All About Diabetes

Words: Dr Rajgopal NIDAMBOOR

Diabetes means different things to different people. For some, it is a disease that affects kids. For others, it is something that affects people who are overweight, or fat.

It may also, for some people, be something they would never ever get affected with. “It can’t happen to me.”

For others, it may be a disease that one of your relatives suffers from.

You have seen them take pills, or insulin shots, right? Or, it’d mean something that you have to live with it each day of your life.

Whatever your idea of the disorder, you cannot take diabetes lightly. Because, no sooner than later, it is going to affect you, or someone close to you.

You now feel you are okay, fine. You may be wrong.

Remember, the frequency and intensity of diabetes, a potentially upsetting disease, is expanding rapidly. This only means that the number of people affected by the disease is only going to increase. In other words, it could affect anybody, anytime now, including YOU.

Most of us are unaware what diabetes really is. Does it matter to know what it is? Yes — because, diabetes can kill you.

Well, it does not have to, if only you know what you can do to keep it at bay and/or under control.

Believe in yourself and believe in medical science. With appropriate medical treatment, most diabetics [people affected by the disease] can lead long, active and healthy lives.

What Is Diabetes?

Diabetes mellitus, or diabetes as most of us know, is a disorder in which the islets in the pancreas fail to secrete adequate insulin, or it can be the body’s decreased ability to use insulin.

Diabetes mellitus, in Greek, means “a passing through of sweetness.” This relates to the passing of sugar-rich urine too — a distinctive symptom of the disease.

Diabetes is a serious problem. It is sometimes fatal. It is the leading cause of death worldwide, because of the damage it causes to the cardiovascular system [heart].

In a healthy individual, food is digested to release glucose into the blood. This causes the beta cells in the pancreas to release insulin into the bloodstream. Beta cells reside in the islets of Langerhans. Insulin, as you may know, helps in the transportation of glucose from the blood to the liver and muscle cells. This is released into the blood for metabolism.

When the pancreas fails to produce adequate amounts of insulin, or if there is insulin ‘resistance,’ diabetes could set in. Either way, the consequences are dangerous.

More Than A Metabolic Disease

The failure of the islet cells of the pancreas to assemble adequate amounts of insulin and deliver the ‘product’ to the endogenous, or internal, needs of the body is the most important factor for the cause of diabetes.

This is, however, not the only cause. Because small insulin requirements of people, whose pancreas has been removed, is comparable to the insulin needs of folks affected by diabetes.

The most prominent metabolic defect in diabetes appears to be the inability of the human organism to ‘carry’ glucose properly, which, in turn, has a marked secondary influence on protein and fat metabolism.

As a consequence of this imprecise functioning, the oxidation of glucose goes awry, leading to excess sugar in the blood. The sequence of events may be illustrated as follows:

  • Loss of glucose in the urine; this depletes the body stores of carbohydrates
  • Impairment in the supply of glucose to the body
  • Excessive loss of proteins [gluconeogenesis]
  • Fat mobilisation to the liver and consequent destruction
  • Escalation of acetate giving rise to ketone bodies [organic fatty acids] — which are excreted in the urine
  • Metabolic acidosis [acidaemia; i.e., low blood pH].

Laboratory tests are non-specific as one, or all of them, may occur in some disorders of the liver and hyperthyroidism [overactive thyroid].

The presence of hyperglycaemia [high blood sugar], glycosuria [excretion of glucose into the urine], elevated serum cholesterol and decreased glucose tolerance, in the absence of other disease, may clinch the diagnosis for diabetes.

The presence of glucose in the urine is excellent evidence. So is the finding of increased fasting blood and glucose/high sugar level, two hours after a meal containing 100gm of carbohydrate, or a dose of 100gm of glucose orally.

The latter is performed only after the patient has been on a high carbohydrate diet for 48-72 hours, because a high fat diet could decrease carbohydrate tolerance in normal individuals.

On the other hand, a normal gastric blood glucose level does not rule out the diagnosis.

If the two-hour post-prandial [after meal] level is over 140gm/100ml, one may be quite convinced that the condition is diabetes.

However, to establish diagnosis, it may be necessary to perform a glucose tolerance test [GTT], if the true post-prandial blood level is between 90 and 140.

HbA1c test is evidenced to be more accurate. It measures the amount of glycated haemoglobin in your blood, while giving a good estimation of how well you have managed your diabetes levels over the last 2-3 months. An HbA1c of 6 per cent, or less, is normal. If your HbA1c is above 6.5 per cent, you may be diagnosed with diabetes.

For home management, the use a glucometer to keep track/record of your blood sugar levels is ideal.

Type-1 Diabetes 

There are two types of diabetes, insulin-dependent diabetes mellitus [IDDM]. This is also known as juvenile-onset diabetes, or type-1 diabetes, and non-insulin-dependent diabetes mellitus [NIDDM], also known as maturity-onset diabetes, or type-2 diabetes.

Environmental and genetic factors contribute equally to both forms of diabetes mellitus. However, the precise cause of diabetes is not known yet.

In either type, however, any excess sugar in the blood, known as hyperglycaemia, needs to be expelled by the kidneys.

Primary Symptoms

  • Excessive thirst
  • Frequent urination
  • Weight loss
  • Excessive hunger.

In type-1 diabetes, the body’s immune system damages the pancreas’ beta cells resulting in low insulin levels.

To prevent death, insulin injections, as you may know, are needed. This is also one reason why it is called insulin-dependent diabetes mellitus [IDDM].

As a matter of detail, ‘early-onset’ diabetes is most common in people under 20 years. It persists throughout life.

By the way, do you know that in untreated IDDM individuals, the cellular metabolism is similar to that of a starved person? Can anything be more dangerous?

This state is present because insulin is not available to help glucose reach into the body cells to produce the fatty acid, adenosine triphosphate [ATP], for your energy needs. As you may know, most cells use fatty acids.

Triglycerides [you have heard of the expression] are stored in adipose [fat] tissues which are catabolised to yield fatty acids and glycerol. The breakdown of fatty acids triggers a by-product of organic fatty acids called ketones, or ketone bodies. This build-up of ketones causes a fall in blood pH. It is called ketoacidosis.

When left untreated, it can cause diabetic coma and death.

Weight loss is often a result of the breakdown of stored triglycerides. When lipids [e.g., cholesterol] are deposited on the walls of blood vessels, they are transported by the blood from the cells’ storage depots. This leads to atherosclerosis [hardening of the arteries] and heart problems, such as:

  • Cerebrovascular insufficiency [decreased blood supply to the brain]
  • Ischaemic heart disease [reduced blood supply to the heart muscle]
  • Peripheral vascular disease [related to blood vessels located outside of the heart and brain]
  • Gangrene [tissue death]
  • Severe kidney problems from damage to renal blood vessels
  • Loss of vision due to cataract [clouding of the lens in your eye], because excess glucose attaches itself to lens proteins
  • Damage to the retina [light sensitive tissue lining the inner surface of the eye], its blood vessels and blindness.

There is no need to panic, provided you pull up your socks and redefine, or reinvent, yourself and your lifestyle.

Type-1 diabetes is often treated with a method of self-monitoring the blood glucose level, sometimes up to 5-6 times a day, insulin injections, up to three times a day, exercise and regular meals containing 45-50 per cent carbohydrates and less than 30 per cent fats.

This regimen will help keep the levels of insulin and sugar in the blood normal.

While it may be possible to have a pancreas transplant today, the fact is immune-suppressive medications must be taken for life. This is not free of side-effects. Besides, not everyone can opt for a transplant procedure.

Eating foods containing carbohydrates, such as rice, potatoes, bread and cereals will help raise blood sugar and insulin levels. This sugar-raising effect of a food is called the glycaemic index. This is used to measure how quickly carbohydrate is absorbed by the body.

Studies have found that people with type-1 diabetes have better control over their blood sugar levels by following a low-glycaemic-index-diet.

It may also be mentioned that diabetics with neuropathy [diabetic nerve damage] have found their condition improved by following a vegan type of diet — i.e. avoidance of all meat, eggs and dairy products.

When you avoid meat and dairy products, the chances of developing heart disease and kidney problems, which diabetics are susceptible to, are reduced.

As for diabetics who smoke, they are definitely at a higher risk of developing heart disease and kidney problems.

Diabetics who consume excess amounts of alcohol are, of course, at a still higher risk of developing problems with their eyes.

Type-2 Diabetes

Non-insulin-dependent diabetes mellitus [NIDDM], or type-2 diabetes, is also known as maturity-onset diabetes. It typically occurs in obese people 25-30 years of age, albeit some obese children have been diagnosed with type-2 diabetes due to lack of exercise and poor diet.

The clinical symptoms of NIDDM are mild. Besides, high glucose levels can be controlled by:

  • Exercise
  • Weight loss
  • Excessive hunger.

Some type-2 diabetics have sufficient amounts of insulin in the blood. Diabetes occurs in them not because of shortage of insulin, but because the cells become desensitised due to ‘down-regulation’ of insulin receptors.

Ketosis rarely develops in NIDDM.

Eating foods containing carbohydrates will elevate blood sugar and insulin levels.

  • Rice
  • Potatoes
  • Bread
  • Cereals.

This sugar-raising effect of a food, as you now know, is called the glycaemic index. It measures how quickly carbohydrate is absorbed by the body.

Persons whose diet consists of a high amount of sugary foods and foods with high glycaemic index are more prone to develop type-2 diabetes.

In people, whose diet consists of a high amount of foods, which have a low glycaemic index, there is a low risk of developing type-2 diabetes.

Typical foods with a low glycaemic index are as follows. You would do well to make them a part of your daily diet plan.

  • Oats
  • Fruits
  • Beans
  • Peas.

If you wish to prevent, or control, type-2 diabetes, it is best to:

  • Avoid processed and fast-junk/snack foods, which are typically high in sugar
  • Eat high fibre whole foods such as oats, fruits, vegetables [e.g., bitter melon, or karela] and seeds, which have a low glycaemic index
  • Regular exercise, especially walking for 30 minutes a day, 4-5 days a week, to reduce excess weight is fundamental
  • High fibre supplements, such as psyllium [isabgul], flaxseed, guar gum, oat bran, pectin and fenugreek seeds, are beneficial for type-2 diabetes
  • Stop smoking
  • Cut down; better limit, or avoid, alcohol.

The following supplements are useful in type- 2 diabetes.

  • Alpha-lipoic-acid [ALA]
  • Biotin
  • Brewer’s yeast
  • Chromium picolinate
  • Co-enzyme Q10
  • Evening primrose oil
  • Fenugreek [seeds]
  • Fish oil [EPA/DHA]
  • Flaxseed powder
  • Fructo-oligosaccharides [FOS]
  • Inositol
  • L-carnitine
  • Magnesium
  • Manganese
  • Multivitamins and multiminerals
  • Psyllium [isabgul]
  • Quercetin
  • Starch blockers
  • Taurine
  • Vanadium
  • Vitamin B1 [thiamine]
  • Vitamin B12
  • Vitamin B3 [niacin]
  • Vitamin B6
  • Vitamin C
  • Vitamin D
  • Vitamin E
  • Zinc.

Speak to a professional dietician, or nutritionist, for appropriate intake/dosages.

Dr RAJGOPAL NIDAMBOOR, PhD, is a wellness physician-writer-editor, independent researcher, critic, columnist, author and publisher. His published work includes hundreds of newspaper, magazine, web articles, essays, meditations, columns, and critiques on a host of subjects, eight books on natural health, two coffee table tomes and an encyclopaedic treatise on Indian philosophy. He is Chief Wellness Officer, Docco360 — a mobile health application/platform connecting patients with Ayurveda, homeopathic and Unani physicians, and nutrition therapists, among others, from the comfort of their home — and, Editor-in-Chief, ThinkWellness360.

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