Q. 1. What is diabetes, how it is caused?
Diabetes is a metabolic disease, due to deficiency of insulin or its inadequate action. Insulin is a hormone produced by B cells of pancreas, a gland situated behind stomach. It is no fault of yours that you got diabetes. It is equally common both in male and female.

Q. 2. What is the significance of sugar (glucose) in blood?
When we eat food, it is first digested, i.e. starch is converted to glucose which is absorbed into blood for circulation. This circulating glucose which is the vital source of energy for all the cells of our body is really the life line. It has to be kept within a range so that it is available all the time, whether we are eating or not. Insulin regulates its range, the normal is 80-140 mg. %.

Q. 3. Why does sugar go up in urine or blood?
Insulin helps in utilization of glucose by the cells and its storage if there is any excess. When there is deficiency of insulin, excess glucose in blood is neither utilized by the cells nor stored, the main sites being in the liver or muscles. The result is that blood glucose level goes up, whenever it crosses 180 mg. % (normal kidney thresh-old) levels, it appears in urine.

Q. 4. Can the blood glucose be lower than 80 mg. %?
Yes, it can. Whenever there is excess of insulin (either in response to tablets of diabetes or if injected) blood glucose can be lower than 80 mg. %. If it goes down lower than 50 mg. % one becomes unconscious, as brain cells are totally dependent on glucose for its functioning. One can recover very fast if glucose is given by mouth or in serious state through vein for immediate result.

Q. 5. When do we say that a person is suffering from diabetes?
Diagnosis of diabetes is based on blood glucose levels. In normal person blood glucose level in fasting state should be 60-110 mg/dl and after any meal (or 75 g glucose by mouth called post prandialor PP) it should remain < 140 mg/dl if fasting blood glucose exceeds 126 mg/dl after meals or PP it exceeds 200 mg, person has diabetes. If fasting is between 110-126 mg/dl and PP 140-200 mg/dl we say that person is having impaired glucose tolerance (IGT).

Q. 6. Is impaired glucose tolerance (IGT) a disease state?
In real sense no, as sometimes it can revert to normal, and remain so for years. But there are equal chances that one may become frank diabetes in future. In 1GT state too one can have diabetic complications, so it should not be neglected; in fact with little attention both diabetes and its complication can be reversed.

Q. 7. If once a diabetic, is it lifelong?
Yes, diabetes is not cured, it can be only controlled. But a well controlled diabetic patient is as good as a normal person. They can live a normal span of life, can pursue any profession, and enjoy a normal life, so many have done it, you too can.

Q. 8. What could be the symptoms of diabetes? How to identify it?
Diabetes may occur without any symptoms, or with some vague symptoms like fatigue, not feeling too well, minor loss or gain in weight, or frequent common ailments. But its classical symptoms are frequent urination, increased thirst, loss of weight, and weakness. It is because of excess sugar in blood, which appears in urine causing more urination. The earliest indication is when you have to get up more often during night to pass urine or need to drink more water.

Q. 9. What are the uncommon forms of presentations of diabetes?
Many a times classical symptoms may not be there, some complications may be in the fore front, like appearance of carbuncle, itching in private parts, severe chest or urine infection, or vision problems. One must be vigilant to confirm diabetes in such situations, as its treatment may not be effective.

Q. 10. Diabetes runs in family, what is its relevance?
Diabetes is an inherited disease. If one parent is diabetic, chances are that 12-20% children may get diabetes, if both parents are diabetic chances increase to 30-50% or even more. One inherits the trait to become diabetic; other environmental factors which can precipitate it are like
• Overweight,
• Physical inactivity,
• Stressful life style,
• Unbalanced diet,
• Some viral infections etc.
If there is any member in the family diabetic, all others should be cautious and avoid these risk factors.

Q. 11. How often other family member of diabetic patients should get themselves checked?
The first degree relatives of diabetic patients should get themselves checked once in a year after the age of 35 years. They must keep an eye on vague symptoms, un-explained weight gain or loss or some uncommon symptoms as well.

Q. 12. Is diabetes of same type in all?
No, diabetes is of two types, Type 1, which occurs in younger age group, they are severely deficient in insulin, the symptoms are classical, and they can survive only with insulin. Type 2 diabetes occurs in older age group (>35 yrs.), symptoms may or may not be there, in them insulin is primarily not so effective, later they too have less insulin. They can control their disease with diet adjustment, regular exercises or some oral tablets, but later on insulin may be needed.

Q. 13. Is Type 2 diabetes less severe?
No, they may have less symptoms or even no symptoms, the course of the disease is not so stormy, they may be easily controlled, but their disease is no less severe. They are exposed to same chronic complications of diabetes such as heart attack, stroke, kidney failure, loss of vision, r gangrene. It should never be taken less seriously.

Q. 14. Why is prevalence of diabetes increasing?
It is a very disturbing fact that diabetes is increasing world over at an alarming speed, more so in developing countries According to W.H.O. by 2025 India will have the maximum number of diabetic patients (57 out of 300 million) throughout the world. The main reasons seems to be rapid urbanization and its associated stress, change of life style, less physical activities, wrong food and expo-sure to infection and toxic substances.

Q. 15. Can diabetes be prevented?
In Type 1 diabetes, since there is autoimmune destruction of 11 cells, only if some triggering mechanism like certain virus infection can be checked, there is a chance to prevent it, there is a larger scope in prevention of Type 2 diabetes as majority of risk factors can be controlled. No doubt these are tedious, prolonged and need lot of will power. If not totally preventable, at least onset of diabetes can be postponed for a decade or two.

Q.16. If not cured, what is meant by controlled?
Ideal control of diabetes ensures a normal life, it should be attempted earnestly. An ideal control means
i. symptom free survival
ii. Normal growth and development
iii. Normal demographic parameters like weight according to height, body mass index and waist hip ratio
iv. Normal blood pressure (< 140/90 mm of Hg)
v. urine free of sugar, albumin and ketones
vi. Normal blood glucose Fasting, PP, Random, HbA1c
vii. Normal lipid profile:
Cholesterol, triglycerides, HDL, LDL
viii. Normal kidney functions reflected by negative micro albuminuria, normal blood urea and creatinine
ix. Evaluation of retinal changes, heart functions like ECG, Treadmill test, and echocardiography, or any neuro-logical changes.

Q. 17. What is diabetic discipline?
Living in a natural way is the ideal i.e. getting up and sleeping in time, eating a balanced diet at regular intervals, working methodically and exercising regularly disciplines our system too. Occasional deviation can be taken as a challenge. But if life style is totally hay wire, body after some times fails to adjust. The result is disturbed metabolism, and if there is inherited trait as well, it results in diabetes mellitus. In the beginning by adjusting the diabetic discipline it can be reversed, but later when tablets or insulin are required, diabetic discipline still plays an important role in achieving a good control of diabetes. It should be made a part of life.

Q. 18. What has weight to do with diabetes?
A healthy body weighs within a normal range according to height, which indicates proportional weight of bone, muscle and distribution of fat. Whenever one is over-weight, it is mainly due to collection of fat (except in body builders) or if under-weight there is loss of muscle tissue. Obesity or extra fat cause’s insulin resistance i.e. same amount of insulin is now unable to keep blood glucose within normal range. Once this extra weight is lost, blood glucose becomes normal. Alternatively one may require more tablets or insulin to keep the blood glucose normal. It will further enhance insulin requirement. If any patient is progressively gaining weight (over and above their normal), either patient is
i. taking more food than needed or
ii. Not exercising enough or
iii. Taking more tablet or insulin than required or
iv. Suffering from some other conditions like under active thyroid or
If someone is progressively losing weight, it indicates
i. Diabetes remains uncontrolled or
ii. Drug or insulin is not enough or
iii. Taking less food than required or

Q.19. Why does one feel weak in diabetes?
Although there is excess of glucose in circulating blood, the main source of energy, it is not available to the cells because of insulin deficiency, therefore cells are starving even in presence of excess, the cells convey it as if short of energy i.e. weakness.

Q. 20. What happens when cells are starving of glucose?
When blood glucose is high as it cannot enter the cells for production of energy due to deficiency of insulin, cells starts using fat as source of energy for survival. In such situations some by products like ketones get accumulated, which may be harmful.

Q. 21. How to recognize that sugar is not being utilized by the cells?
Urine test for ketones (with Gluketur strips) confirms this condition. It should not be taken lightly; it can lead to serious condition like diabetic coma. This condition can be reversed with insulin treatment.

Q. 22. What is meant by a balanced diet?
Human body needs a diet which is perfect in all respects, i.e. a balanced diet. It has the following component:
i. It should be palatable and well distributed in 24 hours
ii. Adequate amount of calories according to weight, growth & development, age, type of activities needed
iii. Enough carbohydrates i.e. starch
iv. Right amount of proteins as needed in different conditions
v. Rest as fat
vi. Vitamins and minerals
Food should be distributed as
Bed tea
Breakfast           8-9 am
Midmorning          11 am
Lunch                1-2 pm
Evening tea           5 pm
Dinner               8-9 pm
Bed time             11 pm

Q. 23. Should the diabetic patients change from their conventional diet?
No, it is not needed, it just requires some modification. We do not insist rice eaters to change to wheat, nor vegetarian to become non-vegetarian, or change the cooking oil or condiments they are used to. It is not practical, nor patients will comply with, it is really not required.