| Various companies are coming up with newer ways to administer insulin (above); diets for diabetics should include raw vegetables
The term “diabetes” is derived from the Greek word for siphon, and the depiction is apt. Ignored, untreated or mismanaged, the disease silently siphons off our life itself. The prevalence of diabetes in India is high, ranging from five per cent (rural) to 15 per cent (urban). Many of those affected are in their early 30s, the productive years, and they often succumb to diabetic complications like coronary artery disease (CAD).
Diabetes is inherited in a complex fashion, with manifestation of the defective genes (depending on the type of diabetes) influenced by intra-uterine nutrition, birth weight, childhood viral infections, diet, lifestyle and other environmental factors.
The classification of diabetes is no longer simply “juvenile” or “maturity onset”. Doctors have many fancy acronyms ' plain DM (diabetes mellitus), MODY (maturity onset diabetes of the young), NIDDM (non'insulin dependent diabetes), IDDM (insulin dependent diabetes) and MIDD (maternally inherited diabetes and deafness).
Irrespective of the moniker, “diabetes” means that the fasting blood sugar is more than 125mg/dL and the random sugar more than 200mg/dL.
Food eaten, whether carbohydrates, fats or proteins, is eventually converted to simple sugars which are then absorbed, utilised or stored as fat for later use. This is under the control of insulin, a hormone secreted by the pancreas.
In normal people, the insulin level fluctuates in response to the variations in the blood sugar and this remains normal irrespective of fasting or gluttony.
Control of the blood sugar level becomes unsatisfactory if the insulin secretion is inadequate. The pancreas may have been damaged by recurrent attacks of pancreatitis or by viral infections (measles, mumps, German measles or the coxsackie viruses). The insulin produced may be faulty or antibodies may render it ineffectual.
In obese people, the insulin becomes inefficient. If the insulin available is less than 20 per cent, the classical triad of increased appetite, thirst and weight loss appears, heralding the onset of diabetes.
Complications occur in organs like the kidneys, eyes, brain and heart which may become damaged if diabetes is uncontrolled. Ordinary infections also become frequent, uncontrolled, fulminant and life threatening.
For adequate control, food intake has to be on time and the calories restricted to around 1,500 calories a day with (ideally) 1 gm/kg of protein, less than 35 per cent of the calories from fat and 40-60 per cent from carbohydrates. Complex carbohydrates and fibre have to be added to delay digestion and absorption and maintain the blood sugars on an even keel. Instead of vitamin supplements, 4-5 helpings (1 cup) of raw vegetables or fruits can be eaten. The salt should be kept at 5 gm/day or lower than this.
If there is no endogenous insulin, the hormone has to be supplied from outside. The dose of the insulin required varies and is an equation of the calorific value of the total amount of food eaten, and an estimate of the energy expenditure till the next meal. Eight-ten units are required for 500 calories of food. As insulin is a protein, it gets digested and destroyed by the stomach acids. It therefore has to be administered as subcutaneous injections on the arm, thigh or abdomen. Convenience and control dictate whether the administration should be once, twice or thrice daily.
Insulin needles are now disposable, fine and very sharp. This reduces the pain and makes self-administration a less masochistic procedure. The newer pen type pushes out the needle with a trigger, avoiding hesitant self-administration. The sites of injection should be rotated and massaged to prevent local reactions and dimpling.
Allergic reactions now are fewer as porcine and bovine insulin are being increasingly replaced with human insulin. Research is underway to produce a nasally inhaled insulin, which hopefully will make administration easier for insulin dependent diabetics. Glucometers are available locally and enable patients to make fine adjustments to the insulin dose themselves.
Tablets act by increasing the secretion of insulin by the failing pancreas, and making peripheral tissues more responsive. If combined with a sensible diet, it is possible to maintain a lifetime of adequate control. Non-allopathic “sugar reducing” herbs and seeds should be avoided as the dosage is uncontrolled and erratic and side effects are unknown.
If the food intake has been inadequate or activity excessive, the blood sugar levels may suddenly drop in a diabetic on treatment. This causes a sudden feeling of tiredness, uncontrolled yawning, slurred speech, sweating, twitching, fainting or seizures. This is dangerous and should be tackled immediately by eating or drinking something sweet.
Regular exercise releases body chemicals that help to keep the blood sugar under control all day. An hour of aerobic activity (running, jogging, swimming, etc) burns up around 300-400 calories, and should be combined with 20 minutes of anaerobic exercises like yoga or light weights.
Diabetes cannot be cured but it can be well controlled with diet, exercise and medication.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at firstname.lastname@example.org