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Sixth most affected disease in the world- Diabetes

14th November is celebrated as World Diabetes Day. diabetes refers to a group of diseases that affects how our body uses blood sugar (glucose). Glucose is vital to our health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain’s main source of fuel.

Pancreas is situated in the abdomen, behind the stomach and duodenum (first part of small intestine). It can broadly be divided into 2 parts; the acini and the islets of Langerhans.

Diabetes mellitus is characterized by high blood glucose level resulting from defects in insulin secretion, insulin action, or both. Insulin is a hormone necessary for use and/or storage of body fuels (carbohydrate, protein, and fat). It acts like a key. It unlocks cells to let in glucose from blood to make energy. Sometimes, this lock-and-key process doesn’t work. Then glucose builds up in the blood, even when the body produces more insulin.

Immediately after a high carbohydrate meal, the glucose that is absorbed into the blood causes rapid secretion of insulin from the beta cells of islets of Langerhans in the pancreas. The insulin in turn causes rapid uptake, storage, and use of glucose by almost all tissues of the body, but especially by the muscles, adipose tissue and liver.

● The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014. Prevalence has been rising more rapidly in low- and middle-income countries than in high-income countries.

● Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.

● Between 2000 and 2016, there was a 5% increase in premature mortality from diabetes.

● In 2019, diabetes was the ninth leading cause of death with an estimated 1.5 million deaths directly caused by diabetes.

● A healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.

● Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications.

Insulin resistance is said to occur when the body is able to produce insulin but is unable to respond to its effects, leading to build-up of glucose in the blood. This is seen in prediabetes , type 2 diabetes and gestational diabetes mellitus. Hyperglycemia induced beta cell dysfunction ultimately leads to the death of beta cells, leading to insufficient insulin production. Insulin resistance is demonstrated first in target tissues, mainly muscle, liver, and adipose cells.

Initially there is a compensatory increase in insulin secretion (hyperinsulinemia), which maintains glucose concentrations in the normal or prediabetic range. Insulin resistance demonstrated at the adipocyte level, leads to lipolysis and an elevation in circulating free fatty acids. In particular, excess intra abdominal obesity, characterized by an excess accumulation of visceral fat around and inside abdominal organs, results in an increased flux of free fatty acids to the liver, leading to an increase in insulin resistance. Increased fatty acids also cause a further decrease in insulin sensitivity at the cellular level, impair pancreatic insulin secretion, and increase hepatic glucose production. The above defects contribute to the development and progression of T2DM and are also primary targets for pharmacologic therapy.

The metabolic syndrome (MetS) or Syndrome X is a group of risk factors. MetS raises the risk of an individual developing atherosclerosis. Cardiovascular disease (CVD), Diabetes Mellitus, and Cerebrovascular Accident (CVA). an individual is diagnosed with MetS if any three of the following risk factors are present;

A large waistline or also known as abdominal obesity or ‘having an apple shape’

Obesity is diagnosed using waist circumference and not BMI as waist circumference has been shown to better correlate with visceral adiposity and insulin resistance as well as the development to T2DM. waist circumference more than 35 inches in men and 32 inches in women.

Waist-to-height ratio has been demonstrated to be superior to waist circumference and BMI as a screening tool for cardiometabolic risk factors (diabetes, hypertension, cardiovascular disease, and all outcomes) as well as predicting visceral adipose tissue mass.

Elevated triglyceride levels [>150 milligrams per decilitre of blood (mg/dl)].

Reduced-high density lipoprotein cholesterol (HDL) less than 40mg/dl in men or less than 50mg/dl in women.

High blood pressure - systolic 130 mmHg or higher and/or diastolic 85 mmHG or higher

Impaired Fasting Glucose -elevated fasting glucose of 100 mg/dl or greater

Thanks Giving

This article is written and submitted to The E Today by Shrushti Mehta.

We thank her for her research and analysis and hope to see the awareness about health and nutrition being spread ahead to larger mass of our citizens.

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