Diabetes

The precursor to diabetes is defined as IGT or Impaired Glucose Tolerance. As the name suggests, in this condition, the body is unable to "tolerate" glucose, and cannot metabolize it in a "normal" manner. The glucose therefore remains in circulation and the result is elevated Blood Glucose (BG). So Diabetes can be thought of as an advanced "beyond the IGT stage" of dysfunctional glucose metabolism. There are many types and forms of diabetes. Unfortunately, in India, many doctors are unaware of some of these types, and often end up with a mis-diagnosis. This can be dangerous because each type has it's own cause, effect and requires a different treatment approach. Treating every diabetic case, the same way without proper investigation, could have drastic consequences. Let's briefly look at each type & their characteristics.

Impaired Glucose Metabolism : The presence of glucose in the body, requires the pancreas to secrete the hormone insulin. Insulin is more particularly secreted by the beta-cells of the "islets of Langerhans" located in the pancreas. The secreted insulin, acts as a carrier for the glucose, and supplies it to all of the body cells, to be used as a source of energy. When there is a malfunction of this normal metabolic process, the pancreas reduce or completely stop creating and secreting insulin. Alternatively, there is some or normal secretion of insulin, but the cells become Insulin Resistant, and refuse to accept the insulin, and in turn the glucose that it is carting. In either case, or even in a combination of the above scenarios, the glucose remains un-utilized and circulating in the blood. This causes the BG (Blood Glucose) to rise and remain elevated in affected individuals.    

Gestational Diabetes (GD) : This is the type of diabetes that strikes about 8-10 % of women during pregnancy. The treatment could include preferably insulin or oral pills if the BG (Blood Glucose) does not normalize. High blood sugar in the mother is very dangerous for the growing fetus, as it depends solely on the mother's blood supply for its own nourishment. Usually GD resolves soon after the delivery on it's own. Once the big "D" rears it's ugly head during pregnancy, the woman can be considered to be at potential risk for getting the full blown version later in life. Even the babies born from such pregnancies are considered to be susceptible to the disease during their lifetime.

Type 1 Diabetes (T1) : is also known as Juvenile Diabetes, because it usually strikes during the childhood years. This is an Auto-Immune disease, in which the Auto Immune System of the body, malfunctions and causes the onset of T1. Usually the afflicted children come under some kind of viral attack. The make up of the virus/es is similar to that of the beta cells of the pancreas. In a case of mistaken identity, the auto immune system not only attacks the invading virus but also the pancreatic beta cells. The attacked beta cells degenerate and are not able to make and secrete insulin for the remainder of the life cycle. T1s have therefore to rely on exogenous insulin injections to survive.

Type 2 Diabetes (T2) : This form of diabetes is also known as Mature Onset diabetes and normally strikes a person in the middle ages - mostly after the late 30s. This form of diabetes is more common and is mostly a combination of reduced insulin secretion capacity and (IR) Insulin Resistance. Where and which cells within the body have IR and to what extent, determines the person's diabetic imprint, and response to therapy. In majority of the cases, the BG can be well managed with lifestyle changes and sometimes oral medication. In extreme cases, a combination therapy or exclusive use of injected insulin is advised.

Type 1.5 (LADA) : Off late, 2 mid-way strains of diabetes have evolved. These forms of diabetes are understood to lie between T1 & T2, and therefore designated as T1.5. LADA stands for "Latent Auto Immune Diabetes in Adulthood". LADA, is also an Auto-Immune disease, but it lies dormant during childhood and begins to appear only late in life. In simpler words LADA is T1 appearing in adult years. As opposed to T2, these persons also cannot secrete any insulin just like the T1s and have to depend on exogenous insulin to manage BG.

Type 1.5 (MODY) : Just like LADA, this is a variety thought to lie in between T1 & T2. MODY stands for "Mature Onset of Diabetes in the Young". These cases are that of young people getting afflicted by T2 diabetes very early in life. They suffer from part faulty insulin secretion and part IR just like the T2s. Most cases can be managed by lifestyle changes and oral medication. In some rare cases insulin needs to injected. Due to their young age, these type of patients can many times cause a dramatic reversal of their conditions, provided that their lifestyle and/or medical intervention is maintained. An increasing number of youngsters have been joining the MODY group off late, indicating the fast pace at which diabetes variants are spreading in the global population.

Symptoms : There are many ways that high blood sugars start to show up. The most common symptoms are  - excessive thirst and urination. Small wounds not healing well. Fungal and yeast infections on the body. Problems with visibility. Sudden unexplained weight loss. Sensations like hot/cold/tingling/pain or fatigue in the legs and/or hands. Many times there are no symptoms at all. High diabetic levels of blood sugar appear only after years of metabolic damage within the body. After the age of 35, it is a good idea to keep an annual check on your blood sugars.

Diagnosis : In India BG is measured in mg/dL or milligrams per deciliter. Normal levels are 60-100 mg/dL at fasting (morning) or before meals and Postprandial (after meals) levels of 140 mg/dL at 2 hrs after meals. Though all efforts should be made to keep the PP numbers at 140 at 1 hr & 120 by 2 hrs. Fasting readings of 100-125 mean that your metabolic challenge has started and it is time something should be done about it. Doctors may make one undergo an OGTT - Oral Glucose Tolerance Test. A sugary drink containing 75 gms of glucose is to be had and the blood sugar levels are checked over time. At 1 hr one should be below 200 mg/dL & at 2 hr below 140 mg/dL to escape the Diabetic tag. 

Insulin is bound with another pancreatic protein secretion known as C-peptide. Insulin secretion capacity can be evaluated by measuring the levels of C-peptide in the blood. T1s & T1.5s who are under constant attack by their Immune system also have antibodies in their blood. These are known as GAD antibodies, and the GAD-65 antibodies test can determine their presence. These tests help in better type determination.   

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