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Diabetes Guide
Get help on the following topics on insulin and diabetes
What is Diabetes?
Causes of Diabetes
Types of Diabetes
Symptoms of Diabetes
Diagnosing Diabetes
Diabetes Urine Tests
Diabetes Blood Tests
Ketoacidosis
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What is diabetes?
What is diabetes?
The medical term 'Diabetes Mellitus' is derived from the Greek words 'syphon' and 'sugar', describing symptoms of uncontrolled diabetes, passing huge amounts of urine containing sugar-glucose.
Diabetes is a condition characterized by high blood sugar (glucose) levels due to a lack or insufficient production of a hormone called insulin in the body. Insulin is responsible for decreasing the blood sugar levels and aids in producing energy for the cells. Without enough insulin, glucose obtained from the food builds up in the blood stream leading to a hike in blood sugar levels above than the normal limits. This causes many health complications.
It is a lifelong condition that can be managed with careful diet control and proper medication (either oral or insulin medication) under your physician's and dietitian's supervision.
How?
We eat rice, bread, fruit, vegetables, sweets, meat, butter, eggs, etc. Of these, the group called carbohydrates, found usually in wheat, rice, fruits and potatoes is converted into glucose or sugar. Glucose is the energy supplier to all body cells, which in turn powers and runs the whole human body. The extra glucose is stored in the liver and muscles.
Now, glucose can't just go straight into the cells, as on the surface of the cell wall, there are receptors, the proteins. Hormones in the body can act on cells through receptors. Glucose enters cells only if insulin, which is a hormone, attaches itself to the receptor cell wall. By going and attaching itself like a magnet to the receptors, insulin helps cells to extract glucose from the blood.
When there is absolutely no insulin supply or if it is insufficient or the quality is poor or abnormal, the glucose can't enter your cells. Consequently, there is not enough energy to run your body and everything begins to shut down and you become a diabetic.
What is Insulin?
Insulin comes from the pancreas, a six-inch long gland, about 100 gm, placed behind your stomach between the kidneys.
In healthy people, the pancreas produces many fluids and enzymes, one of them being insulin.
In a person with diabetes, the pancreas produces no insulin or not enough or the quality of insulin produced is not good. And, in all these cases, it shows that there is something wrong with your system, it's not normal. The end result being glucose floats around in your bloodstream, at different levels, unable to enter cells, get processed and converted into energy to run the body. So, all this excess sugar remains in your blood.
Causes of Diabetes
Causes of Diabetes
Even after so much of advancement, particularly in the past 50 years, no one is very sure, about the why and how of diabetes? The reason varies from person to person and country to country. But never ever compare one person with another. Each human is a totally different entity. Still, we can put the causes into certain broad categories.
Diabetes was once considered a malady of the affluent society. It is no longer so. Today, diabetes makes no distinction between the rich and the poor. It strikes men as well as women, young as well as old, urbanites as well as villagers.
All the causative factors of diabetes have still not been discovered. Yet, the known factors have been discussed below :
What commonly causes Diabetes?
Genetics (heredity)
Obesity
Irregular and unhealthy eating habits
Stress
Other Reasons
Causes of Diabetes- Genetics (Heredity)
Causes of Diabetes- Genetics (Heredity)
A reference to the familial nature of diabetes can be found in ancient medical texts too. Of the total diabetics, more than 46 per cent give a family history of the disease.
There are varied opinions about how parents pass on this disease to their children. But none has been able to fully explain how heredity actually acts.
Till recent past, it was believed that the hereditary character of diabetes follows the principles of renowned geneticist Mendell, i.e.,
(1) If both the parents are diabetics, all their children get the disease,
(2) If one of the parents is a diabetic and another is a diabetes-carrier (one who does not have the disease, but can transmit it), half the number of their children get the disease,
(3) If both the parents are diabetes-carriers, one fourth the number of their children get the disease and
(4) If one of the parent is a diabetic and other is healthy, their children remain free from diabetes.
Some researchers believe that diabetes develops not because the person has inherited defective chromosome from his parents but because he has not received that chromosome from his parents, which imparts resistance to this disease.
In short, it can be said that even though hereditary factors do play a role in the development of diabetes, to what extent and in what way these factors act is still a mystery.
It can be said that hereditary factors can become effective only when certain other exciting environmental factors like obesity, faulty dietary habits and inadequate physical exertion are at work.
Causes of Diabetes - Obesity and Inadequate physical work
Causes of Diabetes - Obesity and Inadequate physical work
Obesity
Nearly ninety per cent of overweight people will develop diabetes when around 40 to 60 years of age. The more you eat, the more the demand for insulin and the pancreatic cells collapse. Fat cells of fat people do not respond to regular supply of insulin. With less quantity and quality food and regular exercise, 80 per cent of the time your diabetes will disappear provided you developed diabetes only because of overweight. Obesity is a risk factor for Non-Insulin Dependent Diabetes Mellitus (niddm). But in case you are insulin dependent, obesity may not have much of a role to pay.
Inadequate physical work
Because of the industrialisation, man has drifted away from physical labour. Sedentary life, too, plays an important role in the origin of diabetes. During physical work, muscles use up a lot of glucose present in the blood. Consequently, the work-load on the pancreas is reduced. Moreover, physical labour also prevents or reduces obesity, which is intimately connected with diabetes.
Causes of Diabetes - Irregular and unhealthy eating habits
Causes of Diabetes - Irregular and unhealthy eating habits
Food can maintain or save life; it can destroy life as well. Proper food serves the purpose of medicine while improper food works as poison and causes disease.
We may take pride in calling ourselves highly civilized; but we have started to flout all the norms about the quality and quantity of food. Attracted to material pleasures, we have become slaves to our tongues. We have deleted bran from the flour; we mostly eat processed foods and refined sugar. In short, we have drifted away from mother nature, thereby initiating a rise in the incidence of diabetes. This fact is applicable to all the developing countries which have been influenced by western culture and lifestyle.
By offering chocolates, cakes and ice creams too often to our children, by giving the refrigerator a place in our homes and by attending parties every other day, we in fact invite obesity and diabetes.
for the origin of diabetes, excessive food is as much to be blamed as improper (i.e., refined and processed) food. The body has to produce more digestive juices and insulin to digest excessive food. Under the pressure of such excessive work-load, the pancreas gland weakens and ultimately breaks down, leading to diabetes.
Many a renowned researcher holds the belief that a deficiency of vitamin B6(pyridoxine) in our diet may also be a cause of diabetes. Lack of Vitamin B causes the transformation of tryptophane (an amino-acid present in our diet) into xanthurenic acid which harms the beta cells of the pancreas to cause diabetes.
Consumption of food containing excessive animal proteins, saturated fats and calories also stimulates the production of xanthurenic acid inside the body. A similar effect is produced by the penicillin group of drugs.
Some researchers believe that diabetes arises not because of inheriting defective chromosome but because of genetically determined excessive requirement of vitamin B6 Of course, further research and investigations are called for to validate this belief.
Causes of Diabetes - Stress
Causes of Diabetes - Stress
Stress is a very major factor, which not only leads to diabetes but also heart problems, blood pressure and even cancer. When you are under great stress, your body function, electronic system, signals all go haywire and negative juices, enzymes, hormones, cortisones are released. When that happens, nothing works positively. In some cases, even insulin does not help the cells to function positively and normally.
At the same time, stress is also a normal part of life and a normal reaction to challenges and problems that we face. When you are under stress and can't cope with the pressure, the body releases stress hormones and cortisones, the liver releases sugar and blood-sugar rises.
It is in these circumstances that good friends, family, religion, yoga, psychologists can be of real help in countering or reducing stress and stress-related problems.
Causes of Diabetes - Other Reasons
Causes of Diabetes - Other Reasons
Viral infection:
After severe viral flu, viral infection, mumps, quite a few children and grown-ups show diabetic symptoms. In some cases, anti-bodies that are the soldiers to fight any virus or aliens that enter the body, turn around and start attacking the very body cells that they are supposed to protect, like beta cells in pancreas.
Hormones :
Some hormones produced in the body have an action opposite to that of insulin, i.e., they increase the amount of glucose in the blood. Such hormones include glucagon, cortisone, growth hormone, adrenaline and thyroxine. If the secretion of these hormones is excessive, the effectiveness of efficiency of insulin decreases and blood glucose level rises.
Side Effects of Certain Drugs:
Long-term use of certain drugs like cortisone (used for asthma, respiratory diseases, arthritis and skin-diseases), contraceptive pills and thyroid group of drugs can also produce diabetes by harming the pancreas.
Psychological factors :
Acute emotional upset, shock or mental stress may unmask latent diabetes. However, this factor plays a greater role in enhancing established diabetes than in actually causing this disease.
Types of Diabetes
Types of Diabetes
Type-1: It is definitely the far more serious and complicated, the simple reason being in this that the pancreatic beta cells are totally dead or defective, and hence no production of insulin. Therefore, regular, lifelong, insulin injections are required to maintain normal blood sugar.
Children, young men, women and those whose sugar levels can't be controlled by tablets come under this category. It can happen to older persons, too, but very rarely. It is also termed as Juvenile Diabetes, Insulin-Dependent Diabetes Mellitus or IDDM. This illness develops fast.
Type-II: Nearly 90 per cent of diabetics come under this category. Their bodies produce little or defective insulin. Most of them develop this type of diabetes when they are around 40 to 50 years of age, and if they follow proper diet and exercise, can live on tablets without ever having to take insulin. But usually they don't take it seriously and they end up with insulin sometime in their lives.
It's also termed maturity-onset diabetes, non-insulin dependent diabetes mellitus or NIDDM. This illness progresses slowly.
Some Other Types
Malnutrition-related diabetes: Millions, especially among the rural population, suffer from malnutrition-related diabetes. Also young people with severe malnutrition and starvation, develop diabetes.
Gestational diabetes: Some women have high blood sugar during pregnancy. This is termed gestational diabetes. 95 per cent of the gestational diabetes disappears after childbirth. If women are below 25 years, it's very rare. Generally, gestational diabetes symptoms are mild.
Symptoms of diabetes
Symptoms of diabetes
The following symptoms point towards a possibility of diabetes :
Increased thirst and Dryness of mouth
Increased thirst naturally leads to frequent urination. Your kidneys continuously filter thousands of litres of blood per day. They flush out the waste and water as urine and keep good filtered blood and glucose. In a diabetic's blood, there is extra glucose, more than what the kidney can absorb, so to flush it out, it draws more water to get it out as urine. The more water you drink more urine there will be, more urination, more thirst, increased hunger, tiredness and loss of weight.
Excessive and frequent urination :
The sugar escaping in the urine, drags along with itself, a large quantity of water. A diabetic, therefore, frequently passes large amounts of urine.
Excessive hunger :
In diabetes, glucose cannot enter the various body cells. Thus the cells starve in spite of being bathed by the glucose-rich serum. They suffer from 'poverty in the midst of plenty'. To overcome this cellular starvation, the body gives rise to abnormal and excessive hunger.
Loss of weight:
When the cells cannot utilise glucose, the body disintegrates stored fats to provide the cells with the necessary nourishment. Therefore, the person loses weight.
Weakness, fatigue and body ache:
The body also disintegrates stored muscle-protein to nourish the starving cells. This is the cause of undue weakness and fatigue.
Mental fatigue and lack of concentration:
The brain-cells have to depend chiefly on glucose for their nourishment. However, they cannot utilize the available glucose, due to which the person experiences undue mental fatigue, cannot concentrate and becomes forgetful.
Cuts, wounds, boils, and sores not healing:
Glucose rich blood is a good breeding medium for pus forming micro organisms. Moreover, diabetes also affects the small blood vessels (micro angiopathy) and nerves (neuropathy) leading to a decrease in the blood-supply of the skin and derangement of skin-sensations. That is the reason why even a small wound on a diabetic person's body easily gets infected and fails to heal in time.
Skin itching all over the body, especially that of the genital parts:
Skin infections, especially around genital area, vaginal infections in women, urinary track infections.
Frequent changes in the sharpness of vision and the spectacle Numbers:
Changes in the glucose concentration of the internal fluid (aqueous) of the eyes leads to variations in their focusing power. That is the reason why a diabetic has to often change his spectacle lenses. The crystalline lens of the eye depends, for its nourishment and transparency, on the glucose dissolved in the aqueous. In diabetes, the nourishment of the crystalline lens is jeopardised, leading to an untimely cataract.
Continuous ache, pain in your legs and feet including numbness, burning sensation, or no sensation.
Frequent changes in the sharpness of vision and the spectacle numbers:
Changes in the glucose concentration of the internal fluid (aqueous) of the eyes leads to variations in their focusing power. That is the reason why a diabetic has to often change his spectacle lenses. The crystalline lens of the eye depends, for its nourishment and transparency, on the glucose dissolved in the aqueous. In diabetes, the nourishment of the crystalline lens is jeopardised, leading to an untimely cataract.
Sexual debility or impotence :
General weakness, disintegration of muscle-protein, mental depression and undesirable changes in the blood-circulatory and nervous systems give rise to these symptoms.
Diabetic unconsciousness (hyperglycemic coma) :
As stated earlier, the body disintegrates stored fats to nourish starving cells. Fat disintegration leads to the production of ketone bodies in the blood. Excessive increase of ketone bodies makes the blood acidic and gradually leads to unconsciousness. Many a time, diabetes is suspected or diagnosed after the victim becomes unconscious.
Diagnosing Diabetes
Diagnosing Diabetes
Doctors will send you for a routine check-up even when you are not a diabetic or even when you don't have any symptoms of diabetes. This check-up will include random blood sugar and urine test. This can be done any time of the day or night, it does not matter where you go or what you have eaten or drunk.
If the doctor sees some signs of you becoming diabetic in future, he will ask you to go for a test that is after dinner. You will be told not to eat anything or drink anything till next morning; no breakfast, coffee, and tea.
All tests must be conducted under absolutely normal conditions, not when you have just recovered from sickness, or when you have been in bed for long time or after a travel binge. The test results will not be correct.
A common mistake which even most educated people make is when they go for these tests before breakfast; they will not take the medication which they usually take, so the results will not be correct. Many doctors will not advise the patients about what medication to take and what not to take before they go for different diagnostic tests. As a matter of fact, all doctors and people at the diagnostic labs will re-check and ask you, 'Hope you have not taken anything, no coffee, no tea?'
Diabetes Urine Test
Diabetes Urine Test
When it comes to Diabetes test urine testing is an essential part of complete physical examination routine. Urine test will help in diagnosing state of the body and provide valuable information.
However, urine test are rarely used to diagnose diabetes. They are less accurate and are difficult to understand. And level of sugar in the blood required for producing sugar in the urine changes from person to person. A person can have blood sugar without having sugar in the urine.
Benedict's test to detect the presence (or absence) of sugar in the urine is extremely simple and should be learnt by every diabetic. Even when sugar has been found to be present in the urine, the diagnosis of diabetes should be confirmed by blood-sugar estimation.
The following are the two tests done to diagnose the diabetes in urine:
Diabetes Urine Test - Benedict's Test
Diabetes Urine Test - Benedict's Test
This is a very simple and effective method of ascertaining the presence or the amount of glucose in the urine and can be done by the diabetic himself.
Apparatus :
Benedict's solution (fresh; certainly not more than 3 months old),
Dropper,
Test-tube,
Test-tube holder.
Procedure:
Take 5 ml (one teaspoon) of Benedict's solution in the test-tube.
Holding the test-tube with the holder, heat it over a spirit lamp till the Benedict's Solution boils without overflowing.
Drop 8 to 10 drops of urine into the boiling Benedict's solution.
After again boiling the mixture, let it cool down.
While cooling, the mixture changes colour.
The colour of the mixture serves as a guide to the amount of sugar in the urine : blue-sugar absent; green-0.5% sugar; yellow-1% sugar; orange-1.5% sugar; brick red-2 % or more sugar.
It is essential that the above test be performed two hours after a meal. In the initial stages of the disease, a diabetic does not lose sugar in his urine, when on empty stomach. Hence if the Benedict's test is performed in the fasting state, it is possible to miss the diagnosis of the disease.
Even if sugar is detected in the urine by Benedict's test, the diagnosis of diabetes should be confirmed by blood-analysis.
Diabetes Urine Test - Glucose Oxidase Test
Diabetes Urine Test - Glucose Oxidase Test
Paper or plastic strips, called diastix or tes-tape are available in the market. A colour-chart is provided along with the strips. While passing urine two hours after a meal, the person has to hold a tes-tape or a diasix strip in the urine-stream for a few moments.
The strip changes colour on coming in contact with the urine. After 30 to 60 seconds the colour of the strip should be matched with one of the colours of the provided chart to assess the amount of sugar in the urine.
Both the above tests are more simple and sensitive than Benedict's test; but they are somewhat expensive. They are very useful to a person who is away from home.
The note given below Benedict's test is applicable to glucose oxidase test as well.
Diabetes Blood Test
Diabetes Blood Test
It should be noted that a certain amount of sugar is always present in the blood and necessarily so. In diabetes, the blood-sugar level rises above the normal or physiological limits. Diabetes Blood tests are done to detect the amount of sugar in the blood.
The below are the tests done for Blood Sugar:
Diabetes blood Test - Fasting blood sugar and Post-prandial blood-sugar:
Diabetes blood Test - Fasting blood sugar and Post-prandial blood-sugar:
Fasting blood sugar
A sample of the blood is obtained when the person is in a fasting state and the amount of sugar is assessed.
This test alone is not adequate for the diagnosis of diabetes because in early or mild diabetes, the blood-sugar values may be normal in the fasting state. Thus a diagnosis of diabetes may be missed.
However' if the amount of blood-sugar in the fasting state is found to be greater than 140 mg% on two separate occasions, it is a sure indication of diabetes.
Post-Prandial blood sugar (amount of sugar in the blood after a meal or after consuming 75 gms of glucose):
A blood sample is obtained two hours after having a carbohydrate-rich meal and the amount of sugar present is determined.
According to the WHO criterion, if the amount of blood-sugar two hours after a meal is greater than 200 mg% on two separate occasions, diabetes is present. Blood-sugar values between 140 and 200 mg% should be termed 'impaired glucose tolerance'.
This is a more reliable test to diagnose diabetes than fasting blood-sugar estimation.
Diabetes blood Test - Glucose tolerance test:
Diabetes blood Test - Glucose tolerance test:
This is a superb test to evaluate the metabolism of dietary carbohydrates in the body.
After taking the evening meal on the day prior to the test-day, the person should not eat or drink anything. He should not even smoke. On the test-day, the person should go for the test early in the morning, with an empty stomach.
First of all, urine and blood samples are collected to determine fasting urine-sugar and blood-sugar. After overnight fasting, your blood will be tested for glucose, then you are given a certain amount of glucose to drink, then for every 30 minutes, your blood will be retested to see how your body is handling the glucose. Simultaneously, your urine will also be tested.
The following characteristics are seen in a healthy person during this test:
Fasting blood-sugar level is less than 120 mg% (many a time 100 mg%).
The amount of glucose in the blood rises to a maximum value in 30 to 60 minutes after the meal. This maximum value is not more than 160 mg%.
Two hours after the meal, the blood-glucose level comes down to the fasting level.
Diabetics, on the other hand, show the following characteristics during this test :
Fasting blood-sugar level is equal to or greater than 140 mg%. However, in early or mild diabetes the value obtained may be a little lower, say 120 mg %.
After the meal, the concentration of blood-sugar takes more than an hour to reach the maximum value. This maximum value is equal to or greater than 200 mg %. However in early or mild diabetes the maximum value obtained may be180 mg%.
Two hours after the meal, the amount of blood-glucose is still quite high (140 mg% or more) as compared to normal.
Normal:
Fasting Value less than 120 mg
Maximum Value less than 160 mg
Value two hours after consuming glucose less than 120 mg
Early (borderline):
Fasting value 120 to 140 mg
Maximum value 160 to 180 mg
Value two hours after consuming glucose 120 to 140 mg
Established Diabetes:
Fasting Value more than 140 mg
Maximum value 200 or more mg
Value two hours after consuming glucose more than 140 mg
Diabetes blood Test - Stress (steroid primed) glucose tolerance test:
Diabetes blood Test - Stress (steroid primed) glucose tolerance test:
This test is more important to detect prediabetes or latent diabetes. The logic behind this test is that if persons with a possibility of developing diabetes in future (especially those having a family history of the disease) are given, besides glucose, a steroid drug like cortisone (50 mg) or prednisone (10 mg) or triamcilone (8 mg), a physical state resembling diabetes develops; such a diabetes like state cannot be developed in healthy persons even with steroid drugs.
The procedure of this test is exactly similar to that of glucose tolerance test. After the person consumes 75 gms of glucose and the steroid drug (in above-mentioned amount), blood samples are periodically drawn from his body. If the blood-sugar is 1600 mg or more after one hour or 140 mg or more after two hours, the person may be considered to be in a prediabetic or latent-diabetes state and may develop frank diabetes in the future.
Diabetes blood Test - Glycosylated haemoglobin test
Diabetes blood Test - Glycosylated haemoglobin test
This test is not important to detect diabetes. It is more important to judge the control of diabetes during a period of 6-10 weeks prior to the test, in a person undergoing treatment for the disease.
The haemoglobin present in the red blood corpuscles has a tendency to get bound to glucose. The greater the blood-glucose concentration, the greater is the amount of glucose-bound (called glycosylated) haemoglobin. Such glucose haemoglobin linkage is quite stable and lasts for 60 to 120 days (the life-span of red blood corpuscles). Thus the amount of glycosylated haemoglobin is a sure guide to the concentration of glucose in the blood during the past 6-10 weeks (i.e., the degree of control over the disease achieved).
To detect the amount of glycosylated haemoglobin, the blood is passed through a chromatographic column, where glucose-bound haemoglobin separates out from normal haemoglobin. Normal and abnormal values of glycosylated haemoglobin have been given below.
Amount of Glycosylated Haemoglobin
Control of Diabetes
6 to 8 %
Excellent
8 to 10%
Good
10 to 12%
Satisfactory
Above 12%
Unsatisfactory
This test is most important for pregnant diabetic women because uncontrolled diabetes may risk the lives of the mother and the child; therefore ignorance about the degree of control of the disease is undesirable.
Diabetes blood Test - Glutamate Acid Di-carboxylase (GAD) test:
Diabetes blood Test - Glutamate Acid Di-carboxylase (GAD) test:
A new test, the Glutamate Acid Di-carboxylase (GAD) test, can predict the onset of diabetes, especially type-I (insulin dependent) 10 years in advance. If the test shows very high anti-bodies, it means you are heading for diabetes in future. So you can take all precautions and, maybe, prevent it altogether. GAD test costs about Rs 350, but it is good to have it done every year.
If there is diabetes in your family, it's better to go for GAD test and if you are on the suspect list, you should avoid all kinds of refined sugar, ice creams, cakes, halwa, payasam and ghee. Eat plenty of greens, whole wheat, lentils, drink plenty of water (at least three litres a day) and do regular exercise. You can prevent or delay diabetes or at least delay for a fairly long time the onset of diabetes.
If any of your family members has had or has any of these problems or symptoms, like diabetic history, sudden death of someone before 45 years of age, heavy cigarette smoker, heavy drinker, heavy consumer of sweets and saturated fats, increased waist-hip ratio, beer-belly, lazy bones and feeling tired most of the time, then you must go for this test (GAD) and save yourself a lot of agony in future.
Ketoacidosis (Diabetic Coma)
Ketoacidosis (Diabetic Coma)
Diabetic coma or ketoacidosis, primarily affects Type-I diabetics. Type-II diabetics can also get it, but it's rare, and is called non-ketonic. Today, however, the mortality rate due to this complication has been brought down to 1 -2 %, thanks to effective treatment with insulin.
This type of unconciousness ensues when the concentration of glucose in the blood rises much above normal, a condition called hyperglycemia. When diabetes is very much out of control, the body cannot use glucose for energy. So, it starts burning fat for energy and the waste product of this process is termed ketones and the resulting complication is termed ketoacidosis (blood becomes highly acidic).
Ketoacidosis Symptoms
Excess urination
Thirst
Stomach ache
Rapid, erratic breathing
Nausea
Vomiting
Unconsciousness Diabetic coma
Hypoglycemia
Diabetic may become unconscious even when the concentration of glucose in the blood drops much below normal (a condition called hypoglycemia).
Symptoms:
Sleepiness
Trembling
Intense hunger, weakness
Sweating
Slight heaviness or loss of control of your lips and tongue
Palpitation, quick pulse
You may feel disoriented and angry
Confusion
In severe cases, unconsciousness or seizures may occur, called insulin coma.
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