Understanding Diabetes: Types, Causes, Treatment, and Lifestyle Management

Sugar is slowly losing its fame as a sweetener and is increasingly being understood more as a disease than the role that nature has bestowed on it. It is also losing its role as a snack that a guest is treated with as a gesture of welcome. Instead, it is now a dreaded word that implies impaired life. The following statistic alone is enough to prove the point. 

Diabetes affects millions of people around the globe. over 101 million people in India living with diabetes in regions like Goa, Puducherry, and Kerala, depicting the highest prevalence rates. 

So, in most households today, sugar has lost its traditional importance as a cooking medium. Because sugar, in our everyday parlance, has replaced diabetes. If one is afflicted with diabetes, it is more likely that one would refer to it as being afflicted with ‘SUGAR’. It is general knowledge that diabetes is essentially triggered by excess glucose in the body. And sugar derives its credence as a synonym of diabetes from glucose.  However, the dread associated with diabetes may not be as dreadful as is generally believed if it is taken care of properly and detected early. This blog will dive deep into the details of this disease for effective diabetes management and to help you make wise health-related choices.

What is Diabetes

Diabetes is largely classified into two broad categories—Type I and Type II. It is triggered by the inadequate release of insulin from the pancreas. Now, insulin plays a crucial role in bodily functions as it regulates the amount of glucose in our system. If blood sugar levels rise too high or drop too low, it can pose serious health risks, requiring medical attention.

Managing Diabetes: The Role of Insulin

When we talk about treating diabetes, we essentially mean managing insulin so that it functions effectively to regulate glucose levels. The effectiveness of insulin is key. On a cellular level, insulin can become less effective, leading to elevated glucose levels and, in some cases, hyperinsulinemia (a condition where excess insulin circulates in the blood). This is not just about glucose levels; it can lead to other complications such as high blood pressure, cardiovascular diseases, and cerebrovascular problems.

What is Type I Diabetes?

Type I diabetes typically develops in childhood or early adolescence, though it can also occur in young adults. It is an autoimmune disorder where the body's immune system destroys the pancreatic beta cells responsible for insulin production. As a result, individuals with Type I diabetes require lifelong insulin therapy. However, proper type 1 diabetes care prevents this disease from damaging the different organs. 

What is Type II Diabetes?

Unlike Type I diabetes, Type II diabetes can initially be managed with oral hypoglycemic agents (OHAs)—medications that lower blood sugar levels. However, as the disease progresses, insulin therapy may be required eventually. As this disease progresses, insulin therapy may eventually be required along with strategic type 2 diabetes care.

Is Diabetes Reversible?

Yes, but not all types. Type II diabetes is largely reversible, especially within the first six to eight years of onset. The correct term, however, is "remission" rather than "reversal." Remission occurs when a patient remains drug-free for three months or more, with an HbA1c level of 6.5 or lower, fasting plasma glucose under 126 mg/dL, and an oral glucose tolerance test (OGTT) result below 200 mg/dL.

Even in remission, patients remain at risk for diabetes-related complications, such as microvascular issues (retinopathy, nephropathy, and neuropathy) and cardiovascular diseases. Therefore, regular check-ups are essential.

For Type I diabetes, remission is not possible. Some patients experience a temporary "honeymoon phase" after initial treatment, but this is short-lived and does not equate to true remission.

Can Stress Trigger Diabetes?

Yes, stress is a known risk factor for diabetes and can exacerbate the condition in those already diagnosed. Conversely, diabetes can cause stress, creating a cycle that affects overall health.

Is There a Link Between Mental Health and Diabetes?

Yes. Most people do not realise that diabetes, if left uncontrolled, may lead to various other complications, including issues related to mental health. Studies have shown that diabetes can even lead to depression, with major depression being up to 2.5 times more prevalent in diabetic patients. The reverse is also true—depression can increase the risk of diabetes. Schizophrenia has also been strongly linked to diabetes. A recent study by ICMR India found that one in nine adults in India suffers from Type II diabetes.

Are Diabetics More Susceptible to Infections?

Yes. Diabetic patients are at a higher risk of infections compared to non-diabetic individuals. The likelihood of infections depends on the duration of diabetes and how well blood sugar levels are controlled.

Why Do Blood Sugar Levels Fluctuate Throughout the Day?

The complaint that despite regular medications sugar level in the blood is fluctuating so much so that at times it falling below the accepted level. Blood sugar fluctuations, known as glycemic variability, occur due to improper medication dosage or timing. If left unaddressed, this can increase the risk of cardiovascular and microvascular complications. To manage this, a patient’s medical history should be reviewed, and medication regimens should be adjusted accordingly.

What Role Do Patients Play in Diabetes Management?

In managing diabetes patients themselves play the most crucial role. This makes self-monitoring of blood glucose (SMBG) crucial, particularly for those who are on insulin or sulfonylureas. Owning a glucometer is highly recommended for the effective management of diabetes, as no one from outside can detect that a patient’s sugar level is dipping. The initial unease associated with it can only be felt by the patient. As soon as such a feeling of unease surfaces, a patient needs to test their own sugar level and take the initial steps in mitigating the issue. 

For patients experiencing hypoglycemia (low blood sugar), insulin dosage may need adjustment. It is something that can be addressed by the patient. In cases of mild hypoglycemia, a 10% dose reduction is advisable, while severe hypoglycemia requiring third-party intervention may necessitate a 30% reduction. This is the reason why in diabetes empowerment of patients is deemed crucial. Besides the medication, following a diabetes diet plan can help to attain control over the blood sugar level. 

Can Physical Activity Help Control Diabetes?

Yes. Diabetes is often linked to a sedentary lifestyle, so physical activity is vital. A minimum of 30 minutes of aerobic walking (4–5 km per hour) for at least six days a week is recommended. Consecutive rest days should be avoided. Additionally, incorporating light resistance training twice a week can be beneficial. These activities are even beneficial for those diabetes patients suffering from insulin resistance.

Do’s and Don’ts for Diabetic Patients

Do’s:

• Follow a regular exercise regimen.
• Seek psychological counselling if needed.

Don’ts:

• Avoid trans fats found in chips, deep-fried foods, and processed snacks.
• Refrain from addictive substances.

The key to diabetes management is calorie control. Patients should be empowered to make informed food choices while maintaining a balanced diet.

What Should a Diabetic Diet Look Like?

Caloric intake must be monitored, especially for those on insulin or sulfonylureas. Snacks should be low-calorie, fibre-rich, and have a low glycemic index (GI), such as fruits. Intermittent fasting is not generally recommended, except in cases where significant weight loss (10–15%) is required for remission.

For individuals with a sedentary lifestyle, a daily intake of 1400–1500 calories is advised. A balanced diet should consist of:

• 60% carbohydrates
• 25% protein
• 15% fats, ideally from a mix of healthy oils

Are There Other Types of Diabetes?

Yes. Apart from Type I and Type II diabetes, other forms include:

• Steroid-induced diabetes – Elevated blood sugar levels due to prolonged use of glucocorticoids.
• Drug-induced diabetes – Some oncology medications can cause diabetes.
• Pancreatic diabetes (Type 3c diabetes) – Caused by pancreatic disease, leading to reduced insulin production.
• Gestational diabetes – occurs during pregnancy and usually resolves postpartum.

Can Diabetes Lead to Cancer?

Yes, there is growing evidence that diabetes can increase the risk of certain cancers. However, custom diabetes treatment options should be selected as every diabetes patient is unique. 

Given the tendency of diabetes to impact almost all the major organs of the body, it may be advisable to visit a hospital like Peerless which is multi-speciality offering a multitude of required diagnostic options