Type 2 Diabetes
Type 2 diabetes, also known as non-Insulin Dependent Diabetes Mellitus (NIDDM), has a strong foothold in the diabetic population. Around 90% of the adults with diabetes suffer from type 2 diabetes.
Is there a genetic cause to it?
Several have asked this question either to themselves or their physicians. The answer to this is an obvious YES. Studies have shown that in Mexican Americans a susceptibility gene was isolated – NIDDM1 – in the region of D2S125 – D2S140. But this gene was capable of causing Type 2 diabetes in several other populations as well. The study had also shown that its genetic capability enhanced when it coupled with chromosome 15. NIDDM1 have been identified to encode gene cysteine protease calpain – 10 (CAPN10). CAPN10 has now been identified as a diabetic gene.
The first step in management of type 2 diabetes is screening of individuals who have probably never known that they were diabetic. Obese individuals above 30 yrs of age and with a body mass index of 23kg/m2 should be the primary subjects of diabetic screening.
Goals for management
The fasting plasma glucose should ideally be maintained between 80-110mg/ dl (less than 125mg/dl is also satisfactory). The Body Mass Index should be maintained at 20-23kg/m2. The target for the Waist Hip ratio should be less than 0.9 for men and for women it should be less than 0.85. The HbA1c should be ideally less than 7.
Keeping the noose tight!
Though these numbers mean a lot, but to an individual what matters is obtaining these theoretical grounds with practical means. But how do we go about it? There are several pharmacological methods for managing and treating diabetes, but the first step is realizing the risk factors associated with it and ardently working towards achieving the numbers. Since most of the times a sense of guilt of being obese is associated with type 2 diabetes, interactive sessions should be encouraged. Interactive sessions should also aim at identifying the problems and pledging to make this happen.
Apart from the pharmacological aspects, lifestyle management is an integral part of managing the disease.
- The total caloric intake though would vary considerably depending on the amount of physical activity and nutritional status of the individual, should not be more than1000 – 1200Kcal per day for women and 1200 – 1600 Kcal per day for men.
- Carbohydrates should account for the daily 45-50% of the calorie intake. The fiber content of these foods should be high and should comprise more vegetables, fruits and whole grains. Fats should comprise of the 20 – 25 % calorie intake of the diet. Instead of saturated fat (red meat, butter) the consumption of monounsaturated (olive oil, peanut oil, nuts) and poly unsaturated fats (fish, walnut) should be encouraged.
- Proteins should generally contribute around 12 – 20% of the calorie requirement.
- Smoking and alcohol intake should be discouraged.
- Physical activity is an important part of management. Brisk walking for 30 to 6o minutes every day should be done or it might be substituted with equivalent form of physical activity.
The obstacles to achieve the desired objective are many, but to control the epidemic named diabetes we need to proclaim – ‘Yes We Can’.
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