All About Diabetes
As of 2019, India was home to more than 77 million diabetics with researchers predicting that this will increase to 134 million by 2045. Various researches have also estimated that about 57% of diabetes cases remain undiagnosed until they start causing complications. So, why is diabetes rising in India at such an alarming rate? Are young Indians now prone to Diabetes too?
To deep-dive into the conversation around Diabetes, Dhani’s Senior Strategist, Prakhar Khandelwal spoke to Dr. Smita Dash, who helped us in understanding diabetes, its various types, and how we can cohesively work towards putting a fight against the disease.
Dr. Smita Dash is Chief Medical Officer at Dhani. Prior to practising in India, Dr. Dash spent several years with the Royal College of Physicians, UK working to develop the NICE clinical guidelines across a wide range of topic areas for U.K.’s National Health System.
PK: Doctor, to begin with, could you throw some light on Diabetes?
Dr: Diabetes is a condition in which the person has high blood glucose or blood sugar. This happens because the body has no insulin or has less insulin or the body’s cells may not be responding properly to the insulin, or both. When our food is digested, it is converted to glucose which is taken up by the cells for energy and growth. However, glucose cannot enter our cells without insulin being present – Insulin makes it possible for our cells to take in glucose. This means that the glucose remains present in the blood without being used causing the blood sugars levels to go up. This high blood sugar also causes the more harmful effects of Diabetes that we see. In India, this is a huge problem. In 2019 there were about 77 million people with diabetes and the numbers are expected to grow.
PK: What are different types of Diabetes?
Dr: Depending on whether there is insulin deficiency or if there is resistance to insulin in the body that is, if the body cells are not responding to insulin, diabetes is classified into different types. Predominantly two types- Type 1 – where external insulin needs to be given and Type 2- where medications can be given to make the insulin present work effectively are noted. There are also other types such as MODY (Maturity Onset Diabetes of the Young) or LADA (Latent Autoimmune Diabetes in Adults) which are genetically mediated or gestational diabetes (diabetes in pregnancy), but we mainly talk of the two types.
PK: Does this have any signs and symptoms? How can people know that they have diabetes? Is there anything that happens early on in the course of the disease?
Dr: Very classically, diabetes is associated with three cardinal symptoms of excessive thirst, excessive eating/ appetite and excessive urination. However, in most cases in clinical practice we find that there may not be any symptoms at all, especially in the early stages. Patients complain of feeling tired and fatigued or of wounds not healing quickly. Sometimes, we note a great amount of weight loss, but mostly there are no complaints at all. The diagnosis is usually incidental when the person has checked their blood sugar levels and these are found to be high. Hence it is very important that one gets checked themselves regularly. In cases where the condition has gone undiagnosed for long, patients may at first be seen for complications of diabetes rather than the condition itself.
PK: You mentioned about complications developing in people with diabetes. Could you tell us more about this?
Dr: Complications such as ketoacidosis can be seen if blood sugar levels rise to very high levels suddenly and this is a medical emergency. However, people with poorly controlled diabetes or long standing diabetes can go on to develop certain complications over time. Diabetes affects almost all organs and systems of the body. In the heart, it can cause coronary artery disease or congestive heart failure; it affects the blood vessels and causes peripheral vascular disease and stroke. The retina in the eye can be affected along with more or cataracts, glaucoma. The kidneys, organs which clear the waste out of the body via urine can be affected. It affects the nerves which we call neuropathy- people can lose their sensations- typically noticed in feet. There can be increased chances of infection such as urine infections and skin infection. When it affects the feet, it can cause ulcers which may require surgery or amputation if not managed well. So you see, it affects all organ systems.
PK: So, could you tell us a bit about how one is diagnosed?
Dr: As we discussed before, diagnosis is mostly incidental with patients finding out they have diabetes when they are getting tests done for something else. There are certain criteria for the diagnosis of Diabetes. We test the blood glucose levels and a fasting blood glucose level > 126 mg/dl or a random BG of >200 mg/dl in someone who has symptoms or a HbA1C of > 6.5% gives us a diagnosis of diabetes. Typically one should discuss with their doctor who will take a complete medical history asking about weight, exercise, smoking, and alcohol use, any family history of diabetes or risk factors. At this time, we also do certain tests to find out what type of diabetes one has – type 1 or type 2. As I mentioned we also see a lot of patients who have already developed some complication, so at the first diagnosis a thorough work up should also be done to check for any complications.
PK: What kind of tests do we use to check for complications?
Dr: These can be test of the different organ systems, so for example, such as testing for the sensation in feet for any nerve damage. We also test for kidney function, retina involvement and any raised blood pressure or heart involvement. These things should be monitored regularly after the diagnosis.
PK: What is the treatment of this condition?
Dr: The goal of any treatment in a person with diabetes is to maintain normal blood glucose levels and prevent complications. It is important to remember that Diabetes is a lifestyle disease and hence the treatment of it can also not be done just with medications. Equal attention has to be paid to diet, exercise and lifestyle modifications. It is very important that patients understand this and why they are asked to do certain things and how it affects them. In terms of medications , depending on whether a person has Type 1 or Type 2 diabetes, they will be advised either insulin or oral medications or a combination of both. One has to be diligent in taking these medications as advised; non-compliance is a very common challenge that doctors face in the treatment of diabetic patients. Besides this, proper diet including balanced meals which have moderate carbohydrate, low saturated fat and high fiber are advised. In type 2 diabetes, a diet which targets weight loss is associated with positive outcomes. Exercise also plays a key role here to maintain a healthy weight and to prevent complications.
PK: How frequently should one monitor their blood glucose levels in a person with Diabetes?
Dr: In a patient with established Diabetes assessment of prior diabetes care, hba1c levels, self-monitoring blood glucose, frequency of hypoglycaemia (episodes with low blood glucose levels), and patients’ knowledge about diabetes mellitus should be obtained. Depending on this, patients will be advised to set up a schedule and monitor. If the levels are high, they might be asked to monitor more frequently at first and the frequency reduces as the levels stabilize. Other than blood glucose, attention should be given to periodic retina examination, blood pressure examination, foot examination, peripheral pulses and insulin injection sites.
PK: Is there anything else you would like to share?
Dr: People often think that diabetes is a condition of middle age and beyond. However, this is not true. We are seeing more and more cases of diabetes in younger populations which remain undiagnosed for long. Please get yourself routinely checked, say once a year, for diabetes if you are above the age of 25 and earlier if there is a family history of diabetes. There is a condition called pre-diabetes, where the sugar levels are borderline. At this time, the conditions can be reversed with diet and lifestyle modifications. We often find that people are averse to start medications. This would be the time to correct the parameters before diabetes sets in, so do get your health check-up done and discuss your reports with one of our doctors who will be able to guide you.
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