http://www.journal.com.ph/index.php?issue=2008-11-16&sec=14&aid=78315
November 16, 2008 04:09 PM Sunday
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Understanding diabetes and its complications
By: Dr. Gary Sy, M.D.
GABAY SA KALUSUGAN
Diabetes Mellitus is a disease in which blood sugar (glucose) levels are
abnormally high because the body does not produce enough of the hormone insulin
or the body fails to respond to insulin.
When sugar from food is absorbed into the bloodstream, the pancreas responds by
producing insulin. Insulin plays a key role in moving the sugar from the
bloodstream into the cells, where it is then converted into energy. The body
uses this energy to function; sugar is the fuel on which the body runs. If the
body cannot adequately produce or respond to insulin, sugar cannot enter the
cells, instead, sugar accumulates in the blood, and the cells must turn to
other sources for energy.
Diabetes is extremely common in older people, of whom about 15 to 25% have the
disease. Statistically, there are about 500 daily diagnosed cases of diabetes
in the Philippines. Diabetes can lead to such complications as chest pain
(angina pectoris) and heart attacks, heart failure, stroke, kidney failure,
erectile dysfunction, blurred vision and blindness, pain and loss of sensation
in the hands and feet, and amputation. Many of these complications arise
because elevated blood sugar leads to narrowing and hardening of the blood
vessels, which impairs circulation and damages tissues. These complications are
even more likely in people who smoke or have high blood pressure and high
cholesterol levels, both of which often accompany diabetes. Fortunately, many
complications can be prevented by quitting smoking and by taking steps to
control blood pressure and cholesterol levels as well as blood sugar levels.
Causes of Diabetes
Diabetes is categorized as Type I or Type II, each with a different cause. Type
II diabetes is the main form of diabetes among older people. Obese older people
with a family history of diabetes have the highest risk of developing Type II
diabetes which accounts for 90% of the entire diabetes population worldwide.
In Type I diabetes, the type that usually becomes evident in childhood or young
adult, the pancreas cannot produce insulin or produce tiny amount of insulin.
Symptoms include intense thirst, frequent urination, extreme hunger, and rapid
weight loss. It can be controlled by regular lifetime doses of insulin in the
proper amounts. Keeping the balance between insulin dose and sugar intake is
one of the major challenges faced by people with Type I diabetes.
Type II diabetes, also known, as adult-onset diabetes usually doesn't appear
until the early to mid forties. In most cases, the problem is not a simple lack
of insulin, but a defect in the receptors for insulin in the cell walls. The
body does not respond normally to the insulin produced by the pancreas.
Long-term complications of Type II diabetes are similar to those of Type I, but
include higher incidence of heart disease, high blood pressure, and stroke. So
it's worth it to have blood sugar monitoring regularly.
The main risk factor for Type II diabetes is obesity. Obesity causes insulin
resistance, possibly by increasing the blood levels of building blocks of fats
and certain proteins that interfere with the action of insulin.
Aging itself puts people at higher risk of developing diabetes. As people age,
insulin secretion tends to decrease slightly and insulin resistance tends to
increase slightly, even among people without obesity or diabetes.
Heredity is a risk factor as well.
Signs and Symptoms
People with Type II diabetes may have no symptoms for months or even years
before the disease is diagnosed. When the blood sugar level raises too high,
sugar spills into the urine. The kidneys then must excrete additional water to
dilute the sugar. Therefore, a person with high blood sugar urinate large
volumes (Polyuria). The loss of water due to excessive urination also creates
abnormal thirst (Polydipsia). Also, the body cannot use sugar as energy, a
person with diabetes may experience excessive hunger and thus eat more
(Polyphagia) and yet still lose weight. Other symptoms include blurred vision,
drowsiness, lightheadedness, irritability, fatigue and weakness, decreased
endurance during exercise, numbness in the hands and feet, body itchiness, hard
to heal wounds, frequent vaginal discharges, recurring skin infections, hard to
maintain or achieved an erection in men.
Diagnosis and Screening
A simple blood test called Fasting Blood Sugar (FBS) or Glucose test is most
commonly used to make a diagnosis. The level of sugar (glucose) in the blood is
measured, usually after the person has fasted for at least eight hours.
Sometimes the blood sugar level is measured randomly without regard to when the
person last ate, but this is not as accurate.
In a person who does not have diabetes, blood sugar levels after fasting range
from 70 to 110 milligrams per deciliter (mg/dl) of blood. Diabetes is the
likely diagnosis if the blood sugar level is 126 mg/dl or higher if the person
fasted before the test or 200 mg/dl or higher if the test was performed at
random.
People who have two or more fasting blood sugar levels between 110 and 125
mg/dl (a condition called impaired fasting glucose) should repeat the test
yearly.
The diagnosis of diabetes mellitus is confirmed if any one of the following
results is obtained:
Two fasting levels are 126 mg/dl or higher
Two random levels are 200 mg/ml or higher
Fasting level of 126 mg/dl or higher and a random level of 200 mg/dl or higher.
Prevention
Diabetes often can be prevented. Losing weight through dietary changes,
increased physical activity, or both is a very effective measure. Brisk walking
for 30 minutes daily is one type of beneficial physical activity.
Treatment
The goal of treatment is to maintain blood sugar levels within the normal range
so as to prevent or control symptoms and reduce the risk of complications.
There are maintenance drugs that could help control blood sugar levels but
these are not substitute for proper diet, exercise and weight reduction.
Drug Treatment
Insulin
Function: control blood sugar levels in people with Type I diabetes and some
Type II diabetes. Side effects: overused can raise cholesterol levels, blood
pressure and increase body fat.
Oral Hypoglycemic Drugs (Sulfonylureas)
Function: lower blood sugar levels by stimulating cells in the pancreas to
release more insulin. Side effects: with long-term use, increased risk of death
from heart attack.
Biguanides
Function: increase insulin's activity in muscle and fat tissue and prevent the
liver from releasing extra glucose into the blood stream. Side effects: nausea,
diarrhea, loss of appetite, and abdominal discomfort.
Thiazolidinediones
Function: counteract insulin resistance by increasing the activity of receptors
in the liver, muscle, and fat cells. Side effect: not common.
Glucosidase inhibitors
Function: prevent blood glucose from rising after ingestion of complex
carbohydrate when used with a starchy, high-fiber diet. Side effects: gas,
bloating and poor absorption of nutrients.
Interestingly, before the advent of insulin and oral hypoglycemic drugs, herbal
medicines were often used to help treat diabetes. There are many safe botanical
medicines that are helpful in managing Type I and II diabetes. But it doesn't
mean that you can discontinue insulin or other drugs without consulting your
doctor.
Herbal Remedies
1. Gymnema (Gymnema sylvestre)
This Ayurvedic remedy is probably one of the most common herbs used to treat
diabetes. Gymnemic acid, a component of the herb, acts directly on the tongue
to block its ability to sense sweetness. This action can help you forgo the
sweet treats that may be aggravating the condition. Gymnema also appears to
stimulate the pancreas to produce more insulin and enhance the activity of
insulin. Consequently it can be helpful in both Type I and Type II diabetes. It
can be taken along with hypoglycemic medication.
2. Fenugreek (Trigonella foenum-grecum)
Modern research has shown that fenugreek seeds not only lower blood glucose
levels but also total cholesterol, and triglycerides while increasing HDL, the
good cholesterol. Fenugreek seed also contains fiber that helps slow down the
rate at which food is emptied from the stomach. This in turn delays the
absorption of glucose from the small intestine, resulting in lower blood sugar.
3. Bitter melon (Momordica charantia)
Also known as bitter gourd or balsam pear is widely used in folk remedy.
Clinical studies have verified its benefits. Bitter melon contains compounds
that are close chemical relatives of insulin, polypeptide-P, which lowers blood
sugar level.
4. Eugenia Jambolana (Jambul)
The fresh seeds found to be effective for diabetic people as they quickly
reduce sugar in the urine which is known as glucosuria. Jambolana regulates the
diabetes-inducing conversion of starch into sugar in case of an increased in
production of glucose.
The four herbs mentioned above are available in capsule form under the brand
name "DIABTROL." Its recommended dosage is 1-2 capsule twice daily after meals.
For weight reduction, DIABETROL can be taken three times a day, 1 capsule 30
minutes before each meal. DIABETROL, from the words "Diabetes Control", is now
available at all leading drugstore nationwide.
Always remember: Your best assurance for maximum health and an active life
comes from your own responsible attitude and from following the advice you get
from physician. Plant-based therapy should not be used by itself. Proper and
effective natural treatment of diabetes and hypoglycemia requires careful
integration of diet, proper exercises, lifestyle modification, nutritional
supplements and prescribed medication.
Dr. Gary S. Sy, M.D. is the Medical Director of Life Extension Medical Center
located at The Garden Plaza Hotel (formerly Swiss Inn Hotel), 1370 Gen. Luna
St., Paco, Manila. He is a diplomate in gerontology and geriatrics, advocate,
diet -- nutritional therapy, and conducts free seminar every Friday about
age-related health problems. For more details, please call telephone numbers:
400-42-05 or 522-48-35 local 315. Email Address: [EMAIL PROTECTED]
