How many of you have not heard the word DIABETES? It would be unusual for someone in 21st century to have missed the term diabetes or sugar ki bimari. Most of us have heard about it, many of us know that it means to have high glucose levels in blood and many understand the dreaded complications it is associated with. Most understand that our lifestyle choices have a role to play in diabetes development and progression. Let’s start the discussion with some basic questions, which we will try to answer as best as we can.

Question 1: Where does blood glucose come from, what is it used for in the body, where does it go?

Answer: All living organisms need energy to live, grow and reproduce. All living beings on earth rely on energy from sun, which fortunately is trapped by plants in the form of “carbohydrates”, which we then consume as food. Carbohydrates are compounds made up of one, two or many “glucose” (or Fructose) molecules which are like building blocks for carbohydrates. Glucose and fructose are MONOsaccharides, sucrose (common sugar) is a DIsaccharide (it has one glucose molecule and one fructose molecule) and starch (e.g. in wheat) and cellulose (e.g. in grass) are POLYsaccharides; so is glycogen (the storage form of glucose in our bodies). Our foods provide us these carbohydrates which we ultimately digest down to the basic building block molecule GLUCOSE. The energy stored in glucose molecule is released and captured in ATP molecules inside the MITOCHONDRIA (power houses) of our cells. All body cells use this ATP as energy for muscle contraction, opening and closing of channels and all bodily activities which keep us alive.

The glucose molecules which are not immediately used for energy are stored in liver as glycogen, which is used when we are not eating (fasting).

“If we imagine our bodies as cars, glucose is like petrol (fuel) to run this car. The Petrol has to be poured into the engine. If you keep buying petrol and keep in on the backseat, pretty soon, there will be a spillover of petrol, but the car won’t run until the petrol is poured into the engine. Insulin is the guy who is going to open the engine to push petrol inside and body stocks extra petrol in the liver as store for a long drive. In-between the car may not find any petrol pump. Then the stored petrol is taken from the liver and put in the engines as needed.”

A little bit of anatomy shots: Hormones are the way organs send messages to each other. These are the telephone services. Pancreas send signals through Insulin and Glucagon. The signals are received by other organs who have receivers (or receptors) for these signals (or Hormones). When glucose levels start going up in the blood, pancreas knows that and it starts secreting INSULIN message to liver and muscle cells especially- “Hello, glucose arriving. Please be ready, Over” The receptors on these cells, receive the message and respond appropriately. Muscle cells open up the glucose transporters (GLUTs) or gates for the entry of glucose. Liver takes up glucose, combines then into GLYCOGEN and stores it for later use if needed. Fat cells store any more glucose in the form of fat, if there is a surplus.

Question 2: Why does the level of glucose in blood go high in diabetes?

Answer: If the pancreas doesn’t send enough insulin signals, liver and muscle will not respond properly and glucose levels go high in the blood. 

If the muscle or liver cells do not receive the insulin signals properly, then also blood glucose levels can go high. This is called INSULIN RESISTANCE.

The pancreas may not make enough insulin if it is damaged by abnormal fat deposition (called ectopic fat deposition), which can happen because of genetic abnormalities, or some defects which happen during fetal growth (epigenetic reasons which are especially very important in India-a Mother’s health during pregnancy determines the child’s health lifelong-not unlike Abhimanyu’s story in Mahabharata) or due to consumption of surplus calories for prolonged times, leading to more fat which then starts getting deposited in liver and pancreas; or due to inability to expend much calories over the years, leading to a surplus in the body.

Liver and muscle defects also result from abnormal fat deposition, which in turn happens for the reasons described above in short and in details later.

The concept of food insecurity as a foetus and during early childhood, leading to a thrifty phenotype explains the high risk for diabetes in low and middle income countries (LMIC) like India which are undergoing socioeconomic transition. This theory underlines the need to improve maternal health, which ultimately can happen through girl education and health.

Question 3: Why are we worried of high blood glucose? Can it harm me, and how?

Answer: High blood glucose can affect the organs gradually and silently over years, leading ultimately to irreversible damage of kidneys, eyes, nerves of the feet; or it can facilitate the process of atherosclerosis in vessels which can result in heart attack and stroke. Fortunately these “complications” of diabetes are preventable, by knowing early enough if glucose levels are going high and taking measures to then bring it down.

Question 4: How will I know or “feel” when my blood glucose levels are high?

Answer: Mostly you will not “feel” anything unless the glucose levels are so high that glucose starts leaking out of kidneys and being a solute, drags water also along with it. This will cause frequent urination, leading to dehydration and thirst. Glucose our important source of energy being drained into urine leads to weight loss and weakness.

However if you are feeling all these symptoms, glucose levels are already quite high. Ideally we want to detect the problem much earlier, and that can ONLY be done by checking the glucose level in blood. That can be easily done through laboratory test.

Question 5: How high is too high for blood glucose? Who decides what is “high” and what is normal?

Answer: Studies have shown that if fasting blood glucose levels are more than 126mg/dl, and 2 hours postmeal are more than 200mg/dl, and glycosylated haemoglobin (HbA1c) ls more than 6.5%, over 10- 15 years this can affect our organs like retina, kidneys and nerves. Therefore, these levels were decided as the cut off to call someone as having diabetes, ensuring that he/she takes measures to reduce the levels below this and reduce the risk of future complications.

We now have sufficient knowledge to prevent some problems before they appear or even begin. This is done by predictions made from data science. A peek into the chemicals like glucose and cholesterol help us predict future risks and gives us tools to prevent serious, painful, expensive, debilitating and sometimes fatal complications; thus improving and prolonging lives. All we need to do is use this knowledge wisely and make smart choices in our lives.