Tag Archives: diabetes

Health Risks Associated with Type 2 Diabetes

20 Jul

From hearing loss to foot numbness, the complications that result from type 2 diabetes vary as much as the patients. Whether you are a man or a woman, Caucasian or African-American, there are subtle differences in the way the disease progresses. Type 2 diabetes is known to quietly attack various groups of people in slightly different ways.

Type 2 diabetes is the most common form of diabetes, affecting millions of people each year. Some groups have a higher risk for developing the disease, including Native Americans, Asian-Americans and Latinos. However, it is India that has developed the world’s largest diabetes population with over 50.8 million people living with diabetes. While India’s government continues to raise awareness to its public, many other countries are facing the widespread epidemic.  Scientists are not completely sure what mechanism causes the disease; they do know that it causes the body’s cells to either not produce or ignore insulin, a naturally occurring hormone made by the pancreas. Without insulin, glucose in the body does not properly break down. That leads to diabetes complications. The list of type 2 diabetes complications is a long one and covers all parts of the body, from head to toe:

  • Eye complications – Type 2 patients are more at risk for developing glaucoma, cataracts and retina dysfunction.
  • Heart disease – This very real risk is especially prevalent in men with diabetes. Type 2 patients are also at a higher risk for a stroke.
  • Mental health problems – Many patients go through stages of anger, denial and depression, especially when initially diagnosed.
  • Skin disorders – Having diabetes puts patients at an increased risk of getting bacterial and fungal infections, as well as other diabetes-related skin conditions.
  • Sexual dysfunction – Men with diabetes are more likely to suffer from erectile dysfunction and low testosterone.
  • Foot problems – Also called neuropathy, diabetic nerve damage can lessen the ability to feel pain, cold or heat. Neuropathy causes poor blood flow.

From the list, it’s easy to see why it is so important for type 2 patients to be vigilant about their health care. At the initial diagnosis, most doctors will recommend a strict diet, a steady exercise regime and medication to stabilize insulin levels. While a new diet and exercise routine might be difficult to establish, the medication aspect of the process could prove to be even more challenging. That’s because of the lingering safety questions surrounding the most popular type 2 diabetes drug, Actos.

Also known as pioglitazone, Actos has been linked to a variety of life threatening side effects, including congestive heart failure and bladder cancer. The drug is known to cause edema, or swelling, which increases the risk for heart failure. Worse yet, recent studies show that those taking the drug for longer than two years have a more than 80 percent chance of developing bladder cancer. It seems that this drug puts already compromised bodily functions at risk for even more damage. In fact, many users of this medication have filed an Actos lawsuit against the drug manufacturer, Takeda.

Today, many doctors are steering their patients to more trusted medications, such as metformin, as a means to control blood sugar levels. Many feel that the risks that Actos presents are far too great for patients who are already struggling with a life-threatening disease.

Diabetes and Diabetic Retinopathy – Dr Rahul Shroff

27 Dec

The past two decades have seen an explosive increase in the incidence of diabetes mellitus worldwide, making it one of the most common non-communicable diseases today. According to the World Health Organization (WHO), there were an estimated 135 million diabetics in the world in 2000, and this number is expected to increase to 300 million by 2025.

What is of more consequence is that India has the largest number of diabetics in the world. In 1994, 19.4 million suffered from diabetes mellitus, 32 million were diabetics by 2000 and the number is expected to increase to 57.2 million by 2025. Moreover, according to current estimates, diabetics will increase by 42 per cent in developed nations and by 170 per cent in developing nations. According to an ICMR study, prevalence of diabetes mellitus, which was 2.3 per cent in urban population in 1970, increased to 12.1 per cent in 2001.

The increase in incidence of diabetes mellitus and its complications has been attributed to change in life style caused by increased urbanization, high calorie diet, decrease physical activity and stress. Other important factors are genetic factors, family history and increased longevity. And what is worrying that diabetes is striking at an early age among the urban population.

 

Types of Diabetes:

Diabetes mellitus occurs in two forms:

Type 1 (Insulin dependent) – Also called juvenile diabetes, this is seen in younger people and is characterized by absolute insulin deficiency due to which these patients are completely dependent on insulin treatment. The incidence of this form of diabetes is doubling every decade.

Type 2 (Non-Insulin dependent) – This is seen in older people and is characterized by insulin resistance or abnormal insulin secretion. These patients can be treated with tablets or may require insulin. This form accounts for 90 per cent of all cases seen globally, but its increasing incidence in India is due to changing diet, from traditional Indian food to modern diet caused by a more stressful life-style and increased urbanization. This type is being seen in younger people due to obesity. Moreover, type 2 diabetics have a greater tendency to develop hypertension and heart disease.

It’s not just the disease itself that is a cause for concern. Diabetics are more prone to develop systemic complications. They are also 25 times more likely to develop blindness, twice as likely to have a stroke, 2-4 times more likely to have myocardial infarction and much more likely to develop kidney disease or undergo amputation.

 

Effect of diabetes on the eye:

Diabetes can cause eye complications such as:

1. Diabetic Retinopathy: This is the most common complication and it has been seen that 25 per cent of all diabetics develop this complication after 10 years of diabetes and 50 per cent develop it after 20 years of diabetes. Diabetic Retinopathy is also more common in the upper socio-economic group.

 

Diabetic Retinopathy has two types –

Non-Proliferative Diabetic Retinopathy – This is the early stage in which tiny blood vessels in the retina get damaged and leak blood or fluid, which cause the retina to swell or form deposits called exudates. 90 per cent of Diabetic Retinopathy cases are of this type. This stage often has no symptoms.

Proliferative Diabetic Retinopathy – This is the advanced stage. Abnormal new blood vessels grow on the surface of the retina and often bleed into the jelly in front of the retina, giving rise to floaters, dots or lines or sometimes loss of vision. These new vessels can eventually pull the retina causing a traction retinal detachment. 10 per cent of Diabetic Retinopathy is of this type.

Maculopathy – Leaking fluid collects in the centre of the retina called the Macula giving rise to blurring of vision.

Studies have shown that there has been a 3-fold increase in the incidence of Diabetic Retinopathy in India in the last 10 years.

 

2. Cataract – This is more commonly seen in diabetics at a younger age and more commonly in the lower socio-economic group. Important causes are exposure to ultraviolet light and oxidative stress.

 

3. Glaucoma – This involves increase in intra-ocular pressure within eye and is more commonly seen in persons afflicted with diabetics.

 

4. Diabetics are also more prone to develop paralysis of the nerves of the eyes due to obstruction of the blood supply.

 

Incidence of vision loss:

The following categories of individuals are at a higher risk of losing vision in diabetes:

  • Those who have had diabetes from a younger age
  • Those who have had diabetes for many years
  • Those who have poorly controlled blood sugar
  • Those who have poorly controlled blood pressure
  • Those who smoke

 

Improving diet:

Diet plays an important role in the control of diabetes and diabetic retinopathy. Studies have shown a much lower incidence of diabetic retinopathy in persons who follow a healthy diet. A good diet consists of

 

  • Ghee as the cooking medium
  • Fish and fish-oil capsules, which are rich in selenium and zinc. Fish is considered to be one of the best foods for diabetics
  • Green leafy vegetables
  • Vitamin A rich foods like carrot and green leafy vegetables

·         Vitamin C rich foods such as citrus fruit like orange, lemon

  • Vitamin E rich foods like cereals and grains

 

Diabetics must avoid fried food, animal food (except milk and fish), processed food and preserved food.

Regular eye examination

All diabetics must have the eyes examined regularly with dilated pupils. Juvenile diabetics must have their eyes examined at least once a year after the age of 12 years because diabetic retinopathy is rarely known to occur before puberty. Those with diabetes at an older age must have the eye examination done once at the time of diagnosis and then at least every 6 months to one year thereafter.

If Diabetic Retinopathy has been diagnosed, they should have the eyes examined as often as recommended by their eye doctor.

 

Laser treatment:

A special test called fluorescein angiography may be required to identify areas that require laser treatment. If leakages or new vessels are detected, laser treatment must be promptly given. Sometimes there is leakage of blood from the retina of the eye into the jelly in front of the retina, which may cause blurring of vision. An operation called vitrectomy may be required to remove the bleeding and replace it with clear fluid.

Studies have shown that vision can be preserved in 90 per cent of diabetics if laser treatment in done in time.

 

Newer treatment modalities:

 Anti-VEGF Injections for Diabetic Retinopathy

 Injection treatments (Lucentis™, Avastine™) used commonly for macular degeneration have also proven to be effective for diabetic eye disease, in some cases better than laser treatment.

Results from a large clinical trial conducted by the Diabetic Retinopathy Clinical Research Network, or DRCR.net, demonstrated that patients receiving a combination of anti-VEGF treatments and laser treatments had greater gains in visual acuity as compared to others.

 

A newer injection viz. EYLEA™ (aflibercept), known in the scientific literature as VEGF Trap-Eye, is also being used as an injection into the eye to provide a therapeutic effect in patients suffering from various eye disorders including in some cases of diabetic retinopathy.

Prevention of complications:

All diabetics must adhere to the following to prevent complications:

 

  • Avoid obesity and have regular physical exercise
  • Control the blood sugar and blood pressure at all times
  • Avoid self-medication. It is better to follow the advise of a physician
  • Maintain a healthy diet. Insulin or pills is not a substitute for a proper diet
  • Have your eyes examined at least once every 6 months to a year by an eye doctor

Being a diabetic does not mean that you cannot enjoy a happy and healthy life. Follow the above-mentioned simple rules with a positive attitude, and you will see the change in your life.

Issued in public interest by Shroff Eye Hospital, Mumbai, India

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Shroff Eye Hospital

222 S V Rd,

Bandra West,

Mumbai – 400050.

Ph: 66921000/ 66939372/ 26431006

 

Shroff Eye Clinic,

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Marine Drive,

Mumbai – 400002.

Ph: 22814077 / 22811863/ 22029242

 Helpline: 98211-63901

Lipid Guidelines – Dr. Ajay Kantharia

20 Apr

Date: 20th April 2011

Author: Dr. Ajay Kantharia, M. D., Physician – Cardiologist & Critical Care Physician

About: Dr. Ajay H. Kantharia has an active practise since last 22 years. & has treated thousands of critically ill (cardiac, respiratory, abdominal & neurological) patients.He is the pioneer in starting Cardiac Ambulance Service in Mumbai, the success of which is seen by the number of cardiac ambulances mushrooming in the city of Mumbai today. This fully equipped ambulance service is available to anyone, at any time & to go anywhere-to any hospital/destination of his/her/your choice. He has a website fromwww.websitefordoctors.in

Phone no: 020-22843454, 020- 22843455, +919820036165

Website: www.ajaykantharia.com

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