Diabetics – 100 common doubts answered PART1
The most frightening diseases of 21st century – diabetics, cholesterol and heart problems! These three are related to one another in some way or another. It’s most happening due to our life style, food habits and lack of proper exercises. November 14 is dedicated to diabetics and it’s known as World Diabetics Day. In this occasion, let me try to clear 100 common doubts of diabetics through this article; also to make you remember that it’s possible to keep away from this attack if you determine so.
What is diabetics?
According to recent survey conducted in Kerala, there are 30 lakh diabetic patients and its number is increasing day by day. Diabetics is a part of old age – every one think so. Though 30 lakh cases are reported not even 1/4th are getting proper treatment. Main hindrance is the ignorance of people – says WHO.
1. What is diabetics? Why it happens?
If sugar content in blood becomes excess such a condition is known as diabetic. Hormone insulin is responsible for controlling sugar levels in blood. If blood is deficient in sugar what happens? Sugar level rises in blood. It also happens when insulin is not accepted by our body. Now also many facts are still to be known why blood becomes insulin deficit. Insulin is produced by beta cells of pancreas and it’s assumed that some genetic factors can also reduce the insulin production. Over eating and less exercising increase body weight. It increases the fat content of the body which acts against insulin. So, both our life styles and genetic factors can lead to diabetics.
2. What are the different types of diabetics? What’s the difference between type1 and type 2 diabetics?
Diabetics is of four types – type 1 and 2, pregnant related and due to some external factors like steroids.
Type-1 diabetics occur when beta cells that produce insulin stop functioning. It may be formed from early childhood also.
Type 2 is of two types – resistance of body against insulin and low insulin levels in blood. 95% of diabetic patients belong to type-2 category.
3. What’s the relationship among insulin, glucose and diabetics?
If we intake sugar in excess, glucose level of blood increases. It happens if you are going through some tensions also. Normally, in a healthy person, according to the demanding situation insulin production also adjusts by itself. Body uses this insulin to reduce those glucose levels. Energy flow or chemical deposits similar to fats are its end results. But in an insulin deficient person, these functions won’t take place properly. In other words, their body cells are incapable of using that excess glucose for body functions. Result - increase of sugar level in blood leading to diabetic condition.
4. How should a diabetic patient maintain his sugar levels?
Diabetic patients should maintain their fasting sugar levels below 110 mg/dl. After food, it should never exceed 140 mg/dl. HbAlc, also known as Glycosylated hemoglobin should never exceed 7% in diabetic patients.
5. Why is it told that diabetic patients should avoid sugar?
Sugar level in blood determines diabetics. When a diabetic patient is incapable of digesting already existing sugar in his blood, more added sugars can make his condition only worse than before.
6. What is HbAlc? What’s its significance?
HbAlc, also known as Glycosylated hemoglobin test is an advanced one. When glucose level increases, it gets bind with certain proteins. One such protein is hemoglobin, found in RBC. Life span of hemoglobin is 90-120 days. By examining hemoglobin or HbAlc level, it’s possible to know average of blood sugar level of previous three months. This test can be done fasting or after a diet. If measurement is taken using good quality instruments, we will get accurate values.
7. Are gestational diabetic patients prone to diabetic attacks later?
Diabetics during pregnancy is known as gestational diabetics and such ladies have more chances for this disease later. During pregnancy period, hormone level is very high; particularly sex hormones and placental hormones. These hormones are capable of resisting insulin which leads to diabetic condition during gestation period. It most happens after 3 months and in normal cases, she becomes normal soon after delivery.
It can be said that those disease symptoms have exhibited during gestation period. As she becomes more aged, due to obesity and lack of exercise, insulin may be resisted and dip is insulin production rate can make them permanent diabetic. So, such ladies should maintain good life style to avoid diabetics in distant future. They need to check their blood sugar at frequent intervals as well.
8. Does excess sugar intake gives more chances to diabetics?
Excess sugar intake can invite diabetics without any reason. If you are already a diabetic patient, your condition will worsen with your sugar diet. Both diabetic and pre-diabetic patients can take sugar in mild quantities. But studies say that intake of sweets can adversely affect insulin production and functioning. It happens through a complex function, glucotoxicity. Some studies have already proved that while we intake sugar, certain chemical substances called incretins are produced that temporary arrests the production of insulin. But as age passes by, our sweet intake can increase blood sugar level which makes beta cells lazier in producing insulin. When beta cells become lazy, insulin levels dip resulting in higher blood sugar levels. Not only that, sugar contains high energy with high calories and hence only provision available is to store them in cells in the form of fat. Such fat deposits reduce proper functioning of insulin by resisting them giving more chances for diabetics.
9. Is it possible to know chances of diabetics earlier?
Many risk factors can pave way to diabetics – obesity, hereditary, fast food, excess calorie intake, less body exercises, steroids, physical and mental problems are most common among them. High blood pressure, heart problems and high cholesterol levels give more chances to diabetic attacks. If you are an alcohol addict, you may be affected by pancreatitis which may lead to diabetics in future.
10. Why diabetic chances increases with our age?
When we become aged our muscle mass is reduced considerably and more energy gets deposited as fats. They can’t do heavy exercises and activities also. Their tensions – physical, mental and financial are also high. These pressures give them more chances for diabetics as it induce and activate such diabetic-causing hormones more. Cortisol and adrenalin hormones come under this category.
11. Through food control and regular exercises, is it possible to bring diabetics under full control?
Food and exercise are the main factors that influence type-2 diabetics. But in 90% cases, diabetic patients need medicine in addition to controlled food and regular exercise.
12. Can high blood pressure increase chances for diabetics?
It’s observed that high blood pressure patients have diabetics as well. It can’t be completely assumed that hypertension leads to diabetics. But it’s sure both are risk factors pointing towards each other. For example, 50% of persons who became blood pressure patients due to obesity, tensions, absence of exercise and high intake of calories have diabetics as well. Diabetic patients may be attacked by high blood pressure also.
13. What’s the relationship between cholesterol level and diabetics?
There is no direct co-relation between these two. But, increased level of serum triglyceride - a fat content in blood is a diabetic risk factor. Obesity, particularly central obesity has direct relationship with serum triglyceride and diabetics.
14. What’s pre-diabetics? What’s its significance?
It’s the condition just before diabetics. Though it can’t be treated as normal, this condition never falls in diabetic category too. There are two types of pre-diabetics.
a. Impaired Fasting Glucose (IFG) where fasting plasma glucose level ranges between 100 mg/dl and 125 mg/dl.
b. Impaired Glucose Tolerance (IGT) where glucose is given and readings taken after 2 hours. Its value comes between 140 mg/dl and 199 mg/dl.
If a person is detected pre-diabetic in this stage, it’s possible to take him back to normal conditions through strict diet and regular exercises and without the use of medicines.
15. If pre-diabetics stage is diagnosed is it possible to come back to normal conditions?
Yes, 100% possible. If the person is willing to control the intake of calories and do regular exercises it can reduce its growth to diabetics. In some cases medicines may be necessary.
16. If diabetics is detected, can the patient recover from it?
If it’s in first stages, by reducing body weight it’s possible, though can’t completely assure. Genetic traits play an important role in diabetics and that’s the reason why doctors can’t say with confirmation that it’s possible. But if it’s controlled in preliminary stages the person can live as if he is not a diabetic patient.
17. Can we predict hypoglycemia in diabetic patients?
Hypoglycemia is a condition of sudden dip of glucose level. A diabetic patient should have regular food habits. Otherwise he may be attacked by this condition even after taking medicines and insulin. He should never quit a meal. If he takes a meal late, it can happen. Common symptoms are high heart beats, sweating, excess hunger, dizziness, fatigue and loss of consciousness. Sometimes such symptoms may be misinterpreted.
18. What’s the first aid of hypoglycemia?
He should take food first. If possible check his blood sugar level using glucometer to know how much it has dipped. If it has gone below 50 mg/dl, he should intake glucose. Nowadays glucose tablets are available in market. Most important thing to be noted, next day he should take medicines in less quantity (low doze). Otherwise hypoglycemia can occur again.
Diabetics – some basic facts
19. What are the primary symptoms of diabetics?
Excess thirst and hunger, frequent urination, unhealed wounds, tiredness, pain and tiredness of hands and legs – these are the common symptoms. But these primary symptoms are not seen in 50% of diabetic patients, particularly at pre-diabetic stage. So, it’s possible to detect diabetics and pre-diabetics only through blood reports.
20. What are the common methods to test diabetics?
- Oral glucose tolerance test – 75 gm glucose is given and value checked after 2 hours. If value is above 200 mg/dl, it’s diabetics
- Fasting plasma glucose – Blood sugar checked after 12 hours of fasting. If value is above 126 mg/dl, he has diabetics.
- Random plasma glucose – If value is above 200 mg/dl, it’s diabetics.
American Diabetic Association and similar organizations say that if HbAlc value is above 6.5% it can be assured that it’s diabetics. But in India, GTT is still considered as the measurement of diabetics.
Treatment and medicines
21. How diabetics is treated?
Diabetic treatment doesn’t imply that it’s just medicines and insulin injections. Most important factors are healthy food and regular exercise. Body mass index should be maintained. So, if needed, patient need to reduce his weight through food control and exercise. BMI should be in between 19 and 23. Waist length in healthy men and women should be less than 90 cm and 80 cm respectively. Smoking and alcohol consumption should be avoided. Then only treatment through medicines and insulin take place.
Medicines should be chosen according to characteristics of disease and it differs from person to person. Age, diabetic type and complexities are the different attributes that determine its treatment. A patient’s diabetic prescription may be entirely different from another. Some persons may need insulin while some others just tablets. So, never do self-treatment. It can lead to many complications in future.
22. When treatment should be started?
If you carry genetic traits of diabetics or if you are following a life style which gives diabetic possibilities, precautions should be taken as early as possible. The moment which you detect diabetic or pre-diabetic condition, treatment should be begun. Insulin resistance begins to show at early stages itself. Tablets like metformin may help you at this stage. Type-1 diabetics occurs when person’s body is deficient of insulin. In such cases insulin injection is the only remedy.
23. What’s the aim of diabetic treatment?
Aims are two. First one is to control glucose level in blood as much as possible. Second aim is to reduce complexities that may occur in his life in future and take suitable precautions if necessary. Controlling blood pressure and cholesterol and treatment of kidneys and eyes also fall in this category.
24. If diabetics is under control, can the patient stop medicines?
Diabetic medicines are prescribed to bring glucose level to normal values. So healthy food and good exercises are needed in all conditions. In some persons, if it’s uncontrollable glucose levels excess doze may be needed. But through good life style condition of the patient can be improved and helps in controlling diabetics easier. Doze of medicines can be reduced at this stage, which is very important. Yet, medicines should be taken to improve the functioning of insulin. To regulate sugar levels, patient may be needed to continue his medicines and insulin injection.
25. What things should be noted while insulin is selected?
Diabetics control and insulin injections are prescribed according to patient’s age, job, food style and exercise. Tests are conducted to know how much insulin is needed to be injected. Taking into note, insulin’s functioning time, the time to inject insulin is decided.
Regular insulin and 30/70, 25/75 and 50/50 mixtures are to be taken half hour before food. Some analogue injections are to be taken 15 minutes before food or along with food. Some insulin injections are taken in the late night to control glucose level before breakfast. All these factors are decided by the doctor and the person who takes these injections should understand it well.
26. Why insulin is injected?
Diabetics is formed either when body doesn’t produce sufficient insulin or if it’s not able to use the insulin of the body. For the following conditions, insulin injections are prescribed.
- Type-1 diabetics
- In type-2 diabetics if blood sugar can’t be controlled by tablets only.
- Diabetics in pregnant ladies during gestation period
- If patient have many other severe diseases
- Excess diabetic and complexities
27. Is it necessary that insulin injections should be taken at particular body parts only?
Yes, of course. Back side of hands below the shoulders, backside of thighs or two inches below the navel in stomach – these are the common body parts where insulin injections are taken. While taking injections in different body parts, its effects also differ. Absorption speed and rate may also differ. So, take injections in the same body parts daily. If today morning injection is taken on one hand, in the evening inject in the same position of the other hand. But never adopt methods like tomorrow in both thighs and day after tomorrow below the navel.
28. Why insulin treatment often becomes inefficient in some cases?
Insulin treatment is so simple. But, even a careless mistake gives you ineffective results. In rooms, if it’s normal temperature, insulin can be kept safe for 1 month. But never place it above TV tops or refrigerator tops or cool places like freezer. It’s safe to place them in fridge side doors during summer. Never keep them in vehicles. Insulin mixtures with NPH content are like rice starch and should be mixed soft by placing in your palm before use. You should carefully follow doctor’s instructions before taking insulin injections.
29. Irregular medicine intakes or not taking for a long period – how can they both harm?
Aim of medicines is to foresee future conditions as well, in addition to regulating present sugar levels. So, if you don’t take medicines properly and discontinue them, complexities may increase and can even damage your internal organs like kidneys and heart.
30. Can medicines taken for a long period increase chances for other diseases or problems?
Very often, complexities associated with diabetics are misinterpreted as side effects of medicines. Such difficulties are not occurring as a part of diabetic treatment or medicines. If you take regular medicines, complexities will be minimized and many problems can be postponed at least for a short period.
Yet some medicines do have side effects in some persons. Hypoglycemia is one example. Such conditions should be identified, treated and avoided in future. Also self treatments invite a lot of complications later. It’s a myth that diabetic medicines cause kidney damages. If kidneys are to be protected, diabetics should be identified at primary stages itself and taken proper precautions so that other organs won’t be affected as complexities increase. When diabetics is detected, control should be strictly followed in the first 10 years. If this period is treated careless, there will be no use if complain about kidney problems or eye problems at the later stages.
31. When should a diabetic patient consult doctor?
After detection, if sugar level is in control he needs to visit doctor once in 3-4 months. If he needs to take insulin treatment for the first time, he should consult doctor or diabetic team members once in a week during first stage to regulate the insulin doses. All diabetic patients should undergo a detailed checkup once in every year.
32. If medicine is taken during pre-diabetic stage is diabetics curable?
During pre-diabetic stage, more chances are there for heart attacks and heart problems. So, such persons need to be strict in food and exercise to keep his sugar levels in control. Persons with high blood pressure, diabetics during pregnancy, hereditary traits of heart diseases, over weighted or unhealthy living habits can adopt medicines also. Such persons are at high risk! Metformin and Acarbose are the normal prescribed medicines.
33. While checking blood by glucometer what are the things to be noted?
Clean your fingers first. Even traits of soap should be removed. As soon as strip is taken out replace the lid of strip container. Otherwise strips may be damaged by moisture. Calibrate your glucometer frequently.
34. How life style is to be changed as part of treatment?
30-45 minutes regular exercise everyday and calorie control are most important. Smoking and drinking habits should be given up. Then, medicines should be taken in correct doze at correct time. Consult doctor once in 3-4 months and do periodic body checkups including cholesterol and blood pressure.
35. How treatment differs in type-1 and type-2 diabetics?
In type-1 patients, first aim is to control their sugar levels. Since they have insulin deficiency, they need to take insulin from first month itself. But in type-2 patients, insulin treatment is needed once in 3 or 5 years. Here, special care should be taken to protect heart. So, such patients should keep control on blood pressure and cholesterol. They are more prone to eye, kidney and nerve disorders and hence detailed checkup of the functioning of these organs should be carried along with the treatment of diabetics.
36. While using other medicines, what care should be taken?
While taking extra medicines, inform your doctor. Steroids can increase or decrease diabetic conditions. Some antibiotics, particularly those belonging to quinalong group can change sugar levels, increase or decrease. Common medicines won’t cause such problems. Yet it’s better to consult doctor before taking new medicines.
37. Is insulin pump effective?
It’s a substitute of insulin injections and can be used whenever necessary, effectively. If insulin is to be taken along with food, insulin pumps are effective. It’s more helpful to type-1 patients. Due to its cost, still it’s not popular in our country.
38. Should all diabetic patients use glucometer at home?
All patients who use insulin should prefer a glucometer. In patients who intake medicines if exhibit hypoglycemia can use glucometer at home to know sugar levels. If you use glucometer regularly, it’s possible to know variation in sugar levels over a time period and its readings will help doctors to take decisions easily.
39. What’s CGMS? What’s its significance?
Continuous evaluation of sugar levels for a period of 4 or 5 days, once in every 5 minutes is taken to get accurate results is known as Continuous Glucose Monitoring System or simply CGMS. It may cost 5000 to 7000 rupees. But it helps doctors to give accurate insulin intake levels and other medicines in correct quantities and more effectively. In some patients blood characteristics may change continuously giving different values at different times. CGMS is most applicable for such cases.
40. Why diabetic patients are given vaccines?
Defensive power is low in diabetic patients. So they get disease attacks easily than normal persons. To avoid hospitalization due to problems like influenza, hepatitis and pneumonia they are given vaccines. Influenza vaccine protects the person for one year.
Diabetics make body tired
Diabetics is now included in the red list of diseases like cancer and heart attack. Consequences of this disease is not affecting just one or two body parts, but reduce functioning of every cell of our body including heart, eyes, kidneys, nerves, skin and liver. It can also influence our nervous system a lot!
41. Are diabetic patients taking treatment prone to other attacks?
Diabetic patients have low immunity power comparing normal people. So, they may be attacked by many disease-causing viruses easily. There are remote chances for TB also. Since sweat of diabetic patients contains excess sugar level they can get skin diseases easily. They get vaginal or urinary infection easily due to the above case. Frequent injections and blood tests give them more chances to contagious diseases like hepatitis B, hepatitis C and AIDS.
42. Can other diseases cause diabetics in kids? Also, vice versa?
In kids, type-1 diabetics is common. Since beta cells that produce insulin are destroyed, sufficient insulin is not produced in pancreas. Yet, now a days, type-2 diabetics is seen in kids though rare. Age group 10-20 can be added to this list and it happens most due to bad food habits.
Some viral diseases in kids may affect pancreas leading to diabetics. It’s most seen in kids who have chances on type-1 diabetics and those viral diseases just bring those conditions to visibility. If detected late, it may affect other organs as well. Such kids may get Autoimmune thyroid disease affecting the functioning of thyroid gland.
43. Can blood pressure and cholesterol lead to diabetics?
It’s true bp and cholesterol are most seen in diabetic patients. Diabetics is formed to low insulin or insulin resistant body condition. So, blood pressure and cholesterol never give rise to diabetics. But all these diseases are linked with over eating and lack of exercise.
44. Can diabetics affect our nervous system?
Two types of problems may occur. Blood sugar is to be used by insulin to do metabolic activities to keep our nervous functioning intact. In diabetic patients, as this function won’t work properly it may lead to nervous disorders. This condition is known as diabetic peripheral neuropathy. In addition to this complication, small blood vessels of body may be affected by microangiopathy which leads to seizing of blood circulation. This condition affects nervous system and is known as Ischemic Neuropathy. It leads to non-functioning of many nerves suddenly and is known as Mononeuritis. A diabetic patient may get this condition any time and if diabetics has already passed many stages, condition reaches worse.
45. Are diabetic patients prone to heart diseases? Is it true that they get painless attacks?
Non-treatment of diabetics can lead to heart diseases for sure. Fat deposits in blood and blood vessels are also its factors. Arteriosclerosis may appear in diabetic patients even from early ages which results in low blood flow through vessels resulting in heart diseases. Yes, it is true that they get painless attacks. Nervous disorders formed as a result of diabetics affect nerves around heart resulting in painless attacks. So all diabetic patients, after 30 should take an ECG once in every year. If seen differences, it’s good to do an exercise ECG and ECO.
46. Can non-treatment of diabetics lead to other diseases? If so what are they?
If diabetics is not treated properly blood sugar level increases considerably leading to many other diseases. It can affect many internal organs as well. Diabetics restructure the fat content of our body increasing the quantity of bad cholesterol. It may lead to arteriosclerosis. When blood vessels are blocked it may lead to heart attacks, strokes and many other problems related to heart. Diabetics attack eyes and kidneys and may cause nervous disorders. In short, diabetics affect all body parts if not brought under control.
47. Can diabetics lead to mental problems?
Yes, it’s possible. Depression, loss of appetite, sleeplessness etc are its symptoms. Family members should strictly check the life style of the patient. They should make him understand that diabetics is a common disease everywhere.
48. Can diabetics affect your eye sight?
Cataract is most common in diabetic patients. Also, such patients may be attacked by this eye sight problem earlier. Diabetic retinopathy is a disease that affects small nerves of eyes. Both diabetics and high blood pressure can damage small nerves of eyes which affects retina resulting in the gradual decrease of eye sight. If it’s detected at first stages and given laser treatment retinopathy can be suppressed. It’s also possible, the rupturing of eye nerves resulting in bleeding. If it happens so, the patient may feel pain and eye sight problems. If diabetics is treated and controlled and blood pressure brought below 130/80 mm, such conditions can be avoided. Diabetic patients should do an eye check up once in 6 months or 1 year.
49. Can diabetic patients donate blood?
Healthy and less diabetic complicated patients can donate their blood. But they should not have any infections or low blood count.
50. Diabetics during gestation period – what care should be taken? Is normal delivery possible in this case?
Gestation diabetics appears during pregnancy period and disappears within 6 weeks of delivery. If not treated properly, fetus may be over-weighted resulting in extra amniotic content and this condition is known as Hydramnios. Also, soon after delivery, blood sugar of the baby may fall and some changes may occur in his blood composition. Jaundice is another treat. He may have weight above 4 kg. His respiratory organs may not be well-developed and hence normal delivery is difficult.
Through this article, I have completed 50 common doubts of diabetics. Very soon I will submit its second part with the same title. Hoping it will help you people a lot.
If you want to read my most recent article dealing with conditions leading to daibetics, pre-diabetic period and common mistakes committed by diabetic patients, just refer this link
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