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What is diabetes?
Diabetes is a disease that occurs when your body doesn't make enough of a hormone
called insulin, or if your body doesn't use insulin the right way. If left untreated, it may
result in blindness, heart attacks, strokes, kidney failure and amputations. Only half of
the people who have diabetes have been diagnosed, because in the early stages of
diabetes there are few symptoms, or the symptoms may be the same as symptoms of
other health conditions.

What are the symptoms of diabetes?
Early symptoms of diabetes may include the following:
Extreme thirst
Extreme hunger
Frequent urination
Sores or bruises that heal slowly
Dry, itchy skin
Unexplained weight loss
Blurry vision that changes from day to day
Unusual tiredness or drowsiness
Tingling or numbness in the hands or feet
Frequent or recurring skin, gum, bladder or vaginal yeast infections

Who is at risk for diabetes?
The early stages of diabetes have very few symptoms, so you may not know you have
the disease. But damage may already be happening to your eyes, your kidneys and your
cardiovascular system even before you notice symptoms. You are at risk for having
diabetes if:
You're older than 45 years of age
You're overweight
You don't exercise regularly
Your parent, brother or sister has diabetes
You gave birth to a baby that weighed more than 9 pounds or you had gestational
diabetes while you were pregnant

How will I be tested for diabetes?
Testing (also called "screening") is usually done with a fasting blood test. You'll be
tested in the morning, so you shouldn't eat anything after dinner the night before. A
normal blood sugar test result is below 110 mg per dL. A test result higher than 125 mg
per dL suggests diabetes. However, you should have 2 tests that are higher than 125 mg
per dL, on 2 different days, before a diagnosis of diabetes is made. Test results from
110 mg per dL to 125 mg per dL suggest that you have a higher risk of diabetes.
Why is it important for diabetes to be diagnosed early?
Many people have diabetes for about 5 years before they show symptoms . By that
time, some people already have eye, kidney, gum or nerve damage caused by diabetes.
There's no cure for diabetes, but there are ways for you to stay healthy and reduce the
risk of complications. If you exercise, watch your diet, control your weight and take the
medicine your doctor may prescribe, you can make a big difference in reducing or
preventing the damage that diabetes can do. The earlier you know you have diabetes,
the sooner you can make these important lifestyle changes.

Medical Terms
Insulin: The hormone produced by the pancreas for regulating carbohydrate
metabolism. Used in the treatment of diabetes mellitus.
Glucose: Dextrose. A simple six-carbon sugar naturally found in fruits, honey and
blood.
Hypoglycemia: Low blood sugar.
Hyperglycemic: High blood sugar.
Medicines

The goal of diabetes treatment is to keep your blood sugar level as close to normal as
possible. The first step is to have a healthy diet and to exercise. This may mean you'll
need to change your diet and exercise habits. You'll also have to watch your weight, or
even lose weight, to keep your blood sugar level as normal as possible. Your doctor will
talk to you about the kinds of food you should eat and how much exercise you'll need
every week.
Sometimes diet and exercise alone can't keep your blood sugar levels normal. Then
your doctor will talk to you about other treatments, such as medicine or insulin shots.
Many people with diabetes find it fairly easy to keep track of their own blood sugar
level at home. Your doctor can use the results to see how your treatment is working.

Are there medicines I can take?
Several kinds of medicine can help you control your blood sugar level. Some medicines
are pills that you take by mouth (orally). Oral medicine doesn't work for everyone,
though. Some people need to take insulin. If you need insulin, you'll have to give
yourself a shot. Most people with type 2 diabetes start with an oral medicine. Your
doctor will tell you which kind of medicine you should take and why.

What medicines could my doctor prescribe?
Six kinds of diabetes medicine are available in pill form: sulfonylureas, metformin,
thiazolidinediones, alpha-glucosidase inhibitors, repaglinide and nateglinide. Each
medicine has good points and bad points. Your doctor will decide which medicine is
right for you.

Sulfonylureas
Sulfonylureas (some brand names: (GLIMER) are the most commonly prescribed
diabetes medicines. They are inexpensive and have few side effects. These medicines
help your body make insulin. They can be taken alone or with metformin, an alpha-
glucosidase inhibitor, pioglitazone or insulin. If you're allergic to sulfa, you can't take a
sulfonylurea.

Biguanides
Metformin (brand name: GLUFORMIN ) may be prescribed for people with diabetes
who are overweight, because it may help with weight problems. It helps the body use
insulin better. Metformin can cause problems like nausea or diarrhea in some people. It
can be taken with a sulfonylurea.

Thiazolidinediones
This class of medicines includes rosiglitazone (brand name: Avandia) and pioglitazone
(brand name: Actos,PIOZONE). An older medicine, troglitazone (brand name: Rezulin)
is no longer being made because of the risk of liver problems. Rosiglitazone and
pioglitazone appear less likely to cause liver problems, but people taking them need
periodic liver tests. These medicines help your body respond better to insulin.
Rosiglitazone and pioglitazone can be used alone or in combination with other diabetes
medicines.

Alpha-glucosidase inhibitors
Alpha-glucosidase inhibitors (brand names: Precose, Glyset) work in your stomach and
bowels to slow down the absorption of sugar. If another medicine doesn't control your
blood sugar, you might use this kind. This medicine can cause stomach or bowel
problems, so it may not be a good choice if you have a history of stomach or bowel
trouble. It can be taken alone or with a sulfonylurea.

Meglitinides
Repaglinide (brand name: Prandin) is taken with meals to control your blood sugar.
Your doctor can tell you how to adjust the dose according to the number of meals you
eat. Repaglinide can be taken alone or with metformin. Nateglinide (brand name:
Starlix) is taken with meals to keep your blood sugar level from getting too high after
you eat. Nateglinide can be taken alone or with metformin.
Your doctor may prescribe a combination of 2 or even 3 types of medicine to help you
control your blood sugar levels. Some combinations are available together in one pill.
Some of these include a combination of a thiazolidinedione and a biguanide
(Avandamet and ACTOplus Met) or a sulfonylurea and a biguanide (Glucovance and
Metaglip).
Living With Diabetes
What do actor Kamal Hasan, politician Sushma Swaraj and VJ Gaurav Kapoor have in common? Well, they all have Type I diabetes. Type I diabetes is caused by the destruction of beta cells in the pancreas, which produces insulin and is different from Type II diabetes, which is linked to a sedentary lifestyle and unhealthy eating habits. Incidentally, 90 per cent of the world's diabetics are of the Type II variety. While diabetes is a common ailment, afflicting as many as 35 million people in India alone, the social fallout is perhaps the least-discussed aspect of the disease. Yet, for a majority of those who suffer from Type I diabetes, it is a reality they have to contend with in their daily lives. A recent survey - carried out by the Delhi Diabetes Research Centre (DDRC) among the age group of 19 to 31 has revealed that matrimony is among the most common concerns for a diabetic. Not only does the Type I diabetic patient find it difficult to be accepted as an eligible life-partner but more than 90 per cent of those who were married faced problems in their marital life with confrontation, separation and divorce being the most common amongst them. The survey further revealed that of the married women who were Type I diabetic, nearly 50 per cent were sent back to their parental home within a year of marriage. Nearly, 25 per cent of the diabetic married women surveyed lost interest in taking care of themselves, much less monitoring the disease. This happened mainly because the financial assistance to do so was not forthcoming at their husband's home. Death due to health-related complications are also common. Stigma and misconceptions persist. According to Dr A K.Jhingan, Chairperson, DDRC, there is a fear that diabetes-affected persons cannot have normal and healthy children. In fact, more often than not, diabetic men chose to remain silent about their disease before entering matrimony. According to Jhingan, what was most worrisome was the lack of sufficient knowledge about the disease. "The social implications of diabetes for the Indian subcontinent need special attention because of the region's prevalent culture," he says. The problem - which is especially acute in India, Sri Lanka, Pakistan and Bangladesh - can only be addressed through mass movements, focused health campaigns, private, and public sector involvement. India, with a figure of 35 million diabetics, also has the dubious reputation of being the "diabetes capital of the world". At the current growth rate, the number of diabetics in the country is likely to touch 57 million by 2020. On its part, the Delhi Diabetes Research Centre (DDRC) a private outfit established in 1985 by a team of six Delhi-based doctors) with its pool of 10 doctors - including three dieticians and two diabetes specialists, has been regularly organizing public awareness campaigns. The Centre has also been holding a Diabetes Health Mela for the last four years at Delhi's Talkatora Stadium to raise awareness on this issue. The Centre is also in the process of establishing a "Matrimonial Bureau" where Type I diabetics, who are keen to seek out life partners, can register themselves. "It will be a wonderful platform for these patients to seek alliances in an enlightened way," asserts Jhingan. The Centre already has 300 Type I and 22,000 Type II diabetics registered with it, and these people are kept posted about new developments and research on the disease. DDRC also conducts workshops where celebrities are invited to speak on the subject. VJ Gaurav Kapoor, politician Sushma Swaraj, cricketer Wasim Akram, actor Kamal Hasan - all of who suffer from Type I diabetes - have been invited to various DDRC forums to educate the public on the issue. According to diabetologists, though diabetes is a tenacious disease, it is surprisingly easy to live with provided one takes a few lifestyle-related precautions. Symptoms: Blurred vision, unexplained extreme exhaustion, weight loss, increased thirst, frequent urination Tips for patients: Be physically active. Walking, gardening, jogging, playing with pets and kids and doing simple household chores are greatly beneficial. If you are overweight, try to knock off excess weight through a correct diet and exercise regimen. Take the help of professional dieticians, if need be. Ideal body weight is Body Mass Index (BMI) which is weight in kgs divided by height in metres. The BMI should be 23 for Asians. Follow the concept of glycemic index (GI). This refers to the extent of rise in blood sugar in response to a food item compared to the rise in glucose. Foods with a high GI (70 or more), lead to a sudden spurt in blood glucose followed by an equally sharp plummet. The human body copes better with a low GI food items (55 or less) as they do not cause a sudden spike in blood glucose levels. Eat a variety of foods -grains, pulses, fibres, fruits, veggies, seeds, nuts, dairy and cold pressed oils (olive, sesame, and mustard). High-fibre, low-fat food is ideal. Include fresh fruits, veggies, cereals like bran flakes, muesli, corn flakes, porridge, broken wheat, brown/unpolished rice in your diet. Stick to skimmed milk, monounsaturated/polyunsaturated fats. Have six small meals rather than three heavy ones. Follow the reverse culinary pyramid with breakfast being the heaviest meal of the day and dinner the smallest. (WFS) What are diabetic complications?
Diabetic complications are health problems caused by diabetes. Diabetes causes your blood sugar level to be higher than normal. Over time, high blood sugar levels can damage your blood vessels and nerves. This damage can cause problems in many areas of the body. Keep reading to learn more about some diabetic complications and how to prevent them. Nerve damage
Nerve damage (also called diabetic neuropathy) makes it hard for your nerves to send messages to the brain and other parts of the body. If you have nerve damage, you may lose feeling in parts of your body or have a painful tingling feeling. Neuropathy most often affects the feet and legs. If you have neuropathy, you may not be able to feel a sore on your foot. The sore can become infected, and, in serious cases, the foot may have to be amputated (removed). People who have neuropathy may continue walking on a foot that has damaged joints or bones. This can lead to a condition called Charcot foot that causes the injured foot to become deformed. However, this problem can often be avoided. If you have diabetes, check your feet every day. If you see swelling and redness and feel warmth in your foot, see your doctor immediately. These can be signs of Charcot foot. Your doctor should also check your feet at least once a year. Warning signs of nerve damage
 Sores on your feet  Muscle weakness  Burning feeling  Inability to get an erection (in men)
Eye problems
The retina is the part of the eye that is sensitive to light and helps you see. Diabetes can damage and weaken the small blood vessels in the retina. This damage is called diabetic retinopathy. When the blood vessels are weak, they can leak fluid. This causes swelling in the eye that blurs your vision. If the retinopathy gets worse, it may lead to blindness by causing your retina to break away from the back of the eye. Laser surgery can often be used to treat or slow down retinopathy, especially if the problem is found early. People who have diabetes should see their eye doctor once a year for an eye exam. Warning signs of eye problems
 Blurred vision for more than 2 days  Sudden loss of vision in 1 or both eyes  Black spots, cobwebs or flashing lights in your vision  Redness in your eye  Pain or pressure in your eye
Kidney damage
Diabetes can also damage the blood vessels in your kidneys so they can't filter out the body's waste. This damage is called diabetic nephropathy. Some people who have nephropathy will eventually need dialysis (a treatment that eliminates waste from the blood) or kidney transplants. The risk for nephropathy is increased if you have both diabetes and high blood pressure, so it is important to control both of these conditions. Protein in the urine is usually the first sign of nephropathy. This should be checked yearly. If your doctor notices early signs of this, he or she can put you on medicine that helps protect your kidneys from damage. Heart disease and stroke
People with diabetes are at greater risk for heart disease and stroke, The risk is even greater for people who have diabetes and smoke, have high blood pressure, have a family history of heart disease or are overweight. Heart disease is easiest to treat when it is caught early. It is very important to see your doctor on a regular basis. He or she can test for early signs of heart disease or stroke. The recommended cholesterol level for a person with diabetes is the same as for someone with heart disease. If your cholesterol is higher than the recommended level, your doctor will talk to you about lifestyle changes and medication to help get your cholesterol under control. What can I do to prevent or delay diabetic complications?
To prevent problems, keep your blood sugar level as close to normal as possible and follow your doctor's instructions. The following are some other tips:  Eat a variety of healthy foods. Avoid foods that are high in fat and sugar.  Maintain a healthy weight. If you're overweight, your doctor can give you  Control your blood pressure and cholesterol levels.  Be physically active on a regular basis.  Quit smoking.  See your doctor regularly, even when you feel fine. Your doctor will check for
Diabetic Nephropathy
What is diabetic nephropathy?
Diabetes can affect many parts of the body, including the kidneys. In healthy kidneys,
many tiny blood vessels remove waste products from your body. These vessels can be
damaged if diabetes is not controlled. This damage can cause kidney disease, which is
also called nephropathy (say: nef-rah-puh-thee). If the damage is bad enough, your
kidneys could stop working.

How do I know if diabetes has hurt my kidneys?
Your doctor will test your urine for protein. This test will tell your doctor if there is a
problem with the way your kidneys are working. Your doctor may also want to do a
blood test to see how much damage has been done to the kidneys. Your doctor will find
out if it is diabetes or something else that is hurting your kidneys.
Unless the damage is severe, you probably will not have any symptoms. If your kidneys
stop working, your feet and ankles may swell. You also might feel weak or not want to
eat.

What can I do to slow down the damage? The following are some of the most
important things you can do to protect your kidneys:
 Keep your blood pressure lower than 130 over 80. Your doctor may give you medicine to help lower your blood pressure.  Check your blood sugar level (also called your A1C level) often. Keep your A1C level below 7 percent. Your doctor may give you medicine to help lower your blood sugar level.  Stick to your diet. Ask your doctor how many calories and carbohydrates and  Be physically active every day.  Take the medicines your doctor prescribes for you. Check with your doctor before taking any new medicines. This includes vitamins, herbal medicines and over-the-counter medicines.  Keep all of your doctor appointments.  Stop smoking.

What happens if my kidneys stop working?
Even with the right treatments, diabetic nephropathy can get worse over time. Your
kidneys could stop working. This is called kidney failure. If this happens, waste
products build up in your body. This can cause vomiting, weakness, confusion and
coma.
If you have kidney failure, your doctor will refer you for dialysis (say: die-al-uh-sis). In
dialysis, a machine is used to take waste products out of the blood. One kind of dialysis
has to be done in a clinic. For another kind of dialysis, the machine is so small it can be
strapped to your body while you go about your daily activities.
Diabetic Ketoacidosis
Diabetic ketoacidosis (say: key-toe-acid-oh-sis), or DKA for short, happens when your
body has high blood sugar (also called glucose) and a build-up of acids called ketones.
If it isn't treated, it can lead to coma and even death. It mainly affects people who have
type 1 diabetes. However, it can also happen with other types of diabetes, including
type 2 diabetes and diabetes during pregnancy.

What causes DKA?
The main cause of DKA is not having enough insulin (a hormone produced by the
pancreas). This raises your body's blood glucose levels, but stops the body from using
the glucose for energy. To get energy, the body starts to burn fat. This causes a build-up
of ketones in your body. Ketones can poison the body.
For people who don't realize they have diabetes, DKA may be the first sign of their
illness. For others, DKA can be caused by missing an insulin dose, eating poorly or
feeling stressed. Infections, surgery or heart attacks can also lead to DKA.

What are the warning signs of DKA?
DKA is a very serious condition. If you have diabetes, you should contact your doctor
right away if you experience any of the following:
 Vomiting more than once  Stomach pain  Diarrhea 5 or more times in 6 hours  2 blood glucose level tests higher than 300 mg per dL  A blood glucose level less than 70 mg per dL more than once, or symptoms of  Trouble breathing  Moderate or high ketones if you are using urine test strips  High beta-hydroxybutyrate levels if you are using blood test strips  A high level of blood glucose can also cause you to urinate often, which leads to a lack of fluids in the body (dehydration).
If you have signs of infection, including fever, cough, sore throat, or pain when you go
to the bathroom, contact your doctor to make sure you are getting the right treatment.

How can I prevent DKA?
When you are sick, you need to watch your blood glucose very closely so that it doesn't
get too high or too low. Ask your doctor what your critical blood glucose level is. Most
patients should watch their glucose levels closely when they are higher than 250 mg per
dL.
When you're sick, you should check your blood glucose level every 3 to 4 hours. If your
blood glucose reaches a critical level, check it every 1 to 2 hours. Test your blood
glucose levels at least every 4 hours during the night.
You should talk to your doctor to develop a plan if your blood glucose level gets too
high. Make sure that you know how to reach your doctor in an emergency.
You should also test your urine for ketones or your blood for beta-hydroxybutyrate
every 4 hours or if your blood glucose is over 250 mg per dL.

Should I keep taking insulin when I'm sick?
Yes, you should keep taking your insulin, even if you are too sick to eat. Your body
needs insulin even if you are not eating. Ask your doctor whether it is necessary to
adjust your insulin dose or take extra insulin.
If you are on an insulin pump, make sure that you have short-acting insulin, long-acting
insulin and needles in case your pump is not working right. You also should have an
emergency phone number to call for help with your pump.

What else should I do?
When you're sick, drink lots of sugar-free, caffeine-free liquids. Sip small amounts
every few minutes if you are feeling sick to your stomach.
If your blood glucose is more than 250 mg per dL, do not eat or drink foods that are
high in carbohydrates.

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