Diabetes: The Sweet Killer

What is Diabetes?

Diabetes is one of the most common chronic diseases in India. Recent nationwide data reveals that the overall prevalence of diabetes in India is now around 11.4% (affecting over 100 million people), with urban prevalence around 17-18% and rural areas rapidly catching up at around 9.5%. People with diabetes are about three to five times more likely to develop coronary heart disease than people without diabetes. Coronary heart disease is by far the leading cause of death among people with diabetes.

People with diabetes have problems regulating the amount of sugar or glucose in their blood. When left untreated, they have too much glucose in their blood. Once the amount of glucose in the blood exceeds a certain level, excess glucose spills over into the urine. Diabetes mellitus comes from the Greek word diabetes (to flow through; urine) and the Latin word mellitus (sweetened or honey-like).

When you eat sugars and starches, the body changes them into a form of sugar called glucose. Glucose enters the blood and is carried to all the cells of the body where it is ready to be used for energy. The hormone insulin, which is produced in the pancreas, is responsible for moving the glucose out of the blood and into the cells. Too much glucose in the blood, a condition known as hyper (high) glycemia (glucose), is dangerous and can cause damage to organs in the body. Too little glucose in the blood (hypoglycemia) means the cells can’t get the energy they need to function properly.

Types of Diabetes 

There are four main categories of diabetes and its precursor stages:

• Type 1 Diabetes: With Type 1 diabetes, excess glucose builds up in the blood because the pancreas is either completely unable to produce insulin or is able to produce only a tiny amount. People with type 1 diabetes must have insulin injections for the rest of their lives.

• Type 2 Diabetes: With type 2 diabetes, excess glucose builds up in the blood mainly because the cells become resistant to the insulin the body makes. The pancreas still secretes insulin. Insulin levels in the blood may be normal or even too high, but the body doesn't respond properly to the insulin's action. While often initially managed with oral medications, dietary changes, and exercise to help keep blood glucose levels within a normal range, Type 2 diabetes is a progressive condition. Over time, many people with Type 2 diabetes may eventually require insulin therapy to properly manage their blood glucose.

• Gestational Diabetes: This type of diabetes develops only during pregnancy. While it often resolves after the baby is born, it significantly increases the risk of the mother developing Type 2 diabetes later in life.

• Prediabetes: This is a precursor stage where blood sugar levels are higher than normal, but not yet high enough to be diagnosed as Type 2 diabetes. With early intervention, lifestyle modifications, and exercise, prediabetes can often be reversed.

Symptoms of Diabetes 

Some people with diabetes have very mild symptoms or no symptoms at all. Increased urination and thirst are two of the most common symptoms of diabetes. Other symptoms may include:

• Unexplained weight loss

• Fatigue or weakness

• Hunger, especially after eating

• Infections and cuts that are slow to heal

• Numbness, tingling, burning or intense sensitivity in certain areas of the skin especially in the feet and legs

• Dry, itchy skin

• Frequent bladder or vaginal infections

• Blurred vision

How is Diabetes Diagnosed?

The diagnosis of diabetes is made using specific blood tests. The primary methods include:

• Fasting Blood Glucose Test: A normal fasting blood glucose level is below 100 mg/dL. Fasting means at least eight hours without eating any food or drinking anything other than water. Fasting blood glucose values of 100 to 125 mg/dL are referred to as impaired fasting glucose or Prediabetes. If your fasting blood glucose level is 126 mg/dL or higher, you have diabetes. A diagnosis of diabetes must be confirmed on a subsequent day.[cite: 2]

• HbA1c Test (Glycated Hemoglobin): This is widely considered the gold-standard diagnostic tool. It measures your average blood sugar levels over the past 2 to 3 months. An HbA1c of 6.5% or higher indicates diabetes, while 5.7% to 6.4% indicates prediabetes.

• Oral Glucose Tolerance Test (OGTT): This involves checking your fasting blood sugar, then having you drink a sugary beverage, and testing your blood sugar again two hours later. A reading of 200 mg/dL or higher at the two-hour mark indicates diabetes.

Author: Dr. Aashish Contractor is India's pioneer in cardiac rehabilitation and the Founding Medical Director of the Mumbai Marathon. With over 25 years of experience, he has guided hundreds of heart patients to run safely.