Diabetes Mellitus

GR Sridhar, Endocrine and Diabetes Centre, Visakhapatnam - 530002.

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All of us are sweet, more or less. For that is the taste of the major fuel that keeps the body's machinery going: glucose, the breakdown product of the food we eat. Glucose courses through the blood, moving in and out of cells, stoking their metabolism. In a narrow sense, the level of blood glucose defines the limits of normalcy. Too much of it, and one has that sweetness nobody is keen to have -- Diabetes Mellitus.

Diabetes can exist silently. It can appear as insidiously as its brother, high blood pressure. Symptoms, when they are present are merely guideposts. They alert to the possibility of having something wrong. The accepted criteria to diagnose diabetes is elevated levels of glucose in the blood. A touch of sugar in the urine does not constitute disease, nor does an absence exclude it.

Diabetes mellitus is the most common of all endocrine diseases; it affects more than two out of every hundred Indians. That may at first sound like a bland statistic, but the figure increases manifold in select groups, say,those aged 40 and above, who are obese, who have a family history of diabetes, and so on. Age is no bar to getting the disease. It can strike as early as the sixth month of life, just as it can wait until the 80th year, and all ages in between and beyond.

Unlike children who often present with weight loss, increased urination and increased thirst, adults may not have such a clear picture; in adults it could well be easy tiredness, vague body pains, weight loss, pins and needles, infections, or just as often, nothing: the blood glucose shows a high reading.

Mind you, none of these symptoms is itself diagnostic. The message is, be aware of the disease. At the same time, don't panic. You could get your blood sugar measured in the routine annual medical examination. A high blood sugar level may not always signify the terror one associated this common metabolic anomaly with. Leave the decision to your doctor. As in so many other diseases, so in diabetes, there is no sheer white and black. Take your doctors expertise to place you in the continuum of gray.

Finally, diabetes is often not the end of everything in life. It could be the harbinger of a new you: trimmer, fitter, and yes, healthier!

HOW DOES DIABETES DEVELOP

The body depends on glucose to function properly. Glucose in the blood is kept within a narrow range by insulin, a chemical secreted by the pancreas, which is a slender gland lying across deep in the abdomen. When the pancreas does not produce enough insulin, glucose circulates aplenty in the blood, without being able to get into cells, where it is really needed. Thereby, tissues are starved of glucose, in the face of plenty that cannot be utilised for lack of the transporting substance, insulin.

On the other hand, in adults (and adult diabetics comprise more than 95th of all diabetics in India), insulin is not completely absent from the body. Whatever insulin is there is not sufficient for the body's needs. In other words, adult diabetics have relative insulin deficiency unlike childhood diabetics who have complete lack of insulin. Adults thus have relative insulin deficiency, whereby the circulating insulin is either unable to act as well as it should, or the body needs more than what the pancreas can produce.

RISK FACTORS FOR DIABETES

Are there any conditions that predispose one to developing diabetes ? Although the risk factors by themselves cannot induce diabetes, they increase the chances of becoming diabetic, if a diabetogenic 'soil' exists.

In summary, genes seem to be important risk factors for developing diabetes. Others are contributory. some people may however have diabetes without any known risk factor.

DOES DIABETES EVER GO AWAY

The usual type of diabetes does not. In a way, one should be glad to get that kind of the disease. For there are some very rare forms that can be cured by removing the underlying disease that causes diabetes. The catch is, the underlying disease is much more dangerous: for example, a tumour in the pituitary gland of the brain, or in the pancreas. These conditions are far more serious than the diabetes, which is a byproduct of altered hormonal secretion. In case the tumour can be successfully removed diabetes is likely to regress. My guess is, few would like to get that kind of diabetes, even if it is potentially reversible.

That caveat aside, once diabetes sets in, it is for life. If it isn't so, one would not have diagnosed it as diabetes in the first place. Diabetes can only be controlled; it cannot be cured.

CAN DIABETES BE PREVENTED

At least can we prevent diabetes from occurring ? For a long time there was no practical way to prevent the usual adult onset form of diabetes. Recent studies have shown that regular physical exercise can delay the onset of diabetes. Exercise can be walking, jogging, or any other form, about 60 minutes a day, five to six times a week.

This indeed is welcome news, particularly to those who are at risk: eg, siblings or children of persons with diabetes.


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