Diabetes or diabetes mellitus (DM) is a condition in which there is absolute or a relative lack of insulin in the body. Insulin, a hormone synthesized and secreted by the pancreas, is responsible for controlling the circulating levels of the blood sugar (glucose). In diabetes, the blood sugar exceeds the normal range of 70 to 110 mg per 100 ml of blood, and may appear in the urine.

It is estimated that over 2% of India's population suffers from diabetes and the number is increasing. Diabetes has a hereditary component and often runs in families. If both the mother and father are diabetic, there are more than 90% chances that their children will also be diabetics. If one parent is diabetic, there are 40% chances of diabetes in children.

Symptoms of Diabetes: There are three important symptoms which usually indicate the presence of the disease. There is increased appetite, thirst and excessive formation of urine. However, the diagnosis is confirmed either by urine or blood sugar check or when complications resulting from diabetes appear, such as delayed healing of wounds, premature vascular disease, a neurotic pain, or diminution of vision. It is vital to know if a person is diabetic before any complications develop. An early diagnosis may not only retard serious complications but may also prevent the shortening of life expectancy. Quite often high blood sugar may be a coincidental finding during a routine annual check-up. Nevertheless, even if there are no obvious symptoms, it must be confirmed and treated.

Types of Diabetes Mellitus: Based on the functional state of the pancreas and the age of onset, diabetes has been divided into two categories: 1) Insulin dependent diabetes mellitus (IODM) or type-1, and 2) Non-insulin dependent diabetes mellitus (NIODM) or type-2.

IDDM starts in childhood, adolescence, or young adult life. Patients in these categories have an aburpt onset of symptoms are prone to ketoacidotic coma, and require exogenous insulin for normal well-being. The exact cause of IDDM is not known. It is thought to be allergic (auto­ immune) or infective (viral infection by picorna group) in origin. In contrast, NIODM starts at an older age, usually above 40 years, and increases slowly. Patients of NIDDM are not dependent on exogenous insulin for normal well-being. It usually besets those people whose pancreas still has some capacity to synthesize and secrete insulin. Therefore, it is relatively easy to manage .

NIDDM as compared to IDDM, in which only alternative is to replace the insulin. There are four pillars to manage diabetes-1) Diet 2) Insulin 3) Exercise and 4) Tablets (DIET).

Treatment

Role of Diet and Exercise: The basic treatment of diabetes is control of diet. However, it is difficult to change the dietary habits and most diabetics find it almost impossible to adhere to a strictly regulated diet (a diabetic has more weakness for sweets than a non-diabetic). Fortunately, according to the latest concept in treatment, drastic restrictions in diet are not necessary. The nutritional requirements of a diabetic are the same as that of a non-diabetic. At one time it was believed that the carbohydrate intake should be drastically cut down, but now it is not considered to be that important. In diabetes, the metabolism of fats and proteins is directed in such a way that these are broken down into glucose. A drastic cut in carbohydrates further enhances the breakdown of fats and proteins, leading to serious consequences. For this reason it is recommended that 40% of the patient's diet should be made up of carbohydrates in the form of cereals, vegetables, and fruits. Direct sugar, such as sweets, syrups, candies, and pastries are best avoided. Fat should be restricted to 60 to 80 g per day; it is known to increase the risk factors of atherosclerosis in diabetics. Unsaturated fats like til, groundnut, kardi or sunflower oil are preferable to saturated fats like butter, ghee. animal fat, coconut oil, and hydrogenated vegetable oils.

The aim of dietary management is to have smaller and frequent meals to avoid a sudden increase in after-meals blood sugar levels. The total caloric intake should be about 20 calories per kilogram of body weight. To this 200-300 calories per day should be added if the patient is a thin, young male, and the same amount should be deducted if the patient is an old, obese female.

In type-2 diabetes, the patient is usually overweight, and reducing the caloric intake and regular exercise to restore the normal body weight help in controlling the disease if it is mild.

Monitoring and Control: It has been proved that tight control of elevated blood glucose may prevent or delay complications. Pay now and benefit later is a dictum all diabetics should know. Monitoring is done by home glucose measurement in urine (Glucotest, diastix, strips) or blood. For regular blood glucose monitoring, at home, a low cost glucometer (One­ Touch Horizon) is available nowadays. To check the haemoglobin levels in blood a test called glycosylated haemoglobin levels (HbAlc) is done. If percentage of haemoglobin is less than 8% the control is said to be excellent, if the level is more than 10% then the control is poor. For early detection of complications other blood tests (lipids, creatinine) urine albumin levels, eye examination and electrocardiaogrant are done annually.