Type 2 Diabetes and your body

Understanding how Diabetes affects you:

Taking steps towards managing your Type 2 Diabetes

YOU ARE NOT ALONE. Millions of people of all ages, from all walks of life are living with Type 2 diabetes.

Having Type 2 Diabetes doesn’t have to mean that all the good times are behind you. There are many things you can do today to help you achieve a brighter tomorrow.

This blog post will help you get to know the basics about Diabetes and will help you to gain a better understanding of how your treatment works.

If you have questions, ask your Doctor.

Type 2 Diabetes affects your whole body

Learning the key parts:

·        Glucose: When you eat, some of your food is broken down into Glucose (A Type of sugar).This sugar travels through your blood to all of your body’s cells, where it is used for energy.

While sugar gives you the energy you need for healthy living it is vital that it is kept under control and at just the right levels. Some one with Type 2 Diabetes will have trouble doing this.

Having too much sugar in your blood is called Hyperglycaemia while having too little sugar in your blood is called Hypoglycaemia.

·        Insulin: A key job for insulin is to make sure your blood sugar levels go down after eating. Insulin lowers the blood sugar by helping to move it from your blood stream into your cells where it is used for energy.

For people with Type 2 Diabetes a shortage of insulin can mean there is not enough sugar moving into the cells to meet the body’s energy needs.

·        Beta Cells: Beta cells are important cells in your pancreas (A small gland under your stomach) their job is to make the right amount of insulin, at the right time, to keep your blood sugar levels normal.

In people with Type 2 Diabetes these beta cells stop working and start to die off. Infact most people with Type 2 diabetes have already lost half of their beta cells by the time they are diagnosed. This means the surviving beta cells must work harder to make the insulin your body needs.

·        GLP-1: When you eat an important hormone called GLP-1 helps the body to control the amount of sugar in the blood. It does this in several different ways. In people with Type 2 Diabetes Glp-1 stops working normally.

·        GLP-1 & Insulin: GLP-1 tells the pancreas to make insulin when your blood sugar level is high (A condition called Hyperglycaemia).This helps move sugar out of the blood and into the cells where it is stored or used for energy.

·        GLP-1 & Digestion: GLP-1 also helps slow your digestion to keep your blood sugar levels from getting too high, too fast after meals. This can help you feel full for longer reducing your desire to eat.

·        GLP-1 & Liver: Unused sugar is stored in the liver. When it is needed, it is released using a hormone called Glucagon.Unfortunately in people with Type 2 Diabetes there is Glucagon over secretion, the liver releases too much sugar at the wrong times.

GLP-1 helps lower Glucagon levels and stops the liver releasing sugar into the blood stream when it is not needed.

About Type 2 Diabetes:

Type 2 Diabetes is more common in over weight older adults but it is also becoming more common in young people and children.

Problems are caused because either the body makes some insulin but not enough, or the insulin you do make doesn’t work properly. in some cases it can be a combination of both.

While in its early stages it can be treated with life style changes (Such as diet, exercise and stopping smoking), if left uncontrolled it can lead to more serious health problems.

Other effects on your body:

Increased blood sugar levels can also raise your risk of other long term illnesses, such as heart disease, stroke, kidney disease, and eye and nerve damage.

This makes it very important to stay on top of your Diabetes with good blood sugar control, a healthy diet and regular exercise. Doing this will help you minimize your risk of developing these conditions.

Treatments for Diabetes:

The medicines available for treatment of diabetes all lower blood sugar level, but each type of treatment works in a different way.

The two main groups are those that work with your body’s own insulin and those that involve injecting insulin from an out side source.

Of the treatments that work with your body’s own insulin, most help to boost insulin levels and effieciency.There is also a newer type of treatment called GLP-1 analogue. These also reduce some of the wider health risks of Type 2 diabetes such as high Blood Pressure and weight gain.

Take control with healthy eating and staying active:

To get the most out of managing your Type 2 diabetes it is important to eat healthily and stay active as suggested by your Doctor.

Eating Healthily:

People with Type 2 Diabetes don’t need to eat special foods. By making smart decisions about what to eat you can help reach and stay at a weight that’s good for your body.

Choosing the right food is also important for keeping your blood sugar and cholesterol under control.

Healthy eating can also prevent heart and blood vessel disease.

Suggestions for healthy eating:

Nutrition experts recommend that you:

• Take wide range of healthy foods
• Limit your calories as per your activity level
• Eat lean meats (Such as poultry and fish) and beans for protein
• Eat 5 to 6 times a day in small quantity

Staying active:

Nutrition experts recommends staying active as a key part of managing Diabetes. Regular activity can help prevent health problems, keep your weight down and make insulin work better to lower blood sugar and give you more energy. You will see and feel the difference if you are active almost every day for about 30 minutes.

Walking every day is one way to be more active.Some people start slowly by walking for 5 to 10 minutes a day adding more time until they reach 30 minutes daily. Be sure to talk to your doctor about ways you can be more active everyday.

Remember to always talk with your doctor before beginning or changing your exercise routine.

Find an activity you like:

Try having fun while staying active by mixing up your activities and joining other people in group class. Below are some ideas for getting started.

• Walk briskly somewhere you enjoy being such as the park
• Climb stairs whenever you can
• Swim or take a water aerobics class
• Join a dance class
• Ride a bicycle outdoors, or a stationery bicycle indoors
• Play basketball, volley ball, tennis or other sports

Correct the CHOLESTEROL !

Lipid metabolism (CHOLESTEROL) disorders:

Lipid-metabolism (Cholesterol) disorder, which quite frequently occurs together with diabetes, high blood pressure, cigarette smoking, overweight and lack of exercise, the main risk factors responsible for the development of coronary heart disease-i.e. disease of the arteries supplying blood to the heart itself.

VALUABLE YEARS OF LIFE DESPITE DYSLIPIDAMAEMIA!

Dyslipidamaemia can be favorably controlled by dietary measures and if necessary

medicaments. If dyslipidamaemia is not treated it contributes a major risk for coronary heart disease. The presence of other risk factors such as high blood pressure, cigarette smoking, Diabetes, severe obesity further increase the risk.

The increased blood lipids put a burden on the walls of the blood vessels it also leads to the deposition of lipids on the arterial walls, resulting into a progressive narrowing of the blood vessels, which reduces the blood flow to the heart and other parts of the body ,you should therefore control and monitor your lipid levels.

             

 Your doctor can give you advice on the necessary measures to take. The appropriate measures must be taken continuously to decisively lower the risk.

WHAT ARE BLOOD LIPIDS?

Blood lipids consist of various fats or fat like substances which serve as suppliers of energy and building material. The important lipids are:

1. Cholesterol

2. Triglycerides

3. HDL-Cholesterol

1. CHOLESTEROL: A blood lipid mainly produced in the body itself. The type and composition of food ingested does affect the blood cholesterol levels. (e.g.eggs, butter, meat, are high in cholesterol content).

2. TRIGLYCERIDES: Triglycerides are fatty substances taken in by the body predominantly in animal and vegetable food stuffs as well as are formed in the liver.

3. HDL-CHOLESTEROL: HDL-Cholesterol is good cholesterol which removes excess cholesterol from the body as well as that deposited on the linings of arteries.

Higher the HDL-Cholesterol, lesser the risk.

CAUSES OF DYSLIPIDAEMIA

Excessive food intake (foods rich in fat, high intake of sugar, high intake of saturated fatty acids e.g.butter, coconut fat etc)

Inheritance from your family

Diabetes or disorders of the thyroid, kidneys or liver

Lack of physical exercise

RECOGNISE THE IMMINENT DANGER

If you have other risk factors e.g.hypertension, diabetes, family history, cigarette smoking you should determine your lipid levels at the earliest. Your doctor can tell you what measures have to be taken to restore to the normal lipid levels.

WHAT CAN YOU DO TO AVERT DANGER

Your cooperation is of decisive importance

DIET:

• Eat the right food (you probably have to give up some of your favourite eating habits and learn to enjoy with low calorie low fat diet).
• Reduce saturated fat and cholesterol in the diet
• Use less oils and fats
• Eat low fat food.
• Use skim milk and skim milk products
• Cook with polyunsaturated and mono saturated vegetable oils.
• Trim fats from from meat and choose lean cuts.
• Avoid sweet foods such as jams, chocolates, cakes, sweets and ice creams.

(Do not replace oils, fats with calories in terms of sugar, other carbohydrates since these ultimately get converted into fats in the body, when they are supplied in excess.

Diet change should never be drastic; you can harm your health by cutting out essential food)

HAVE A NORMAL WEIGHT :

If you are overweight you should attempt to reach your normal weight. Just losing weight can lead to a fall in your elevated blood lipids. Increase your self image by

“Eating yourself slim”.

EXERCISE REGULARLY: Regular physical activity should be a part of your programme.Exercise helps you to increase your HDL (good cholesterol)

DO NOT SMOKE CIGARETTES: Sometimes 1pack (pack of 10) of cigarettes per day doubles your risk of heart attack compared to a non-smoker. It will also reduce your HDL(the good cholesterol)

                           Stop smoking if you are a smoker

CONTROL HIGH BLOOD PRESSURE:

High blood pressure makes arteries susceptible for heart attacks and raised lipids may further enhance pressure on the arterial walls through deposition of cholesterol in the blood vessels.

CONTROL DIABETES MELLITUS:

The risk of heart attack increases at least by 2fold in diabetes

Dyslipidaemia usually is present in diabetics. Diabetics usually show elevated levels of triglycerides and low levels of HDL.

AVOID ALCOHOL:

Alcohol can lead to an increase in the blood lipids.

If your doctor has additionally prescribed you a medicament, take it regularly.

You will find that it is not too difficult to get your blood lipids to normal values in this manner. Make absolutely sure and have your blood lipids monitored by your doctor. Together, with diet measures, doctor’s advise and  your co-operation soon you will be able to say:

MY BLOOD LIPIDS ARE OKAY…. I AM ON THE ROAD TO HEALTHY LIVING.                                                 

Foot care in Diabetes

How will diabetes trouble me?

How can it affect my feet?

How can I prevent it?

Read this to find answers for above questions:

       With uncontrolled diabetes (consistent high blood glucose values), the nerves of the feet get affected start loosing sensation. With the loss of sensation, small injuries go unnoticed. Also in people with diabetes wounds take a long time to heal. All this may finally lead to amputation of feet.

How can I prevent it?

·        Never walk bare feet

·        Carefully inspect your feet every day. Due to diabetes the sensation is reduced and hence you may not notice any blisters, corns or injury. Use a mirror to view the feet properly or ask other family members to help you in inspecting the feet,

      Looking out for the following :

           Changes in the colour of leg(Red or purple colour)

           Changes in shape and colour of nails

           Changes in shape of feet

           Changes in temperature of feet

           Any wounds/blisters

           Dry and cracked feet

           Inflammation of feet

·        Do not cut the corns or callus, always consult the doctor

·        Cut your nails strait across, corner cutting may give injuries to toes.

·        Keep the nails well trimmed. Longer the nails, higher the chance of injury.

·        If you find nails changing shape (thickening, bending inwards etc) immediately consult a doctor

·        Keep your feet clean to prevent infections

·        Always check the temperature of the water before you put feet in, use warm water to wash the feet.

·        Use only mild soap, do not soak the feet for long

·        Dry feet carefully with clean, soft towel, pay special attention to the surface between toes

·        To avoid excessive drying of feet use a moisturizer but not between the toes

Importance of shoes and socks:

Shoes and socks are very important, most of the problems occur due to ill- fitting shoes.

Check list for selecting right shoes:

·        Wear soft and fit footwear, should not be very tight to ensure blood circulation is not hampered

·        Buy shoes during evening time as the leg size is maximum at this time

·        When changing over to new shoes, do so gradually. wear the new shoe for a few hours everyday.

·        For long walks, use sports shoes which have a smooth inner lining and cushioning

·        If you have wet feet, socks should be of permeable material which allows evaporation of sweat.

·        If you have cold feet, use socks which keep the feet warm

·        Use white colored socks, to spot any bleeding due to injury

·        Use socks which have cushioned heels to protect the feet from any shocks

·        Go for a morning walk daily with proper footwear. This will help in the proper blood circulation in the feet

·        To prevent injury, keep your feet covered at all times. Change socks everyday and keep your feet clean

Regular checking by Doctor:

Monofilament test – is a test done to check the level of sensation in feet.The monofilament is touched against various part of sole of the feet and the sensation is checked

Incase of any unusual thing happening like red patches,athlete foot etc consult your doctor immidiately

WHAT IS HbA1C?

INTRODUCTION

Diabetes mellitus is a disorder in which sugar (glucose) in blood exceeds normal levels. The

Transport of glucose from the blood stream to the cells does not function properly resulting in

Increased levels of sugar in the blood.

The reason for this could be that your pancreas is not producing enough quantity of insulin

or the insulin that’s produced is not being utilized properly.

HbA1C IS VERY USEFUL INDICATOR TO KNOW THE HISTORY OF BLOOD GLUCOSE LEVELS.

Haemoglobin A1C

(HbA1c)

HbA1C gives you an idea of your blood glucose control over the last 60 to 90 days.

Haemoglobin has the tendency to bind with the glucose present in the

Blood to form Glycated Hemoglobin or HbA1c.

RELATION BETWEEN HbA1C AND BLOOD GLUCOSE

The life of a red blood cell is approx 120 days. During its life it keeps circulating in blood and finally is destroyed in the liver and spleen.

During this period of 120 days, the RBCs keep binding with the glucose present in the blood.

The extent of binding depends upon the amount of glucose-higher the glucose in blood (poor diabetes control ) higher is the binding and thus higher is the HbA1c.

Thus HbA1c can provide a true picture of your last 60 to 90 days blood glucose level.

HbA1C and Diabetes complications:

If  HbA1C levels are high it means that the average blood glucose value for the last 60 to 90 days was continuously higher.

A consistently high HbA1C indicates a poor control of diabetes and can lead to lots of long term

Complications.

DIABETIC COMPLICATIONS

• Diabetic Retinopathy
• Stroke /Cerebral Haemmorhage
• Weakening of gums.
• Loss of sensation/numbness of fingers.
• Cardiac problems
• Diabetic nephropathy
• Excessive sweating
• Erectile dysfunction
• Diarrhea/constipation.

 In a famous study done in the US, it was found that a HbA1cValue >6.5 greatly increases the chances of diabetic retinopathy (eye problems)

The same study also found that a 1% decrease in HbA1c value can reduce the chances of complications by 40%(neuropathy, nephropathy and neurological complications)

                                                      TARGETS OF CONTROL

   

                            EXCELLENT     GOOD     NOT ENOUGH      NOT GOOD    UNACCEPTABLE

 HbA1c                        5.8 ---           5.8-6.5    ---   6.5-7.0    -----        7.0-8.0         ---      8%

             

IS HbA1C GOOD FOR ALL ?

There are some diabetic patients who cannot depend on HbA1c:

Pregnant women with Diabetes: During pregnancy the weight and the amount of water in the body keeps fluctuating every day which results in a lot of variations in blood glucose. In such cases HbA1c does not give a true picture of the daily variations in blood glucose.

Patients with Hemolytic anaemia, patients on dialysis and patients with cirrhosis of liver.In such patients the life of the RBC is shortened and hence the HbA1c value is always lower than actual. For such patients another similar test called Glycated Albumin can be done. This test gives blood glucose value for the past 1-2 weeks.

FREQUENTLY ASKED QUESTIONS

Q.I check my blood glucose once in a month and the value is normal. However when I did my HbA1c, the doctor told me that the value is high. Is it possible?

A. Blood glucose test done in a lab shows the value at that point of time. This value is affected by the food eaten, exercise done just before the test. HbA1c gives the average blood glucose value for the

last 60 to 90 days and hence gives a more truer picture of the blood glucose control.

Q.How often should I do a HbA1c test?

A.HbA1c gives the average blood glucose value for the past 1-2 months. Hence it is advisable to do a test once every 2-3 months.

Q.For the last 1 month I have been doing regular exercise and strictly controlling my diet.However there is no change in my HbA1c value. What is the reason for this?

A. Though there will be a marginal reduction in the HbA1c value, the full benefit will be seen only after 3 months.In case you want to see the impact of exercise and diet test yourself with a blood glucose meter

regularly. It will help you to monitor the progress you have made.