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Blood Glucose, Lipids and Blood Pressure Control

This is a part of diabetic care.It is important to reach target levels mentioned below.
Failure to do so would lead to a deteriorated lifestyle.

Diabetic Retinopathy

It can result due to some disease or damage to the small blood vessels of the retina.
Eye problems get complicated and can result in retinopathy,premature cataract and
glaucoma.Retina is the area of the eye on which the image( picture of what we see)
is formed by our lens system.People with long standing diabetes often develop this
disease.

Skin Disease
Diabetic Dermopathy; It is the commonest kind of skin disease seen in diabetics.Skin develops brown scars over the shin of legs.This is due to abnormal changes in the small blood vessels on the skin.If diabetes is not kept under control,
the process of aging gets faster.

EFFECTS OF KIDNEY MALFUNCTION

ulcer in the foot

* If kidney damage ( nephropathy) progresses, a person may have to undergo kidney
dialysis.Kidney transplantation might also be an option . High uncontrolled blood
sugar can also lead to neuropathy.
* Nerve problems (neuropathy) may occur, causing a 'pins and needles' sensation in
the hands & legs.
* Diabetes damaging the nerves can also lead to reduced pain or loss of sensation
in the feet. Skin sores or ulcers on the feet can be a result of bad footware.
* Injuries or infections do not heal well. Often an injury on the foot does not heal and
can lead to gangrene.

THE KIDNEY MALFUNCTION

Just as the kidneys lose their ability to discharge wastes, they also lose their ability to
retain protein and sugar. Sugar and protein are detected in urine tests often in large
amounts.Blood tests detect high levels of urea, nitrogen and creatining which indicate damaged kidneys.

DIABETIC COMPLICATIONS

High Blood Sugar
High blood sugar levels over a period of time can lead to major health problems.

* Blood vessels can get affected, leading to heart attack, stroke and circulatory .
problems
* Frequent urinary infection is due to the presence of high sugar ( not well controlled)
which results in the damage of the kidneys.
* Kidney disease (nephropathy) may result, which often leads to end-stage renal
disease and kidney failure.

Studies show that if there is even 1% reduction in HbA1c (glycosylated haemoglobin)
in diabetics then :

* The risk of microvascular complications ( e.g- in kidney,eye ) is reduced by 37%.
* The risk offatal and non-fatal heart attack is also reduced by 14%.

DIABETES MELLITUS AND LDL OXIDATION

In diabetes mellitus, LDL is glycosylated by the process of glycosylation, i.e.attachment
of sugar to LDL-C.This modified LDL-C makes it stick to the arteries,thus enhancing the
process of atherosclerosis and heart disease.

SECONDARY DIABETES
It can occur due to a number of causes:
* Hormonal abnormalities.
* Insulin receptor disorders
* Pancreatic disease
* Drug induced diabetes
* Corticosteroid administration
* Genetic syndrome.

DIABETES MELLITUS AND OBESITY

Overweight and obese people keep producing the hormone insulin,but it cannot
act appropriately.An obese person having a high carbohydrate intake puts a strain on the body's glucose metabolism.Also, obesity reduces the insulin receptors on the surface of the cells. As the uptake of insulin is less by fewer
receptors, the body's sensitivity to the insulin is reduced.

Cells (mainly fat or muscle ) requiring glucose, cannot get it from the blood.There is a famine in the midst of plenty, resulting in diabetes.

In response to the high blood sugar present , the pancreas works more to produce more insulin.Eventually, this constant pumping of the pancreas
exhausts the pancreatic beta cells.Insulin secretion from the pancreas starts becoming inadequate and overweight people become diabetic

* A woman delivering a baby weighing over 9 lbs ( approx. 4 kg) has a tendency to develop type 11 diabetes.
* If a person's blood sugar levels are regularly above normal , then heor she is becoming a prediabetec and will probably become a diabetic within 10 years.
* Continuous stress is today known to be a predisposing factor for developing diabetes
mellitus.
* A family history of Type 11 diabetes (particularly in a first-degree relative) in presence
of other risk factors can precipitate the development of diabetes.
* Ethnic groups (Asians or Afro-Caribbean) are more prune to develop diabetes.
* Previous history of gestational diabetes or previous diagnosis of impaired glucose
tolerance, can both lead to the development of diabetes mellitus.

RISK FACTORS FOR DEVELOPING TYPING 11 DIABETES

* A person having a parent or sibling with type 11 diabetes.
* If a person is overweight or has high blood pressure, he or she is at a greater risk of
developing diabetes.
* A person having high levels of cholesterol and triglycerides is at a greater risk of
developing diabetes.With diabetes and abnormal fat levels, a person increases up
to four times in comparison with the general population.
* A person having a sedentary lifestyle has greater chances of developing diabetes.
This risk can be reduced by exercising regularly.

SCREENING FOR DIABETES

This should be done at 30 years of age. If a history of heart attark, stroke or diabetes prevailsin the family, then a blood sugar test should be done along with lipid profile at 20 years of age to determine
the person's baseline level.The test can be repeated every 3 years if normal.If abnormal or borderline,
test should be repeated annually or as your doctor advises.

URINE TEST

You may also be advised by your doctor to get a routine sample of urine tested for albumin, sugar
and microalbuminurea.

THE SINGLE STICK BLOOD GLUCOSE TEST

The finger is pricked with a needle. The blood samples is placed on a stripe. The stripe is then placed
in the slot of the glucometer machine, which assesses your blood sugar level. This method is to be
used only to monitor your blood sugar levels at home.It is not completely reliable, so a venous sample
should also be assessed in the laboratory as guided by your doctor.

Glycosylated Haemoglobin Test;
HbA1c is a measurement to assess the level of your blood sugar over the past 120 days.An HbA1c reading of over 6.1% is suggestive of diabetes.
Oral Glucose Tolerance Test:
After fasting overnight, you are given water with 75 gm sugar ( in a water-sugar solution).Your blood glucose levels are tested over a 24-hour period.

In a diabetic person, blood glucose levels rise higher than normal and do not fall as
quickly.A normal blood glucose reading, two hours after drinking the solution, should be less than 130 mg/dl. All readings between zero to two hours should be less than
200 mh/dl.

In addition to these ,a random blood sugar reading can be taken any time.A reading
of above 140 mg/dl can be indicative of diabetes.

MEASURE YOUR RISK

A few simple tests can help determine whether you have diabetes.

The Venous Sample Test
This is done in the laboratory.It can be of four types; fasting (F),postprandial (PP),
glycosylated haemoglobin and oral glucose tolerance test(GTT). Except for postprandial, all the other tests should be done 12 hours after an overnight fast, without
even a cup of tea.
Fasting;The normal fasting blood sugar level is less than 100mg/dl.If your reading is
higher than this,a diagnosis indicative of developing diabetes is made.
Postprandial;The postprandial is conducted 2 hours after a heavy meal or after taking
75gm of glucose. A reading of over 130 mg/dl along with other positive tests, is indicative of diabetes.

FACTORS CAUSING LAW BLOOD SUGAR( hypoglycaemia)

*Skipping or delaying a meal.
*Taking too much of insulin or diabetic medications.
* Not taking enough carbohydrates in a meal.
* Sudden increase in exercise.

FACTORS CAUSING HIGH BLOOD SUGAR( hyperglycaemia)

* Eating food containing simple sugars which are rapidly absorbed by the body, e.g: sweets,ice-creams,and pastries.
* Drinking sweetened beverages such as carbonated drinks & juices
* Sedentary lifestyle-not burning the consumed sugar,carbohydrates and other products.
* Not enough administration of insulin or other medication.
* Physical stress (e.g; infections, flu )
* Psychological stress.

SOME COMMON TERMS IN DIABETES

HOW DOES DIABETES MELLITUS DEVELOP

Due to malfunctioning in the production and utilisation of insulin, the amount of glucose
produced remains in the bloodstream, causing high blood sugar or hyperglycaemia.
In turn, the cells do not have enough blood sugar to provide the energy required.

IMPAIRED GLUCOSE TOLERENCE

Impaired glucose tolerence is a term when blood sugar levels are higher than normal.
but do not high enough to be diagnosed as diabetes mellitus.This impair ment is indicated by a fasting glucose reading ranging between 100 and 130 mg/dl.This
symptoms relating to diabetes mellitus are normally absent.If a person reduces his risk
factors, his impaired glucose tolerance may improve.

Blood sugar level therefore may become normal or stabilise.Some people with impaired
glucose tolerence may go on to develop diabetes.

TYPE -2 DIABETES

Type 11 diabetes is often called non insulin dependent diabetes mellitus.
This type of diabetes develops in adulthood.It develops due to less production of insulin or ineffective use of insulin.This form of diabetes is present in 90-95% of diabetes in the world.
Women during their pregnancy can develop a form of Type-2 diabetes called gestational diabetes.40% of women with gestational diabetes during pregnancy develop Type-2 diabetes
within four years.

SYMPTOMS OF KETOACIDOSIS

* Frequent urination

* Great Thirst

*Nausea and vormiting

*Blurred vision

*Drowsiness and disorientation

To Detect Ketoacidosis

Ifyour blood sugar levels are over 200mg/dl for two consecutive tests, test your urine for
ketones. Ketones also known as acetones can be detected in the urine by the acetone
test.

Ketoacidosis and Coma

If a person goes into coma due to ketoacidosis, it is a serious situation .Mild ketoacidosis does not lead to coma.It is only when the ketone bodies are present above certain level that coma occurs. Any of the symptoms mentioned above and the presence of ketones in the urine are an indication of administering insulin when blood sugar is high.

DIABETIC KETOACIDOSIS

Ketoacidosis develop mainly in people with Type 1 diabetes.This disease is the result of persistently
high levels of blood sugar (hyperglycaemia).
Blood sugar builds up in the body as your cells cannot adsorb glucose for energy.The glucose not
available to the body , starts burning body fat as fuel, thus producing waste products called ketones.
This accumulation of ketones in the blood is known as ketosis.

When these ketone bodies are excerted in the urine the process is called ketonuria.The increase of ketones in the body over a course of some days leads to fluid being depleted from the body in the form of urine.This results in dehydration leading to the pH of the blood becoming acidic.The process
of ketoacidosis sets in. Unrecognised and untreated ketoacidosis can lead to coma and death.

The Thrifty Gene Theory

This theory was proposed by J.A.Neel in 1962. It suggested the reason as to why Indians suffered from a dispeoportionate high rate of Type-2 diabetes.According to him , Indians lived a hunter
gatherer existence for centuries.For their survival, they developed a gene which allowed them to
survive the cycles of feast and famine.Their metabolism was adequate in itself in both these conditions, it utilised the calories efficiently.

With an unsatable food supply, their survival was better as they could somehow store surplus energy
(in the form of fat) during the time of feast.This fat was probably stored as abdominal fat and utilised during famines.

Exposing this gene to abundance of food continuously in the present environment in all likelihood is
proving to be detrimental.

* In type-1 diabetes, the body loses the ability to make insulin, as the immune system destroys the insulin-producing cells.

* When insulin is notavailable, the glucose remains in the bloodstream and cannot be used as energy.

* A person having Type-1 diabetes has to take insulin injections to stay alive.

@ Virus Infections

@ Cold Weather

Theories on the Development of Type 1 Diabetes

Genetic Predisposition :-Genetic predisposition determines entirely whether a person will develop
immune reactivity against insulin producing beta-cells in the pancreas. However environmental factors
and infections can have major impact on whether type-1 Diabetes will manifwst itself clinically.This
occurs after 80-90% of the beta-cells have been destroyed. The remnants of beta-cells are transported to the pancreatic draining lymph node (PDLN), where the ensuing auto immune is thought
to be coordinated. Debris from the beta-cells is picked up by Antigen-Presenting Cells (APC) and
displayed to immune cells called lymphocytes(L) promting them either to kill beta-cells or to signal
further immune responses.

There are several type of islet cells including alpha cells and beta cells.Insulin is produced by beta
cells. On increase of sugar in the blood, these cells manufacture insulin and then release into the
blood stream.The roll of these cell is to monitor levels of blood sugar. In people with Type-1
diabetes, beta cells are attacked by the immune system and are destroyed slowly. What exactly
causes the immune system to get affected is still based on a number of theories. The unfortunate
part is that, though this slow destruction takes place over a number of years (5-7), the symptoms
of diabetes mellitus do not surface until about 80% of these beta cells are destroyed. Eventually,
insulin production comes to a halt as no beta cells remain.

TYPES OF DIABETES

TYPE 1 DIABETES;

Type 1 diabetes is a severe form of disease. It is an auto-immune disease, which mostly develops
in childhood or in adults under 30 years of age. (Auto-immune is where the body's immune system
starts destroying itself)
'Juvenile diabetes' develops in childhood and must be treated with insulin.It accounts for 5-10% of
diabetics in the world.
Inside the pancreas are cell clusters knowns as the islets of langerhans.

TEST YOURSELF FOR DIABETES Questionire

The more times your answer "Yes" to the undermention questionire , the greater you are at the risk
of developing diabetes mellitus

to enter the cells.It acts as the key, unlocking the receptors for glucose to enter the cells. The cells
then metabolise the glucose to give energy to the body.

Insulin Resistance

The pancreas makes enough insulin, butdue to certain factors, the insulin is not effective in transferring glucose from the blood into the cells of the body.Such a disorder is reffed to as insulin
resistance.

Factors involved can be;
* The number of receptors on each cell becomes lower than normal.
* Insulin is not able to attach itself to the receptor.
* Insulin produced may be defective.
* With the passage of time, the capacity of the pancreas to produce insulin declines.

Understand Diabees Mellitus

What is Diabetes ?

Diabetes Mellitus means 'honey sweet'. Diabetes occurs due to the inability of the body to convert
food into energy. It is a condition where we have high blood sugar (glucose) levels in our body.
It is a chronic disease, which can be managed well through proper guidence.

The Insulin Factor

Normally our body converts the food we eat into sugar or glucose, which is used for the production
of energy. This is done by the pancreas, an organ lying near the stomach.The pancreas makes a
hormone called insulin, which attaches itself to the receptor on the cell wall,thereby allowing glucose.

TEST YOURSELF FOR DIABETES

Diabetes or high blood-sugar is a disease that occurs if there is disorder in certain body functions that utilise carbohydrates,fat and proteins in the food to produce energy.Lack of hormone called insulin or inadequate production of insulin by the pancreas result in this disease.Insulin regulates the amount of sugar in the blood.An imbalance in the amount of insulin produced can lead to the onset of
diabetes mellitus