KATHMANDU: Type 1 diabetes is caused due to a lack of insulin in the body. This is more common in children.

Diabetes can also be hereditary. In this type of diabetes, insulin should be administered throughout life.

Similarly, another type of diabetes can start at the age of 35 or even before. Medicines should be taken for this. If the drug stops working, insulin should be given.

The amount of sugar in the body of a healthy person is considered appropriate if it is less than 90 on an empty stomach and less than 140 after a meal.

Khabarhub’s Bina Neupane approached hormone specialist Dr. Deepak Malla to talk about the issue. Excerpts:

Diabetes was previously thought to be a problem that occurs with age or after the age of 45. But, now it is seen a lot in the youth, what does it suggest?

Diabetes is a disease. Diabetes is the loss of sugar in the urine. It is of two types type one and type two. Type 1 means that the body does not release enough insulin and the blood sugar rises.

Type two is also insulin. However, this happens when insulin does not work properly.

Another type, the gestational diabetes is one that was not present before but appears during pregnancy.

Earlier old people used to come to our OPD. However, now many 20 to 22-year-old also come as the diabetes patients. Most of such patients are those who have come back from abroad.

Their age ranges from 30 to 35 years. There they are stressed by being away from family. Diabetes is caused by lack of good diet and good rests i.e. sleep.

Is the modern lifestyle aggravating the problem?

Yes, this is the reason why there is no insulin and it does not work. Obesity is a problem. The current lifestyle is also a problem.

Now we don’t walk anywhere because of the increasing convenience of vehicles. We eat a lot of outside food. We order lunch from outside. Nowadays, this problem is more common for those who work in the office.

Some pregnant women with diabetes get better after delivery whereas others suffer this even after delivery. Why does this happen?

The condition before diabetes is called pre-diabetes. Our aim is to prevent the patient from becoming diabetic from the pre-diabetic stage.

If someone’s parents have diabetes, we send them for screening. So is the case with thyroid. Newly married couples are advised to find out if anyone in the family has diabetes and if so, get screened once.

At 26 to 28 weeks of pregnancy, the body gains weight and other hormones also change. This leads to insulin resistance. Sugar levels can grow.

That is when we should treat the patient. Whether it is by giving medicine or by doing physical exercise, we treat it to prevent it become chronic.

How can it happen that the sugar level does not decrease even after taking the drug during  and after delivery?

Physical exercise during pregnancy is very less in our Nepal. In the health care systems abroad, the pregnant women are guided exercising or go swimming.

However, in Nepal, different foods are fed during postnatal care, and the sugar level may increase when the baby is breastfed.

How do you know that you are suffering from diabetes?

The patient should always know what happened to him. Even after 10 years, the patient I saw should have eyes, kidneys, legs, veins and heart in good condition. Screening for pre-diabetes is essential. If someone in the family has diabetes, they should go for screening once before reaching the age of 30. Screening is very easy now. There are labs everywhere. A random sugar (Random Sugar) and Hb1c test can be done for screening, if not, a urine test alone helps in identifying diabetes condition.

Is it possible to control it by giving medicine or by other means if the diabetes is in initial stage?

Now the patient hesitates to take medicine. The patients with sugar levels from 300 to 500 come to see us. We always recommend to hold the level less than 126 in fasting and less than 180 in fasting or PP (Post Prandial).

If the patient comes late, there will be many problems. One should take medicine in time. If the eyes are damaged, there will be darkness.

If the kidney itself is damaged, dialysis should be done. In that case one has to go to the transplant. It is not easy to get the kidney donors. So, you have to pay attention in time.

What is the trend of the patients coming to the doctors of late? Do they come in initial stage?

The literatures on diabetes often claim diabetes means dry mouth, thirst, hunger, and weight loss. However, many patients do not notice the symptoms and realize the presence of diabetes when they have sudden kidney failure.

What we care most about is the feet. If there is an itchy sore that is dirty and it keeps on spreading, the situation might come when one has to get the leg amputated.

Should one take medicine throughout one’s life if they get diabetes once?

We have to change our way of life. There should be physical exercise 45 minutes a day and a leisurely walk five days a week.

Timely treatment and medication is of vital importance. If the sugar decreases after taking medicine, we reduce the medicine; in that case the medication can be stopped. However, the patient should proceed only according to the doctor’s advice.

Shouldn’t you eat carbohydrates if you have sugar?

If someone has diabetes, they should eat properly. However, physical exercise should be done after or before eating food.

You should exercise as much as you eat. For this you need the support of the family. Rice should be reduced in food.

Sometimes, the patient does not eat rice, but eats 6 loaves of bread. Don’t do that. Diabetics should not eat too much of anything. Instead, you should eat from time to time. We suggest diabetic patients to eat at 6 am, 9 am, 12 pm, 3 pm, 6 pm and 9 pm.

Can diabetics eat fruits?

Mangoes, guavas, melons, in fruits, increase the sugar label. After eating that, you should eat a lot of green vegetable salad soup. Vegetables should also be eaten with more sauce.

One should eat more vegetables, and less rice and breads. It is better not to eat too much food made from flour. If you drink alcohol or smoke, you should stop it.