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Basics
What is Diabetes?
Diabetes is a disorder of metabolism, involving high blood sugar levels due to the malfunctioning of an important hormone called insulin. Most of the food we eat is broken down into glucose, the form of sugar in our blood. Glucose is the main source of energy for the body. For glucose to get into cells, insulin must be present. Pancreas, a large gland behind the stomach produces insulin. When we eat, the pancreas produces the right amount of insulin to move glucose from blood into our cells. Among people suffering from diabetes, however, the pancreas either produces insufficient insulin or the body cells do not respond appropriately to insulin. As a result glucose in blood increases above the normal limit. Once glucose builds up in the blood, and crosses the kidney threshold i.e., 180 mg per dL, it overflows into urine, and passes out of the body.
Types of Diabetes
There are two main types of diabetes:
Type I Diabetes: The is caused by immune system malfunction leading to destruction of  the insulin-producing cells in the pancreas; as a result the pancreas produces little or no insulin. A patient, therefore, has to take insulin daily. This type of diabetes is also known as insulin-dependent diabetes mellitus (IDDM). Type I diabetes develops most often among children and young adults but can occur at any age.  Type 1 Diabetes accounts for about 5% to 10% of all diagnosed cases of Diabetes. It is mostly diagnosed in young people below 30 years of age, with a peak incidence at around ages 10 to 12 years in girls and ages 12 to 14 in boys.
Type II Diabetes: The pancreas is usually producing enough insulin but for some reason(s) the body cannot use the insulin effectively and insulin resistance develops. After several years of unmanaged diabetes, insulin production decreases. The result is the same as for type I diabetes. About 90 to 95 percent of people with diabetes have type II. This form of diabetes usually develops in adults aged 40 or more and is most common among adults over the age of 55.  About 80 percent of people with type II diabetes are overweight or obese. As more children and adolescents are becoming overweight, type II diabetes is expected to become more common in younger adults.
Symptoms and Diagnosis
·         Some of the symptom symptoms of diabetes are excessive thirst, excessive urination, dehydration and weight loss. However, one may not notice these symptoms at an early stage and the best way is to get a blood glucose test done
·         A blood glucose test measures the glucose levels in the blood under the following conditions:
·         After Fasting of 8 hours: This is called Fasting Glucose Level
·         2 hours after intake of food/glucose: This is called Postprandial Glucose Level
·         Following are the interpretation of the blood sugar levels:
o   Fasting:
§ Normal: Less than100 ml/dl
§ Pre-Diabetes: Between 100 and 126 ml/dl
§ Diabetes: Greater than 126 ml/dl
o   Post Prandial:
§ Normal: Less than 140 ml/dl
§ Pre-Diabetes: Between 140 and 200 ml/dl
§ Diabetes: Greater than 200 ml/dl
 
·         A1C Test: An even more reliable test for diagnosing and managing diabetes is the A1C test. This test measures the percentage of your haemoglobin that is coated with sugar. This indicates the average sugar level over the past 2-3 months and hence is considered a more reliable test for diagnosing diabetes by many experts internationally.   A value of less than 5.7% is considered Normal, 5.7 to 6.4 is interpreted as Pre-diabetic, and greater than 6.5 is considered Diabetic. In well controlled diabetes, it is less than 7%. The American Association of Clinical Endocrinologists (AACE) recommends that people with Type II diabetes should have a target A1C level of less than 6.5%.
Risk Factors
The main risk factors for Type II diabetes are:
·         Heredity: The risk increases if you have a family history of diabetes
·         Ethnic background: Diabetes is more common in populations of the following ethnic backgrounds: Africans, Latinos, Native Americans, Asians
·         Obesity
·         Age. The risk increases after the age of 45.
·         Sedentary lifestyle
Complications associated with Diabetes
·         Cardiac Problems: Diabetes doubles the chances of heart attack, stroke and hypertension.
·         Ocular Problems: Risk of Premature cataract, Retinopathy and Glaucoma increases with diabetes. Diabetes is a leading cause of adult blindness.
·         Nephropathy (Damage to Kidneys): It is a major cause of illness and early death in diabetics. High blood pressure associated with diabetes increases the risk of kidney failure.
·         Neuropathy: Damage to peripheral nerves leads to numbness, tingling, burning sensation and later loss of sensation in extremities. Damaged peripheral nerves and reduced blood supply in feet, leads to foot ulceration. Diabetes is a leading cause of non-accidental amputations.
·         Brain stroke: Diabetics are more prone to suffer brain stroke than non-diabetics especially if they have associated hypertension.
·         Impotence: Almost 50 to 60 percent of men with diabetes may experience impotence. Some anti-diabetic medicines may also contribute to impotency.
·         Diabetic Ketoacidosis and Coma: Severe and uncontrolled diabetes may lead to severe metabolic derangement and coma.
·         Low Blood Sugar: Diabetics may develop low blood sugar because of blood sugar-lowering medication or from not eating enough food. It is important to follow the eating and medication schedule that your doctor has prescribed to avoid low blood sugar.
·         Increased complications during pregnancy.
Preventive Care and Management of Diabetes
Type II Diabetes is a generally a lifestyle related disease and can be prevented and managed by appropriate changes in eating habits and increase in physical activities.   It has been shown in a study that just 30 minutes of moderate physical activity daily along with 5-10% reduction in body weight produced 58% reduction in diabetes.
Self Monitoring
Self-monitoring of blood sugar level is important as sugar levels can vary with medications, diet and exercise. Best time for routine monitoring of blood sugar is in the morning after about eight hours of fasting. If at any other time it is felt that blood sugar is low (feeling of weakness, shaking of hand and sweating etc.) it should be confirmed by a test and immediately glucose or some other sugary drink should be consumed. Low blood sugar (hypoglycaemia) is very harmful. Easy to use blood sugar monitors (glucometers) are available for use at home. Also test strips are available to check sugar in urine. If urine test is positive, it means that blood sugar is very high.