India houses over 61 million diabetics and a forecast that diabetics will cross 100 million by 2030. China today is the world capital for diabetes with India following as a close second. And Chennai is the diabetes capital of the country!
Diabetes Mellitus a Latin term meaning ‘honeyed urine’ was well known to ancient Indian Physicians, from 400 B.C. “More than 70% of middle aged Indians, will suffer with non-insulin dependent diabetes during their lifetime. Results of a ten year analysis from Southern India (1994 - 2004) reveal a trend towards increasing prevalence in both urban and rural population and more number of younger persons, particularly women, afflicted with diabetes. “Though diabetes is caused by a complex interaction of genetic and lifestyle factors, the most obvious reason for this increase in the number of young diabetics is their frenetic lifestyle”, says Dr. Rajesh Shah, Consulting Physician and Cardiologist, Better Health Foundation.
In layman terms, diabetes is a metabolic disorder in which the body is unable to control the amount of sugar in the blood, because the body either does not produce enough insulin or there is resistance to the action of insulin. “Diabetes is one of the diseases that affects the endocrine system. The pancreas produces a hormone, insulin. In type 1 diabetes, the insulin producing cells in the pancreas are destroyed. In type 2 diabetes, insulin is still produced but the body becomes resistant to it.” Says Dr.M. Ravi Kiran Endocrinologist, Agada Health Care. “We as endocrinologists can help you manage your diabetes, by prescribing insulins and/or medications, and offering diet plans .”
“Diabetes may damage almost every tissue and organ of the body, the kidney being one of them”, says Dr. Soundarajan, Head of the Department of Nephrology SRMC. “Neglected, one could go into diabetic nephropathy. Once a month albumin in the urine, blood urea, and creatinine levels should be checked. Diabetics should avoid painkillers.. One should watch out for swelling of the feet, extreme fatigue, weakness and breathlessness. Obese children should also be screened for diabetes.”
“A person afflicted diabetes needs to take utmost care of his or her feet”, says Dr.V.Ramnarayan, Consultant Orthopaedic Surgeon SRMC. “Watch out for numbness, foot ulcers and carefully examine spaces between the toes and the soles of the feet.. Socks should be washed regularly and changed everyday and one should use footwear preferably with ankle support. Nails should not be cut short and sharp edges should be filed. Lack of trained professionals in diabetes foot care in India and podiatry as a profession being non- existent in India compound the problem further.” Patients with neuropathy who visit religious places during summer months when the day temperature varies from 40 to 45 degrees celsius, develop severe thermal injuries as they have to walk barefoot.“Trivial foot lesions precede 85% of leg amputations in India. Almost 75 percent of amputations are carried out in neuropathic feet with secondary infection, which are potentially preventable.”
“When diabetes is diagnosed the patient needs to go in for regular eye check ups,” says Dr. Amar Agarwal Chairman and Managing Director, Agarwal’s Eye Hospital. “The retina gets affected, and the blood vessels in the eye start leaking blood. Fluorescein angiography is performed to trace the leakage, and laser surgery performed to stop the leakage. Diabetes also produces early cataract. In extreme cases where diabetes is neglected the patient can lose his or her eyesight.”
“There is a strong relationship between depression and diabetes”, says Dr. Thara, Psychiatrist and Director, SCARF... Research studies have also demonstrated that the chances of developing diabetes within two years was increased for persons with current depressive and/or anxiety disorders. “Some of the newer drugs used in the treatment of mental disorders might increase blood sugar levels. It is now important to monitor all patients on such drugs for their blood sugar levels.”.
“Diabetes is a generalized micro and macro vascular disease, affecting various organs” says Dr. S. Thanikachalam, Chairman & Director of Cardiac Care Centre, Prof. &Emeritus, Sri Ramachandra University. “It is the prime responsibility from those involved in Cardio Vascular Disease Management to address the evolution manifestation to quell the cardiovascular disease in diabetics as they have 2 – 4 fold higher risk of CVD as compared to normal. The cluster which harbours hyperglycemia, high BP, altered lipid profile, smoking, high body fat content and sedentary habits needs appropriate intervention to prevent emerging epidemic of sub clinical and manifesting CVD. A concerted attempt to identify the pre-diabetics and intervene to reverse the metabolic abnormality will prevent further increase in the prevalence of diabetes, with its inherent complications.”
According to Dr. M.Thanikachalam, Cardiac Surgeon, (American Board of Thoracic Surgery) preventive health check up and a year-round management of health and wellness customized to one’s health profile and screening are absolutely essential. This led him to follow his dream project Agada a one stop institute for comprehensive therapy with the focus on preventive treatment, and established in association with the world leader in Diabetes Prevention Management and Care, Joslin Diabetes Centre, Harvard Medical School, Boston USA. “We believe in empowering you with skills to take ownership and manage your health optimally”, says he.
The future is not as bleak as it was, and with tri annual checks and regular physician consultation diabetes can be kept under control without the feeling of despair that it usually evokes. See box below
· Under normal circumstances the blood glucose level does not rise above 160 mg/dl even after food
· Normally the kidney does not allow any glucose to be lost and hence the urine is sugar free. However if the blood glucose level rises above 180 mg/dl, sugar "spills over" into the urine.
· Symptoms could be excessive thirst, excessive appetite and excessive urination and swelling of feet. Delayed wound healing, frequent infections, nausea, vomiting and weight loss may be other symptoms.
· Neglected, diabetes will affect the heart, eyes, kidneys and all major organs
· With proper treatment, counseling and personal management, diabetes can be controlled.
Sabita Radhakrishna (firstname.lastname@example.org)