Diabetes Mellitus Type 2

Type 2 Diabetes Mellitus is a common form of diabetes that mainly develops in adults and most often in obese individuals. The moment one is diagnosed with type 2 diabetes mellitus your tea becomes without sugar along with bringing full stop to consumption of sweets and chocolates and the story ends there.  What most people miss out is to reduce/limit consumption of fat as in this act fat is the main villain.

Insulin hormone facilitates movement of glucose in to the all body cells, due to which we derive energy to carry out daily activities. With increased consumption of fat, it gets deposited in and around the cells. This fat obstructs the action of insulin thus more insulin is required and slowly insulin producing cells are exhausted and cannot meet the demand of excess sugar in the blood thereby unable to clear the glucose load, thus leading to high sugar condition. Diabetes is not caused by the sugar but rotates around sugar control.

Risk of developing type 2 diabetes include:

  • People with prediabetes.
  • People having dark velvety patch on their neck, armpits, groin area known as acanthosis Nigerians and small mole like boils called skin tags on their neck.
  • People aged 35 and over who are, Asian (including the Indian subcontinent, or of Chinese origin) Middle Eastern, North African or Southern European.
  • People who are obese or overweight, have high blood pressure or have a first-degree relative with type 2 diabetes.
  • All people with cardiovascular disease such as heart attack, angina, stroke, or narrowed blood vessels.
  • Women with polycystic ovary syndrome (PCOS) who are overweight.
  • Women who have had gestational diabetes.
  • People taking certain antipsychotic medication or corticosteroid medication.

Lifestyle risk factors for type 2 diabetes include:

  • Being overweight or obese, especially around the waist; Males more than 90cms and females more than 80cms.
  • Low levels of physical activity, including more than two hours of television watching per day.
  • Unhealthy eating habits, such as regularly choosing high-fat, high-sugar, high-salt or low-fibre foods.
  • Cigarette smoking.
  • You can assess your and your family’s risk of developing type 2 diabetes by completing the Indian diabetes risk score test.

Common symptoms of type 2 diabetes include:

  • Increased thirst and frequent urination. Excess sugar in the blood pulls in water from the nearby cells making them dehydrated and leaves you thirsty. As a result, you may drink and urinate more than usual and may have wake up in the night more frequently for urination.
  • Increased hunger. Without enough insulin to move glucose into your cells or obstacle to insulin to help glucose move into the cells, your cells and organs become depleted of energy. This triggers intense hunger.
  • Weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine.
  • Glucose is normally one of the body’s main sources of energy. When cells cannot absorb sugar, you can become fatigued or feel exhausted and irritable in spite of eating food.
  • Blurred vision. If your blood sugar is too high in the blood, fluid is retained in the lenses of your eyes making newspaper reading better and television screen blurred. This affects your ability to focus.
  • Slow-delayed or non-healing of sores/cuts/wounds or frequent infections. Elevated glucose levels may make it harder for your body to heal. Therefore, injuries like cuts and sores stay open longer. This makes them more susceptible to infection.
  • Areas of darkened skin. Some people generally obese, have patches of dark, velvety skin in the folds and creases of their bodies, usually near the armpits and neck. This condition, called acanthosis Nigerians, which is a sign of insulin resistance.
  • Erectile dysfunction

According to the American Diabetes Association, diabetes can be diagnosed through any one of the following tests:

  1. A glycated hemoglobin test, which is commonly referred to as an HbA1c, or simply A1c, test. This test measures the body’s average blood sugar levels from the past 3 months. An A1c of 6.5% or higher is considered a diagnosis of diabetes, 5.7% to 6.4% is considered prediabetes, and an A1c of under 5.7% is considered normal.
  2. A fasting plasma glucose (FPG) test, which measures the body’s glucose level after fasting (no caloric intake) for eight hours. An FPG result of 126 mg/dl or greater indicates a positive diagnosis of diabetes. Fasting sugar between 100 and 125 mg/dl is called as impaired fasting glucose (Prediabetes Stage).
  3. An oral glucose tolerance test (OGTT), which measures the body’s blood glucose level two hours after the intake of 75-grams of glucose. An OGTT result of 200 mg/dl or greater indicates a positive diagnosis of diabetes. Post meal sugar between 140 to 199 mg/dl is called impaired glucose tolerance (Prediabetes Stage).

With continuous lifestyle modification and correct dosage of insulin if following results are achieved and maintained forever, then insulin can be stopped in Type 2 Diabetes forever.

  • Waist:

Male less than 90 cms or 36 inches

Female less than 80 cms or 32 inches

  • Weight:

Male Height in cms -100 = ____ Kg

Female Height in cms -105 = ____ Kg

  • Blood Pressure:

<140 / 80 mmHg

  • Blood Sugar:

HbA1c: < 7%

Fasting Blood Sugar: <120mg/dl

Post Lunch Blood Sugar: <160 mg/dl

Post Dinner Blood Sugar: <<160 mg/dl

  • Fat:

Cholesterol: <200 mg/dl

Triglycerides: <150 mg/dl

LDL: <100 mg/dl

HDL: <45 mg/dl

Complications

Avoiding complications requires regular disciplined continuous consistent efforts to maintaining healthy eating pattern, physical activity, blood sugar monitoring and optimal use of medications as per blood sugar levels. These complications develop over many years, high blood glucose can damage the body’s blood vessels, both tiny and large.

Damage to your tiny blood vessels causes microvascular complications; damage to your large vessels causes macrovascular complications.

Microvascular Complications: Eye, Kidney, and Nerve Disease

High blood sugar damages the small blood vessels by consistently high blood glucose over time. Damaged blood vessels don’t deliver blood as well and leads to other problems, specifically with the eyes, kidneys, and nerves.

  • Eyes: High blood sugars for a long period of time can cause cataracts and/or retinopathy in the eyes. Both can cause loss of vision. To avoid eye problems associated with diabetes, keep your blood glucose within range and have yearly eye check-ups that include a dilated eye examination by an eye doctor specialized in diabetic retinopathy to monitor your eye health.
  • Kidneys: If untreated, kidney disease (also called diabetic nephropathy) leads to impaired kidney function, dialysis and/or kidney transplant. Uncontrolled (or poorly controlled) diabetes can cause the kidneys to fail; they’ll be unable to clean the blood properly.
  • To prevent diabetic nephropathy, you should be tested every year for microalbuminuria, which is a condition that’s an early sign of kidney problems. The test measures how much protein is in the urine. This test is easily done with a urine sample. When the kidneys begin to have problems, they start to release too much protein. High blood pressure is frequently accompanied by Proteinuria.
  • Nerves: Nerve damage caused by diabetes is also known as diabetic neuropathy. The tiny blood vessels “feed” your nerves, so if the blood vessels are damaged, then the nerves will eventually be damaged as well.
  • In type 2 diabetes, some people will already show signs of nerve damage when they’re diagnosed. This is very serious as complications are already existing and better control is must.
  • There are various forms of diabetic neuropathy: peripheral, autonomic, motor and sensory, and focal. Diabetic peripheral neuropathy is the most common form of nerve damage, and it most often affects the nerves going to the hands and feet.
  • Another serious complication of diabetic peripheral neuropathy in the feet is that people may not realize when they have a sore on their foot. The sore can become infected, the infection can spread, and left untreated, the foot may get infected and need to be amputated.

Macrovascular Complications: The Heart, Brain, Blood Vessels and Feet

Type 2 diabetes also affects the large blood vessels, causing plaque to eventually build up and potentially leading to a heart attack, stroke or vessel blockage in the legs blood supply (peripheral vascular disease).

To prevent heart disease and stroke as a result of diabetes, you should also make heart-healthy choices in other areas of your life: don’t smoke, keep your blood pressure under control, and pay attention to your cholesterol.

Treatment

A car cannot move ahead unless its four wheels are in its place, similarly treatment of diabetes has four aspects which need to be in sync, which can be called as four wheel of my health car. Absence of even one wheel makes the journey with diabetes impossible.

These four wheels of health care are as follows:

  • Healthy Food
  • Exercise
  • Monitoring of blood sugar and other blood parameters
  • Stress Management, medication, insulin

To keep diabetes in a good control such that you aren’t faced with any diabetes related complications these four aspects have to be maintained on lifelong basis. This isn’t a punishment but a formula to remain disease free, healthy and happy. Maintaining good health is a process and has to be done continuously and regularly.

Health Food: Every time you eat remind yourself whether you are fulfilling body’s biological needs or feeding the cravings cropping up in your mind. Decide whether you are eating to live and living to eat!

Include foods rich in protein, fiber, complex carbohydrates. Avoid fried, refined food products and all simple sugars. Stay away from addictions and all kinds of processed food.

Exercise: Regular exercise all days a week goes long way in maintaining fitness, stamina and blood sugar control. Exercise improves insulin sensitivity of the cells as well as it releases feel good hormones which make you happy(endorphins).

Medications: Your medications will work if you work. Main focus has to be lifestyle modification since type 2 diabetes is a lifestyle disorder. Depending upon the blood sugar levels, doctor suggest optimal medications required to keep sugars in control. Medications are a support to lifestyle modifications and not a replacement.

What is the connection between diabetes and stress?

Stress: In stress our body tends to respond as if it were under attack. This can be regardless of whether the stress is physical (like an injury or infection) or psychological (like an argument, a marriage breakup, a bereavement, or financial problems).

The body responds to stress by preparing itself to take action. This is called the “fight-or-flight” response. In the fight-or-flight response, the levels of many hormones which include adrenaline, growth hormone and glucocorticosteroids rise. These hormones stimulate the body to release stored glucose and fat into the bloodstream. If you don’t have diabetes you will respond to the higher blood glucose levels by increasing your insulin levels. The end effect of this is that more energy (in the form of glucose) will be available to your body’s cells. This means that they have more energy to either fight the stress or run away from the stress. When you have diabetes, the fight-or-flight response can cause you problems. As your blood glucose increases, you may not have enough insulin to move this glucose into your cells. This can result in your blood glucose levels becoming high.

Simple and effective steps to relieve stress are;

  • Breathing exercises
  • Relaxation therapy
  • Doing regular physical exercise
  • Consciously replacing bad thoughts with good ones

Whatever method you choose to relax, practice it. Just as it takes weeks or months of practice to learn a new sport, it takes practice and patience to learn relaxation.

Minimum one month is required to developed a habit and 3 months to change the blood parameters i.e. HbA1c. Lipids, creatinine. It takes minimum one year to reverse complications.

Freedom from Fear of Poking of Insulin Injection- Dr. Deepak Dalal