Prevention and Management of Diabetes

What Is Diabetes Mellitus (DM)?

Diabetes is slow in onset and is an iceberg disease. With little awareness of its symptoms, one can detect the disease in its early stage. Most of the time, 60 % of patients are accidentally diagnosed, and only 40 % feel the symptoms of the disease.

What Are the Types of Diabetes?

1. Type 1 - Formerly known as insulin-dependent diabetes mellitus (IDDM). People with this type of diabetes produce a very low amount or no insulin in their bodies and need regular insulin injections to survive and manage diabetes. It can occur at any age but usually starts in childhood. This usually happens before the age of 40.

2. Type 2 (DM2) - Earlier known as non-insulin-dependent diabetes mellitus (NIDDM). Type 2 DM is strongly related to genetic tendency and obesity. The body produces normal or high insulin levels, but certain factors make its utilization ineffective (insulin resistance). The common causes of type 2 DM are a sedentary lifestyle, unhealthy diet, and obesity. It will usually start in adulthood, but it can also be seen in adolescents who are obese.

3. Gestational Diabetes Mellitus - Gestational diabetes is also called pregnancy-induced diabetes, where the blood glucose level is raised during pregnancy. It occurs in five percent of all pregnancies and usually disappears when a pregnancy ends. Women who have had gestational diabetes have an increased risk of developing type 2 diabetes later in life.

4. Prediabetes - Prediabetes state can increase the risk of developing type 2 diabetes, heart disease, and stroke. In a prediabetes state, blood sugar levels are higher than normal but not high enough to diagnose type 2 diabetes. However, the prediabetic state can be reversed by following healthy steps and lifestyle changes.

What Are the Symptoms of Diabetes?

Symptoms are frequent urination, increased thirst, increased hunger, tingling in the feet, fatigue, weakness, delayed healing, diminished vision, itching in the private parts, and repeated abortion. Those who have these symptoms, along with a family history of diabetes, aged more than 35 years, overweight, suffering from a heart attack, high blood pressure, or TB (tuberculosis), should undergo a diabetes checkup annually.

What Are the False Beliefs About Diabetes?

Despite advanced and extensive diagnostic facilities available, almost 50 % of people with type 2 diabetes remain undiagnosed in most parts of the world. A 9 to 12-year gap exists between the onset of type 2 diabetes and its clinical diagnosis. And those who know that they have diabetes because of ignorance, superstition, false belief, and carelessness not taking proper treatment. Studies showed that almost 70 % of diagnosed patients have uncontrolled blood sugar according to their HbA1C level.

More than 80 % of patients do not follow the advice to change their health behavior. Factors like inadequate knowledge, initial non-acceptance, rebellion when diagnosed, and no physical discomfort in the early stages can prevent patients from understanding diabetes as a severe disease. Trusting the myths prevalent in the community about the disease makes the patient fail to take treatment for diabetes. Instead of asking the doctor, they take advice from relatives and friends and follow their advice.

What Are the Complications of Diabetes?

• Up to 50 % of diabetic patients have complications at the time of diagnosis.

• Diabetic retinopathy can cause blindness in young adults.

• 10 % to 21 % of all people with diabetes develop severe kidney diseases.

• 60 % to 70 % of people with diabetes have mild to severe forms of neuropathy.

• There is a 15 to 40-fold increased risk for leg amputation in diabetes compared to the non-diabetic population.

• People with diabetes are two to four times more likely to have coronary heart disease and stroke.

How to Manage Diabetes?

Diabetes mellitus cannot be cured, but it can be controlled very successfully. The main aim of treating all types of diabetes is to control blood glucose, blood pressure, and cholesterol levels as normal as possible. Medication, along with a healthy lifestyle, can improve normal well-being and protect against long-term complications.

Being active is good and important for people with diabetes. Physical activity, with a healthy diet and medication, can help one manage diabetes and prevent long-term complications.

People with diabetes usually need additional medication treatment and lifestyle changes to control their blood pressure and blood cholesterol levels. The physician will prescribe medication for diabetes according to the body's condition, and stopping them on one’s own can create lots of problems.

How to Keep Diabetes Under Control?

People with diabetes should undergo a regular physical examination, including consultation with a doctor, fundus examination, electrocardiogram, stress test, foot examination for blood circulation, sensation and vibration perception, ulcer-prone areas, and necessary laboratory investigations.

• 30 % of people with type 2 diabetes can control diabetes by proper diet, regular exercise, and yoga alone. In other cases, medicines and, in some cases, insulin may be required.

• No restriction in diet is required in diabetes. Patients with diabetes should be advised to take a healthy and balanced diet.

• Sweet substances and fatty foods such as ice cream, sweets, cakes, biscuits, chocolate, etc., should be avoided.

• Green vegetables and salads can be taken freely. Meals should be divided into four to six times a day.

• Eating fruits is beneficial for diabetes patients. More sweet and ripe fruits like mango, sapodilla, custard apple, banana, etc., should not be taken if diabetes is not under control.

• Diabetic patients should make regular exercise, physical activity, or yoga a routine part of their lives. Generally, exercising should be done early in the morning. One should keep sweets handy during exercise for any emergency conditions like hypoglycemia.

• Patient education program and counseling is a must for every person with diabetes for total diabetes management. It helps the patient to comply with drugs and lifestyle modification more effectively.

What Dietary Factors Are There to Prevent Diabetes?

• A lifestyle modification that included cutting back on calories and activity to encourage loss of weight substantially decreased the possibility of developing diabetes by 58 % in high-risk individuals with a reduced tolerance for glucose.

• Relative to diets with higher glycemic index (GI) and glycemic load (GL), low GI and GL diets were linked to a decreased incidence of diabetes.

• Consuming whole grains has continuously been linked to a lower likelihood of diabetes.

• Consuming more processed white rice has been linked to an increased risk of diabetes, particularly in Asian countries where white rice is an everyday food.

• Regular eating of red meats was substantially linked to an increased risk of diabetes, particularly processed red meats like bacon and hot dogs.

• Consuming more sugar-sweetened drinks has been linked to an increased risk of type 2 diabetes.

What Dietary Elements Are Important for Diabetes Management?

• A low glycemic diet helps to decrease the HbA1C level than a high glycemic index diet. Individuals with diabetes must be aware of tools like glycemic index and glycemic load to have better control over their diet.

• Increasing fiber intake helps reduce HbA1C levels, and individuals must lower their intake of sugar-sweetened drinks to control their sugar levels.

• The type of fat consumed matters more than the total amount. Consuming polyunsaturated fatty acids (PUFA) helps to improve the overall health. Several studies have shown that consuming monounsaturated fatty acids instead of carbohydrates or fat helps to have better control over glucose levels.

• For the control of diabetes, a number of dietary patterns that combine various foods or food groups are advantageous.

When to Visit a Physician?

According to the American Diabetes Association, anyone who is 45 years of age or older should undergo periodic checks for type 2 diabetes through diagnostic testing:

• Individuals under 45 who are fat or overweight and possess a couple of diabetes risk factors.

• Individuals who had gestational diabetes.

• Those who have been identified as prediabetic.

• Children who are fat or overweight with a family record of type 2 diabetes.

Conclusion

The clinical management of diabetes now has significantly more options than ever before, and every year, new molecules and technologies are coming into the market for better diabetes management. With proper diagnosis and appropriate treatment, one can live a long, healthy, and cheerful life without developing diabetes complications. However, everything will fail if the lifestyle does not adhere to it.