Diabetes

Diabetes Mellitus is a common syndrome- a constellation of disorders. It is commonly understood to be an excess of blood sugar. But it actually involves inability of the body to use glucose and other related substances due to a lack of or resistance to the hormone insulin, secreted by the pancreas.

Diabetes impairs many major chemical processes in the body. The most important of these is fat and cholesterol metabolism. Blood vessels all over the body are affected by diabetes. Hence almost every organ is vulnerable to damage. (This is due to cholesterol only in the heart and brain, it is different in other organs)

Though defined as a disorder of the body’s glands and the hormone insulin-endocrine, in reality, it causes its long term effects by affecting the major and minor blood vessels. It ultimately manifests as a disorder of the heart and its blood vessels or cardiovascular system. And, in general, disorders of the smaller blood vessels are more amenable to prevention and treatment.

Thus, the term ‘Cardio Diabetes’ or diabetes involving multiple organs of the body.

Diabetes increases the risk of coronary artery disease- blockages due to fat in the blood vessels supplying the heart. Heart attacks in diabetics may be missed- entirely symptom free as the nerves supplying the heart are also affected. Further, they are more often fatal. Multiple blood vessels are often involved; which makes both angioplasty and bypass difficult and increases the risk. Poor wound healing and infection after surgery are well known.

High blood sugar levels affect the functioning of the white blood cells. Hence the body is vulnerable to infections. These are severe, hard to treat and infections caused by unusual organisms are known. Infections of the skin, kidney and urinary passages are the most common.

Diabetes affects both the larger and small vessels of the brain causing paralysis of the affected body part- stroke. Diabetics also have a greater risk for disorders of memory and understanding-dementia, which occurs with age.

By affecting the small blood vessels, diabetes affects the nerves supplying the limbs and internal organs. This causes loss of sensation- most commonly in the feet. Loss of function, vomiting diarrhea constipation, disorders of the urinary bladder, drop in blood pressure while standing and sexual disorders are also common. Hence the need for a neurological evaluation each year even if there are no symptoms.

Diabetics are at risk of depression and anxiety. There is a disorder called ‘Diabetes Distress’ as a result of coping with a chronic disease, medications, dietary restrictions and the long term effects of the disease. The empathy and support of the medical team and, if needed, the help of a clinical psychologist, can go a long way to address these!

The eyes are hit hard by uncontrolled diabetes. The good news is that disorders of the eye are almost completely preventable by correct treatment. Diabetes can cause infections of the eyelids, tear glands and inner chambers of the eye. Cataracts are far more common in Diabetics and occur at an earlier age than in others.

The Retina or the image forming the inner screen of the eye is most sensitive to high blood sugar. There may be distortions of the small blood vessels, small bleeds, infarcts, formation of new blood vessels, exudations and larger bleeds. In severe cases, Diabetes could result in total loss of vision. Hence the need for regular eye checkups even if there are no symptoms.

n addition to multiple ear infections, diabetes can cause hearing loss of hearing due to affliction of the nerves involved. Serious infections with multiple complications of the nose are known, as are frequent throat infections. A sizable number of diabetics have reduction in both smell and taste.

Diabetics are at risk of infections of the teeth, the mouth and the covering of the jaw bones. These can become severe and complicated. Diabetics have a tendency to develop cavities in the teeth – caries. Due to multiple factors, they often end up losing their teeth. The good news is that all of these are almost preventable with good diabetic care.

Skin problems are often the first sign of diabetes. Diabetics have a greater risk of skin ulcers and infections. There are classic skin lesions in diabetes manifesting as brown patches, loss of skin and fat tissue which carry specific names. Diabetes causes hair loss in patches –alopecia areata. Nails are prone to fungal infections. Problems with the nerves and blood vessels compound the risk. Loss of nails is also a possibility.

One of the dreaded complications of diabetes is the diabetic foot- ulcers in the feet which get infected along with problems in the nerve supply that may eventually penetrate into the bones; amputation may be needed.

We are an online program which is readily accessible. The ‘Diabetes’ syndrome is approached holistically thereby treating individuals in the context of their lifestyle and work demands. We do not limit ourselves to treating the blood sugar which is only a number but at the cellular level.

We combine the highest levels of clinical expertise with experience to give the individual a better quality of life. We are approaching this program as a therapeutic alliance where the patient would be an equal partner who is proactive and participating actively in the treatment.

The American Medical Association has opined that the physical examination was created hundreds of years ago to deal with acute problems. It might not have the same level of significance in the present day insofar as chronic lifestyle related problems are concerned. In India as well, the practice of telemedicine has been legally validated by the Government.

Medicine has advanced to the point where diseases are being addressed before they become symptomatic. Clinical signs only develop when the problem has become advanced!

Certainly as physicians we would like to examine the patient conventionally due to our emotional bonding but it may not be medically necessary. Adequate medical history, vital parameters and laboratory findings provide us with the information we need.

Diabetes is a multisystem syndrome affecting many major chemical reactions and every blood vessel in the body. The care of diabetes must necessarily be comprehensive and continuously designed to evaluate multiple organs and prevent or manage the disorders.

As diabetes in effect is a disorder of the heart and blood vessels or of the cardiovascular system, Cardiodiabetes represents a high degree of expertise and state of the art care.

An MBBS doctor is trained to deliver primary and acute care. They do have the expertise to deal with any ailment at a basic level but a complex syndrome like diabetes needs to be dealt with by an expert. Only then can every organ be protected and the patient have a normal lifespan and quality of life.