Blood Sugar and Diabetes Mellitus. Diabetes has now become a major health problem worldwide. Research suggests that in another 10 years 75% of the world adult population will suffer from diabetes. It used to be a disease of the western population but with increasing wealth in India and China, it is predicted that it will soon become a major problem in these two countries. Sugar in our blood is essential for life, as glucose is the primary source of energy for all living cells in the body. Glucose is absorbed and transported from the intestine to the cells. With the help of the hormone insulin the cells use the sugar for their metabolism. What is not used by the cells is stored in organs like the liver and muscle. The body tightly regulates the blood sugar level It is remarkable that despite widely variable intervals between meals or the occasional consumption of meals with excessive sugar, the level of blood sugar remains within the normal range. The delicate balance is done through hormones. Insulin produced by the body helps the cells to use the sugar. The blood sugar level is lowest in the morning before you start eating and rises 1 or 2 hours after every meal to its highest level. In a normal individual the blood sugar when you are fasting ranges from 70 mg/dl to 120 mg/dl (4 to 6.5 mmol/L) with occasional slightly lower or higher values. When blood sugar levels drop too low (hypoglycaemia) a person feels lethargic with diminished mental function, irritability and weakness of muscles. Sometimes the person may develop fits. It can lead to unconsciousness and can be fatal. Hypoglycaemia is more dangerous than hyperglycaemia (excess sugar). In diabetes mellitus the cells are unable to use the circulating sugar effectively because of lack of insulin or because very little insulin is produced or the cells are resistant to using insulin. When no insulin or very little insulin is produced you develop type 1 diabetes. When reduced amount of insulin is produced or the cells become resistant to use the insulin you develop type 2 diabetes. Type 1 diabetics will therefore require insulin injections, whereas type 2 diabetes can often be managed with dietary and lifestyle changes with or without a tablet. How do we know whether it is type 1 or type 2 diabetes? Type II diabetes is more common than Type I diabetes and it usually occurs in older people. However it may only be picked up during a routine medical check-up as patients may not have any symptom to start with. There are a number of diagnostic tools for differentiating type 1 from type 2 diabetes. As type 1 diabetes is an autoimmune disease anti-islet cell antibodies and anti-insulin antibodies may be detected. Physicians distinguish type 1 and type 2 diabetes by performing a blood test called the C-Peptide Test. If the C-Peptide is negative it means that the person is not making insulin and that they have type 1 diabetes and if the C-Peptide is positive it means that the person is making insulin and that they have type 2 diabetes. Symptoms Some symptoms are common to both type 1 and type 2 diabetes. They are: • Excessive thirst • Passing urine frequently • Feeling tired and light headed • Loss of weight. • Symptoms of Type I diabetes may come on suddenly and can be severe. In Type 2 Diabetes in addition to the above, after a while the person may also notice – • Painful legs • Foot ulcers and delayed wound healing • Changes in sensation affecting the toes or fingers • Blurred vision • Symptoms may be mild or you may not even be aware of it as they often come on gradually. Most experts agree that the rapid rise in the number of cases reporting now is because of: • An aging population • Increasing obesity • Unhealthy food being consumed • Lack of exercise If we can persuade the population to take a note of this and adopt the necessary lifestyle changes we will see a rapid fall in the incidence of type 2 diabetes. In the long-term diabetes causes many of the health problems including heart disease, eye, kidney, and nerve damage. People with diabetes are up to five times more likely to develop cardiovascular disease and stroke than normal people. Changes affecting the blood vessels contribute to delayed wound healing, ulcers and infection involving the feet and fingers. This has directly resulted in increased number of amputations involving the leg and fingers. There is no cure for diabetes. Treatment is aimed at keeping blood sugar to near normal levels. Treatment of Diabetes: Type 1 diabetes: In Type 1 diabetes as there is very little or no insulin available the affected person will need regular insulin injections to maintain normal sugar levels. The type of insulin and the amount of insulin required will be decided by the health professional after a few blood tests. Type 2 diabetes In type 2 diabetes as some insulin is still being produced it may be possible to maintain normal blood sugar levels by making a few lifestyle changes, such as eating a healthy diet and exercising regularly. If the diabetes is still not controlled you may then need medication in the form of tablets. In later stages if oral medication is not adequate then insulin injections may be needed. Here again the health professional will decide on the type of medication required. They will also monitor the blood sugar levels to check if the treatment is adequate. Investigations When diabetes mellitus is suspected, a blood test is necessary. This is often done first thing in the morning after you have fasted for 12 hours (fasting blood sugar). Then a further test is done 2 hours after you have ingested 75gms of glucose (Post prandial Blood Sugar) . You are at risk of developing diabetes when the blood sugar level is between 7.8 and 11.1 mmol/l (140 and 200 mg/dl). You are diabetic when equal or above 11.1 mmol/l (200 mg/dl). Fasting and postprandial levels of glucose indicate the level at the time when the blood sample is taken. When the sugar level is on the border line of suggesting diabetes and we need a clearer picture before we say you are a diabetic we should check the blood for a special test called HbA1c. HbA1c is an overall marker of what the average levels of blood sugar has been over a period of 2 to 3 months before the test. It is also the test done to assess whether the diabetes is properly controlled when on treatment. For normal people, the range is 20-41 mmol/mol (4-6%) For people with diabetes, an HbA1c level of 48 mmol/mol (6.5%) is considered good control. For people with diabetes this is important as the higher the HbA1c, the greater the risk of developing diabetes-related complications. For diabetics to maintain good control the American Diabetes Association recommends a post-meal glucose level of less than 10 mmol/L (180 mg/dL) and a fasting blood glucose of 3.9 to 7.2 mmol/L (70–130 mg/dL). K.Badrinath Dr Chandrasekhar Varma, Attending Physician for Endocrine Service, Veterans Administration Hospital, La Jolla, explained recently how the different organs in our body play a part in controlling the blood sugar levels. He said by understanding the pathophysiology of the disease one can Individulalize therapy for patients with Type 2 Diabetes. His talk can be viewed in our Madras Red Fort Youtube Channel.