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  Diabetopaedia.com--Frequently Asked Questions
 

 
 
1. IS DIABETES A HEREDITARY DISEASE ?
 
 

Yes, Type-2 diabetes (Adult onset type) is genetically transmitted through a process called recessive trait. Maturity onset diabetes of the young (MODY) Viz. Type 2 occurring below 25 years is hereditary and transmitted by an autosomal dominant gene through three generations (Mason-type of MODY); but there are other genetic subtypes, recently described amongst this group
- Childhood diabetes.
Type 1 diabetes (Juvenile-onset type) is not strictly a hereditary disorder and is not passed on from parent to off spring.

There are some rare genetic syndromes associated with diabetes in children which are conveyed through a recessive trait -eg. Prader-Willi syndrome, Refsum's disease, DIDMOAD syndrome, Freidrich's ataxia, etc.
 
     
  2. IF MY PARENTS/RELATIVES HAVE DIABETES, WHAT ARE MY CHANCES OF GETTING IT ?

 
  If both parents are diabetic the chances are more than 99%; such persons are termed as genetic prediabetics (or) offsprings of conjugal diabetes (OCD).
 
 
If one parent and one second-degree relative have diabetes - 70% Risk.
If one parent positive - 60% Risk.
If two second degree relatives positive (From both paternal and maternal side) - 40% Risk
If one second degree relative positive - 30% Risk.
If two cousins (3rd degree relatives from both maternal and paternal sides) - 20%.
If one cousin positive - 10%
If no known family history - 5%
 
     
 
All the above estimated risk percentages are approximate and obtained from our personal practice data over the past 35 years. These are not absolute and will vary from place to place and from country to country. They do not indicate when or at what age a person with risk will develop diabetes (see Question no. 3).
 
     
  3. WHAT ARE THE RISK FACTORS FOR DEVELOPING DIABETES ?  
     
  a) Heredity  
  b) Obesity /over weight (Particularly visceral (inner abdominal fat)obesity)  
  c) Sedentary habit  
  d) Sudden severe emotional stress, accidents etc.,  
  e) Frequent pregnancies, multiple gestation (Twins/ Triplets etc)  
  f) Delivering overweight babies (over 4 kgs) and still birth (Intra uterine demise of fetus)  
  g) Gestational diabetes (Diabetes detected for the first time during pregnancy - about 40% of these may develop diabetes within 7 years of delivery).  
  h) Drugs - Like Thiazide diuretics, steroids (cortisone) etc.,  
  i) Acute infections and critical illnesses eg., Jaundice (Hepatitis), Myocardial infarction (Heart attack), Pancreatitis etc.  
 
j) Toxins - Ingestion of certain substances (accidental or intentional) like organo- phosphorous compounds, or those which may release minute amounts of streptozotocin within the body eg. some variety of preservatives specifically damage the pancreatic Beta cells and lead to diabetes
 
     
  4. ONCE A DIABETIC, ALWAYS A DIABETIC -  
  (a) IS THIS STATEMENT TRUE ?  
  (b) IS THERE A "CURE" FOR DIABETES ?  
     
     
 
a. This is true of type -1 or IDDM : please read our introduction to understand. The condition called diabetes Type 2, strictly speaking, is primarily not a disease - it is a disorder. If we can bring 'order' by early detection and correction through diet, exercise, weight correction etc, the disorder can be reversed in a majority of individuals. But it is a two-way street. It can again pop up its head when body conditions get reversed. So we can't really look for a 'cure' for a condition like diabetes, which is present within us from the womb, manifests clinically (i.e. comes out as a clinically detectable disorder) at some stage in our life depending upon many interacting host and environmental factors, and may progress to create complications (or) regress to remission, which could be called "Temporary Cure". To hold the remission (Cure) in place for several years or a lifetime requires careful surveillance and a good degree of luck! Diabetes is thus a life-long Companion - Condition rather than a disease or disorder and it is up to the individual to keep it like the former rather than the latter.
 
     
 
b. As of date there is no "Cure" for diabetes since this is a complex genetically transmitted disorder and manifests at variable periods in the life of various persons.A variety of environmental factors and internal trigger factors play key roles in bringing out the clinical condition and its complications. Hence, until a fuller understanding of the genetic aspect is gained, any approach to finding a "cure" for diabetes on the basis of drug interventions is unlikely to succeed.
 
     
  5. DOES DIABETES ALWAYS REQUIRE DRUG TREATMENT ?  
     
 
a. Upto 40% Type - 2 diabetes can be controlled with diet, exercise and lifestyle modifications, especially when they are Detected Early, Motivated and Sustained Properly and Compliant Regularly; a small proportion of these may even show Remission (Temporary Cure).
 
     
 
b. About 45% to 55% of people with Type 2 diabetes may require ORAL DRUGS for maintaining good control. Again if they are regular in their approach to therapy and follow-up, a proportion - 10% to 20% - of these people could go off drugs for varying lengths of time.
 
     
 
c. 5% to 10% of Type 2 diabetes patients may require insulin injections for control of diabetes at discovery due to various reasons like infection, auto immune causes (e. g. Latent Auto Immune Diabetes of Adults) etc.
 
     
 
A small proportion i.e. between 10 to 20% of those treated with OHAs could be requiring insulin injections for control of diabetes after several years of oral therapy (15-25 years or more) due to "secondary failure" of OHA or due to complications like nephropathy, renal failure etc.
 
     
 
Those who require insulin due to serious complications like kidney affection (Nephropathy), will require it for lifetime; but in many instances insulin treatment resorted due to "Secondary Failure" of drugs could be salvaged back to oral therapy with effective control of chronic septic foci ( Dental Problems & Diabetes) and some times addition of alternate modalities in therapy (Ayurveda & Diabetes).
 
     
  6.It is said that once Insulin, Always Insulin - Is this true ?  
     
  Only Type 1 or IDDM require daily insulin injections for survival, growth and maintaining good health.  
     
  7. CAN A YOUNG MAN / WOMAN (25 - 35 Years) MARRY AND LEAD A NORMAL LIFE, IF HE / SHE HAS DIABETES ?  
     
  Yes, if he / she has Type 2 diabetes they can marry and lead a normal conjugal life provided:  
     
  a. They should be fully educated and aware of the necessity for regular, long term medical surveillance and control of their diabetes.  
  b. It is advisable that they do not marry into a family with strong family history of Diabetes.  
 
c. In Type 1 diabetes (IDDM), it is important that full institutional back-up support is available to them, before they venture into marriage; also, they need the full support of the spouse and their family. The Voluntary Health Services Diabetes Department has experience of looking after over 400 children with IDDM over the past 35 years. Nearly 25 of these have grown up and married and also begotten healthy children. There have been occasional (three cases) loss of newborns and correctable congenital defects (two cases). But the majority of these young IDDM persons have the satisfaction of being able to live a full life of conjugal satisfaction.
 
     
 
Type 1 diabetes (IDDM) therefore requires detailed counselling, long term backup, intensive support, understanding, courage and above all GOOD LUCK in marriage.
 
     
  8. DOES DIABETES CAUSE IMPOTENCE? IS IT REMEDIABLE OR PERMANENT ?  
     
 
Longstanding diabetes ( duration of 5 to 10 years or more ) can affect the autonomic nervous system and cause Erectile Dysfunction (ED) or Impotence. It can affect satisfactory conjugal union in about 25% to 30% of longstanding diabetic males. Till recently there were many cumbersome and unconvincing modalities of therapy for this condition and they gave inconsistent results.
 
     
 
However about 2 years ago (1999) the discovery of the ORAL THERAPY - SILDENAFIL CITRATE - has radically improved the quality of life for those with Erectile Dysfunction (Impotence) particularly in diabetics. The drug is popularly known by the trade name "VIAGRA" in the USA and other Western Countries. There are many pharma companies marketing this drug in India. Please Consult your Doctor / Diabetes Specialist before taking this drug, because It is Contra Indicated in Persons with Coronary Heart Disease, Angina and those taking nitrates, Low B.P., Past history of Stroke, Cardiac failure, Retinitis Pigmentosa etc.,. For more info, visit www.penagra.org
 
     
 
9. CAN DIABETICS UNDERTAKE "Fasts" (Prolonged Starvation), STRENUOUS PHYSICAL EXERTION (Like Climbing Mountains e.g., Thirupathi Hills).
 
     
 
Religious "Fasts" are common in India both amongst The Hindus (e.g., Ekadasi) and Muslims (Ramzan Month). So, this question is frequently addressed to the doctors caring for diabetics.
 
 
In general, prolonged starvation is not good for diabetics, as fat breakdown will cause acetone to appear in the urine and set up a vicious cycle of vomiting and more acetone in the urine.
 
 
But in practice, persons with mild to moderate cases of diabetes who are on diet alone or on oral therapy are able to "keep" fasts for religious or other reasons successfully with the help of their doctors / specialists. However it is important that those diabetics who fast for a long period daily (12 hours as in the month of Ramzan) should adjust their medications and diet suitably and also keep a closer and frequent watch of their Blood Sugars, and Urine Sugar / Acetone during this period.
 
     
 
10. IF I HAVE HIGH URINE SUGAR (but normal Blood sugar) DO I HAVE DIABETES? HOW CAN I DIAGNOSE DIABETES WITH CERTAINTY ?
 
     
 
Presence of sugar in the urine test (however high) with normal blood sugar values is not diabetes - it is called RENAL GLYCOSURIA - a harmless genetic defect where the kidney threshold for leaking blood sugar (usually 180 mgm / dl or 10 mmol / L) is lowered to 120 mgm / dl or less. No treatment is required for this condition. Diabetes can be diagnosed with certainty by the Glucose Tolerance Test (GTT), using 75 grams Glucose load in borderline cases.
 
     
  The following table will give the W.H.O. recommended cut off values for Normal, IGT cases and Diabetes.  
 
Glucose concentration, mmol l^1(mg dl-1)
 
Venous Whole Blood
Venous Plasma
Diabetes Mellitus
Fasting or >6.1 (>110) >7.0 (>126)
2-h post glucose load >10.0 (>180) >11.1(>200)
Impaired Glucose Tolerance (IGT):
Fasting (if measured) and <6.1 (<110)and <7.0 (<126)and
2-h post glucose load >6.7 (>120) >7.8 (>140)
Impaired Fasting Glycaemia (IFG)
Fasting >5.6 (>100)and >6.1 (>110)and
<6.1 (<110) <7.0 (<126)
 
 
However when blood sugar values are very high in both Fasting state (> 180 mgm / dl or 10 mmol / L) and the Post Prandial state (> 270 mgm /dl or 15 mmol / L) there is no need to confirm with a G.T.T.
 
 
Again in Type 1 diabetes (IDDM) where blood sugars are very high (e.g., Fasting > 250 mgm /dl, Random > 300 mgm / dl and PP > 400 mgm /dl) and acetone may be present in the urine, there is no necessity for confirming the diagnosis with G.T.T.
 
     
 

11. IT IS SAID THAT WOUNDS DO NOT HEAL EASILY FOR DIABETICS - IS IT TRUE? Is it risky therefore for diabetics to undergo major surgery ?

 
 

 

 
 

Usually diabetics without complications (Like Neuropathy or Peripheral Vascular Disease) whose blood sugars are reasonably under "Control" (e.g., Fasting < 140 mgm / dl & PP < 200 mgm / dl) do not have any difficulty in their wounds healing normally, provided they take usual medical care to cleanse the wounds, avoid infections and take antibiotics if prescribed by their doctors.

 
 

 
 

However when people with "Diabetic Foot" get injured or develop an infection in their foot / legs, they have to take special care under the close supervision of their doctor / specialist / surgeon team.

 
 

 
 

Very often Type 2 diabetes may be "discovered" (Detected) when a middle aged person gets an injury which heals quite easily, but on a routine test by his doctor he is found to have diabetes. Usually such patients do not believe that the diagnosis is right and double-check their tests! Because they believe wounds healing easily and well indicates non - diabetic state.

 
 

 
 

The fact is that usually only in longstanding and uncontrolled diabetes the body's (White Blood Cell's) capacity to fight external infection is lowered and also the high tissue levels of sugar act as a good growth medium for the microbes which flourish and cause severe infection and consequent complications.

 
 

 
 

At the same time, people who have no previous diabetes, if they have any major injury or infection should always check with necessary tests to exclude diabetes.

 
 

 
 

It is quite safe for diabetics to undergo any major surgery which is well planned. With the advent of glucose meter for bedside monitoring of blood glucose, insulin infusion pump and intensive care facilities, even emergency surgery in diabetes could be managed satisfactorily averting diabetic complications.Diabetes & surgery

 
     
  12. What exactly does the term diabetic foot mean ?  
     
 

Diabetic foot does not mean the foot of a person with Diabetes. It is the term used to denote the insensitive foot (feet) of a diabetic person whose nerves have been affected and sensations blunted or absent (Neuropathy).The full term for this is Diabetic Neuropathic Foot. The sensations of touch,pain,heat or cold are not felt easily or even totally absent (in advanced cases) in their feet ; in very advanced cases joint sense is also blunted and the foot becomes twisted and distorted (called CHARCOT'S CHANGES). The diabetic foot is at high risk for injury

 
     
  13. My Blood sugar is 110mgm/dl. Is it normal or abnormal ?

 
 
If you are not a diabetic this blood sugar at any time of the day (before or after a meal) is NORMAL. If you are a diabetic and not on any medications, then also it is normal . If you are a diabetic on medication it is normal for fasting or pre-meal values , but would be considered slightly low for post-meals (post-prandial) value ; and you will need to consult your doctor for advice regarding possible reduction in medication or other adjustments.
 
     
  14. My Blood sugar is 140mgm/dl. Is it normal or abnormal ?  
     
 
If you are not a known diabetic, this would be a borderline value for post-meal (PP) sample or higher than normal upper limit (126 mgm/dl or 7 mmol/L) for the fasting value . This will indicate the need to do a full oral glucose tolerance test (with 75G glucose load) for making a definitive diagnosis of Diabetes. If you are already known to have Diabetes and on no medication this is slightly higher for fasting sample and represents very good control if it is a PP sample. If you are diabetic on medication the same explanation as above will hold good.


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