India is termed as the Diabetic capital of the world. The term “Diabetes” refers to a group of diseases that affects the way our body uses Blood Glucose, commonly called Blood Sugar. Glucose is vital for our health as it is the main source of energy for the cells that make up your muscles and tissues.
Ruby General Hospital provides the “technologically” latest care in the management of Diabetes & Diabetes related complications like Hypertension, Lipid disorders, Obesity, Neuropathy and Nephropathy. The hospital also provides Super-specialist consultations on other Endocrine related problems like Infertility, Growth Problems, problems of Secondary Sexual development, Thyroid & Adrenal Disorders.
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin. Insulin is a hormone needed to allow sugar (glucose) to enter cells to produce energy.
Different factors, including genetics and some viruses, may contribute to type 1 diabetes. Although type 1 diabetes usually appears during childhood or adolescence, it can develop in adults.
Despite active research, type 1 diabetes has no cure. Treatment focuses on managing blood sugar levels with insulin, diet and lifestyle to prevent complications.
Type 1 diabetes signs and symptoms can appear relatively suddenly and may include:
The exact cause of type 1 diabetes is unknown. Usually, the body’s own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet, or islets of Langerhans) cells in the pancreas. Other possible causes include:
Once a significant number of islet cells are destroyed, little or no insulin is produced. Insulin is a hormone that comes from a gland situated behind and below the stomach (pancreas).
Glucose — a sugar — is a main source of energy for the cells that make up muscles and other tissues.
In type 1 diabetes, there’s no insulin to let glucose into the cells, so sugar builds up in the bloodstream. This can cause life-threatening complications.
Some known risk factors for type 1 diabetes include
Over time, type 1 diabetes complications can affect major organs in the body, including heart, blood vessels, nerves, eyes and kidneys. Maintaining a normal blood sugar level can dramatically reduce the risk of many complications.
Eventually, diabetes complications may be disabling or even life-threatening.
Diagnostic tests include
This blood test indicates the average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin). The higher the blood sugar levels, the more hemoglobin one will have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates diabetes.
If the A1C test isn’t available, or if one has certain conditions that can make the A1C test inaccurate — such as pregnancy or an uncommon form of hemoglobin (hemoglobin variant) — the doctor may use the following tests:
Blood sample will be taken at a random time and may be confirmed by repeat testing. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when one eats, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst.
A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it is 126 mg/dL (7 mmol/L) or higher on two separate tests, then it is diabetes.
If diagnosed with diabetes, the doctor may also run blood tests to check for autoantibodies that are common in type 1 diabetes. These tests help the doctor distinguish between type 1 and type 2 diabetes when the diagnosis is uncertain. The presence of ketones — by products from the breakdown of fat in the urine also suggests type 1 diabetes, rather than type 2.
Treatment for type 1 diabetes includes
Anyone who has type 1 diabetes needs lifelong insulin therapy.
Types of insulin are many and include
Insulin cannot be taken orally to lower blood sugar because stomach enzymes will break down the insulin, preventing its action. One needs to receive it either through injections or an insulin pump.
Additional medications also may be prescribed for people with type 1 diabetes, such as
Certain life circumstances call for different considerations.
Hypoglycemia can occur at any time. It is a good idea to check the blood sugar anytime one is getting behind the wheel. If it’s below 70 mg/dL (3.9 mmol/L), have a snack with 15 grams of carbohydrates. Retest again in 15 minutes to make sure it has risen to a safe level.
Type 1 diabetes can pose some challenges in the workplace. For example, if the job involves driving or operating heavy machinery, hypoglycemia could pose a serious risk to oneself and those around. He / she may need to work with the doctor and the employer to ensure that certain accommodations are made, such as additional breaks for blood sugar testing and fast access to food and drink.
The risk of pregnancy complications is higher for women with type 1 diabetes, experts recommend that women have a preconception evaluation and that A1C readings ideally should be less than 6.5 percent before they attempt to get pregnant.
The risk of birth defects is increased for women with type 1 diabetes, particularly when diabetes is poorly controlled during the first six to eight weeks of pregnancy. Careful management of diabetes during pregnancy can decrease the risk of complications.
For those who are frail or sick or have cognitive deficits, tight control of blood sugar may not be practical and could increase the risk of hypoglycemia. For many people with type 1 diabetes, a less stringent A1C goal of less than 8 percent may be appropriate.
Despite best efforts, sometimes problems will arise. Certain short-term complications of type 1 diabetes, such as hypoglycemia, require immediate care.
Some people may lose the ability to sense that their blood sugar levels are getting low, called hypoglycemia unawareness. The body no longer reacts to a low blood sugar level with symptoms such as lightheadedness or headaches. The more one experiences low blood sugar, it is more likely to develop hypoglycemia unawareness. If one can avoid having a hypoglycemic episode for several weeks, one may start to become more aware of impending lows. Sometimes, increasing the blood sugar target (for example, from 80 to 120 mg/DL to 100 to 140 mg/DL) at least temporarily can also help improve hypoglycemia awareness.
This occurs when the blood sugar level drops below the target range. Consult the doctor about what range should be considered a low blood sugar level for oneself. Blood sugar levels can drop for many reasons, including skipping a meal, eating fewer carbohydrates than called for in the meal plan, getting more physical activity than normal or injecting too much insulin.
Learn the symptoms of hypoglycemia, and test the blood sugar level if one thinks that the sugar levels are dropping. Early signs and symptoms of low blood sugar include:
Later signs and symptoms of low blood sugar, which can sometimes be mistaken for alcohol intoxication in teens and adults, include:
Night time hypoglycemia may cause one to wake with sweat-soaked pajamas or a headache. Due to a natural rebound effect, night time hypoglycemia sometimes might cause an unusually high blood sugar reading first thing in the morning, also known as Somogyi effect.
If one has a low blood sugar reading
If a blood glucose meter is not readily available, treat for low blood sugar anyway if one has symptoms of hypoglycemia, and then test as soon as possible.
If left untreated, low blood sugar can cause loss of consciousness. If this occurs, one may need an emergency injection of glucagon — a hormone that stimulates the release of sugar into the blood. Make sure to always have an unexpired glucagon emergency kit available at home, at work and whenever outside. Make sure that co-workers, family and friends know how to use the kit in case one is unable to inject oneself.
The blood sugar can rise for many reasons, including eating too much, eating the wrong types of foods, not taking enough insulin or fighting an illness.
What to watch out for:
If one suspects hyperglycemia, one should check the blood sugar level. If the blood sugar is higher than the target range, one likely needs to administer a “correction” — an additional dose of insulin that should bring the blood sugar back to normal. High blood sugar levels do not come down as quickly as they go up. A doctor should be consulted as to how long one should wait until a recheck. If an insulin pump is used, random high blood sugar readings may mean one needs to change the pump site.
When the cells are starved for energy, the body may begin to break down fat — producing toxic acids known as ketones. Diabetic ketoacidosis is a life-threatening emergency.
Signs and symptoms of this serious condition include :
If one suspects ketoacidosis, check the urine for excess ketones with an over-the-counter ketones test kit. If one has large amounts of ketones in the urine, consult a doctor right away or seek emergency care. Also, call the doctor if one has vomited more than once and ketones are present in the urine.
Careful management of type 1 diabetes can reduce the risk of serious, even life-threatening complications. Consider these tips :
Take proper medications as recommended. Learn about type 1 diabetes. Make healthy eating and physical activity part of the daily routine. Establish a relationship with a diabetes educator, and seek help from a health care team.
Wear a tag or bracelet that says you have diabetes. Keep a glucagon kit nearby in case of a low blood sugar emergency, and make sure friends and loved ones know how to use it.
Regular diabetes checkups are not meant to replace yearly physicals or routine eye exams. During the physical, the doctor will look for any diabetes-related complications, as well as screen for other medical problems. The eye care specialist will check for signs of retinal damage, cataracts and glaucoma.
High blood sugar can weaken the immune system. Get a flu shot every year. The doctor will likely recommend the pneumonia vaccine, as well.
Wash feet daily in lukewarm water. Dry them gently, especially between the toes. Moisturize the feet with lotion. Check the feet every day for blisters, cuts, sores, redness or swelling. Consult the doctor if one has a sore or other foot problem that doesn’t heal.
Eating healthy food and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Medication may be needed, too.
Smoking increases the risk of diabetes complications, including heart attack, stroke, nerve damage and kidney disease. Consult a doctor about ways to stop smoking or to stop using other types of tobacco.
Alcohol can cause either high or low blood sugar, depending on how much one drinks and eats at the same time. If one chooses to drink, do so only in moderation and always with a meal. Check the blood sugar levels before going to sleep.
The hormones produced by the body due to prolonged stress may prevent insulin from working properly, which can be stressful and frustrating. Take a step back, and set some limits. Prioritize the tasks. Learn relaxation techniques. Get plenty of sleep.
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