FAQ’s

Diabetes

What is diabetes?
Diabetes is a condition in which the level of sugar (glucose) in the blood is high. The body produces insulin, a hormone secreted by the pancreas, which breaks down the sugar consumed in food. A reduction in the production and/or utilization of insulin causes diabetes. If left untreated or uncontrolled, diabetes can lead to serious problems, such as heart disease, stroke, blindness, kidney failure, among others. Some of these may be life threatening.

What is type 1 diabetes?
In type 1 diabetes, the body completely stops producing insulin due to destruction of the insulin-producing pancreatic cells by the body’s immune system. It was previously referred to as juvenile diabetes because it is usually diagnosed in young adults or children, or insulin-dependent diabetes, as insulin therapy is essential for survival and maintenance of good health.

What is type 2 diabetes?
This is the more common form of diabetes, accounting for about 90% of cases. In type 2 diabetes, the pancreas either produces inadequate amounts of insulin, or the body is unable to use the available insulin properly. Type 2 diabetes usually occurs in adults, and is more common in people who are overweight or obese.

What tests can be done to check for diabetes?  What are the normal values?
Several tests can be done to estimate the blood sugar level. All these tests estimate the amount of sugar in a certain quantity of blood.

• RPG (random plasma glucose): this is a blood test done at any time of the day to check the blood sugar level at that point in time. If the RPG value is ≥200 mg/ dL(11.1 mmol/L) of blood, it indicates that the person has diabetes.
• FPG (fasting plasma glucose): this tests the amount of sugar in the blood stream after one has not eaten for 8–10 hours (overnight fasting). This is usually done first thing in the morning before breakfast. An FPG value ≥126 mg/dL (≥7.0 mmol/L) indicates that the person has diabetes.
• Glycatedhaemoglobin (HbA1C): this test measures how well the blood sugar has been controlled over the past 3 months. If the HbA1C is ≥6.5% (47.0 mmol/ mol), it indicates the presence of diabetes.
• OGTT (oral glucose tolerance test): this is another type of test for diabetes. The blood sugar level is checked in the fasting state and then 2 hours after drinking a certain amount of glucose. It shows how the body processes glucose. If the 2-hour value is ≥200 mg/dL (11.1 mmol/L), it indicates the presence of diabetes.

What is prediabetes?
Prediabetes is a condition in which the blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes.

Millions of people worldwide do not know that they have prediabetes. That is why it is important to get screened for prediabetes.
If the HbA1C is between 5.7% and 6.4%, or the FPG is more than 110 mg/dL but less than 126 mg/dL, or the OGTT (2-hour glucose test) is between 140 and 199 mg/dL, the condition is termed as prediabetes.
Prediabetic persons may develop type 2 diabetes in later life.

What is insulin resistance?
Insulin resistance is a condition in which the body’s ability to respond to the effects of insulin is decreased. Insulin has many actions within the body, such as the breakdown of carbohydrates (sugars and starches), fats and proteins into glucose. As cells must have glucose to survive, the body compensates for the inadequate response to insulin by producing additional amounts of insulin. This results in high level of insulin in the blood, which is one of the signs of insulin resistance.

What is gestational diabetes?
Gestational diabetes is a temporary type of diabetes that develops during pregnancy (gestation). A woman who had gestational diabetes in one pregnancy has a higher risk of developing gestational diabetes in future pregnancies. Although gestational diabetes reverts to normal after pregnancy, it increases the risk of type 2 diabetes in future.

Who is at high risk for developing gestational diabetes?
There are a number of factors that increase a woman’s chances of developing gestational diabetes. These factors include:

• Being older than 25 years of age.
• Being overweight prior to pregnancy,
• Having a family history of diabetes,• previous history of raised blood glucose level,
• History of repeated abortions or stillbirth or a previous history of delivering a big baby and
• Having poly cystic ovarian syndrome.
• A sedentary lifestyle, hypertension and other cardiovascular diseases also increase the risk of developing gestational diabetes.
• Hence, screening of all pregnant women for diabetes is recommended as a standard protocol.

Who is at risk of developing type 2 diabetes?
certain factors that increase the risk are given below:

• Family history
• Age
• Race
• Overweight/obesity
• Inadequate physical activity
• Unhealthy diet
• High blood pressure or a high lipid. •
• Gestational diabetes

Why does being overweight or obese put one at risk for developing diabetes?
Being overweight can keep the body from producing and utilizing insulin properly. It can also cause high blood pressure. Overweight people are twice as likely to develop type 2 diabetes’s people with normal weight. Losing weight and increasing physical activity reduces the risk of developing this type of diabetes.

What are the common signs and symptoms of type 2 diabetes?
The classical symptoms of diabetes include (3 ‘P’):1

1. Frequent urination (polyuria)
2. Excessive thirst (polydipsia)
3. Excessive hunger (polyphagia)

However not all patients may have these classical symptoms. It is important to understand that diabetes can present any of the following symptoms:

• Unexplained weight loss
• Extreme fatigue
• Frequent infections, especially upper or lower urinary tract infections
• Slow healing of wounds
• Tingling /numbness in hands and feet
• Blurred vision

Why is it important to go for regular check-ups?
The symptoms of type 2 diabetes may be so mild that it may not be noticed for years, and therefore remains untreated. This may lead to complications.
Screening for diabetes is done in a doctor’s office, clinic or laboratory under the supervision of a health-care provider.

High-risk individuals should be screened for diabetes at regular intervals, beginning at the age of 35 years

What are the types of treatment for diabetes?
The aim of treatment is to maintain the blood sugar level as close to normal as possible. The type of food and level of physical activity play an important role in controlling blood sugar, as do medicines

Insulin is mandatory for people with type 1 diabetes.
Type 2 diabetes is usually treated with oral medicines but insulin injections may be prescribed if oral medications do not adequately control the blood sugar level.

Treatment depends on the type of diabetes, complications, presence of other risk factors, coexisting active medical problem, age and general health at the time of diagnosis.

How do patients with diabetes know that their disease is well controlled?
A glycatedhaemoglobin (HbA1c) test accurately assesses how well the blood glucose has been controlled over a period of 2–3 months. For non-diabetic individuals, the normal HbA1c level is usually below 5.5%. In people with diabetes, an HbA1c level below 7.0% indicates good control.

What are the complications and consequences of diabetes?
Short term (Acute) complications are-

• Hypoglycemia
• Hyperglycemia
• Ketoacidosis
• Hyperosmolar hyperglycemia

Long term (chronic) complications are-

• Cardiovascular disease
• Cerebrovascular disease
• Peripheral vascular disease
• Nephropathy
• Nephropathy
• Retinopathy

Can the complications of diabetes be prevented?
The complications of diabetes can be prevented by doing the following important things:

• Take medicines regularly
• Keep a track of the blood sugar level
• Well balanced  healthydiet–Stay physically active.
• Stay alert for skin infections and skin disorders
• Regular eye check-ups.
• Watch for any tingling, burning, loss of sensation, and wounds on the bottom of the feet.
• Stress management

Does the diet for those with diabetes differ from that of non-diabetic persons?
The diet for diabetic individuals should be healthy, well balanced and should control the blood sugar level.

A healthy diet comprises complex carbohydrates (whole grain cereal) low in fat and has plenty of green leafy vegetables and fruits. With proper planning, one can still enjoy a wide variety of favorite food.

And follow a structured diet planned by qualified dietitian to achieve your target glucose levels and other health goals.

Why it is important for people with diabetes to be physically active?
Physical activity delays or prevents the onset of type 2 diabetes. Studies have shown that physically active individuals have a 30–50% lower risk of developing type 2 diabetes compared to sedentary individuals.

Physical activity helps to control the blood glucose level, weight and blood pressure, reduce the cholesterol level and prevent cardiovascular disease.

Can diabetes lead to serious emergencies?
Yes, it can lead to serious and life-threatening medical emergencies. These can occur if the blood sugar is too high or too low. Diabetic emergencies are best treated in a hospital as quickly as possible.

What is hypoglycaemia and how can it be prevented and managed?
Hypoglycemia (low blood sugar) is the most common complication seen in individuals with diabetes. The blood sugar level may suddenly become too low for various reasons, including vigorous physical activity, taking the wrong dose of insulin/antidiabetic medicine or not eating enough or eating too late.

It is usually mild and can be treated quickly by eating or drinking something with a high sugar content.

The symptoms of low blood sugar are usually non-specific and patients may feel some discomfort, sweating, palpitations, weakness and giddiness.

If left untreated, it can get worse and lead to confusion or even coma.

What can individuals do?

• Achieve and maintain a healthy body weight.
• Be physically active – at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control.
• Eat a healthy diet.
• Avoid tobacco use and use of alcohol.
• Manage stress.
• Test the blood glucose and glycatedhaemoglobin levels regularly