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Diabetes and your health

If you develop diabetes during pregnancy, then you are at greater risk for developing it later in life

Look at these alarming numbers. Thirty-five million people in India are diabetics. India has the dubious distinction of having the largest population of diabetics in the world. There are nearly another 13 million who are undetected. The disquieting fact is that 30 per cent of diabetics in the urban population and 50 per cent in the rural population go undetected. Diabetes can occur at any age. Some people develop diabetes as children or teens. Indians develop diabetes much earlier than their Western counterparts.

What is diabetes?

Insulin is a hormone that helps balance the amount of glucose in the blood. Diabetes is a disease in which the body does not make enough insulin or does not use it as it should. Most Indian diabetics have the problem of high insulin levels which the body is resistant to.

Normally, the body changes most of the food we eat into glucose. Glucose is then carried to the body's cells with the help of insulin. If the body does not utilise the insulin as it should, the glucose cannot enter the body's cells. Instead, it stays in the blood. This makes the blood glucose level too high.

Women and diabetes

In some cases, diabetes may first occur during pregnancy. This is called gestational diabetes. In most cases, the diabetes disappears after the baby is born. However, women who develop diabetes during pregnancy are at greater risk for diabetes later in life. Women are also at greater risk for developing diabetes if they have polycystic ovarian syndrome or have delivered a baby weighing 4.0 kilos or more.

Type 1 diabetes

Type 1 diabetes is also known as insulin-dependent diabetes. A person with Type 1 diabetes needs to take insulin to survive because their body makes little or no insulin on its own. Type 1 accounts for a small percentage of cases of diabetes in India.

Type 2 diabetes

Type 2 diabetes is also known as non-insulin-dependent diabetes. In Type 2 diabetes, the body becomes resistant to the effects of insulin and produces more insulin to keep glucose levels normal. Over time, the body cannot maintain high enough levels to keep the glucose levels normal, and diabetes occurs. People with Type 2 diabetes may not need to take insulin. They may be able to control their glucose with proper diet, medication, or both. It is important to remember that sometimes there are no symptoms with Type 2 diabetes, or symptoms can be so mild that they are not noticed.

Risk factors for developing diabetes — being Indian; overweight; family history of diabetes; physical inactivity; previous abnormal glucose screening results; high blood pressure; high cholesterol; and history of cardiovascular disease.

Testing

Blood glucose testing can detect a high level of glucose in the blood. If the blood test shows a high level of glucose, it diagnoses diabetes. There are three types of tests done to diagnose diabetes:

Fasting plasma glucose test is the easiest and most common way to test for diabetes. Before the test, you must not eat or drink anything but water for at least 8 hours.

Random plasma glucose test is done in a non-fasting state.

Oral glucose tolerance test (GTT) must be done after an overnight fast. A fasting plasma glucose blood test is followed by a glucose containing drink. Blood samples are taken to measure the blood glucose over the next few hours.

Problems

If diabetes is not controlled over a period of time, severe health problems may occur — kidney disease that can lead to high blood pressure or kidney failure; eye problems that can lead to blindness; nerve damage and blood vessel damage in the feet that can cause pain, numbness, infection, and possibly the need to remove a toe, foot, or leg; high blood cholesterol levels that can lead to stroke and heart disease; certain infections, such as bladder or kidney infections, vaginal infections, yeast infections and skin infections; problems in pregnancy; and thyroid problems.

The best defence against these problems is keeping the blood glucose at a normal level and taking good care of oneself. This often can be done with lifestyle changes, but may require taking medications.

Reducing the risk of problems in a diabetic

Reaching and keeping a healthy weight; eating healthy, low-fat foods; getting regular exercise; not smoking; checking your feet each day (prevent ingrown toenails, corns, and calluses on your feet to reduce the risk of infection); having your feet, eyes, and kidneys checked by a doctor on a routine basis; and keeping your blood glucose level close to normal. If glucose cannot be controlled through weight loss, diet, exercise, or oral medication, insulin therapy may be needed.

(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women's health issues)

GITA ARJUN

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