Health Bulletin January 2025

BASICS OF DIABETES MELLITUS

What is Diabetes Mellitus?

Diabetes is a medical problem in which the body does not produce enough insulin or respond normally to insulin causing raise in blood glucose/blood sugar.

What are the types of Diabetes?

Type 1 diabetes mellitus in which the body's immune system attacks insulin producing cells leading to decreased insulin production and high sugar. This is also called juvenile onset diabetes as it usually develops before the age of 30.
Type 2 diabetes mellitus in which the body develops resistance (does not work) to insulin hence despite having normal level of insulin it causes high sugar.
Other types which are rare.
The extension is available to certain applicants who filed Form I-765 (Application for Employment Authorization) renewal applications on or after October 27, 2023.

How common is this?

It is a quite common disease affecting approximately 415 million people worldwide, 37.3 million people in the United States which is about 11 % of the total population. Type 2 diabetes is the most common type affecting up to 90-95 % diabetic patients. As age advances, the risk of type 2 diabetes increases.

7.5% of adults in India are diagnosed with diabetes between 2012 and 2014.

What are the causes of Diabetes?

Insulin resistance from obesity
Autoimmune disease
Hormonal imbalances
Genes
Pancreatic damage Pancreas is a body part which produces insulin and other digestive enzymes).
Other causes.

What increases the risk of diabetes?

Obesity
Family history of diabetes
Steroids use.
Pregnancy hormones
PCOS (polycystic ovarian syndrome).
Metabolic syndrome (high BP, high sugar, high cholesterol level).

What are the symptoms of Diabetes mellitus?

Increased thirst
Increased urine
Increased hunger
Decreased energy.
Blurred vision
Nausea
Belly pain.
Tingling and numbness in hands and feet.
Wounds that don't heal.
Weight loss without trying.
Frequent infections.
It can be silent without any symptoms hence screening (blood test) is required for early diagnosis and prompt treatment.
If you have darkness around your neck and arm pits it could be a sign of insulin resistance. You need to see your doctor to get it checked.

Can diabetes lead to other problems?

Yes.

Heart attacks and strokes/paralysis: It's important to have good blood sugar control to prevent heart attacks and strokes. Goal HbA1c (it's a blood test which gives information about average blood sugar in the last 3 months) is usually less than 7. Patients may need to take aspirin and cholesterol lowering medication, keep their blood pressure under control, quit smoking, avoid sedentary lifestyle and maintain normal weight to reduce the risk. Doctors may check EKG, cardiac stress test, lipid panel (blood cholesterol level) to assess heart attack risk.
Kidney disease is detected by performing yearly urine and blood tests. Sometimes patients may end up on dialysis due to kidney failure from uncontrolled diabetes.
Blindness (vision problems). A yearly eye exam by an ophthalmologist or optometrist is very important for early detection and treatment of vision issues.
Pain and numbness in hands and feet: Your doctor will check temperature, pain sensation in your feet. Diabetic patients may lose sensation leading to foot ulcers/wounds. Wound healing is delayed in diabetic patients.
Delayed wound healing sometimes led to deep infection requiring removal of toe, foot, or leg.
Low blood glucose can lead to dizziness and loss of consciousness which needs immediate treatment like drinking juice or taking glucose tablets or any glucose-containing carbohydrate is acceptable. If it happens frequently then your doctor will prescribe glucagon
Decreased hearing
Anemia (low blood count) could be detected by blood test/complete blood count, blood Iron level and B12 level.
Dental diseases are more common in diabetic patients hence needs yearly dental exam by dentist.
Anxiety and depression rates are higher in diabetic people which could be detected by yearly screening

What should I do?

If you notice any of the symptoms, then contact your primary care doctor and get it assessed. As type 2 diabetes can be silent it's important to get a screening blood test through your primary care doctor. And the frequency of screening depends on the risk factors like age, family history, weight etc.

How is Diabetes Mellitus diagnosed?

Your doctor will check your blood sugar level, urine sugar level, and other blood tests like HbA1c (average blood glucose in the last 3 months). You need to fast for 8-10 hours for a fasting blood glucose test. The American diabetic association recommends regular screening for anyone after 35 yrs.

How is Diabetes treated?

The goal of the treatment is to control blood sugar levels close to normal range. Treatment depends on the type of diabetes. Type 1 diabetes is treated with insulin. Type 2 diabetes is treated with lifestyle changes, medications, insulin injection based on the severity. It's important to

Eat healthily
Exercise regularly (for 30-60 min a day and 5-7 days a week).
Take Medicines or/and Insulin as prescribed.
Getting annual eye, foot exam and blood tests.

Can I stop it from happening?

Yes. Type 2 diabetes and diabetes during pregnancy could be avoided by a healthy lifestyle like eating healthy, exercising, quitting smoking, and maintaining normal weight.

Can I reverse diabetes?

Yes. Type 2 diabetes, which is the most common type of diabetes, could be reversed by healthy lifestyle and weight reduction.

NOTE: Use the following from previous edition.

Coordinated By

Sujeeth R. Punnam, MD
Chair, ATA Health Committee

(Dr. Sujeeth R. Punnam is a cardiologist in Stockton, California and is affiliated with multiple hospitals in the area, including Dameron Hospital and St. Joseph's Medical Center-Stockton. He received his medical degree from Kakatiya Medical College NTR and has been in practice for more than 20 years.)