Things Your Clinician Should Have Told You About Diabetes – The expert explained that insulin resistance cannot be called diabetes as the blood sugar levels are higher than usual but not high enough to be diagnosed as a disorder

A usual visit to your clinician is often shortened due to the high patient burden and economy of time, hence some questions on the disease that many of us wish to ask as patients and many doctors wish to explain, goes unanswered

Diabetes is a silent pandemic that has been claiming lives with the least noise. Often taken as just a metabolic disorder or a lifestyle disease, experts say that the disorder can hollow one from the inside. While earlier, diabetes was a fatal disorder but with inventions in medicine, the disease can now be managed well at home with medical intervention taken at an appropriate time. However, the adverse impact of the disorder on the human body remains monumental. The effects of the disease are far-reaching. Mismanagement of the disease can lead to serious consequences for your nervous and cardiovascular health.

Untreated or mismanaged diabetes can result in stroke, renal failure, vision loss and other life-threatening conditions. Diabetes can disrupt blood circulation, weaken muscles and cause chronic inflammation that plays a huge factor in the birth of cardiovascular disorders. It all might start with high glucose present in your blood that will set off your body to rectify it, initiating chain reaction after chain reaction that might force your body to work even harder to control the rising blood sugar. These defences might be able to protect you for a while but with years come exertion and exhaustion. Years of living with the disease will eventually bring down these defences and this will end in extreme clinical outcomes.

With still a large percentage of people living with undiagnosed, untreated and mismanaged diabetes, it is high time to start a conversation around the topic. A usual visit to your clinician is often shortened due to the high patient burden and economy of time. Very rarely, clinicians are able to make patients understand the long-run consequences of living with this disease. On World Diabetes Day 2022, Dr Abhishek Gupta, a practising physician affiliated with LNJP hospital in Delhi spoke to, answering those questions on the disease that many of us wish to ask as patients and many doctors wish to explain.

Nipping the bud: Familiarize yourself with Pre-Diabetic Stage

A good thing about Diabetes, it never starts with a boom. The disease builds in slowly, giving enough time for patients and clinicians to diagnose and manage it at different stages. Invisible changes in the body begin much before the onset of Type 2 Diabetes. Experts identify a pre-diabetic stage where the condition remains reversible if rectified with dietary and lifestyle changes. A person in the prediabetic stage might often experience insulin resistance, a communication defect where the body cells might not be receptive to insulin’s command and will remain ineffective in utilizing blood glucose effectively. In response to this, the affected person’s pancreas will be working even harder to produce more insulin to manage the rising sugar in the blood. Over time, the pancreas will lose its ability to produce insulin, resulting in the development of Type 2 Diabetes.

Dr Gupta explained that certain disease markers can alert patients and clinicians much before the onset of the disease. He said: “There are signs that be can indicative of diabetes much before it manifests in obvious symptoms. One could be high fasting or postprandial blood glucose level if you go for regular glucose charting or blood sugar test. One could also go for HbA1c monitoring. It’s a kind of blood test that will measure your average blood sugar level over the past two to three months. A value between 5.7 and 6.4, could be indicative of pre-diabetes. Another factor we might put into the picture is the increasing abdominal girth. For men, a girth value greater than 102 cm and in women, a girth value greater than 88 cm can be taken as an indicator. Constantly high blood pressure for some time and a disturbed cholesterol picture are also good indicators of this stage.”

As per reports, there could be other subtle symptoms such as velvety patches on skin, sudden appearance of skin tags, changes in appetite, frequent thirst and increased urination.

Be On Alert If You Have Genes

The expert explained that Diabetes Mellitus or Type 2 Diabetes has a high genetic susceptibility. He said: “Not discounting the environmental factors, diabetes does run in families. You might not necessarily have it but there is a probability that you might end up having it.” Hence, extra vigilance should be exercised by those whose families have been affected by the condition.

Insulin resistance is not diabetes

Dr Gupta said that insulin resistance or insulin sensitivity is often a term we closely associate with diabetes. He explained it as a condition when the body is producing more insulin as a result of more resistance the body cells are showing to the sugar-controlling hormone. He said that this condition might result in elevated fasting insulin levels but it cannot be called diabetes yet.

He explained that insulin resistance cannot be called diabetes as the blood sugar levels are higher than usual but not high enough to be diagnosed as a disorder. However, the person might lie at a very high risk of developing diabetes if the condition prolongs for a large time.

“It is a signalling defect where the insulin is not able to get glucose inside cells. It means glucose will stay in the blood for a long time and will have more time to cause damage for instance interfering with the structure of haemoglobin and other such disturbances. However, since the condition alone cannot be taken as diagnostic criteria for diabetes,” said the expert.

Not curable but manageable

Dr Gupta explained that diabetes has no absolute cure yet. The only way forward to tackle the complex condition is to manage it well. “The best thing you can do is to manage the disease as well as possible. It is extremely important to take your medications on time and keep tight control of your blood sugar. In Medicine, we call it “Metabolic memory of diabetes”. By this term we mean an intensive treatment aimed at tight glucose control that can delay or postpone the anticipated complications for a very long time,” said the physician.

While answering what is the right time to make a switch from medicine to injectable insulin, the physician informed that the degree of insulin resistance decides the course of treatment. “When the insulin resistance develops stronger as the condition advances, even high-dose medications are unable to work. At this stage, we might ask the patient to switch to injectable insulin,” he informed.

A general notion exists that many clinicians might put patients directly on medicine or injection without giving the body the required time and space to manage the condition with dietary and lifestyle changes. To this, the expert responded and said: “In pre-diabetic stages, you might be able to manage or even avoid the disease with lifestyle changes if you are diagnosed at time and there are some visible changes like weight fluctuations but if you are not screened at the right time or presented at a stage where the stake of damage isn’t high, then prescribing medicine might be the only way out.”

Diabetic emergencies see no weather

Mismanaged diabetes can turn into a life-threatening condition in no time. If one has a loved one suffering from the condition, one has to be prepared all the time. “Diabetes builds up slowly and if left unchecked, it can have massive complications in the future. It can lead to conditions like stroke, cataracts, glaucoma (a group of eye conditions that can damage the optic nerve), renal failure and sometimes an episode of ketoacidosis (when the body due to an extreme shortfall of insulin might break down fat for fuel and result in the formation of ketones that could further raise the acidity of blood to dangerous levels). This condition can be a life-threatening situation,” informed Dr Gupta.

Early screening and lifestyle changes can change the game

As per the health expert, early diagnosis can lead to better management of the disease. So getting regularly screened can make decrease the mortality burden of the disease. In his last word, the expert said: “You can reduce the risk of diabetes by consuming less added or processed sugar, having a diet rich in fruits and vegetables with moderate physical activity.” Home

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