Diabetes - Is it a Disease or Syndrome?

We have entered 21^st century, we are in technical era, and Science is developing as fast as we blink our eyes but still there are many people who don’t have definite knowledge about their own body. That is the cause why many people are killed by simple diseases. Diabetes is one among them. Truly speaking it is not a disease, it is an abnormality or malfunctioning of pancreas. Nobody dies with diabetes but with complications emerging out of neglected Diabetes. So we can perhaps call it as a Syndrome?

Discovery of diabetes:

      Diabetes has been mentioned in Ebers Papyrus, an Ezyptian complication of 1500 B.C. Diabetes was discussed as Prameh and Madhumeh in Ayurvedic systems like Sushrut Samhitha (400 B.C) and Charaka Samhitha (600 B.C) where the chief symptom of diabetes, passing of an excess of sweet urine was mentioned. Aretaeus, a Roman physician introduced the name diabetes in First century A.D. In 1869, Paul Langerhans discovered islet cells of pancreas, which produce insulin. Benedict discovered the test to detect glucose in urine and blood, which is a milestone in diabetes treatment. Von Mering and Minkowsli demonstrated the relationship of pancreatic hypo function and diabetes mellitus as early as 1890. Fredric. G. Banting and Herbert Best finally succeeded in extracting insulin from pancreas in 1922 and were awarded Nobel Prize for their work. Elliot P Joslin, writer of “The Treatment of Diabetes Mellitus” is “Father of Diabetes”. 

      The word Diabetes literally means “excess of urine”. Bouchardat in 1950 proved that the sugar in diabetic urine is glucose. Benedict discovered the test for glucose in urine and blood. Folin Otto introduced the colorimeter used for the biochemical estimation of glucose. Later on many scientists worked to disclose many factors associated with diabetes and succeeded too. But till date there are some more facts to be disclosed upon which many scientists are working. Results of their work are with us in the form of medicines, insulin injections, which are helping a lot for diabetic patients. From 1922 we are celebrating November 14, as World Diabetes Day to create awareness in people and in 1971 World Health Organization has given a slogan “Diabetes goes public”.

      But one should be aware of facts about diabetes as it can affect anybody. Each person should know basics of his own body and do take care of his health. At present Diabetes became a common disease. In the world, 60% of the diabetics are obese. This infers that ‘the main cause for diabetes’ is excess of fat. Heredity is another cause. Heriditeral influence cannot be prevented. But becoming obese can be prevented, by good food habits and exercise. Of course, when once one is diagnosed to be diabetic, the best treatment for this is ‘control of food plus exercise’ in the Type I cases followed by medicine in Type II and above (Types of diabetes discussed in the following paragraphs). 

Statistics:

      Globally, diabetes is likely to be the fifth leading cause of death. To estimate cause-specific deaths for diabetes, the researchers are using a computerized generic formal disease model that assesses disease burden by a variety of relationships, including those of age, sex and disease-specific mortality. It is estimated that overall, 7.5 million people with diabetes died in 2000. These comprised 4.6 million people with diabetes who died from other causes and 2.9 million excess deaths due to diabetes. Of these, 1 million were reckoned to have taken place in developing countries and the remaining 1.9 million deaths were in developed nations. At present millions of people are with diabetes, which became a common abnormality in India.

What is diabetes?

      It is an abnormality in the body. Diabetes is the state where blood glucose level of the body is not maintained properly.

Types of diabetes:

      Type 1 diabetes:

Results from the body s failure to produce insulin. It may lead to hyperglycemia. It is also called as juvenile diabetes or insulin-dependent diabetes. It is first diagnosed in children, teenagers, or young adults.

      Type 2 diabetes:

Results when our body is unable to utilize the insulin produced. It is also called as non insulin-dependent diabetes. People can develop type 2 diabetes at any age, even in child hood

      Gestational diabetes:

Diabetes, which is developed in last stages of pregnancy, is called as gestational diabetes. It is the result of hormones of pregnancy or shortage of insulin. Women become normal after delivery. But this is the sign that she is going to develop type 2 diabetes in future.

      Pre-diabetes:

Pre-diabetes is a condition that occurs when a person s blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes.

How and why it happens:

      Insulin is a hormone produced by beta cells that are located in the islets of langerhans cells in pancreas. Insulin is a hypoglycemic hormone (hypoglycemia: low sugar level). It stimulates the glycogenesis i.e. increases synthesis of stored glucose of liver and muscle into glycogen. Insulin controls the level of glucose in the body. Insulin controls blood sugar level (Blood sugar is the main sugar found in the blood and the body s main source of energy). The blood sugar concentration of arterial blood that enters pancreas is the best controller of insulin secretion. High blood sugar concentration stimulates the insulin secretion from islets of langerhans cells and low blood sugar depresses the secretion of insulin from islets of langerhans cells. The blood sugar level is noted in milligrams in a deciliter, or mg/dL. If a person is healthy his blood sugar level before taking food should be in between 70-110mg/dl and after taking food should be in between 80-140 mg/dl. 

      Diabetes is a result of mal functioning of pancreas where insulin is not properly produced. As a result optimum level of glucose will not be maintained in blood. This results in either increased level of blood sugar or decreased level of blood sugar.

      Hyperglycemia is the state of increased level of glucose.

      Diabetes mellitus is a condition caused by hyperglycemia resulting from the body s inability to use blood glucose for energy. Diabetes mellitus is the condition where the urine is sweet i.e. containing glucose.

      Hypoglycemia is the state of decreased level of glucose in the blood.

      Diabetes insipidus is a condition characterized by frequent and heavy urination, excessive thirst and an overall feeling of weakness. And the urine is tasteless. This condition may be caused by a defect in the pituitary gland or in the kidney. In diabetes insipidus, blood glucose levels are normal. 

      Albuminuria is a condition in which the urine has more than normal amounts of a protein called albumin. Albuminuria may be a sign of nephropathy (kidney disease).

      Diabetic ketoacidosis is an emergency condition, in which extremely high blood glucose levels, along with a severe lack of insulin, which results in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine. Signs of diabetic ketoacidosis are nausea and vomiting, stomach pain, fruity breath odor and rapid breathing. If it is untreated it can lead to coma and death.

      Brittle diabetes is a term used when a person s blood glucose level moves often from low to high and from high to low.

Chemistry of insulin:

      Insulin is a hormone, which is a polypeptide. Human insulin is made up of two polypeptide chains (A&B) linked by two disulfide linkages and a total of 51 amino acids.

Symptoms:

   Common symptoms caused by diabetes are

      Feeling tiredness

      Excessive thirst

      Excessive appetite

      Sweet taste in mouth

      Burning sensation of hands and feet

      Tendency to sleep

      Excessive urine with glucose

      Non-healing ulcers

      Repeated infections of skin and gums

      Intense itching of the external genital organs

      Loss of concentration

      Sudden refractory errors of eye or failing eyesight

      Pain and numbness of feet

      Sexual impotence

Is it lethal?

      No body dies with diabetes, but with complications resulted from diabetes. Diabetes causes variety of abnormalities to lungs, skin, kidney and heart etc. The complications are

      Coma

      Tuberculosis of the lung

      Lung abscess

      Pyelonephritis - due to high glucose content of urine

      Diabetic neuritis

      Heart attack

      Ulcer of foot

      Diabetic gangrene

      Diabetic retinopathy

      Diabetic diarrhea  

Who is more prone to diabetes?

      Anybody can get diabetes who is not properly taking care of own health. Also, it is running in the families through genetic inheritance. Children, whose both parents are diabetic and having born with the weight more than 3.5 Kg, have more chances to get diabetes. Obese persons will definitely get diabetes during their lifetime. People with excess weight and high blood pressure are having more chances to become diabetic.

Solution:

      Healthy soul in healthy body. By these studies it is clear that high or low glucose level can take ones life also. It is always advised to give more importance to physical fitness. Diabetes can be avoided and postponed by exercise. Most of the studies proved that obese personalities are more prone to diabetes. Over eating also leads to diabetes. While some people are dying hungry due to poverty, diabetic dies with over eating. So “we should not dig our graves with our teeth”. A man has to walk 36 miles to rid himself of one pound of fat. It is far better to prevent obesity that to slim it out later. To those lucky persons who can spend to eat and unlucky as they cannot eat due to Diabetes, ”may I advise to spend the same to help poor and enjoy?”

      The best method to keep our physical fitness is through exercise. Through exercise the muscles burn sugar into carbon dioxide and water in order to generate energy. In this way the deposits of extra sugar in the form of fat can be burnt. One should monitor his BMI periodically. Body mass index (BMI) is  
a measure used to evaluate body weight relative to a person s height. BMI is used to find out if a person is underweight, normal weight, overweight or obese and guides to act accordingly. Westernization of food habits is another cause that is increasing the number of diabetics in India. Food with more cheese like fast foods, oily foods are taking us in the way to obesity, which ultimately leading to diabetes.

      Knowing about the various complications of uncontrolled diabetes is not in the scope of this presentation. Every complication needs a separate presentation. Hope either this author or some other author try to work in this line sooner or later.

blood glucose level   
the amount of glucose in a given amount of blood. It is noted in milligrams in a deciliter, or mg/dL.

blood glucose meter   
a small, portable machine used by people with diabetes to check their blood glucose levels. After pricking the skin with a lancet, one places a drop of blood on a test strip in the machine. The meter (or monitor) soon displays the blood glucose level as a number on the meter s digital display.

blood glucose monitoring   
checking blood glucose level on a regular basis in order to manage diabetes. A blood glucose meter (or blood glucose test strips that change color when touched by a blood sample) is needed for frequent blood glucose monitoring.

Brittle diabetes   
a term used when a person s blood glucose level moves often from low to high and from high to low.

      diabetic ketoacidosis (DKA)  (KEY-toe-ass-ih-DOH-sis) 
an emergency condition in which extremely high blood glucose levels, along with a severe lack of insulin, result in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine. Signs of DKA are nausea and vomiting, stomach pain, fruity breath odor and rapid breathing. Untreated DKA can lead to coma and death.

                                                                Sahitya@krify.com

                                                       satya_sahitya@rediffmail.com