Know About Diabetes
What you must know about Diabetes
What happens when we eat food?
Ever wondered about where we get the energy to breathe, to move, to laugh, or to walk from?

Yes, you are right; we get it from food, which is converted into energy in our cells.

Most of the food eaten by us has to be converted into glucose or sugar to be used by the body as an energy source. An organ called the pancreas, located close to the stomach, produces a hormone named insulin that helps in the entry of this sugar into the cells in the body. This sugar is utilized by the cells for energy.

This is how it happens in steps

What you must know about Diabetes
How does one describe Diabetes Mellitus (DM)?
In people with diabetes, the ability of the body to use food as an energy source, as described above, is hampered due to the inability of the body to make enough insulin, or the inability of insulin to transport glucose into the cells, where it is utilized to make energy. As a result, glucose remains in the blood instead. This situation ultimately leads to high blood sugar.

Diabetes Mellitus is a condition where the level of sugar in the blood is too high as the body cannot use sugar properly.

For more information, click on the below video.
What you must know about Diabetes
What are the Types of Diabetes Mellitus (DM)?
The earlier section described the basic defect responsible for raising the sugar levels in the blood and thereby causing diabetes. Depending on the extent and nature of this defect, diabetes can be of more than one type.

Normal response - Pancreas releases adequate insulin to transport the sugar into cells.
Type 1 diabetes – Inadequate insulin leading to elevated blood sugar
Type 2 diabetes – Inadequate or defective insulin leading to elevated blood sugar
Type 1 Diabetes mellitus: Among those affected with diabetes, 5-10% have Type 1 Diabetes. This category of diabetes mostly presents before age 30.

Type 2 Diabetes mellitus: This is a common type of diabetes and comprises 90–95% of those with diabetes. Once again, sugar does not reach the cells, and the body does not get enough energy. This type of diabetes mostly occurs in adults of age 40 and above; however, it is being diagnosed much more frequently in the young, sometimes even among adolescents.

Some of the factors that would increase your risk of developing Type 2 Diabetes are
• If you are older than 35 years
• A waist circumference >/=31 inches if you are a female and >/=35 inches if you are a male
• A positive family history
• If you exercise irregularly or have a sedentary lifestyle

You must know that even if you have any one of these, you are at risk of Type 2 Diabetes

Among the above, having a normal body weight and sufficient physical activity will help you improve your diabetes control.

Gestational Diabetes: Gestational diabetes occurs during pregnancy. Women presenting with this condition have a 40–60% increased chance of developing diabetes, generally type 2 diabetes, in the next 5 to 10 years.

Apart from the above, there is a situation, which deserves our attention, Pre-diabetes. Pre-diabetes is not a type of diabetes, but a stage before you get diagnosed with diabetes. If positive lifestyle changes are adopted in this stage, you could reverse this condition, saving yourself from being diagnosed with diabetes.

Pre-diabetes is a condition in which blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes. People with pre-diabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke.

The information in this website and the tools we have provided you in Patient Tools are more appropriate to those with Type 2 Diabetes, it being the predominant type of diabetes among people.
What you must know about Diabetes
Recognizing symptoms of high blood sugar (hyperglycemia)
You may experience any of these symptoms when your blood sugar is high:
• Frequent urination
• Increased thirst
• Extreme hunger or fatigue
• Weight loss
• Slowly-healing sores
• Dry and scratchy skin
• Numbness or tingling in the feet
• Blurry vision

Common symptoms of high blood sugar (hyperglycemia)
How does high blood sugar or Hyperglycemia affect you?
High blood sugar levels affect most parts of the body, but the parts that are most often affected and which suffer from complications are
• Heart
• Eyes
• Kidneys
• Nerves
• Feet
• Hands and arms
• Mouth
• Skin

Diabetes also causes and worsens high blood pressure or hypercholesterolemia (if it already exists), which in turn contributes to heart disease and stroke.

The World Health Organization report in 2004 recorded an estimated 34 lakh deaths due to consequences of high blood sugar. The global burden of Type 2 Diabetes mellitus (T2DM) for India is estimated to increase by 58%, from 5.10 crore people in 2010 to 8.7 crore in 2030. Thus, by the year 2025, >75% of the people with diabetes will be from developing countries like India.

Take a look at the widespread effects of high blood sugar on your health and therefore on your quality of life!

Apart from its impact on your physical health, diabetes affects your day-to-day living in addition to increasing your medical expenses.
The most-often seen complications of diabetes
Some of these problems are very common in those who do not keep their diabetes under control. Let us throw some more light on the most common ones.

For more information, click on the below video.
Damage to blood vessels
Vascular disease (or a disease of the blood vessels) is two to four times more common in people with diabetes. It is caused by stiffening and clogging of arteries (atherosclerosis), the blood vessels that supply oxygen and nutrients to body parts. In diabetes, when the blood sugar is always high, excessive amounts of glucose attach to the inner walls of the blood vessels, making them thick and hard, thereby decreasing their elasticity. These changes in the blood vessels restrict the easy flow of blood, which leads to strokes, high blood pressure, heart disease, and other large blood vessel diseases. This is referred to as macrovascular disease.

Over a long period of time, high blood sugar damages the retina of the eye, the blood vessels of the kidneys, the nerves, and other blood vessels. These types of damage are the result of damage to small blood vessels, referred to as microvascular disease.
Damage to your heart
3 out of 4 people with diabetes die of cardiac disease

Elevated blood sugar also contributes to atherosclerosis (plaque deposits in the blood vessels of the heart) by promoting plaque formation. High blood pressure, high cholesterol and triglycerides, and smoking further increase this risk. Even mildly increased blood sugar (as in pre-diabetes) increases the risk of heart disease.

Often, heart disease is silent in people with diabetes, because of possible nerve damage or neuropathy. In other words, very often, there are no symptoms, sometimes even during a heart attack, which can be fatal as the person will not recognize that s/he is suffering from a heart attack.
Damage to your eyes
People with diabetes are at risk of eye problems, ranging from minor changes with no effect on vision to significant visual loss. Diabetic retinopathy is the commonest eye complication caused by prolonged high blood glucose levels. Over time, this causes damage to the small blood vessels within the retina. This may cause hemorrhages, exudates, and even swelling of the retina. With regular screening and eye examinations by an eye doctor (ophthalmologist), and with stable and near normal blood glucose control, most of the serious complications can be avoided or successfully treated.

Retinal changes due to high blood sugar levels

Visual disturbances in retinopathy
Damage to your kidneys
Upto 25% of all patients with type 2 diabetes mellitus suffer from diabetic kidney disease or diabetic nephropathy. In India, diabetes has been calculated to drain 5–25% of the average Indian family’s income. Chronic kidney disease acts to aggravate this problem, and the onset of diabetic kidney disease is associated with a 10–30% increase in treatment costs.

Our kidneys are vital organs, since they help to clean waste products from the blood. Chronically elevated blood sugar damages the blood vessels and filtering units in the kidneys. This condition is known as diabetic nephropathy. Early detection and treatment may successfully stabilize and maintain the kidney function. When the kidney damage is significant, it may require either dialysis or a kidney transplant, both of which are very expensive and can significantly impair one's quality of life.

What you should know:
  • Early damage can go unnoticed.
  • The first sign of a problem is increased protein or microalbumin in the urine.
  • Damage is less likely to occur in individuals whose blood sugars and blood pressures are controlled.
Damage to your feet
Every 30 seconds, a lower limb is lost to diabetes.

People with diabetes can develop many different foot problems. Foot problems most often happen when there is nerve damage, also called neuropathy, which results in the loss of sensations in your feet.

Nerve damage is frequent due to high blood glucose, and it can cause either a loss of feeling in the feet or intense pain in the feet. Your chances of injuring your feet are high due to the loss of sensations or altered sensations as a result of nerve damage.

Poor blood flow (as a result of microvascular complications) affects the blood circulation in your legs; therefore, any sores occurring on the feet do not get cured and can also become infected. If left un-noticed (most likely due to the loss of sensations) or untreated, this may be a cause of amputation. Since nerve damage may lower the sensation to pain, a person may not notice the ulcer or injury and will fail to take corrective action in time. Regular and proper examination of the feet is therefore necessary.
You must attempt to learn from your doctor and healthcare team about foot inspection. If you get enrolled in SPARSH, you will receive material and training from your care counselor on foot care.

You may not even recognize the presence of such nerve damage; hence, a routine check-up is a must. You could click on the Patient Tools for some useful tips on foot care and avoiding diabetic foot complications.
Damage to your nerves
People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness (loss of feeling in the hands, arms, feet, and legs). Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs. One may not recognize even alarming symptoms of a heart attack in such situations.

One may experience the following symptoms:
  • Pain, numbness, and tingling of the hands and feet
  • Muscle weakness such as foot drop, double vision, trouble climbing stairs, and getting out of a chair
  • Stomach symptoms including bloating, nausea, vomiting of undigested food many hours after a meal, and a feeling of fulness without eating much food and bowel troubles such as episodes of diarrhea, especially at night
  • Difficulty in emptying the bladder
  • Sexual dysfunction
  • Dizziness and lightheadedness
Patterns of diabetic neuropathy
Higher risk of infections
Increased risk of infections
The frequency as well as severity of infections is greater when you have diabetes. You may develop infections of the skin, nails, and soft tissues often. Common infections that one could suffer from are pneumonia, tuberculosis, urinary infections, and foot infections. Poor diabetes control may also cause a delay in recovery from these infections.

Poor oral health
High blood sugar causes inflammation of the gums and promotes infection. Common signs of periodontal disease are gums that are swollen and bleed easily. Chronic high blood sugar can also cause yeast infections in the mouth and dental caries.

It is important to recognize that when a person is suffering from diabetes, it is likely to affect the quality of life of his/her family. Diabetes is a lifestyle disease; thus, once you imbibe healthy eating habits and adopt an active lifestyle, you will become a role model for others and prevent them from acquiring diabetes.
How does diabetes affect your productivity and quality of life?
The quality of life is found to be lower and the incidence of depression is higher in patients with diabetes and those at high risk of developing it. Individuals with more positive risk factors for diabetes have poorer quality of life scores compared to those at a lower risk. Overall health not only deals with your physical wellbeing, but also your mental and social status. Thus, enjoying a good quality of life along with making changes to manage diabetes better is vital. Sometimes, these quality of life aspects can increase the risk of complications. The only solution to this is the proper management of diabetes by taking the precribed medications, following a good lifestyle, and enhancing your knowledge about coping with your situation in the best possible way. This approach will definitely improve your glycemic control as well as your quality of life!
Hypoglycemia; why you must recognize and manage it?
If you are suffering from diabetes, you may experience low sugar levels. Does that surprise you?
Hypoglycemia is a condition that occurs when your blood sugar (glucose) is very low.
As the term implies, low blood sugar or hypoglycemia occurs when your brain and body are not getting enough sugar. For most people, a blood sugar reading of less than 70 mg/dl can be considered low, or hypoglycemic.
Hypoglycemia may cause unpleasant symptoms and disrupt daily activities, but one can learn to identify it and manage it effectively when it is mild.

What are the possible causes of hypoglycemia (low blood sugar)?
  • Taking a larger amount of the advised medications (pills or insulin)
  • Skipping a meal or eating less than needed
  • Strenuous exercising
  • Not eating on time
  • Consumption of alcohol, particularly on an empty stomach
What are the symptoms of hypoglycemia (low blood sugar)?
The common signs of hypoglycemia are:
  • Headache
  • Sweating
  • Pale skin color
  • Increase in appetite
  • Unsteadiness and dizziness
  • Inattention and confusion
  • Unexpected changes in mood and behavior
  • Clumsy or trembling movements
  • Seizures
  • Tingling feeling around the mouth
Such a condition will require support from another individual, and it is advisable to contact your doctor.
However, one can learn to identify it and manage it better. Proper lifestyle management, particularly dietary changes, can minimize the occurrence. One can learn tips that can help to minimize the inconvenience caused by hypoglycemia.

For more information, click on the below video.
How do we define good control?
The ABCs of diabetes can help you attain your goals in holistic diabetes management.

Accurate method to measure your diabetes control
The overall management of your blood sugar levels can be ascertained by you and your doctor with the HbA1c test. A1C provides a measure of the average glucose control over the preceding 2–3 months and indicates the overall effectiveness of treatment. The test basically aids in quantifying the sugar coating on blood cells. A red blood cell survives for 3 months; thus, this test is conducted every 3–6 months to evaluate your level of blood sugar control. Hence, A1C will show if your treatment is working and if your diabetes is under control.


Maintain an A1C level between 6.5%–7%

For a newly detected case of diabetes, a level between 6%–6.4% is recommended

Simple steps you must take to lead a healthy normal life?
Your approach to good diabetes management
You can manage to have a holistic approach to diabetes management, which goes beyond blood glucose control, by taking care of the five M's. These are some self-management skills:

A combined program of healthy eating, physical activity, and education directed at behavioral changes, is often successful.

The Global Partnership for Effective Diabetes Management recommends to encourage individuals with diabetes to play an active role in diabetes management and emphasizes on the significant impact of awareness and participation in better management of the disease.
Simple steps you must take to lead a healthy normal life?
Your four key actions for a healthy life

1. Exercise

Maintaining a fitness regime will help you to
  • Keep your weight under control in conjunction with your diet plan
  • Achieve lower blood glucose levels, as it helps insulin function better
  • Have a healthier heart and lungs
  • Revitalize and provide you with more energy
Your healthcare team or SPARSH counselor will be able to help in making a good start. Check Patient Tools for tools on this topic.

For more information, click on the below video.
2. Medication

Do you at times not take your medicines regularly or in the right doses because
  • You are concerned about the side-effects of continuing the medication, especially when you "feel" fine or when your sugar is in control
  • You are not sure of how long you need to continue treatment, or whether you could restart at the onset of a diabetes-related complication
  • You believe that you could save money by withdrawing treatment when you are fine
You are not the only person having these concerns. However, not using medicines in the correct doses or in the right frequency does more harm than good.

That is not the right way to look at diabetes, as diabetes, when neglected, progresses slowly; and over the years, continues to affect your major organs.

Adherence to medication is crucial to reach and retain good control of diabetes. Any change or modification in the treatment should be done only when recommended and as recommended by the doctor.

Please consult your doctor before starting or discontinuing any medication or treatment advised.

For more information, click on the below video.
3. Diet

Eating the right food in the right amount will help you to
  • Attain and maintain a weight that is good for your overall health
  • Manage your ABCs (A1C, blood pressure, and cholesterol) at the required levels
  • Ultimately avoid health and blood vessel problems
A qualified dietician or SPARSH care counselor can provide you with a healthy diet plan and help you follow it.

For more information, click on the below video.
4. Monitoring

For more information, click on the below video.
Steps you can take to prevent serious complications
  • Being regular with health check-ups
Monitoring your blood sugar may alone not be enough. Good diabetes management and control by strictly following the principles described in the ABC of diabetes management above is very important since diabetes affects various organs of your body.

We therefore recommend the following.
At each visit be sure to check the following:
  • Blood pressure
  • Feet
  • Weight
Two times each year, do an
  • A1C test - it may be done more often if your value is >7
Once every year, be sure you go for a
  • Cholesterol test
  • Triglyceride test
  • Complete foot examination
  • Dental examination to check teeth and gums - tell your dentist that you have diabetes
  • Dilated eye examination to check for eye problems
  • Urine and blood tests to check for kidney problems

Being proactive and acting responsibly

Check with your doctor, or ask your SPARSH counselor to know more about it. You can also check it in Patient Tools to make your own action plan to manage diabetes.

For more information, click on the below video.
How can SPARSH help you manage diabetes effectively?
The nature of services SPARSH provides can be described as below.
To know more about SPARSH, click on SPARSH for good diabetes management.