Diabetes, is a long-term metabolic disorder that occurs when blood glucose levels remain above normal limits. It occurs when the pancreas – which produces the hormone insulin – either fails to produce (any or enough) insulin or fails to effectively use the insulin to keep the blood glucose in control.

Globally, an estimated 463 million (2019) people have diabetes.

Usually seen in Both men and women

Type 1 diabetes: Children below 15 years of age

Type 2 diabetes: Adults between 20 to 80 years of age

SYMPTOMS OF DIABETES

Irrespective of the types, some of the common symptoms of diabetes include:

Frequent urination

Excessive thirst

Sudden loss of weight

Increased hunger

Blurry eyesight

Bedwetting

Lack of energy/fatigue

Delayed healing of cuts and other injuries

Dry skin

Fungal infections

If diagnosed with diabetes (fasting >125 mg/dL and/or post meal >200 mg/dL), you may need to undergo several health tests periodically. The common lab tests include blood tests and urine tests.

Diabetes can be treated with lifestyle modifications, oral medications, and a few injectables. Uncontrolled diabetes over the long term, can cause damage to the eyes, nerves, kidneys, legs, and heart.

BLOOD TESTS

Random Blood Sugar

The random blood glucose test is done to measure the levels of glucose circulating in the blood. This test is done to diagnose diabetes. You can take this test at any time of the day as it does not need you to fast unlike other tests for diabetes. However, other tests are required to confirm the diagnosis. The test is done as a part of routine preventive health check-up or if you have symptoms of high blood glucose/hyperglycemia.

According to the American Diabetes Association guidelines for diabetes testing, the values for random blood glucose test are as follows:

Normal: Less than 140 mg/dl

Prediabetes: Between 140 and 200 mg/dl

Diabetes: Greater than or equal to 200 mg/dl

Pregnant women: Greater than or equal to 200 mg/dl

Fasting Blood Sugar

The fasting blood glucose test is one of the most common tests prescribed for diabetes. It is a blood test that measures the levels of glucose in the blood in the fasting state (empty stomach). Ideally, it is advised to not eat or drink anything (except water) for 8-12 hours before the test. It is the simplest as well as the fastest test to diagnose and monitor diabetes.

According to the American Diabetes Association guidelines for diabetes testing, the values for FBS are as follows:

Normal: Less than 100 mg/dl

Prediabetes: Between 100 mg/dl to 125 mg/dl

Diabetes: Greater than or equal to126 mg/dl

Pregnant women: Between 90-140 mg/dl 

Postprandial Blood Sugar (PP)

It is performed to measure glucose levels in the blood after a period of 2 hours from the start of the last meal. It is usually recommended to screen for prediabetes and diabetes types 1 and 2. It is also used to monitor treatment efficacy in patients undergoing treatment for diabetes. The test is usually recommended when the blood glucose level falls between 140 and 200 mg/dl.

According to the American Diabetes Association guidelines for diabetes testing, the values for PP are as follows:

Normal: Less than 140 mg/dl

Impaired glucose tolerance (prediabetes): Between 140 and 200 mg/dl

Diabetes: Greater than or equal to 200 mg/dl

Hemoglobin A1c (HbA1c)

It is a blood test that measures a person’s average blood glucose level over the past 2 to 3 months. It is ideally used to check how well your diabetes is managed with medication. However, if your fasting and postprandial levels are high, then HbA1c is advised to confirm the diagnosis.

According to the American Diabetes Association guidelines for diabetes testing, the values for HbA1c are as follows:

Normal: Less than 5.7%

Prediabetes: Between 5.7% to 6.4%

Diabetes: Greater than or equal to 6.5%

Pregnant women: Between 6% to 6.5%

Glucose Tolerance Test (GTT)

The test is used to check the blood glucose levels before and 2 hours after you have a sweet drink (which in most cases is a glucose solution). The test tells your doctor how well your body processes the glucose (sugar) which in turn aids in the diagnosis of diabetes.

According to the American Diabetes Association guidelines for diabetes testing, the values for GTT are as follows:

Normal: Less than 140 mg/dl

Prediabetes: Between 140 mg/dl to 199 mg/dl

Diabetes: Greater than or equal to 200 mg/dl

Pregnant women: Greater than or equal to 200 mg/dl

OTHER TESTS

If diagnosed with diabetes, you may need to undergo several health tests periodically. These include:

Blood pressure

According to the American Heart Association, your blood pressure must be less than 120/80 mmHg. This is because patients who keep their blood pressure under control are less likely to suffer from diabetes-related complications such as heart attacks, blindness, or kidney damage.

Get your blood pressure checked at every doctor’s visit or twice every month. You should also self-monitor your blood pressure and maintain a blood pressure diary if you have high blood pressure coexisting with diabetes.

Eye examination

You should visit an ophthalmologist (eye specialist) once every year for a detailed eye examination. The doctor would check for any damage to the nerve tissues on the back of the eye (retina). Diabetes may lead to diabetic retinopathy and cataract.

Foot examination

You must visit your doctor for a foot examination at least once every year to get your pulse and reflexes checked in your feet. You may also be examined for any unhealed cut, infections, sores or loss of feeling anywhere in your feet. Here are a few footcare tips for diabetes.

Lipid profile test

Cholesterol is a waxy substance present in your blood as HDL (good cholesterol) and LDL (bad cholesterol). With diabetes, the LDL levels and triglycerides tend to increase while the HDL levels decrease, increasing the risk of heart disease and stroke.

Kidney function tests

You should get a yearly check for your kidneys through kidney function tests (blood tests) and a urine test. This is because, in diabetics, the blood vessels in the kidneys get injured and your kidneys cannot clean your blood properly. As a result, your body will retain more water, salt and protein than it should, which in turn can affect your kidney’s health.

Liver function tests (LFT)

It should be done once annually as it helps determine the health of your liver by measuring the levels of proteins, liver enzymes, or bilirubin in your blood. Type 2 diabetes is associated with impairment in liver function by increasing the level of the liver enzymes and the risk of fatty liver disease, liver cirrhosis and liver failure.

Vitamin B12 test

In case you are taking metformin for a long time, then you must get your Vitamin B12 levels checked as the use of metformin may cause Vitamin B12 deficiency. Periodic measurement of Vitamin B12 levels should be considered especially if you have anemia or peripheral neuropathy.

Dental checkup

Get yourself examined every 6 months by a dentist for your gums, teeth and regular cleaning. This is because high levels of glucose in blood can lead to pain, burning and redness in the mouth and increase the risk of various oral problems such as gingivitis (inflamed gums), periodontitis (gum disease), oral thrush, and dry mouth.

TYPE OF DIABETES

Type 1 diabetes

It is known to be caused due to an autoimmune reaction in which the immune system attacks the insulin-producing beta cells of the pancreas and leads to destruction. As a result, there is very little or no insulin production, which affects the blood glucose control.

Although the exact cause of this process is not yet fully understood, it is believed that genes as well as environmental factors such as viral infection, toxins or dietary factors play a role. It occurs most commonly in children and young people.

Type 2 diabetes

It is caused because of the inability of the body to respond properly to insulin, leading to insulin resistance. This causes the hormone insulin to be ineffective, which in turn, causes the body to produce more insulin. As a result, the pancreas fails to keep up the body’s demand for more insulin. This gradually causes inadequate production of insulin leading to high blood glucose.

Most cases of type 2 diabetes go through a stage known as prediabetes, in which the cells do not respond normally to insulin.

Although type 2 diabetes is common in adults, it is also seen in older children due to childhood obesity becoming more common. The list of factors that increase the risk of type 2 diabetes include:

·       Being overweight or obese

·       Being a smoker

·       Family history of diabetes

·       Family history of high cholesterol, hypertension, or cardiovascular disease

·       Having a sedentary lifestyle

·       Suffering from polycystic ovarian syndrome (PCOS)

·       Suffering from prediabetes

·       Being pregnant

·       Recurrent wounds/ulcers, which fail to heal

·       Stress

·       History of diabetes in pregnancy

·       History of impaired glucose tolerance

Prediabetes

As the name suggests, prediabetes is a condition where the blood glucose levels are higher than normal but not high enough to be classified as diabetes. In simple terms, it is a stage that, if left ignored, can develop into type 2 diabetes and diabetes-related complications. This is the reason why it is also known as ‘non-diabetic hyperglycemia’ or ‘intermediate hyperglycemia.’ There are no clear symptoms of prediabetes, so you may have it and not know it. However, early treatment with lifestyle modifications can help to keep your blood glucose levels within the normal range.

Gestational diabetes

Gestational diabetes mellitus (GDM), defined as diabetes diagnosed during pregnancy, affects a significant proportion of pregnant women worldwide. Women usually develop gestational diabetes between the second or third trimester of pregnancy. The risk of developing this condition during your future pregnancies may also be higher. It also increases the risk of brain and spinal cord anomalies, obesity, and glucose intolerance (diabetes) in the child. Due to the major repercussions in mother and baby, it is important for every pregnant woman to be aware of GDM.

According to the IDF, women with prior GDM are at a 7.4-fold risk of type 2 diabetes compared to women with normal blood glucose levels during pregnancy. This risk is higher 3 to 6 years post-delivery. Certain factors that put you at high risk of gestational diabetes include:

·       BMI (Body Mass Index) that exceeds 30

·       Excessive weight gain during pregnancy

·       Family history of diabetes

·       History of giving birth to a baby weighing 4.5kg or more

·       Expecting more than one baby (twins/triplets)

·       Family history of hypertension

·       History of miscarriages or stillbirth

·       History of conditions related to insulin resistance or polycystic ovarian syndrome (PCOS)

·       History of habitual smoking

·       Giving birth to a child with congenital abnormality

Monogenic diabetes

As the name implies, monogenic diabetes results from a single gene rather than the contributions of multiple genes and environmental factors as seen in type 1 and type 2 diabetes. It is much less common and represents 1.5–2% of all cases. It is often misdiagnosed as either type 1 or type 2 diabetes. These monogenic forms present a broad spectrum from neonatal diabetes mellitus (or ‘monogenic diabetes of infancy’), maturity onset diabetes of the young (MODY) and rare diabetes associated syndromic diseases.

Note: Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at a high risk of progressing to type 2 diabetes, although this is not inevitable.

PREVENTION OF DIABETES

With simple lifestyle changes such as diet control, staying active, keeping a tab on your weight, and staying away from vices, you can lower your risk of type 2 diabetes. Here are a few tips to get started.

Make healthy food choices

Taking care of your diet is one of the most essential components to manage and prevent diabetes.

Switch to oils with high volume of monounsaturated fats & polyunsaturated fats like olive oil, canola oil, soybean oil or rice bran oil. Limit intake to one tablespoon a day.

Restrict intake of foods with high glycemic index like white breads, white rice, fatty foods, and soda.

Consume foods with low glycemic index like multigrain flour, whole grains, daals, most fruits, non-starchy vegetables, and carrots.

Limit consumption of fast food such as chips, processed foods, etc.

Watch your weight

Losing weight can help to regulate blood sugar levels. If you have type 2 diabetes, losing just 4-6 kgs can lower your glucose levels.

The way fat is distributed in the body can also impact diabetes risk and management. People who have abdominal adiposity (fat around belly) are more prone to type 2 diabetes than those with fat mostly in the thighs, hips, and buttocks.

Exercise regularly

Regular exercise is a good way to keep your body healthy and prevent diabetes.

Exercises are designed to help people with diabetes avoid problems which can result from unwise exercise choices. Aerobic activity is one of the effective exercise options to control diabetes. When done at moderate intensity it raises your heart rate and makes you sweat thereby helping you to maintain an optimum blood glucose level.

Some of the common forms of aerobic exercises are: Brisk (fast-paced) walking, Light jogging, Bike riding, Playing tennis or badminton, Swimming/ water aerobics, Gymming

Warm up for 5 minutes before starting to exercise and cool down for 5 minutes after exercise.

Be more active throughout the day. This includes parking your car further from your house/office, opting for stairs instead of the elevator or walking instead of sitting while talking on the phone.

Manage stress better

Stress can make blood sugar levels harder to control. Avoid unnecessary stress by indulging in activities that can help you relieve stress such as reading, traveling, sports, and other hobbies.

You can also try relaxation techniques such as meditation and yoga to alleviate anxiety and stress. You may join a yoga club or take out 10-15 minutes every day to practice meditation.

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Quit smoking

Smoking has been found to directly increase the risk of several diabetes complications such as cardiovascular diseases, stroke, eye diseases, nerve damage, and kidney damage. It has also been found to reduce blood flow to the feet and other body extremities. This can lead to foot problems and slow down the healing of injuries. Irregular blood flow can lead to infections and unwanted mouth ulcers, which puts you at risk of oral health problems.

Go for regular health check-ups

As most of the symptoms of diabetes are not detected until late in its course, it is wise to get a preventive health checkup to know about diabetes. Get HbA1c level every three months along with a doctor visit every six months to a year if you have any risk factors of diabetes like hypertension, obesity, or heart disease.

Recording and maintaining charts of your blood glucose levels daily helps you to know how well your treatment is working. Do not skip your medicines or stop taking your medicines even if your diabetes is in control.

Specialist to Visit

If you have been experiencing symptoms such as tingling sensation or numbness of the limbs, feeling excessively hungry or thirsty, or unexplained weight loss, then it is wise to consult following specialists:

Endocrinologist

Diabetologist

If you are already diagnosed with diabetes, then getting a regular health check-up is a must. This is because, chronic or uncontrolled diabetes can impact other major organs of the body such as the eyes, legs, nerves, kidneys, and gums. So, if you suffer from any complications due to diabetes, then getting in touch with the respective specialist can help you to manage and prevent these problems. Some of the common specialists who can help are:

Nephrologist

Neurologist

Dentist

Ophthalmologist

Dietician

DIET IN DIABETES

Whether you are trying to prevent or control diabetes, your nutritional needs are virtually the same as everyone else, so no special foods are necessary. However, certain modifications in terms of quantity and type of food might be required.

Eat more

Healthy fats from nuts, olive oil, fish oils, flax seeds, or avocados

Fruits and vegetables—ideally fresh, the more colorful the better; whole fruit rather than juices

High-fiber cereals and breads made from whole grains

Fish and shellfish, organic chicken, or turkey

High-quality protein such as eggs, beans, low-fat dairy, and unsweetened yogurt

Eat less

Trans fats from partially hydrogenated or deep-fried foods

Packaged and fast foods, especially those high in sugar, baked goods, sweets, chips, desserts

White bread, sugary cereals, refined pastas, or rice

Processed meat and red meat

Low-fat products that have replaced fat with added sugar, such as fat-free yogurt

Choose high-fiber, slow-release carbs

Carbohydrates have a big impact on your blood sugar levels—more so than fats and proteins—so you need to be smart about what types of carbs you eat. Limit refined carbohydrates like white bread, pasta, and rice, as well as soda, candy, packaged meals, and snack foods. Focus on high-fiber complex carbohydrates—also known as slow-release carbs. They are digested more slowly, thus preventing your body from producing too much insulin.

Fruits

There is mixed perception about intake of fruits for diabetes. Some people believe that diabetics should completely cut down fruits from their diet while some think that one can include as much fruits as they want in their diet as it does not have any impact on blood glucose level. However, neither is true. It is best to include fruits as an integral part of your daily meal plan while keeping a tab on the carbohydrate content. Here is a quick guide to help you out with your daily needs of fruits:

Whole fruits:1 small apple, chickoo, orange, guava, pear

Cut fruits: Half banana,1 slice mango,1 cup papaya, 3/4th cup muskmelon,1 ¼ cup watermelon

Medically Reviewed by

Mr. Ramendra Kumar Raman, PhD, Clinical Research

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