WHEN a person found out that he or she is diagnose with diabetes, it must have been very upsetting. For people who don’t know much about diabetes may ask the question, “What is it?” The word diabetes may have reminded you of a family member or friend who became blind or lost a leg because of diabetes; or of someone working with you who has to watch what he eats because of diabetes; or a cricket friend who has diabetes but is still the best player on your team. So it is common for the following questions to be asked: “What is diabetes?” “What causes diabetes?” “How can I know if I have diabetes?” “Will it go away?” Can I still do the things I enjoy doing?” “Can I still keep my job?” “What lies ahead?” etc.
Whatever your thoughts are, it’s only natural to have a lot of questions. Diabetes is a serious illness and there is no cure, however it is manageable and once it is controlled, people living with diabetes have a normal life ahead. Taking care of your diabetes will not always be easy, and you should strictly follow the instruction of your health care provider and then you are on way to challenge your illness.
What is diabetes?
Diabetes (diabetes mellitus) is a metabolic disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of the food (carbohydrates) that we eat is broken down into smaller units called glucose. Glucose is a form of sugar in the blood and it is the main source of fuel for our bodies.
After digestion of food, the glucose get does into the bloodstream. Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin (a hormone produce by the pancreas) being present. Insulin makes it possible for the cells of our body to take in the glucose and utilise it.
After we take a meal, the pancreas automatically releases an adequate amount of insulin to move the glucose present in our blood into the cells and as soon as glucose enters the cells the amount of glucose in our blood drop.

For a person with diabetes the quantity of glucose in the blood is too high because the body does not produce enough insulin and/or has cells that do not respond to insulin produce by the pancreas (type two diabetes), or produces no insulin ( type one diabetes) . As a result there is too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.

How can I know if I have Diabetes? Signs and Symptoms
People can often have diabetes and be completely unaware. The main reason for this is that the symptoms, when seen on their own, seem harmless. However, the earlier a person is diagnosed with diabetes the greater the chances are that serious complications, which can result from having diabetes, can be avoided. Many of the signs of Type 1 and Type 2 diabetes are similar. In both, there is too much glucose in the blood and not enough in the cells of your body. Sometimes there may be no signs and people may be living with diabetes for many years and only seek medical help when a complication occurs. Some of the signs commonly experienced include:
• Frequent urination– Are you visiting the bathroom much more lately? Does it seem like you urinate all day long? Urination becomes more frequent when there is too much glucose in the blood.

• Excessive thirst – If it feels like you can’t get enough water and you’re drinking much more than usual, it could be a sign of diabetes, especially if it seems to go hand in hand with frequent urination. If your body is pulling extra water out of your blood and you’re running to the bathroom more, you will become dehydrated and feel the need to drink more to replace the water that you are losing.

• Increased hunger – you may tend to eat more than usual.

• Weight loss – The body desperately looks for an energy source because the cells aren’t getting enough glucose. It starts to break down muscle tissue and fat for energy and as such you may lose body mass.

• Tiredness, weakness and lack of interest and concentration – When the insulin isn’t there or if the cells don’t react to it anymore, then the glucose stays outside the cells in the bloodstream. The cells become energy starved and you feel tired and run down.

• A tingling sensation or numbness in the hands or feet– This symptom is called neuropathy. It occurs gradually over time as consistently high glucose in the blood damages the nervous system, particularly in the extremities. Nerve damage can creep up without our knowledge.

• Blurred vision, skin that is dry or itchy, frequent infections or cuts and bruises that take a long time to heal, vomiting and stomach pain (often mistaken as the flu) are also signs that something many may take for granted. When these signs are associated with diabetes, they are the result of high glucose levels in the body.
In addition to the above mentioned signs and symptoms, diabetes can be diagnosed or confirmed with the following tests from a medical laboratory.
1. Fasting plasma glucose level ≥ 7.0 mmol/l (126 mg/dl) (this is the blood glucose reading after eight hour fasting)
2. Plasma glucose ≥ 11.1 mmol/l (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test
3. Symptoms of hyperglycemia (high blood glucose) and casual blood glucose ≥ 11.1 mmol/l (200 mg/dl)
4. Glycatedhemoglobin (Hb A1C) ≥ 6.5%. (A lab test that shows the average level of blood sugar (glucose) over the previous 3 months. It shows how well you are controlling your diabetes).
If you show these signs and symptoms and/or have any of the mentioned laboratory findings,you need to consult a health professional.He or she will be able to tell you if you have reason to be concerned about a diagnosis of diabetes.
Please feel free to send an email to kumarsukhraj@yahoo.com or call 6228032 for further enquiry and discussion on the topic. Patient education plays an important in the diagnosis and management of diabetes and any other illness. Please look forward for a continuation of the discussion on diabetes in the next publication.

References:
1. Williams textbook of endocrinology (12th ed.). Philadelphia: Elsevier/Saunders. pp. 1371–1435.
2. International Diabetes Federation. 17 March 2006.
3. “Diabetes Care” January 2010″. American Diabetes Association. Retrieved 2010-01-29.

(Dr. Kumar Sukhraj)