Demystifying diabetes: Different types, their causes, signs and symptoms, treatments and tips to manage them

In an interview with HT Lifestyle, Dr Ashok Kumar Jhingan, Senior Director, Centre for Diabetes, Thyroid, Obesity and Endocrinology at BLK-Max Super Speciality Hospital, shared, “Incidence of diabetes is increasing in India due to changes in lifestyle. India is the capital of diabetes. At present, about 42.5% of the Delhi population suffers from diabetes. Every third household (35.77%) had at least one known case of diabetes. High rates of obesity and central obesity are observed in the population. There are an equal number of people who are prediabetic and the conversion rate of prediabetes to diabetes is 10% per year. It's estimated that between 15% to 30% of people with prediabetes will develop diabetes within the next 3-5 years if no lifestyle changes are made.”

He explained, “Diabetes is a metabolic disease with a genetic background that gets precipitated by environmental factors. These include a sedentary lifestyle, changing food habits, and stress. The increased 'westernization' and Seven Sins of modern lifestyle: sedentary life, stress, sleeping for fewer hours, excess salt, sugar, smoking, spirits, and alcohol have led to a drastic change in our lifestyle. The longer the duration of diabetes, the higher the chances of complications like retinopathy, heart diseases, kidney failure and neurological problems.”

Types of Diabetes:

Dr Ashok Kumar Jhingan briefed, there are three main types of diabetes:

1. Type 1 diabetes

2. Type 2 diabetes

3. LADA

About 90 percent of diabetics have Type 2 diabetes, and 10 percent of diabetics have Type 1 diabetes. He elaborated -

Type 1 Diabetes: In Type 1 diabetes, the Beta cells that make insulin are destroyed by the immune system, attacking the insulin-making cells of the pancreas. This process takes months to years and can be caused by genetic background, environmental factors, or viral infections that trigger an auto-immune response. When only a few Beta cells are left, and insulin secretion is minimal, the child develops symptoms of high blood sugar.

Type 2 Diabetes: Type 2 diabetes is very common. In this type, the insulin-producing Beta cells of the pancreas either produce too little insulin, or the insulin they produce cannot be used properly by the cells, resulting in high blood sugar. Insulin resistance occurs, where the body's cells don't respond normally to insulin. Type 2 diabetes is usually seen in adults with a genetic background, but nowadays, it is also seen in young children who consume high-calorie fast foods, leading to obesity and susceptibility to diabetes and its complications. Type 2 diabetes can be controlled by diet, regular exercise, weight loss, and sometimes medications or insulin injections.

LADA (Latent Autoimmune Diabetes of Adults): LADA happens because your body makes antibodies that cause the immune system to attack the insulin-producing cells of the pancreas. This occurs in people aged 22-30 years, leading to sudden weight loss due to high blood sugar levels and potential diabetic ketoacidosis. They also need insulin like Type 1 diabetes. As the ability to make insulin is lost, your body can no longer control blood sugar levels. Symptoms worsen slowly, and investigations reveal a lack of regular insulin production, similar to Type 1 diabetes in adults.

Bringing her expertise to the same, Dr Richa Chaturvedi, Senior Consultant, Endocrinology at Indraprastha Apollo Hospitals in New Delhi, revealed that there are four main types of diabetes -

1. Type 1 Diabetes:

• This is an autoimmune disease, meaning your body attacks the insulin-producing cells in your pancreas.
• Occurs most often in children and young adults, but can develop at any age.
• Requires lifelong treatment with insulin.

2. Type 2 Diabetes:

• This is the most common type of diabetes, accounting for about 90% of cases.
• Occurs when your body doesn't produce enough insulin or doesn't use it effectively.
• Can be prevented or delayed with healthy lifestyle choices, such as maintaining a healthy weight, eating a healthy diet, and exercising regularly.

3. Secondary Diabetes:

• Secondary diabetes results from external factors such as prolonged use of certain medications (steroids, Anti-Retroviral Therapy), genetic conditions (MODY), or underlying health issues.
• Unlike primary diabetes, secondary diabetes is not primarily due to pancreatic dysfunction but involves disruptions in insulin function or production due to external influences.
• The consequence of secondary diabetes is elevated blood sugar levels, emphasizing the importance of addressing underlying causes for effective management.

4. Gestational Diabetes:

• This type of diabetes develops during pregnancy.
• Usually goes away after the baby is born, but increases the risk of developing type 2 diabetes later in life.

Distinctive Features:

Dr Richa Chaturvedi highlighted that each type of diabetes has its own distinctive features -

Type 1 Diabetes:

• Symptoms: Frequent urination, increased thirst, extreme hunger, unexplained weight loss, blurred vision, slow-healing sores, fatigue.
• Cause: Autoimmune attack on insulin-producing cells.
• Treatment: Insulin injections, blood sugar monitoring, healthy diet and exercise.

Type 2 Diabetes:

• Symptoms: May not have any symptoms, but some common ones include increased urination, increased thirst, extreme hunger, blurred vision, slow-healing sores, fatigue.
• Cause: Insulin resistance or insufficient insulin production.
• Treatment: May include healthy diet and exercise, weight loss, oral medications, and/or insulin.

Gestational Diabetes:

• Symptoms: May not have any symptoms, but some common ones include increased thirst, frequent urination, fatigue.
• Cause: Hormonal changes during pregnancy.
• Treatment: Healthy diet, exercise, and possibly insulin.

Secondary Diabetes

• Symptoms: Symptoms of secondary diabetes mirror those of primary diabetes and include increased thirst, frequent urination, unexplained weight loss, and fatigue. Identifying and addressing underlying causes is crucial for accurate diagnosis.
• Causes: Secondary diabetes arises due to external influences like extended use of specific medications (steroids, Anti-Retroviral Therapy), genetic factors (MODY), or underlying health conditions.
• Treatment: Treatment involves managing the underlying condition or factor causing secondary diabetes. This may include discontinuing specific medications, addressing genetic factors, or treating the primary health issue. Additionally, lifestyle modifications, medication, and regular monitoring of blood sugar levels are employed to control and manage the condition effectively.

Living with Diabetes:

According to Dr Richa Chaturvedi, while there is no cure for diabetes, it can be managed with proper treatment and lifestyle changes where people with diabetes can live long and healthy lives and some tips for living with diabetes include:

• Work with your doctor to develop a treatment plan that is right for you.
• Monitor your blood sugar regularly.
• Eat a healthy diet.
• Exercise regularly.
• Take your medications as prescribed.
• Learn about diabetes and how to manage it.
• Get support from family and friends.

Talking about controlling diabetes, Dr Ashok Kumar Jhingan said, “Diabetes is a lifestyle disease that can be controlled by reducing weight by 7-10% and by regularly exercising. Brisk walking is associated with a nearly 40% lower risk of developing type 2 diabetes later in life. Aerobic and weight-resistant exercises increase insulin sensitivity, while meditation and Yogic exercises play an important role in controlling stress.”

As for dietary management, he pointed out, “Diet plays a crucial role in managing diabetes. A balanced, healthy diet is essential, avoiding fast and processed foods. Sugar-free does not mean calorie-free. Fresh fruits and dry fruits can be consumed as per doctor's advice. Losing weight, eating right, and exercising are key components of diabetes management.”

Change your lifestyle before diabetes changes you. With the right care and support, people with diabetes can live full and active lives.