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Four decades ago the adage "Know Syphilis fully and you will know all about Medicine" was the medical teaching.

Today with significant advances in therapeutics, this paradigm is truly reflective of Diabetes mellitus - a metabolic disorder which is herido-familial with complex genetic transmission (recessive trait as in type 2 Diabetes Mellitus and autosomal dominant as in M.O.D.Y.). Type 1 Diabetes Mellitus (IDDM) is what is called true primary insulin deficient diabetes and is currently thought to be caused by a process of auto destruction of the insulin producing Beta Cells of the pancreas. This type of Diabetes occurs in very young children & adolescents (age 1 year - 15 years) and requires insulin injections - one, two or more times daily for survival, growth and normal activities.

It is very interesting and pertinent to note that the incidence of type 1 or Juvenile Diabetes is 20 to 30 times more in Western/developed countries - viz. 10% of all Diabetes - than in India, China and Japan - where it affects one in 200 persons with Diabetes (< 0.5% of all Diabetes). This aspect of the epidemiology and causation of Juvenile diabetes affords a perfect platform for Research in our country into the true nature of Juvenile diabetes.

The prevalence of Diabetes Mellitus, particularly the Type 2 (adult-onset, Non insulin Dependent Diabetes Mellitus - NIDDM) in the world, is close to 150 million and is continually increasing with increase in longevity, changes in lifestyle, environment, ecological factors, and dietary habits.

It is important to appreciate that diabetes is not a single organ or system-specific disorder. It is not an infection or inflammation caused by microbial organisms, viruses, parasites or fungi. It involves a complex interaction of the body's internal milieu, which is kept in a state of equilibrium, (termed the normal metabolic status) from the energy obtained by the utilization of ingested food, muscular activity, and disposal of waste products by the excretory system (kidneys). The hormone insulin and the integrity of its action at the tissue level are essential for maintaining this equilibrium. The vital centers in the Brain (Hypothalamus), the autonomic nervous system, the Gastro Intestinal System (specially the Liver and the Pancreas),the circulatory system especially the macro and micro circulation, the tissue receptors, endocrine glands - Thyroid and Pituitary - all these have to function smoothly and in harmony to keep the body metabolism in the normal groove.

Any deficiency or defect at any one or more levels, starting with insulin, can cause a derangement of the metabolic jigsaw and result in diabetes (IDDM) type I or type 2 (NIDDM) or other types. Diabetes Mellitus is thus not merely an elevated blood sugar level in the body (or) a disorder of only the Carbohydrate metabolism, but truly it is the bio-chemical (later clinical) manifestation of the derangement in the various regulatory and counter-regulatory mechanisms in the body. Diabetes mellitus can be stated to start with altered fat metabolism (liver / adipocyte) progressing to altered carbohydrate metabolism (Digestive system, the lactate metabolism and the peripheral tissue receptors) and also affecting the protein metabolism (Anabolic and catabolic) in which the kidneys play an important role. Thus Diabetes has the potential to structurally and functionally damage the micro and macro vascular system, the Nervous System, loco motor system, the Eyes, Kidneys, the Heart as well as the epidermis (skin) and the other organs.

It takes months or years for the metabolic jigsaw to get deranged. For normalizing the deranged metabolism, a multipronged approach is required, which would help the regulatory processes in the body to put the jigsaw back in alignment. This takes time and understanding the basic pathophysiology of the human body and its reaction to the environmental forces.

The following inputs are required to correct the deranged Diabetic Jigsaw:

  • Defining the philosophy and lifestyle of the affected individual and discussing the possible changes that would benefit the person in the long-term.
  • Assessment of Dietary and nutritional habits and helping the affected individuals on the required modifications, again with a view to their long-term practicability and application.
  • Physical exercise and its incorporation into daily life style - this has to be individualized.
  • Drug Therapy - Insulin, Oral agents and co-agents - individualized approach.
  • Treating Concurrent Illnesses - (Co-morbid conditions) appropriately
  • Stress Management and Relief Measures.
  • Educational Efforts in the individual for enhancing the understanding of the disorder, its long-term surveillance, self-monitoring and self management modules to be optimized, so that the affected persons would be able to seek medical help and intervention early, for any complications, thus significantly reducing the morbidity and possible mortality.

" Do not trust Schemes or Classifications too much. After all a patient has a right to be himself regardless of the pattern he should fit into in accordance with your theories."

Jean Pirart
Belgian Diabetologist - 1983

Finally it is very important and encouraging to realize that diabetes and its major complications are almost always (except in very rare instances) reversible in the early and even moderately advanced stages. Even in the late stages, they are manageable with reasonable improvement in the quality of life. Thus the Onus of Living a Healthy and Full Life with Diabetes primarily rests with the affected Individual, who should first understand the disorder fully, and be able to respond to the medical plan adequately, so that he/she could derive the full benefit of the advances that we have today in the therapeutic armamentarium, to tackle Diabetes Mellitus and its protean complications successfully.

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