Disease Prevention & Care

  • Diabetes Mellitus
  • BP & Hypertension
  • Cardiovascular Disease
  • Thyroid Problem
  • Kidney Disorder

Diabetes Mellitus

Understanding Diabetes

India is termed as ‘diabetes capital of the world’. The number of people with diabetes in India currently more than 62 million is expected to cross 100 million mark by 2030. Surprisingly, 35% diabetic People are not even aware that they have diabetes. More than one million Indians die every year due to diabetes-related complications. Others suffer whole life with a variety of diseases.

Diabetes is known as "diabetes mellitus". It is a common condition and is characterized by abnormally high blood sugar levels. Diabetes essentially changes the way your body uses food. Diabetes is not a disease but is a disorder. Diabetes is the common term for several metabolic disorders in which the body no longer produces insulin or able to use the insulin produced. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

The most common forms of diabetes are type1 diabetes and type2 diabetes. One more type of Diabetes is called Gestational Diabetes (GDM).

What happens in Diabetes?

We all rely on insulin, a hormone made in the pancreas, to move glucose from the blood into the body's cells. When we eat, digestion of food breaks down carbohydrates into glucose that is absorbed into the blood in the small intestine. If the insulin is working properly, then the glucose levels rise and fall normally, as insulin moves glucose into the cells to produce energy. Insulin is the key that opens up the cell to allow glucose to enter. People with diabetes have partial or complete lack of insulin production in the body. The key to open the cell is not working and so instead, glucose levels pile up in the bloodstream. The unused glucose circulates through the kidneys. When the amount of glucose is more than what the kidneys can handle, the extra glucose spills out into the urine.

HbA1c

HbA1c refers to glycated haemoglobin (A1c), which identifies average plasma glucose concentration. By measuring glycated haemoglobin (HbA1c), clinicians are able to get an overall picture of what our average blood sugar levels have been over a period of weeks/months. For people with diabetes this is important as the higher the HbA1c, the greater the risk of developing diabetes-related complications.

Types of Diabetes

There are three main types of diabetes:

  • Type 1 diabetes
  • Type 2 diabetes
  • Gestational diabetes

Diseases or chemicals that damage or destroy the pancreas can also cause diabetes. Examples include pancreatitis, pancreatic cancer, and hemochromatosis - a disorder in which excessive amounts of iron accumulate in the pancreas and other organs. Other specific types include diabetes due to genetic defects, drug induced diabetes etc

Type 1 diabetes

Type 1 diabetes is an autoimmune disease in which the body destroys insulin-producing beta cells in the pancreas. Without insulin, the body starves to death. Type 1 diabetes is a lifelong condition that is treated with insulin. Insulin must be given each day and multiple injections a day (3+1, minimum 3 short acting and 1 long acting) are required to help maintain blood glucose control.

Type 1 diabetes most often affects people under 20 years of age. It was previously called juvenile-onset diabetes or Insulin-Dependent Diabetes Mellitus (IDDM).Treatment involves daily insulin injections, in conjunction with healthy eating and regular exercise. 5-10% of those with diabetes have type 1 diabetes. Usually patients are young and lean.

The cause of type 1 diabetes is still unknown, although many have speculated that it is a combination of genetic predisposition and environmental factors such as viruses that serve as the catalyst for the disease’s onset.

Type 2 diabetes

Type 2 diabetes is a term for several disorders with different causes and degrees of severity. It is the most common type of diabetes. Often, people with type 2 diabetes can still make their own insulin in the pancreas, but the insulin that is produced is not used as effectively by the body.

Type 2 diabetes often improves as a result of weight loss, a healthy diet and exercise. With the progression of the disease, some people may have to take oral medication(s) or insulin injections. Type 2 diabetes is much more common than type 1 diabetes. It occurs in 90 -95% of people with diabetes .It usually occurs in people who are over 40, overweight, and have a family history of the disease although it is also becoming more common in younger people, particularly adolescents. Although the cause of type 2 diabetes is unknown, there are some risk factors that can predispose some people to this condition. The symptoms of type 2 diabetes are the same as type 1 diabetes. Some people may also experience slow healing cuts and bruises, recurring gum or bladder infections, or tingling in their hands or feet.

Gestational Diabetes Mellitus (GDM)

Gestational diabetes is another common type of diabetes. It is a temporary condition that occurs during pregnancy.

Extra demands on the pancreas cause some women to develop diabetes during pregnancy. Often, it goes away after delivery. But, later in life, diabetes may return. Gestational diabetes affects 2% to 4% of all pregnancies, with an increased risk of developing diabetes for both the mother and the child. The risk of type 2 diabetes returning is greater if the mother has given birth to a baby that weighed over 4 kg (9 lbs) at birth.

Symptoms of Diabetes

Symptoms of diabetes include:

  • Frequent urination
  • Extreme thirst and/or hunger
  • Sudden Weight loss
  • Lack of concentration
  • Fatigue & tiredness
  • Numbness
  • Slow healing
  • Blurred Vision
  • Increased infections
  • Sexual Problems
  • Dry & itchy skin
  • No Symptoms

People with type 2 Diabetes may have no symptoms for nearly 5 - 7 years after high glucose levels develop- even when there are no symptoms, they may experience vague symptoms like tiredness, muscle pain, headache, anxiety etc. And therefore, one must keep a close watch on HbA1c level.

Complications of Diabetes

Diabetes is a chronic disease condition that can cause many serious complications. Numbness and tingling in your feet or hands (neuropathy), kidney failure (nephropathy) and vision problems (retinopathy) which can lead to blindness, are the most well-known complications. Following are the complications which a diabetic person may develop anytime. Poor control of diabetes can lead to an increased risk of:

  • Heart disease
  • High blood pressure
  • Stroke
  • Nerve disease
  • Kidney and bladder failure
  • Gum disease
  • Diabetic retinopathy, Cataract, Glaucoma etc
  • Foot and leg infections
  • Sexual Dysfunction
  • Complications of pregnancy
  • Hearing impairment
  • Skin conditions
  • Alzheimer's disease etc.

Uncontrolled diabetes can even lead to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma.

Who are at Risk

People all over the world get diabetes. The numbers vary from place to place and among ethnic groups. The risk of getting diabetes increases by who you are, how you live and where you live. Chances are if you have a family history of diabetes, you may get it and you may pass the disease on to your children.

Type 1 diabetes can develop at any age, but it most often strikes younger people (under 20 years of age) who are of slim build and especially children at the beginning of puberty. Whereas, Type 2 diabetes most often affects overweight individuals over 40 years old who have a low level of physical activity and wrong diet.

Risk factors of Diabetes include:

  • People with sedentary lifestyle
  • People with stress
  • Ethnic background or race / Asian Indian Phenotype
  • Having a parent with type 1 diabetes
  • Age (being over 4O years old)
  • Being overweight or obese (Adiposity factor)
  • Having a family history of diabetes
  • Having given birth to a large baby (over 4 kg or 9 lbs)
  • People with pre diabetes (Impaired glucose tolerance) or the metabolic syndrome-two
  • People with diseases that are closely related to type 2 diabetes
  • People with High Blood pressure
  • Abnormal Lipid Profile

BP & Hypertension

Blood Pressure

Blood Pressure is the force by the flow of the blood against the wall of the arteries. When this pressure is consistently high it is known as hypertension. Hypertension is a medical term used for high blood pressure. High BP is a serious condition which affects every 3rd person. In India hypertension is the major killer. About 33-40% population in urban India and about 12-17% of rural India are afflicted with hypertension. High BP is the attributable cause for 57% of stroke and 24% of coronary heart disease deaths in India.

Blood pressure is called ‘silent killer’ because most of the time, high blood pressure or hypertension has no obvious symptoms to indicate that something’s wrong and yet it can lead to some serious and sometime even fatal conditions. It can speed up blocking of arteries and can damage the heart (leading to heart attack), brain (leading to stroke), kidney (leading to kidney disease) and eye leading to eye trouble and blindness). The only way to know (diagnose) if you have high blood pressure (HBP or hypertension) is to have your blood pressure tested. Understanding your blood pressure numbers is key to controlling high blood pressure.

When you have your blood pressure measured, you get two values - Systolic & Diastolic and it written as systolic over diastolic. Systolic blood pressure (the upper number) indicates how much pressure your blood is exerting against your artery walls when the heart beats. Diastolic blood pressure (the lower number) indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats. Normal blood pressure is < 120 mm Hg systolic & < 80 mm Hg diastolic. Blood Pressure > 120-139 mm Hg or 80-89 mm Hg is known as pre-hypertension which means you could end with high blood pressure unless you take steps to prevent it. If blood pressure is more than or equal to 140/90 mm Hg then you have high blood pressure. The higher the number, the greater the risk.

Typically, more attention is given to systolic blood pressure (the top number) as a major risk factor for cardiovascular disease for people over 50. In most people, systolic blood pressure rises steadily with age due to the increasing stiffness of large arteries, long-term build-up of plaque and an increased incidence of cardiac and vascular disease. However, elevated systolic or diastolic blood pressure alone may be used to make a diagnosis of high blood pressure. And, according to recent studies, the risk of death from ischemic heart disease and stroke doubles with every 20 mm Hg systolic or 10 mm Hg diastolic increase among people from age 40 to 89. The blood pressure is measured in mm Hg. The abbreviation mm Hg means millimeters of mercury.

High blood pressure develops slowly over time and can be related to many causes like - consumption of food containing too much salt and fat, and not eating enough fruit and vegetables, harmful levels of alcohol use, physical inactivity and lack of exercise, poor stress management etc. High blood pressure cannot be cured. However, it can be managed very effectively through lifestyle changes and, when needed, medication. The best ways to protect yourself are being aware of the risks and making changes that matter.

Being aware of your risk factors and identify changes you can make to avoid the threats is the way. The risk factors are :

  • Age: Older people are at greater risk for high blood pressure
  • Gender: Women over 65 are more likely to have blood pressure and men under 45 are more likely to have high blood pressure than women.
  • Family History: If your parents or sibling have high BP then you are at higher risk.
  • Other factors: Like obesity, genetic, psychological stress, physical inactivity, high salt intake, less vitamin D, certain chronic conditions, smoking, high alcohol consumption etc.

Symptoms of Blood Pressure:

Most of the time there is no symptom. The myth is that people with high blood pressure will experience symptoms, like nervousness, sweating, difficulty sleeping or facial flushing. Whereas the fact is that high blood pressure is a largely symptomless “silent killer.” If you ignore your blood pressure because you think a certain symptom or sign will alert you to the problem, you are taking a dangerous chance with your life. In most cases, high blood pressure does not cause headaches or nosebleeds. A variety of symptoms may be indirectly related to blood pressure, but are not always caused by, high blood pressure, such as - blood spots in the eyes, facial flushing, dizziness etc.

Prevention & Care:

Living a healthy lifestyle and following DELs theory can prevent you from blood pressure. Early detection of hypertension can minimize the risk of heart attack, heart failure, stroke and kidney failure. Digital blood pressure measurement machines enable this to be done outside clinic settings. For some people, lifestyle changes are not sufficient for controlling blood pressure and prescription medication is needed. To keep your blood pressure in check you should:

  • Regular physical activity
  • Nutrition & Healthy food choice
  • Lose weight
  • Cut the salt intake
  • Check your BP regularly
  • De-stress & sleep well
  • Take your medicine (if you are prescribed for)

Cardiovascular Disease

Cardiovascular disease (CVD) includes all the diseases of the heart and circulation including coronary heart disease, angina, heart attack, congenital heart disease and stroke. It's also known as heart disease.

Your heart muscle needs oxygen to survive. A heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. This happens because coronary arteries that supply the heart muscle with blood flow can slowly become narrow from a buildup of fat, cholesterol and other substances that together are called plaque. This slow process is known as Atherosclerosis. When a plaque in a heart artery breaks, a blood clot forms around the plaque. This blood clot can block the blood flow through the heart muscle. When the heart muscle is starved for oxygen and nutrients, it is called Ischemia. When damage or death of part of the heart muscle occurs as a result of ischemia, it is called a heart attack or myocardial infarction (MI).

Cardiac arrest is the abrupt loss of heart function in a person who may or may not have diagnosed heart disease. The time and mode of death are unexpected. It occurs instantly or shortly after symptoms appear. The term ‘heart attack’ is often mistakenly used to describe ‘cardiac arrest’. While a heart attack may cause cardiac arrest and sudden death, the terms don't mean the same thing. Heart attacks are caused by a blockage that stops blood flow to the heart. A heart attack refers to death of heart muscle tissue due to the loss of blood supply, not necessarily resulting in the death of the heart attack victim. Cardiac arrest is caused when the heart's electrical system malfunctions. In cardiac arrest death results when the heart suddenly stops working properly. This may be caused by abnormal, or irregular, heart rhythms (called arrhythmias). A common arrhythmia in cardiac arrest is ventricular fibrillation. This is when the heart's lower chambers suddenly start beating chaotically and don't pump blood. Death occurs within minutes after the heart stops. Cardiac arrest may be reversed if CPR (cardiopulmonary resuscitation) is performed and a defibrillator is used to shock the heart and restore a normal heart rhythm within a few minutes.

Other Types of Cardiovascular Disease

  • Heart failure: This doesn't mean that the heart stops beating. Heart failure, sometimes called congestive heart failure, means the heart isn't pumping blood as well as it should. The heart keeps working, but the body's need for blood and oxygen isn't being met. Heart failure can get worse if it's not treated. If your loved one has heart failure, it's very important to follow the doctor's orders.
  • Arrhythmia: This is an abnormal rhythm of the heart. There are various types of arrhythmias. The heart can beat too slow, too fast or irregularly. Bradycardia is when the heart rate is less than 60 beats per minute. Tachycardia is when the heart rate is more than 100 beats per minute. An arrhythmia can affect how well the heart works. The heart may not be able to pump enough blood to meet the body's needs.
  • Heart valve problems: When heart valves don't open enough to allow the blood to flow through as it should, it's called stenosis. When the heart valves don't close properly and allow blood to leak through, it's called regurgitation. When the valve leaflets bulge or prolapse back into the upper chamber, it’s a condition called prolapse.

Risk Factors

Risk factors are conditions or habits that make a person more likely to develop a disease. They can also increase the chances that an existing disease will get worse. Important risk factors for heart disease that you can do something about are:

  • High blood pressure
  • High blood cholesterol
  • Diabetes and prediabetes
  • Smoking
  • Being overweight or obese
  • Being physically inactive
  • Having a family history of early heart disease
  • Having a history of preeclampsia during pregnancy
  • Unhealthy diet
  • Age (55 or older for women)

Some risk factors, such as age and family history of early heart disease, can't be changed. For women, age becomes a risk factor at 55. After menopause, women are more apt to get heart disease, in part because their body's production of estrogen drops. Women who have gone through early menopause, either naturally or because they have had a hysterectomy, are twice as likely to develop heart disease as women of the same age who have not yet gone through menopause.

Prevention & Care

You can prevent heart disease by following a heart-healthy lifestyle. Keeping your heart healthy, whatever your age, is the most important thing you can do to help prevent and manage heart disease. Following are few strategies to help you protect your heart.

  • Always Eat heart heathy diet
  • Stay active & Happy
  • 30 minutes excercise
  • Get enough quality sleep
  • Manage your stress well
  • Maintain a healthy weight
  • Stay away from Alcohol
  • No Smoking
  • Get regular health screening

Thyroid Problem

In India about 32% people are suffering from various kinds of thyroid disorders. It is important for us to be aware of the causes, symptoms, treatment and importance of testing for thyroid problems. Women are a key audience because there is a higher incidence of thyroid disorders amongst women than men. The women of child bearing age, during period from planning for a baby or once they are pregnant must make sure that their thyroid functions are normal.

The thyroid gland lies in the front of your neck in a position just below your Adam’s apple. It is made up of two lobes - the right lobe and the left lobe, each about the size of a plum cut in half - and these two lobes are joined by a small bridge of thyroid tissue called the isthmus. The two lobes lie on either side of your wind-pipe.

The thyroid gland is an endocrine gland in your neck. It makes two hormones that are secreted into the blood - Thyroxine (T4) and Triiodothyronine (T3). These hormones are necessary for all the cells in your body to work normally. An erratic thyroid can throw this hormonal play out of control due to iodine deficiency, immune system related disorders, inflammation or genetic diseases. This leads to various abnormalities with which more than 42 million people in India are suffering with. Thyroid disorders are very common and about one in 20 people has some kind of thyroid disorder, which may be temporary or permanent.

The thyroid makes two hormones that it secretes into the blood stream. One is called thyroxine; this hormone contains four atoms of iodine and is often called T4. The other is called triiodothyronine, which contains three atoms of iodine and is often called T3. In the cells and tissues of the body the T4 is converted to T3. It is the T3, derived from T4 or secreted as T3 from the thyroid gland, which is biologically active and influences the activity of all the cells and tissues of your body. Your TSH levels are from your pituitary, they are your internal dimmer trying to make the lights bright enough to read by. So, your TSH levels go up when your thyroid is not pumping out enough T4 and T3, in an effort to increase your thyroid glands production of T3 & T4. But sometimes you pituitary fails to succeed so you can’t produce all the T3 and T4 you need.

Thyroid disorders

There are many different causes of the different thyroid disorders. Most commonly the cause is due to autoimmune thyroid disease - a self-destructive process in which the body’s immune system attacks the thyroid cells as though they were foreign cells. In response the thyroid gland becomes underactive (hypothyroidism) or overactive (hyperthyroidism). You may find that other members of your family have thyroid problems or another autoimmune disorder.

Hyperthyroidism

Hyperthyroidism is a condition where the thyroid gland produces too much thyroid hormone for the body’s needs. It is also known as an over-active thyroid or thyrotoxicosis. It is caused due to over production of T3 and T4. Symptoms include weight loss, nervousness, difficulty sleeping, rapid and irregular heartbeat, bulging eyes, vision changes, excessive hunger, frequent bowel movements, heat Intolerance etc.

Hypothyroidism

Hypothyroidism is a condition where the thyroid gland produces too little thyroid hormone for the body’s needs. It is also known as an under-active thyroid. Symptoms include excessive weight gain, pregnancy & infertility, intolerance to cold, muscle cramps, dry skin, constipation, fatigue, puffy eyelids, irregular menstrual flow etc.

Goiter and Iodine Deficiency

A swollen or enlarged thyroid, goiter is seen as a mass in neck. Salt iodization by govt has massively reduced the iodine deficiency cases but has not completely controlled.

Autoimmune Disorders

When body fails to recognize its thyroid, it starts attacking its cells, bringing in the wrath of autoimmune thyroid disorders like – Hashimoto’s thyroiditis, Grave’s disease etc.

Thyroid Cancer

Thyroid cancer is the most common cancer of the endocrine system and occurs in all age groups, including children. It starts in the thyroid gland that produces thyroid hormones. The exact cause of thyroid cancer remains unknown and the common symptoms include a lump or thyroid nodule in the neck, trouble with swallowing, throat or neck pain, swollen lymph nodes in the neck, persistent cough and vocal changes.

The most common thyroid function tests

  • TSH - Thyroid stimulating hormone
  • FT4 - Free T4 (the active part of thyroxine)
  • FT3 - Free T3 (the active part of triiodothyronine)

Causes of Thyroid disorder

Thyroid malfunction can be caused by several conditions like:

  • Certain Drugs or Medication
  • Genetic Dysfunction
  • Thyroid Surgery
  • Radiation therapy
  • Treatment for Hyper or hypo
  • Radiation Therapy
  • Damage to the Pituitary Gland
  • Autoimmune Thyroid Disease
  • Etc.

Prevention & Care

Unfortunately, at this time there are no strategies for preventing thyroid diseases. People who have a family history of thyroid diseases may benefit from early testing that could lead to early, more effective treatment. Avoiding radiation exposure to the neck can reduce the risk of thyroid disease, but may be necessary to diagnose or treat other conditions. So, the key is being aware and have a regular thyroid function checkups (T3, T4, & TSH) done know how well your thyroid gland is working. Prevention is better than cure.

Kidney Disorder

Your kidneys are bean-shaped organs, each about the size of your fist. They are located near the middle of your back, just below the rib cage. Kidneys are sophisticated reprocessing machines in the body. Every day, your kidneys processes and re-processes your blood to sift out waste products and extra water. This is changed into urine, which flows to your bladder through internal tubes called ureters. Urine is stored in the bladder until you go to the bathroom.

The waste products in your blood come from different parts of the body and from the food you eat. Your body uses food for energy and self-repairs. After your body absorbs what it needs from food and changes it to energy, some of the byproduct is sent to the kidneys to either recycle back to the body or excrete as urine. If your kidneys did not remove these by-products as urine, waste would accumulate and damage your body and ability to function. The urine that we excrete takes a few hours to produce. In addition to removing wastes, your kidneys also are responsible for regulating blood pressure. Other important kidney functions are maintaining bone health and helping keep the body’s hemoglobin body within normal levels. In short your kidneys:

  • Remove waste products from your body
  • Balance chemicals in your body, such as potassium, phosphorus, calcium, and sodium
  • Balance your body’s fluids
  • Regulate your blood pressure
  • Promote strong, healthy bones
  • Kidney is therefore called Master Chemists of the Body

Your kidneys perform important functions that affect every part of your body. Many other organs depend upon the kidneys to function normally. The kidneys perform complicated jobs that keep the rest of the body in balance. When the kidneys become damaged, your body’s other organs are affected as well. Your kidneys can be affected by a number of problems, including urinary tract infections, kidney stones, and chronic kidney disease (CKD). Medical advances have improved our ability to diagnose and treat these problems. Even when the kidneys no longer function, treatments such as dialysis and transplantation have brought new life to hundreds of thousands of people.

Warning signs of kidney disease

Although many forms of kidney disease do not produce symptoms until late into the course of the disease, there are six warning signs of kidney diseases:

  • High Blood Pressure
  • Blood and/or protein in the urine.
  • A creatinine blood test greater than 1.2 for women and 1.4 for men.
  • A filtration rate (GFR) less than 60
  • More frequent urination, particularly at night; difficult or painful urination.
  • Puffiness around eyes, swelling of hands and feet, especially in children.

Prevention & Care

Kidney disease can be prevented or successfully treated. Careful control of diseases like diabetes and conditions like high blood pressure can help prevent kidney disease or keep it from getting worse. Sometimes, kidney disease progresses to kidney failure. When that happens, a person needs treatment with dialysis or a kidney transplant to survive. There is lot you can do to help keep your kidneys healthy and help prevent kidney disease.

  • Watch your weight – being overweight increases your risk of diabetes and high blood pressure, which in turn increase your risk of kidney disease.
  • Eat healthily – a diet high in fruit and vegetables and low in salt, sugar and fats is best.
  • Drink plenty of water – avoid sugary drinks like soft drinks.
  • Exercise regularly.
  • Don’t smoke.
  • Limit your alcohol intake.
  • Do things that help you relax and reduce stress.
  • Be well aware of your risk factors
  • Get the regular check up done for renal parameters.