Diabetes Corner

What is Diabetes?

Diabetes Mellitus is a metabolic disorder characterised by the body's inability to maintain blood sugar levels within the normal range. This could be due to:

A deficiency in insulin secretion
Biological ineffectiveness of the insulin secreted>
Both the above causes
Depending on the amount of insulin produced and other observations, diabetes is classified into Type I and Type II. If untreated, diabetes could lead to many complications.

However, we know that careful management of the condition will help those with diabetes lead a near normal life.

The appropriate level of sugar in the blood

How much of glucose is too much? If you want a rough idea, you can do a random check at a laboratory. If the lab report says that you have more than 180 milligrams of glucose for each decilitre of blood (180mg/dl) then there may be a problem. You have to go in for more accurate tests like the ones detailed below.

Fasting Sugar Test
Post Prandial
Glucose Tolerance Test
Glycosylated Haemoglobin Test
Fasting Sugar Test

Test your blood sugar level after fasting for at least eight hours. The best way to do this is to get your blood tested before you eat anything in the morning.

The normal fasting blood sugar level is between 80 – 120 mg/dl

Post Prandial

This test is done after you have had a meal. A blood sample is taken after 1-½ hours after your meal and is checked for blood glucose.

The recommended level of blood glucose is between 120 – 160 mg/dl

Glucose Tolerance Test

You can go for this test when you do not have any illness and when you have not taken any medication.

You will have to take this test after fasting over eight hours (or overnight). A blood sample is collected before you take anything. After this you will have to take a glass of water with about 75 grams of glucose dissolved in it. In the next three hours your blood glucose is measured five times.

In normal people the blood sugar rises and falls quickly.

In people who have diabetes it rises higher and does not come down enough.

Here is what the result might indicate:

Not diabetic
At the end of the two-hour period if the blood sugar level is less than 140 mg/dl and all the readings in the two-hour period are less than 200 mg/dl, you are not diabetic.

Impaired glucose Tolerance
You have a problem with using up sugar when the 2-hour glucose level is between 140 and 199 mg/dl but and your fasting sugar is less than 120 mg/dl.

This does not mean you are diabetic. But it just shows that the possibility exists. If you exercise, keep your weight in check and monitor your blood sugar regularly, you may never need to take medication.

Diabetic
If at the end of two hours your blood sugar value is more than 200 mg/dl and the result from another test as in the case of fasting test, also shows a high value, you have diabetes.

Glycosylated Haemoglobin Test

Tracking your control
To monitor how well your diabetes has been managed in the past 2-3 months your doctor may advise another test: the glycosylated haemoglobin test. When the glucose in the blood attaches to the haemoglobin, glycosylated haemoglobin is formed. These cells stay in circulation for a period of two to three months. Monitoring their level gives the doctor an idea how well your sugar control has been in the past two months.

The Role of Insulin

One of the basic functions of the body is to convert food into energy and nutrients. We can get energy from fats, proteins and carbohydrates, but carbohydrates are especially important because they are rapidly converted to sugar and produce energy quickly.

To help the sugar enter the body's individual cells, the pancreas sends insulin into the blood, enabling the hormone to reach insulin receptors on the surface of these cells. Only when insulin binds to the surface of the cells, can the cells absorb sugar from the blood.

When blood sugar increases after a meal, the amount of insulin (called "mealtime insulin") also increases, so that excess sugar can be rapidly absorbed by the cells. The liver stops secreting sugar and instead stores sugar from the blood for later use. When insulin has done its work, it is broken down. The body must therefore constantly renew its supply of insulin.

When the pancreas does not produce enough insulin, the cells are not able to absorb sugar from the blood for growth, repair or energy. Cells begin to "starve" and the blood sugar level is constantly too high.

Where does the insulin come from?

The pancreas is a gland located behind the stomach. It is attached to the small intestine and the spleen. Inside the pancreas are small clusters of cells called Islets of Langerhans. Within the islets are beta cells, which produce insulin.





What are the symptoms of Diabetes?

Frequent urination
Thirst
Dry skin
Blurred vision
Hunger
Exhaustion
Slow recovery from injuries and illnesses
Frequent urination

When the cells do not use the excess sugar in the blood, it gets excreted in the urine. But the sugar cannot come out by itself, so it soaks up the urine and spills out. Therefore people with diabetes need to use the bathroom frequently.

Thirst

Because of frequent urination, there is water loss from the body and diabetics feel thirsty easily.

Dry skin

This is a symptom of dehydration or water loss.

Blurred vision

The levels of water and glucose in the eye fluctuate due to dehydration causing blurred vision.

Hunger

When insulin that helps cells take in sugar is missing, the cells starve and this sends the message of hunger to the brain. So even though there is sugar in the blood, it does not get absorbed and the message of hunger is sent to the brain frequently.

Exhaustion

When sugar in the blood is not being used by the cells to grow, repair or produce energy, it remains in the blood. It is sent out through the urine by the kidneys. The body thus loses the sugar and the nutrients. A diabetic is not able to get the full benefit of the food he is taking. A diabetic therefore feels hungry, exhausted and generally in poor health.

Slow recovery from injuries and illnesses

Our body fights diseases through its immune system, consisting of white blood cells. When the sugar level in the blood is high, the white blood cells function poorly. When body fluids have higher level of sugars, it makes it more attractive for bacteria and other disease organisms to thrive. Once they fall ill it takes a long time for diabetics to get well. The immune system plays an important part in the healing of cuts and bruises. Diabetics take a long time to recover from cuts and bruises as well.





Who is at risk?

Two factors seem to be related to diabetes, especially Type II diabetes. Heredity and Obesity. If you have a parent, grandparent, brother or sister with diabetes Type II there is a possibility that you will also have it. If you are obese, you are increasing the risk.

Listed below are some of the other factors, which might cause or trigger the disease:

Viruses - Researchers feel that viruses may play a role in the destruction of insulin producing beta cells in some people.

Age -Diabetes Type II is a forty plus disease. As people age, their bodies may have fewer insulin-producing beta cells.

Pregnancy - Hormones produced in the womb during pregnancy may block the effect of insulin. For details read Gestational diabetes.

Problems in the immune system - It is now believed that the immune system might play a part in the destruction of the insulin producing beta cells

Injury - An accident or injury may destroy the pancreas, where insulin is normally produced.

Stress - There is the possibility that hormones released during periods of stress may block the effect of insulin.