World Diabetes Day - 2023

Dr Ksh Manglem Singh *

World Diabetes Day is celebrated each year to draw attention to issues of utmost importance to the diabetes community. Millions of people with diabetes around the world do not have access to diabetic care . World Diabetes Day is observed on the birthday of Sir Frederick Banting, who discovered insulin along with Charles Best in 1922.

Between 2021 and 2023 the theme is a topic close to our heart ‘Access to Diabetes Care‘. Slogan for World Diabetes Day is ”Know your risk, know your response. ”Our actions focus on the importance of knowing your risk of developing type 2 diabetes to delay or prevent the condition.

India has over 69.2 million diabetics. Within two decades,the number will touch approx. 120 million Diabetes patients are two to four times more prone to Coronary artery Disease(CAD).In a low income family group in India, 25% of family income goes to diabetes care.

Diabetes is a disease in which the body is unable to produce or properly use insulin(hormone released by pancreas)causing one’s blood sugar to rise too high.

Two major types of Diabetes:

Type 1 diabetes - The body completely stops producing insulin,a hormone that enables the body to use glucose.This form of diabetes usually develops in children or young adults, but can occur at any age.People with type I diabetes must take insulin daily to survive.

Type 2 diabetes - This results when the body does not produce enough insulin and/or is unable to use insulin properly(insulin resistance). This form of diabetes usually occurs in people who are over 30 yrs, overweight, and have a family history of diabetes and in younger people, particularly obese adolescence.

Symptoms of diabetes: Increased thirst and frequent urination,increased hunger,weight loss,fatigue,blurred vision,infections,slow healing ulcers.In nearly 50% cases there are no symptoms, this happens in Type 2 diabetes. In this case people can live for months, even years without knowing they have the disease.

Risk factors for type 2 diabetes:

1 Obesity or overweight-The single best predictor of type 2 diabetes is being overweight or obesity. A Body Mass Index(BMI) of 23-24.9 is considered overweight , BMI of more than 25 is defined as obesity.
2 Abdominal(central) obesity carries more risk for becoming type 2 diabetes.
3 Impaired fasting blood glucose(FBG) indicates Prediabetes(forerunner of diabetes). It is a major risk factor for developing type 2 diabetes.
4 Insulin resistance-With insulin resistance the Pancreas(insulin producing organ)has to work overly hard to produce enough insulin so cells can get the energy they need. This eventually leads to type 2 diabetes.
5 Ethnicity-Indians are more prone to central obesity and hence are more prone to diabetes.
6 Hypertension (High blood pressure)-Defined as 140/80 mmHg,is a major risk factor for diabetes.
7 Gestational diabetes(diabetes during pregnancy). The person is at high risk of developing type II diabetes later in life.
8 Sedentary lifestyle- Exercise fewer than three times a week puts you more likely to develop diabetes.
9 Family history- A parent or sibling who has been diagnosed of having diabetes increases your risk of developing type 2 diabetes.
10 Age-Increasing age puts you at higher risk of developing type 2 diabetes, however diabetes can develop at any age.

Who should be screened ?

Get screened for diabetes if:
1 You are 40 yrs or above
2 At the younger age of 30 yrs under certain conditions like:overweight or obesity,family history,high BP,high cholesterol,inactivity,having diabetes during pregnancy,history of heart disease or stroke,history of PolyCystic Ovary(PCO) in women.

Diagnosis of Diabetes:

1 Fasting blood sugar test: A blood sample is taken after an overnight( 8 hrs)fast.A fasting blood sugar level between 100 and 125 mg/dl( specifically 110 mg/dl) is considered prediabetes.If it is 126 mg/dl or higher on two separate tests,you will be diagnosed with diabetes.

2 2 hour plasma glucose test: 5 tablespoonfuls(75 gms) of glucose dissolved in 200ml water orally ingested.After 2 hrs a blood sample will be taken.Sugar reading 200 mg/dl or more indicates diabetes.

3 Glycatedhemoglobin(HbA1c)test: This blood test indicates average blood sugar level for the past three months. It measures percentage of blood sugar attached to hemoglobin. An A1c level of 6.5 percent or higher indicates that you have diabetes so if you are under treatment it indicates that diabetes is not well controlled.

Treatment of Diabetes:

1 Proper planning of meal
2 Physical activity-Exercise for 30 minutes at least 5 days in a week.It can help the body to use insulin better so it can convert glucose into energy for cells.
3 Every one with type 1 diabetes,and some people with type 2 diabetes also need to get insulin injections.
4 Some people with type 2 diabetes take Oral Anti Diabetic Drugs(OAD) with or without insulin injection.
5 Some people with type 2 diabetes can manage their disease without medication by appropriate meal planning and proper physical exercise.
6 Every one who has diabetes should get the following tests done at least once in a year
i) Eye-To exclude diseases of the eye(retinopathy)
ii) Blood tests-For detection of kidney,liver,cardiovascular diseases,more tests as advised by health providers are to be performed.
7 People with diabetes need to know daily self monitoring of blood glucose(SMBG.Accordingly proper planning of meal,activity and medication can be done.

Complications of Diabetes Mellitus:

Diabetes if not properly controlled affects the larger(macrovascular) as well as small blood vessels(microvascular)of the important organs such as heart,kidneys,eyes and nerves leading to heart failure,kidney failure,blindness,neuritis(tingling,numbness,pain in the limbs),foot ulcer etc.

Diet:
Improving an individual’s diet in terms of both nutritional composition and total energy content can improve health by several mechanisms.
Microvascular risk can be reduced by good BP and glucose control.
Macrovascular risk can be reduced by management of weight and lipids.

A healthy, balanced diet, as recommended for the general population,is suitable for people with type 2 diabetes mellitus.Because 90% of people with type 2 diabetes mellitus have excess weight,high calorie,low carbohydrate and low glycaemic load are important.

Advice on food and food choices:

Less or moderate intake of fibre rich starchy food(complex carbohydrate) e”50% i.e. less than half of the daily diet.
Reduce daily salt intake(5 gm of common salt or 1.5 gm of sodium); this is particularly important for hypertensive patients.
Increase fish(especially oily fish)intake(one or or two portions/week).
Choose protein (e”20% of total energy intake)preferably of vegetable source as animal protein contains higher quantity of fat.
Limit sugar and sugary foods.
Eat three regular main meals or about every 4 hours.
Reduce fats(especially saturated fat)in the diet;
choose monounsaturated fats(d” 30% of total energy intake)

People with diabetes mellitus have a greater need for antioxidants,increase fruit and vegetable consumption(at least five servings a day).

Exercise:

o The purpose of increasing exercise as part of a weight reduction programme(including low calorie diet) is to increase energy output,resulting in the mobilization of fat from adipose tissue stores.

o Daily aerobic physical activity(e.g.brisk walking for 30 min/day or active swimming for 1 hr three times a week)should be encouraged,but advice about physical activity must be tailored to the patient,the aim is for regular aerobic exercise to be enjoyable,convenient and,preferably sociable.Jumping type of exercise is not advised for overweight persons.

o The benefits on health of initial body weight loss of 5-10% should be highlighted.

o Increasing the level of aerobic exercise can improve diabetes control(improve insulin sensitivity,BP and lipid profile)and slow progression of the disease.

o Age, sex, sedentary or active lifestyle, general health (feet problems)and presence of any chronic diseases(e.g.ischaemic heart disease)are all factors that must be considered when prescribing increased exercise.

Prevention of Diabetes:

A healthy lifestyle can delay and even prevent type 2 diabetes.A few changes in your lifestyle and it will help you avoid serious health complications of diabetes.

1 Get tested

Because you can have Prediabetes and Type 2 diabetes without any symptoms,simple blood tests are used to diagnose both.
Prediabetes Diabetes
Fasting glucose(mg%) 100-125 > 125
Random glucose(mg%) 140-200 > 200
HbA1c 5.6-6.4% > 6.4%

2 Exercise
Make every effort to make yourself physically fit.Combination of aerobic exercise and resistance training is ideal

3 Reduce weight
Losing weight can yield health benefits:lower blood glucose,reduce blood pressure,improve cholesterol,increase energy,improve sleep,decreased pressure on joints and decreased risk of cancer.

4 Control intake of food
This can be accomplished by cutting down portions per serving of rice,potatoetc.Replace calorie rich drinks with herbal tea(without milk and sugar)or plenty of water.

5 Take high fibre foods
So as to consume at least 25-40 gms of fibre a day you can have fibre rich whole grains,beans,vegetables and fruits. Fibre can help lower blood sugar and some forms of starch improve insulin sensitivity.