Diabetes Overview: Diabetes Care, Prevention of Diabetes & Is Diabetes curable?

Diabetes is a growing epidemic worldwide with India on top of the list. We have been declared the world’s diabetes capital. Prevention of Diabetes is the need of the hour, which is why we are going to talk about diabetes overview.  The disease remains a major health challenge with factors including inactive lifestyles, unhealthy diet, and damaging habits adding fuel to the fire. To this day, many myths and facts about diabetes need clarification among those diagnosed with the disease

Most people diagnosed with the disease wonder “is diabetes curable”. The truth is it can be managed well.The ongoing situation has also contributed to a steady rise in the diagnosis of diabetes. The prevalence of Diabetes in India as of 2021 is about 30 million- 3% to 9% of the nation’s population. Read on to get diabetes overview & to find out more about the prevention of diabetes and how to live a good life with diabetes by regulating your blood sugar levels. 

If you are someone who has been diagnosed with Diabetes, then Diabetes care includes a major part of living well with the disease.

1. Diabetes Overview?

Diabetes is a condition that occurs when a metabolic dysfunction causes an increase in blood sugar. The food we eat is transformed into a simpler substance called glucose and is an important substance necessary for normal body functioning.

Insulin that is produced by the pancreas is important for the glucose to be utilized by the body cells. When glucose is not effectively used, its level in the body increases than usual. This may be due to inadequate production of insulin or inefficient usage of normally produced insulin. Consult with your diabetologist to clear myths about insulin and how it can help you

Ideally, blood sugar levels during fasting must be less than 100mg/dl and not more than 140 mg/dl after food. You can always work on the prevention of diabetes, which is the best choice. Most of us wonder if diabetes is curable, it is not completely so, but can be controlled well.

Diabetes care that incorporates self care as well as timely medical attention is an important strategy of managing Diabetes.

2. What are the types of diabetes?

The most common types of diabetes include

1. Type I Diabetes or IDDM – Insulin-dependent Diabetes Mellitus
2. Type II Diabetes NIDDM – or Non-insulin-dependent Diabetes Mellitus 
3. Pre Diabetes
4. Gestational Diabetes

Effective diabetes care becomes very important if you want to live a normal life with Diabetes

1. Type I Diabetes

A type of cell known as beta-cell is the one responsible for the production of insulin. When these cells do not produce an adequate amount of insulin, the glucose remains unprocessed. This causes a high blood sugar level known as hyperglycemia. 

In Type I Diabetes, the body lacks the necessary amount of insulin. If the blood sugar is constantly high and uncontrolled, it may cause organ damage. Is diabetes curable? No, not really. 

2. Type II Diabetes

When the insulin produced in the body is not efficiently used, the glucose level in the body remains high. The body cells do not react well to insulin, causing blood sugar to shoot up. Type II Diabetes develops over time and remains undiagnosed until a complication drives the patient to seek medical attention. 

3. Prediabetes

Prediabetes is when your blood sugar is increased but doesn’t come up to a level that is classified as Diabetes.  Essentially, you are on the verge of being diabetic. With proper care, most prediabetic people can reverse their sugar levels back to normal. 

If you are prediabetic, you have a greater chance of progressing to Diabetes as well as heart disease. Studies indicate that 1 in 6 Indians are prediabetic, which is alarming. Prevention of diabetes of this type from progressing to Diabetes is vital to avoid full-blown disease.

4. Gestational Diabetes

• When a woman has been non-diabetic before pregnancy but has high blood sugar levels while pregnant, the condition is called gestational diabetes.
• This change occurs in women who have not been diabetic before.
• In most women, the blood sugar levels revert back to normal after delivery. 

Prevention of diabetes after childbirth in these women is possible with the right diet and healthy lifestyle.

Gestational diabetes treatment depends upon its two stages – 

• Stage  I- where the high blood  sugar is manageable with diet 
• Stage II-  where the  blood sugar levels require medication and insulin to be maintained

Without lifestyle modification, women with gestational diabetes often develop Type 2 Diabetes and obesity following delivery. Prevention of diabetes is possible by planning a healthy pregnancy 

Often the diagnosis is made during a routine antenatal checkup and about 1% to 8% of pregnant women experience gestational diabetes. Is diabetes curable? Yes, this type can be prevented and progression to NIDDM

Apart from the above common types of diabetes, there are some other less common types of diabetes such as:

• Monogenic diabetes syndrome
• Cystic fibrosis-related diabetes
• Drug/ Chemical induced diabetes

1. Monogenic Diabetes Syndrome :

In our body, genes are responsible for providing instructions to cells on how to make proteins. Insulin is a type of protein. This type of diabetes is caused due to the genetic mutation of a single gene. The mutation affects insulin production or its efficiency and causes high blood sugar levels. Prevention of Diabetes of this type is not really possible as it is congenital

It  includes two types

• Neonatal diabetes – This type is often diagnosed at birth up to about six months of age and is different from Type I or juvenile-onset diabetes
• Maturity Onset Diabetes of the young (MODY)-   This type is often diagnosed during prepubertal age to adulthood.

If you ask, is diabetes curable, this type has a genetic involvement and hence it can only be managed well.

2. Cystic fibrosis-related diabetes (CFRD)

             Cystic fibrosis is a rare genetic condition that causes the pancreas to scar, along with many other symptoms. When there is excessive scarring, the beta cells lose their capacity to produce insulin.

This type of diabetes is seen in about 35 – 50% of adults with cystic fibrosis. There is insulin deficiency that keeps the blood sugar levels high. Prevention of Diabetes is not really the norm here, but effective management is possible

3. Drug-induced diabetes 

         When hyperglycemia is induced due to a drug intake or chemical exposure, then it is categorized as drug-induced diabetes. It occurs as an adverse effect of the drug or chemical. There are many drugs that are prescribed for other conditions but carry a probability to cause drug-induced diabetes.

The prevalence of this is very rare and occurs in a negligible amount of people taking the drug. Prevention of diabetes with this type is possible by staying aware of the adverse effects of the medication. It becomes very important to control your blood sugar levels while on steroids. Some of the drugs involved in the mechanism are:

1. Glucocorticoids (very common)
2. Beta-Blockers for cardiovascular and hypertension 
3. Oral contraceptives
4. Certain hormone medications
5. Anti-cholesterol medications
6. Antivirals for HIV/ AIDS treatment

Irrespective of the type of the condition, it is possible to live well if you adopt the right Diabetes care strategies

Is diabetes curable?

Even with the latest research, diabetes is not curable per se. But living a normal life with Diabetes is very much possible by properly managing your diet and fitness levels.

3. Who is more likely to get diabetes?

 There is a higher chance of you getting Diabetes, if:

1. There are one/more parents or siblings who are diabetic. 
2. Your age is more than 45 years
3. Are known to have hypertension
4. You have a high cholesterol level (high LDL / VLDL, low HDL)
5. Your body weight borderlines on obesity
6. You lead a sedentary life along with an unhealthy lifestyle
7. Have been prediabetic for awhile
8. Have had gestational diabetes in the recent past

Prevention of Diabetes in most types is possible by following a healthy lifestyle and eating wisely. 

Type 1 Diabetes has a higher incidence if:

1. You have a parent, sibling, or a close family member with Type 1 Diabetes
2. Your pancreas has been hit badly by tumor, infection, accident, etc
3. You have an autoimmune disease that produces antibodies against the beta cells
4. Physical stress
5. Have had a recent viral illness

Prevention of diabetes must be resorted to especially if there is a strong family history. 

Gestational diabetes is common in women who:

1. Are pregnant after the age of 27
2. Have had gestational diabetes with their previous pregnancies
3. Stay inactive during pregnancy
4. Were overweight at the onset of pregnancy
5. Have conditions such as PCOS that increase the chances of gestational diabetes

Other genetic types of diabetes have an increased prevalence if you have or are predisposed to the specific genetic condition. Physical activity to manage  type 1 & type 2 diabetes is very important

People with Diabetes  need to make an allegiance to themselves to manage their health well with Diabetes care.

4. How does PCOS cause diabetes?

PCOS or polycystic ovarian syndrome is a hormonal dysfunction that affects about 3% to 22.5% of Indian women. It is characterized by an imbalance of the female hormones responsible for menstruation, an excess of male hormones causing multi-system symptoms. Prevention of diabetes is important to avoid the complications of PCOS combined with Diabetes that may become a vicious cycle.

The increased androgen (male hormone) levels negatively influence the utilization of glucose by the body. Insulin is secreted normally but the response of the body to insulin action is diminished. Therefore the blood sugar levels remain high. Women with PCOS are often found to be prediabetic or at increased risk of NIDDM.

Prevention of diabetes associated with PCOS is made possible by maintaining a healthy weight and regulating ovulation.

5. Common symptoms of Diabetes

Symptoms of Type I Diabetes include:

1. Excessive thirst
2. Increased weight loss without trying
3. Excessive hunger
4. Frequent bedwetting in children
5. Increased frequency of urination
6. Mood swings
7. Undue fatigue 
8. Excessive tiredness
9. Blurred vision
10. Recurring infections of the skin, urinary tract, and vagina

Prevention of Diabetes automatically decreases the probability of infections associated with Diabetes

Type II Diabetes shows the following symptoms:

1. Frequent urination
2. Excessive thirst
3. Loss of consciousness after you skip a meal or doing strenuous exercise
4. Tingling sensation in the hands and feet
5. Headache
6. Dehydration
7. Dry mouth
8. Swollen and painful gums
9. Loose teeth

6. Hyperglycemia vs Hypoglycemia

Features	Hyperglycemia	Hypoglycemia
Blood sugar levels	More than 140 mg/dl	Less than 70 mg/dl
Causes	Infection of the pancreasSkipped medicationToo low medication than neededInsulin resistanceComa	Liver failureStarvationDiminished functioning of the adrenal glandsEndocrine gland tumoursWrong medication
Symptoms	Dry mouthExcessive thirstFatigueVision disturbancesIncreased urinationOvertly sweet breathNauseaVomiting	Excessive hungerPalpitationSweatingShiveringIncoherent speechConfusionComa
Risks	Retinopathy- eye damageNephropathy- Kidney damageNeuropathy- Nerve function damage and possible loss of function	SeizuresHypoglycemic comaLoss of consciousnessDeath

By the prevention of Diabetes, the risks associated with organ damage is highly reduced.

7. How is it diagnosed?

Diabetes is often diagnosed through a blood test. The following tests are the criteria for the diagnosis of diabetes.

1. Blood sugar level
2. HbA1C
3. Oral Glucose tolerance test – GTT

                                               Normal                       Pre Diabetes                                    Diabetes

          Blood sugar             below 100 mg/dl             100- 125 mg/dl                   .> 126mg/dl

          HbA1C                         below 5                                 5.1-6-4                                  > 6.4 

         Oral GTT             below 140  mg/dl                       140- 199 mg/dl                     > 200 mg/dl

8. What health problems can occur due to diabetes?

Diabetes can predispose a person to various health conditions such as 

1. Heart disease- Long term diabetes causes damage to the blood vessels making them susceptible to fat deposits contributing to heart disease
2. PCOS-  The insulin resistance in diabetes triggers the excessive production of male hormones from the brain, becoming a causative factor of PCOS
3. Heart attack-  People with Diabetes have a higher risk of hypertension.
4. It also increases the probability of high cholesterol levels. This, in turn, causes problems with the heart’s blood supply increasing the possibility of a heart attack
5. Stroke-  The blockage in the arteries exacerbated by  diabetes increases the chance of a stroke
6. Narrowing of arteries- Known medically as atherosclerosis, the plaque build-up decreases the diameter of the arteries, disrupts blood flow, and possibly cause complete occlusion if left undiagnosed and untreated
7. Eye disorders-  Changes in the fluid composition inside the eyes, damage to the minute blood vessels of the eyes, etc can impact vision
8. Blood flow impairment- Interference with normal blood flow especially to the feet can cause insufficient blood to reach the area and cause damage to the tissues
9. Sexual dysfunction- A decrease in sexual desire and erectile dysfunction may occur if the nerve functions are impaired.
10. Risk of dental problems- The increased level of blood sugar and also in the saliva causes more harmful bacteria in the mouth increasing the risk of infections
11. Skin lesions- Deficient blood flow can cause circulatory problems. High blood sugar levels may heighten the risk of infections and cause delayed healing of wounds.

In spite of scientists and patients wondering is diabetes curable, Type I diabetes is not, but Type II can be reversed with the right lifestyle. 

PCOS

The polycystic ovarian syndrome is a hormonal imbalance having multifactorial causes as well as affects various systems of the body. PCOS and Diabetes interact very closely and account for each other in many women. Scientists are working towards it and we still do not have an answer for “ is diabetes curable”

The increased androgen levels in PCOS instigates the impairment of glucose metabolism in the body, causing insulin resistance leading to high blood sugar levels. In turn, the insulin resistance in Diabetes alters the brain signals to secrete excessive male hormone and is responsible for the symptoms of PCOS such as cysts, excessive hair growth, weight gain, etc

9. How is diabetes treated?

Diabetes is treated based on the reason that caused it and its classifying type.

Type I Diabetes is Insulin-dependent and requires:

1. Regular insulin shots
2. Continuous monitoring of blood sugar
3. Eating right

Type II Diabetes is non-insulin-dependent and is effectively managed by:

1. Lifestyle modification
2. Blood sugar monitoring
3. Watching your diet
4. Diabetic medications as prescribed, insulin or both 

Proper Diabetes care with the right medication, healthy diet and a good lifestyle makes living a full life with Diabetes possible.Other types of Diabetes also require close blood glucose monitoring, dietary changes, and regular checkups. You will need to learn why low blood sugar level is dangerous, learn self care etc to manage Diabetes well.

10. How to prevent Diabetes?

Of the different types of Diabetes, Type 2 Diabetes is preventable. Some ways to prevent diabetes are:

• Reduce sugar intake 
• Minimize the number of carbohydrates in your diet
• Cut down on carbonated beverages and alcohol
• Monitor portion size 
• Maintain a healthy weight  depending on your height
• Stick to an exercise routine
• Avoid a sedentary lifestyle
• Stick to a diet that has a good amount of fiber
• Make healthy fruits and vegetables a part of what you eat
• Avoid excessive stress
• Quit smoking

The integral part of a proper Diabetes care plan involves staying aware of your blood glucose levels , possible complications and knowing when to seek medical attention.

11. How to manage Diabetes?

All types of diabetes can be effectively managed by:

1. Checking your blood sugar regularly and keeping it within normal range
2. Discuss a diet plan with your doctor/ nutritionist
3. Know what levels are normal for you
4. Keep a set schedule for some form of exercise
5. Stay aware of the warning signs and be informed of what can be an emergency
6. Follow up with your diabetologist through periodic checkups
7. Get your eyes and nerves checked to ensure their normal activity
8. Keep your sugar levels in control to avoid organ and nerve damage
9. Choose wisely what goes into your plate

Managing diabetes involves seeing a Diabetes care specialist who will

• Help you manage the blood glucose
• Enable you to develop skills to manage the disease
• Eliminate the risks and complications
• Reduces the chances of emergency visits due to fluctuating blood glucose levels

12. Necessary lifestyle changes for managing diabetes

There may be no cure for diabetes, but by making the right choices, you can manage it well .

• Eat a balanced meal
• Maintain the right body weight
• Cut down on junk food
• Limit alcohol and drinks that contain empty calories
• Quit smoking
• Balance your meals and medications- excess medication and less intake can be detrimental to your health
• Maintain portion size
• Maintain fluid intake especially while exercising
• Store medications and insulin properly
• If the blood sugar levels fluctuate in spite of eating well and taking the medications, inform your diabetologist. You may need a medication modification
• In case you need to take other medications for conditions other than Diabetes, make sure you inform the concerned doctor that you are on anti-diabetic medications. This will  help to rule out  the possibility of any negative interactions between them 
• Carry all medications and insulin while traveling and eat well while outside
• Monitor your levels before bed
• If you must drink, choose wisely. Stick to light beer and wine.
• Periodic visit to a Diabetes care specialist is one of the best things in Diabetes management.

13. Beware of myths about Diabetes

Many myths cropped up from time to time about Diabetes and its management. Let’s explore some of them here.

• Diabetic people have to give up sugar for a lifetime –  We do not know if sugar intake is responsible for Diabetes, but limiting sugar- especially refined white sugar makes it easier to manage Diabetes. 
• Diabetes affects only fat people – Excess body weight is definitely a risk factor, but it is one piece of a huge puzzle and people with an ideal or lesser body weight are also affected.
• People having diabetes can’t play sports- If you manage Diabetes well, you can very well play sports. In fact, players are better at managing their diet and fitness levels
• Diabetic people should not do jobs – Diabetics are as good as anyone else in terms of skill and eligibility for any kind of job. The disease doesn’t affect your skills in any way
• Type 2 diabetes is mild – Not necessarily. It depends on the general health condition, your sugar levels, and whether there has been any organ damage
• Diabetic people lose their legs and their vision – They don’t have to. When the nerves and vision management is done well by maintaining blood sugar levels and preventing organ damage, they can retain the functional abilities of all organs.

Take Away

Dr. Hemi Soneja is the best choice for your Diabetes specialist doctor in Delhi ( Diabetologist ). She has always focused on diabetes care along with the latest research. Her global experience along with international expertise enables comprehensive care. Your associated conditions such as weight management issues, high blood pressure, etc will be effectively managed under her care. She will work closely with you to create a personalized management plan that will enable you to live life to the fullest.