in diabetic patients are likely to lead to hardening of the arteries and may take a turn into atherosclerosis (it is a disease in which plaque builds up inside the arteries).  

5.8) DHHS (Diabetic Hyperglycemic Hyperosmolar  Syndrome)

Hyperglycemia (high blood sugar) may occur for many reasons that include: overeating/ being sick/ not taking enough glucose-lowering medications (for controlling diabetes). When sky-high blood sugar level  (33.3  mmol/ L  or more) occurs, then the condition becomes life-threatening that turns blood thick and syrupy. The complication arises mostly in case of patients who have type 2 diabetes and is often preceded by an illness Caution: Immediate medical treatment is needed within hours which includes intravenous fluids to counter dehydration, and  Intravenous insulin is injected to lower the too high level of blood glucose.  

5.9) Severe Hypoglycemia

The condition takes a serious turn when blood sugar level excessively drops to 3.0 mmol/ L.  The serious condition may arise for many reasons. (Too much intake of medication  that lowers blood sugar level/ larger dose of insulin/ skipping of a meal/ excessive physical exertion). Caution: Emergency medical help is needed  that includes intravenous fluids  by pushing extra glucose in the body  

5.10) Gum Infection

Diabetes may leave the patient more prone to gum infection, It is, therefore, important for the patients suffering from type 1 or type 2 diabetes to undergo regular gum  check up to ascertain whether the gum bleeds or looks swollen or red which should be at once brought to the notice of the dentist,  

5.11) Delayed Healing of Cuts/Sores

In the case of the diabetic patients, any cut, sore, or injury does not heal promptly of its own.  

 

6) Signs, Symptoms and Diagnostic Tests

Signs and symptoms are not the same things. So Signs are mostly the physical phenomena detected by the doctor through suitable tests results. While symptoms are subjective phenomena observed or experienced by the patient. And the diagnosis is to identify the root problem through applying various tests, observing symptoms and interrogating the patient about his feelings, genetic history, personal history including his lifestyle  

6.1) Symptoms (Both for Type 1 and Type 2 Diabetes)

 6.1.1) Polyuria (Increased Urine Output)

Polyuria happens on account of uncontrolled diabetes mellitus which causes osmotic dieresis when blood glucose levels are so high that glucose is excreted through passing an abnormally large volume of urine (at least 2.5 liters for an adult per day). The patient who has diabetes displays symptom in terms of frequently going to the toilet for passing urine. Frequent urination can also happen due to various chemical substances, such as diuretics (Also known as water pills. These are medications designed to increase the amount of water in order to expel excess glucose from the body as urine), caffeine (A chemical found in tea/ coffee /cola/ and other products. Caffeine is mainly consumed to improve mental alertness), ethanol (Also known as ethyl alcohol/ grain alcohol).  

6.1.2) Polydipsia (Excessive Thirst)

It is a common diabetes symptom. In patients with diabetes, excessive sugar builds up in the blood. If the kidneys can’t keep up the load, the excess sugar is excreted through urine in the process of dragging along the fluids from the tissues.  

6.1.3) Polyphagia (Excessive Hunger)

Diabetes halts the sugar in food from reaching the cells of the body, thus resulting in constant desire.  

6.1.4) Fatigue

Patients with type 2 diabetes demonstrate a hyperglycemic condition with high blood sugar. This can cause fatigue that arrives as one of the significant symptoms.  

6.1.5) Skin Problem

Diabetes can affect every part of the body, including the skin. Skin problem is the 1st problem of diabetes that includes: bacterial infections/ fungal infections/ itching.  

6.1.6) Slow Healing of Wounds

High level of glucose caused by diabetes can, over time, affect the nerve (neuropathy) leading to poor blood circulation. That can make it too difficult to support blood need for skin repair.  

6.1.7) Depression

High blood sugar resulting in nerve damage, can invite sleeplessness as well as stress and anxiety.  

6.1.8) Yeast Infection

High blood sugar among diabetic patients, can cause yeast to overgrow with the symptom of yeast infection, particularly in the vaginal area.  

6.1.9) Weight Loss

Body weight loss is both a symptom as well as a significant health complication. The patients are having diabetes lose sugar through frequent urination.  In consequence, a substantial amount of calories pass out in the wake of frequent urination leading to body weight loss.  

6.2) Diagnostic Tests

6.2.1) Diagnostic Tests (for people having risk factors)

The ADA (American Diabetes Association) recommends tests to be performed for the people having high-risk factors (although, having no diabetes at present).

  • 6.2.1.1) The patient having BMI (Body Mass Index) higher than 25 regardless of age, must undergo diagnostic tests (especially those having additional risk factors, such as high blood pressure/ abnormal cholesterol levels/ heart disease/sedentary lifestyles/ history of polycystic ovary syndrome/family history having diabetes)
  • 6.2.1.2) The people with age 45 years and over are well advised to receive an initial blood sugar screening. If the test results appear normal, then blood sugar screening is needed every three years.
  • 6.2.1.3) Anyone who has been diagnosed with pre-diabetes before he advises test every year.

 

6.2.2) Diagnostic Tests (for type 1 and type 2 diabetic patients)

Symptoms of type 1 diabetes often appear suddenly (unlike type 2 or other diabetes) that needs checking the blood sugar level. The tests required are enumerated below.  

6.2.2.1) Glycated Hemoglobin (A1C) test

It is also called hemoglobin A1 C test.  Hemoglobin is a part of red blood cells that carries oxygen to the cells. The blood test needs no fasting. The test indicates the average blood sugar level for the last three months. It measures the percentage attached to hemoglobin and oxygen-carrying protein in red blood cells. The higher the blood sugar level, the more hemoglobin the patient will have attached. An A1C test level of 6.5% or higher on two separate tests indicates the presence of diabetes. An A1C test level between 5.7%- 6.4% indicates pre-diabetes, and test level below 5.7% is standard. Conclusively, if the A1C tests are not able to find consistent or certain other conditions exist that make the A1C test result in inaccurate, (such as, if the patient is pregnant or have an extreme form of hemoglobin), then the doctor may recommend the following diagnostic tests.  

6.2.2.2) Random Blood Sugar Test

For the analysis, a blood sample is drawn at random regardless of when the patient took foods. An arbitrary blood sugar level of 200 mg per deciliter (or 11.1 ml moles per liter) suggests the presence of diabetes.  

6.2.2.3) Fasting Blood Sugar Test

In this test, a blood sample will be taken overnight fasting  (at least 8 hours after eating at night).  A fasting blood sugar level less than 100  mg/Dl (5.6 mmol/L) is standard.  A fasting blood sugar level (5.6-  6.9 mmol/L) is pre-diabetic. If on two separate tests, the result is 7 mmol/L  or higher, then there is diabetes.  

6.2.2.4) Oral Glucose Tolerance Test

For administering the test, overnight fasting is required (at least for 8 hours after eating at night) and fasting blood sugar level is measured. Then the patient drinks sugary liquids (breaking the fast). After that, the blood sugar level is measured periodically for the next 2 hours. The following results show the health condition of the patient (2 hours after glucose). Conclusively, if type- 1 diabetes is suspected, then the urine is tested to look for the presence of a by-product (produced when the muscle and the fat tissue are used for energy. Because the body does not have enough insulin to use the available glucose). Further, the doctor is likely to run a test to see whether there is a destructive immune system cell associated with type 1 diabetes called auto-antibodies (it is such antibodies cause an antibody produced by the immune system that is directed against one or more of the proteins owned by the patient. Many auto-immune diseases)  

6.2.3) Diagnostic Tests (for gestational diabetes)

  • 6.2.3.1) If the patient with gestational diabetes, has, in addition, other health risks (such as, obesity or stands at the start of pregnancy or the patient had gestational diabetes during previous pregnancy or any family member has diabetes), then the doctor may recommend diabetes test at 1st prenatal visit (prenatal is a period between conception and birth of the baby)                     
  • 6.2.3.2) If the patient is at medium risk of gestational diabetes, then she needs a screening test, sometimes during the 2nd trimester period (during the 24th -26th week of pregnancy period). The doctor will recommend the following tests                    

 

6.2.3.2.1) Initial Glucose Challenge Test: 

  • The patient needs to drink a syrupy glucose solution. After I hour, the blood glucose level of the patient will be measured to ascertain the presence of diabetes. If the blood glucose level is 7.8 mmol/L  or less, then the condition is reasonable.  However, the test results may insignificantly vary at different clinics or labs. But if the test still shows blood glucose level higher than the normal, then ‘Follow -up glucose tolerance test’ may be needed.      

 

6.2.3.2.2) Follow–up Glucose  Tolerance Test:

  • For the test, the patient will be asked to fast overnight (at least for 8 hours fasting after eating at night), and then a fasting blood sugar level will be measured.  Immediately after measuring the fasting blood sugar level, the patient will get a sweet solution to drink. The solution will contain a higher concentration of glucose and the blood sugar level will be checked every hour (within 3-hour duration)

Conclusively, if at least two results of the blood tests (performed within 3-hour duration) are found higher than normal values (established for each of 3 hours of the test), then the patient needs to be diagnosed with gestational diabetes.  

6.2.4)  Diagnostic Tests (for pre-diabetes)

Anyone who has already been diagnosed before with pre-diabetes needs to test every year.  

7) Warning Signals

  • 7.1)  When fasting glucose level rises to 7 mmol/L or higher, then symptomatic treatment becomes essential.
  • 7.2) Both too low blood sugar level (3.0 mmol/L or below) and too high blood sugar level- (33.3 mmol/L or higher) are dangerous which need medical emergency.  Warning signals (in case of too high blood glucose) is for symptoms: feeling very thirsty and tired/ weight loss/ blurred vision/ frequent urination. The condition is known as HHNS (Hyperglycemic Hyperosmolar Nonketonic Syndrome). And symptoms that arrive as warning signals in case of too low blood sugar include abnormal heartbeat, which may speed up the heart rate. This is potentially dangerous known as hypoglycemic unawareness. Other symptoms include fatigue/ sweating/ irritability /hunger.

 

8) Treatment

8.1) Treatment for Type 1 and Type 2 diabetes

Regardless of the type of diabetes the patient has, the treatment procedure includes blood sugar monitoring/ oral medications/ insulin injection and more importantly, meticulously following a healthy lifestyle to manage and keep diabetes under control.  

 8.1.1) Treatment for Type 1  Diabetes

The treatment procedure involves the insulin injection/ or use of an insulin pump /regular blood sugar check/ limit carbohydrate consumption.  

8.1.2) Treatment for Type 2 Diabetes

It primarily involves lifestyle changes. Additionally, it requires blood sugar monitoring as well as medication.  

8.2) Treatment for Gestational Diabetes

Controlling blood sugar level is quite important to keep the body fit of both the pregnant mother as well as the incoming baby during pregnancy period. As such (in addition to using insulin and oral medications), regular monitoring of blood sugar level, as well as a healthy diet and physical workout, must be maintained as a part of the whole treatment plan. The doctor will also monitor blood sugar level during labor, so that high blood sugar level, if crops up, may be brought down to normal level right after delivery of the baby. As an alternative (or in addition to insulin ), the doctor may also prescribe  oral medications (such as, Glynase/ Micronase/ Glumetzo/ Glucophage/ Fortamet/ Riomet).  

8.3) Treatment for Pre-diabetes

Although, it needs no medication, but still  pre-diabetic condition is a warning signal for the patient to become alert and follow a healthy lifestyle by consuming healthy and  nutritious  foods and drinks and taking regular physical exercise (preferably, 30 minutes mooring walk every day) in order to maintain a healthy weight and stay away from overweight/ obesity. Additionally, a diagnostic test is essential for every year as a part of the overall treatment plan. If pre-diabetes takes a deteriorating turn or the patient has fatty liver (it is a term that describes the fat built up in the liver. However, having a small amount of fat in the liver is considered quite normal. But too much can become a health problem.) heart disease (It includes the conditions that affect the functions of the heart. Such as coronary artery disease, i.e., narrowing of the arteries/  heart attack/ abnormal heart rhythm/ heart failure/ heart valve disease) and PCOS (Polycystic Ovary Syndrome, which is a hormone problem that can cause irregular periods in women/ unwanted hair growth),  in that case taking  Metformin can be a good option.

Conclusively, medication is not enough to control diabetes of any type. In addition to preventive measures (in terms of consumption of healthy nutritious foods and physical activity), the following unhealthy foods/fruits/ drinks need to avoid which is also an essential part of the total treatment plan.  

A few Examples of Foods to Avoid Are

Trans-fat foods (These include: cakes, cookies, crackers, especially with frosting, breakfast sandwiches, microwave popcorn, cream-filled candies. Trans-fat foods containing trans-fatty acids have no known health benefits- whether these are of animal or plant origin. Additionally, the trans-fat foods increase LDL- the bad cholesterol.  On the other hand, the meals have little HDL- the good cholesterol) /Dried fruits (Dried fruits are those from which the majority of the original water content has been removed either naturally through sun drying, or artificially through the use of specialized dryers or dehydrators. Examples of dried fruits are raisins, apricots, figs, pitches) / sugary and sweetened beverages/rice/ white bread/ pasta/ fruit flavored yogurt/ maple syrup/ flavored coffee drinks.  

9) Diabetes Prevention

9.1) Natural Ways

9.1.1) Physical Activity

Regular physical exercise (at least 30 minutes morning walk daily) can significantly reduce excess body weight and increase insulin sensitivity that will help lower blood sugar level.  

9.1.2) Control Carb Intake

Carbohydrates are essential parts of nutritional diets. But there is also another side of the coin. Carbs (carbohydrates) when taken, are turned into glucose. So, indiscriminate eating of carbs can make blood sugar level rise, which is harmful to diabetic patients.  

9.1.3 ) Increase Fiber Intake

Various studies reveal the fact that high fiber food reduces blood sugar level and in consequence, reduces the risk of type 2 diabetes. Besides, high fiber food reduces high blood pressure as well as an infection.

9.1.4) Drinking Sufficient Water

It is essential to drink daily at least 2 liters water and stay hydrated. Drinking adequate water can lower the blood sugar level by diluting the amount of glucose in the bloodstream.  

9.1.5) Choose Foods With a Low Glycemic Index

These categories of foods include whole wheat/ pumpernickel bread/oatmeal/oat bran/ pasta/ converted rice.  (Glycemic index is a number from 0 to 100 assigned to a particular food with pure glucose. The amount which is arbitrary shows the relative rise in the blood glucose level, 2 hours after consuming the food)

9.1.6) Control Stress Level

Stress is a significant risk factor for any malignancy, including diabetes. So, managing stress is quite essential for preventing diabetes. In addition to avoiding other health complications, such as high blood pressure, stroke, and heart disease.  

9.1.7) Monitor Blood Sugar Level at Home

As a preventive measure after age 45 years, one must remain alert and as such, monitor blood glucose level regularly. In this connection, one first needs to wash hands/ insert a test strip into the meter/ use the lancing device on the side of the fingertip to get a drop of blood/ hold the edge of the test strip to the drop of the blood and wait for the result.  

9.1.8) Follow Portion Control

As a preventive measure against diabetes, one must be alert about when/where/what/ how much is consumed throughout the day. It is wise to eat nutritiously (but not calorie dense) small meals every 3 hours daily (rather than eating large meals with a long interval of 5 or 6 hours). In this connection, the following portion control is quite essential to have a balanced diet, especially for weight loss and diabetes control. Healthy food balance requires daily: 1-2 cups of fruits/ 2-3 cups of vegetables/ 5-8 ounce grain (of which 1-2 ounce must be of whole grain)  

9.2) Best Foods to Prevent Diabetes

The following foods, in general, are most important to focus on the prevention and even reversal of diabetes

  •    9.2.1) Nutrient dense green vegetables
  •    9.2.2) Leafy greens
  •    9.2.3) Cruciferous vegetables (Examples include: cauliflower / Broccoli- a type of cauliflower)
  •    9.2.4) Non-starchy vegetables
  •    9.2.5) Beans /nuts/seeds

 

 9.3) Best Fruits to Prevent Diabetes

  • 9.3.1) Orange  (The fruit has many high concentration antioxidant - which is the 1st line of defense against the damage of healthy cells. Besides, orange is rich in vitamins which include: vitamins A, C, E.  It is suitable for diabetic patients to eat the orange fiber, rather than drinking the orange juice.)
  • 9.3.2) Tart cherries
  • 9.3.3) Apricots
  • 9.3.4) Zesty Green kiwi

 

10) Key Global Information

  • 10.1) globally, 6% of the world population is suffering from diabetes. (In the case of the USA, the figure is alarmingly high which is 8.3%. And in the case of Bangladesh it was found 4.8% in 2007 which is expected to rise to 6.1% in 2025)
  • 10.2) Country wise comparison reveals the USA holds the fact that China has the highest number of diabetic patients (110 million) in the world followed by India (70 million diabetic patients) and the 3rd position.
  • 10.3) Western Pacific region displays the highest concentration of diabetic patients (30% of the adult population) in the world.
  • 10.4) Of total diabetic patients in the world, almost 80% are living in developing countries.
  • 10.5) About 50% among the women who had gestational diabetes before, are likely to develop type 2 diabetes later in life.
  • 10.6) Among the total diabetic patients. Only 5% have a type- 1 diabetes.
  • 10.7) The explosion of diabetes prevalence will place Bangladesh (by 2025) among the top 10 countries in the world in terms of the number of people living with diabetes.
  • 10.8) England has about 3.4 million patients with type 2 diabetes and 0.2 million new diagnoses every year.

 

11) Concluding Remark

  • 11.1) Type 1 diabetes can’t be prevented.  But type 2 diabetes is mostly preventable through lifestyle changes. Whereas, type 1 diabetes is not linked to lifestyle changes    
  • 11.2) Before meeting the doctor for treatment, it is essential to record all symptoms experienced as well as the time when the symptoms first arrived in addition to the severity of the symptoms. Any other health problems, such as high blood pressure, allergy, heart problem as well as the medicines taken and the dose of medication, should be clearly stated.  Over and above, the doctor may ask about the patient’s family history, personal history, including the lifestyle for which the patient should get well prepared.
  • 11.3) Living with diabetes is possible, although painful.  Veritably, blood sugar level may be fluctuating and hence seem frustrating (even though, all diabetic rules are meticulously followed). Under the circumstances, regular check-up, in addition to a frequent visitor to the doctor, is quite essential. Additionally, there is strong evidence which demonstrates how behavioral interventions (supporting people to maintain a healthy weight and remain active) can significantly reduce the risk to develop diabetes.
      
  • 11.4) It is also essential to share the feelings, problems if any, with other known diabetic patients having the same issues. Sharing the issues with the doctors, from among friends and relatives, is still better. They can best guide what to do and what not to do.  

12) TIPS

  • D = DIABETES is a disease which can be controlled, but not cured.
  • I = INSULIN is produced by the pancreas that regulates blood glucose level.
  • A = AGE is a vital risk factor for any malignancy including diabetes
  • B = BLOOD sugar screening once a year is essential for everyone, age over 45 years.
  • E = EMERGENCY; medical help is needed both for a too high or too low blood glucose level.
  • T= TYPE 1 diabetes consists of only 5% of total diabetic patients.
  • E = EXERCISE reduces excess body weight/raises insulin sensitivity/lowers blood sugar.
  • S = SWEET; the taste of urine attracting the ants, was the ancient test for detecting diabetes)  

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