Diabetes Management

Diabetes, another name for diabetes mellitus, is a chronic disease characterized by high blood glucose, which results from the failure of the body to provide adequate insulin secretion or inability of cells to utilize the available quantity of insulin, or both. Insulin is a hormone produced by the pancreas that facilitates glucose transport into cells in the bloodstream to be utilized for energy.
If this process is impaired, then glucose builds up in the blood and can cause hyperglycemia. Long-term high blood sugar causes many complications with the heart and nerves, kidneys, as well as vision loss in the affected individual.
A diabetologist is a medical practitioner, specializing in the proper diagnosis, treatment, and management of diabetes. Our panel of expert diabetologists at Marengo Asia Hospitals ensures comprehensive diabetes care with customized treatment plans, advanced therapies, and continuous management for a healthy life.

Types of Diabetes

Diabetes refers to a group of disorders characterized by elevated levels of blood sugar. Type 1 and Type 2 are the most common types, but there are several others that vary considerably in causes and prevalence. Let's understand the types of diabetes:

• Type 1 Diabetes: Type 1 diabetes is an autoimmune condition where the immune system destroys the insulin-producing beta cells in the pancreas. It is a common diagnosis and is seen in children and young adults, with the necessity of lifelong insulin therapy. It accounts for approximately 5-10% of all diabetes cases.
• Type 2 Diabetes: The most common form of diabetes is Type 2, which is mainly caused by insulin resistance and relative insulin deficiency. It is strongly linked to obesity, sedentary lifestyles, and genetic predisposition. It represents more than 90% of diabetes cases globally and is highly prevalent in India due to both lifestyle and genetic susceptibility.
• Gestational Diabetes Mellitus (GDM): GDM arises during pregnancy due to changes in the pattern of hormones that lead to resistance to insulin. Most often, it spontaneously resolves after delivery but predisposes the individual to Type 2 diabetes later in life. In India, GDM incidence is more common than is generally found around the world due to genetic predispositions and the already high rate of Type 2 diabetes at baseline.
• Maturity-Onset Diabetes of the Young (MODY): MODY is a rare, hereditary form of diabetes caused by genetic mutations that impair insulin production. It typically appears in adolescence or early adulthood and can often be managed without insulin. In India, MODY is often underdiagnosed due to similarities with Type 1 and Type 2 diabetes.
• Neonatal Diabetes Mellitus (NDM): Neonatal diabetes mellitus is highly likely to be caused by an underlying monogenic defect when it presents at under 6 months of age. Early identification and expedient genetic analysis are critical in predicting the clinical course.
• Post-Pancreatitis Diabetes Mellitus (PPDM): PPDM develops following chronic pancreatitis, which destroys the pancreas, rendering it unable to produce any insulin. This is the type that occurs in quite significant numbers of Indians because of the prevalence of tropical calcific pancreatitis (a condition linked with malnutrition).
• Brittle Diabetes: Brittle diabetes is not a formally recognized medical condition but is used to describe difficult-to-control diabetes. Medical professionals may also refer to it as labile diabetes or unstable diabetes. It primarily occurs in people who have Type 1 diabetes, but it may also occur in individuals who have insulin-dependent Type 2 diabetes. Brittle diabetes typically develops secondary to other physical and/or mental health conditions.
• LADA stands for Latent Autoimmune Diabetes in Adults: LADA is sometimes referred to as Type 1.5 diabetes, which exhibits features of both Type 1 and Type 2 diabetes. It occurs mainly in adults and progresses slowly, often initially misdiagnosed as Type 2 diabetes.

Complications of Diabetes

Diabetes often leads to many short and long-term complications, mainly because of chronic hyperglycemia. It can have a huge impact on the quality of life and may sometimes be fatal. Some of the complications of diabetes include:
Short-term (Acute) Complications:

• Hyperosmolar hyperglycemic state (HHS): Common among patients with Type 2 diabetes, HHS results from severely elevated blood sugar levels (above 600 mg/dL), associated with significant dehydration, confusion, and even altered consciousness. Its clinical course necessitates prompt intervention with medical treatment.
• Diabetic Ketoacidosis (DKA): A serious complication for the majority of Type 1 diabetics, DKA occurs when the body is without insulin and begins metabolizing fat, producing poisonous ketones. It may cause difficulty breathing, nausea, vomiting, and even unconsciousness, requiring immediate medical treatment.
• Severe Hypoglycemia (Low Blood Sugar): The severe hypoglycemia caused by incorrect intake of insulin or some diabetes drugs may present as blurred vision, sweating, dizziness, confusion, or loss of consciousness. It should be treated promptly with glucose or glucagon.

Long-term (Chronic) Complications:

• Cardiovascular Issues: Diabetes significantly increases the risk of heart-related conditions such as coronary artery disease, heart attack, stroke, and atherosclerosis (narrowing of the blood vessels).
• Nerve Damage (Neuropathy): High blood sugar can impair nerve function, leading to numbness, tingling, pain, and, in severe cases, loss of sensation, particularly in the hands and feet.
• Eye Problems (Retinopathy): Diabetes can lead to damage in the blood vessels of the eyes, increasing the risk of blindness or other serious vision issues.
• Foot Problems: Due to nerve damage and poor circulation, diabetes can cause foot ulcers, infections, and in severe cases, amputations.
• Skin Infections: Individuals with diabetes are more susceptible to infections, particularly in areas like the skin, where poor blood circulation and nerve damage can impede healing.
• Gastroparesis: This condition slows down stomach emptying, leading to digestive problems such as nausea, vomiting, and bloating.
• Hearing Loss: Diabetes can increase the risk of hearing loss due to nerve damage.
• Oral Health Issues: Diabetes raises the risk of gum disease, infections, and other dental problems due to reduced blood flow to the gums and higher blood sugar levels that encourage bacterial growth.

Managing these complications requires a well-rounded approach and diabetologists play a very important role in diagnosing, treating, and preventing the multitude of problems that can arise due to diabetes. The expertise can help address such complications more effectively and eventually improve health and quality of life.

What Are The Various Tests Performed By Diabetologists To Diagnose And Treat Diabetes?

Some of the tests performed by diabetologists to diagnose and treat diabetes include the following:

• Fasting Plasma Glucose (FPG) Test:

The Fasting Plasma Glucose (FPG) test measures the concentration of glucose in the blood after an overnight fast of at least 8 hours. It is mainly used for the diagnosis of diabetes and prediabetes. At the time of taking this test, a healthcare provider will draw a blood sample in the morning before you have eaten. Elevated fasting glucose may be a sign that your body is not utilizing glucose effectively, which is a hallmark of either diabetes or insulin resistance. A result that is above the normal range may warrant further testing to establish a diagnosis, and this is the most frequently used screening test for diabetes.

• HbA1C Test (Hemoglobin A1c):

The HbA1c test, commonly known as the glycated hemoglobin test, measures your average levels of blood glucose over the past two to three months. It measures the amount of glucose attached to the hemoglobin in your red blood cells. This test is non-fasting and can be taken at any time of day. It is often used not only for the diagnosis of diabetes but also for monitoring long-term blood sugar control in people who are already diagnosed with diabetes. Normally, an HbA1c level of 6.5% or greater would indicate diabetes and any value between 5.7% and 6.4% may be an indicator of prediabetes.

• Oral Glucose Tolerance Test (OGTT):

The Oral Glucose Tolerance Test is a more complex test to determine how your body can process glucose. For this, one needs to fast overnight, and the next morning, blood is drawn. Then you'll have to take a sugary liquid containing a standard dose of glucose. At intervals of usually an hour or two after glucose solution intake, blood samples are drawn to measure how the body responds to sugar intake. The OGTT is particularly useful for diagnosing gestational diabetes in pregnant women and for confirming a diagnosis of Type 2 diabetes especially when other tests do not yield positive results.

• Blood Sugar Test:

The random blood sugar test measures your blood glucose at any time of the day, irrespective of what you have eaten. This test is applied when a patient complains of excessive thirst, constant urination, unexplained weight loss, and other similar symptoms that point to diabetes. A blood sample is drawn, and the glucose level is tested immediately. While this test is great in diagnosing diabetes, it is not as exact as other tests like the fasting plasma glucose or HbA1c test because there are instances when random fluctuations in blood sugar can happen due to stress or illness.

• Serum Fructosamine Test:

The serum fructosamine test measures fructosamine in the blood. It is a compound that is formed by a chemical reaction when glucose binds to a protein, such as albumin. It may be particularly helpful for patients with disorders involving abnormalities that could potentially affect red blood cells (e.g., anemia) or for people who have recently altered their diet or diabetes medication. Testing for fructosamine can be an important means of getting information on the patient's recent control of blood sugar levels and guiding treatment decisions.

• Perception Threshold (VPT) or Biothesiometry Testing:

VPT, or Biothesiometry, tests nerve sensitivity to vibrations, mainly to detect diabetic neuropathy. A device emits vibrations on the skin, usually on the feet, and the patient reports when they feel it. An increased threshold indicates nerve damage, often a sign of early diabetic neuropathy.

• Ankle Brachial Index (ABI):

The ABI test measures the blood pressure of the ankle and the arm to detect peripheral artery disease, which is one of the most common complications for patients with diabetes. An abnormally low score of the ABI (below 0.9) indicates reduced circulation through narrowed or blocked arteries and increases the risk of heart disease.

These tests will help a diabetologist accurately diagnose diabetes and customize treatment plans in order to prevent complications. The skilled diabetologists at Marengo Asia Hospitals
use advanced tests, providing comprehensive care and treatment tailored to meet the individual needs of the patients in managing their diabetes.

Comprehensive Diabetes Management at Marengo Asia Hospitals

At Marengo Asia Hospitals, diabetes management is approached through a multi-faceted and person-centered strategy of lifestyle modification, medications, and cutting-edge technologies aimed at delivering optimal care with an enhanced quality of life for the patient. Here's a breakdown of the key components of diabetes management at the hospital:

Lifestyle Modifications:

• Dietary Counseling: Diet plays a vital role in the management of diabetes. Diabetes educators and dieticians at Marengo Asia Hospitals give individualized dietary advice on controlling blood sugar levels, weight loss, and hormonal balance. Patients are advised to take low-carb diets and reduce sugar intake while incorporating high-fiber diets to enhance insulin sensitivity and control blood sugar levels.
• Avoiding Harmful Foods: The hospital strongly advises against processed foods including refined flours, reheated oils, and other processed foods that promote a negative impact on metabolism as well as on the blood glucose level.
• Exercise Programs: Exercise is one of the most important interventions in the management of obesity and insulin sensitivity. It includes brisk walking, strength training, as well as other exercise programs specifically tailored to assist patients in shedding extra weight while improving glucose absorption. This is essential for long-term diabetes management and metabolic health.
• Balanced Meals: It focuses more on including vegetables, lean proteins, and healthy fats while cutting down on more processed foods to assist with the maintenance of healthy blood glucose levels and good health.
• Weight Loss Strategies: Weight loss is highly encouraged, especially in patients with early-stage diabetes since losing weight improves insulin sensitivity and may even reduce drug utilization. The management program for obesity through scientific interventions under the supervision of trained professionals is offered at Marengo Asia Hospitals to both diabetic and nondiabetic patients.

Medications:

• Insulin Therapy: Insulin is essential for the management of Type 1 diabetes and for advanced Type 2 diabetes. It is administered via injections or through insulin pumps, keeping blood glucose tightly controlled as it mimics the natural release of body insulin.
• Oral Hypoglycemic Agents: For Type 2 diabetes, oral drugs are commonly prescribed as part of treatment for managing blood glucose levels. These are:

• Biguanides (e.g., Metformin) to reduce insulin resistance.
• Sulfonylureas, which allow the pancreas to secrete higher amounts of insulin.
• Gliptins :they increase release of insulin in glucose dependent manner.
• SGLT2 Inhibitors: inhibit glucose reabsorption in the kidneys
• Alpha-glucosidase inhibitors manage blood sugar levels by impacting carbohydrate digestion and absorption.
• Oral GLP-1 analogs like Semaglutide: that reduce appetite

For patients with multiple comorbid cardiovascular conditions, SGLT2 inhibitors and GLP-1 receptor agonists may be prescribed, as they provide additional cardiovascular, renal (kidney), liver health improvement and even weight loss benefits in addition to better glucose control.

Cutting-Edge Innovations

• Continuous Glucose Monitors (CGM): Marengo Asia Hospitals uses CGMs, through which the real-time data on blood glucose levels enable more accurate and timely management of diabetes. This technology helps both patients and healthcare providers monitor and adjust treatments effectively.
• Insulin Pump: In combination with CGMs, insulin pumps are used to deliver insulin throughout the day. This can provide a more precise control over blood glucose levels.