Diabetes Symptoms, Causes, Management and Etiology

1. Diabetes Symptoms, Causes, Management and Etiology By Dr. Prakash R. Naik. Ph.D Professor and Coordinator for UGC SAP DSA Phase III Programme Department of Studies in Zoology University of Mysore By Dr. Prakash R. Naik. Ph.Dand Professor and Coordinator for UGC SAP DSA Phase III Programme Department of Studies in Zoology University of Mysore

2. What is diabetes? • Diabetes mellitus is a condition in which a person has a high blood sugar (glucose) level as a result of the body either not producing enough insulin, or because body cells do not properly respond to the insulin that is produced. ...

3. OR • Diabetes is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).

4. Diabetes in India • With India having the highest number of diabetic patients in the world, the sugar disease is posing an enormous health problem in the country. • Calling India the diabetes capital of the world, the International Journal of Diabetes in Developing Countries says that there is alarming rise in prevalence of diabetes, which has gone beyond epidemic form to a pandemic one.

5. The International Diabetes Federation estimates that the number of diabetic patients in India more than doubled from 19 million in 1995 to 40.9 million in 2007. • It is projected to increase to 69.9 million by 2025. • Currently, up to 11 per cent of India’s urban population and 3 per cent of rural population above the age of 15 have diabetes.

6. Diabetes affects all people in the society, not just those who live with it. • The World Health Organization estimates that mortality from diabetes and heart disease cost India about $210 billion every year and is expected to increase to $335 billion in the next ten years. • These estimates are based on lost productivity, resulting primarily from premature death.

7. Various studies have shown that the high incidence of diabetes in India is mainly because of sedentary lifestyle, lack of physical activity, obesity, stress and consumption of diets rich in fat, sugar and calories.

8. The most prevalent is the Type 2 diabetes, which constitutes 95 per cent of the diabetic population in the country. • In this, patients are non-insulin dependent and they can control the glucose in their blood by eating measured diet, taking regular exercise and oral medication. • Worldwide, millions of people have Type 2 diabetes without even knowing it and if not diagnosed and treated, it can develop serious complications.

9. Type 1 diabetes (insulin dependent), however, is not preventable. • In India, the Chennai-based Diabetes Research Centre says that over 50 per cent cases of diabetes in rural India and about 30 per cent in urban areas go undiagnosed. • Globally, diabetes affects 246 million people, which is about 6 per cent of the total adult population. • It is the fourth leading cause of death by disease and every 10 seconds a person dies from diabetes-related causes in the world.

10. Each year, over three million deaths worldwide are tied directly to diabetes and even greater number die from cardiovascular disease. • Modification in lifestyle and proper medication can delay and prevent diabetes in high-risk groups. • Eating whole grain carbohydrates and moderate exercise and avoiding excessive weight gain could eliminate over eighty per cent of Type-2 diabetes.

11. Fri,03 Sep 2010 India, world diabetes capital Saikat Neogi, Hindustan TimesNew Delhi,, September 03, 2007

12. Types of diabetes • There are three main types of diabetes: • Type 1 diabetes: results from the body's failure to produce insulin, and presently requires the person to inject insulin. (Also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes.)

13. Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. • Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM.

14. Other forms of diabetes mellitus include • congenital diabetes, which is due to genetic defects of insulin secretion, • cystic fibrosis-related diabetes, • steroid diabetes induced by high doses of glucocorticoids, • and several forms of monogenic diabetes.

15. Type 1 Phenotype: Onset primarily in childhood and adolescence Often thin or normal weight Prone to Ketoacidosis Insulin administration required for survival Pancreas damaged by an autoimmune attack Insulin deficiency is absolute Treatment: Insulin injections Genotype: Increased prevalence in relatives HLA association: Yes Type 2 Phenotype: Onset predominantly after 40 years of age, increasingly diagnosed in younger patients Often obese Not Prone to Ketoacidosis Insulin administration not required for survival Pancreas not damaged by an autoimmune attack Insulin deficiency is relative and/or insulin resistance Treatment: Healthy diet and increased exercise; hypoglycemic tablets; insulin injections Genotype: Increased prevalence in relatives HLA association: No TYPES OF DIABETES

16. Clinical diagnosis of diabetes • The following tests are used for diagnosis: • A fasting plasma glucose (FPG) test measures blood glucose in a person who has not eaten anything for at least 8 hours. This test is used to detect diabetes and pre-diabetes.

17. 2. An oral glucose tolerance test (OGTT) measures blood glucose after a person fasts at least 8 hours and 2 hours after the person drinks a glucose-containing beverage. This test can be used to diagnose diabetes and pre-diabetes. 3. A random plasma glucose test, also called a casual plasma glucose test, measures blood glucose without regard to when the person being tested last ate. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes.

18. Test results indicating that a person has diabetes should be confirmed with a second test on a different day.

19. FPG Test • The FPG test is the preferred test for diagnosing diabetes because of its convenience and low cost. However, it will miss some diabetes or pre-diabetes that can be found with the OGTT. The FPG test is most reliable when done in the morning.

20. Results and their meaning are shown in Table 1. • People with a fasting glucose level of 100 to 125 milligrams per deciliter (mg/dL) have a form of pre-diabetes called impaired fasting glucose (IFG). • Having IFG means a person has an increased risk of developing type 2 diabetes but does not have it yet. • A level of 126 mg/dL or above, confirmed by repeating the test on another day, means a person has diabetes.

21. *Confirmed by repeating the test on a different day.

22. OGTT • Research has shown that the OGTT is more sensitive than the FPG test for diagnosing pre-diabetes, but it is less convenient to administer. • The OGTT requires fasting for at least 8 hours before the test. The plasma glucose level is measured immediately before and 2 hours after a person drinks a liquid containing 75 grams of glucose dissolved in water.

23. Results and their meaning are shown in Table 2. • If the blood glucose level is between 140 and 199 mg/dL 2 hours after drinking the liquid, the person has a form of pre-diabetes called impaired glucose tolerance (IGT). • Having IGT, like having IFG, means a person has an increased risk of developing type 2 diabetes but does not have it yet. • A 2-hour glucose level of 200 mg/dL or above, confirmed by repeating the test on another day, means a person has diabetes.

24. *Confirmed by repeating the test on a different day.

25. Gestational diabetes is also diagnosed based on plasma glucose values measured during the OGTT, preferably by using 100 grams of glucose in liquid for the test. • Blood glucose levels are checked four times during the test. • If blood glucose levels are above normal at least twice during the test, the woman has gestational diabetes. • Table 3 shows the above-normal results for the OGTT for gestational diabetes.

26. *These numbers are for a test using a drink with 100 grams of glucose.

27. Random Plasma Glucose Test A random, or casual, blood glucose level of 200 mg/dL or higher, plus the presence of the following symptoms, can mean a person has diabetes: • increased urination • increased thirst • unexplained weight loss

28. People with type 1 diabetes usually develop symptoms over a relatively short period. • Symptoms in people with type 2 diabetes are not as noticeable as in type 1. • Type 2 symptoms are often diagnosed by chance through routine medical check-ups. • Symptoms vary from person to person, but common symptoms include:

29. Other symptoms can include fatigue, blurred vision, increased hunger, and sores that do not heal. • The doctor will check the person’s blood glucose level on another day using the FPG test or the OGTT to confirm the diagnosis.

30. Symptoms of Diabetes

31. Who should be tested for diabetes and pre-diabetes? • The American Diabetes Association recommends that testing to detect pre-diabetes and type 2 diabetes be considered in adults without symptoms who are overweight or obese and have one or more additional risk factors for diabetes. • In those without these risk factors, testing should begin at age 45. • The Body Mass Index table can be used to find out whether someone is normal weight, overweight, obese, or extremely obese.

32. People aged 45 or older should consider getting tested for pre-diabetes or diabetes. • People younger than 45 should consider testing if they are overweight, obese, or extremely obese and have one or more of the following risk factors:

33. being physically inactive • having a parent, brother, or sister with diabetes • having a family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander • giving birth to a baby weighing more than 9 pounds or being diagnosed with gestational diabetes • having high blood pressure—140/90 mmHg or above—or being treated for high blood pressure • having an HDL, or “good,” cholesterol level below 35 mg/dL or a triglyceride level above 250 mg/dL

34. having polycystic ovary syndrome, also called PCOS • having IFG or IGT on previous testing • having a condition called acanthosis nigricans, characterized by a dark, velvety rash around the neck or armpits • having a history of cardiovascular disease—disease affecting the heart and blood vessels

35. If results of testing are normal, testing should be repeated at least every 3 years. • Doctors may recommend more frequent testing depending on initial results and risk status. • People whose test results indicate they have pre-diabetes should have their blood glucose checked again in 1 to 2 years and take steps to prevent type 2 diabetes.

36. When a woman is pregnant, the doctor will assess her risk for developing gestational diabetes at her first prenatal visit and order testing as needed during the pregnancy. • Women who develop gestational diabetes should also have follow-up testing 6 to 12 weeks after the baby is born.

37. Type 2 diabetes has become more common in children and teens than in the past, and those at high risk for developing diabetes should be tested every 2 years. • Testing should begin at age 10 or at puberty, whichever occurs first. • Children and teens who are overweight or obese and have other risk factors, such as a family history of diabetes, are at high risk for developing diabetes.

38. Body Mass Index (BMI) • The body mass index (BMI), is a statistical measure of body weight based on a person's weight and height. • Body mass index is defined as the individual's body weight divided by the square of his or her height. • The formulae universally used in medicine produce a unit of measure of kg/m2.

39. a BMI of 18.5 to 25 may indicate optimal weight; • a BMI lower than 18.5 suggests the person is underweight • while a number above 25 may indicate the person is overweight; • a BMI below 17.5 may indicate the person has anorexia nervosa or a related disorder; • a number above 30 suggests the person is obese (over 40, morbidly obese).

40. Strong history of diabetes Obese 24-28 weeks of pregnancy Women with previous history of still births & neonatal deaths Skin, genital & urinary tract infections Neuropathy, CAD, retinopathy under 60 y Abnormal glucose level during surgery 115 mg/dl -GTT 140 mg/dl & above Who should be screened?

41. What are the complications of diabetes? • Complications are more likely if the diabetes has not been well controlled — studies have shown that good glucose control can significantly reduce the likelihood of complications occurring. • Late-stage complications do not usually develop for 10—15 years in type 1 diabetic patients. • In type 2 diabetes symptoms can appear close to the time of the diagnosis because the disease may have been undetected for a long time. Complications can include:

42. Low blood sugar levels leading to weakness, confusion and sometimes seizures and loss of consciousness. • Susceptibility to infections. • Ulcers and infections of the feet. • Arteriosclerosis (hardening of the arteries), particularly in smokers and those with high blood pressure. • Diabetic nephropathy (kidney disease). • Diabetic retinopathy (diabetes-related eye disease). • Diabetic neuropathy (nerve damage).

43. How to maintain good health? In type 1 diabetes: • Learn how to use your home blood glucose testing kit and use it regularly — this will enable the one to measure his/her blood glucose levels and control insulin dose. • Learn how to give insulin injections — one to need them for the rest of life. • Quit smoking. • Follow the diet advised by your doctor and eat at regular times. • Exercise regularly and eat more or decrease the insulin you are taking to prevent low blood sugar levels.

44. Carry some form of sugar so that you can treat low blood sugar quickly and a protein snack to make sure you eat as often as you should. • Visit your doctor regularly so that your blood glucose levels can be checked and your eyes, kidneys and feet examined for signs of any late stage diabetic symptoms.

45. Tell your doctor if you feel ill or if you have been diagnosed with another disease. • Carry identification (such as a card or bracelet) that says you have diabetes, in case of an emergency.

46. In type 2 diabetes: • If you’re overweight, lose weight — losing as little as a few pounds can reduce your need to take medication. • Follow the diet advised by your doctor. • If you smoke, quit. • Learn how to use your home glucose testing kit (either blood or urine) and use it regularly — this will enable you to measure your glucose levels.

47. If you need insulin, learn how to give yourself insulin injections. • Visit your doctor regularly so that your blood pressure, blood glucose levels and amount of lipids (fat) in the blood can be checked, and your eyes, heart, kidneys and feet examined. • Tell your doctor if you feel ill or if you have been diagnosed with another disease. • Carry identification (such as a card or bracelet) that says you have diabetes, in case of an emergency.

48. How is diabetes treated? • While dietary control and an organised exercise programme are important for both types of diabetes, the medications used are different. • Type 1 diabetes will require insulin treatment. • Type 2 diabetes may be sufficiently controlled by diet and exercise alone. • If medications are required, it is usually treated with oral glucose-lowering tablets (oral hypogylcaemics). • Occasionally, those with type 2 diabetes will need insulin treatment.

49. Insulin therapy • Insulin therapy is the main treatment for type 1 diabetes. • It may also be required by some people with type 2 diabetes., • The aim of insulin therapy is to control the amount of insulin in the bloodstream so that glucose levels are normal or near normal. • You will be put on insulin and begin to regulate your diet as soon as the diagnosis is confirmed.

50. As well as self-injections of insulin every day, you should also check your blood sugar level every day to ensure you get the right dosage of insulin — if you have too much or too little sugar in your blood, you will need to change your diet or the amount of insulin you are taking to keep your blood sugar at a healthy level.