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DIABETES

While the very word in common parlance is associated with a condition where one’s urine has a high sugar content as well as the blood, the fact of the matter is that in the good old days (or is it bad that I am referring to I sometimes wonder) diabetes was a condition where there was an increased necessity of going to the loo, and the condition was diagnosed, in the absence of any chemical tests, by the doctor tasting the urine of the patient (yuck!). If the urine was sweet, the condition was diagnosed as diabetes mellitus, or if it was tasteless or insipid, diabetes insipidus. It is on the former type of condition that I shall be discussing today.

Neither age nor any body-part is free from the affliction of this disease. To top that, it is never cured, However, it can be kept well under control through the adoption of a healthy life style of proper diet, exercise, and if necessary, medications. It can thus be found in children when it is known as juvenile diabetes mellitus, fortunately though for some as yet unexplained reason it is not as common in the Eastern hemisphere as much as it is in the West. Pregnant mothers may show the signs of having this disease when it is known as pregnancy induced diabetes mellitus. Such ladies do more often than not go on to develop diabetes mellitus at a later stage. Then there is of course the stressed obese (as well as non-obese) adults who show the manifestations of the disease.

There are various types of the disease which may broadly be stated to be as follows. IDDM or insulin dependent diabetes mellitus, NIDDM or non insulin dependent diabetes mellitus, MODY or maturity onset diabetes of the young, and insulin resistant diabetes. It must be stated that there is a lot of controversy regarding the terminology as many patients show different manifestations of the disease at various stages. Insulin dependent diabetics must take insulin shots on a regular basis as they cannot do without them (hence the term insulin dependent).

Most juvenile diabetes, which exclusively occur in children, is insulin dependent. That means that they will have to have insulin shots administered to them every day for the rest of their lives. There is no escape from the daily pricks and the unfortunate mother of such children have to compassionately made to understand that sometimes it is indeed necessary to be cruel in order to be kind. The pain will be there but with insulin coupled with a regular diet and exercise should see the condition being well control. Most children with controlled disease have been found to have a reasonable growth and development. Modern day treatment has resulted in achieving a remarkable increase in the average life-span. It is of course necessary to take ample precautions which are common for all diabetics. Some examples of these are regular health check ups by a consultant specialising in diabetes mellitus, proper care of all types of wounds and infections, daily care of the feet, regular exercise, apart from the diet schedule formulated by a qualified dietician. Some more information is available by following this link.

The signs of this disease are usually a need to get up at nights to go the toilet on a regular basis, something that the individual did not need to do before. There is a simultaneous increase in the desire to drink a lot of water and inspite of having eaten a lot there is a constant feeling of hunger. The person also begins to feel tired very easily and is mostly demoralised and / or depressed. Children often show a significant lack of interest in their studies and their class performance appears to be on a firm downhill course for no otherwise apparent reason. Another interesting way of arousing suspicion is the finding of black ants crowding around in the urinal area of the bathroom (in the subcontinent especially).

The doctor should be immediately consulted. Though checking the urine for the presence of sugar with the help of a reagent-tipped strip which gives the result in a minute is a good method, it is not very reliable since urine may contain sugar for a variety of purposes other than diabetes. A drop of blood taken from the finger and checked with the help of an electronic gadget is quite a reliable fast and easy method of detection. The best sample is a RBS or random blood sugar though your doctor may ask for a Fasting (the blood sample being taken with the patient fasting) or a PP (when the blood sample is taken 2 hours after the meal) BS test. Of these, fasting is the more frequently undertaken one as it is the most reliable indicator of how much sugar is present in the body in the blood when it normally should be on the lower side. Once the diagnosis is established it must be borne in mind that it is never cured. The situation is not hopeless either. A changed lifestyle should see the person through relatively well. Regular checkups are however a must. Such checkups must include, apart from the blood sugar level test, regular checking of the eyes by an ophthalmologist for the appearance of the dangerous consequences of high blood sugar in the eyes. Also high on the checkup list is a thorough examination of the heart since diabetics are very prone to heart attacks. Cataract formation in the eyes is a common finding and usually such persons are prone to develop a condition called ‘after cataract’ which typically appear after cataract surgery.

The condition is principally controlled by diet and indeed there are some very fortunate individuals who are able to control their blood sugar levels on diet alone. Others require some medication either in the form of insulin shots or OHA (oral hypoglycaemic agents). Your doctor is the best person to advise in these matters. The insulin preparations that are used these days are either porcine or human. The human variety is obtained by genetic engineering the pig cells which then produce insulin that is precisely the ones that are found in the humans. The process is quite costly and this is reflected in the price of the insulin preparation. However, this type is the best there is and one is strongly advised to go for this type of insulin if one can. The porcine variety that is derived from pigs is also very close to the human ones and so are quite good too. The bovine ones which were in use before is cheapest but not so well tolerated as the variety of insulin is much different to that which is produced normally by humans.

When one talks of the diet of a diabetic one can write a book. In a very short nutshell (if there can be such a thing), the diet should be well balanced with high fibre and without simple sugars. Hence simple sugars in the form of glucose, sweets, honey, jaggery are all out of the diet permanently. One should try to eat fish for their source of proteins (unless of course one is a vegetarian or hates fish) since red meat is a rich source of fat which is not recommended in such persons especially for the risks of heart attacks. Fruits can be taken in moderation since they give us fructose rather than the glucose that is harmful for diabetics. If one is particularly predisposed to the possession of a sweet tooth one can try artificial sweeteners like aspartame but not saccharin. Any way, the best bet is to consult a dietician for the preparation of a food chart. The dietician will be able to accurately calculate the daily calorie intake required by a particular individual and prepare a chart accordingly. Children should not be forced to accept a strict diet regime. One thing must be remembered, no treatment works unless the sufferer understands and fully cooperates with it.

The feet are particularly at risk of developing infections. So they must be cared for on a daily basis. Properly fitting shoes must be worn and they must be kept clean, dry and adequately soft (but not too soft) with the application of creams and / or moisturizers. Daily exercise is also very important. One the diabetes is under control there is no reason not to undertake a full schedule of exercises though vigorous exercises are not encouraged. Aerobics is a good form of exercise for both the young and the old. Swimming and cycling at gentle pace is both relaxing and invigorating. Light jogging may be undertaken though brisk walking is probably better. Yoga has also been found to have good effects. Patients with an existing heart condition should exercise with caution and only after seeking prior permission of their doctor.

If you are on insulin or for that matter on any OHA, remember that you may become hypoglycaemic. Never starve for long. Always carry a card with your details saying that you are a diabetic and if you are found to be unconscious or behaving in a peculiar manner you should be given glucose liberally. You must also carry glucose or glucose biscuits or some sugary toffees or chocolates and should you ever start feeling light-headed you must take them without delay. Remember, you can be saved if you have high blood sugar levels and even if you have the dangerous ‘diabetic coma’ but if you have very low blood sugar levels or ‘hypoglycaemic coma’ you are in better chance of entering the Pearly Gates rather than the gates of your house.

Last but not the least, please note that the condition is never curable but if excellently controlled it may help the patient in leading a normal life under the given circumstances. Thus, you must never stop taking the prescribed drugs nor should you ever stop controlling your diet. Do undergo health checkups on a regular basis. If you take daily insulin shots try not to take them in the same areas day in and day out. There are various areas of the body where you can be injected, like the upper arm, stomach, buttocks, thighs, so do rotate your injection areas. If you are also in the possession of a blood glucose checking machine then try not to prick your fingertip for that drop of blood. Instead try to prick on the side of the finger in between the area of the tip and the nail. The blood drop is more easily transferable on to the reagent tipped strip and the prick is far less painful.

In conclusion I must admit in all honesty that emotionally it is very difficult to accept that one has a chronic disease that requires a complete and major change in their life style. The goal should be to live with the condition and not for it. More and more diabetics are increasingly being found to be living a fuller and productive life than ever before. Any sound advice should be is to never give up hope and never to despair.

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Compiled from various sources by Dr. S. B. Bhattacharyya.
Copyright [SUDISA]. All rights reserved.
Revised: September 09, 1999.