April 21, 2017
Ambulatory Glucose Profile
India is known as diabetes capital of the world, for holding the maximum number of diabetic patients worldwide. With a huge population of 1.25 billion, India has a very high prevalence of Diabetes. Going by published data, every 8th Indian above the age of 40 years is diabetic.
Diabetes is defined as having high levels of glucose in blood, more than 125 mg/dl in fasting condition and more than 200 mg/dl 2 hours post meal (or post glucose challenge when done for diagnosing diabetes).But Diabetes is not just high levels of blood glucose. There are variety of causes, associated conditions and complications associated with diabetes. The worst part about diabetes is that the patient usually remain symptom free until the disease has progressed. And after being asymptomatic the patients of diabetes need to be treated for preventing the deadly complications that are very common in long term diabetic patients.
Types of Diabetes
The most common type of diabetes is Type 2 DM constituting about 95% of diabetic patients. We will restrict our discussion to type 2 DM in this article. Diabetes seen in very young children who are not at risk of type 2 DM is called type 1 DM. Patients of type 1 DM usually require insulin injections and cannot be treated with oral medicines. Some females develop a temporary type of diabetes during pregnancy and is called as gestational diabetes. There are number of other secondary types of diabetes which are rare and may not be discussed here.
What causes Diabetes?
It would be necessary to understand the concept of Insulin Resistance which has been explained in an earlier article. Type 2 DM is traditionally considered as disease of dual defect, though several new defects are being discovered now. In addition to insulin resistance the patient has insulin deficiency. So the body produces less amount of insulin and the insulin produced is not able to produce the desired results. Due to shortage of insulin the cells fail to take up glucose and that leads to high levels of glucose circulating in blood.
How does it harm?
On the one hand the cells of body are starving as they cannot take up insulin while on the other hand the high levels of glucose circulating in the blood keep damaging other organs. High levels of glucose for a short period may not harm the body unless the levels are very high but in long term it leads to various complications.
What are symptoms of diabetes?
In early stage of diabetes when the blood glucose levels are not very high, the patient may not feel anything at all. If the glucose levels go further high beyond renal threshold, it is filtered through kidneys. Glucose is passed out through urine, and with osmotic pressure it pulls water out. This leads to frequent urination. Due to frequent urination body is short of water and patient feels thirsty and drinks more water. Though the glucose levels in blood are high, cells are unable to take it up. The cells are starved and that leads to weakness, fatigue. This also passes on signal to brain and leads to excessive hunger. The glucose generated from food that patient takes is passing out through urine. So in spite of excessive eating the patient may start losing weight. The patient may also feel abnormal sensation in his feet, he may feel dizzy. Wounds may not heal soon and patient gets more prone to number of infections. In patients with long standing diabetes there might be some other symptoms due the complications of diabetes described below.
What are the complications?
As explained in the article on Insulin Resistance, people with high insulin resistance are prone to atherosclerosis (thickening of arteries supplying blood to various organs). Due to this the blood supply to various organs is hampered. If small vessels are affected it leads to complications like Neuropathy (abnormal sensation starting with feet usually), retinopathy (which may lead to loss of vision) and Nephropathy (which may lead to kidney failure). If the large vessels are affected it can lead to heart attack, paralysis or gangrene.
How to prevent diabetes?
People with family history of diabetes, obesity, inactivity are at high risk of developing diabetes. Routine check up should be done after age of 30 years. A healthy diet with limited carbohydrates (specifically sweets) and high proteins should be consumed. Regular exercise of at least 45 minutes a day is the best for prevention. There are a few drugs that your doctor may prescribe.
How to treat diabetes?
Controlling high levels of blood glucose is the easiest task that even a pharmacist can do. But treating diabetes is far beyond controlling blood glucose levels. The drugs to be used vary from person the person. An expert in diabetology is the best person to choose drugs for a patient. Wrong choice of drugs may control blood glucose levels in initial stages but may lead to beta cell failure, making the patient dependent on insulin injections. The most important aspect of treating diabetes is preventing deadly complications that may arise a few years later.