Diabetes is a chronic syndrome and occurs due to an imbalance between fats, sugars and proteins due to the deficiency of insulin or tissue insensitivity(resistance) to insulin.
Insulin is made by β-cells in the pancreas. In type 1 diabetes, there is a complete lack of insulin due to autoimmune destruction of these cells or a defective formation of the pancreas congenitally. In type 2 diabetes, there is either a deficiency of insulin due to poor functioning of β-cells or loss of tissue sensitivity to insulin.
The symptoms of diabetes are due to excess glucose in the blood which cannot be taken up by the cells without insulin. This excess glucose reaches the kidney and osmosis causes excess water to drain out. This leads to polyuria (increased micturition or urination), dehydration, increased electrolyte disturbances.
Vascular complications represent the continuum of diabetes mellitus. Hyperglycemia causes inflammation and formation of glycated end-products. This ultimately leads to changes in the macrovascular wall causing coronary artery disease due to atherosclerosis, stroke or retinopathy, neuropathy and nephropathy when microvasculature is affected.
The diabetic complications are dangerous and progressive. It’s important to combat the disease from every angle. This means a three-pronged approach of medication, diet and exercise must be adopted. The role of food and sedentary lifestyle cannot be ignored and is the primary reason for the rising numbers of diabetes in India.
It’s a simple theory that if excess carbohydrates (sugars) are consumed then excess amount of it will be in the blood. There will be poor effect of medication and doses would have to be continually increased if a patient does not eat a well-balanced diet.
Exercise plays a significant role in preventing and controlling diabetes. Carbohydrates are a source of energy and when you exercise you need to utilize that energy. This is why a sedentary lifestyle is ill-advised.
There is a belief among some patients that once a diagnosis of diabetes is made, they can continue to live their life as before as long as they take their medication regularly. There is enough research that proves the efficacy of combined diet and exercise and medication over only medication in the management of diabetes. Infact there are certain cases where diet and exercise alone can help to keep diabetes in check. The American Diabetes Association recommends nutrition therapy as an effective component of a comprehensive treatment plan1.
If the diet and exercise portion of the management is ignored, then a steady increase in dosage, constant addition of new medicines and an increased risk of the extreme forms of diabetes like hyperosmolar coma or diabetic ketoacidosis occurs. This is expensive, ineffective and dangerous. On the contrary, when lifestyle changes are made and sugar levels are brought under control, a gradual decrease in medication can be considered.
Attain individualized glycemic, blood pressure, and lipid goals. General recommended goals are as follows:
Diabetes is a complex disease affecting the arteries of almost all the organs and once diagnosed can only be controlled. Hence, a holistic management is necessary to be able to live a healthy life with a chronic disease like diabetes. Always remember “ A moment on your lips is forever in your arteries!”.
(Dr Syed Iftikhar Ali is a doctor by profession. He completed his MBBS from King George Medical University, Lucknow and his MS in general surgery from Jhansi Medical College in 2013. He has more than 7 years of work experience in the field of medicine.)
 Evert et al ,Diabetes Care. 2013 Nov; 36(11): 3821–3842. Published online 2013 Oct 15. doi: 10.2337/dc13-2042
 Evert AB, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37(Suppl 1):S120-S143