By Faruque Ahamed
With increasing trend of sedentary lifestyle like regular habit of eating junk food without any
physical activities India is on the doorstep of becoming one of the global capitals of diabetes and hypertension.
The World Health Organisation (WHO) has already pressed a panic button sounding an alert in India in this regard.
More attention is directed in preventing the disease. Efforts in screening for diabetes is essential with millions of individuals are being identified in having prediabetes, which is present than higher normal blood sugar levels.
But it’s not quite high enough to diagnose diabetes mellitus. A normal fasting blood sugar is 60 to 100 mg/dL. It is diagnosed by a fasting blood sugar >125 mg/dL. Prediabetes, or impaired fasting glucose may be diagnosed by a fasting blood glucose >100 mg/dL and <126 mg/dL.
In western countries like US diabetes has become a common disease affecting 9% of Americans with diabetes mellitus, and 90% to 95% of them have type 2 diabetes. Type 2 diabetes is different from type
1 diabetes, previously it was called insulin-dependent diabetes mellitus (IDDM).
Dr. Chitharanjan Duvoor (CD), an endocrinologist who was earlier associated with UAMS in Little Rock, Arkansas and currently at St. Bernard’s Medical Center in Jonesboro, Arkansas, is proactive in early diabetes detection and its appropriate control.
In an interview to ibgnews.com he has shared his views with Faruque Ahamed (FA) on how to prevent and combat with the life-threatening disease sweeping across the world.
Excerpts of the interview are given below.
FA: What are the risk factors of diabetes?
CD: Diabetes mellitus is the 6th leading cause of death in the US as well other countries also, and its prevalence in global healthcare cause a huge burden to the national health care system. Risk factors
like family history, age, ethnicity, lifestyle risk factors like eating, physical activity, and weight all this can affect chances of developing type 2 diabetes. 90% of the diabetes are Type 2 and its
affects almost all age group but its prevalence is in the adults.
FA: What are Type 1 and Type 2 diabetes?
CD: Type 1 diabetes was called juvenile-onset diabetes. The cause is by an auto-immune reaction where the defence system of the body attacks the cells that produce insulin. People affected with type 1 diabetes produce little or no insulin. The disease can affect people of any age, but usually is developed in children or young adults. People suffering from this form of diabetes need injections of insulin every day in order to control the glucose levels in their blood.
Type 2 diabetes is called non-insulin dependent diabetes affects at least 90% of all cases of diabetes.
The prevalence of type 2 diabetes can occur at any age. Type 2 diabetes can remain undetected for many years and the diagnosis is often made when a complication appears, or a routine blood glucose test is done. Type 2 diabetes can be controlled through regular exercise, maintain diet and also in some time through oral drugs or insulin.
FA: What are the manifestations of diabetes?
CD: Preliminary manifestations of diabetes include increased thirst and urine, increased hunger, fatigue, blurred vision, numbness in the feet or hands, sores that do not heal, unexplained weight loss.
FA: Who should go for tests to confirm diabetes?
CD: Anyone who has symptoms of diabetes should be tested. Sometime the symptoms are not always
proactive, but screening is always an important for preventing complications. Prediabetes can also be found through screening. Gestational diabetes can occur in pregnant women and test is mandatory for them.
FA: What are the common tests performed for diagnosing diabetes and prediabetes?
CD: The preliminary test Fasting Plasma Glucose (FPG) test with 8 hrs of fasting. A1C test provides average blood glucose levels over 3 months. Random Plasma Glucose (RPG) are also done when diabetes is dominant. For Gestational diabetes Glucose Challenge Test is done in 24 and 48 weeks in pregnancy. Oral Glucose Tolerance Test (OGTT) also helps to determine prediabetes and Type 2 diabetes.
FA: What are the main health complications for patients suffering from diabetes?
CD: Diabetes has a risk of developing a number of serious health complications. High blood glucose levels can lead to serious illness in the heart, eyes, kidneys, nerves. In addition, people with
diabetes have a higher risk of developing infections. In almost all countries, diabetes is the leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation.
Women with any diabetes during pregnancy have risk if they do not carefully monitor and manage. Women with any type of diabetes have a risk of organ damage to the foetus and monitoring of glucose levels is important as these stage.
FA: How do you clinically diagnose Type 2 Diabetes?
CD: My studies have been focussed on challenges of diabetes control across the globe specially in US and India. I have published this important topic of discussion in a prestigious international journal Frontiers in Endocrinology. Clinical diagnosis of a serious disease like diabetes is important for
adults over 40 years. The recommendation is regardless of body weight, and to test adults of any age who are overweight with a diagnostic symptom and have an additional risk factor for development of diabetes. Early diagnosis of Type 2 Diabetes is accomplished through blood tests that measure PG (plasma glucose) levels. FPG (fasting plasma glucose) is a common test to detect diabetes. Level of ≥126 mg/dL or 7.0 mmol/L confirmed by repeating the test can effectively diagnose the disease. This test is done by fasting for at least the previous 8hrs and can affect better result when blood is drawn in the morning.
FA: How do you clinically manage diabetes?
CD: Patient care for diabetes requires evaluation of the risk factors, the presence of any diabetes complications. The main objective of diabetes management may include lifestyle changes along routine blood glucose monitoring and pharmacological treatment. Nutrition and weight loss are the main management plan one must have in patients suffering from diabetes. Patients with diabetes with low carbohydrate diet can have possible side effects of hypoglycemia. Lifestyle measures in treatment plan with patients suffering from diabetes are suggested with moderate alcohol consumption and reduced intake of sodium. Use of oral pharmacological agents and insulin should be taken if required and under special care from any physician.
Insulin therapy can be introduced to patients with T2DM with severely elevated blood glucose levels [≥300–350 mg/dL (16.7–19.4 mmol/L)]. But this management is vital and has be specially managed by healthcare providers.
FA: Any other thoughts on control of this disease
CD: It is evident that the efforts of the physicians can definitely help you identify and control diabetes. But there are certain guidelines that I follow for diabetes management. Self-monitoring of blood glucose level is very essential who are suffering for diabetes and this can assessment is vital through which own control methods are implemented.
As in type 2 diabetes, the use of insulin that helps regulate blood glucose levels is not fully effective, so glucose accumulates in the blood. High blood glucose levels lead to complications like kidney disease, stroke, and nerve damage. Some patients with type 2 diabetes may require insulin, the
majority of patients can manage diabetes through diet, exercise, and medication. Modern lifestyles have challenges in physical inactivity that is must to control the disease.
Healthy diet by choosing water, coffee or tea instead of sweet beverages, green leafy vegetables must be there in every day diet. Fresh fruits can be daily in diet. Limited or no liquor can control the disease.