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Effects of long-term Diabetes & newer therapies for Diabetes control

What-Is-An-Endocrinologist

Dr Tejal Lathia, Consultant Endocrinologist, Hiranandani Hospital, Vashi – A Fortis Network Hospital

India is home to over 50 million adults with Diabetes and this number is likely to increase to over 120 million by 2040. Diabetes Mellitus is characterized by high blood sugar levels. Exposure to high blood sugar leads to weakness, weight loss, increased thirst and frequent urination. The long term complications include damage to eyes, Heart, Kidneys and Nerves resulting in loss of vision, Heart failure, Kidney failure and often, amputation.

What-Is-An-Endocrinologist

There are two main types of Diabetes Mellitus – Type 1 and Type 2. Type 1 Diabetes Mellitus predominantly occurs in children and adolescents, and is characterized by complete deficiency of Insulin (a hormone required to keep blood sugar levels normal) in the body. Such patients are completely dependent on Insulin injections for their survival.

Type 2 Diabetes Mellitus results primarily from an imbalance in the demand and supply of Insulin. Though insulin is present in the body, it is not sufficient to control the blood sugars. However, newer research has caused a paradigm shift in the way we look at Diabetes. Not only insulin but other hormones like Glucagon, GLP-1 play a part in Diabetes. The way the Kidneys handle blood sugar is also of importance. These myriad defects have resulted in the coinage of the term – ‘Ominous Octet’.  Identifying these novel defects has been helpful in the sense that we now have medicines to tackle these individual defects opening up a new era in the treatment of diabetes.

Case study:

A 56 year old gentleman, presented to our hospital for a routine health check-up. He has been diagnosed with Diabetes Mellitus 5yrs ago, for which he has been on medications. Recently, he was also diagnosed with Hypertension. His fasting blood sugar was 150 mg/dl and post-meal blood sugar was 200 mg/dl, which is satisfactory to the patient.

However, on evaluating for complications, it was found that there are changes in his eyes because of Diabetes, which threatens his vision, though he has no symptoms. The nerves of his feet are damaged with reduced perception of pain and temperature. His Serum Creatinine (measure of his Kidney function) is abnormally elevated; this leaves the patient shocked.

Diabetes Mellitus unfortunately is a silent killer. There are no symptoms of the damage it is doing to the body, before it is too late. And once the damage is done, it is irreparable. A common misconception is that if the blood sugar level is below 200 mg/dl, you are safe. A normal person’s fasting blood sugar is below 100 mg/dl and after-meal sugar is less than 140 mg/dl. Any increase in the blood sugar values above this leads to damage of vital organs.

Medications like DPPIV inhibitors, SGLT2 inhibitors, GLP-1 agonists as well as newer insulin co-formulations are the key to the future of Diabetes management. Newer rapid acting and ultra-long acting insulins have further strengthened our armamentarium against Diabetes.

There is no substitute for lifestyle modifications though – regular aerobic exercise like walking, cycling, swimming (at least 150 mins per week) and a diet which eschews refined carbohydrates and excess oil is mandatory. These lifestyle changes need to be followed throughout life. Early diagnosis and aggressive treatment of the disease with medications, is imperative to avoid complications and improve quality of life of a Diabetic.

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