Effects of long-term Diabetes Treatments for Diabetes control

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

India is with Diabetes and this number is likely to increase to over 120 million. Diabetes Mellitus is characterized by high glucose levels. Exposure to high blood glucose contributes to increased thirst, weight loss, fatigue and urination. The long term complications include damage to eyes, Heart, Kidneys and Nerves leading to loss of amputation, Heart failure, Kidney failure and frequently, vision.

There are two types of Diabetes Mellitus — Type 2 and Type 1. Type 1 Diabetes Mellitus predominantly occurs in children and adolescents, and is distinguished by absolute deficiency of Insulin (a hormone necessary to keep blood glucose levels normal) from the body. Patients are dependent on Insulin injections for their own survival.

Type 2 Diabetes Mellitus results mostly from an imbalance in the demand and distribution of nourishment. Though insulin is within the body, it isn’t sufficient to control the blood sugars. But research has caused a paradigm shift. Not insulin but hormones like Glucagon, GLP-1 play a part in Diabetes. The way blood glucose is handled by the Kidneys is also of importance. These flaws have resulted in the coinage of the expression –‘Ominous Octet’.   Identifying these novel defects has been helpful in the sense that we now have drugs to tackle these flaws that are individual opening up a brand new age.

Case study:

A gentleman, introduced for a health check-up to our hospital. He has been diagnosed with Diabetes Mellitus for. Recently, he was diagnosed with Hypertension. His fasting blood glucose was 150 mg/dl and blood glucose was 200 mg/dl, which will be satisfactory to the individual.

However, on assessing for complications, it was found that there are fluctuations in his eyes because of Diabetes, which threatens his vision, though he has no signs. His feet’s nerves are damaged with perception of temperature and pain. His Serum Creatinine (measure of his Kidney function) is abnormally elevated; that leaves the individual shocked.

Diabetes Mellitus is a silent killer. There are no indicators. And after the damage is done, it is irreparable. A common misconception is that when the blood glucose level is below 200 mg/dl, you’re safe. A man’s fasting blood glucose is below 100 mg/dl and after-meal sugar. Any increase in the blood glucose values over this leads to damage of vital organs.

Medications like insulin co-formulations that are newer as well as DPPIV inhibitors, SGLT2 inhibitors, GLP-1 agonists would be the key to the future of Diabetes management. Insulins and newer acting have strengthened our armamentarium from Diabetes.

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

Don’t be shellfish…

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