Educating diabetic patient is as important as it’s treatment and management. This is mainly because, once diagnosed then day to day management of blood sugar control is patient’s responsibility. Further they should be able to identify any complications and report the same to the treating physician. So, ideally after diagnosing diabetes, the patients and their closed relations must be called and they should be given a briefing about the disease, so that the patient get full support of their family members in managing their diabetes. But unfortunately, due to large numbers of patients and time constraints this ideal situation is not happening. Moreover the special diabetic clinic conducted by the hospitals are also working like the routine OPD. In view of this problem I thought of elaborating the basics of diabetes to help them understand the disease.

Glucose, the end product after digestion of food is the main source of our energy. But, the glucose is not able to enter the cell on its own to provide energy and it needs the help of insulin. So, those who have deficiency of insulin the glucose is not able to enter the cell and it remains in the blood, causing high blood sugar.

As in the case of glucose which needs the help of insulin to enter into the cell, the insulin also needs the help of “receptor protein”.

The Obese individuals the insulin secretion is four times more than the normal weight individuals. This has been studied and results are presented in the graph below.

The graph above shows, whether a person is normal weight or obese has normal sugar level, before and after meals (Breakfast, Lunch and dinner are shown as three raised graphs).

The graph below shows that normal weight individuals need 40 units of insulin for their each meal (Breakfast, Lunch and dinner). But obese individuals need 160 units of insulin for their each meals (Breakfast, Lunch and dinner).

From the above graph, one can easily conclude that, by secreting four times more insulin for each meal, the obese individuals will exhaust their insulin reserve in few years and become diabetic.

Now, the question arises that if obese individuals uses four times more insulin, then why only some of the obese individuals develop diabetes.

The answer for this question is that apart from obesity, “genetic factor” is very important for the development of diabetes. Persons born to diabetics parent have “very low reserve of insulin”. Therefore, if they are not careful in their lifestyle and become obese, they are bound to exhaust their insulin in middle age and develop diabetes. Whereas persons born to non-diabetic parents have a “large reserve of insulin” and therefore even if they develop obesity in their middle age, they can afford to secrete more insulin and yet will not develop diabetes.

Now finally, one more question the patients usually ask how is that a normal weight person, who has also an active life still develop diabetes. The answer for this that, apart from obesity and genetic factors there is an important contribute factor which in present days fast life is STRESS.

STRESS in life releases certain hormones which blocks the action of insulin. Therefore, they also need like obese persons more insulin to maintain normal sugar level. At this rate they also exhaust insulin reserve by middle age and become diabetic.

The following graph summarizes the points discussed above that, how diabetes develops due to increase secretion of insulin and there by exhausting the insulin reserve.

So, on conclusion, I would like to suggest that the obese individuals and individuals with stress in their life should frequently check their insulin level. If the level of insulin is high, it indicates they are in a pre-diabetic state. Now they have to take up relaxation techniques of Yoga and also regular exercises with the change in the way of life. All these things together will help them to reduce their weight and reverse the condition. By these preventive measures they can escape from developing diabetes. This is possible because, once they come to normal weight and stress-free life, insulin receptors re-appear, and they become normal.

Prof Dr. V. Srinivasan, MD.,
RETD DIRECTOR OF PHYSIOLOGY,
JIPMER, PONDICHERRY,
INDIA