Sedantary lifestyles and diabetes

Increasingly sedentary lifestyle, and high carbohydrate diets are leading to not just diabetes but also obesity and hypertension says Dr. Shyama Subasinghe MBBS (Colombo) Hon MD (SL) Consultant Physician Sri Jayewardenepura General Hospital . She obtained her overseas training at Redland hospital Brisbane Australia. She has presented her research in several national and international fora and authored the book SUwabara Mahluviyak

What is Diabetes?

Diabetes is a disease condition where the living being can’t maintain the blood sugar levels within the normal range and it remains elevated. Usually this is due to insulin deficiency or insulin resistance.

Sedentary lifestyles and High Carbohydrate diets are leading to diabetes obesity, hypertension explain?

There is a disease entity called metabolic syndrome. In this condition an individual has several or all the below mentioned conditions Obesity, Hypertension, diabetes, fatty liver, polycystic ovarian syndrome. A sedentary lifestyle pre-disposes to this by increasing insulin resistance in the body.

Can Type 2 diabetes be reversed?

Dr. Shyama Subasinghe

Type 2 Diabetes is usually not curable but controllable. In a newly diagnosed patient, there can be a temporary remission, and this is called honeymoon period, but careful regular monitoring of blood sugar is needed because majority of these people again develop high blood sugar values which needs to be controlled promptly. With good lifestyle modification, Diabetic diet, regular exercises and weight reduction certain individuals will be able to reduce or stop their diabetic medication altogether. This is not a true cure for diabetes because these individuals also develop high blood sugar levels with time.

How has the prevalence been evolving over the years and how do you explain the continuous growth?

Yes, unfortunately diabetes prevalence and incidence both are increasing despite all the measures we have taken up to date. Non adherence to health advice is the major reason. The percentage of people who are doing regular exercises is very low. And most of the people still live a sedentary lifestyle and the majority are consuming unhealthy diets. The stress level of the community has gone up with the very competitive lifestyle. Maternal obesity is identified as the independent risk factor for future development of diabetes in the offspring. Usage of certain medications like steroids and antipsychotics also contribute to increasing prevalence.

Any new innovations in the field of diabetes treatment?

Diabetic medications are divided into two major categories. Insulins and non-insulin hypoglycemic drugs. There are modern recombinant insulins available. Rangers from ultra short acting to intermediate, long and very long-acting ones making the diabetic control easier. We still do have very old oral medications like metformin, Gliclazide and acarbose. Newer medications (GLP-1 agonist, DPP-4 inhibitors, SGLT-p2 Inhibitors) has become the groundbreaking drugs due to its effect on the diabetic control and their favourable effects on the cardiovascular and renal function.

What are diabetic complications?

Diabetic complications can be divided into acute and long-term complications. DKA (Diabetes keto acidosis), HHS (Hyperglycemic hyperosmolar state) and hypoglycemic coma are some of the common acute complications. Long term diabetic complications can be divided into macro vascular or micro vascular complications. Ischemic heart disease, Stroke (CVA) and peripheral arterial disease (PAD) are the macro vascular complications of diabetes. Retinopathy, Neuropathy and nephropathy are micro vascular complications. Diabetic retinopathy is sight threatening. Therefore, every individual with diabetes should visit their eye surgeon annually. Diabetic neuropathy can affect the central as well as the peripheral nervous system. Meticulous blood sugar control is essential to prevent this complication. Diabetic nephropathy can lead to end stage renal failure requiring dialysis.

Yes, depending on the blood sugar fluctuations, escalations and de-escalation of the treatment is needed. Depending on other comorbidities, treatment changes need to be made. depending on the renal and liver functions drugs need to be changed accordingly.Now we have very long-acting insulin which needs to be injected once a week. It is good for people like travellers, mountain climbers and pilots. Insulin pumps that can detect patient own blood sugar and adjust the insulin rate accordingly are available now. They switch off the insulin delivery when the blood sugars are low there by preventing hypoglycemic coma. Nasal and oral insulins are on the way to making a happy life for patients with needle phobia. Isolated pancreatic transplant or combined pancreatic and renal transplant is the way forward for certain individuals with diabetes.

Stress causes diabetic ?

Long term stress is a well-recognized risk factor for the development of diabetes. Even short-term stress associated with acute medical conditions are known to elevate blood sugar levels.

Difference between adult diabetes and Juvenile diabetes ?

Adult diabetes is type 2 diabetes. It is due to insulin resistance. It can be managed with oral hypoglycemic drugs initially, eventually they also develop insulin deficiency requiring insulin treatment. Young Diabetes is type 1 diabetes. It is due to insulin deficiency. They need insulin from the beginning. Certain young individuals develop MODY (Maturity onset diabetes in young.) They behave like adult type 2 diabetes and can be managed with oral diabetic drugs. Rarely adults can develop type 1 diabetes then it is called LADA (Late onset Autoimmune Diabetes in Adults.). They need insulin from the beginning.

Do people with diabetes need to change their medicines over time?

Diabetic medications should go hand in hand with regular exercises, good diet control and stress reduction.Have your meals and medicines on time .Eat equal amounts every day. If you eat more and larger quantities, sugar will go up, if you eat less sugar will go down this will lead to derangement of human body’s metabolism,then your eyes and nerves get affected. Relax all the time. Consult your doctor immediately if you feel ill or discomfort any time.