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.