Diabetes is a major risk factor for kidney disease
By Dr. Pankaj Aneja
Every year the number of diabetics increase at an alarming rate worldwide. The growing figures are not just shocking but it’s also posing the greatest challenge to the healthcare industry. According to the International Diabetes Federation (IDF), there are some 387 million diabetics worldwide and this number is expected to shoot up to 592 million by 2035 out of which India alone is expected to have some 50 million cases. And, that’s what makes us the diabetes capital of the world!
Basically, diabetes burden which also increases the economic burden in India results from various factors which include genetic makeup, modern lifestyle that is a combination of poor diet, sedentary lifestyle and lack of exercise, etc.
And what makes the situation worse is that more than 50% of people with diabetes in India remain undiagnosed. Be it due to lack of awareness or lack of resources. These individuals are also at danger mark for developing diabetes-related complications like CAD, cerebrovascular, or PVD and diseases like retinopathy, nephropathy, and neuropathy, etc.
However, if the past two decades have witnessed an increase in the number of diabetes patients, there has been some exciting advancements in the field of improved medications and new treatments due to a better understanding of the disease. In fact, the newer drugs available in form of injectable and oral anti-diabetes drugs are safer and have better control over the disease. These new class of medications are intended to boost insulin production, lower insulin resistance, reduce the production of glucose by the liver or slow down the absorption of carbohydrates by the intestine. In addition, most of these drugs are effective enough to restore normal blood glucose levels, and they do not have any effect on the progression of the disease. But again, their effect may vary from a patient to patient depending on the type or severity of diabetes.
However, the latest advancement in terms of anti-diabetes drugs is encouraging – better treatment options, improved monitoring devices and an understanding of how diet and exercise can impact diabetes are adding up to the positive outcomes for patients. But the decision about which medications are best suited depends on factors like, a patient’s blood sugar level and health history, etc.
Use of Insulin and Other injectable Drugs
Diabetes and insulin always go together. Basically, insulin is a hormone that utilizes the glucose from food so as to provide us energy. In type 2 diabetes, the pancreas either cease to make enough insulin or there is resistance to the effects of insulin or both. The treatment typically begins with oral metformin, a veteran drug that is considered to be the backbone of many diabetes treatment regimens. From there, different drug classes may be added to metformin, and for some patients, the use of insulin may become necessary.
In the past, insulin therapy was used as a last resort, but these days it’s often prescribed at an earlier stage because of its benefits. In fact, it is must for the survival of people whose pancreas stop making insulin. Approximately 40-60% of type 2 diabetes patients use insulin to survive. So, advancement in insulin treatment benefits many diabetics, especially the ones with type 2. In newly diagnosed patients with type 2 diabetes, use of short-term insulin can prove beneficial but it has to be accompanied by a strict diet and regular exercise program.
In terms of new additions, the last one decade has witnessed new types of insulin flooding into the markets. These are variations of injectable insulin.
Apart from syringe, there’s an insulin pen injector, which is a device that looks similar to an ink pen, except that the cartridge has to be filled with insulin.
Besides, a totally different form of insulin, which is inhaled human insulin is the recent advancement. It is rapid-acting insulin which a patient can inhale for instant relief.
In terms of other injectable drugs meant for diabetics, until recently all we had was insulin, but of late, there are various new additions that mimic natural hormones other than insulin. These hormones have different roles and additional benefits.
The drugs in this category aid in the regulation of blood sugar, appetite, losing weight, which can be beneficial for type 2 diabetes patients.
If you are diagnosed with diabetes then devoid of what medicines you have been prescribed, keeping a constant check on your blood sugar level every now and then is of utmost importance. Roughly two decades back people with diabetes monitored their disease with urine strips. Then with the advent of blood sugar monitor things became easier as people could then monitor their blood sugar levels as many times a day. However, the newest addition to this area has been the continuous glucose monitoring (CGM) device which has a tiny sensor that sits under your skin and it continually keeps a check on your sugar levels. It’s convenient as you can even set alarms for low and high levels. It’s a wonderful invention as this can save life of people who can’t sense when their blood sugar levels drop down.
If you have type 2 diabetes and your body mass index (BMI) is greater than 35, then you may be at a higher risk of developing cardiac or Kidney infections. Hence for your well being, it is advisable for you to consider weight-loss surgery. Post surgery not only your sugar levels will return to normal but it will help you lead a normal healthy life. But before going ahead consult with your Diabetologist as there are certain risks involved with this surgery.
Nonpharmacologic Therapy in Diabetes
Apart from taking antidiabetic medicines, lifestyle modifications are necessary for the management of diabetes. This includes healthy eating, not skipping meals, regular exercise, stress management, and avoidance of tobacco/alcohol. The aim of dietary management is to achieve and maintain ideal body weight, and desirable lipid profile.
Also, regular exercise has shown improvement in blood glucose levels, reduction in cardiovascular risk factors helps in weight loss, and above all improve total well-being.
Diabetics and Pregnancy
Women with type 2 diabetes need to be extra careful while they are pregnant as they may need to alter their treatment during pregnancy. women require insulin therapy during pregnancy.cholesterol-lowering medications and some blood pressure drugs can’t be used during pregnancy.
If a woman has symptoms of diabetic retinopathy, it may worsen during pregnancy, therefore, it is advisable to visit an ophthalmologist during the first trimester and also at one year postpartum.
Dr. Pankaj Aneja, Senior Consultant – Diabetes & Metabolic Diseases Max Super Speciality Hospital, Shalimar Bagh