All food items contain glucose and we eat food to get glucose which then provides us energy. Inadequate Insulin release causes glucose accumulation in blood and hence Diabetes.
We all Human beings need energy to survive. We are made of trillions of small units called cells. Our body cells need energy to work. We eat to get energy from food. Whatever we eat has Carbohydrates, Proteins and Fats as energy providing substance. A healthy diet contains nearly 60% carbohydrate, 20% proteins and 20% fats.
After eating, carbohydrate component of food is broken to glucose in our intestine. This glucose reaches in blood & then to cells of body. This glucose needs to enter inside the cell to provide energy.
But glucose cannot enter inside the cell without a help, called Insulin. Insulin is a hormone continuously released from pancreas & this Insulin takes glucose inside of cells.
Food is converted to glucose & this glucose is provided to body cells with help of Insulin. Insulin is not a drug as most people think. It is a hormone produced in our pancreas. There is a continuous secretion of Insulin by pancreas from birth to death.
Whenever we eat, glucose enters in blood and as per rate of glucose entry; quantity of Insulin produced is increased by pancreas. This extra amount of Insulin then shifts glucose coming from food to inside of body cells where it is utilized to provide energy.
If our pancreas does not produce sufficient quantity of insulin or Insulin circulating in blood works less effectively, then after eating food, glucose enters in blood but cannot be shifted to body cells and thus its level starts rising in blood and this stage is called as Diabetes.
Thus in Diabetes, on one hand body cells are deprived of glucose and on other hand glucose circulates in high level in blood & gets converted to various chemicals which damage Eyes, Kidneys, Nerves, Heart etc.
Aim of treating diabetes is to keep desired amount of insulin in blood, so as to keep glucose level in normal range. Any treatment strategy, which can keep Insulin level in required amount, will help in keeping glucose level in normal range.
There are 5 strategies to treat Diabetes. Diet modification, Exercise, Oral Drugs, Insulin and Incretion based treatments.
Aim of diet management is to modify diet in such a way that it matches to limited Insulin release. Thus all food containing high amount of refined glucose or sugar are avoided. Diet should be balanced with a carbohydrate intake around 60 %. It is observed that Indian diet already has nearly 75 % carbohydrate and adding sugar and sweets makes this up to 80%. Thus aim of diet modification is to take such food which provides a slow glucose entry in blood.
Exercises increase action of Insulin at muscle level. This increase effectiveness of Insulin reduces Insulin requirement of body. It can be compared with a sprinkler system for farming where less water is used for more plants.
When after diet modification and exercise, if Glucose levels are high, then drugs like Metformin and Pioglitazone / Rosiglitazone are used. These drugs improve Insulin action at cell level. Other drugs like Sulfonylureas are prescribed to increase Insulin levels. These drugs can stimulate Insulin release from beta cells of pancreas. There are incretin based treatments also available which increase GLP1 level effect. GLP1 has many effects including insulin release. Drugs like Sitagliptin, Vildagliptin, Saxagliptin increase GLP1 levels and this then releases Insulin. These drugs differ from sulfonylureas by the fact that they usually do not cause hypoglycemia as they stop working when glucose level becomes low. GLP1 analogs like Exenatide, Liraglutide are injectable preparation which also release Insulin and help in weight loss and are very useful in treatment of Diabetes.
But all these drugs themselves are not Insulin. To be effective, they require sufficient active beta cells to be present in pancreas.
As duration of Diabetes increases, number of Insulin producing beta cells decreases and at one point of time, even with maximum doses of oral drugs, Insulin release is inadequate. This is the time when Insulin is given as a prick with help of syringes, pen devices, And Insulin pumps etc.
Thus, if we take the analogy of farming, Insulin can be considered as water. Tablets work as motor pump, taking water [Insulin] out of land [Pancreas]. If there is no water in land, then there is no sense of changing motor pump, increasing horse power of motor pump etc. In this situation a alternative arrangement of water like through tankers etc has to be done. Similarly, if there is no Insulin in pancreas, then it should be replaced. It is important that it should be replaced without waiting for body organ damage by high glucose. Insulin therapy should be viewed as most natural treatment of Diabetes.
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