Diabetes: Causes, Symptoms, Dietary management.

Globally, an estimated 463 million adults are living with diabetes, according to the latest 2019 data from the International Diabetes Federation.[1] Diabetes prevalence is increasing rapidly; previous 2017 estimates put the number at 425 million people living with diabetes.[2] The number is projected to almost double by 2030. Diabetes mellitus occurs throughout the world but is more common (especially type 2) in the more developed countries.

Diabetes mellitus is a metabolic disorder characterized by decreased ability or total inability to utilize carbohydrates (glucose). It is mainly due to an absence of insulin, its deficiency, or ineffectiveness. This results in shifts and disturbances in the fat and protein metabolism and water and electrolytic balance.

It is also known as madhumeham in India.

As you know diabetes has various forms and can be classified variously. And WHO gives the most common classification of diabetes.

1.Type I – Insulin Dependent Diabetes Mellitus (IDDM):

This is also known as Juvenile Onset Diabetes Mellitus. Most children and adolescents suffer from this type of diabetes however, it may appear in adults and the elderly too. In this, there is little or no production of insulin by β-cells of the pancreas. Hence insulin injections may be needed or else there would be life-threatening metabolic complications. In this condition, the people are generally underweight.

2.Type II – Non-insulin Dependent Diabetes Mellitus (NIDDM): 

This is also known as Maturity Onset Diabetes Mellitus. The insulin produced by the pancreas is normal or even high. The symptoms of the disease are gradual. The problem is caused by insulin resistance. Obesity is the main cause of insulin resistance weight reduction, diet and exercise can be helpful to decrease insulin resistance. Antidiabetic drugs can also be helpful.

3.Type III – Malnutrition Related Diabetes Mellitus (MRDM): This type of diabetes has been categorized as a separate entity. It occurs mostly between the ages of 15-30 years. People look thin, lean, malnourished. The reason for this type of diabetes is that the pancreas does not produce enough insulin ( necrotic tissues on the pancreas) and hence this individual requires insulin. The very often hormonal disorder may occur.

4.Gestational diabetes: 

When a pregnant woman develops diabetes during the gestational period it is known as gestational diabetes. It occurs only to 1% of pregnant women. A pregnant woman who has a risk of diabetes because of family history or bad obstetric history should be screened for diabetes. Pregnant mothers develop diabetes-related complications and after delivery can also continue with the diabetic conditions.

Besides these types, another form of diabetes called Maturity-onset Diabetes of the Young (MODY) has been identified. MODY refers to any of several rare hereditary forms of diabetes mellitus due to dominantly inherited defects of insulin secretion. As of now, six different types of MODY have been identified.

Causes of diabetes: There are various causes of diabetes and these multiple factors are interacting and complex- 

1.Genetic: There is a familial tendency to develop Type-I diabetes. Altered frequency of certain antigens like Human Lymphocyte Antigen (HLA) on specific chromosomes, autoimmunity, an abnormal immune response is some of the genetic factors leading to diabetes.

2.Dietary intake: Excess food intake leads to excess calorie intake which can cause energy imbalance that can lead to obesity – a risk factor for diabetes. A low intake of fiber in the diet is associated with diabetes. High intake of refined foods and fatty foods may also lead to diabetes. Over and under an important cause of diabetes.

3.Infections: Viral infections such as measles and mums can trigger an abnormal autoimmune response that destroys β-cells of the pancreas which produce insulin.

4.Increased catabolism: Excess breakdown of liver sugar (glycogen)can lead to excess glucose accumulation in the blood. Tissue protein and fat breakdown cause metabolic changes causing diabetes. 

5.Hormones (endocrine factors): About one-third of diabetics have shown to have excess growth hormone Cortisol and Corticosteroids leads to an increased protein breakdown and inhibit sugar utilization by the tissues, thus increasing blood sugar level. Adrenalin increases the breakdown of glycogen in the liver. It also suppresses insulin secretion thus increasing the blood sugar level. Excess thyroid hormone also aggravates diabetes increases blood glucose levels by several mechanisms.

6.Diseases: Several diseases may be responsible for causing diabetes. E.g. pancreatitis carcinoma of the pancreas, are some of the disease related to diabetes.

The normal blood sugar level is: 70-100 mg/dl

Factors affecting Blood Sugar level- 

• Hormones –

 1. Anterior pituitary

2. Thyroid

3. Adrenalin

• Liver glycogen breakdown
• Intestinal sugar absorption
• Protein Catabolism (breakdown)

Diabetes may be referred to as primary and secondary.

Primary- This type of diabetes occurs due to insufficient production of insulin resistance.

Secondary- Diabetes that occurs due to some other factors other than insulin is known as secondary.

Metabolic changes during diabetes: Diabetes mellitus leads to severe metabolic changes in the body. Uncontrolled diabetes affects not only carbohydrate metabolism but also fat and protein metabolism. 

The following are some of the common metabolic aberrations taking place in the body during diabetes mellitus-

• Decreased utilization of glucose by the body cells.
• Reduced fuel supply to the body cells for energy purposes.
• Increased mobilization of fats from the fat storage areas.
• Abnormal fat metabolism
• Deposition of lipids in vascular walls leading to the production of ketone bodies.
• Depletion of protein in tissues of the body causing changes in protein metabolism
• Increased excretion of nitrogen due to excess catabolism.
• Potassium in the blood increased.

Symptoms of diabetes: In mild cases of diabetes mellitus, no symptoms are usually seen; but in severe cases, symptoms may be pronounced. The most common symptoms are:

1.Polyuria: Excessive urinary output especially at night. In very small children bedwetting may be seen.

2.Polydipsia: Excessive thirst due to the lass of water from the body.

3.Polyphagia: Increased appetite, urge for sweet items of food due to heavy loss of sugar in the urine.

4.Loss of weight: Muscle and tissue wasting due to increased catabolism, leading to a reduction in weight.

5.Lassitude and lack of energy: Improper carbohydrate metabolism leads to low energy utilization by the body and thus causes tiredness, drowsiness, and even coma at later stages.

6.Paraesthesia: A tingling sensation felt in the hands and feet.

7.The blurring of vision: Excess sugar deposits on the eye lens causing refraction changes resulting in the blurring of vision.

8.Delay in wound healing and minor infections: Lack of nutrients to the wound delays wound healing. Minor recurrent infections also occur.

Diagnosis: Diabetes can be diagnosed by carrying out the following 

1. Random Blood Sugar Measurement
2. Oral Glucose Tolerance Test (OGTT)
3. Ketonuria Detection
4. Urinary Sugar Test ( benedict’s Test)
5. Glycosylated Haemoglobin Test (HbAIC)
6. Impaired Glucose Tolerance Test (IGTT)

Dietary Management: Diet plays a very important role in the management of diabetes as it exerts a direct influence on the blood glucose level. The goal of diet therapy is to maintain a prolonged healthy, productive, and happy life. The specific dietary goals include the following:

• Supplying optimum nutrition to maintain good health.
• Providing calories for maintaining ideal weight and allowing for normal growth and development (in the case of children).
• Maintaining blood sugar control (glycaemic control).
• Help to achieve blood lipid levels.
• Minimize acute and chronic complications of diabetes mellitus.

The major dietary modification includes:

1.Calorie: The energy requirement of adult patients is governed by their present body weight and the need to maintain desirable or ideal body weight.     

 Calories required/kg Ideal Body Weight-

  Ideal body weight- 25

  Over weight-15-20

  Underweight-30

  

2.Protein: Proteins should be provided an adequate amount to maintain normal body composition and prevent depletion of lean tissue mass. A diet moderately high in protein is good for health since it supplies the essential amino acids. 1gm of protein/kg body weight is adequate but more may be given if necessary.

3.Fats: Fat content in the diet should be15-25% of total calories and higher in polyunsaturated fatty acids. Saturated fat should be 7% of total calories. Vegetable oils rich in MUFA/PUFA should be preferred over animal fats which are generally rich in saturated fatty acids. The dietary cholesterol intake should be kept below 200mg/day for diabetes.

4.Carbohydrates: Carbohydrates should be maintained to about 60-65% of total calories. Most carbohydrates should be in the form of polysaccharides such as whole grains. High glycemic index food and simple sugar should be avoided.

5. Vitamins and Minerals: Vitamin and mineral supplementation may be beneficial. Diets rich in all vitamins particularly vitamins C and E (antioxidants) are found to be beneficial. Low magnesium levels have been associated with the risk of diabetes and insulin insensitivity. so magnesium supplementation may be beneficial. Chromium and zinc supplementations have also been found to be beneficial. Sodium restriction is generally suggested.

6. Dietary Fibre: High fiber meals are found to give the best glycaemic control in diabetics. It not only reduces blood sugar but lowers blood cholesterol and hence is good for other diseases like cardiovascular diseases. High fiber diets promote weight loss, increase satiety, delay gastric emptying, etc. Moreover, high fiber diets usually take longer to eat. Fenugreek seeds which contain high fiber, are useful to diabetics. Both soluble fibers like pectin, gums, etc. and insoluble fibers like cellulose, lignin, etc. were found to be beneficial for the diabetics.

Other dietary guidelines:

· Mealtime should be maintained.

· Fried, fatty and calorie-dense foods should be avoided; fast food should be avoided.

· Glycemic index of the food should be considered.

· Small, frequent meals are suggested.

· Artificial sweetness may be used, if necessary.

· Distribution of calories for each meal.

· A mixture of oils should be preferred i.e., a combination of PUFA, MUFA, and other oils.

· Fasting and feasting should be avoided.

· Fenugreek, containing Trigonellin, is an important hypoglycaemic agent.

· Acarbose, present in whole wheat, is an excellent hypoglycemic agent.

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