What is Diabetes Mellitus?

Diabetes Mellitus is the name given to some diseases that arise because either there is no insulin in the body, insufficient insulin in the body or because insulin, even when higher than normal, is not able to do its job properly, leading to a rise in blood glucose levels. 

Insulin is an essential hormone produced by the pancreas. The role of Insulin in the body can be described as that of a conductor in an orchestra -- it  communicates to many cells in the body how to play their part in the system of the body to maintain homeostasis. One easily measurable effect of Insulin is to move the glucose to inside cells (and out of the circulation) where it can be used to provide energy. Several other hormones work in conjunction with insulin to maintain the glucose homeostasis . There are many types of Diabetes Mellitus.

Diabetes Mellitus type 1 (also previously called Insulin Dependent Diabetes Mellitus, IDDM in short) is an autoimmune disease in which the pancreas is not able to produce any Insulin. To treat type 1 diabetes, Insulin is given using injectibles and blood glucose is monitored very often, ideally through Continuous Monitoring. Type 1 Diabetes is a disease altogether from type 2 Diabetes Mellitus, with a different treatment and course. Some famous people with Diabetes type 1 include cricketer Wasim Akram, singer Nick Jonas, and actor Sonam Kapoor.

Diabetes Mellitus type 2 ( also previously called Non-Insulin-Dependent Diabetes Mellitus, NIDDM for short) is a disease in which in the initial stages larger amounts of Insulin are needed to move the same amount of glucose from circulation to inside cells and keep the blood glucose levels in the normal range. This is what is called Insulin Resistance. No mention of Diabetes type 2 is complete without mentioning Insulin resistance. Finally, once the pancreas cannot keep up with the demand for insulin, increasing quantities of glucose remain freely in the bloodstream instead of being inside the cells where they can be used. The blood glucose levels start to climb up. Most diabetics, almost 90-95%, suffer from type 2.  You or someone you know might have type 2 Diabetes Mellitus.

Gestational Diabetes Mellitus is seen in pregnant women.

Another condition called Prediabetes is diagnosed when the blood glucose levels are seen to rise up, but are still within acceptable limits. Pre-diabetes is the precursor condition of  type 2 Diabetes Mellitus.

My focus is Insulin Resistance and Diabetes Mellitus type 2. Some risk factors for developing  type 2 Diabetes Mellitus are older age, ethnicity, family history, overweight and obesity, physical inactivity, stress and alcohol. Some symptoms of this kind of Diabetes are:

• Excessive thirst and hunger
• Frequent urination
• Fatigue
• Blurred vision
• Fruity odor on the breath
• Irritability
• Slow-healing wounds
• Darkening of skin in some areas of body creases
• Weight loss or gain
• Tingling or numbness in the hands or feet
• 
  

Some individuals may not experience any symptoms but abnormal values will show up on the annual preventive check up.

The ranges and cut-offs for diagnosis of prediabetes and Diabetes are as follows-

Normal range

FBS 70 mg/dl (3.9 mmol/L) to less than 100mg/dl (5.5 mmol/L) 

Hba1c 3.9 to less than 5.7

Prediabetes

FBS 100 (5.5 mmol/L) - 125 mg/dl  (6.9 mmol/L)

Hba1c 5.7 to less than 6.5

DM type 2

FBS 126 mg/dl (7 mmol/L) or higher.

Hba1c 6.5 or higher

There are other tests like Random blood glucose level and Oral Glucose Tolerance Test.

There are many new promising drugs to treat Diabetes Mellitus type 2, but wouldn’t it be wonderful to not have the disease in the first place?.

The pathology of Diabetes starts many years before as Insulin Resistance, before any alarming numbers show up. So, when a person gets diagnosed with Diabetes Mellitus type 2 using these current standards, they have already been living with Insulin Resistance for years.. Insulin Resistance usually predates the diagnosis of Diabetes Mellitus type 2 by many years. This means that diabetes can be predicted before it arrives, and you can take steps to counter your insulin resistance risk factors before it evolves into diabetes. If insulin resistance can be diagnosed and reversed in time, the development of DM type 2, as it’s known now, can be averted.

Scientific research has uncovered and is following many promising leads. The measurement of insulin levels has become widely available in recent years but it doesn't yet figure in the Diagnostic Criteria.

Dr Joseph Kraft did pioneering work in the field of use of Insulin Assay and made a strong case for early diagnosis of  type 2 Diabetes Mellitus using Insulin Assay. More advanced tests for early diagnosis are on the horizon for use in the Clinic, like the Quantose IR index. Diabetes Mellitus type 2, itself, is in the process of getting redefined.

There is new hope with the Low Carbohydrate Diet which could prove to be an important tool in the management of Insulin Resistance and Diabetes Mellitus type 2, and scientific consensus is rallying around it. High Fat diets like the Ketogenic Diet have been used in medicine for the treatment of Intractable Epilepsy for a long time now. I have to say here that Keto is a very powerful tool, it is only safe when used under direct supervision of a qualified healthcare practitioner who has experience with keto. Like all powerful tools, it can hurt, sometimes fatally,  if not used with care.

Early diagnosis and treatment is a cornerstone of Diabetes management. If you have type 2 Diabetes Mellitus or your doctor has said that you have pre-diabetes, you should work with your doctor and take the treatment very seriously to prevent advanced disease from happening. Diabetes and its complications severely impact the quality of life and contribute to early death. Diet, physical activity, weight loss and, when needed, prescription medication are all part of the management plan that your doctor will recommend for you and each of these are critical. 

If you have neither Diabetes Mellitus type 2 nor prediabetes, you should still rule out Insulin Resistance and work on reducing risk factors by living a healthy lifestyle. It is Insulin Resistance which many years later will progress to Diabetes Mellitus type 2. Science and the healthcare system are there to support you, but you have to take responsibility for protecting your own health and wellbeing. 

Happy Healthy living to you.