“The Doctors Diabetes Melody – A Comprehending Look at Diabetes Mellitus”
Table of Contents
History of Diabetes
The history of Diabetes mellitus dates back to the sixth or fifth century AD when Hindu doctors or physicians recognized it as a condition characterized by excessive sugar indulgence in the human body. It was then termed or named “Madhumeh.” Though correct data was not present at hand at that time, the suggestion its prevalence was relatively high in middle-aged individuals and also in obese individuals and socially wealthy individuals.
37 million adults will be living with Diabetes as of this day (2024) now, and the numbers may increase more by 2030. Diabetes is very much responsible for 6.7 million deaths in 2021. By 2045, there could be global spanning data of 783 million with Diabetes, and a significant chunk of people relatively and regressively have Type 2 Diabetes.
The driving factors for it are immense and many, such as localization to urbanization, aging people, reduced physical activity, increase in weight (obesity), and more.
It is necessary to treat oneself with an optimistic attitude toward Diabetes. Early diagnosis and proper care will be very beneficial and best serve the helm of an individual’s personalized healthy care.
Meet The Author
Dr.Vedala Ramakrishna is a Preventive Diabetes Specialist and Medical Researcher in “Tissue Engineering & Regenerative Medicine.” He emphasizes the adage, “Health is an integral part of humanity from god, and it should be treated as a divine entity.” Dr. Vedala Ramakrishna is the inventor and innovator behind the BIOGEN HEART project, which focuses on anti-aging and promoting longevity. He employs a precision care-centric approach in his practice, emphasizing proactive and preventive treatment measures.
Chapter-1| A Comprehensive Study of Diabetes Prevention
Diabetes is a chronic disease that happens when the human pancreas does not produce sufficient Insulin, or the human body cannot use the Insulin produced correctly.
Insulin is a hormone that regulates the blood glucose level in the human body. Hyperglycemia is a state where the blood glucose level is raised—this is seen as an effect of uncontrolled Diabetes, where the blood glucose level is very high, and this condition can lead to much damage to the human body and its systems, especially the nerves and blood vessels.
Now, if we look at the symptoms of Diabetes – we are to understand that they occur suddenly. Symptoms may include:
- feeling thirsty quite often
- the constant need to urinate more than normal
- blurred vision
- tiredness
- Involuntary weight loss
With time and days, Diabetes may damage the blood vessels in the heart, kidneys, eyes, and nerves.
People who are diabetic have a higher risk of health problems, including heart attack, stroke, and kidney failure. Diabetes may cause permanent loss of vision, and people with Diabetes may also develop problems with their feet – which is due to nerve damage and less blood flow.
Type 1 diabetes is a chronic condition in which the human pancreas produces little or no Insulin. Different amalgamative factors, such as genetics and viruses, may be responsible for causing this type of Diabetes. Though this type usually appears during childhood or adolescence, it may also be present in adults.
When the islet cells are destroyed in the human pancreas, the body produces very little or no Insulin, which may lead to type 1 diabetes. Insulin is a hormone produced from the pancreas, precisely from the islet’s beta cells. Read more about islet beta cell at https://pubmed.ncbi.nlm.nih.gov/14687913/
So, in normal human physiology, glucose, a source of energy – from the foods we eat – is absorbed into the human bloodstream. So, glucose has an impeccable presence inside our body from two sources. The first one is from the foods that we eat. The second one is in the form of glycogen in the human liver. When the human body has less glucose (due to many obvious – related – unrelated reasons), the human liver breaks down the glycogen, which is stored back into glucose.
Insulin is needed to absorb glucose or get inside human cells. It is the key to unlocking the door of the human cells for glucose to go inside. So, the human pancreas puts Insulin in its place, and Insulin travels all throughout the body, ranging from head to toe, and helps glucose go or absorb into the cells. By this, the glucose that is present in the bloodstream gets lowered.
Coming back to the pathology, Type 1 diabetes complications can affect majorly most organs in the human body and may lead to disabilities and life-threatening problems.
A study has shown that Type 1 diabetes affects 10-15 percent of all diabetics and may have its impact at any age given that the major or the most cases occur under the age of 40. The triggering factors can be many, such as infections, diet, toxins, and genetic predisposition.
Type 2 diabetes is also another quite chronic condition. In this type, the human pancreas does not produce the much-needed Insulin needed to make the glucose enter or be absorbed inside the cells. Also, cells do not respond positively to Insulin, making significantly less glucose absorbed or go inside the cells. As time goes by, type 2 diabetes may cause some severe damage to the human body – nerves and blood vessels.
But, the illuminating fact is. Type 2 diabetes is often preventable. The factors that contribute to developing type 2 diabetes are – being overweight, not getting sufficient physical activity or exercise, and also genetics.
If early diagnosis can be made, worse effects can be prevented. The best way is to get regular checkups and consult with a personal or family physician.
Symptoms of type 2 diabetes are usually mild. They include increased thirst, quite frequent need to urinate, rise in hunger, fatigue, blurred vision, sores that heal slowly, and frequent infections, apart from unexpected weight loss. Then, areas such as the neck and armpits are darkened, along with tingling sensations in the hands and feet and numbness.
Gestational diabetes mellitus is a human body conditional problem, where specific hormones are made from the placenta- to prevent the body from using Insulin. This type of Diabetes will not be manifested by lack of Insulin but rather due to certain hormones that are produced during pregnancy – which actually renders Insulin less effective. The possible symptoms include – Obesity, familial inheritance of Diabetes, and previous birth of an infant weighing more than 9 pounds.
Gestational Diabetes has two paradigms – Macrosomia and Hypoglycemia. The condition known as macrosomia refers to a large baby that weighs more than normal. This occurs when the maternal blood is more filled with glucose, and subsequently, the fetal pancreas knows and senses and rightly deciphers and produces more Insulin – in a predictive attempt (right sensed) to use the glucose for all of the obvious reasons. In turn, the fetus turns the excess glucose into fat. In this condition, the fetus’s head grows excessively. Read more at https://www.ncbi.nlm.nih.gov/books/NBK557577/
Hypoglycemia, on the other hand, is a condition in which the baby’s blood sugar level is low. This condition occurs when the mother’s blood sugar level is high, which causes the fetus to possess more Insulin within the circulation.
Once the delivery has happened, the baby or infant will continue to have high Insulin levels, but the baby doesn’t get the higher levels of sugar from the mother. This inadvertently results in low blood sugar levels in the newborn.
Diabetes has become the most significant public health, maybe one of the largest – we may infer. There are several reasons, intended, unintended, obvious, unnamed, etc. Still, the primary reasons are less physical activity, over and more nutrition (Yes! It’s also a fact and reason), and hyper amalgamation of changes in lifestyle (known and unknown), cardio-metabolic diseases being the leading corner pillar-kilometer stones.
The ardent shift from undernutrition to hyperover nutrition often indicates that chronic diseases are apparent public health concerns. Statistics usually show a lot of data, which may be that more than 2 billion people are obese or more in weight and 400 million patients and even more are members of the disease – Diabetes Mellitus globally.
The influence of environmental factors on human metabolism can be observed throughout the lifespan. Increased attempted consumption of the Western diet, coupled with less intake of homemade food, which is rich in health functionality, have been actively associated with the cause and wake of this disease. Chronic metabolic diseases are high and are more common in major countries across the world – over the likes of obesity.
The intake of fast and processed fast foods, which are high in fat and sugar along with counted and uncounted calories, have replaced traditional cultural heritage foods, a dangerous habit spreading and branching worldwide. Such diets are often welcoming factors for all chronic metabolic-related inflammation problems and include diseases such as Diabetes and CVDs.
Another significant development in recent years is the correlation between gut microbiota and metabolic diseases. The human intestine has approximately 100 trillion microorganisms or more, comprised of 1000 different species. It has been shown that a significant chunk of Lactobacillus and Bifidobacterium has been reduced and decreased, and a substantial increase of Firmicutes and Bacteroidetes has been seen. Also, an incremental overt ratio of Clostridium has been observed in most obese people and populations.
It has been shown that a significant chunk of Lactobacillus and Bifidobacterium has been reduced and decreased, and a substantial increase of Firmicutes and Bacteroidetes has been seen. Also, an incremental overt ratio of Clostridium has been observed in most obese people and populations.
So now, the million-dollar question, expecting an answer, is whether Diabetes can be prevented. The answer lies in the equality of cause and effect—lifestyle modification.
Lifestyle modification means modifying your life into a better style and scenario so that you can reap the benefits of your diet.
This includes regular physical activity, healthy dietary changes, and a complete stoppage of smoking and alcohol. Additional aspects include sleep management, mindfulness practices, and home-based environment adaptation.
For centuries, we have all heard and known that exercise will benefit the human race and how to make the world a suitable, straightforward way of periodic exercise management. This means that although an individual is performing their daily fitness regime and exercises, the mode of conductivity should be in accordance with the individual’s physical activity sustenance pattern.
Excess weight lifting (although not in accordance) should be stopped as it may lead to multiple complications and a burden on their cardiovascular health. The mode of preventable pathway lies in walking and more brisk walking – which accentuates the heartbeat, helps the human body to make use of the Insulin in a much better way, and helps to relieve stress and anxiety (which are the sublime causes of elevating the individual’s blood sugar levels) and also reduce depression (now that’s something which we all want!! Don’t we?).
Now, you see, brisk walking helps you to build stamina through the constant motion of your calf muscles, which enables you to build stamina, maintain a regular healthy weight, and lose body fat effectively. An advanced version of brisk walking is called power walking – Power walking is a particular kind of walking where the walk is emphasized towards having a very straight body posture, with eyes forward, the head held high and upright and tight, shoulders put broad and towards back – which actually engages your core confidence and gaze.
This adaptable walking is suggested for all diabetics. Daily walking at a brisk pace, at an average pace, or at a gentle pace usually helps to gain control and help to improve glycemic control in type 2 diabetes individuals.
Ideally speaking or writing, -10,000 steps per day usually helps a lot for every individual to burn lots of calories and make the human heart healthier than ever (but, of course, it is also essential to see and put initiatives on time, duration, and place along with external and internal factors for such walks).
“Walking is an important form and force of nature, inclined and proclivated towards aerobic exercise, which gives amazing and numerous benefits of health, more so for people with diabetes.”
The critical aspect in the prevention of Diabetes is lifestyle-modified intervention, and to achieve this, weight loss is the cornerstone and pillar of strength. Weight loss helps to gain momentum and also paves a healthy way to improve cardiometabolic health willing and considering moving forth in the direction of having reduced blood pressure and reduction in cholesterol levels to achieve weight loss and also to reduce and decrease the forward progression to Type 2 Diabetes.
It’s important to eat healthy foods in order to maintain a good lifestyle and overall health. Being mindful about what we eat and understanding the nutritional components of food (both micro and macro, organic and inorganic) can greatly benefit us. Opting for smaller portions and choosing water over sweetened beverages can also have a positive impact on our health.
It’s common knowledge that fruits and vegetables are essential for good health, but many people don’t prioritize this. Neglecting these foods can lead to serious health issues like diabetes and cardiometabolic challenges. While natural fruits are recommended, it’s best to avoid sugary fruit juices in various forms.
Consume foods rich in fiber and reduce carbohydrate quantities so that your metabolism is excellent and suitable for your endeavor. Moderately consume good sources of proteins and cereals and minimize foods rich in fats and fried.
A healthy, balanced diet that is rich in nutrients is the key to unlocking the door to good health. Such a diet should contain the necessary nutrients like carbohydrates, fats, proteins, vitamins, and minerals in suitable proportions. You can find this type of diet in your home, where your parents and ancestors have prepared food to satisfy hunger and promote a healthy lifestyle.
CHAPTER –2|A Comprehensive Study of Diabetes Research
Much has been said and written about diabetes research in the past century, but the latest technology offers an in-depth insight into nanotechnology’s role in diabetes.
In diabetes, nanotechnology has a more significant part to play and has significance as well.
Nanoparticles can be used to enclose or cover Insulin or any other drug for that matter to have a precision based delivery to concerned cells or tissues. This singularly targeted delivery module helps minimize the side effects and will have a greater effect in enhancing efficacy in terms of therapeutic usage.
Nanotechnology sensors are also used to detect glucose levels in the right, accurate proportions. These particular sensors can be inoculated and integrated into wearable devices, which has the advantage and application of continuous glucose monitoring.
Nanomaterials can revive tissue regeneration and wound healing, which is very important for diabetes complications like diabetic foot ulcers.
Nanotechnology helps develop highly sensitive tools for diagnosis, promoting the prompt detection of diabetes proleptics and its complications and making time and space for immediate intervention and management.
Alongside, Nanotechnology is a gift of mankind that provides relative solutions to initiate drug delivery to diseased targeted blood vessels and also for the potent development of very advanced stents. This offers potential solutions for targeted drug delivery to diseased blood vessels, as well as for the development of advanced stents and vigorous scaffolds used in tissue engineering.
To learn more, nanoparticles are tiny particles with dimensions in the Nanometer range. They can be made from varied materials and have unique properties, such as high surface area. They are used in different fields, such as Medicine, Electronic Engineering, biomaterials, and material sciences.
Insulin was discovered in the year 1921 (which is a miracle) by Frederick Banting and Charles Best – Insulin is a hormone that regulates blood sugar levels. This breakthrough discovery earned Banting the Nobel Prize in Physiology or Medicine in 1923, which is shared with John Macleod. Sulfonylureas like tolbutamide stimulate insulin release from the pancreas. Biguanides is another variant that has become a primary drug along with metformin for type 2 diabetes management.
Modern Drugs like sitagliptin clearly accentuate the human body’s ability to lower blood sugar by inhibiting the enzyme called DPP -4. Another class, called GLP-1 Receptor Agonists, like exenatide and liraglutide, have mimicking properties for the incretin hormone GLP -1, which help stimulate insulin secretion and hamper glucagon release. SGLT2 Inhibitors such as canagliflozin and empagliflozin help prevent glucose reabsorption back into the kidneys and, henceforth, lower the blood sugar level.
Biosimilar insulins are almost identical replicas of the original insulin products and byproducts that have been developed. Recent Advances such as Closed-loop Insulin Delivery Systems, gene therapies, and stem cell therapies have made the inventions more noteworthy. Also, developing insulin production by cells to replace damaged pancreatic cells is a new entity in medical diabetic research.
Rapid-acting, long-acting, and ultra-long-acting insulin analogs were developed later, providing a high-quality physiological replacement for Insulin. Such amazing advancements have improved the best possible management of diabetes and significantly improved the quality and quantity of life.
While the latest newer interventions and innovations happen in the Diabetes melodious world, the thing to consider is how far these are going. There are many concepts about relative advancements in islets of Langerhans technology and therapies, which are important for better outcomes for patients of type 1 diabetes.
Diabetes researchers are investigating with rigorous invigorating methodologies like bioengineered tissue of pancreatic and organoids. These are based on the aim of originating cells that produce insulin outside the body and use it for transplantation.
There is also something called “Integration of AI and Digital health,” – which is used for personalization of Diabetes situational management, which can be used for leveraging data – from the ongoing continuation of glucose monitoring, count of Insulin pump executions, and bodily wearable devices.
These innovative approaches represent the forefront of Diabetes research and hold the potential to transform the way diabetes is managed and treated in the future.
Chapter-3| Diabetic Management – A Comprehensive Study
Management of Diabetes is essential to keep the blood sugar levels within the range recommended. Not only healthy eating but eating for your own individual health is essential. Oral sulfonylureas have a long duration of action and are effective in providing glucose control for twenty-four hours and beyond.
Meglitinides, one of the major classes of medications, act by closing ATP-based sensitive potassium channels in the pancreatic beta cells. This leads to the opening of calcium channels, which again, therefore, will result in increased intracellular calcium levels and, subsequently, insulin release. Biguanides are another class of medications primarily used in type 2 Diabetes. They act by constantly lowering blood glucose levels through different active mechanisms.
Another class of medications is the Alpha-glucosidase inhibitors, which work by inhibiting the alpha-glucosidase enzyme. This particular enzyme is the rightful initiator for breaking down complex carbohydrates into simpler sugars.
Thiazolidinediones are a class of medications that basically work by activating a receptor called the peroxisome proliferator-activated receptor—gamma—which is particularly found in the muscles, liver, and adipose tissues.
DPP 4 inhibitors work by blocking the actions of an enzyme called DPP 4, which destroys the action of DPP-4, an enzyme that destroys the hormone incretin.
CHAPTER-4|Insulin Resistance: A Comprehensive Study
Insulin resistance occurs when the body’s cells become less responsive to the hormone insulin, which is crucial for regulating blood glucose levels. As a result, the pancreas produces more insulin in an attempt to assist glucose entry into cells. Over time, this leads to elevated blood glucose levels and eventually Type 2 diabetes.
To control insulin resistance the major walking initiative to think and rethink and apply is to reduce sugars and also refined carbohydrates – It is mandatory to limit foods which are high in sugars and in refined carbohydrates which usually leads to increased blood sugar levels.
Increased fiber uptake for gut beneficial pathway is required and not only the intestinal motility but overall human body health. Periodic consumption of fruits, vegetables, legumes should be a necessary habitat to improve blood sugar control.
In dietary life, we should include high sources of healthy fats over the likes of nuts, seeds, and also olive oil.
With balanced meals which are of a combination of proteins, healthy fats and carbohydrates, the way towards a healthy life and clear diet style and good physical activity will be a great and more so a good combination towards establishing better blood sugar levels.
Regular aerobic exercises such as brisk and power walking, swimming, running, skipping, jogging, cycling and most importantly having a positive mind aerobic functionality helps a lot.
Lifting moderate weights (as per the body requirement) or taking up the required body weight exercises helps to build muscles and also improves usage of insulin. The motto of the resilient mind therapy should be to cover 150 minutes of intense and yet moderate exercise weekly.
Also, losing small amount of weight can help to improve sensitivity of insulin. Adequate sleep for 7 to 9 hours daily is good for insulin resistance. Practicing calming and hypnotic response which is quite the opposite of disquietude response- should be inculcated.
Practice relaxation techniques such as yoga, meditation, or deep breathing to reduce stress, which can impact insulin sensitivity. Regularly blood glucose levels should be monitored and medical checkups should be included with healthcare providers and physicians.
By combining these strategies, individuals can effectively manage and reduce insulin resistance, improving overall health and reducing the risk of developing Type 2 diabetes.
Risk Factors for Insulin Resistance could be over the kinds of obesity, having no physical activity, diet, hormonal concerns, and medications of certain type Insulin resistance may offer symptoms like increased urination, fatigue, dark patches of the skin, more thirst and hunger aspects.
Proper management can often prevent the ascension progressively to Type 2 Diabetes.
The treatment of this variant primarily lay impact on lifestyle modifications (overall changes in every way and possible), henceforth medications also do play a good role. Basal Insulin Analogs such as Insulin Glargine and Insulin Detemir along with Insulin Degludec are to be administered. Prandial insulin, such as Insulin Aspart, Insulin lispro, and Insulin Glulisine, are also very effective.
Premixed insulin’s like Insulin Aspart / insulin Aspart protamine are often used which a combination of rapid acting and intermediate acting is. For insulin resistance, mealtime insulin is often combined with basal insulin to manage both fasting and post-meal glucose levels. Then, there are latest insulin developments such as Insulin Lispro aabc – which is a form of Insulin lispro and also Biosimilars Insulin.
Insulin initiation therapy added on with lifestyle modification with high physical activity, limited diet and moderate exercise are the penultimate means and methods to have a good, healthy cultivated life.
CHAPTER – 5| Diabetes Reversal Facts in Depth
Diabetes, especially Type 2 diabetes, may be reversible in certain cases when the diagnosis is made early and coupled with a changed lifestyle, better guidance, a meditative mindset, and a coherent attitude.
The approach towards a fitter and healthier lifestyle, which primarily focuses on a healthy diet and balanced diet, goes towards a longer pathway or highway towards improving one’s blood glucose control. Regular physical and brain-induced memory activities and aerobic exercises are a must for weight management and insulin sensitivity. Subsequently, low-calorie foods must be eaten. If the need of the hour is medications, then so be the management to be done.
Type 2 diabetes can be reversible in many cases through a sheer combination of willpower, lifestyle modifications, weight loss, positivity gain, and, at times, medical or if needed, maybe surgical interventions. But, still, diabetes is a looming large disease – although a silent one, very loud in its actions, it is present everywhere amongst the worldly population. To combat it, lifestyle changes, weight loss, and sometimes medical or surgical interventions require a long-term commitment to health.
Type 1 diabetes, however, remains irreversible, is what we know and have seen and researched upon – but with the new existing options of treatment and lifestyle modifications, there will and can be a chance, although a lot has to happen to explore the potentiality and curve management guidelines and options ahead forth in this beautiful, mysterious, sweet disorder.
THE CONCLUSION
As a Physician Researcher for Diabetes, in my twelve years of experience, I have seen many growths, disruptions, and newer interventions in the field of diabetes. Yet, we all need to understand that this disorder, or rather an entity (I would specifically term it as an entity because of its varied scenarios and associated conditions), will continue to percolate and prevail in the human ecosystem’s heliosphere.
We may not go back and forth in any worrisome state as there has been umpteenth research going on with considerable uptakes and reuptakes – we can have our own bodily research basing on our individual health, as I believe that every individual has their own bodily health mechanics and dynamics.
As a physician-researcher specializing in diabetes, I am eagerly anticipating World Diabetes Day on November 14th. This day is significant as it brings together hundreds and thousands of doctors who pledge to work towards a society free of this condition. While it is important to manage and take timely measures if diagnosed with Diabetes Mellitus, prevention is always the best approach for improving overall health. Also read “Sleep in Diabetes” at https://journals-times.com/2023/09/19/sleep-in-diabetes-how-blood-sugar-is-responsible/
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