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Diabetes

Diabetes is a chronic disease that occurs when the pancreas are no longer able to make insulin or when the body cannot make good use of the insulin it produces.

According to the International Diabetes Federation (IDF), in 2019 approximately 463 million adults (20-79 years) were living with diabetes. It is estimated that by 2045 this will rise to 625 million.

Type 2 diabetes is becoming more common in young adults, teens and children and accounts for roughly 90% of all diabetes cases worldwide. Diabetes is a major health problem and has become a lifestyle disease worldwide.

The rising prevalence of diabetes and other noncommunicable diseases is driven by a combination of factors – rapid urbanization, sedentary lifestyles, unhealthy diets, tobacco use, and increasing life expectancy.

Knowing diabetes better

Diabetes is a chronic disease that occurs when the pancreas are no longer able to make insulin or when the body cannot make good use of the insulin it produces.

Type 1 diabetes can develop at any age but is seen to occur most frequently in children and adolescents. In type 1 diabetes, the body produces very little or no insulin, which means that you need to take daily insulin injections to maintain your blood glucose levels.

Once diagnosed with type 1 diabetes, you’ll have to visit your doctor regularly to manage your diabetes. S/he will check your HbA1c levels and may also take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function.

Type 2 diabetes is more common in adults and accounts for approximately 90% of all diabetes cases.
In type 2 diabetes, the body does not make good use of the insulin that it produces. Type 2 diabetes can be treated by introducing lifestyle changes, that includes increased physical activity and healthy diet. However, over time many people may require oral medications and/or insulin to keep their blood glucose levels under control.

Gestational diabetes is a type of diabetes that causes high blood glucose during pregnancy and is associated with complications to both mother and child. It usually disappears after pregnancy.

Type 1 diabetes is caused by an autoimmune reaction where your body’s defence system attacks the cells that produce insulin, therefore it cannot be prevented.

You are more likely to develop type 2 diabetes if you are overweight/obese, have a family history of diabetes, age 45 or older, have high blood pressure, physically inactive, history of gestational diabetes, etc. Therefore, it can sometimes be prevented.

Know the symptoms. Take action

• Abnormal thirst and dry mouth
• Sudden weight loss
• Frequent urination
• Lack of energy, tiredness
• Constant hunger
• Blurred vision

The largest number of people with diabetes is between 40 and 59 years of age

Understanding the test numbers

DiagnosisA1c [percent]Fasting plasma glucose (FPG) [mg/dL]Oral glucose tolerance test (OGTT) [mg/dL]Random plasma glucose test (RPG) [mg/dL]
Normalbelow 5.799 or below139 or below
Prediabetes5.7 to 6.4100 to 125140 to 199
Diabetes6.5 or above126 or above200 or above200 or above

HbA1c test is a blood test that shows how your body has handled the blood sugar over the last 3 months and provides your average blood sugar level. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells (RBCs). Higher the glucose level in your bloodstream, the more glucose attaches to hemoglobin.

This test is performed in the morning and requires fasting for 8-10 hours.

For OGTT test, the fasting blood sugar level is measured after overnight fast. A high glucose dose is given, and the blood sugar levels are tested periodically for the next two hours. A glucose tolerance test measures how well the body’s cells are able to absorb glucose after consuming a specific amount of sugar.

RPG test is a blood test performed at any time of the day to check the blood sugar level.

Early diagnosis of diabetes and pre-diabetes is important so that you can begin to manage the disease early and potentially prevent or delay the serious disease complications that can decrease your quality of life.

It can help you to reduce the risk of serious complications such as premature heart disease and stroke, blindness, limb amputations, and kidney failure.

The treatment options depend on the type of diabetes

Type 1 diabetes
Treatment for type 1 diabetes involves taking insulin injections and frequent blood sugar check-ups. The body no longer makes this hormone. One can also use an insulin pump which gives small and steady doses throughout the day.

Type 2 diabetes
For type 2 diabetes, the treatment primarily involves lifestyle changes, monitoring of blood sugar, and one may have to use medications or/and later insulin.

Lifestyle changes for type 1 and type 2 diabetes
A balanced diet and physical activity are important parts of a healthy lifestyle when you have diabetes. What you choose to eat, how much quantity you eat, and what time you eat are all very important in keeping your blood glucose level in the range.

Physical activity
If you are overweight or obese, your doctor might ask you to lose weight. You should set a goal to be more physically active. Regular 30 minutes of physical activity, brisk walking, swimming, aerobics, etc. can be beneficial.

Medications for type 2 diabetes

Sometimes a healthy lifestyle may not be enough to keep blood glucose levels under control and people with type 2 diabetes may need to take one or multiple oral medications. If treatment with orally taken medication is not sufficient, people with type 2 diabetes may require insulin injections.

The most commonly used oral medications for type 2 diabetes are:

Metformin: Reduces insulin resistance and allows your body to use its own insulin more effectively. It is the first-line treatment for type 2 diabetes in most guidelines around the world

Sulfonylureas: Stimulate the pancreas to increase insulin production. eg. gliclazide, glibenclamide, glipizide, glimepiride, tolbutamide, etc.

Meglitinides: These are faster acting medications, that works like sulfonylureas by stimulating the pancreas to secrete more insulin. eg. repaglinide, nateglinide

Thiazolidinediones: Acts by making the body’s tissues more sensitive to insulin. eg. rosiglitazone, pioglitazone
DPP-4 inhibitors: Helps reducing blood sugar without causing weight gain. eg. sitagliptin, saxagliptin, vildagliptin, etc.

GLP-1 receptor agonists: Acts by inhibiting digestion and help lower blood sugar levels, these are available in injectable format. eg. exenatide, liraglutide, dulaglutide, albiglutide, etc.

SGLT2 inhibitors: Prevents the kidneys from reabsorbing sugar into the blood and get excreted in the urine. eg. dapagliflozin, canagliflozin, empagliflozin, etc.

Diabetes can affect anyone. But, knowing the risk factors can help identify the changes to be made to your lifestyle.

Different types of insulin and how they work

Insulin has 3 characteristics
Onset: The length of time before insulin reaches the bloodstream and begins lowering blood sugar

Peak time: The time during which insulin is at maximum strength in terms of lowering blood sugar

Duration: How long insulin continues to lower the blood glucose level

There are different types of insulins depending on how quickly they work, when they peak and how long they last. It is delivered with a syringe, insulin pen or insulin pump.

Insulin typeHow fast it starts to work (onset)When it peaksHow long it lasts (duration)
Rapid-acting

(Aspart, Glulisine, Lispro)

About 15 minutes after injection1 hour2 to 4 hours
Regular or Short-acting

(Actrapid, Humulin R, Novolin R)

Within 30 minutes after injection2 to 3 hours3 to 6 hours
Intermediate-acting

(Insulin NPH: Humulin N, Novolin N)

2 to 4 hours after injection4 to 12 hours12 to 18 hours
Long-acting

(Detemir, Glargine)

Several hours after injectionDoes not peak24 hours; some last longer

Your doctor might also recommend you a premixed insulin, which is a mix of two types of insulin. Insulin that comes in pre-mixed formulations combines insulins that have different onsets and duration to best manage your blood glucose levels.

Premixed insulin can also be helpful if you have trouble drawing up insulin out of two bottles and reading the correct directions and dosages. It is useful for patients who have poor eyesight or dexterity.

Talk to your doctor about the options to take insulin and which is best for you. Most people use a needle and syringe, pen, or insulin pump. Inhalers, injection ports and jet injectors are fewer common options used.

Insulin Vial
Insulin shots are given using a needle and syringe. You will draw up the recommended dose of insulin from the vial, or bottle, into the syringe. Injection spots include your lower abdomen (belly), thighs, buttocks, or upper arm.

Insulin Pen
Some of the insulin pens come filled with insulin and are disposable. Others have space for an insulin cartridge that you can insert and then replace after use. Insulin pens cost more than needles and syringes but many people find them convenient to use.

Rotating injection sites can help protect the skin
Choose a different area of each time you inject your diabetes medicine. For example, if you inject in your abdomen in the morning, inject in your outer thigh or upper arm the next time. Where you inject can affect how the medicine works and avoid lumps or buildup of scar tissue.

Consulting a dietitian can help you control your diabetes
Your dietician will work along your diabetes consultants and plan a personalized treatment plan for you according to your needs. This helps your diabetes to be controlled and managed possible through a good understanding of the condition and the best use of medications where appropriate.

Diabetes and your eyes
The best way to handle eye related problems is through early detection of retinal abnormalities, regular monitoring, and prompt treatment. Early detection and treatment usually begins with eye check-ups.

Diabetes and its economic impact

Diabetes and its complications can have an economic impact on people who are diagnosed with diabetes, their families, and to the health system and national economy through direct medical costs and loss of work and wages.

Indirect and intangible costs are seen to be larger. Indirect costs result from lost production due to frequent absence from work, inability to work, premature retirement and even premature mortality as a result of diabetic complications like cardiovascular diseases, neuropathy, nephropathy, retinopathy, etc. Intangible costs include those that reduce the quality of life, because of pain, anxiety and stress.

Useful links:
• https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html
• https://www.diabetes.org/a1c/diagnosis
• https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis
• https://www.diabetes.org/diabetes/medication-management/insulin-other-injectables/insulin-basics
• https://aspe.hhs.gov/report/diabetes-national-plan-action/importance-early-diabetes-detection

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