Diabetics at risk for second stroke

After suffering a first stroke or transient ischemic attack (TIA), people with type 2 diabetes are at greater risk of having another stroke or a heart attack. But, aggressively lowering cholesterol can help reduce that risk.

Previous research has shown that type 2 diabetes mellitus is associated with increased risks of both stroke and coronary heart disease (CHD). Metabolic syndrome or insulin resistance identifies individuals at higher risk for developing type 2 diabetes and is also associated with an increase in stroke and cardiovascular disease.  Metabolic syndrome is a group of conditions, including high blood pressure, high blood sugar and high cholesterol that increase the odds of developing diabetes and heart disease.

Researchers in the United States analysed data from the Stroke Prevention by Aggressive Reduction of Cholesterol Levels Trial, which was designed to look at whether taking high doses of cholesterol-lowering drugs called statins would reduce the risk of having a second stroke or TIA. The trial did find that lowering cholesterol reduced the likelihood of another cardiovascular event in patients with recent stroke or TIA. In their secondary analysis, the researchers also looked at the risk of having another stroke or a heart attack among diabetics and people with metabolic syndrome and whether statin treatment could reduce that risk.

Of the 4,731 people in the trial who had had a stroke or TIA, the researchers identified 794 diabetics and 642 with metabolic syndrome. Compared with non-diabetics, people with diabetes were more likely to have another stroke, TIA or other cardiovascular event. They were also more likely to need an angioplasty to open blocked arteries, it was found. However, people with metabolic syndrome were not at greater risk of another stroke or TIA or cardiovascular event but were at higher risk of needing an angioplasty. Treatment with the statin did significantly reduce the risk of these events in participants with type 2 diabetes or metabolic syndrome.

The study results confirm earlier findings but highlight the differences in risks between diabetes and metabolic syndrome while pointing out that statin use is protective in such patients.

Losing baby weight and pregnancy-linked diabetes

Women who gained 8 or more kilograms after their first baby was born are more than three times more likely to develop gestational diabetes during their second pregnancy.

Gestational diabetes, a condition that occurs during pregnancy, can cause serious complications in the final weeks of pregnancy, birth and right after a baby is born. Research shows that women who have had the condition during one pregnancy have a greater chance of developing the condition again. Excess weight gain before or during pregnancy also boosts a woman's risk.

But women who trim extra kilos after the birth of a baby could significantly reduce their risk of developing gestational diabetes in a subsequent pregnancy. The benefits of this weight loss are even greater for women who were overweight before they had their first child.

Over the course of a decade, researchers studied more than 22,000 women from Northern California. It was found that women who gained 5 to 7 kg between pregnancies were more than twice as likely to develop gestational diabetes compared with women whose weight remained relatively unchanged. A weight gain of 8 or more kilograms tripled a woman's risk of developing the condition. Losing more than three kilograms after giving birth could cut women's risk of gestational diabetes in half - especially among women who were obese to begin with. The study also found that women who were able to shed three or more kilos between babies cut their risk of the condition by 50 percent.

The above results suggest that the effects of body mass gains may be greater among women of normal weight in their first pregnancy, whereas the effects of losses in body mass appear greater among overweight or obese women.

Women diagnosed with gestational diabetes at a healthy weight could be genetically predisposed to the condition, the researchers noted. In these cases, weight loss may not be as effective in reducing their risk of the condition in a later pregnancy.

What is diabetes mellitus? Symptoms?Diagnosis?Treatment?

Diabetes mellitus (DM) is the body's inability to regulate the level of glucose in the blood. Glucose is the main form of sugar in the body. The body breaks down food into glucose and uses it as a source of energy. In healthy people insulin helps to regulate the glucose (sugar) levels. Insulin is a hormone produced by the pancreas (a long, thin organ located behind the stomach against the back).

In diabetics, the body does not produce enough insulin or does not use the produced insulin effectively. This results in a high level of glucose in the blood ("hyperglycaemia").

There are four main types of diabetes mellitus:

a) Type 1, earlier known as insulin dependent diabetes mellitus (IDDM) or juvenile-onset diabetes mellitus. People with this type of diabetes make little or no insulin in their body, and need regular insulin injections for survival and management of diabetes. It usually starts in childhood, but can occur at any age.

b) Type 2 (DM2), earlier known as non-insulin dependent diabetes mellitus (NIDDM) or adult-onset diabetes. This is the most common form of diabetes, and is strongly associated with genetic tendency and obesity. The body produces normal or even high levels of insulin, but certain factors make its utilization ineffective ("insulin resistance"). Sedentary lifestyle, unhealthy dietary patterns, and the consequent obesity are common causes. It usually starts in adulthood, but is beginning to be seen in obese adolescents also.

c) Gestational diabetes mellitus, or pregnancy-induced diabetes.

d) Secondary diabetes mellitus, caused by genetic conditions, pancreatic diseases (e.g. inflammation, surgery or malignancy of the pancreas, etc.), drugs (e.g. steroids like prednisolone, pentamidine, excess thyroid hormone, etc.) or other medical conditions (acromegaly, Cushing syndrome, pheochromocytoma, hyperthyroidism, congenital rubella, etc). Medications such as thiazide diuretics or oral contraceptives can precipitate diabetes in a person predisposed to get it later.

What are the symptoms?

Symptoms depend on the type and duration of diabetes. Some of the signs and symptoms are related to the high blood sugar levels. These include:

• Increased urination
• Increased thirst
• Hunger

Other common symptoms:

• Fatigue
• Blurred vision
• Urinary and vaginal infections
• Skin infections, especially fungal or more serious bacterial infections
• Frequently upset stomach, stomach pains, nausea and vomiting

There may be weight loss, especially if the amount of insulin made by the body is decreasing. If insulin deficiency is marked, the person can become drowsy and then go into coma. This is called Ketoacidosis, and usually occurs in DM1. Rarely, if the diabetes is completely out of control, it can also occur in DM2. Other symptoms of ketoacidosis include:

• Deep rapid breathing, sometimes with a fruity odour to the breath
• Pain in the stomach, with nausea and vomiting

What is the diagnosis?

Diabetes mellitus is diagnosed based on a high level of glucose or sugar in the blood. The doctor may suspect diabetes mellitus after taking the medical history and doing a physical examination. There are several blood sugar tests used for diagnosis:

1. Fasting plasma glucose test: In this test, a person is asked to fast overnight, at least 8 hours, and the level of glucose in the blood is then checked. Normal fasting plasma glucose levels are less than 110 mg/dl. A fasting plasma glucose level of more than 126 mg/dl usually indicates diabetes mellitus. A level of 110-125 mg/dl is called "impaired fasting glucose".
2. Post prandial (PP) plasma glucose: This is tested two hours after having a meal, which serves as a challenge for the body to regulate the blood sugar. Normal PP levels are <140 mg/dl; a glucose level of more than 200 mg/dl indicates diabetes mellitus, while a level between 140-199 mg/ dl is called "impaired glucose tolerance".
3. Random plasma glucose test: is that which is done at any other time. A level of 200 mg/dl or higher generally indicates the presence of diabetes.
4. Oral glucose challenge test (oGTT): The blood glucose is tested 2 hours after giving 75 gm glucose by mouth. This is useful for detecting borderline diabetes and a condition called "impaired glucose tolerance".
5. Oral glucose tolerance test: is the preferred way to diagnose pregnancy-induced diabetes. Ideally all pregnant women in India should have a blood glucose test done 30 minutes after taking 50 gm gluocse (screening test). If this is abnormal, the lady should undergo an oGTT: with 100 gm glucose (not the conventional 75 gm). Blood samples are then drawn at intervals of one hour upto 3 hours (ie at 1, 2 and 3 hours post-glucose).

What is the treatment?

The treatment of diabetes depends on the type of diabetes. It is aimed to decrease symptoms and prevent complications such as low blood sugar levels (hypoglycemia), eye problems, kidney disease, and nerve damage.

DM1 needs treatment with insulin injections to replace the insulin that is not produced in the body. There are several types of insulin available. The most commonly used are the genetically engineered that are similar to human insulin. The difference in the various types of insulin is the times at which they "peak" or are most effective. Insulin schedule depends upon the meal pattern of the individual. This is required to avoid low blood glucose levels, causing hypoglycaemia. Insulin is administered with a syringe, and newer devices such as insulin pens and insulin pumps. The latter devices control diabetes more efficiently.

DM2 (earlier called NIDDM) is initially treated with weight reduction, diet control and regular exercises. When these measures fail to control the blood sugar levels, oral medicines are used. Sulphonylureas are a group of drugs that stimulate the release of insulin from the pancreas. Metformin reduces insulin resistance, and the production of glucose by the liver. Thiazolidenediones also increase insulin efficiency and sensitivity. Acarbose delays the absorption of glucose by the intestines. When the action of oral drugs is insufficient, insulin injections are added.

Exercise: It is an important component of diabetes therapy. Exercise utilizes blood sugar and makes the body more sensitive to insulin. It also reduces high blood pressure and high lipid levels, which are often associated with diabetes.

Diet: There is no such thing as a "diabetic diet". Persons with diabetes should eat a normal, balanced diet, which is designed to meet their nutritional requirements, maintain normal blood sugar levels and at the same time to help in achieving appropriate weight (i.e. reduction in case of obese persons, regain in case of very lean persons). It is also important to eat meals at regular time intervals, especially if insulin is used.

TRAVEL TIPS FOR DIABETICS

Diabetes is a chronic illness and needs to be continuously managed. However, it does not mean that diabetics cannot travel or will have any problems while on a trip. There are only some tips that the patient needs to keep in mind to have a tension-free and safe holiday. Get the location and duration of the trip approved by the treating physician. If possible, get the doctor to prescribe medication that may be required during the travel period. The medications may include not only those used to treat diabetes, but also ones for preventing nausea, vomiting, diarrhoea etc. Make preparations for getting your blood sugar checked at the destination. You should also try to identify medical services in the vicinity of your area for any emergency.

Travel tips:

Apart from the medical services available at the place of your stay, it is also necessary to be alert and make preparations thereof, during the duration of your journey. Some tips for the journey are: Keep the insulin or the oral anti-diabetic drugs handy; carry it in hand baggage in the plane or train. Protect the insulin from extreme heat or cold. Maintain your food habits even when your routine is different. Eat at regular intervals and do not overeat. Keep candies or toffees handy in case of a sudden drop in blood sugar.

Common myths related to diabetes

Sugar causes diabetes- Type 1 diabetes is caused by genetic factors combined with environmental triggers. Type 2 diabetes is caused by a combination of genetic and lifestyle factors. Diabetics do not need to stop eating foods that are concentrated sources of sugar, but they can eat small amounts of sugar. 

Diabetics can’t eat sweets or chocolates- Small quantities of sweets and chocolates are occasionally OK as a part of a healthy eating and physical activity plan. 

Diabetics have to eat special foods- Like everyone, people with diabetes have to eat healthy. That means a diet low in saturated fat and high in fibre and whole-grain foods.

You can catch diabetes- You can never catch diabetes. It is not contagious like cold and cough. 

People can have a “touch of diabetes”- You can’t have mild or borderline diabetes. All diabetes is serious and, if not managed properly, can lead to serious complications.

Diabetes: The 10 warning signs

Frequent urination

Frequent urination is one of the very early signs of diabetes. It occurs due to too much glucose in the blood. If insulin is nonexistent or ineffective, the kidneys are unable to filter glucose back to the blood. They then try to draw extra water out of the blood to dilute the glucose. This keeps the bladder full.

Extreme thirst

If you feel abnormally thirsty, especially if it seems to go hand in hand with frequent urination, get your blood sugar levels checked. If your body is pulling extra water out of your blood and you're running to the bathroom more, you will become dehydrated and feel the need to drink more to replace the water that you are losing

Constant hunger

Those with high blood sugar levels often feel hungry because of loss of energy and extreme tiredness.

Blurred vision

High blood sugar changes the shape and flexibility of the lens of the eye distorting the ability to focus and causes blurred vision.

Sudden weight loss

In Type 1 diabetes, the pancreas stop making insulin, possibly due to a viral attack on pancreas cells or because an autoimmune response makes the body attack the insulin producing cells. The body looks for an energy source because the cells stop getting glucose. It starts to break down muscle tissue and fat for energy. This results in weight loss.

Nausea & vomiting

If you often feel nauseate and vomit frequently without a known cause, get your blood sugar levels tested.

Extreme tiredness

Due to lack of insulin, the body cells become energy starved and you feel tired.

Slow-healing wounds

If you notice that your wounds are not heeling in normal span of time, get your sugar levels tested as poor circulation can limit the amount of oxygen and healing nutrients that reach a wound.

Itching and skin infections

Diabetes can affect every part of the body, including the skin. Skin problems are sometimes the first sign that a person has diabetes. These skin troubles may include bacterial infections, fungal infections, and itching.

Mood swings

If your observe that you have been experiencing extreme mood swings without any reason, it's advisable that you get your blood sugar levels checked.