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What it is
Diabetes mellitus or DM, defines
Dr. Shaikh Altaf Basha, Professor
and Head of the Department of
lnternal Medicine, is a group of
metabolic diseases in which a
person has high level of blood
sugar, either because the pancreas
does not produce enough insulin or
because the cells do not respond to
the insulin that is produced. He tells
that there are essentially three main
types of DM; “One is Type 1 DM
which results from body’s failure
to produce insulin,” he says and
this form was previously referred
to as insulin dependent diabetes
mellitus or juvenile diabetes. “The
second type is Type 2 DM which
results from insulin resistance,
a condition in which cells fail to
use insulin properly, sometimes
combined with an absolute insulin
deficiency,” he says and this form
was previously referred to as non-
insulin dependent (NIDDM) or
“adult onset diabetes”. And finally,
the third main form Gestational
Diabetes occurs when pregnant
women without a previous diagnosis of
diabetes develop a high blood glucose level. It
may precede development of type 2 DM.
Early symptoms
You may discover you have diabetes mellitus
from some early symptoms of the disease if
you recognize the symptoms. According to
Dr. Basha, the early symptoms of untreated
diabetes are related to elevated blood sugar
levels and loss of glucose (spillage of sugar)
in the urine. “High amounts of sugar in the
urine cause increase urine output (polyuria)
and leads to dehydration,” he says and
dehydration causes increased thirst and water
consumption (polydipsia), and dryness of
mouth and throat. “Other symptoms include
frequent passing of large amounts of urine
(polyuria), getting up frequently in the night
to pass urine (nocturia), tiredness, fatigue,
lethargy, and/or weight loss despite good
appetite,” he says. “Also included is blurring of
vision, change in the power of lenses, itching
in the genitalia (pruritus vulvae), hyperphagia,
predilection for sweet foods and/or mood
changes, irritability, difficulty in concentration
and apathy.”
In fact, having diabetes and not
knowing it can be dangerous. “Several well
designed clinical trials involving large number
of diabetes have shown that good control of
blood sugar in a diabetic shows the disease
progression significantly lowers micro vascular
complications such as involvement of retina,
kidneys and heart,” he says.
Screening
Unfortunately, Dr, Basha says that people can
have diabetes and not even be aware of it.
“This is especially true of type 2 DM,” he says
as it takes several years—around four to seven
years--before the typical symptoms develop.
“However, this can be checked by regular
screening of all the vulnerable groups for
diabetes,” he says.
Lifestyle
Rates of diabetes are increasing worldwide,
points out Dr. Basha. “One important reason
for this is increase in obesity,” he says while
other reasons are decreased physical activity,
adoption of Western lifestyle, change in food
habits, lack of exercise, increased facilities
for checking blood sugar and so forth. “The
cause of diabetes appears to involve complex
interaction between environmental and
genetic factors,” he says and it is presented
that the disease develops when a diabetogenic
lifestyle is superimposed on a susceptible
genotype. “This lifestyle includes excessive
caloric intake as in an excessive consumption
of carbohydrate rich junk foods, fast foods,
an inadequate caloric expenditure such as
sedentary lifestyle, and/or obesity,” he says.
Prevention
While the genetic factors cannot be modified,
the environmental factors can be tackled to
some extent in helping prevent the onset of
diabetes, says Dr. Basha. “One way is to be sure
to maintain ideal body weight of a BMI 25 or
less,” he says and another way is to eat a well-
balanced food and avoid energy rich foods,
fast foods and junk foods. And aim to partake
in regular exercise and avoid a sedentary
lifestyle. “Also screen the first degree relatives
of diabetic patients,” he says. “Educate yourself
and others about diabetes, its complications
and management.”
Advice:
Strictly follow the dietary measures as
prescribed by my physician or nutritionist
•
Stick to the medications as prescribed by
my physician.
•
Periodically check your blood for sugar
control, for lipid levels and attend
regularly the diabetic clinic/physician
for follow up.
•
Exercise regularly and remain physically
active.
•
Learn to monitor blood sugar by
yourself using a glucometer under the
guidance of my physician.
Who Should be Screened?
Screening for Type 1 DM:
•
Screening asymptomatic low risk
individuals - not recommended
•
High risk individuals ( those who have
first degree relatives with type 1 DM
- should have annual screening for anti-
islet antibodies before the age of 10 year
along with one additional screening
during adolescence
For type 2 DM indications for diabetic
screening include:
•
People with sustained blood pressure of
>135/80mmHg
•
Overweight Individuals
•
People with first degree relative with
type 2 DM
•
ADA recommends screening at age 45
in the absence of the above criteria
Oct/Nov 2013
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