Keep Calm And Cure Diabetes

Diabetes mellitus is the third leading cause of death (after heart disease and cancer) in many developed countries. The complications of diabetes affect the eye, kidney and nervous system. Diabetes is a major cause of blindness, renal failure, amputation, heart attacks and stroke.


Diabetes mellitus is a clinical condition characterized by increased blood glucose level (hyperglycemia) due to insufficient insulin. In other words, insulin is either not produced in sufficient quantity or inefficient in its action on the target tissues. As a consequence, the blood glucose level is elevated which spills over into urine in diabetes mellitus.



Classification of Diabetes Mellitus-

Diabetes mellitus is broadly divided into 2 groups -

1. Insulin-dependent diabetes mellitus (IDDM)

2. Non-insulin dependent diabetes mellitus (NIDDM)




1. Insulin-dependent diabetes mellitus (IDDM)

IDDM, also known as type I diabetes or (less frequently) juvenile onset diabetes, mainly occurs in childhood (particularly between 12-15 yrs age). IDDM accounts for about 10 to 20% of the known diabetics. This disease is characterized by almost total deficiency of insulin due to destruction of beta-cells of pancreas. The beta-cell destruction may be caused by drugs, viruses or autoimmunity. Due to certain genetic variation, the beta-cells are recognized as non-self and they are destroyed by immune mediated injury. Usually, the symptoms of diabetes appear when 80-90% of the beta-cells have been destroyed. The pancreas ultimately fails to secrete insulin in response to glucose ingestion. The patients of IDDM require insulin therapy.

2. Non-insulin dependent diabetes mellitus (NIDDM)

NIDDM, also called type II diabetes or (less frequently) adult-onset diabetes, is the most common, accounting for 80 to 90% of the diabetic population. NIDDM occurs in adults (usually above 35 years) and is less severe than IDDM. The causative factors of NIDDM include genetic and environmental. NIDDM more commonly occurs in obese individuals. Over-eating coupled with underactivity leading to obesity is associated with the development of NIDDM. Obesity acts as a diabetogenic factor and leads to a decrease in insulin receptors on the insulin responsive (target) cells. The patients of NIDDM may either normal or even increased insulin levels. Many a times weight reduction by diet control alone is often sufficient to correct NIDDM.

Management of Diabetes

Diet, exercise, drug and, finally, insulin are the management options in diabetics. Approximately, 50% of the new cases of diabetes can be adequately controlled by diet alone, 20-30% need oral hypoglycemic drugs while the remaining 20-30% require insulin.


Dietary management

A diabetic patient is advised to consume low calories (i.e. low carbohydrate and fat), high protein and fiber rich diet. Carbohydrates should be taken in the form of starches and complex sugars. As far as possible, refined sugars (sucrose, glucose) should be avoided. Fat intake should be drastically reduced so as to meet the nutritional requirements of unsaturated fatty acids. Diet control and exercise will help to a large extent obese NIDDM patients.

Hypoglycemic drugs

The oral hypoglycemic drugs are broadly of two categories- sulfonylureas and biguanides. The latter are less commonly used these days due to side effects.

Management with Insulin

Two types of insulin preparations are commercially available - short acting and long acting. The short acting insulins are unmodified and their action lasts for about 6 hours. The long acting insulins are modified ones (such as adsorption to protamine) and act for several hours, which depends on the type of preparation.