Diabetes is a major healthcare challenge affecting millions in India . India has to dubious  distinction of being the  ‘diabetes capital’ of the world. Currently, there are an estimated 41 million diabetics in India.  Unfortunately  owing  to poor  awareness  and  socio-economic  reasons, only 37% of cases are detected, while the rest of those affected are blissfully unaware of their condition. Another sad fact is that Indians get this disease about a decade earlier than their counterparts. It is usually detected ‘by accident’.

It is good that consequences  of the disease, are known to public to  some extent that, it is appropriate to know the reasons for the onset of this disorder :  Changing  food habits, lack of exercise and obesity are the main causes, disturbing the body’s ability to handle glucose (sugar). The demand for glucose is relatively low but the body is supplied with more glucose  than it needs. It is this difference in demand and supply that causes diabetes.

Available evidence suggests that derangement in  glucose metabolism takes place over time and that every diabetic passes through a ‘pre-diabetes stage. Sugar levels during the pre-diabetes stage are slightly above normal but not so high as to case diabetes. It is during this period that we have  the best chance to prevent  the onset of diabetes. Many studies have shown that it is possible to prevent the onset of diabetes  by losing weight, exercising regularly and sticking to a meal plan. Hence, people with a family history of diabetes or those who are obese or overweight or lead a sedentary lifestyle are encouraged to alter their lifestyle and also undergo screening for diabetes at regular intervals (every year after the  age  of 40).

It has  also been shown in  many  studies that during the pre-diabetes stage, the major blood vessels  (those that supply blood to the heart, brain and legs) get affected, pre-disposing people to develop complications like heart attack and brain attack  later in life.

Once diabetes sets in, it cannot be reversed out only controlled. The aim of therapy after diabetes  sets in  is not only to keep glucose levels under check, but also  to prevent or postpone micro-vascular complications. Organs that get affected  due to micro-vascular complications are the eyes, kidney and nerves.

Damage to nerves manifests as numbness, a tingling sensation or calf music pain. Neuropapthy (otherwise  known a damage to nerves) is present in some Type 2 diabetes (people who do  not need insulin for survival at least during initial stage of diabetes) at the time of detection

The other complication is diabetic eye diseases, which is the  commonest cause of painless loss of vision. Cataract is common  among diabetics and occurs  earlier than in non diabetics. Good control of blood glucose, blood pressure and lipids prevents the progression of eye disease and even decreases the demand for laser therapy.

In diabetes, not only  are glucose levels disturbed but there is  an increase in the level of ‘bad’ cholesterol (LDL) and a decrease in the level  of ‘good’ cholesterol (HDL) and most patients have hypertension. All these factors contribute to the damage of vital organs. Therefore, control of diabetes truly means not only control of blood glucose but also  lipids, blood pressure, body weight and the adoption of a healthy lifestyle.

Dr. Sharda  Jain
Content abstracted from article of Dr. Anil Kumar, PGIMER