CAUSES

Blood sugar levels are regulated by a hormone called insulin that is synthesised by beta cells of the pancreas. The main function of the hormone is to bind to receptors on the fat, liver and muscle cells so as to allow the entry of glucose molecules inside them. Inside the cells, glucose is stored and then utilised as an energy source whenever needed.

In type 2 diabetes, the cells of the fat, liver and muscles fail to respond to the presence of insulin. This means that even in the presence of insulin, glucose does not enter inside the cells, which results in an increased blood sugar level. In simple terms, the cells display insulin resistance causing an increased level of sugar, also called  hyperglycemia.

RISK FACTORS

Type 2 diabetes is a silent killer as it progress slowly over a period of time. Although, non-modifiable factors like age, genetics and ethnicity do play a role in the development of type 2 diabetes, it’s the modifiable risk factors like diet and lifestyle habits that have increased the incidence of diabetes in the past few years.

Obesity : Most people who get diagnosed with type 2 diabetes are overweight. That’s simply because increased fat stores makes it harder for your body to use insulin in the right way.

Physical inactivity: Sedentary lifestyle is one of the main contributing factors for development of obesity that is linked to diabetes. 

Family history: It has been estimated that children with one parent having diabetes have double the risk of developing diabetes as an adult, while those having both parents with diabetes have six times greater risk of developing diabetes compared to healthy individuals. The average age at which diabetes may develop in such people is dependent on the kind of lifestyle they follow. A person who follows a healthy lifestyle may develop the condition at a much later stage compared to a person who follow unhealthy eating and lifestyle habits.

SYMPTOMs

Increased appetite: Diabetics are unable to utilise glucose for energy so they keep feeling hungry all the time since the cells are craving for glucose.

Increased thirst: Increased blood sugar can make diabetics dehydrated, inducing thirst all the time.

Frequent urination: Dehydration along with the constant feeling of thirst, diabetics tend to drink more water which is the reason they end up visiting the bathroom more often. Excess urination is a common sign of diabetes.

Sudden weight loss: In diabetics, despite the intake of glucose, the body isn’t able to utilise it for deriving energy. Therefore, the body utilises fat to derive energy, causing weight loss, without exercising and dietary changes.

Poor wound healing: Increased blood sugar causes hardening of blood vessels affecting blood circulation. When blood flow to injured tissues gets affected, blood clotting proteins and other factors that promote healing do not reach the site of injury. This causes wounds to heal slowly.

Other symptoms include

• Blurred vision
• Pain in the hands and feet or numbness
• Depression
• Frequent infections of the kidney, bladder and skin

DIAGNOSIS

If your doctor suspects you of having diabetes, you’ll have to undergo a blood test to check your blood sugar levels.

Fasting blood glucose test: It measures blood sugar level after fasting for at least 8 hours. Ideally, when you’re fasting, your blood sugar levels should lower because of lack of source of glucose through food intake. A high fasting blood glucose level indicates ineffective regulation of blood glucose.

Oral glucose tolerance test (OGTT): Like the fasting plasma glucose test, this test also requires 8 hours of fasting. Following that, you have to drink a glass of water mixed with 75g of glucose. The blood glucose is then checked after 2 hours of taking the fluid.

HbA1C test or glycated hemoglobin test: This test measures the amount of sugar or glucose attached to hemoglobin present in the membrane of red blood cells (RBCs) circulating in the body. It’s advisable for all diabetics to get HbA1c test done atleast twice a year. 

COMPLICATIONS

Peripheral neuropathy: Foot problems are common among diabetics due to poor blood circulation. Without proper attention, something as trivial as a minor cut can result in foot ulcers, which are susceptible to infection, as a result of peripheral neuropathy.

Diabetic retinopathy: Diabetics often start experiencing blurred vision, vision loss or swelling around the eyes, it could indicate  diabetic retinopathy. 

Diabetic gastroparesis:  Diabetic gastroparesis is a complication that results in digestion problems among people with diabetes. ‘The condition may occur as a result of damage to the vagus nerve that controls contractions of the stomach muscles. So, the food moves slowly or stops moving through the digestive tract,’ explains Dr Pradeep Gadge, consultant diabetologist.

Erectile dysfunction: It’s true that erectile dysfunction and other sort of sex-related problems are extremely common among diabetics. It’s estimated that 60-70% men who suffer from diabetes suffer from some sort of erectile dysfunction or another.

TREATMENT

Diabetes cannot be cured or reversed. Treatment options involve medication for controlling and preventing a sudden spike in blood sugar levels. Here are medications used for treatment of diabetes.

• Sulfonylureas like DiaBeta, Glucotrol and Amaryl are prescribed to lower blood glucose levels by increasing the release of insulin from the pancreas. These drugs decrease blood sugar rapidly but may cause abnormally low and dangerous levels of blood sugar (hypoglycemia) leading to mental confusion and even coma.
• Biguanides like Metformin lower the amount of glucose released from the liver  and reduces absorption of glucose in the intestines.
• Thiazolidinediones (Actos and Avandia) lower blood glucose by increasing the sensitivity of the muscle and fat cells to insulin. These drugs may be taken with metformin and/or a sulfonylurea. They can cause mild liver problems but are reversible with discontinuation of the drug.
• Insulin injections: Insulin is also important in type 2 diabetes when blood glucose levels cannot be controlled by diet, weight loss, exercise and oral medicines. There are different types of insulin depending on their range of acting. Rapid-acting insulin like Insulin lispro starts working in about 15 minutes and lasts for 3 to 5 hours, while short-acting insulin starts working within 30 to 60 minutes of infusion and lasts 5 to 8 hours.

Bariatric surgery: Weight management surgery is recommended for diabetics who are overweight. The surgery changes hormonal levels in the blood. Post-surgery, the insulin produced by the pancreas becomes insufficient and resistance is increased and blood sugar is controlled. 

HOME REMEDIES

Several herbs and plants easily available in Indian households hold the potential to regulate blood sugar levels according to Ayurveda. 

Tulsi leaves: Also known as tulsi, leaves of holy basil are packed with antioxidants and essential oils that produce eugenol, methyl eugenol and caryophyllene.  Collectively these substances help the pancreatic beta cells (cells that store and release insulin) function properly. This in turn helps increase sensitivity to insulin.

Neem: Found abundantly in India, the bitter leaf has a number of amazing medicinal properties. Neem enhances insulin receptor sensitivity, helps improve blood circulation by dilating the blood vessels, lowers blood glucose levels and reduces one’s dependence on hypoglycaemic drugs.

Fenugreek or methi: Used in paranthas and various Indian curries, methi has many health benefits. In recent times, clinical trials on people with type 2 diabetes show that fenugreek has the valuable property of reducing the rate at which sugar is absorbed from the stomach during the process of digestion.

Exercise: ‘We should look at exercise like a drug to control diabetes. Just like prescribed medicine, exercise too, when taken in the right frequency, dose and duration can help regulate sugar levels.

Diet changes: Dietary changes include avoidance of refined sugars and saturated fats. Diabetic patients should focus on improving the intake of leafy vegetables, salads, fruits and low-fat dairy products.

Managing stress: For keeping stress levels low, ensure that you sleep for at least 6-8 hours at night. Practice yoga or meditation to induce relaxation.

PREVENTION

Diabetes prevention is possible with correct lifestyle changes and modifications. Here are a few:

• Physical activity
• Quit smoking
• Limit alcohol intake
• Regular health checks
• Healthy diet