Diabetic Clinic

Following are the different types of diabetes:

• Type 1 diabetes
  It is an autoimmune disease, meaning that the body attacks itself. The cells that produce insulin in the pancreas are destroyed. Around 10% of people with diabetes have Diabetes Type 1. Although it is usually diagnosed in children and young adults, it can affect people of all ages. For this reason, it was earlier called “juvenile diabetes”. Those who have Diabetes Type 1 are required to take insulin every day. So, it is also referred to as insulin-dependent diabetes.
• Type 2 diabetes
  It is the commonest type of diabetes. In this type of diabetes, the body either does not produce enough insulin or the cells don’t respond normally to the insulin produced. It usually affects middle-aged and older individuals. Other common names for this type of diabetes are insulin-resistant diabetes and adult-onset diabetes.
• Prediabetes
  This condition characterizes a stage before diabetes Type 2. The blood glucose level of the patient is higher than normal but not high enough to be diagnosed as Diabetes Type 2.
• Gestational diabetes
  This type of diabetes develops in pregnant women. It usually goes away after pregnancy. Having gestational diabetes places you at a higher risk of developing Diabetes Type 2 later in life.

Lesson common types of diabetes

• Monogenic diabetes syndromes
  These forms of diabetes are rare and inherited and account for around 4% of all cases. Examples of this type of diabetes are maturity-onset diabetes of the young and neonatal diabetes.
• Cystic fibrosis-related diabetes
  This type of diabetes is specific to people with cystic fibrosis diseases.
• Drug or chemical-induced diabetes
  This type of diabetes occurs following HIV/AIDS treatment, after organ transplant, or post-glucocorticoid use.
• Diabetes insipidus
  It is a rare, distinct condition that causes the kidneys to release large amounts of urine.

Factors increasing your risk of developing diabetes depend on the type of diabetes you end up developing.

Risk factors for Type 1 diabetes include:

• Pancreatic injury due to tumour, infections, accident, or surgery.
• Family history of Type 1 diabetes.
• Presence of autoantibodies that mistakenly attack the own organs and tissues of the body.
• Physical stress due to an illness or injury.
• Exposure to viral illnesses.

Risk factors for prediabetes and Type 2 diabetes include:

• Being Hispanic, Black, Asian-American, Native American, or Pacific Islander.
• Having a family history of Type 2 diabetes or prediabetes.
• Being obese.
• Having hypertension.
• Having low HDL levels and a high triglyceride level.
• Being physically inactive.
• Aged 45 or older.
• Developing gestational diabetes or delivering a baby weighing more than 9 pounds.
• Having polycystic ovarian disease.
• Having a history of stroke or heart disease.
• Being a smoker.

Risk factors for gestational diabetes include:

• Family history of Type 2 diabetes or prediabetes.
• Being Hispanic, African-American, Asian-American, or Native American.
• Being obese or overweight before pregnancy.
• Age above 25 years.

Regardless of the type of diabetes, the main cause of diabetes is the circulation of too much glucose in the bloodstream. However, the reason for your high blood glucose levels differ depending on the type of diabetes

• Causes of Type 1 diabetes
  Type 1 diabetes is an autoimmune disease. Your body attacks and destroys the pancreatic cells that produce insulin. Without insulin to facilitate the entry of glucose into the cells, glucose accumulates in the bloodstream. In some patients, genes may also play some role. Apart from that, viruses may trigger the immune system attack.
• Cause of Type 2 diabetes and prediabetes
  The cells of the body don’t let the insulin to function as it should to allow glucose into the cells. The cells of the body have developed resistance to insulin. The pancreas fails to overcome this resistance by making enough insulin. All this results in a rise of glucose levels in the bloodstream.
• Gestational diabetes
  Placental hormones produced during pregnancy make the cells of the body resistant to insulin. The pancreas can’t produce enough insulin to make up for this resistance. This results in accumulation of too much glucose in the bloodstream.

The main symptoms of diabetes include weak, tired feeling, increased thirst, blurred vision, slow-healing cuts or sores, tingling or numbness in the feet or hands, frequent urination, unexplained weight loss, dry mouth, and frequent unexplained infections.

Other symptoms of diabetes include:

• In women
  Frequent yeast infections, urinary tract infections, and dry, itchy skin.
• In men
  Erectile dysfunction, decreased sex drive, decreased muscle strength.
• Type 1 diabetes symptoms
  The symptoms of type 1 diabetes develop quickly over a course of a few weeks or months. The symptoms start developing when you are a young child, teen, or adult. Additional symptoms include stomach pain, nausea and vomiting, and recurrent yeast or urinary tract infections.
• Type 2 diabetes and prediabetes symptoms
  These conditions may be asymptomatic or you may notice symptoms developing slowly over several years. The symptoms usually start developing when you are an adult. However, prediabetes and Type 2 diabetes is on the rise in people of all age groups.
• Gestational diabetes
  The disease is typically asymptomatic. Your obstetrician might test you for the disease between 24-28 weeks of your pregnancy.

If the blood glucose level continues to stay high over long time periods, the organs and tissues of the body can undergo serious damage. Over time, some complications can be life-threatening.

The complications of diabetes include:

• Cardiovascular issues
  These include chest pain, coronary artery disease, stroke, heart attack, high cholesterol, high blood pressure, and atherosclerosis.
• Neuropathy
  Nerve damage can lead to a numbing and tingling sensation that starts at the fingers or the toes and then spreads.
• Nephropathy
  Kidney damage can result in kidney failure or the need for dialysis or kidney transplant.
• Retinopathy
  Eye damage can result in glaucoma, cataract, and even blindness.
• For damage including poor blood flow, nerve damage, and poor healing or sores and cuts.
• Erectile dysfunction.
• Skin infection
• Depression.
• Dental problems.
• Hearing loss.
• Dementia.

Following are the possible complications of gestational diabetes:

In the mother:

• Preeclampsia
  This condition is characterised by high blood pressure, excess amounts of proteins in the urine, swelling in the feet or the legs, increased chances of developing gestational diabetes during future pregnancies, and increased risk of developing diabetes later in life.
• In the newborn
  A birth weight higher than normal, hypoglycaemia or low blood sugar, higher risk of developing Diabetes Type 2, and death soon after birth.

Diabetes is usually diagnosed by checking the level of glucose in a blood sample. Three tests are usually used to measure the blood glucose levels - Hb1ac test, fasting glucose test, and random glucose test.

• Fasting plasma glucose test
  This test is best performed in the morning after fasting for eight hours. The patient should eat nothing during this period except sips of water.
• Random plasma glucose test
  There is no need for fasting prior to this test, and it can be performed at any time.
• HbA1c test
  This test is also referred to as HbA1C or glycated haemoglobin test. It provides the average level of blood glucose over the past 2-3 months. The amount of glucose attached to haemoglobin is also measured. Haemoglobin is the protein in the red blood cells that carries oxygen. There is no need to fast before this test.
• Oral glucose tolerance test
  In this test, the level of blood glucose is first measured after fasting overnight. Then you are asked to drink a sugary drink. The blood glucose level is checked at hours one, two, and three following this.
• Gestational diabetes tests
  Two blood tests are usually used to diagnose gestational diabetes. One is a glucose challenge test, during which you are required to drink a sugary drink following which your glucose level is checked. There is no need for fasting before this test. If this test reveals a glucose level higher than normal, an oral glucose tolerance test is followed.
• Type 1 diabetes
  If type 1 diabetes is suspected, your healthcare provider will collect and test your blood and urine samples. While the blood is checked for the presence of auto antibodies, the urine is checked for ketones. If this test is positive, a diagnosis of Type 1 diabetes is made.

If you present with risk factors or symptoms for diabetes, you should undergo testing. The earlier a diagnosis of diabetes is established, the earlier management can be started and complications can be prevented or lessened. If you are found to have prediabetes on a blood test, your healthcare provider will work with you to formulate a lifestyle changes plan which include exercise, healthy diet, and weight loss. This will help prevent development of Type 2 diabetes or progression to severe complications if you already have the disease.

Additional specific testing advice based on risk factors:

• Testing for Type 1 diabetes
  Tests are performed in children and young adults with family history of diabetes. Older adults may also sometimes develop diabetes type 1. Therefore, testing in adults who show up at the hospital and are found to have diabetes-related ketoacidosis is vital. Ketoacidosis is a severe complication of diabetes type 1.
• Testing for type 2 diabetes
  Adults aged above 45 years or those between 19-44 years and obese or have one or more risk factors for the disease, women with history of gestational diabetes should be tested. Children aged 10-18 who are obese and have at least two risk factors for developing type 2 diabetes should also be tested.
• Gestational diabetes
  All pregnant women with a diagnosis of diabetes should be tested. Apart from that, all pregnant women between weeks 24-28 of pregnancy should be tested. If the woman has other risk factors for developing gestational diabetes, the obstetrician may decide to test her earlier.

How to manage type 2 Diabetes

In recent years, India has seen a rapid increase in number of diabetes cases. In fact, India houses the second largest number of diabetic people in the world. A healthy diet and lifestyle could help people control type 2 diabetes and other aspects related to their health.

To help people keep blood glucose under control and within a normal range, it is recommended to engage in weight management, eat a nutritious diet, exercise regularly, stop smoking, and reduce stress. Medications may be recommended if dietary and lifestyle changes do not help reach and maintain healthy blood sugar levels. However, if someone is diagnosed with diabetes and their blood sugar is only mildly elevated, taking medications might not be necessary.

Goals for management of diabetes type 2

• Alleviate symptoms of diabetes to improve quality of life
• Attain glycemic control and prevent acute complications
• Identify and manage comorbid conditions like obesity, hypertension, and dyslipidemia
• Prevent cardiac, nervous system, and peripheral vascular diseases
• Prevent infections

Following healthy lifestyle changes may help decrease blood sugar levels:

Aim for a healthy weight

People who are overweight or obese should aim for weight loss as it is a measure toward reducing blood glucose from the diabetic to the non-diabetic range. Two ways to manage weight are eating a healthy, balanced diet and engaging in regular exercise. Consuming fewer calories than the body uses for activities and physiological processes is crucial to controlling weight loss.

Consume a healthy diet

• A healthy diet consists of consuming nutritious foods in appropriate quantities while avoiding or limiting the amounts of non-nutritious foods.
• Foods people can freely eat may include whole grains, such as oatmeal, brown rice, and whole-grain bread; fruits and vegetables, non-fried fish that is high in omega-3 fatty acids, such as salmon and lake trout; lean meat, such as sirloin and white meat from chicken or turkey; non-tropical vegetable oils, such as olive oil; unsalted nuts and seeds, legumes, such as beans and peas, and low-fat dairy products.
• Foods and ingredients that people should limit include sugary foods and beverages, such as candy, cakes, jelly, honey, sodas, sweet tea, fruit drinks, and concentrated fruit juices; sweet food additives, such as high fructose corn syrup, dextrose, maltose, fructose, and sucrose; processed and fatty meats, such as bacon, hot dogs, and fatty cuts of beef and pork salty foods; partially hydrogenated and trans fat foods, such as margarine, frozen pizzas, microwave popcorn, desserts, and coffee creamer saturated fat, such as foods containing palm oil or coconut oil.
• A diet similar to the Mediterranean diet is recommended by the American Diabetes Association (ADA), which focuses on fruits, vegetables, whole grains, nuts, olive oil, and fatty fish. This eating plan improves blood glucose control.

Get regular exercise

• Getting regular exercise promotes blood glucose management and burns calories, contributing to weight loss. Adequate physical activity also increases insulin sensitivity, which facilitates the entry of blood sugar from the bloodstream into the cells.
• People must aim to get 30 minutes of moderate physical exercise per day on most days, amounting to at least 150 minutes each week. A brisk walk classifies as moderate exercise, according to experts. Alternatively, aerobic activity of 75 minutes per week is equally beneficial.

Stop smoking

Experts recommend quitting smoking to help control blood sugar for several reasons. Smokers have a 30–40% higher risk of getting diabetes than nonsmokers. Smoking also makes it harder to exercise. Smoking increases blood glucose levels temporarily, which poses an additional challenge in maintaining non-diabetic blood sugar levels. This enhances the risks of a person developing complications of diabetes, such as kidney and nerve damage.

Manage stress

Research conducted in 2019 suggested that although stress does not lead to type 2 diabetes, it can worsen it. Stress triggers hormone release, and those hormones interfere with the blood glucose regulation of the body. It also impels a person to engage in activities that make it harder to control blood sugar, such as overeating and smoking. A way to decrease stress involves taking a break from electronics and spending more time in nature.

It is important to check your blood glucose levels periodically as the results help doctors determine a lifestyle and treatment plan. You can also plan what to eat and how much physical activity to perform.

The easiest way to check blood glucose levels is by using a blood glucose metre. During this test, the side of the finger is pricked, a drop of blood is taken on a test strip, the strip with the blood sample is inserted into the metre, and the metre shows up the glucose level instantly. How often you need to check your blood glucose level will be conveyed by your healthcare provider.

Having a blood glucose level lower than normal is called hypoglycaemia. This means that your body requires more sugar to perform its function normally at that time. If you have hypoglycemia, you might present with symptoms like shaking or weakness, sweating or moist skin, dizziness, fast heartbeat, confusion, sudden hunger, pale skin, nervousness and irritability, numbness in the tongue or mouth, unsteadiness, blurred vision, nightmares, bad dreams, and restless sleep, headaches, and seizures. If the hypoglycaemia is not managed properly, you may even pass out.

If your blood contains an excess amount of glucose, you are said to be hyperglycaemic. This condition also gives rise to many complications, the most prominent of which is metabolic syndrome.

Although some risk factors for diabetes such as race and family history can’t be changed, other risk factors like obesity and sedentary lifestyle can be managed to an extent. Adopting the healthy lifestyle suggestions given below can help modify these risk factors and help reduce your risk of developing diabetes:

• Eat a healthy diet
  like the Dash or the Mediterranean diet. Maintain a food diary and calorie count of everything you consume. Cutting your calorie intake by 250 calories per day can help you lose half pound per week.
• Get physically active
  You must try to have at least 30 minutes of physical activity at least five days a week. You can start with slower, less intense exercises and slowly build up to more intense ones. Walking is a great exercise too.
• Work to achieve a healthy weight
  Don’t try to lose weight if you are pregnant. However, you must check with your obstetrician about healthy weight gain during pregnancy.
• Work towards lowering stress
  Learn deep breathing exercises, relaxation techniques, yoga, mindful meditation, and other strategies to reduce stress.
• Limit the intake of alcohol
  Men should not consume more than two alcohol-based beverages a day. Females should take no more than one.
• Get an adequate amount of sleep every night
  You must try to get 7 to 9 hours of sleep every night.
• Quit smoking if you are a smoker
  If you are not, don’t start smoking.
• Take medications as suggested by your healthcare provider
  To gain control over existing risk factors for heart disease such as high cholesterol and high blood pressure or to decrease the chances of developing diabetes type 2.

If you think you might have symptoms suggesting prediabetes, talk to your healthcare provider.

No, diabetes type 1 can’t be prevented. It is an autoimmune disease, which means that your body attacks its own cells. The exact cause behind this is not known. Other factors like genetic changes may also be involved.

Chronic complications of diabetes are responsible for most illnesses and mortality cases associated with diabetes. Chronic complications generally occur after several years of hyperglycaemia. As Diabetes type 2 patients may have increased blood sugar levels for several years before diagnosis, these patients may have signs suggesting complications at the time of diagnosis.

Although the complications of diabetes can be wide, there are many fundamental principles of prevention that most complications share. These include:

• Take all your medications to manage risk factors like high cholesterol, high blood pressure, and other health conditions.
• Take your diabetes medicines regularly, as prescribed by your doctor.
• Carefully monitor your blood sugar levels.
• Follow a healthy diet like the Dash or Mediterranean diet. Don’t skip meals.
• Exercise regularly at least thirty mins five times a week.
• Maintain a healthy weight.
• Make sure to keep yourself hydrated.
• If you are a smoker, quit smoking.
• Make sure to attend your doctor regularly so that he monitors your diabetes and keeps your complications in check.

There is not much you can do to prevent getting diabetes, but if you experience symptoms of diabetes, you must talk to a healthcare provider. The earlier your diabetes is diagnosed, the sooner you can take steps to manage it. The better you can manage your blood sugar level, the more likely you are to live a healthy and fulfilled life.

The staff at the Diabetic Clinic at Kokilaben Dhirubhai Ambani Hospital, Indore provides skilled diagnosis and tailored individual treatment plans to patients with pulmonary hypertension. Consult the best diabetologists in Indore at our hospital. Kokilaben Dhirubhai Ambani Hospital, Indore houses the best doctors for diabetes treatment in Indore, with extensive experience in diagnosing and treating different types of diabetes and their complications.