Diabetes and its Implications: 9 Burning Questions, Answered
Diabetes: A Major Global Health Concern
As per the IDF Diabetes Atlas Tenth edition 2021 report, the total number of people living with diabetes is projected to rise to 643 million by 2030 and 783 million by 2045. Diabetes can lead to a range of health problems, including heart disease, stroke, kidney failure, blindness, and amputations. In addition, people with diabetes often require expensive medical treatment and face significant social and economic challenges. Clearly, diabetes is a major public health concern that requires concerted action from individuals, governments, and the global community. To find answers to the 9 burning questions around this disease, the team at FTEM (From The Experts Mouth) got in touch with Dr Sharwari D Dua, a Consultant Physician and Endocrinologist.
Diabetes – A Lifestyle Disorder
Why has diabetes become so widespread in the last few decades?
A lot has been known about diabetes in past decades, and many facts are still emerging about its origin, progression and treatment. As years of research was put together many theories surfaced about diabetes being a lifestyle disorder. In the recent decades, we have seen a higher surge in the number of diabetics due to unhealthy lifestyles, faulty food habits and excessive weight. Most of the cases of type 2 diabetes suffer from obesity or being overweight. A rise in obesity and an unhealthy lifestyle has led to a rise in diabetes.
Diabetes Then and Now
Was it not prevalent in the earlier generations who would feast on sweets, or was it merely not detected/tested?
It has multiple types, the most widely recognized are type 1 and type 2. Type 1 is mostly due to the absence of insulin from the pancreatic cells, which could be genetic or from birth due to the presence of antibodies against the cells (autoimmune disease), whereas type 2 diabetes is mostly genetic or due to insulin resistance developed due to lifestyle changes or obesity. In earlier days, due to lack of knowledge about the disease many patients were un-diagnosed until complications begin to occur. However, it was also that the eating and lifestyle habits were different, which means less processed food or saturated fats intake, lesser sedentary lifestyle, more of physical activity including walking miles for work or use of non motored medium to travel, which helped many to stay far from this disease.
Reasons Why Diabetes Continues to Increase at an Alarming Rate
Looking at the big picture, why are we losing the battle so badly, as the incidence of diabetes continues to increase at an alarming rate?
There are many un-diagnosed and under-treated patients, most of which is due to a lack of awareness of the disease or a compelling lifestyle change and compliance to treatment. Many people think that achieving shorter targets can save them from keeping the complications away, and hence they give up on the diets and exercise regime or stop the medications and end up with complications. It is only during this time, controlling sugar gets difficult and insulin needs to be incorporated for many, which again leads to fear of injections and eventually less compliance to the treatment.
A regular health check and good sugar control in time can save many complications and prolong their quality of life.
Can Diabetes be Reversed?
Can diabetes be reversed? And, if so, is the reversal permanent?
In the past few years, research has led to a better understanding of the disease. Diagnosing it at an early stage and beginning of the treatment sooner has led to remission of the disease, that is the values of sugar can be reversed to the non-diabetic range with appropriate treatment and lifestyle changes. But, since it is an autoimmune disease it cannot be completely reversed to normal. On leaving the treatment or dietary control, the sugar can rise again to alarming levels.
Important Factors in Fighting Diabetes
What is the role of western medicine vs traditional medicine vs food intake vs lifestyle and any other important factors in fighting diabetes?
As we discussed earlier, depending on the type of diabetes, various modes of treatment are involved in the management of the disease. Since type 2 diabetes is largely on the rise now, it is mostly due to an unhealthy lifestyle. Be it western or Indian, the first and foremost treatment will always start with good diet control, which means adequate amount of proteins, vitamins and fats in your diet, and any aerobic activity or exercise regime every day, for at least 150 minutes a week. It is only with the lifestyle changes and medication combined together, that we can fight the disease better.
Physical and Mental Health Implications
What is the collateral damage caused by diabetes? For instance, have you observed mental health issues in diabetics?
It is a chronic illness and has an effect on most of the major organs of the body, including the heart, kidneys, blood vessels, nerves, eyes, etc. It not only affects the organs but also leads to a mood disorder in case of uncontrolled sugar. It is observed with research that almost 30% of diabetics suffer from depression, mainly due to chronic illness and secondary complications of the disease.
Watch on YouTube: Top 10 Questions To Ask Yourself Relating to Mental health
Advice to Diabetics, Pre-diabetics and People with Family History of Diabetes
What are your top 3 pieces of advice to:
a) Diabetic– Judicious treatment and regular checkups with the concerned doctor.
b) Pre-diabetics – early diagnosis and action to incorporate lifestyle and dietary changes in order to prolong the onset of type 2 diabetes.
c) People with family history, with normal sugar levels – genetic preponderance plays a stronger role especially in type 2 diabetes. Hence, maintaining a good lifestyle with a nutritious, low-fat diet, avoiding processed food, walking and exercising regularly to maintain weight and BMI in order to avoid early onset of the disease.
Monitoring Sugar Levels
Should we track sugar/blood glucose levels continuously or is there any other marker or metric that could be more relevant?
Its treatment needs to be modified periodically, hence regular blood sugar checkups help in stricter sugar control. Tracking sugar regularly needs to be done for patients taking insulin, as it may lead to hypoglycemia or low sugar which is equally risky. There are various devices such as CGM, that help in tracking the sugar continuously for 24 hours with a chip placed under the skin, which is extremely helpful for uncontrolled diabetes with insulin treatment, and show better results of sugar control. Other than that, the HbA1c test which shows an average sugar of the last three months, is also useful to modify the treatment and maintain good control of sugar.
Treating Diabetes with Insulin
So many people are dependent on insulin injections. Is there some way to avoid getting into the insulin trap or getting out of it?
Insulin was the most primordial treatment invented to treat diabetes in the past. It is still considered the most effective way of controlling blood sugar levels, but a few disadvantages include inject-able mode of delivery, frequent hypoglycemia and weight gain.
It is a myth that once insulin is started it cannot be stopped, insulin works best to control high sugar level faster, or in case of critical conditions like heart disease, kidney disease or severe infections. With assisted help and diabetes education, insulin can be taken conveniently and grave complications can be avoided. Insulin could be necessary in many cases and the fear around it needs to be allayed.
Note: This information is provided for educational and informational purposes only and does not constitute providing medical opinion.
About Dr Sharwari D Dua
Dr Sharwari D Dua is a Consultant Physician and Endocrinologist at Fortis La Femme, GK2, Fortis Vasant Kunj and Rainbow Hospital Malviya Nagar, New Delhi. She is a post-graduate MD in Internal Medicine from MGM Medical College Navi Mumbai. She has attained clinical training In Endocrinology in Apollo hospital and has received PGDip in Endocrinology from University of South Wales, UK.
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