Type - 2 Diabetes: The Causes and Treatment

Type-2 diabetes is strongly linked to unhealthy lifestyle marked by sedentary life and lack of regular exercise and over-indulgence with food. Certain behaviors like tobacco smoking and alcoholic drinks are major risk factors associated with the occurrence of type-2 diabetes and its complications.

Being a disease linked to our unhealthy lifestyle, it manifests in an age dependent manner after crossing some sort of a threshold damage to the body’s metabolism; this makes the disease more prevalent after the age of 45 and onwards. However, the type-2 diabetes can also occur in younger age groups.

Unhealthy lifestyles that are strongly linked to the occurrence of Type-2 diabetes are high consumption of saturated fat and sugar, lack of physical activity, overweight, cigarette smoking and alcohol consumption. Genetic predisposition for the disease is also an important contributory factor is some patients.

The above factors are known to act as environmental factors which disturb the body’s metabolic machinery related to carbohydrate and lipid metabolism. As a result the obesity sets in and fat is deposited around the waist. The fat cells are known to have close association in promoting type-2 diabetes.

High blood sugar levels are produced when insulin is not secreted in appropriate quantity or there is resistance to insulin’s ability to convert glucose into energy in cells and into glycogen in the muscles and the liver.

In type-2 diabetes, the fat cells produce substances that inhibit insulin’s role to convert glucose into energy (or into glycogen in muscles and the liver) thus leading to high sugar levels in blood.

Prevention of diabetes:

A healthy lifestyle is the most basic requirement to prevent weight gain and obesity. The essence of healthy lifestyle is active life involving regular physical activity or exercise and a healthy and nutritious diet.

About 150-300 minutes moderate intensity physical activity, like walking or swimming, per week, is essential to prevent obesity.

The diet must follow a strict regime and it should balance calories taken and calories spent through work. The diet should be balanced by using healthy ingredients like fruits, vegetables, whole grains, nuts, beans etc. which are rich in fiber, complex carbohydrates, proteins and omega fatty acids.  

Red meat should be substituted by lean meat, white meat or sea foods. High calorie foods like sweets, packaged snacks rich in salt and trans fat must be avoided to the maximum possible. Monitoring of weight at regular intervals helps regulate diet and exercise.

Symptoms of diabetes: 

Those with a family history of diabetes should keep a watch on any signs and symptoms of the disease appearing after 40 years of age; however symptoms can also appear earlier in case of obese persons.

Increased thirst and hunger, frequent urination, fatigue, blurred vision, slow healing and obesity, especially accumulation of fat on waist, are some commonly observed symptoms of diabetes.

The disease commonly occurs along with hypertension which can aggravate the effects of diabetes and complicate the clinical outcome or consequences.

What patient can do to promote health: 

Patient can stay healthy by following a strict regime of regular exercise and healthy and nutritious diet. A balance of work, leisure and proper eight hours sleep are the essence of a healthy lifestyle which should be followed.

At any cost, overindulgence with food must be avoided. Proper hydration of body by drinking plenty of water promotes health. Those with a tendency to weight gain must check their weight regularly and maintain their weight within the prescribed BMI index for their height.

Special diet issues: 

Diet assumes the most important role in prevention and control of type-2 diabetes. The disease sets in due to increased fat deposited in parts of body and consequent increase in weight.

This trend needs to be reversed by regulating eating habits. The diet should essentially comprise healthy and nutritive elements like fiber, slow energy releasing carbohydrates, white meat (chicken and fish), omega fatty acids and vitamins and minerals.

In general, plenty of vegetables, fruits, whole grains, nuts and beans are ideal diet for diabetics. Colorful fruits and vegetables, which are rich in anti-oxidants and omega fatty acid, are highly useful as these contents protect cells and tissues against damage and promote tissue repair.

Foods containing high sugar, salt content, high contents of saturated fat and trans fats are harmful and must be avoided. The diet should normally comprise two meals and 2-3 snacks in between.

Prevention of diabetes is a highly rewarding strategy, because the same strategy applies to other NCDs, such as cancer and hypertension. 

Beware of Diabetes: It Exposes You To Infections

Diabetics are vulnerable to infection by a host of organisms primarily due to their increased virulence in the favorable environment offered by increased glucose contents in tissues and blood. 

Diabetics show low immunity to fight out infections due to disturbance in the immune system. The overall condition of the diabetic patient is a state of metabolic stress under which most functions of the body are stressed for one or the other reasons. 

The patient’s inappropriate lifestyle, unhealthy diet and overweight add to the problems and further aggravating disease and chances of infection and associated complications.

Diabetics are especially vulnerable to infections by germs like Streptococus pneumoneae, influenza virus, Mycobacterium tuberculosis, Escherichia coli, Proteus sp., Klebsiella, Candida sp., Hepatitis C virus and enteroviruses. 

In general, diabetics are at a greater risk of contracting respiratory infections, in particular influenza, and tuberculosis. Chances of developing multi-drug resistant tuberculosis are higher in diabetics.

Inadequate glycemic control over long period causes damage to blood vessels and this condition promotes infection. Pyelonephritis may be caused by E.coli or Proteus sp and also produces renal abcess and necrosis.

Renal and perinephric abcess caused by E.coli may cause symptoms of fever, backache, and polyurea. Common fungal agents such as Candida sp. may become pathogenic in diabetic condition and cause serious damage and disease.

In diabetic patients, the body’s metabolism is in a disturbed state giving rise to increased blood sugar, immune dysfunction, disturbed blood circulation (due to micro- and macro-angiopathies) and nerve and brain damage.

Decreased antibacterial activity of urine, dysmotility of urinary tract and reduced intestinal output add to deteriorating physiologcal environment. These situations provide a favourable environment for germs to thrive.

Low immunity reduces body’s natural ability to fight infections and increases vulnerability to infectious diseases. Diabetes is known to suppress the immune response by impairing chemotaxis and phagocytosis facilitating progression of the disease.

Damage to fine blood capillaries affects proper blood circulation to cells and tissues thus leading to their damage. 

               

Prevention:

Prevention and control of diabetes is the foremost need in order to prevent any infection. In a diabetic, infection may be the first manifestation of disease and a precipitating factor for its complications.

Proper hygiene, regular care of foot infection, and prompt treatment of any infection are measures to prevent against serious complications.

Patients’ increased chances of catching respiratory infections require prevention by using anti-pneumococcal and influenza (H1N1) vaccines.

Symptoms are common to any other infection in the body, like fever, sweating, skin rash, non-healing foot wounds, sore throat, nasal congestion, white patches on mouth or tongue, painful urination, bloody urine, vaginal itching  as some most commonly observed symptoms.

Treatment and management of infections in diabetic patients primarily focus on immediate and the long-term measures: immediate effort to control infection by using suitable antibiotics and the control of blood sugar by using drugs.

The long-term measures are proper control of blood sugar, healthy and nutritious diet. The other measures are: light exercise, regular walking and physical activity to increase gastrointestinal motility; fibrous diet to control constipation; and Increased water intake to flush out toxins and kidney infection.

Medical Nutrition Therapy for Diabetics

Diabetes is characterized by disturbances in carbohydrate and lipid metabolism leading to elevated blood sugar level over a period of time. While type-1 and type-2 diabetes have different underlying causes, the fundamental approach in the treatment of both forms of the disease is to maintain blood sugar levels within limits.

Diabetics are advised to take a diet that is suitable to them. A ‘diabetic diet’ is worked out by a dietitian keeping in view the requirements of a patient. The diet contains a variety of nutritious foods in moderate quantity. The ‘diabetic diet’ in essence is a personalized ‘medical nutrition therapy’ for a particular patient’s disease status. 

As uncontrolled eating has an adverse effect of the health of a diabetic patient, diet control is very important. For type-1 diabetes insulin dose has to be accurately worked out. The emphasis here is to regulate diet and not increase the insulin dose to maintain blood sugar levels within normal limits.

In case of type-2 diabetes, due to insulin resistance, overall healthy diet has a greater importance in disease control. Further, an increase of insulin dose to lower blood sugar levels is not advisable because of insulin’s anabolic effect in increasing body weight.

Diet has a preventive role before the onset of diabetes. It can effectively prevent onset of disease in most cases except those who have a genetic predisposition. Those genetically predisposed to develop diabetes can however effectively control the disease and its complications to nerves, kidneys and heart.

A healthy diabetic diet can prevent diabetes as well as its worsening into serious complications.

The preliminary symptoms of numbness in hands or feet, increased urination and hunger and gain of body weight around the waist are common warning signs and symptoms of diabetes.

A blood check up may confirm increased blood sugar and this should be an alarm bell calling for immediate changes in lifestyle, in particular the diet and physical activity. 

In most cases, diabetes remains undetected until the late stage of the disease when more visible symptoms help in the detection of the disease when neuropathies, nephropathies and cardiovascular disease have already developed. And, then, diabetes is detected on the sidelines of a major life threatening disease.

In essence a low salt and low calorie diet which is rich in fruits, vegetables and complex carbohydrates (beans, nuts, whole grains) is ideal for diabetics. In case of patients, excluding those having kidney ailments, lean and white meats may be taken in moderation. 

Total calorie intake is to be restricted by total carbohydrate counting and distributing it among different meals. Fruits, vegetable and grains contain fiber and antioxidants which help in restoring health of damaged tissues.

Patients need to follow a healthy lifestyle by adopting measures, such as, change from a sedentary life to an active life by undertaking  regular physical activity or exercise, by changing unhealthy eating habits to a regular healthy ‘diabetic diet’, and by adopting all possible measures for control of body weight  within the prescribed Body Mass Index (BMI) limits applicable to the patient.

Patients having hypertension may give special attention to high fiber diet as fiber reduces hypertension. Patients having cardiovascular disease must take low salt and totally avoid saturated and trans fats. Patients having disturbed renal function must restrict their protein intake.

People falling in the high risk category of diabetes, such as those who have diabetes in the family, or are obese or overweight, or are leading a sedentary lifestyle, must regularly monitor for impending diabetes or cardiovascular disease. Diabetes is a complex disease and therefore any intervention for its control must be carried out only under medical supervision.