Taking Control for Healthier Life
You have been told that you have Type II diabetes. It’s a disease that makes it hard for your body to turn food into energy. After learning that you have diabetes, you may be feeling angry, scared or depressed. These feelings are normal and understandable. After all, having diabetes means making some changes that may be hard at first. But you can do it. Your family, friends, and members of your health care team are there to help.
What Causes Diabetes
No one knows what causes diabetes. But we do know that certain behaviours and conditions, called risk factors, can make you more likely to get it. Being over 40-years old, having family members with diabetes, and being overweight, are all risk factors for Type II diabetes.
When You Have Type II Diabetes
In Type II diabetes, initially there is insulin resistance, i.e. the available insulin is not so effective in lowering the blood sugar, it is compensated with extra secretion of insulin, but that does not last long and insulin deficiency occurs. Initially, normal blood sugar can be maintained with diet adjustment, exercises and change of lifestyle.
Later tablets (Sulphonylureas like Daonil, Glizid, Glynase, etc.) can help in increasing insulin secretion and maintain normal blood sugar. But later on when your own insulin secretion becomes still lower, tablets may not be effective.
If you have followed the right diet, carried on regular exercises, and taken the prescribed treatment, without any added factors of stress, accept the fact that the time has come to switch over to insulin, the hormone, which is very much deficient in your system.
It is a fact that if you have taken full care from the very beginning and kept your blood sugar normal, this stage of total insulin exhaustion will come later.
It is a misconcept that Type II diabetic patients do not need insulin. In fact, if tablets are unable to keep a good control of diabetic state, one should start insulin earlier rather than later. Living with higher blood sugar levels is worse because of risks of cardiovascular (heart attack, high blood pressure) complications.
Insulin treatment, on the other hand, offers rest to overworked “Beta cells” of pancreas and saves them from total exhaustion.
So if your doctor advises you to add insulin alongwith your tablets, it is to your advantage and you will need much less insulin now, than later. Maybe, initially you need only one injection at night to achieve the desired results. Higher doses of insulin has its own disadvantages like risk of hypoglycemia, and weight gain.
It has been seen, specially during stressful situations, that a short course of insulin for a couple of months is much more helpful in maintaining good health, and later you can again come back to tablets.
Elderly patients are difficult to control on tablets as the disease has been there for quite some time and high blood sugar is risky, they need only a small dose of insulin to achieve a better control.
If you have any doubts, discuss with your doctor, but don’t try to avoid insulin due to your misconception.
Balancing Blood Sugar
With diabetes, you need to work to keep your blood sugar in balance. You’ll be told what blood sugar range is right for you. Then you’ll be taught how to test your blood sugar level and told what to do if it’s too high or too low.
When Blood Sugar is too High
Too much glucose in your blood is called high blood sugar (also called high blood glucose or hyperglycemia). It can be caused by eating too much food, eating sugary food, not getting enough exercise, or not taking your medication. It can also happen when you’re sick or under stress. If your blood sugar level gets too high, you may go into coma.
How You May Feel
High blood sugar may cause no symptoms or symptoms may include:
• Blurry vision
• Increased thirst
• A need to urinate often
• Itchy, dry skin
• Feeling tired
• Unexplained weight loss
• Infections
What to Do for High Blood Sugar
1. Check your blood sugar level as soon as you can. That way you’ll know if it’s returning to normal.
2. Drink sugar-free, caffeine-free liquids such as water, diet soda, or herbal tea. Don’t drink fruit juice.
If your blood sugar does not return to the normal range within a few hours or if you don’t feel better, call your doctor.
When Blood Sugar is Too Low
Too little glucose in your blood is called low blood sugar (also called low blood glucose or hypoglycemia). It may occur suddenly if you take too much medication, skip or delay a meal, or exercise more than usual. If low blood sugar is not treated, you can pass out or have a seizure. So, if you have symptoms of low blood sugar, test your blood sugar level to be sure. If you can’t test it, trust your symptoms and follow the steps given below.
How You May Feel
* Pangs of hunger
* Lack of mental concentration – confusion
* Uncoordinated movements
* Restlessness – emotional instability
* Headache – sinking feeling
* Palpitation – sweating
* Fast breathing
* Stupor – convulsions
What to Do for Low Blood Sugar
1. Chew glucose tablets or hard candies as directed. Or take 2 to 3 teaspoons of sugar or honey. These are all fast-acting sugars.
2. Wait for 15 minutes. Then re-test your blood sugar level if you can. If your blood sugar is still too low, repeat step one and two. If you aren’t better after that, get medical help.
3. Once your blood sugar returns to normal, eat. If it’s less than 1 hour before your next meal, eat that meal, immediately. If it’s more than 1 hour, eat a snack, such as half a sandwich and a glass of milk.
Call your doctor if you get low blood sugar often.
Why is being Overweight is so Risky for Diabetes?
Quite a few Type II diabetic patients, i.e., when diabetes occurs around 40 years of age, are overweight. One wonders if overweight has caused diabetes or because of diabetes they have become overweight. Both the statements have some truth in it. All overweight patients are not diabetic, nor all diabetic patients are overweight. Type I (IDDM) diabetes are invariably under-weight. So, what is the truth?
In persons who have inherited the trait of becoming diabetic, when they become over-weight, diabetes gets precipitated. So if you have a family history of diabetes, there are all chances that you have inherited the trait, if you can avoid the precipitating factors like obesity, physical inactivity, or sedentary lifestyle, you can prevent or at least postpone the onset of diabetes.
Obesity can be judged by
• Weight record (related to height)
• Skin-fold thickness at certain points
• Body Mass Index (Wt in Kg/height in meter2)
• Waist / hip ratio
• Visceral fat
Obesity, in general, means extra fat tissue. A good muscular body like that of weight lifters or body builders may have more weight but they cannot be called obese.
Obesity causes insulin resistance, i.e., same amount of insulin is not as effective in lowering blood sugar. Body tries to overcome insulin resistance by compensatory over production of insulin. Over a period of time, these compensatory mechanism of over production of insulin fails, and when enough insulin is not available, blood sugar rises, i.e., diabetes starts.
Those of you who have diabetes must warn your blood relations not to put on weight if they want to avoid diabetes.
It is easy to put on weight, but difficult to lose. Overeating and less exercise causes positive energy balance and it is then stored in the body as fat.
Obesity leads in addition to diabetes, high blood pressure, abnormal circulating fats (cholesterol), heart attack or stroke. As the age advances, obesity may cause problems in mobility with joint pains (ostreoarthritis), respiratory insufficiency, or digestive disorders.
Such patients should be investigated properly to have accurate assessment of damage to various systems and organs such as heart, kidney, and joints.
Even the treatment of diabetes in overweight patients is different. Unless you lose weight oral tablets are not so effective.
Drugs like biguanides (Metformin), Acarbose (Glucobay), fiber rich diet, are helpful in reducing blood sugar as well as weight.
Do not start or change the medicine yourself, always consult your doctor.
Crash diet, or drugs which suppress appetite, or miraculous formula approach, are dangerous for diabetic patients.
While treating such patients, attention should also be paid to normalise, blood pressure, circulating fats and functions of heart.
It is not enough to lose weight, but equally important to maintain it, as recurrence is equally common.
Where do you stand?
• If you are of normal weight, you are lucky, but maintain it.
• If you have a tendency to put on weight, be cautious.
• If you are already overweight, act now, do not postpone it, shed it off as soon as you can.
• Being overweight is a curse for every one, specially for diabetics.
Overweight is not only a physical handicap, but a primary health hazard. Obese persons are more uncomfortable in summer, because the thick layers of fat serve as an insulator. In an obese person, more effort is expended to do a given amount of work because of the increased body mass. On account of their lessened agility, they are more susceptible to accidents. Fatigue, backache, high blood pressure, heart attack and diabetes are common complaints of such persons.
Obesity programmes should make sure that the participants lose weight, nutritiously, under medical supervision. Once the weight loss phase is over, the real benefit begins. These are: a healthier lifestyle, balanced food calories with physical exercise and long-term weight management. Along with this, are the knowledge and skills needed to manage a healthy life and reduce health risk.