Diabetes and Anxiety – A Mental Torment

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Diabetes and Anxiety are linked with each other which takes a mental tole on the patient. Anxiety and depression are the most common problems faced by patients suffering from Diabetes. It is believed that type 1 or type 2 Diabetes is linked with anxiety and mental health issues. There is stimulation of hypothalamus pituitary adrenal gland which in turn releases cortisol, growth hormones, epinephrine, nor epinephrene, other hormones in blood glucose levels. Thus leading to anxiety, depression during diabetes. Also one can not rule out increase in sugar levels or diabetes due to stress, anxiety.

Epidemiology of Diabetes & Anxiety:

According to the recent study in America, around 20 to 25 percent of diabetic people were suffering from anxiety than non diabetics. Around 40 to 45 percent of women population in India who have Diabetes are suffering from anxiety.

Diabetes_anxiety

Ways of identifying anxiety in a diabetic patient:

  • Feeling of fear, nervousness, at the time of commencement of the event.
  • Avoiding visiting public places, events, any occasions.
  • Development of symptoms of headache, palpitation of heart, restlessness, cramps in abdomen, sweating during attack of anxiety.

Patients  get anxious due to diagnosis of complications of Diabetes like neuropathy, retinopathy, nephropathy, gangrene etc. They also face anxiety due to management of Diabetes, following strict diet, taking complicated medications, sometimes insulin injections, exercising, improving lifestyle changes etc.

How to help a diabetic patient suffering with anxiety issues?

Usually in India, the Diabetes of the patient is managed by the diabetologist who is a physician and his mental health issues are treated with psychologist or psychiatrist. This leads to lack of collaboration between the two doctors as far as diabetes and mental health issues are concerned. Hence a Collaborative model of Diabetes and psychologist is practiced in such a way that the Diabetes and mental health issues like anxiety are well managed by the team of physicians working together. Thus the patient is given a self identified goal for Diabetes control and management and also given psychotherapy sessions to identify the mental health issues by the patient.

Management and treatment of anxiety and Diabetes:

  • Management of anxiety by anticholinergic drugs, antipsychotics, beta blockers, nor epinephric drugs, anti depressants, benziodiapides help a lot.
  • Antidepressants help in controlling Diabetes.
  • Psychotherapy is given to patients with anti depressants and cognitive behavioral therapy is proved to be successful in such cases.
  • Counselling sessions are conducted for behaviour therapy and controlling anxiety.
  • Routine check ups for Diabetes is done.
  • Improvement of lifestyle helps tremendously in improving the mental state of an individual.
  • Exercising regularly helps to maintain fitness and control diabetes. It utilizes your glucose for energy this maintaining blood sugar levels.
  • Plate diet is yet another way to improve your lifestyle and eating habits.
  • Having more of fruits and green vegetables helps in boosting immunity and controls diabetes.
  • Taking self care of being cautious of any injury helps preventing any complications.
  • Identifying anxiety at an early stage of onset helps in curing the patient from the mental illness by Counselling and medication.
  • Screening anxiety is extremely important for patients with HbA1C is more than 6.5.
  • Educate the patient on relaxation methods like meditation, yoga, breathe in and breath out exercise, concentrating candle etc.

Thus we conclude that mental illness is equally important as important as Diabetes. Diabetes and anxiety pose a mental torment to the patient. A thorough routine investigation should be done for behaviour changes in such diabetic patients.

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Diabetes and Menopause

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Does menopause women are more prone to Diabetes? As we all know how diabetes hits hard in women after menopause. There are many hormonal changes taking place after menopause, which triggers changes in blood sugar levels. A women after menopause this experiences highs and lows in sugar levels and mood swings.

In United States, nearly 45 to 50 % of the women population suffers from type 2 Diabetes. These women are mostly above 40 years of age and obese. Type 2 Diabetes is usually attributed to family history of type 2 Diabetes, high blood pressure, hypothyroidism, PCOD, cardiovascular disease etc.

Diabetesand menopause

Triggers leading to Diabetes after menopause:

  • History of cardiovascular disease.
  • High blood pressure
  • Hormonal imbalance
  • Obesity
  • Smoking
  • Alcoholism
  • Drug abuse
  • Sedentary lifestyle
  • Lack of exercise
  • Hypothyroidism

Usually women suffering from Diabetes during their menopause can sweep to complications of Diabetes if blood sugar levels go uncontrolled. Going into depression during Diabetes and menopause is very common amonst old women. Mood swings also play a very important part in women suffering from Diabetes.

Have you noticed your blood glucose levels fluctuate when your period is approaching, or that you crave sweets, chocolate or other carb-heavy foods when it’s that time of the month. But when your menstrual cycle seems to be going haywire, with a heavier, lighter, or more irregular flow and you’re approaching midlife?

Perimenopause is the body’s transition to menopause, when the reproductive process permanently ends. One could be experiencing perimenopause, the time when a woman’s body decreases hormone production and when egg production slows down. During this shift, there are high chances of diabetes and menopause complicating each other.

Levels of the hormone oestrogen decrease, causes the ovaries to stop producing an egg each month (ovulation). Reduced oestrogen hormone can result in women experiencing hot flushes, night sweats, mood swings and vaginal dryness. Not all women will experience the same symptoms, but there are some symptoms which are common like hot flushes, sleep disorders, infections, obesity and sexual dysfunction.

Some useful tips to keep Diabetes at Bay in women after menopause:

There are many ways to reduce your risk of diabetes and the risk of diabetes complications:

  • Do weight-bearing exercise
  • Exercise more in general
  • For women with osteoporosis, use of bisphosphonate medication may cut the need for insulin
  • Limit your alcohol intake
  • Increase sources of omega-3 fatty acids in your diet with fatty fishes (such as salmon, mackerel, sardines) or plant-based sources (such as soy, canola oil, flax seeds, and walnuts)
  • Control your weight
  • Improve your life style by eating healthy low fat food, fruits, vegetables, high fibre diet like salads.
  • Regularly test your sugar levels especially when you have hot flushes, irritability, infections, sleep disturbances. If your blood sugar levels is not coming in control then one should consult your diabetologist to either increase your diabetes medicine dose or change your diabetes medication.
  • For vaginal dryness, leading to sexual dysfunction try using vaginal lubricant and antifungals for infections.
  • Being overweight can invite cardiovascular risks, one should get evaluated cholesterol levels.
  • During menopause, there is loss of calcium from the bones especially after 45 years of age. There is thinning of the bones, where the chances of fracture are high. Vitamin D supplements along with calcium serves the purpose during manopause.

Hence we conclude that one should not take Diabetes during menopause lightly. I would recommend women to adopt healthy and active lifestyle for better living.

hope you like this article and share it with your elderly contacts.

Have a great day.

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Relationship between Diabetes and Covid 19

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Hello friends as we all know what’s covid 19 actually. Well let me explain you that how the deadly corona virus infects and its transmission. Corona virus means crown shaped virus which transmits from human to human through droplets of infection. Droplets shed by a patient through sneezing, coughing and touch can cause infection to the other person. The window period of the virus is 14 days where the symptoms can appear.

Covid 19 completely compromises the immunity of the person. It hampers the normal living. Some patients are carriers and completely asymptomatic, which can prove dangerous. These patients are usually not aware of them being carriers and they transmit the disease. In India, though the recovery rate is high nearly 70 % still many being carriers of the infection.

When a person suffering from an uncontrolled diabetes suffers from covid his immunity is compromised a lot. Along with symptoms of Covid like sneezing, coughing, fever, bodyache, loss of taste etc it can worsen the Diabetes and it’s complications. Diabetes and Covid 19 is a deadly combination. A person suffering from pre existing diabetes, blood pressure and cardiovascular diseases are at high risk of getting infected by corona virus. Older people suffering from Diabetes are more prone to get infected.

Diabetes &covid19 relationship

Image credits: Sciencedirect.com

Pathogenesis of Covid19 in Diabetes:

Severe acute respiratory distress syndrome (ARDS) SARS-CoV 2 infection itself represents worsening factor for people with diabetes,  precipitate acute metabolic complications through direct negative effects on pancreatic β-cell function. These effects on pancreatic β-cell function can also lead to diabetic ketoacidosis in patients with diabetes. Hyperglycaemia or raised sugar levels at hospital admission in individuals with unknown history of diabetes and potentially pre diabetic state is very common presentation.

Diabetic patients have impaired immune-response to infection in relation to both cytokine profile and to changes in immune-responses including T-cell and macrophage activation. Poor glycaemic control hampers several aspects of the immune response to viral infection and also to the potential bacterial secondary infection in the lungs.

Epidemiology:

Initial studies has revealed a J-curve relationship between HbA1c and risk of individuals being admitted to hospital for infections in general, and infections of the respiratory tract in particular. A prospective cohort study of patients with COVID-19 from New York City,  USA, revealed that the prevalence of diabetes and obesity was higher in individuals admitted to hospital than those not admitted to hospital. In around 7 meta analysis study, showed that around 67% of people in India suffering with Diabetes are at higher risk with Covid 19.

Signs and symptoms of Covid19 in diabetes:

  • Fever
  • Cough persistent
  • Pneumonia ground glass opacity
  • Pressure on chest
  • Loss of taste
  • Muscle pain
  • Difficulty in breathing
  • Increased frequency of urination due to Diabetes
  • Itching all over the body due to uncontrolled Diabetes

Management of Diabetes and Covid 19:

  • One should regularly monitor blood sugar levels.
  • Avoid unnecessary travel
  • Take necessary precautions like wearing mask and gloves, socks to avoid contact with virus.
  • Take your Diabetes medicine regularly.
  • Keep yourself well hydrated.
  • Take multivitamins like vitamin C and zinc on daily basis and weekly Vitamin D if advised by your doctor.
  • If diabetes is uncontrolled, then visit to your diabetologist at the earliest. Take insulin injections as prescribed by your doctor.
  • If a person suffering from Diabetes is exposed to virus, take your anti biotics and prescribed medication regularly along with anti-diabetic medication.

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Awareness is Prevention.

 

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Diabetic Nephropathy – Symptoms Pathophysiology Treatment

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Diabetic Nephropathy (DN) is also known as Diabetic kidney disease. DN leads to chronic loss of kidney function due to diabetes mellitus. Over 45 percent of cases of kidney failure are caused by diabetes, and it’s estimated that approximately 190,000 people are living with kidney failure caused by complications of diabetes. When the blood sugar levels are increased, there is progressive damage to the kidneys.

Diabetic nephropathy is one of the causes of end stage kidney disease. The kidneys regulate the levels of salts and fluids in the body, which is important for controlling blood pressure and protecting cardiovascular health. In ESRD, the kidneys donot work well enough to meet the needs of daily life. This leads to kidney failure due to failure in filtration of salts and fluids.

Diabetic nephropathy symptoms treatment

Pathophysiology:

When our bodies digest the protein we eat, this process creates waste products. In the kidneys, millions of tiny blood vessels with even tiny holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products pass through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are larger in size do not pass through the holes in the filter and stay in the blood. High blood glucose levels interfere with the function of the glomerulus. The filter function of the kidneys get damaged and proteins start to leak from the blood into the urine. Albumin being the smallest of proteins goes first hence by measuring its presence in urine we can measure the damage to kidneys.

Symptoms of Diabetic Nephropathy(DN) :

  • Albumin in urine
  • Nausea
  • Vomiting
  • Drowsiness/ disturbed sleeping pattern
  • Dryness of skin and itching
  • Stomach upset
  • Swelling of face, feet and hands.
  • Loss of appetite
  • Uremia due to retention of waste products.

Risk factors:

People who have diabetic nephropathy also often have high blood pressure. High blood pressure can further contribute to kidney damage. High blood pressure lead to increase in filtration pressure and can further lead to pores wide open. under high pressure it increases the chances of albumin to slips into the urine and increasing the kidney damage further. so controlling blood pressure is essential to halt kidney damage.

Other risk factors include obesity, smoking, alcohol, hereditary and people suffering from cardiovascular diseases. Diabetic nephropathy is a complication of uncontrolled Diabetes mellitus and usually accompanied with diabetic neuropathy and diabetic retinopathy.

Diagnosis and Management of Diabetic Nephropathy(DN) :

  • X ray kidney ureter bladder (KUB) can help in detection of any damage to the kidney.
  • CBC, ESR, Urine routine and C reactive protein are some of the tests which can help in detecting the nephropathy.
  • Also Blood sugar levels should be monitored at regular intervals.
  • Estimated glomerular filtration rate (eGFR) gives an indication of the kidney function to filter waste products from your blood.
  • Albumin / Creatinine ratio or 24hr albumin in urine is another important test.

Treatment for Diabetic Nephropathy:

Early detection and treatment of diabetic nephropathy can not only stop the progression of kidney disease, but during the early stages can actually reverse it. Treatment involves controlling both your blood glucose levels and your blood pressure. ACE inhibitors and ARBs are the class of drugs which helps in restricting the kidney damage by reducing those pores size by altering the renal glomerular blood vessels flow (afferent and efferent arterioles) and preventing albumin loss. CKD is not reversible as such but we can obviously delay its progression.

Oral medication usually helps in controlling diabetes. Also insulin injections are given when the sugar levels are out of the limits.

Lifestyle changes are a must for a healthy normal life. Working on your obesity is equally important as per body mass index.

Quiting smoking and drinking alcohol usually improves the overall wellbeing of an individual.

Plate diet plan helps often in improving the condition of the patient. Avoid seedy foods like lady’s finger, tomato, seedy foods are a must to consider. A reduced protein diet can help to prevent Diabetic nephropathy this preventing protein in urine.

Exercising regularly for half an hour is a must to vent out energy and utilize extra glucose. (not advisable in last stages)

In last stages salt restriction and water restriction plays an important role in its progression.

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