Four decades ago the adage
"Know Syphilis fully and you will know all about Medicine" was
the medical teaching.
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
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
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.
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.
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
- 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."
Belgian Diabetologist - 1983
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.