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Diabetes Mellitus is a syndrome with disordered metabolism and inappropriate hyperglycaemia due to either a deficiency of insulin secretion or a combination of insulin resistance and inadequate insulin secretion. Diabetes mellitus (DM) has many subclassifications, including type 1 DM, type 2 DM, maturity-onset diabetes of the young (MODY), gestational diabetes, and steroid-induced diabetes. Type 1 and 2 DM are the main subtypes, each with different pathophysiologies, symptoms, and management. Genetic and environmental factors combine to cause both insulin resistance and beta cell loss. Obesity is the most important environmental factor causing insulin resistance.
Symptoms of Diabetes Mellitus:
- Polyuria – Increase urination
- Polydipsia – Increase thirst
- Unexplained hunger
– Losing Weight
– Symptoms due to macro and micro vascular complications
Prevention:
Healthy weight through a healthy diet and staying physically active are the mainstay preventive principles for Diabetes Mellitus. A Whole Food Plant based diet, which focuses on whole grains, lots of fruits and vegetables, omega-3 rich Polyunsaturated fats, antioxidant and fiber rich diets, has shown to not only prevent Diabetes but also help reverse insulin resistance. In patients with obesity – weight reduction by caloric restriction is an important goal of the diet. “Eat Food, Not too much, Mostly Plants” by Michael Pollan, sums it up!
These lifestyle measures have shown to improve glycaemic control and lower combined points for cardiovascular and stroke events. The current recommendations for saturated fats and dietary cholesterol intake for people with diabetes are the same as the general population. Saturated fats should be limited to less than 5-6% of daily calories and dietary cholesterol should be at the least amount possible. Dietary protein should be maintained at the recommended daily allowance of 0.8 gm/kg/day.
What can you do?
Substitute your meals with:
- Fiber rich whole grains like red or brown rice, unpolished millets, steel cut oats, broken wheat.
- Vegetarian protein including lentils,legumes and sprouts
▪ Eat the rainbow-include many different colors of fruits and vegetables and greens.
▪ Avocados, Nuts and seeds rich in omega-3
▪ Cook mostly by boiling, steaming and stews.
Cut down on:
- Saturated fats and cholesterol by avoiding cream, cheese, sauces, mayonnaise, animal foods etc.
- Refined carbohydrates and simple sugars like pastries and pies, sodas and sweets.
- Packaged and processed foods.
- Processed meats and red meats like beef, lamb, cold cuts, ready-made burgers.
- Cooking with oils, deep frying, high heats.
Physical Activity
Physical activity of at least 150 minutes/week of moderate exercise or 75 minutes of vigorous exercise has shown to prevent Diabetes. However, it is to be remembered that any amount of exercise is still useful, so KEEP MOVING! Sedentary lifestyles and prolonged sitting are added risk factors for cardiovascular disease.
Low Salt
A high intake of salt is not good for your heart as it leads to high blood pressure and heart diseases. Therefore, to reduce it, cut down all processed food from your diet and when buying frozen vegetables, choose those that are labelled as “fresh frozen”.
Medications for Diabetes Mellitus
If you can’t maintain your target blood sugar level with diet and exercise, your doctor may prescribe diabetes medications that help lower sugar levels.
Drug treatments for type 2 diabetes include the following.
Metformin (Fortamet, Glumetza, others) is generally the first medication prescribed for type 2 diabetes. It works primarily by lowering glucose production in the liver and improving your body’s sensitivity to insulin so that your body uses insulin more effectively.
Sulfonylureas help your body secrete more insulin. Examples include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl).
Glinides stimulate the pancreas to secrete more insulin. They’re faster acting than sulfonylureas, and the duration of their effect in the body is shorter. Examples include repaglinide and nateglinide
Thiazolidinediones make the body’s tissues more sensitive to insulin. Examples include rosiglitazone (Avandia) and pioglitazone (Actos).
DPP-4 inhibitors help reduce blood sugar levels especially post meals. They tend to have a modest effect. Examples include sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta).
GLP-1 receptor agonists are injectable medications that slow digestion and help lower blood sugar levels. Their use is often associated with weight loss, and some may reduce the risk of heart attack and stroke. Examples include Dulaglutide and Exenatide (Byetta)
SGLT2 inhibitors affect the blood-filtering functions in your kidneys by inhibiting the return of glucose to the bloodstream. As a result, glucose is excreted in the urine. These drugs may reduce the risk of heart attack and stroke in people with a high risk of those conditions. Examples are Dapagliflozin and Empagliflozin.
Other medications in addition to diabetes medications include blood pressure and cholesterol-lowering medications, as well as low-dose aspirin, to help prevent heart and blood vessel disease.
Insulin therapy
Some people who have type 2 diabetes need insulin therapy. In the past, insulin therapy was used as a last resort, but today it may be prescribed sooner if blood sugar targets aren’t met with lifestyle changes and other medications.
A well-balanced, nutritious diet and staying physically active remains the fundamental element of therapy for Diabetes Mellitus. These factors have been shown to be more effective than the medication Metformin, in the Diabetes Prevention Program.
