Bioenergy Conservation and Diabetes mellitus

Diabetes mellitus (DM) is related to common metabolic disorders and is expressed by hyperglycemia (i.e. elevated level of glucose in blood). There are a variety of DM and are caused by complex interactions of genetics and environmental factors. In fact DM is a sort of lifestyle associated metabolic disorder. Sedentary lifestyle, over indulgence in alcohol and excessive consumption of fatty fast-food laced with preservatives are the cause of excessive conservation of bioenergy in human body. One should be calorie conscious and take balanced diet to avoid getting obese and over weight. Obesity is an invitation to metabolic disorders.
Non-insulin dependent diabetes mellitus (NIDDM) is also known as diabetes-II (or Type-II Diabetes, where as Diabetes-I is insulin dependant) and is characterized by variable degree of insulin resistance and pancreatic beta cell dysfunction. Loss of metabolic control is probably associated with neuroendocrine control system that effect hepatic glucose output. Computerization and automation in industrial units is the cause of bioenergy conservation in workers, leading to metabolic disorders like diabetes mellitus. Low energy expenditure due to leisure-way lifestyle and reduced sensitivity to peripheral insulin further complicate the case. Vascular complications associated with DM lead to morbidity and mortality in patients with diabetes mellitus. Energy expenditure needs to be increased in diabetics by way of exercise; brisk walking and cycling.  Optimum energy expenditure in diabetics can act as adjunct to reduce the level of hyperglycemia.

Understanding Obesity

Basically the term obesity means excess of body weight due to increase in adipose tissue-mass. It is important to understand the cause of obesity for its effective management. Weight measures in excess of 'ideal body weight' with reference to normal range ideal for age, sex, height and body built. To define obesity we should measure the adiposity by measuring the skinfold thickness at triceps (normal: 23mm in males and 27mm in females) or at inter scapular region (normal: 35mm in males and 42mm in females). In most of the cases the obesity is due to overeating while in minority it could be associated with the metabolic and endocrine disorders. Beyond certain degree, obesity may increase the state of morbidity and cause associated diseases like diabetes mellitus, hypertension, coronary artery disease (CAD), gall stones, osteoarthritis etc.

Understanding patient's eating habits, likes & dislikes, temperaments, lifestyle, work schedules and adaptability to environment are important to decide a course of treatment. Compliance of doctor's advice is important for effective treatment of obesity. Dietary measurements, exercise and slimming pills are always helpful in controlling the obesity. Treatment of associated metabolic or endocrine disorders should be pursued effectively.

Dietary management:

A variety of dietary schedules ranging from zero calorie to isocaloric high protein diets are available for the treatment of obesity. Diet should be adjusted in such a way that weight loss is not in excess of one kg/week. For the success of diet regime it is important to keep a balance between 'forbidden' and 'permitted' items. Too much recommendation of low carbohydrate diet sometimes leads to a notion that non-carbohydrate diets are absolutely harmless. Rapid weight loss through zero calorie diet or fasting may sometimes be non productive as the weight lost due to loss of water would be regained quickly. The 'ad lib' items should be salads and leafy vegetables.

Exercise:

Exercise is known to increase calorie expenditure and thus leads to loss of adiposity. Exercise also increases our metabolic rate and thus supports the weight loss. In practice, however, exercise alone cannot be sufficient way to try to reduce weight. Exercise along with dietary control is good for both the general fitness and weight loss.

Anti-obesity drugs:

There are a variety of drugs for combating the food-obesity axis. There are drugs for decreasing appetite, digestion, absorption and inhibiting lipogenesis. There drugs for increasing heat production or thermogenesis. The drug treatment of obesity is not very promising, as the majority of drugs at effective therapeutic level have been found toxic.

Diabetes and Pregnancy

Pregnancy brings a sea change in the metabolism in pregnant women. Your bodyhas to produce extra insulin to meet the requirements of your body during pregnancy, especially from 4^th month onwards. Hormonal changes during pregnancy may interfere with the insulin function and if your body can't cope with the situation, you may develop gestational diabetes. Women with family history of diabetes mellitus, older mothers and obese women are at the risk of developing gestation diabetes mellitus (GDM). The diabetes mellitus in pregnancy could be classified as pre-gestational or gestation diabetes mellitus. One out of fourteen cases of pregnancy may develop GDM in second or third trimester of pregnancy due to effect of placental hormones. Ideally, all pregnant women should be tested to rule out gestation diabetes. The routine examination of urine for sugar, on every visit to the gynaecologist could give an indication about onset of gestation diabetes and need for further investigations and medication. If elevated level of blood sugar is observed on random blood sugar (RBS)investigation, one should go for glucose tolerance test (GTT). Diabetic mothers need extra care to prevent spontaneous abortion and malformations in infants. Babies born to diabetic women, who were diabetic before they became pregnant, would have a greater risk of health problems, if diabetes was poorly controlled. Babies grow bigger in diabetic expectants due to extra sugar crossing the placenta and may make labour and delivery more difficult. Periodic screening, dietary control and proper medication are must to avoid GDM associated complications in expectant mothers and babies born.

All Diabetics are not Alike!

All diabetics are not alike, so never take medicines for diabetes on the advice of fellow patients. The term diabetes means inordinate and persistent excretion of excessive volume of urine. Diabetes is a disease of carbohydrate metabolism with a variety of causes. Pancreas is directly associated with carbohydrate metabolism and biobalance of blood sugar (glucose) level. All carbohydrates (starches, polysaccharides, disaccharides and monosaccharides) are converted into glucose in our stomach and small intestine, absorbed in blood and taken to liver for storage in liver cells as glycogen for future use. Glycogen is also stored into muscle cells and utilized for muscle function. Insulin produced by the beta-cells in the pancreas helps in the penetration of glucose into liver and muscle cells and further storage as glycogen. Glucagon produced by alpha-cells of the pancreas regulates the conversion of glycogen in glucose through glycogenolysis, when ever glucose level in the blood falls below normal.

Defective metabolism of carbohydrates may lead to alimentary diabetes. The term diabetes insipidus pertains to a condition characterized by excessive intake of water with excessive urination but without any glycosuria (excretion of glucose in urine). Diabetes insipidus due to congenital failure of renal tubules to respond to anti-diuretic hormone (ADH) is termed as diabetes insipidus nephrogenic. Diabetes mellitus (DM) is a condition characterized by an elevated level of sugar (glucose) in blood and urine. Diabetes mellitus may affect both younger (juvenile diabetes) and older people (maturity onset diabetes). Subclinical diabetes refers to a condition where glucose tolerance test is abnormal but clinical signs of diabetes like polyuria (excessive urination with increased frequency of micturition), hunger, thirst and weight loss are absent. Obesity may be associated with diabetes but all obese people could never be diabetics. Fat metabolism is also impaired in diabetes which may lead to hypercholesterolemia and hypertension (high blood pressure) in diabetics. There is a strict need of controlling hypertension and hypercholesterolemia with customized diet, regular exercise and sometimes with medicines. It is advisable never to copy your fellow patient's treatment. Diabetes need your round the clock commitment and if taken care it would reduce your risk of serious complications like renal disease.

Important Tip: Never copy your fellow patient's treatment.