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What Experts Say On – Diabetes

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What Experts Say On – Diabetes

Dr. Anoop Misra

Dr. Anoop Misra is an Indian endocrinologist and chairman of Fortis Centre for Diabetes, Obesity, and Cholesterol (C-DOC) and heads. He also heads National Diabetes Obesity and Cholesterol Foundation (NDOC). Dr. Anoop Misra has received Dr. B. C. Roy Award, the highest award in the medical field in India. He has also received the Padma Shri award in 2007, for his contribution in the field of medicine in India. He was also a Fellow of the World Health Organisation at the Royal Free Hospital in the UK.

Diabetes is an emerging disease of the modern world. Its prevalence has skyrocketed in recent times, courtesy of industrialization and sedentary lifestyles. But what people fail to understand is that it only types 2 diabetes whose incidence increases due to a lazy lifestyle. So, let’s dive deep into the topic of Diabetes Mellitus and get a comprehensive knowledge of this stubborn global epidemic.

Diabetes Mellitus (DM) refers to a group of common metabolic disorders. Genetic and Environmental factors interact varyingly to give rise to different types of DM. It is essentially a state of raised blood sugar level called hyperglycemia which may be due to A) increased glucose production in the body B) decreased insulin secretion. Insulin is the hormone secreted by the pancreas which in conjunction with glucagon, another hormone secreted by the same organ maintains blood sugar homeostasis. C) Decreased glucose uptake by the cells as a result of insulin resistance acquired by the cells. Insulin acts as a facilitator for cells to take up glucose thereby decreasing the levels of sugar in the blood but due to insulin resistance, cells refuse glucose entry, and it pools in the blood which is consequent upon raised sugar levels in the blood.


  • Type I DM- is an autoimmune disease process where the cells that secrete Insulin (which lowers the blood glucose levels) undergo destruction which leads to complete or near-total insulin deficiency

Individuals with type 1 DM tend to have the following characteristics:

  • Onset of disease before 30 years of age
  • Lean body
  • They require insulin therapy from the start
  • Increased risk of other autoimmune disorders like vitiligo, celiac disease
  • Type II DM- is a heterogeneous group of disorders where insulin resistance and impaired insulin secretion are intertwined variably. There are a number of risk factors for type II DM, family history, obesity, physical inactivity, ethnicity, hypertension, etc.

Individuals with type 1 DM tend to have the following characteristics:

  • Develop diabetes after 30 years of age
  • Usually, obese
  • Don’t require insulin therapy initially where DM can be controlled by diet and lifestyle modifications
  • May have associated conditions like hypertension, PCOS, etc
  • Other Types of DM- like Maturity Onset Diabetes of the young (MODY) and monogenic diabetes, etc are based on specific genetic defects, metabolic abnormalities, and a host of other conditions
  • Gestational Diabetes Mellitus (GDM) – an observation that pregnancy predisposes to conditions like insulin resistance and increased insulin requirements was made. Since then, women who develop Diabetes exclusively during pregnancy were categorized under GDM


Diagnosis of DM can be made with ease using one of the following:

  • Fasting Blood sugar level: ≥ 126 mg/dL
  • Postprandial Blood sugar level (2 hours after a heavy meal): ≥ 200 mg/dL
  • HbA1c (glucose that exists in the blood bound to hemoglobin): ≥6.5 %
  • Random glucose levels ≥ 200 mg/dL + Symptoms of DM like increased thirst, increased frequency of urination, and weight loss

It has become easy to assess blood sugar levels even at home now due to the availability of self-monitoring test kits and strips and glucometers.


Symptoms can be acute which develops early after the onset of diabetes or chronic which arise in the long run if diabetes goes uncontrolled.

  • Polyuria (increased frequency of urine)
  • Polydipsia (increased thirst)
  • Weight loss
  • Fatigue (due to muscle breakdown)
  • Weakness
  • Blurry vision (due to water content changes in the lens of our eyes)
  • Slow healing of skin wounds after minor trauma


Dr. Anoop Misra, a renowned Diabetologist when asked about strategies to combat the diabetic epidemic responds with, “Since we are more predisposed to Diabetes because of certain ethnic specific features, we need to intervene early. The most effective way of countering this epidemic is prevention and early detection. Guidelines regarding diagnosis, screening, healthy food choices, physical activity and management specific to Asian Indians are important.” Guidelines for patients with Diabetes include:
  • Self-monitoring of blood glucose (individualized frequency)
  • Optimal and individualized glucose control
  • HbA1c testing (2-4 times/year)
  • Medical nutrition therapy and education
  • Eye examination (annual or biannual)
  • Foot examination (1-2 times/year by a physician and daily by patient) for early diagnosis and prevention of diabetic foot
  • Screening for kidney damage (annual)
  • Blood Pressure measurement (quarterly)
  • Lipid profile
DM type 2 patients don’t need to be instituted with insulin supplements initially; they can make lifestyle modifications and transform their diets in order to control their blood sugar. This will suffice in regressing its progression and further development of associated complications. Nutritional Recommendations for DM type 2 patients include:
  • Caloric deficit diet that is low in carbohydrates
  • Minimal trans fat consumption
  • Monitor Carb intake in regard to calories
  • Mediterranean-style diet rich in monounsaturated fatty acids may be better
  • Use glycemic index calculator to predict how consumption of a particular food may affect blood glucose
  • Non nutrient sweeteners preferred
  • Dietary fiber, vegetable, fruits, dairy products, sodium intake should be the same as general population
  • Routine supplements of vitamins, antioxidants not needed
  The last 2 decades have seen a dramatic rise in the number of reported cases with diabetes; forget all the undiagnosed cases that still lie in the shadows. Based on current trends, the International Diabetes Federation predicts that around 592 million individuals will have diabetes by the year 2035. It is evident that this disease has posed a major economic burden globally and what worsens the situation is that it can only be controlled to an extent, and never fully cured. Quoting Dr Anoop Misra, “Primordial and primary prevention strategies instituted in potential mothers, prevention of malnutrition in utero and in childhood, healthy diets, adequate physical activity and stress-free environment throughout life are requisites for prevention of diabetes in country. Translating the research findings to a real-world environment poses a considerable challenge especially in countries like ours with limited economic and health care resources.”    
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