World Diabetes Day 2019: Family and diabetes

Dr Chakshu
World Diabetes Day is marked every year on 14 November, the birthday of Sir Frederick Banting, who co-discovered insulin along with Charles Best in 1922. The theme for World Diabetes Day 2019 is Family and Diabetes. International Diabetes Federation is raising awareness of the impact that diabetes has on the family and support network of those affected, and promoting the role of the family in the management, care, prevention and education of diabetes. According to International Diabetes Federation approximately 425 million adults are living with diabetes and by 2015 this will rise to 629 million. 1 in 2 people currently living with diabetes is undiagnosed. It is a major cause of blindness, kidney failure, heart attack, stroke and lower limb amputation. Diabetes can be expensive for the individual and family. Diabetes caused 4 million deaths in 2017.
What is diabetes? Diabetes, often referred to by doctors as diabetes mellitus (DM), refers to a group of metabolic disorders or diseases that disrupt the normal process of converting food to energy and it causes hyperglycemia or high blood glucose (blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin, or both. Insulin is made in the pancreas, an organ located behind the stomach.  Insulin is a hormone that helps your body to control the level of glucose (sugar) in your blood. Without insulin, glucose builds up in your blood instead of being used for energy. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).
There are three types of diabetes.
Type 1 diabetes: The body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes. People usually develop type 1 diabetes before their 40th year, often in early adulthood or teenage years. Approximately 10% of all diabetes cases are type 1. Type 1 diabetes is caused by a lack of insulin due to the destruction of insulin-producing beta cells. In type 1 diabetes—an autoimmune disease—the body’s immune system attacks and destroys the beta cells. Patients with type 1 diabetes will need to take insulin injections for the rest of their life to keep blood sugar levels under control. As with other forms of diabetes, nutrition and physical activity and exercise are important elements of the lifestyle management of the disease.
Type 2 diabetes: The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance). Approximately 90% of all cases of diabetes worldwide are type 2. Some people may be able to control their type 2 diabetes symptoms by losing weight, following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels. However, type 2 diabetes is typically a progressive disease - it gradually gets worse - and the patients will probably have to take insulin, usually in tablet form. Gestational diabetes: This type affects females during pregnancy. Some women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all of the glucose into their cells, resulting in progressively rising levels of glucose. Diagnosis of gestational diabetes is made during pregnancy.
How to diagnose diabetes? Whether a person is suffering with diabetes or not can be ruled out through a urine test, which finds out whether excess glucose is present. This is normally backed up by blood tests commonly known as Random Blood Sugar (RBS), Fasting Blood Sugar (FBS) and two hours post meal or Postprandial (PP) blood sugar. The person will be considered to be a diabetic patient if he or she has symptoms of diabetes and RBS is equal to or greater than 200 mg/dl or FBS is equal to or greater than 126 mg/dl or PP is equal to or greater than 200 mg/dl. A complete diabetes check includes the following tests like fasting blood sugar, postprandial blood sugar, HbA1c or glycated haemoglobin to check the control of blood sugar levels, lipid profile to check cholesterol level, kidney function test, urine for microalbuminuria to detect early signs of kidney damage in people who are at risk of developing kidney disease, HBsAg to rule out hepatitis B infection, ultrasound examination of the abdomen, ECG, Chest X-ray, complete physical examination and consultation with a physician. Based on the findings your physician will refer you to other healthcare professionals like Eye Specialist, Nephrologist as and when required.  
Risk factors for diabetes: The risk factors for type 1 diabetes are still being researched. However, having a family member with type 1 diabetes slightly increases the risk of developing the disease.
Environmental factors and exposure to some viral infections have also been linked to the risk of developing type 1 diabetes. Risk factors for developing type 2 DM include high cholesterol levels, high BP, high fat diet, high alcohol consumption, sedentary lifestyle, overweight, giving birth to a baby weighing 9 pounds and above. The risk of developing type 2 diabetes is also greater as we get older.
Experts are not completely sure why, but say that as we age we tend to put on weight and become less physically active. Men whose testosterone (a powerful hormone, with the ability to control sex drive, regulate sperm production, promote muscle mass, increase energy, and even influence human behavior) levels are low have been found to have a higher risk of developing type 2 diabetes. Researchers from the University of Edinburgh, Scotland, say that low testosterone levels are linked to insulin resistance. Risk factors for gestational diabetes include excess weight. You are more likely to develop gestational diabetes if you are significantly overweight with a body mass index (BMI) of 30 or higher. The risk also increases if you have pre diabetes or if a close family member has type 2 diabetes.
For reasons that are not clear, women who are black, Hispanic or American citizens who are descendants of the peoples of the Spanish speaking countries of Latin America, American Indian and Asian are more likely to develop gestational diabetes. Scientists from the National Institutes of Health and Harvard University found that women whose diets before becoming pregnant were high in animal fat and cholesterol had a higher risk for gestational diabetes, compared to their counterparts whose diets were low in cholesterol and animal fats.
Symptoms of DM: It is possible to have diabetes with only very mild symptoms or without developing any symptoms at all. Such cases can leave some people with diabetes unaware of the condition and undiagnosed. This happens in around half of people with type 2 diabetes. A condition known as pre-diabetes that often leads to type 2 diabetes also produces no symptoms.  Pre-diabetes refers to blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes.
Type 1 diabetes can go unnoticed but is less likely to do so. Symptoms of type 1 diabetes are often dramatic and come on very suddenly in childhood often in association with some illness like nausea, vomiting, stomach pains, viral infection or urinary tract infections.
The most common signs and symptoms of diabetes are frequent urination, disproportionate thirst, intense hunger, weight gain, unusual weight loss, increased fatigue, irritability due to lack of energy, blurred vision, cuts and bruises don’t heal properly, more skin infections, itchy skin, frequent gum disease/infection, sexual dysfunction among men, numbness or tingling especially in hands and feet. Women may experience genital itching.
Complications of DM: DM ultimately leads to hyperglycemia or high blood sugar level. Over a long period of time, it may lead to the following complications.
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