"The Fundamental of Diabetes Mellitus"
The
Fundamental of Diabetes Mellitus
Introduction
Diabetes mellitus is a group of metabolic diseases in
which the person has high blood glucose (blood sugar) level either due to
inadequate insulin production or because the body's cells do not respond
properly to insulin or both. The term "Diabetes Mellitus" describes a
metabolic disorder of multiple etiology characterized by chronic hyperglycemia
with disturbances of carbohydrate, fat (dyslipidaemia) and protein metabolism
resulting from defects in insulin secretion, insulin action or both.
According to W.H.O. about 422 million people worldwide have diabetes, the majority living in low-and middle-income countries and 1.6 million deaths are directly attributed to diabetes each year. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. India is home to the second-largest number of adults with diabetes worldwide throwing several socio-economic and financial challenges. The rising prevalence of diabetes and other non-communicable diseases is driven by a combination of factors - rapid urbanisation, sedentary lifestyles, unhealthy diets, tobacco use and increasing life expectancy.
Obesity and overweight are the most important risk factors responsible for diabetes and the disease burden can be prevented or delayed by lifestyle changes including adopting a healthy diet and doing regular physical activity.
In 2019, the countries with the largest numbers of adults with diabetes in the age bracket 20–79 syears were China, India and the United States and are anticipated to remain so in 2030. In India, the number of people with diabetes is expected to rise from 77 million in 2019 to 101 million in 2030 to 134 million in 2045. India also ranks second in the number of people with undiagnosed diabetes: China (65.2 million); India (43.9 million) and the United States (11.8 million).
With the rising trajectory of diabetes in India, there is a need for more effective health policy interventions. The National Health Policy 2017 aims to increase screening and treatment of 80 percent of people with diabetes and reduce premature deaths from diabetes by 25 percent by 2025. This, however, entails a relook at the existing strategies and devising new measures for arresting the growth.
A series of cost-effective interventions can improve patient outcomes, regardless of what type of diabetes they may have. These interventions include blood glucose control, through a combination of diet, physical activity and, if necessary, medication; control of blood pressure and lipids to reduce cardiovascular risk and other complications and regular screening for damage to the eyes, kidneys and feet, to facilitate early treatment.
Type of Diabetes Mellitus
- Type 1 Diabetes: This
type is an autoimmune disease, meaning your body attacks itself. In this
case, the insulin-producing cells in your pancreas are destroyed. Up to
10% of people who have diabetes have Type 1. It’s usually diagnosed in
children and young adults. It was once better known as “juvenile” diabetes.
People with Type 1 diabetes need to take insulin every day. This is why it
is also called insulin-dependent diabetes.
- Type 2 Diabetes: With this type, your body either doesn’t make enough insulin or your body’s cells don’t respond normally to the insulin. This is the most common type of diabetes. Up to 95% of people with diabetes have Type 2. It usually occurs in middle-aged and older people. Other common names for Type 2 include adult-onset diabetes and insulin-resistant diabetes. Your parents or grandparents may have called it “having a touch of sugar.”
- Prediabetes: This
type is the stage before Type 2 diabetes. Your blood glucose levels are
higher than normal but not high enough to be officially diagnosed with
Type 2 diabetes.
- Gestational Diabetes:
This type develops in some women during their pregnancy. Gestational
diabetes usually goes away after pregnancy. However, if you have
gestational diabetes you're at higher risk of developing Type 2 diabetes
later on in life.
Less common
types of diabetes include:
- Monogenic
Diabetes Syndromes: These are
rare inherited forms of diabetes accounting for up to 4% of all cases.
Examples are neonatal diabetes and maturity-onset diabetes of the young.
- Cystic
Fibrosis Related Diabetes: This is a
form of diabetes specific to people with this disease.
- Drug or Chemical-Induced Diabetes: Examples of this type happen after organ transplant, following HIV/AIDS treatment or are associated with glucocorticoid steroid use.
Symptoms
Diabetes symptoms vary depending on how much
your blood sugar is elevated. Some people, especially those with prediabetes or
type 2 diabetes, may sometimes not experience symptoms. In type 1 diabetes,
symptoms tend to come on quickly and be more severe.
Some of the signs and symptoms of type 1 diabetes
and type 2 diabetes are:
- Increased thirst
- Frequent urination
- Extreme hunger
- Unexplained weight loss
- Presence of ketones in the urine
- Fatigue
- Irritability
- Blurred vision
- Slow-healing sores
- Frequent infections, such as gums or skin
infections and vaginal infections
Type 1 diabetes can develop at any age,
though it often appears during childhood or adolescence. Type 2 diabetes, the
more common type, can develop at any age, though it's more common in people
older than 40.
When to see a Doctor:
- If you suspect you or your child may have
diabetes. If you notice any possible diabetes symptoms,
contact your doctor. The earlier the condition is diagnosed, the sooner
treatment can begin.
- If you've already been diagnosed with
diabetes. After you receive your diagnosis, you'll need close
medical follow-up until your blood sugar levels stabilize.
Causes
To understand diabetes, first you must
understand how glucose is normally processed in the body.
How
insulin works
Insulin is a hormone that comes from a gland situated
behind and below the stomach (pancreas).
- The pancreas secretes insulin into the
bloodstream.
- The insulin circulates, enabling sugar to
enter your cells.
- Insulin lowers the amount of sugar in your
bloodstream.
- As your blood sugar level drops, so does the
secretion of insulin from your pancreas.
The
role of glucose
Glucose — a sugar — is a source of energy for
the cells that make up muscles and other tissues.
- Glucose comes from two major sources: food
and your liver.
- Sugar is absorbed into the bloodstream, where
it enters cells with the help of insulin.
- Your liver stores and makes glucose.
- When your glucose levels are low, such as
when you haven't eaten in a while, the liver breaks down stored glycogen into
glucose to keep your glucose level within a normal range.
Causes
of type 1 diabetes
The exact cause of type 1 diabetes is
unknown. What is known is that your immune system — which normally fights
harmful bacteria or viruses — attacks and destroys your insulin-producing cells
in the pancreas. This leaves you with little or no insulin. Instead of being
transported into your cells, sugar builds up in your bloodstream.
Type 1 is thought to be caused by a
combination of genetic susceptibility and environmental factors, though exactly
what those factors are is still unclear. Weight is not believed to be a factor
in type 1 diabetes.
Causes
of prediabetes and type 2 diabetes
In prediabetes — which can lead to type 2
diabetes — and in type 2 diabetes, your cells become resistant to the action of
insulin and your pancreas is unable to make enough insulin to overcome this
resistance. Instead of moving into your cells where it's needed for energy,
sugar builds up in your bloodstream.
Exactly why this happens is uncertain,
although it's believed that genetic and environmental factors play a role in
the development of type 2 diabetes too. Being overweight is strongly linked to
the development of type 2 diabetes, but not everyone with type 2 is overweight.
Causes
of gestational diabetes
During pregnancy, the placenta produces
hormones to sustain your pregnancy. These hormones make your cells more
resistant to insulin.
Normally, your pancreas responds by producing
enough extra insulin to overcome this resistance. But sometimes your pancreas
can't keep up. When this happens, too little glucose gets into your cells and
too much stays in your blood, resulting in gestational diabetes.
Complications
Long-term complications of diabetes develop gradually. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include:
Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries. If you have diabetes, you're more likely to have heart disease or stroke.
Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.
Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.
Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
Eye damage (retinopathy). Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.
Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
Hearing impairment. Hearing problems are more common in people with diabetes.
Alzheimer's disease. Type 2 diabetes may increase the risk of dementia, such as Alzheimer's disease. The poorer your blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved.
Depression. Depression symptoms are common in people with type 1 and type 2 diabetes. Depression can affect diabetes management.
Complications
of gestational diabetes
Most women who have gestational diabetes
deliver healthy babies. However, untreated or uncontrolled blood sugar levels
can cause problems for you and your baby.
Complications in your baby can occur as a result of gestational diabetes, including:
Excess growth. Extra glucose can cross the placenta, which triggers your baby's pancreas to make extra insulin. This can cause your baby to grow too large. Very large babies are more likely to require a C-section birth.
Low blood sugar. Sometimes babies of mothers with gestational diabetes develop low blood sugar shortly after birth because their own insulin production is high. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal.
Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
Death. Untreated gestational diabetes can result in a baby's death either before or shortly after birth.
Complications in the mother also can occur as a result of gestational diabetes, including:
Preeclampsia. This condition is characterized by high blood pressure, excess protein in the urine and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby.
Subsequent gestational diabetes. Once you've had gestational diabetes in one pregnancy, you're more likely to have it again with the next pregnancy. You're also more likely to develop diabetes — typically type 2 diabetes — as you get older.
Complications of prediabetes
Prediabetes may develop into type 2 diabetes.
Diagnosis
Symptoms of type 1 diabetes often appear suddenly and are often the reason for checking blood sugar levels. Because symptoms of other types of diabetes and prediabetes come on more gradually or may not be evident, the American Diabetes Association has recommended screening guidelines. The ADA recommends that the following people be screened for diabetes:
Anyone with a body mass index higher than 25 (23 for Asian Americans), regardless of age, who has additional risk factors, such as high blood pressure, abnormal cholesterol levels, a sedentary lifestyle, a history of polycystic ovary syndrome or heart disease and who has a close relative with diabetes.
Anyone older than age 45 is advised to receive an initial blood sugar screening and then, if the results are normal, to be screened every three years thereafter.
Women who have had gestational diabetes are advised to be screened for diabetes every three years.
Anyone who has been diagnosed with prediabetes is advised to be tested every year.
Tests for type 1 and type 2 diabetes and prediabete.
Glycated hemoglobin (A1C) test. This blood test, which doesn't require fasting, indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells.
The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5% or higher on two separate tests indicates that you have diabetes. An A1C between 5.7% and 6.4 % indicates prediabetes. Below 5.7% is considered normal.
If the A1C test results aren't consistent, the test isn't available, or you have certain conditions that can make the A1C test inaccurate — such as if you are pregnant or have an uncommon form of hemoglobin — your doctor may use the following tests to diagnose diabetes:
Blood
sugar levels in diagnosing diabetes
The
following table lays out criteria for diagnoses of diabetes and prediabetes.
|
Plasma
glucose test |
Normal |
Prediabetes |
Diabetes |
|
Random |
Below
11.1 mmol/l |
N/A |
11.1
mmol/l or more |
|
Fasting |
Below
5.5 mmol/l |
5.5
to 6.9 mmol/l |
7.0
mmol/l or more |
|
2
hour post-prandial |
Below
7.8 mmol/l |
7.8
to 11.0 mmol/l |
11.1
mmol/l or more |
|
Blood
sugar levels in diagnosing diabetes |
|||
Random blood sugar test. A
blood sample will be taken at a random time. Regardless of when you last ate, a
blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles per
liter (mmol/L) — or higher suggests diabetes.
Fasting blood sugar test. A
blood sample will be taken after an overnight fast. A fasting blood sugar level
less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from
100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126
mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.
Oral glucose tolerance test. For
this test, you fast overnight, and the fasting blood sugar level is measured. Then
you drink a sugary liquid and blood sugar levels are tested periodically for
the next two hours.
A blood sugar level less than 140 mg/dL (7.8
mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two
hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and
11.0 mmol/L) indicates prediabetes.
If type 1 diabetes is
suspected, your urine will be tested to look for the presence of a byproduct
produced when muscle and fat tissue are used for energy because the body
doesn't have enough insulin to use the available glucose. Your doctor will also
likely run a test to see if you have the destructive immune system cells
associated with type 1 diabetes called autoantibodies.
Tests
for gestational diabetes
Your doctor will likely evaluate your risk factors for gestational diabetes early in your pregnancy:
If you're at high risk of gestational diabetes — for example, if you were obese at the start of your pregnancy; you had gestational diabetes during a previous pregnancy; or you have a mother, father, sibling or child with diabetes — your doctor may test for diabetes at your first prenatal visit.
If you're at average risk of gestational diabetes, you'll likely have a screening test for gestational diabetes sometime during your second trimester — typically between 24 and 28 weeks of pregnancy.
Your doctor may use the following screening tests:
Initial glucose challenge test. You'll begin the glucose challenge test by drinking a syrupy glucose solution. One hour later, you'll have a blood test to measure your blood sugar level. A blood sugar level below 140 mg/dL (7.8 mmol/L) is usually considered normal on a glucose challenge test, although this may vary at specific clinics or labs.
If your blood sugar level is higher than normal, it only means you have a higher risk of gestational diabetes. Your doctor will order a follow-up test to determine if you have gestational diabetes.
Follow-up glucose tolerance testing. For the follow-up test, you'll be asked to fast overnight and then have your fasting blood sugar level measured. Then you'll drink another sweet solution — this one containing a higher concentration of glucose — and your blood sugar level will be checked every hour for a period of three hours.
If at least two of the blood sugar readings are higher than the normal values established for each of the three hours of the test, you'll be diagnosed with gestational diabetes.
Prevention
Type 1 diabetes can't be prevented. However, the same healthy lifestyle choices that help treat prediabetes, type 2 diabetes and gestational diabetes can also help prevent them:
Eat healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom.
Get more physical activity. Aim
for about 30 minutes of moderate aerobic activity on most days of the week, or
at least 150 minutes of moderate aerobic activity a week.
Lose excess pounds. If
you're overweight, losing even 7% of your body weight — for example, 14 pounds
(6.4 kilograms) if you weigh 200 pounds (90.7 kilograms) — can reduce the risk
of diabetes.
Don't
try to lose weight during pregnancy, however. Talk to your doctor about how
much weight is healthy for you to gain during pregnancy.
To
keep your weight in a healthy range, focus on permanent changes to your eating
and exercise habits. Motivate yourself by remembering the benefits of losing
weight, such as a healthier heart, more energy and improved self-esteem.
Sometimes
medication is an option as well. Oral diabetes drugs such as metformin
(Glumetza, Fortamet, others) may reduce the risk of type 2 diabetes — but
healthy lifestyle choices remain essential. Have your blood sugar checked at
least once a year to check that you haven't developed type 2 diabetes.
Treatment
of Diabetes Mellitus
As a matter of
principle, over the course of the day, several smaller meals are recommended in
order to prevent greater fluctuations in the need for insulin. Alcohol inhibits
gluconeogenesis, thereby increasing the risk of hypoglycemia during insulin therapy.
If alcohol is consumed, carbohydrates should be consumed at the same time.
The opinion
that diabetic patients should be on a ‘diet low in sugars’ is widespread but
not advantageous. The need for glucose does not decrease because of the
disease.
Instead, a
balanced diet with slowly absorbable saccharides should be adhered to. In
connection with sufficient fibers, slow sugar absorption can be achieved,
reducing spikes in blood glucose levels. Fructose is processed independent of
insulin but leads to more dyslipoproteinemia and excess weight than other
sugars.
Pharmacological therapy for diabetes mellitus
Diabetes
mellitus type 1 essentially depends on insulin delivery due to its absolute
insulin deficiency. With regard to diabetes mellitus type 2, a phase-specific
step therapy consisting of weight normalization, oral antidiabetics and insulin
is implemented.
Oral
antidiabetic drugs (OADs)
The high
prevalence of diabetes mellitus has led to a wide variety of OADs. Here,
insulinotropic and non-insulinotropic medications should be differentiated.
- Non-insulinotropic
pharmaceuticals have a more peripheral effect
on the target tissue of the insulin and improve the effect of insulin on
these tissues. The risk for hypoglycemia is significantly lower here. They
are used especially at the initial phase of the disease.
- Insulinotropic
pharmaceuticals cause increased insulin
secretion in the beta cells and can also be used at the later stages of
the disease. There is, however, an increased risk for hypoglycemia.
Among the non-insulinotropic OADs are biguanides (metformin), alpha-glucosidase inhibitors (acarbose, miglitol), and glitazones (pioglitazone, rosiglitazone)
|
Non-insulinotropic antidiabetic |
Important characteristics |
|
Biguanides (metformin) |
First-choice OAD;
minimal risk of hypoglycemia or weight gain. |
|
Alpha-glucosidase inhibitor (acarbose,
miglitol) |
Inhibits the
splitting of disaccharides in the small intestine; minimal risk of
hypoglycemia or weight gain; frequent gastrointestinal side effects; works
almost exclusively on postprandial blood sugar levels. |
|
Glitazones (pioglitazone, rosiglitazone) |
Third-line
therapy in combination with, for instance, metformin, sulfonylurea or
glinides; minimal risk of hypoglycemia. Contraindications: heart
insufficiency, liver dysfunction; efficacy only after 2–4 weeks. |
Among the
insulinotropic substances are sulfonylureas (glibenclamide, glimepiride),
glinides (repaglinide, nateglinide), and glucagon-like peptide 1
(GLP1)-based therapy via dipeptidyl peptidase-4 (DPP4) inhibitors (sitagliptin,
vildagliptin, saxagliptin) or incretin mimetics (exenatide, liraglutide).
GLP1 is a small intestinal hormone,
which is released during meals, promoting insulin secretion and the release of
glucagon and inhibiting gastric emptying. Therefore, GLP1 primarily stimulates
insulin secretion under hyperglycemic conditions, meaning that under
normoglycemic conditions, GLP1 has a minimal effect.
|
Insulinotropic
antidiabetic |
Important
characteristics |
|
Sulfonylureas
(glimepiride, glibenclamide) |
They stimulate endogenous insulin secretion.
Sulfonylureas are commonly third-line therapy or used if metformin is
contraindicated. There is a risk of hypoglycemia and weight gain! Start off
with low doses and under observation! |
|
Glinides
(repaglinide, nateglinide) |
Similar effect to sulfonylureas with a significantly
shorter half-life which is why it is administered 3 times daily. Start off
with low doses under observation! |
|
DPP4
inhibitors (sitagliptin, vildagliptin, etc.) |
DPP4 is a key enzyme in GLP1 breakdown; due to
the pharmacodynamics there is no risk of hypoglycemia; weight-neutral |
|
Incretin
mimetics (exenatide, liraglutide) |
Have a structure similar to GLP1 but possess a
breakdown-resistant structure; subcutaneous application; no hypoglycemia;
weight loss could occur |
Insulin is a polypeptide
that causes glucose uptake in muscle and fat cells and supports anabolic
metabolism. Hereby, insulin also ensures the intercellular transport of
potassium.
Human usually
experience a permanent basal insulin release as well as a meal-dependent increased
insulin release in order to manage the sudden surplus of sugar. If there is an
absolute lack or relative deficit that can no longer be managed with OADs,
insulin therapy is required, which should resemble as much as possible
‘natural’ insulin production.
|
Insulin characteristics |
Insulin product |
|
Rapid-acting insulin |
Insulin lispro,
insulin aspart, insulin glulisine; fast availability through a change in the
amino acid sequence; efficacy after approximately 10 minutes; efficacy
duration approximately 3.5 hours; no waiting between injection and meals is
necessary. |
|
Short-acting insulin |
Regular insulin;
first-generation insulin; efficacy after 30–60 minutes; efficacy lasts
approximately 5 hours. If administered subcutaneously; a waiting period of
approximately 20 minutes between injections and meals is necessary. |
|
Intermediate-acting insulin |
NPH (Neutral
protamine hagedorn) insulin; efficacy after approximately 60 minutes;
efficacy lasts approximately 9–18 hours |
|
Long-acting insulin |
Insulin detemir,
insulin glargine; efficacy after 60 minutes; efficacy lasts up to 24 hours |
|
Pre-mixed insulin |
Mixes of
short-acting and long-acting insulin with different mix ratios |
Acute
derailments of blood glucose can be potentially life-threatening. Hyperglycemic
and hypoglycemic conditions can lead to somnolence and coma. These metabolic
conditions must be addressed quickly and correctly.
Hyperglycemia
Caused by
insulin deficiency, hyperglycemia leads to hyperosmolar syndrome with
intracellular dehydration.
Typical
symptoms are:
- Loss
of appetite
- Vomiting
- Thirst
- Polyuria
- Weakness
- Tachypnea
- Exsiccosis
At the same
time (especially in type 1 diabetes), there is increased lipolysis which,
through the accumulation of ketone bodies, leads to metabolic acidosis
(ketoacidosis) with pseudo-peritonitis or acidosis.
Therapy
requires intensive medical measures. Need-oriented rehydration with the
balancing of the hyperosmolar syndrome is crucial. Intravenous
regular insulin at a low dose along with regular laboratory monitoring should
achieve a mild decrease of the hyperglycemia. The acidosis can only be balanced
with a significant pH change (< 7.1) with careful administration of
bicarbonate.
Hypoglycemia
Different factors
can cause hypoglycemia in diabetes: excessive insulin, alcohol, sports, or
insufficient carbohydrates in the diet are the most frequent reasons.
Blood sugar
levels of < 50 mg/dL are indicative of hypoglycemia. If the blood sugar
level drops to the point that the assistance of third parties is needed, it is
referred to as severe hypoglycemia.
Alert
individuals can increase their low blood sugar with dextrose tablets or sugary
drinks (no sweeteners!!!). Unconscious patients are administered highly
concentrated glucose (20–60%) while regularly monitoring of their blood sugar
levels. Quick recovery should occur within minutes. If this does not occur,
another dose must be administered (while considering other reasons for the
unconsciousness).
Transplantation. In
some people who have type 1 diabetes, a pancreas transplant may be an option.
Islet transplants are being studied as well. With a successful pancreas
transplant, you would no longer need insulin therapy.
But transplants aren't
always successful — and these procedures pose serious risks. You need a
lifetime of immune-suppressing drugs to prevent organ rejection. These drugs
can have serious side effects, which is why transplants are usually reserved
for people whose diabetes can't be controlled or those who also need a kidney
transplant.
Bariatric surgery. Although
it is not specifically considered a treatment for type 2 diabetes, people with
type 2 diabetes who are obese and have a body mass index higher than 35 may
benefit from this type of surgery. People who've undergone gastric bypass have
seen significant improvements in their blood sugar levels. However, this
procedure's long-term risks and benefits for type 2 diabetes aren't yet known.
Treatment
for gestational diabetes
Controlling your blood sugar
level is essential to keeping your baby healthy and avoiding complications
during delivery. In addition to maintaining a healthy diet and exercising, your
treatment plan may include monitoring your blood sugar and, in some cases,
using insulin or oral medications.
Your doctor also will
monitor your blood sugar level during labor. If your blood sugar rises, your
baby may release high levels of insulin — which can lead to low blood sugar
right after birth.
Treatment for prediabetes
If you have prediabetes,
healthy lifestyle choices can help you bring your blood sugar level back to
normal or at least keep it from rising toward the levels seen in type 2
diabetes. Maintaining a healthy weight through exercise and healthy eating can
help. Exercising at least 150 minutes a week and losing about 7% of your body
weight may prevent or delay type 2 diabetes.
Sometimes medications —
such as metformin (Glucophage, Glumetza, others) — also are an option if you're
at high risk of diabetes, including when your prediabetes is worsening or if
you have cardiovascular disease, fatty liver disease or polycystic ovary
syndrome.
In other cases, medications
to control cholesterol — statins, in particular — and high blood pressure
medications are needed. Your doctor might prescribe low-dose aspirin therapy to
help prevent cardiovascular disease if you're at high risk. However, healthy
lifestyle choices remain key.
Prognosis
The prognosis in people with diabetes varies.
It depends on how well an individual modifies his or her risk of complications.
If blood sugar is not well controlled, it can increase a person's risk of heart
attack, stroke and kidney disease, which can result in premature death.
Disability due to blindness, amputation, heart disease, stroke and nerve damage
may occur. Some people with diabetes become dependent on dialysis treatments
because of kidney failure.
Conclusion
Type 1 diabetes cannot currently be
prevented. Effective approaches are available to prevent type 2 diabetes and to
prevent the complications and premature death that can result from all types of
diabetes. These include policies and practices across whole populations and
within specific settings (school, home, workplace) that contribute to good
health for everyone, regardless of whether they have diabetes, such as
exercising regularly, eating healthily, avoiding smoking and controlling blood
pressure and lipids.
The starting point for living well
with diabetes is an early diagnosis – the longer a person lives with
undiagnosed and untreated diabetes, the worse their health outcomes are likely
to be. Easy access to basic diagnostics, such as blood glucose testing, should
therefore be available in primary health care settings. Patients will need
periodic specialist assessment or treatment for complications.
Dr. Mayank Chandrakar is a writer also. My first book "Ayurveda Self Healing: How to Achieve Health and Happiness" is available on Kobo and Instamojo. You can buy and read.
For Kobo-
https://www.kobo.com/search?query=Ayurveda+Self+Healing
The second Book "Think Positive Live Positive: How Optimism and Gratitude can change your life" is available on Kobo and Instamojo.
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