Society - - NOVEMBER 2014 100 -

more than 300 mil­lion peo­ple suf­fer­ing from di­a­betes glob­ally, this en­tity can­not be con­sid­ered any­thing less than an epi­demic. With the cur­rent trend of in­creas­ing in­ci­dence, the to­tal num­ber of peo­ple with di­a­betes is go­ing to touch more than 500 mil­lion by 2025, ac­cord­ing to Dr Deepak Chaturvedi, MD (Medicine) Meta­bolic Physi­cian, En­docri­nol­o­gist, Di­a­betol­o­gist, An­ti­ag­ing Spe­cial­ist and Bari­a­tri­cian. For a mat­ter of un­der­stand­ing, di­a­betes may be con­sid­ered as the body’s in­abil­ity to utilise blood sugar and hence fac­ing the con­se­quences of high blood sugar lev­els (glu­co­tox­i­c­ity) . Di­a­betes should not be con­sid­ered as a sin­gle clin­i­cal en­tity. With the spec­trum of meta­bolic, bio­chem­i­cal, en­docrine and other sys­temic in­volve­ment, di­a­betes needs to be taken as a ‘Spec­trum of Dis­eases’. The meta­bolic ef­fect of di­a­betes does not re­strict to only at glu­cose reg­u­la­tion ab­nor­mal­i­ties. It causes ad­verse fat (lipids) and pro­teins me­tab­o­lism, lead­ing to dele­te­ri­ous ef­fects of the body by lipo­tox­i­c­ity and pro­teins loss.

Broadly, there are two groups of di­a­betes mel­li­tus:

In­sulin de­pen­dent di­a­betes (Type 1Di­a­betes) Non-in­sulin de­pen­dent di­a­betes (Type 2 Di­a­betes) Ul­ti­mately, all di­a­bet­ics lead to the state of in­sulin de­pen­dence. Con­ven­tion­ally, Type 1 di­a­bet­ics were lean and Type 2 di­a­bet­ics were obese. But now, a big group of lean peo­ple with di­a­betes type 2 has been iden­ti­fied. The causes of di­a­betes are multi-fac­to­rial: - Ge­netic/Hered­i­tary - Life­style - Diet - Au­toim­mu­nity - In­fec­tions - In­flam­ma­tion - Drug in­duced ( oral con­tra­cep­tive pills) A seden­tary life­style with/with­out a high sugar/fat diet in­creases the po­ten­tial of de­vel­op­ing di­a­betes mul­ti­fold in both ge­net­i­cally vul­ner­a­ble and non vul­ner­a­ble pop­u­la­tion. Tra­di­tion­ally, di­a­betes pathol­ogy is re­lated with hy­per­glycemia be­cause of in­sulin de­fi­ciency/in­sulin re­sis­tance. But now, other hor­mones are also im­pli­cated in the patho­gen­e­sis of di­a­betes and its com­pli­ca­tions. The im­por­tant ex­tra in­sulin hor­mones im­pli­cated in di­a­betes are glucagon, cor­ti­sol, DHEA, testos­terone, growth hor­mone, es­tro­gen, pro­ges­terone, thy­roid and cat­e­cholamines—th­ese are di­rectly or in­di­rectly as­so­ci­ated with di­a­betes out­comes. High testos­terone lev­els in women and low testos­terone lev­els in men are as­so­ci­ated with ad­verse out­comes in di­a­betes mel­li­tus and meta­bolic syn­drome. Sim­i­larly, low estra­diol lev­els in women and high estra­diol lev­els in men are as­so­ci­ated with ad­verse out­comes. The other mod­ern day epi­demic, obe­sity, is also as­so­ci­ated as bidi­rec­tional with di­a­betes mel­li­tus type 2. Obe­sity in­creases the risk of in­sulin re­sis­tance/ Type 2 di­a­betes mel­li­tus and vice versa. More im­por­tantly, the obese Type 2 di­a­betes mel­li­tus pa­tients have more com­pli­ca­tions in terms of car­diac and en­docrine health. Di­a­betes mel­li­tus is a chronic, pro­gres­sive spec­trum of dis­eases which in­volves al­most ev­ery or­gan of the body. It’s one of the most com­mon causes of pre­ma­ture aging. In a nat­u­ral course of the un­con­trolled di­a­betes, or­gans like the kid­neys (nephropa­thy/ chronic kid­ney dis­ease), eyes (retinopa­thy/ early cataract), ner­vous sys­tem (neu­ropa­thy),

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