Diabetes, the Silent Killer

Diabetes is a non-communicable disease, which is progressively infiltrating the society and placing millions of lives in jeopardy. Currently the whole world is affected from this, making it a Pandemic. Evidence shows in developed countries more than 35% of patients with diabetes are not diagnosed and day by day we see increasing number of patients walking into medical clinics in National Hospital Sri Lanka with Diabetes. 

There are different types of Diabetes and the commonest type is  type 2 diabetes mellitus (DM), which is a metabolic disease, that causes high blood glucose levels. This is due to body’s resistance to insulin which is a hormone that aids the uptake of glucose from blood into the cells.

Other types of Diabetes

  1. DM type 1 is an autoimmune disease where the body’s immune system attacks theinsulin-producing cells of the pancreas. Therefore it is not preventable. This is less common than type 2.
  2. Diabetes insipidus is a rare condition in which the kidneys excrete too muchwater due to low ADH levels.
  3. Monogenic Diabetes in Young is another type which presents in very early stage of life and its due to a genetic defect.
  4. Gestational Diabetes is a type of DM which occurs for the first time during pregnancy. Usually it resolve after the deliver but sometimes can persist. 

Type 2 DM

Due to the prevalence of DM type 2, it important to be educated on this subject in order to prevent and/or control the disease. Therefore, this article is focused on DM type 2.

What are the symptoms and signs?

  • Recent weight loss despite having good meals
  • Excessive thirst, dry mouth
  • Frequent urination, specially increase urination at night. (Nocturia)
  • Persistent hunger

If high blood glucose levels persist for a long period of time, you will get,

  • Infections ( even with a shorter duration of high blood sugar levels )
  • Slow-healing of ulcers
  • Dark patches on the skin
  • Foot pain
  • Numbness in extremities and neuropathy
  • Frothy urine due to Kidney damage
  • Visual defects due to eye involvement.

If you have these symptoms, you should seek medical help immediately for further evaluation.

What are the risk factors?

  • Overweight, obese
  • Age 45 years or older
  • Have a family history of DM type 2
  • Sedentary life style.
  • History of gestational diabetes or presence of prediabetes
  • High blood pressure, high cholesterol levels, or high triglyceride levels

Though DM type 2 has a genetic component, the commonest predisposing factor is the unhealthy lifestyle adopted by society due to their very busy and fast-moving lives. This has resulted in insidious increase in DM type 2 cases among children as well as adults. But, by making small changes in the day-to-day agenda, this silent killer can be easily tackled.

Long-term complications of diabetes ( usually develop after 10 years )

  • Eye involvement 
  • kidney involvement 
  • Neuronal involvement
  • Ischemic Heart Disease (Heart Attacks)
  • Strokes
  • Peripheral vascular disease

With adequate measures, tight glucose level control and frequent followups, we can prevent all these complications from developing.

How to diagnose DM?

Early diagnosis is very important, which is to treat the symptoms and prevent.

Diagnosis is done by performing,

  • Random blood sugar test ( Normal < 140 mg/dl,  DM > 200 mg/dl)
  • Fasting blood sugar test ( Normal <100 mg/dl,   DM > 126 mg/dl)

(If you have above mentioned symptoms, one of the above tests performing once is enough to diagnose diabetes. But, if you have no symptoms, need to perform two tests (same or different) in to different situations, and high blood sugar levels in both can diagnose diabetes.)

Apart from above mentioned investigations, HBA1c level (DM > 6.5%) in blood will reflect the sugar control in the body, throughout last 3 months in a normal individual and it can be used to diagnose diabetes as well.

In Pregnancy the above mentioned test has limited value and we can use Oral Glucose Tolerance Test (OGTT) to diagnose Gestational DM.

What are the treatments/interventions?

If your blood glucose level lies in between the Normal value and the diabetic range, it indicates that you are in a status call, Pre diabetes. This is a reversible state and if you do adequate lifestyle change you can come back to the normal levels. If not it will progress into diabetes, which is an irreversible state.

Type 2 DM is effectively managed by taking Oral Hypoglycemic Agents and/or Insulin therapy along with altering the lifestyle.

Here are some Lifestyle modifications to keep your glucose levels low,

  • Include foods rich in fiber and carbohydrates with low Glycemic index to your food.  
  • Don’t Fast or Feast.
  • Minimize consumption of refined carbohydrates ( foods with high glycemic index), sweets and animal/trans fats
  • Exercise daily (about 30 minutes a day for at least 5 days a week)

For further advices on your medical management please meet a medical officer.


Rtr. Anuki Mishenka Hewavithana


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