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1. IS DIABETES
A HEREDITARY DISEASE ? |
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Yes, Type-2 diabetes (Adult onset type) is genetically transmitted through
a process called recessive trait. Maturity onset diabetes of the young
(MODY) Viz. Type 2 occurring below 25 years is hereditary and transmitted
by an autosomal dominant gene through three generations (Mason-type of
MODY); but there are other genetic subtypes, recently described amongst
this group - .
Type 1 diabetes (Juvenile-onset type) is not strictly
a hereditary disorder and is not passed on from parent to off spring.
There are some rare genetic syndromes associated with diabetes in children
which are conveyed through a recessive trait -eg. Prader-Willi syndrome,
Refsum's disease, DIDMOAD syndrome, Freidrich's ataxia, etc.
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2. IF MY PARENTS/RELATIVES
HAVE DIABETES, WHAT ARE MY CHANCES OF GETTING IT ?
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If both parents are diabetic
the chances are more than 99%; such persons are termed as genetic prediabetics
(or) offsprings of conjugal diabetes (OCD).
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If one parent and one second-degree
relative have diabetes - 70% Risk. |
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If one parent positive - 60% Risk. |
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If two second degree relatives positive
(From both paternal and maternal side) - 40% Risk |
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If one second degree relative positive
- 30% Risk. |
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If two cousins (3rd degree relatives
from both maternal and paternal sides) - 20%. |
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If one cousin positive
- 10% |
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If no known family history
- 5% |
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All the above estimated risk percentages
are approximate and obtained from our personal practice data over the
past 35 years. These are not absolute and will vary from place to place
and from country to country. They do not indicate when or at what age
a person with risk will develop diabetes (see
Question no. 3).
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3. WHAT ARE THE RISK FACTORS
FOR DEVELOPING DIABETES ? |
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a) Heredity |
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b) Obesity /over weight (Particularly
visceral (inner abdominal fat)obesity) |
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c) Sedentary habit |
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d) Sudden severe emotional stress,
accidents etc., |
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e) Frequent pregnancies, multiple
gestation (Twins/ Triplets etc) |
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f) Delivering overweight babies
(over 4 kgs) and still birth (Intra uterine demise of fetus) |
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g) Gestational diabetes (Diabetes
detected for the first time during pregnancy - about 40% of these may develop
diabetes within 7 years of delivery). |
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h) Drugs - Like Thiazide diuretics,
steroids (cortisone) etc., |
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i) Acute infections and critical
illnesses eg., Jaundice (Hepatitis), Myocardial infarction (Heart attack),
Pancreatitis etc. |
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j) Toxins - Ingestion of certain substances (accidental
or intentional) like organo- phosphorous compounds, or those which may
release minute amounts of streptozotocin within the body eg. some variety
of preservatives specifically damage the pancreatic Beta cells and lead
to diabetes
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4. ONCE A DIABETIC, ALWAYS
A DIABETIC - |
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(a) IS THIS STATEMENT TRUE
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(b) IS THERE A "CURE" FOR
DIABETES ? |
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a. This is true of type -1
or IDDM :
please read our introduction to understand.
The condition called diabetes Type 2, strictly speaking, is primarily
not a disease - it is a disorder. If we can bring 'order' by early detection
and correction through diet, exercise, weight correction etc, the disorder
can be reversed in a majority of individuals. But it is a two-way street.
It can again pop up its head when body conditions get reversed. So we
can't really look for a 'cure' for a condition like diabetes, which is
present within us from the womb, manifests clinically (i.e. comes out
as a clinically detectable disorder) at some stage in our life depending
upon many interacting host and environmental factors, and may progress
to create complications (or) regress to remission, which could be called
"Temporary Cure". To hold the remission (Cure) in place for several years
or a lifetime requires careful surveillance and a good degree of luck!
Diabetes is thus a life-long Companion - Condition rather than a disease
or disorder and it is up to the individual to keep it like the former
rather than the latter.
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b. As of date there is no "Cure" for
diabetes since this is a complex genetically transmitted disorder and
manifests at variable periods in the life of various persons.A variety
of environmental factors and internal trigger factors play key roles in
bringing out the clinical condition and its complications. Hence, until
a fuller understanding of the genetic aspect is gained, any approach to
finding a "cure" for diabetes on the basis of drug interventions is unlikely
to succeed.
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5. DOES DIABETES ALWAYS
REQUIRE DRUG TREATMENT ? |
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a. Upto 40% Type
- 2 diabetes can be controlled with diet, exercise and lifestyle modifications,
especially when they are Detected Early, Motivated and Sustained Properly
and Compliant Regularly; a small proportion of these may even show Remission
(Temporary Cure).
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b. About 45% to
55% of people with Type 2 diabetes may require ORAL DRUGS for maintaining
good control. Again if they are regular in their approach to therapy and
follow-up, a proportion - 10% to 20% - of these people could go off drugs
for varying lengths of time.
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c. 5% to 10% of
Type 2 diabetes patients may require insulin injections for control of
diabetes at discovery due to various reasons like infection, auto immune
causes (e. g. Latent Auto Immune Diabetes of Adults) etc.
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A small proportion i.e. between 10 to 20% of those treated
with OHAs could be requiring insulin injections for control of diabetes
after several years of oral therapy (15-25 years or more) due to "secondary
failure" of OHA or due to complications like nephropathy, renal failure
etc.
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Those who require insulin due to serious
complications like kidney affection (Nephropathy), will require it for
lifetime; but in many instances insulin treatment resorted due to "Secondary
Failure" of drugs could be salvaged back to oral therapy with effective
control of chronic septic foci and some times addition
of alternate modalities in therapy .
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6.It is said that once Insulin,
Always Insulin - Is this true ? |
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Only Type 1 or IDDM require daily
insulin injections for survival, growth and maintaining good health. |
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7. CAN A YOUNG MAN / WOMAN
(25 - 35 Years) MARRY AND LEAD A NORMAL LIFE, IF HE / SHE HAS DIABETES ? |
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Yes, if he / she has Type 2 diabetes
they can marry and lead a normal conjugal life provided: |
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a. They
should be fully educated and aware of the necessity for regular, long term
medical surveillance and control of their diabetes. |
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b. It
is advisable that they do not marry into a family with strong family history
of Diabetes. |
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c. In
Type 1 diabetes (IDDM), it is important that full institutional back-up
support is available to them, before they venture into marriage; also,
they need the full support of the spouse and their family. The Voluntary
Health Services Diabetes Department has experience of looking after over
400 children with IDDM over the past 35 years. Nearly 25 of these have
grown up and married and also begotten healthy children. There have been
occasional (three cases) loss of newborns and correctable congenital defects
(two cases). But the majority of these young IDDM persons have the satisfaction
of being able to live a full life of conjugal satisfaction.
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Type 1 diabetes (IDDM) therefore requires
detailed counselling, long term backup, intensive support, understanding,
courage and above all GOOD LUCK in marriage.
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8. DOES DIABETES CAUSE IMPOTENCE?
IS IT REMEDIABLE OR PERMANENT ? |
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Longstanding diabetes ( duration of 5 to
10 years or more ) can affect the autonomic nervous system and cause Erectile
Dysfunction (ED) or Impotence. It can affect satisfactory conjugal union
in about 25% to 30% of longstanding diabetic males. Till recently there
were many cumbersome and unconvincing modalities of therapy for this condition
and they gave inconsistent results.
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However about 2 years ago (1999) the discovery
of the ORAL THERAPY - SILDENAFIL CITRATE - has radically improved the
quality of life for those with Erectile Dysfunction (Impotence) particularly
in diabetics. The drug is popularly known by the trade name "VIAGRA" in
the USA and other Western Countries. There are many pharma companies marketing
this drug in India. Please Consult your Doctor / Diabetes Specialist before
taking this drug, because It is Contra Indicated in Persons with Coronary
Heart Disease, Angina and those taking nitrates, Low B.P., Past history
of Stroke, Cardiac failure, Retinitis Pigmentosa etc.,. For more info,
visit www.penagra.org
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9. CAN DIABETICS UNDERTAKE "Fasts"
(Prolonged Starvation), STRENUOUS PHYSICAL EXERTION (Like Climbing Mountains
e.g., Thirupathi Hills).
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Religious "Fasts" are common in India both amongst The
Hindus (e.g., Ekadasi) and Muslims (Ramzan Month). So, this question is
frequently addressed to the doctors caring for diabetics.
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In general, prolonged starvation is not good for diabetics,
as fat breakdown will cause acetone to appear in the urine and set up
a vicious cycle of vomiting and more acetone in the urine.
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But in practice, persons with mild to moderate cases
of diabetes who are on diet alone or on oral therapy are able to "keep"
fasts for religious or other reasons successfully with the help of their
doctors / specialists. However it is important that those diabetics who
fast for a long period daily (12 hours as in the month of Ramzan) should
adjust their medications and diet suitably and also keep a closer and
frequent watch of their Blood Sugars, and Urine Sugar / Acetone during
this period.
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10. IF I HAVE HIGH URINE SUGAR (but
normal Blood sugar) DO I HAVE DIABETES? HOW CAN I DIAGNOSE DIABETES WITH
CERTAINTY ?
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Presence of sugar in the urine test (however
high) with normal blood sugar values is not diabetes - it is called RENAL
GLYCOSURIA - a harmless genetic defect where the kidney threshold for
leaking blood sugar (usually 180 mgm / dl or 10 mmol / L) is lowered to
120 mgm / dl or less. No treatment is required for this condition. Diabetes
can be diagnosed with certainty by the Glucose Tolerance Test (GTT), using
75 grams Glucose load in borderline cases.
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The following table
will give the W.H.O. recommended cut off values for Normal, IGT cases and
Diabetes. |
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Glucose concentration, mmol l^1(mg dl-1)
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Venous Whole Blood
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Venous Plasma
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| Diabetes Mellitus |
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| Fasting or |
>6.1 (>110) |
>7.0 (>126) |
| 2-h post glucose load |
>10.0 (>180) |
>11.1(>200) |
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(IGT): |
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| Fasting (if measured) and |
<6.1 (<110)and |
<7.0 (<126)and |
| 2-h post glucose load |
>6.7 (>120) |
>7.8 (>140) |
| Impaired Fasting Glycaemia
(IFG) |
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| Fasting |
>5.6 (>100)and |
>6.1 (>110)and |
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<6.1 (<110) |
<7.0 (<126) |
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However when blood sugar values are very high in both
Fasting state (> 180 mgm / dl or 10 mmol / L) and the Post Prandial state
(> 270 mgm /dl or 15 mmol / L) there is no need to confirm with a G.T.T.
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Again in Type 1 diabetes (IDDM) where blood sugars are very high (e.g.,
Fasting > 250 mgm /dl, Random > 300 mgm / dl and PP >
400 mgm /dl) and acetone may be present in the urine, there is no necessity
for confirming the diagnosis with G.T.T.
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11. IT IS SAID THAT WOUNDS DO
NOT HEAL EASILY FOR DIABETICS - IS IT TRUE? Is it risky therefore for
diabetics to undergo major surgery ?
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Usually diabetics without complications (Like Neuropathy
or Peripheral Vascular Disease) whose blood sugars are reasonably
under "Control" (e.g., Fasting < 140 mgm / dl & PP <
200 mgm / dl) do not have any difficulty in their wounds healing normally,
provided they take usual medical care to cleanse the wounds, avoid infections
and take antibiotics if prescribed by their doctors.
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However when people with "" get injured or develop an infection in their
foot / legs, they have to take special care under the close supervision
of their doctor / specialist / surgeon team.
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Very often Type 2 diabetes may be "discovered" (Detected)
when a middle aged person gets an injury which heals quite easily, but
on a routine test by his doctor he is found to have diabetes. Usually
such patients do not believe that the diagnosis is right and double-check
their tests! Because they believe wounds healing easily and well indicates
non - diabetic state.
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The fact is that usually only in longstanding and uncontrolled
diabetes the body's (White Blood Cell's) capacity to fight external infection
is lowered and also the high tissue levels of sugar act as a good growth
medium for the microbes which flourish and cause severe infection and
consequent complications.
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At the same time, people who have no previous diabetes,
if they have any major injury or infection should always check with necessary
tests to exclude diabetes.
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It is quite safe for diabetics to
undergo any major surgery which is well planned. With the advent of
glucose meter for bedside monitoring of blood glucose, insulin infusion
pump and intensive care facilities, even emergency surgery in diabetes
could be managed satisfactorily averting diabetic complications.
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12. What exactly does the
term diabetic foot mean ? |
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Diabetic foot does not mean the foot of
a person with Diabetes. It is the term used to denote the insensitive
foot (feet) of a diabetic person whose nerves have been affected and sensations
blunted or absent (Neuropathy).The full term for this is Diabetic Neuropathic
Foot. The sensations of touch,pain,heat or cold are not felt easily or
even totally absent (in advanced cases) in their feet ; in very advanced
cases joint sense is also blunted and the foot becomes twisted and distorted
(called CHARCOT'S CHANGES). The diabetic foot is at high risk for injury
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13. My Blood sugar is 110mgm/dl.
Is it normal or abnormal ?
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If you are not a diabetic this blood sugar
at any time of the day (before or after a meal) is NORMAL. If you are
a diabetic and not on any medications, then also it is normal . If you
are a diabetic on medication it is normal for fasting or pre-meal values
, but would be considered slightly low for post-meals (post-prandial)
value ; and you will need to consult your doctor for advice regarding
possible reduction in medication or other adjustments.
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14. My Blood
sugar is 140mgm/dl. Is it normal or abnormal ? |
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If you are not a known diabetic, this would
be a borderline value for post-meal (PP) sample or higher than normal
upper limit (126 mgm/dl or 7 mmol/L) for the fasting value . This will
indicate the need to do a full oral glucose tolerance test (with 75G glucose
load) for making a definitive diagnosis of Diabetes. If you are already
known to have Diabetes and on no medication this is slightly higher for
fasting sample and represents very good control if it is a PP sample.
If you are diabetic on medication the same explanation as above will hold
good. |
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