What is Diabetes ?
Diabetes mellitus (commonly known as diabetes) affect 463 million people worldwide, by 2045 this will rise to 700 million as per IDF Diabetes Atlas Ninth edition 2019.There are estimated 72.96 million cases of diabetes in adult population of India.
In people with this condition, the amount of glucose in the blood is too high (hyperglycaemia) because the body is unable to use it properly.
Glucose comes from the digestion of starchy foods such as bread or potatoes, from sugar and other sweet foods, and from the liver which makes it and passes it into the bloodstream. Insulin, a hormone produced by the pancreas, helps the glucose to enter the cells where it is used as fuel by the body.
The main symptoms of untreated diabetes are increased thirst, passing large amounts of urine, extreme tiredness, blurred vision, weight loss and itching of the genitals.
Insulin dependent diabetes (also known as Type 1 diabetes) occurs when there is a severe lack of insulin in the body because most or all of the cells which produce it have been destroyed. This type of diabetes usually appears before the age of 40. It is treated by insulin injections and diet.
Non-insulin dependent diabetes (also known as Type 2 diabetes) occurs when the body can still produce some insulin, though not enough for its needs, or when the insulin that the body does produce is not used properly by the body. This type of diabetes usually appears in people over the age of 40 and often in those who are overweight.
The two main aims of treatment are to eliminate the symptoms and to prevent long-term complications, such as eye, nerve, kidney and foot problems.
SYMPTOMS OF DIABETES :
The initial symptoms of diabetes include excretion of large amounts of glucose in urine , In some cases it may be as 100 grams per day . This is termed as glycosuria.
Losing so much solute in the urine causes osmotic diuresis and the volume of urine increases (polyuria).Hence, a diabetic urinates very often. The patient feels very thirsty constantly (poly-dipsia) and drinks large quantities of water. These symptoms which persist for many months cause the maturity-onset diabetic to approach a doctor .
In the juvenile-onset type further symptoms can easily complicate matters if treatment is not given soon. Although tissues receive a liberal supply of glucose from the blood, they are unable to utilize it efficiently in the absence of insulin. Such a diabetic, therefore, feels weak and tired. Since, carbohydrates cannot be used as fuel, fats are then mobilized. They are transported from the body stores to the liver. Thus, fat content of blood and liver increases. The plasma of such a patient is often opaque and fatty (lipaemia). This disproportionate metabolism of fat in a patient showing lipaemia results in excessive production of ketone bodies such as acetone, aceto-acetic acid and beta hydroxybutyric acid which cause ketosis, ketonaemia and ketonuria.When ketosis becomes severe, the patient’s breath gives a characteristic smell like acetone.
As by-products of fat metabolism such as aceto-acetic acid and beta hydroxy acids, are produced faster than they can be metabolized, the patient develops acidaemia (acidosis) which gives rise to hyperventilation (or air hunger as it is commonly known). Along with abnormal carbohydrate and fat metabolism there is extensive breakdown of protein in order to provide energy. This energy is obtained by deamination of the amino acids (refer to functions of proteins). At this stage of ketosis, the patient develops lack of appetite (anorexia), nausea and vomiting. The increased loss of water and electrolytes through urine as well as orally leads to dehydration. The ketoacidosis is associated with increasing drowsiness and if untreated, the patient may become unconscious (diabetic coma) which can prove fatal. A combination of hyperglycaemia, ketosis, acidaemia and dehydration may cause the patient’s death.
Other possible symptoms include blurred vision, skin irritation or infections. In women, skin irritation is particularly noticed around the vulva because of the heavy load of glucose in urine.
ACUTE COMPLICATIONS OF DIABETES :
Two complications may develop in diabetes mainly arising from severe insulin insufficiency. They are:
Hypoglycemia : Hypoglycaemia is insulin shock. This may take place in patients who are receiving insulin where there is imbalance between diet and insulin dosage, or it may be caused due to delay in eating, omission of food or loss of food by vomiting and diarrhoea. In some patients excessive exercise may also cause symptoms of insulin shock.
In such cases the patient becomes pale, nervous, weak and hungry. The person tends to have excessive perspiration and a moist skin . He may have nausea, vomiting or convulsions. If not treated by giving sugar or fruit juice , the patient may go into a coma and even die.
CHRONIC COMPLICATIONS OF DIABETES :
- Diabetic Eye Disease
(a) Prevalence of diabetic retinopathy, especially M middle-aged and ddtyty people, causing visual disability.
(b) Risk of blindness especially in older persons which is indicated by deposition of white exudate and haemorrhage or by oedematous swelling of retina tissues. (c) Cataract and other eye diseases occur earlier and more often in diabetics lita, in non-diabetics.
- Kidney Diseases : Progressive impairment of renal function, accompanied by urinary protein loss and culminating in end-stage renal failure may he see, is diabetics.
- Diabetic neuropathy : Damage to nerve fibres conducting sensation and blood vessels as well as the viscera is the most common complication of diabetes.
- Cardio-Vascular Diseases : CND (Coronary Heart Disease) occurs more frequently and has notably more serious consequences for M diabetics than at noon. diabetics. Atheresclerotic disease of the small arteries in diabetics is responsible for the high incidence of claudication and gangrene in the lower limbs, and for cerebral infarction, stroke and diffuse cerebral disease.
- The Diabetic Foot: Diabetics are affected by a peculiar disability which severely damages the tissues of the foot. It is seen in the form of chronic ulceration, sepsis, and gangrene. It may necessitate amputation of the foot. Three major factors have been identified which lead to the diabetic foot. They are:
(a) Chronic diabetic neuropathy
(b) Atherosclerotic obstruction of the arteries that supply the lower limbs
(c) Bacterial infection.
It is possible to control the extent of tissue damage with correct care.
Healthy Eating :
Why is it so important to eat healthily? Research studies worldwide suggest that watching what you eat is not only essential to the management of diabetes, but that it can also help prevent heart disease, constipation, bowel problems, obesity and tooth decay. Following a good diet also makes you feel good!
There is no such thing as bad food; there is only a bad diet. All foods can have some nutritional benefit, but it is the mix of foods and the amounts you eat that make what you eat healthy or unhealthy.
In diabetes, the nutrient value of a food is not the only consideration. The way a particular food is digested and its effect on blood sugar can influence the general control of diabetes. For example, mashed potatoes can make blood sugar rise quicker than the same amount of boiled potatoes, simply because vegetables that are left whole take longer to digest.
The following general guidelines on healthy eating will also help you to choose the right types of food. You don’t need to do everything at once; start by choosing those ideas you find the easiest and gradually try to bring in the others.
- Eat regular meals and try to eat similar amounts of starchy foods from day to day.
- Try to eat more high-fibre foods. The fibre in beans, peas, lentils, vege beans, peas, lentils, vegetables, fruit and oats is particularly good.
- Cut down on fried and fatty foods such as butter, margarine, fatty meat and cheese.
- Reduce your sugar intake by swapping high-sugar foods for low-sugar foods.
- Try to get to the weight that is right for you and stay there.
- Be careful not to use too much salt.
Written By :
Kajal Jain (Student of Physio)
Teerthanker Mahaveer University