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),