Doctors speak

Dr Dwarkanath CS, senior consultant endocrinology, Apollo Hospitals and Dr Saumeel Mehtalia, diabetologist give us a brief overview on diabetes

By Zoha Tapia

What is diabetes?
Dr Mehtalia: Diabetes is a group of disorders characterised by an abnormal metabolism resulting in high glucose levels with or without symptoms as a result of insulin deficiency or insulin resistance or both.

What are the causes?
Dr Mehtalia:
There are numerous factors leading to diabetes like genetic factors, sedentary lifestyle, obesity, food habits, viral infections, drugs and pancreatic disorders. All these factors ultimately lead to progressive destruction of the pancreatic B cells leading to insulin deficiency, insulin resistance or both.

What are the different types of diabetes?
Dr Mehtalia:
There are 4 types of diabetes

  • Type 1 diabetes: An auto immune process or a viral infection of pancreatic B cells leading to its complete destruction and thereby insulin deficiency.
  • Type 2 diabetes: A consequence of primarily progressive insulin deficiency and insulin resistance or both.
  • Gestational diabetes: Diabetes occurring after 14-16 weeks of pregnancy
  • Others: These include pancreatic disorders, drugs induced diabetes and genetic variance

How can one diagnose diabetes?
Dr Dwarkanath:
Type 2 diabetes mellitus, which accounts for about 95 percent may remain asymptomatic for long periods of time. Hence, it is always preferable to screen for this condition. This is especially important in people who are at risk.  Diabetes can be detected in many patients with a routine testing. Typical symptoms are excessive urination especially more at night, excessive thirst, weight loss, and excessive hunger, delayed wound healing, numbness or burning sensation of feet and persistent, recurrent infections.

Laboratory finding of random blood glucose of 200mg/dl or more with typical symptoms is suggestive. An FBS of more than equal to 126mg/dl or post meal glucose of more than or equal to 200mg/dl which can be confirmed by repeat testing. A single test - Glycosylated haemoglobin done in a standardised method has also been proposed. It is yet to be accepted in all places.

What is the treatment process?
Dr Mehtalia:
Lifestyle modification, daily exercise and avoiding junk, fried or oily food is an important aspect of treatment. Drugs like sulphonylureas, metformin, glitazones, DPP4 inhibiytors, GLP1 analogues and insulin is to be had as prescribed by your doctor.

What lifestyle changes are needed to keep the blood sugar level at normal?
Dr Dwarkanath:
The first thing a diabetic patient is advised is to reduce weight and increase activity. A proper diet, which is applicable to the patient in his condition, should be advised. The diet should consider the weight reducing aspect, lipid levels and other factors. Patient and his family members should be involved in this process and a diet should be tailor-made for that patient. 

Exercise is an equally important aspect of management of diabetes mellitus. Advantages of regular physical exercise should be properly explained so that the patient is convinced about it. He can also be advised about changes in his day to day activity, which can increase his calorie burning like avoiding lifts, increase movement in office etc.

Advice regarding quitting smoking, moderation in alcohol, avoidance of tobacco in any form, good control of hypertension should be given and closely followed up.

When conservative measures fail to achieve the target levels of blood glucose then medications will be used.  Medications could be either oral medications or Insulin.  This should be under proper supervision.

How often must one get their blood sugar level checked?
Dr Dwarkanath:
Monitoring of blood glucose and other parameters depends on the patient. In a person who is well controlled and has stable glucose levels blood glucose and Glycosylateed haemoglobin can be measured once in three or four months. In a person who has poor control the monitoring should be more frequent. Self home blood glucose monitoring will add to better control of glucose levels.

Picture credit: Karen barefoot

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