Diabetes

Diabetes or Diabetes Mellitus is a disorder characterised by hyperglycaemia (high blood glucose levels) caused by impairment in insulin secretion and/or action.

When the food we eat is digested, most of it becomes glucose (sugar), which the body uses for energy. In order for this to happen, the glucose must leave the blood and enter the body cells. The hormone that helps glucose enter the cells is called insulin. An organ called the pancreas produces it. In Diabetes, the pancreas either doesn't produce insulin, or the body is unable to use the insulin properly. This causes glucose to build up in the blood instead of entering the cells, a process called hyperglycaemia.

There are two types of Diabetes: type I and type II Diabetes.

TYPE I (Insulin Dependent Diabetes Mellitus- IDDM) can occur at any age but most commonly develops before the age of 30. It accounts for 10 to 15% of Diabetes cases. In Type I patients, the pancreas produces little or no insulin.

TYPE II (Non-Insulin Dependent Diabetes Mellitus) is usually diagnosed in people over 30 years, although it can occur in children and teenagers. In Type II patients, the pancreas produces insulin but the body does not use it properly. This is called INSULIN RESISTANCE.

There is a third type of Diabetes called Gestational Diabetes, which only occurs during pregnancy.

Diabetes is a condition requiring life-long management. There is no cure, but symptoms can be controlled with careful attention to diet and medications. Poorly controlled Diabetes may lead to serious complications. Complications of Diabetes include:

• Diabetic retinopathy (a progressive loss of vision that can lead to blindness).

• Diabetic neuropathy (nerve damage). This causes loss of sensation in the lower limbs and may lead to foot ulcers, joint problems and infections. Diabetes causes changes to the physiology of the foot such as decreased sensation (feeling) which can result in injuries to the foot going unnoticed, less effective wound healing and changes to the foot. Limb amputations are sometimes necessary as a result.

• Diabetic nephropathy (kidney disease).

• Heart disease.

SIGNS AND SYMPTOMS
Symptoms include feeling thirsty all the time, urinating more frequently, blurred vision, tiredness, numbness and tingling in the feet or legs and recurrent infections.

TREATMENT OPTIONS
Diabetes is a serious condition requiring life long management, which should address the following issues:
1. Regular screening for complications. Foot care, eyes, kidney health and blood sugar control should all be checked.
2. Education regarding ideal blood sugar levels and use of blood sugar measuring devices.
3. Reducing risk factors such as smoking, alcohol consumption and obesity.
4. A detailed, individual diet plan.
5. A suitable exercise programme.
6. Education about diabetes medications.
7. Education about concurrent illnesses such as hypertension, high cholesterol, kidney disease and heart disease.

DIET HINTS
There is no one "Diabetic Diet" that is suitable for all people with Diabetes. Dietary needs will vary greatly depending on the person's age, health status, lifestyle and exercise routine.
1. Consult a Dietician, who will help you determine a meal plan suitable for your lifestyle.
2. Foods with a high Glycaemic Index (GI) cause a more dramatic rise in blood glucose levels than foods with a low GI, therefore low GI foods are recommended. Low GI foods are mainly complex carbohydrates such as wholegrain bread, oats, high fibre breakfast cereals, pasta, barley, legumes, fruits, starchy vegetables such as corn and sweet potato and low-fat milk products.
3. Avoid excessive sugar intake from foods such as cakes, biscuits, chocolate and confectionery.
4. Limit the intake of saturated (animal) fat. A diet high in saturated fat interferes with diabetes control, contributes to weight gain and affects blood fat levels. This increases the risk of complications.
5. A recent, controlled study involving 37,000 women has found that middle age and elderly women with high levels of red meat in their diet have an increased risk of developing type 2 diabetes. This risk is increased in women who eat high levels of processed meats such as bacon and hotdogs.
6. Limit alcohol intake to no more than two drinks per day, with two alcohol-free days per week. Studies show that a light to moderate alcohol intake can reduce the risk of developing Type II Diabetes. However alcohol may react with insulin or medications and lead to hypoglycaemia. Alcohol should not be consumed at the same time as medications, and should be consumed with a carbohydrate food.


PREVENTION
• At present, Type I Diabetes cannot be prevented, although with careful management the symptoms can be controlled. Researchers are hoping to develop methods to prevent Type I Diabetes in the near future.
• Type II Diabetes tends to be linked to several risk factors. Those at risk of developing Type II Diabetes include:
• People over 50 with either hypertension (high blood pressure), obesity or a close relative with Diabetes.
• Anyone who is over 65.
• Anyone with a history of heart disease.
• Anyone who has had Gestational Diabetes.
• People from the Indian Subcontinent or people with Chinese backgrounds.

People who fall into one or more of these risk groups should consult their Doctor for advice on preventing Type II Diabetes. Exercise, weight management and a healthy diet can all help prevent Type II Diabetes.

VITAMINS/MINERALS/HERBS
Always consult your Doctor before taking any supplement or herbs. Nutritional supplements may only be of benefit if dietary intake is inadequate.
• Chromium helps control blood glucose levels.
• Essential fatty acids, such as omega 3 essential fatty acids found in fish oil, help to reduce elevated triglycerides and reduce the severity of diabetic neuropathy.
• B Complex vitamins are involved in promoting healthy blood sugar metabolism.
• CoQ10 has a protective effect on blood vessels. Individuals with Diabetes and pre-diabetes are at risk of blood vessel injury.
• Vitamin C, vitamin E and the minerals zinc and magnesium may help to reduce urinary protein output (a marker of glomerular renal function) in patients with diabetic nephropathy.
• Alpha Lipoic Acid has been shown to help regulate blood sugar levels in type 2 diabetes. Alpha-lipoic acid may also be helpful in cases of diabetic neuropathy in type 1 and 2 diabetes.
• Garlic may stabilize blood sugar and help reduce risk of heart disease and other circulatory disorders by improving blood flow, lowering elevated blood pressure and reducing cholesterol levels.
• Psyllium has been shown to reduce blood sugar levels.
• Bilberry may help to prevent diabetic retinopathy and cataracts.
• Gymnema sylvestre is a herb that helps to control blood sugar and may play a role in alleviating Type 2 Diabetes-related symptoms

MEDICAL TERMS
Hormone: a chemical produced in the body that has certain effects and functions in the body.
Ketones: A substance produced when fats are metabolized. During hyperglycemia excess amounts of ketones can be detected in the urine.

ORGANISATIONS & SUPPORT GROUPS
Diabetes India Association (http://www.diabetesindia.com/)

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. If you have any queries regarding your medication for Diabetes, ask your Pharmacist.
2. Blood glucose testing monitors are available to monitor your blood glucose. Ask your MedAux Pharmacist for advice.
3. Urinalysis testing strips can help detect excess glucose and ketones in the urine. These should be used in conjunction with a blood glucose monitor.
4. Sugar-free medications such as cough syrups are available. Remember to ask your Pharmacist for brands suitable for Diabetics.
5. Smoking increases the risk factors for other diseases such as heart disease and vascular disease. Ask your Pharmacist for help quitting smoking. Nicotine patches, nicotine chewing gum, nicotine inhalers and SMOKING CESSATION programme are all available from your MedAux Pharmacy.
6. Foot care products such as wound dressings, corn pads, nail clippers and your Pharmacist can recommend orthopedic shoes. A Podiatrist should always be consulted for any problems with the feet.
7. Exercise is vital, especially for Type II Diabetes. It reduces body fat, improves blood glucose control, lowers fat levels in the blood, lowers blood pressure and reduces the risk of heart disease.
8. See the Vitamins/Minerals/Herbs section in this topic and ask your Pharmacist for advice on dietary supplements.