A DEADLY DISEASE: DIABETES MELLITUS

Masood N. Khan M.D.

The exponential increase in the incidence of diabetes will soon likely make it a pandemic, meaning, so widespread globally that it could assume a rate of spread as that of an infectious disease. People suffering from diabetes around the world have increased from 108 million in 1980 to 422 million in 2014. Once considered a disease of the affluent, it is now affecting more rapidly middle and low-income countries. World Health Organization has projected diabetes to be the 7th leading cause of death by 2030.

Diabetes is a chronic disease, which occurs when:

A. the pancreas does not produce enough insulin

B. The body cannot effectively use the insulin it produces

As insulin is absolutely necessary to regulate proper utilization of glucose by the body, the above defects lead to poor utilization of blood glucose and therefore increased concentration of glucose in the blood which in medical terminology is called ‘Hyperglycemia’.

Diabetes is categorized into two types as follows. This categorization is helpful to understand the underlying defect and select the right treatment.

Type 1 diabetes (previously known as insulin-dependent or childhood-onset diabetes)

Type 2 diabetes (formerly called non-insulin-dependent or adult-onset diabetes)

The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn’t make enough insulin. In the past three decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels. Type 1 diabetes, once known as juvenile diabetes or insulindependent diabetes, is a chronic condition in which the pancreas produces little or no insulin. In both types of diabetes the high concentration of blood glucose can result into an abnormal state of energy production and utilization and an unhealthy cellular function in different organs of the body.

Diabetes is therefore a major cause of blindness, kidney failure, heart attacks, stroke, irritability and abnormal function of the nerves causing pain and discomfort and poor circulation which sometimes results in amputation of a lower limb.

Diabetes is a strong risk factor for heart attack. If it is present with other risk factors like high cholesterol level, increased blood pressure and smoking, the risk of heart attack increases significantly.

People with diabetes, with or without other risk factors should be extremely conscious of the possibility of heart attack and therefore should be seriously compliant with their overall treatment program.

In the treatment of diabetes doctor and patient participate equally as a team. Sometimes other professionals with specialized skills are also involved for example a nutritionist and eye specialist etc.

From patient’s side, healthy diet, regular physical activity, maintaining of normal body weight and avoiding tobacco use is mandatory for controlling diabetes and avoiding its deadly complications. The doctor, besides counseling in diet and exercise, will determine the right medicine or combination of medicines to help the body regularize normal blood glucose level. In type 1 diabetes where the failure of insulin production is the underlying cause, insulin is solely the treatment of choice. In type 2 diabetes the doctor will determine oral medications (singularly or multiple), insulin or a combination of insulin and oral medication(s).

It has to be deeply ingrained in our health consciousness that the four jewels for healthy living are:

1. Healthy diet
2. Regular exercise
3. No smoking
4. Normal body weight