Risk Factors and Symptoms of Diabetes

Diabetes Mellitus is a chronic disorder in which the blood sugar levels are very high due to inadequate production of insulin by the pancreas (insulin deficiency) or resistance to the action of insulin (insulin resistance).

There are 2 major types of Diabetes – Type 1 and Type 2 Diabetes

In Type 1 Diabetes there is absolute insulin deficiency whereas in Type 2 diabetes there is a dual defect of insulin deficiency as well as insulin resistance as described above.

Type 1 Diabetes / Insulin Dependent Diabetes / Juvenile Diabetes is usually seen in children, adolescents, and young adults, though it is also seen in the very elderly population. It is an autoimmune disorder in which the immune system of the body perceives the beta cells of the pancreas (that produce insulin) as alien and mount an attack by producing antibodies against them and destroying them. This leads to an absolute insulin deficiency in the body. These patients need insulin for treatment and survival, else they can go into a coma and can even die.

Genetic factors determine which patient gets Type 1 diabetes – these genetic markers are located on chromosome 6 (HLA complex). Children of parents with Type 1 Diabetes and siblings of patients with Type 1 Diabetes are more susceptible to developing the disorder. Other risk factors for Type 1 Diabetes include certain viral infections, race/ethnicity, geographical factors (northern climates), early exposure to cow milk and other autoimmune disorders like Graves’ disease, pernicious anemia etc.

Type 2 Diabetes / Noninsulin-dependent diabetes is commonly seen in the middle-aged and elderly population though it is now commonly also seen in children, adolescents, and young adults.

Type 2 Diabetes is a lifestyle disorder wherein the hereditary factors, as well as environmental factors, play an important role in its etiology. A strong family history is invariably seen in Type 2 Diabetes. Sedentary lifestyle along with physical inactivity, compounded by stress lead to obesity, which in turn leads to diabetes. Type 2 diabetes is also commonly associated with hypertension and hyperlipidemia.

The most common presentation of diabetes, whether type 1 or type 2, is that it can be asymptomatic (without any symptoms). These are incidentally detected when investigated for other unrelated problems. At times the complications of diabetes like neuropathy, retinopathy or nephropathy could itself be its presenting feature.

However, the most common symptoms of severely uncontrolled diabetes are excessive thirst, excessive hunger, excessive urination (especially during the night time), bedwetting in children, unexplained weight loss, easy fatigability, blurry vision, dizziness, delayed wound healing and fungal infections of the genitals.


Dr. Prakash Pania

Consultant Endocrinologist

Aster Clinic, Bur Dubai (AJMC)


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Diabetes News

It’s never too late to prevent diabetes

Did you know that as per the Dubai Health Authority (DHA), almost 20 percent of the UAE population is diabetic and another 20 percent is pre-diabetic?

Today on the World Diabetes Day, Khaleej Times looks at different aspects of the condition.
The globally increasing pattern of unhealthy diet and sedentary lifestyle has led to the rise in obesity, further driving the prevalence of diabetes. “Diabetes is a silent killer and the condition will only worsen if it is not controlled, because diabetes rates are on the rise in this region now, given the lifestyle choices of people in the UAE, said Dr. Maneesha Pandey, specialist endocrinologist, Aster Jubilee Medical Centre, Dubai.

“Earlier, it was seen in people above the age of 50. These days there are innumerable cases of youngsters who have diabetes.”

Dr. Maneesha handled a case of a 13-year-old Asian boy with short stature. He had a history of type 1 diabetes since he was only 1.5 years old and his blood glucose was uncontrolled over last several years. As compared to his peers his height was very less. “On further checkup, I diagnosed that his short stature was entirely due to uncontrolled blood sugar. On improving his glycemic control, he started gaining height. The take home message from this case is that poor glycemic control in the growing age can adversely affect the overall growth including height.”

In another case, a 12-year-old was suffering from type 1 diabetes for last two years. Recently, his six-year-old sister was also diagnosed with type 1 diabetes and both are currently on insulin. However, there is no other family history of diabetes including the parents and other siblings. “This shows that first degree relatives of patients with type 1 diabetes are at a higher risk of developing the disease,” Dr Maneesha added.

“Our fast-paced lifestyle and eating out regularly combined with the lack of exercise increases rates of obesity and high blood cholesterol levels. These factors, in turn, increase the risk of developing diabetes, which over time, leads to serious damage in many organs of the body, especially the nerves and blood vessels,” said Mohamed Nabil Hassan Abdelrazik Mahna, a specialist endocrinologist at Medcare Hospital, Jumeirah.


Dr. Maneesha Pandey

Specialist Endocrinologist

Aster Clinic, Bur Dubai (AJMC)


News Source – http://www.khaleejtimes.com/lifestyle/health-fitness/its-never-too-late-to-prevent-diabetes

Maneesha Pandey


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Gestational Diabetes

Gestational diabetes is a form of diabetes which is seen in pregnant women who have increased blood glucose levels during pregnancy. Studies suggest that the prevalence of gestational diabetes can be as high as 9.2%.Unlike other types of diabetes, gestational diabetes isn’t permanent. Once the baby is born, the blood sugar will return to normal levels most of the times.

Gestational diabetes is seen affecting mothers in the late pregnancy, ie after the baby’s body has been formed. Therefore it does not cause any birth defects, however, may interfere with the normal growth pattern of babies.

Effect on the baby

  • If your blood glucose levels are high your baby will also have high blood glucose.
  • Baby’s pancreas will have to make extra insulin to control high blood glucose.
  • The extra glucose in baby’s blood is stored as fat if untreated or uncontrolled.
  • Baby born larger than normally called macrosomia, which can lead to difficult delivery.
  • Can have breathing problems called respiratory distress syndrome.
  • More likely for baby as it grows to become overweight and develop type 2 diabetes.

Effect on the woman

  • Preeclampsia (high blood pressure, sometimes with fluid retention and proteinuria)
  • Polyhydramnios (excessive accumulation of amniotic fluid )
  • Maternal birth trauma
  • Higher chances for C-Section
  • Developing Type 2 Diabetes
  • Reoccurrence in next pregnancy

Who is at a risk of Developing Gestational Diabetes?

About 5 to 18 percent of all pregnant women are likely to get gestational diabetes during pregnancy. The following factors may predispose you to gestational diabetes:

  • Age of 25 or older
  • Family history of Diabetes
  • Overweight as suggested by the Body mass index
  • Have Polycystic Ovarian Syndrome (PCOS)
  • Have a medical condition that makes diabetes more likely such as Glucose intolerance
  • Have had Gestational diabetes before
  • Certain ethnic subgroups such as African American, Native American, Hispanic or Pacific Islander

Prevention of Gestational Diabetes

Unfortunately, there is no way to guarantee that you won’t get Gestational diabetes. However, there are some things you may do to reduce the risk of developing it:

  • Eat a balanced diet: chose food high in fiber and low in fat and calories. Focus on eating fruits, vegetables, and whole grains.
  • Control on portion sizes
  • Regular exercise: Try and exercise for 30 minutes daily with some moderate form of exercises such as swimming or a brisk walk
  • Lose excess weight before pregnancy: If you are planning a baby, losing a few extra kilos may help you have a healthier pregnancy. Doctors do not recommend losing weight during pregnancy so plan the weight loss before you conceive.


Dr. Sejal Devendra Surti

Specialist Obstetrician/Gynaecologist

Aster Hospital Mankhool



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Aster - WHD

Best Ways to Beat Diabetes – Simple lifestyle changes.


Type 2 diabetes is on the rise around the world. But if you’ve been diagnosed, there’s a lot you can do to improve your health — and the best place to start is by changing your lifestyle.

“Basic principles of good health like eating right, exercising regularly, and maintaining a healthy weight can be as effective as medicine in the management of type 2 diabetes for most people,”

Managing Type 2 Diabetes

  • Improve Your Diet

Keeping close tabs on your diet is a major way to manage type 2 diabetes. A healthy diet for people with type 2 diabetes includes fresh fruits and vegetables, whole grains, beans, lean meats, and low-fat dairy. Focus on eating fruits and non-starchy vegetables, like broccoli, carrots, and lettuce, and having smaller portions of starchy foods, meat, and dairy products. Be especially careful about loading up on foods that are high on the glycemic index (GI), a system that ranks foods according to how they affect glucose levels. High-GI foods include white breads, white rice, and soda.

Limit fast food, too. In a 15-year study of 3,000 young adults, those who ate fast food more than twice a week developed insulin resistance (a diabetes risk factor) at twice the rate of people who weren’t fast food junkies. Plus, fast food is loaded with refined carbohydrates, Trans fats, and sodium, which can be especially unhealthy for people with type 2 diabetes.

  • Lose Weight

Shedding pounds can improve blood sugar levels and help keep type 2 diabetes under control. And you don’t have to lose a lot of weight to make a difference. “If you already have type 2 diabetes, losing just 10 to 15 pounds can lower your glucose levels,” says McLaughlin.

Where your fat is distributed also affects your diabetes risk and management. People who carry most of their fat in their belly (apple shape) are more prone to type 2 diabetes than those with fat mostly in the thighs, hips, and buttocks (pear shape). A woman whose waist measures more than 35 inches and a man with a 40-inch waist need to lose weight for good diabetes management, says McLaughlin, adding that a healthy diet and regular aerobic exercise will whittle away weight in the stomach area.

  • Exercise Regularly

Even without losing a pound, exercise can help keep type 2 diabetes under control.

“When you do physical activity, such as walking, your muscle contractions push glucose out of your blood into your cells,” explains McLaughlin. The result: Better blood sugar levels.

Of course, the more intense the exercise, the better. In one study of vigorous exercise and type 2 diabetes, women who walked quickly gained more protection from type 2 diabetes than those who walked at a more leisurely pace.

Regular weight-lifting sessions can also help keep blood sugar levels steady. McLaughlin recommends using hand weights or resistance bands for 30 minutes two to three times a week.

  • Control Sleep Apnea

Many overweight people with type 2 diabetes also have sleep apnea, a condition in which a person stops breathing temporarily while sleeping.

People with type 2 diabetes and sleep apnea are at higher risk of death from heart attack and stroke. Their blood sugar levels also fluctuate more dramatically while sleeping than in those who have type 2 diabetes, but not sleep apnea, according to one study. These fluctuations have been linked to a higher risk for diabetic complications.

Severe cases of sleep apnea may need to be treated with surgery or by wearing a special device while sleeping, but less severe cases can be managed by losing weight. Talk to your doctor if you suspect you may have sleep apnea — loud snoring is one sign. A special sleep test can diagnose sleep apnea.

  • Soothe Stress

Stress can make blood sugar levels harder to control, says McLaughlin. Try relaxation techniques to chase away stress. Top-notch stress busters include yoga, tai chi, meditation, massage, and soothing music.

As a bonus, stress relief may help you sleep better, important because studies show that not getting enough sleep can worsen type 2 diabetes. Sleeping less than six hours a night has also been found to contribute to impaired glucose tolerance, a condition that often precedes type 2 diabetes.

Besides yoga, try deep breathing before bed. Other tips to try:

  • Avoid alcohol, caffeine, and spicy foods at night.
  • Maintain a slightly cool temperature in your sleep environment.
  • Block out all light and noise.
  • Go to bed at the same time every night to establish a sleep schedule.




Dr. Abdelraouf Fouad

General Medicine

Aster Clinic, Business Bay


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Aster - WHD

World Health Day – Beat Diabetes

The main goals of the World Health day April 7, 2016 are to increase the awareness on the rise of Diabetes and its staggering burden and consequences on public health. This will include mainly the steps to prevent diabetes and diagnose, treat and long term care for the people with diabetes.

The latest regional statistics of diabetes:

Diabetes is now one of the most common non-communicable diseases globally. It is the fourth or fifth leading cause of death in most high-income countries and there is substantial evidence that it is epidemic in many low- and middle-income countries.

Complications from diabetes, such as coronary artery and peripheral vascular disease, stroke, diabetic neuropathy, amputations, renal failure and blindness are resulting in increasing disability, reduced life expectancy and enormous health costs for virtually every society. Diabetes is certain to be one of the most challenging health problems in the 21st century. It is now recognized that it is the developing countries that presently face the greatest burden of diabetes.

New figures from International Diabetes Federation (November 14 2015) suggests that 415 million people have diabetes in the world and more than 35.4 million people in the   Middle East and North Africa region and by 2040 this will rise to 72.1 million.

There were over 1 million cases of diabetes in U.A.E in 2015. The U.A.E is ranked 16th worldwide, with 19% of the U.A.E population living with diabetes. These statistics indicate that the region has high risk factors for diabetes, mostly related to rising obesity rates and physical inactivity. This sedentary lifestyle and the globally increasing unhealthy diet have contributed to the rise in obesity and have increased diabetes prevalence in the region.

Current practice by the Doctors

We come across a lot of Type 2 Diabetes patients especially which are newly diagnosed. Patients often come with borderline blood sugars also known as Pre -Diabetes. There is a close association between diabetes and hypertension, they are diagnosed sometimes simultaneously. The risk factors are essentially same and so it needs to be screened when the diagnosis of one is made.

Diabetes in pregnant women also known as Gestational diabetes (GDM) is encountered frequently, the screening for this has to be done by standard OGTT at around 24-28 weeks of gestation. Women with a history of GDM should have lifelong screening for the development of diabetes or pre diabetes at least every 3 years.

We see the adverse complications of diabetes, mainly because of poor control of blood sugars. The most severe among them are cardiovascular and kidney complications. The earlier and the more intensive sugar control treatment remarkably postpones and reduces these morbid complications.

Most effective preventive measures.

At present, type 1 diabetes cannot be prevented.

However, there is a lot of evidence that lifestyle changes (achieving a healthy body weight and moderate physical activity) can help prevent the development of type 2 diabetes.

Obesity, particularly abdominal obesity, is linked to the development of type 2 diabetes. Weight loss (7% body weight) improves insulin resistance and reduces hypertension. People who are overweight or obese should therefore be encouraged to achieve and maintain a healthy body weight.

Physical activity is one of the main pillars in the prevention of diabetes. Increased physical activity is important in maintaining weight loss and is linked to reduced blood pressure, reduced resting heart rate, increased insulin sensitivity, improved body composition and psychological well-being.

A balanced and nutritious diet is essential for health. A healthy diet reduces risk factors for cardiovascular diseases.

Smoking: a well-established risk factor for many chronic diseases, including diabetes and its complications. As well as other harmful effects, smoking increases abdominal fat accumulation and insulin resistance. All smokers should be encouraged to quit smoking.

Stress and depression: There is evidence of a link between depression and both diabetes and cardiovascular disease, hence steps towards decreasing stress help prevent diabetes.

Sleeping patterns: Both short (<6h) and long (>9h) sleep durations may be associated with a higher risk of developing type 2 diabetes. Sleep deprivation may impair the balance of hormones regulating food intake and energy balance.

Long term care and mobile apps

Education helps people with diabetes initiate effective self-management and cope with the stress of diabetes when they are first diagnosed. Care of diabetes has shifted to an approach that is more patient centered and places the person with diabetes and his or her family at the center of the care model working in collaboration with doctors. The long term care to get best results we should respect and respond to individual patient preferences, needs, and values and ensure that patient’s values guide all decision making.

People with diabetes should perform at least 150 min/week of moderate-intensity aerobic physical activity, spread over at least 3 days per week with no more than 2 consecutive days without exercise.

The mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes.

Saturated fat intake should be, less than 7% of total calories, also reducing intake of trans-fat lowers LDL cholesterol and increases HDL cholesterol.

If adults with diabetes choose to use alcohol, they should limit intake to a moderate amount (one drink per day or less for adult women and two drinks per day or less for adult men) and should take extra precautions to prevent hypoglycemia.

Regular glucose monitoring using HBA1C has been recommended to perform twice in a year for patients with stable glucose control and at least every quarterly when treatment goals are not met.

Check of blood glucose at home using a glucometer device is very effective in monitoring therapy, especially in patients using multiple insulin doses in a day. However, it is imperative that patients learn the proper technique and the way to interpret the results.

The therapy has to be individualized as per the patient’s age, lifestyle and other co-morbid illnesses.

As the smartphone has become such an important part of our personal and social life, it is needless to say the idea of apps related to diabetes will have an impact. These apps are excellent self-awareness tools, they help in better monitoring and serve as a constant source of continued education about diabetes.

A study published in the journal Clinical Diabetes concludes that “the use of mobile apps leads to improved A1C and self-management in diabetes care.”

It is recommended to choose apps based on individual goals. For some people with diabetes, that’s weight control; others need help tracking blood glucose or remembering to take medication. It is equally important to remember that unused apps stored on a smartphone do not change behavior or improve health.

Once Diabetes is diagnosed, then patients need to continue with the medicines and not stop the medicines abruptly once the sugars are controlled. We need to understand that Diabetes is a chronic disease and in order to “Beat Diabetes “regular monitoring of the blood sugar levels , compliance with therapy and lifestyle modification and continued education about the disease are important.


Dr. Srikanth Badavath Narayana

Specialist Physician

Aster Clinic, Al Butina


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