Symptoms of Diabetes

Most people are well-known with common symptoms of diabetes but in almost 50% patient’s diabetes may be present without any obvious symptoms. In such patients diabetes is diagnosed incidentally or when some serious complication of diabetes has occurred.

Early diagnosis of diabetes is important so as to prevent the long-term complications of diabetes.

The symptoms of diabetes can be divided into 3 groups:

1. Symptoms due to increased blood glucose level:
When the level of glucose in blood rises above a certain limit, it changes the osmotic pressure of blood.

Some diabetes symptoms include:

• Frequent urination
• Excessive thirst
• Extreme hunger
• Unusual weight loss
• Increased fatigue
• Irritability
• Blurry vision

A decrease in vision is also an important symptom of diabetes. Increased glucose level in the blood leads to change in the shape of the lens distorted vision. Once the blood glucose level comes to normal the shape of the lens also comes back to normal & the person’s vision becomes normal again. If a person uses spectacles & becomes diabetic he may have frequent changes in his spectacles power. It is suitable to get the spectacle number corrected only when blood glucose is normal.

2. Symptoms due to non-availability of Glucose in cells:
Tiredness, weakness, irritability, body ache, tingling, increased appetite and weight loss are common symptoms.

3. Symptoms of Complications of Diabetes:
Increased level of glucose in the blood causes damage to various organs leading to symptoms like numbness in hands and legs, pain in the eyes, swelling (edema) in the feet, pricking sensation, tingling, aches and pains, blurred vision, impotence, swelling in body Chest pain (angina) etc.

When alarming symptoms given by the body are ignored and the same status is maintained, it starts damaging body organs, such as heart, kidney, eye, feet, and skin.

Symptoms of diabetes also depend on the type of diabetes. If the patient has Type 1 Diabetes weight loss is very rapid. Frequency of urine is also much more. A child may have complaints of bed-wetting. During Ketoacidosis, unconsciousness may also occur in Type 1 diabetes. Whereas symptoms may be soft in Type 2 diabetes.

Common Symptoms of Diabetes:

• Weight loss
• Increased frequency of urination
• Increased thirst
• Tiredness
• Itching in private parts
• Increased appetite
• Tiredness and easy fatigue ability
• Non healing wounds

Diabetes Risk Factors

Increased mental stress and decreased physical activity anybody can be affected by diabetes. Although the being of certain risk factors increases the possibility of having diabetes. Following are the persons at a greater risk of having diabetes:

1. Family History of Diabetes:
Family history of diabetes is the greatest risk factor for developing diabetes. Persons with first degree blood relatives having diabetes like father, mother, and brother, sister are at the greatest risk of having diabetes.

Following table shows risk of developing diabetes:

2. Obesity:
Obesity causes insulin conflict, which increases the possibility of having diabetes. The risk of having diabetes is more in persons with central obesity

Obesity can be defined in two ways:
I. A Body Mass Index (B.M.I.) greater than 25
II. Increased Waist Hip Ratio
The Body Mass Index (B.M.I.) is calculated by the following formula

Weight grading according to Body Mass Index:

Central Obesity:
For calculating central obesity, waist and hip size are taken and theWaist Hip Ratio i.e. WHR is obtained. For example if the waist of a man measures 90 cm and his hip measures 80 cm then the WHR is 1.12.

For males risk of diabetes is greater if WHR is more than 0.90
For females risk of diabetes is greater if WHR is more than 0.85

OR

If in males waist is more than 102 cm and in female’s waist is more than 88 cm, risk of diabetes is more.

3. Lack of Physical Activity
4. High Cholesterol
5. High Blood Pressure
6. History of Gestational Diabetes
7. Female with history of having high birth weight baby
8. Polycystic Ovary Syndrome in women
9. Person with Low Birth Weight

Different Causes of Diabetes

Diabetes is of many types. The cause of diabetes depends on the type of diabetes.

Type 1 Diabetes:
Type 1 diabetes is much less common than type 2 diabetes. It is mostly found in children and young adults. Type 1 Diabetes is a result of an autoimmune disorder. Type 1 diabetes is associated with lack of insulin. Such patients have a specific type of HLA gene on their chromosomes. Infection in genetically inclined individual leads to commencement of immune system which cannot distinguish between self and non-self cells which leading to damage of insulin producing beta cells.

Type 2 Diabetes:
It is caused by interaction of hereditary factors and environmental factors, resulting in decreased efficacy of insulin and after a few years the ability of pancreas to produce insulin is also decreased. There are several factors, such as genetics, obesity, and physical inactivity that can increase a person's risk of developing type 2 diabetes. Type2 diabetes occurs when the pancreas doesn't make enough insulin or the cells of the body become resistant to insulin.

Insulin binds to insulin receptors on body cells and this insulin-receptor binding cause activation of complex metabolic processes e.g. GLUT activation, protein synthesis and lipid metabolism etc. More than 100 genes are involved in this process. One or more defective genes can lead to destruction of insulin action and hence development of diabetes. In diabetes many genes can turn defective and each patient can have a set of different defective genes. Any defects in the genetic makeup leads to irreparable changes that affect the functioning of insulin. Lack of physical activity, stress and obesity further worsens this situation. After some time production of insulin also diminishes. These changes ultimately lead to the development of diabetes in a person. The figure below explains the working of insulin:

Various Types of Diabetes

American Diabetic Association and World Health Organization have divided diabetes into following types:

Type 1 Diabetes:
Type 1diabetes is an auto-immune disease caused by a serious damage to beta cells found in the pancreas. This type of diabetes is also known as juvenile-onset diabetes accounts for 10-15% of all people with the disease. It is trigged by environmental factors like viruses, diet or chemicals in people heritably predisposed. This leads to the production of antibodies, which destroy the invading organism. At the same time these antibodies damage the beta cells, thinking them to be foreign cells as the immune system fails to recognize host cell.

The presence of special type of HLA genes in the body and immune response which does not be familiar with own body cells and damages beta cells lead to this type of condition. People with specific subtype of HLA genes can get this type of diabetes once the immune system is activated following infection. So beta cells are innocent victims of an immune assault occurring in genetically prone people. Here, it is important to stress that all people with HLA genes subtype do not get type 1 diabetes. Type 1 diabetes is a result of the combination of genetic predisposition and an environmental trigger.

Nowadays it is possible to identify people with HLA subtype, which can help in determining people at high risk of getting Type 1 Diabetes and this type of diabetes the production of insulin almost stops due to damage to beta cells and the patients develop acute symptoms of diabetes like rapid weight loss, weakness, ketones in urine, coma due to ketoacidosis. This type of diabetes is commonly found in children and young adults, although practically any age group can be affected. Before 1921(Pre-Insulin era) this type of diabetes meant sure death.

Availability of insulin has changed the scenario and now people with Type 1 Diabetes can live a near normal life span.

Type 2 Diabetes:
This type of diabetes also known as late-onset diabetes. This type of diabetes occurs when the body stops recognizing the insulin secreted by the pancreas. Initially in such patient’s overproduction of insulin is found leading to a condition called Hyperinsulinemia. This high level of insulin compensates for insulin resistance and thus maintains blood glucose in normal range.
With passage of time the beta cells get exhausted and insulin levels decline, thus blood glucose level starts rising leading to diabetes.

In such patients the number of beta cells decreases after a few years leading to decreased production of insulin. Therefore it can be said that Type 2 Diabetes starts off as reduced efficacy in the working of insulin but later on there is decreased production of insulin as well.

Type 2 diabetes can affect people of any age, even children. Of late this type of disorder has been increasing in young adults. Fatness, high-sugar diet, lack of exercise and increased mental stress give rise to insulin resistance and thus diabetes. The symptoms in Type 2 Diabetes are much less severe than Type 1 Diabetes. This is the reason why many patients of Type 2 Diabetes are unaware of their ailment until it takes a serious form. In our country more than 95% of the patients are Type 2 Diabetes. This type of diabetes is commonly associated with high blood pressure and cholesterol problems

Gestational Diabetes:
Like type 2, is a form of insulin conflict that occurs in the later stages of pregnancy. The hormonal changes in pregnancy lead to insulin resistance leading to Gestational Diabetes. These hormones may get in the way with the mother’s ability to produce and use her own insulin.

It is mostly temporary. It is commonly found in those females who are either overweight or have a family history of diabetes. This diabetes generally disappears after delivery, but such females are at a higher risk for developing diabetes in future life.

Gestational Diabetes is different from Pre-Gestational Diabetes. If a female who is already diabetic and becomes pregnant then such a condition is called Pre-Gestational Diabetes.

Other types of diabetes:

1. Genetic defects in Beta cells.
2. Defects in Insulin receptors.
3. Disorders of Pancreas.
4. Hormonal disorders.
5. Diabetes due to medicines or toxins.
6. Diabetes due to viral infections.
7. Recurrent inflammation (swelling) in pancreas leads to destruction of beta cells causing diabetes. Excess of alcohol intake is the commonest cause of pancreatitis.

What is Diabetes (Blood Sugar)

By definition, when the level of glucose in the blood rises above a certain limit, this condition is known as diabetes. It affects the way of your body uses food for energy. The basic for the increasing sugar level could be either a decrease in the quantity of a hormone or a decreased efficacy in the working of hormone (insulin).

In order to understand the relation between Sugar (glucose) and hormone (insulin), it is essential to know the working of the body at cellular level.

Body Work at cellular level:

Our body is composed of millions and millions of cells. Our muscles are made of muscle cells, our livers of liver cells, and there are even very specialized types of cells that make the enamel for our teeth or the clear lenses in our eyes. Each cell is a complete unit in itself. A number of complex metabolic processes are taking place in these cells for which the required energy is produced by glucose. Anything we eat (carbohydrate) is transformed to glucose after absorption in the intestine. This glucose enters the blood and through the blood vessels is circulated all over the body. When we are in a fasting state, glucose comes from liver (Hepatic Glucose Output).

It means that even in a fasting state glucose is continuously reaching the blood through liver. As liver is known as the store house of glucose and in urgent situation when no food is available it helps in maintaining all the body functions by releasing glucose into the blood. Glucose then acts as a fuel for carrying out the various metabolic processes of the body. So it can be said that glucose is to our body what gas is to a car. Hence, whether we eat or are in a fasting state, glucose level in blood is maintained at all times.

Now the next step is that this glucose should enter the cells where it will be used as a source of energy by the cells to carry out the various metabolic processes.
GL UT4 acts as a door of body cell. In basal state this door GLUT4 is closed. For glucose to enter the cells this door (GLUT 4) must be open. When this door opens, glucose enters the cells of the body and provides energy to the cells. The process of entry of glucose from blood into the cells is complex and is carried out by a hormone called insulin. Insulin opens the door on body cells and makes glucose entry in body cells possible which then provides energy to the cells. So in brief we can say that relationship between glucose and insulin lies in the fact that insulin opens the lock allowing glucose to enter inside the cells.

Projected Diabetic Population by the Year 2030

The numbers of diabetic patients are rapidly increasing all over the world, but the trends are different for different countries. At some places the growth rate is faster than the others. Differences in lifestyle and role of racial factors are the obvious reasons for the rate.

In developed countries like America, great importance is attached to physical activity and so diabetes has been brought under control to an extent. At the same time in India, Pakistan and Gulf countries, the number of diabetic patients is rapidly increasing. A changing and more prosperous lifestyle with little emphasis on physical activity is responsible for this.

A survey conducted by World Health Organization shows that the largest number of diabetic patients in the world is in India, hence India has been accorded the status of “Diabetic Capital” of the world.

In 1995, every 7th diabetic person in the world was an Indian & by 2025 every 5th diabetic person will be an Indian. In 1995 the number of diabetic patients in India was 1.94 Crores however by 2025 this number will swell to 5.70 Crores.

The number of diabetic patients is rapidly increasing in India but what is more worrying is the factor that the younger age group is being more affected. At present 30% of the diabetic patients are in the age group of 20 to 40 years.

Projected Diabetic Population by the Year 2030

Diabetes Diet: Myths and Reality

There are more myths than reality associated with diet of a diabetic. Change in food pattern is an important aspect of treating Diabetes. But most patients have wrong information, which becomes a problem in treating Diabetes.

Once a person comes to know that he has become diabetic, the first fear that pops up in his mind is about dietary restrictions. Diabetes is considered a disorder of sugar and so patients start enquiring about foods, which contain sugar. Often doctors, dieticians, diabetes educators also forbid the patients from taking rice, potato, fruits, fruit juices, sugar, etc. Thus, with the diagnosis of diabetes, everyone in the family becomes concerned about what NOT to give to the patients as they believe these restrictions can only curb or help in the treatment diabetes.

In countries like India, there are many myths about diet in Diabetes and as a result any rise in glucose is believed to have occurred solely due to dietary reasons. This leads to inadequate medical treatment and thus glucose levels remain high leading to higher diabetes complications.

No book and none of the International organizations on diabetes have prohibited any food in Diabetes, says Dr. Sunil M Jain, CEO of diabeteshormone.com. Diabetics can consume all food items but in moderation and as per Calorie requirement, he adds.

There is a need of awareness among healthcare providers about diet in Diabetes. The food we eat contains carbohydrates, proteins and fats. A healthy diet implies that at least 50 – 60% of calories should come from carbohydrates, 20% calories from fats and 20% calories from proteins. If a meal of a diabetic patient has a healthy diet calorie distribution, it can be permitted.

What is required is an understanding of the composition of food items and then planning of a meal pattern. Doctors and nutritionists should consider this concept and try to remove food related myths rather than reinforcing them. It is crucial to understand that if glucose levels are high, there may be other causes like inadequate medications, missing medications, need of insulin, etc and not small amounts of rice or fruits. Blaming to just diet is one of the cause for inadequate treatment and thus high glucose levels. Patients need to think more in terms of Insulin deficiency and this will automatically lead to process of improvement in medical treatment and better glucose control.

Diabetic diet actually comprises a healthy and proportionate diet. Due to misconceptions, people fail to understand the basic and important concept. Diet modification is an adjustment to decreasing Insulin supply. If glucose is high in spite of a healthy diet, then it more advisable to revise treatment so as to improve Insulin supply.

How Insulin pumps differ from injections

All of us produce Insulin for life and Insulin keeps us healthy by keeping Glucose in normal range. Diabetics produce less Insulin and they need Insulin supplementation when pills are unable to release adequate amount of Insulin and thus are unable to control blood glucose.

Normally our pancreas secretes small amount of insulin continuously throughout the day and this is called basal insulin secretion. When a meal or snack is eaten, our Beta cells then secrete large bursts of insulin called bolus insulin.

The aim of Insulin replacement in Diabetes management, is to replace Insulin in a similar way. However, it is easier said than done.

Most patients use pen or syringes to inject Insulin and they use different types of Insulin so as to control glucose levels. But there are problems with Insulin shots, despite the availability of newer Insulin analogs and good devices.

When injections are used, two types of Insulin are needed that work at different speeds. A fast acting Insulin is used to cover meals [bolus Insulin] and it is effective for three and a half to six hours. Long-acting insulin, such as Lente, NPH or Ultralente, Glargine, Detemir etc is used to provide basal insulin requirement.

With injections, it is possible to achieve normal Glucose levels but it demands a much-regulated lifestyle, a rigid eating pattern with the same amounts of carbohydrate each time, fixed exercise plan etc. This is difficult to achieve and maintain by most people particularly young patients.

Insulin shots has four major problems:

1. The action of both short and long-acting insulin is unpredictable. In clinical studies, the amount of insulin that reaches a person's blood varies by 15% to 50 % from one day to the next with injections.
2. Multiple injections are often inconvenient.
3. To achieve normal glucose levels, a very rigid and consistent meal plan is a must. At the same time Carbohydrate every day is needed.
4. Long acting like NPH or analogs like Glargine and Detemir can provide basal Insulin but this may not necessarily match the variable background needs of an individual like Dawn Phenomenon in morning, or a different basal need in late evening.

These all problems can be better dealt with help of Insulin pumps. According to Dr. Sunil M Jain, CEO, diabeteshormone.com, Insulin pump can be considered as artificial pancreas. It provides Insulin constantly mimicking basal Insulin delivery by human pancreas as well as instantly to take care meal related Glucose rise. It is considered as gods standard for Insulin replacement.