Diabetes is a chronic illness in which your body’s normal mechanisms for managing blood sugar, also known as blood glucose levels, fail. Blood sugar levels rise as the meal is broken down by the body. Your body’s cells take the sugar into your circulation and utilize it for energy, done by a hormone called insulin. When your body doesn’t produce enough insulin or uses it inefficiently, your blood sugar levels will be higher than normal. Diabetes that is poorly managed can have severe implications, including damage to a variety of organs and tissues in your body, including your heart, kidneys, eyes, and nerves. Diabetes symptoms include increased thirst, weakness, tiredness, blurred vision, numbness or tingling in the hands or feet, and so forth. Sores or wounds that heal slowly, Weight reduction that was not expected, frequent urination, unexplained illnesses, and dry mouth.

Diabetes-related high blood glucose levels can harm your blood vessels as well as the nerves that control your heart and blood vessels. Diabetes not only increases the risk of heart disease but also increases the chance of heart failure, a critical medical condition in which the heart is unable to efficiently pump blood. This can induce a fluid build-up in the lungs, causing trouble breathing, or fluid retention in other regions of the body, causing swelling of the legs. While all diabetics are at a higher risk of having heart disease, type 2 diabetics are more likely to acquire the ailment. In fact, heart disease is the leading cause of mortality among type 2 diabetics. Some of the symptoms of heart attack are shortness of breath, chest pain, dizziness, excessive and inexplicable perspiration, feeling faint, feeling dizzy, suffering from pain in the shoulders, jaw, and left arm, nausea, chest discomfort, or pressure.

The good news is that taking efforts to control your diabetes reduces your risk of developing heart disease or stroke.

Steps to manage diabetes:

• Healthy nutrition is an essential component of having a healthy lifestyle, whether you have diabetes or not. However, if you have diabetes, you must understand how meals impact your blood sugar levels- Carbohydrates have the greatest influence on blood sugar levels. It is critical for people who use mealtime insulin to understand the number of carbs in their diet so that they receive the correct insulin dosage. Some carbs are better for you than others, such as fruits, vegetables, and whole grains. These meals are low in carbs and high in fiber, which helps to stabilize your blood sugar levels. Too few meals in relation to your diabetes treatments, particularly insulin, might result in dangerously low blood sugar levels (hypoglycemia). Too much food may cause your blood sugar level to rise too high, therefore both should be coordinated properly and it’s best to avoid sugar-sweetened beverages.
• Physical activity is another critical component of your diabetes control strategy– your muscles utilize sugar (glucose) for energy while you work out. Regular physical exercise also aids your body’s usage of insulin. Before you begin exercising, consult with your doctor about what form of activity is good for you and what blood sugar levels are appropriate for you. In general, most individuals should engage in at least 150 minutes of moderate aerobic exercise every week. On most days of the week, aim for 30 minutes of moderate aerobic activity. When exercising, drink plenty of water or other fluids to avoid dehydration, and keep a small snack or glucose tablets on hand in case your blood sugar dips too low.
• When diet and exercise alone are insufficient for treating diabetes, insulin and other diabetic medicines are used to reduce blood sugar levels. The success of these drugs, however, is dependent on the time and quantity of the dose. Medications used to treat illnesses other than diabetes might potentially have an impact on your blood sugar levels. Always report and consult your doctor.
• Diabetes issues such as nerve damage and eye disease might be exacerbated by alcohol. However, if your diabetes is under control and your doctor approves, an occasional alcoholic beverage is fine. To avoid low blood sugar, eat before you drink or drink with a meal if you take insulin or other diabetic drugs. Before going to sleep, check your blood sugar levels. Have a snack before night if your blood sugar level isn’t between 100 and 140 mg/dL (5.6 and 7.8 mmol/L).
• When you’re anxious, the chemicals your body creates in reaction to the stress may cause your blood sugar level to rise. Fight back once you’ve figured out how stress affects your blood sugar. Learn how to relax, prioritize your responsibilities, and establish limitations. Avoid common stresses wherever possible. Exercise can typically help reduce stress and blood sugar levels.

How to prevent heart disease with diabetes:

• Maintain blood sugar levels as much as possible.
• Keep your blood pressure under control, and use medication as needed. Diabetes patients should aim for less than 130/80.
• Take control of your cholesterol levels. To accomplish this, you may need to take medicine.
• If you’re fat, you should lose weight.
• Consult your doctor to determine if you should take an aspirin daily.
• Regular physical activity is essential.
• Consume a heart-healthy diet, such as the Mediterranean or DASH diets.
• Smoke no more.
• Lessen your daily stress by working to reduce it.

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Covid manifests uniquely in each individual. And for those with comorbid conditions, the effect of the infection mostly turns severe. Especially people suffering from diabetes when contracted by Covid 19 infection, witness adverse symptoms. While in the first wave the elderly with conditions like diabetes, cardiac problems were mostly affected by the pandemic, in the second wave even younger generations with lifestyle disorders are hit badly by the infection. Uncontrolled diabetes not only increases the severity of Covid when contracted, but it can also make people susceptible to other bacterial and fungal infections as well.

Uncontrolled diabetes and Covid:

Diabetes lowers the immune response thus making it harder for the body to fight the virus. Therefore, Covid 19 infection combined with diabetes can affect the overall wellbeing of the body causing severe health issues thereby prolonging the recovery time. Also, diabetes can increase blood sugar levels and studies have proven that virus-like Covid can thrive in a high blood sugar environment.
Uncontrolled diabetes can hamper the blood flow making it difficult for the body to harness nutrients which is the natural defense system. Therefore, diabetic patients take time to recover from the infection. Also, diabetes keeps the body in a state of low-level inflammation which usually delays healing.

Increase in blood sugar level with Covid:

The increase in Covid cases and the subsequent lockdown have forced people to stay at home. This has drastically reduced physical activities. Closure to gyms and parks has also added to the woes making people less active. This has had a drastic impact on health as well as the blood sugar level.
When the body encounters any kind of infection, it increases the blood sugar level. An unhealthy diet, high fever during Covid times can increase the sugar level in an individual. The intake of steroids which is unavoidable in few patients as a part of the medication can add to it. Therefore, it is mandatory to get the blood sugar level tested on a regular basis and take precautions to control high blood sugar levels. If the patient is diabetic and has tested positive for Covid, it is important to monitor his sugar levels and if required needs to be treated with insulin.

Diabetes during Covid can cause complications

• Diabetic Ketoacidosis: Uncontrolled diabetes combined with Covid 19 can put a person at risk of developing diabetic ketoacidosis. This occurs when high levels of acids called ketones build up in your blood. This condition can lead to a medical emergency.
• Mucormycosis: Uncontrolled diabetes coupled with Covid 19 may lead to mucormycosis in few patients. High sugar levels, steroid usage along with Covid infection can further add to the risk.
• Pneumonia: People with diabetes who develop COVID-19 have a higher risk of developing a more severe form of COVID-19 like pneumonia.

People with diabetes can protect themselves from contracting the virus by taking precautions like:

• Following hand hygiene
• Avoiding touching surfaces when you are outdoors
• Disinfect surfaces that are more prone to contamination like tabletops and door handles
• Do not touch eyes, nose, or mouth with unwashed hands
• Practice physical distancing
• Avoid all contact with people who are unwell, especially if they are suffering from fever, cough, etc
• Strengthen your immune system by following a regular sleep routine, reduced stress, and adequate amount of exercise
• Maintain adequate intake of food and fluids
• Try to keep blood sugar levels in a healthy range
• Monitor blood sugar levels regularly
• Take medications for diabetes
  In the time of the pandemic, it is crucial to take measures to avoid any unforeseen complications.

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Pancreatic cancer is one of the most prevalent cancer in India and has an unusual mortality rate. According to Conservative reports, not only this cancer is more prevalent among men than women but less than 29% of people are able to outlive this cancer for more than a year without receiving any interventional procedure. The increasing number of fatalities under pancreatic cancer is majorly being caused due to the detection of the disease at a later stage. This makes the early detection, timely treatment, and identification of high-risk people extremely important.

Many leading personalities such as Alan Rickman, Steve Jobs, and Joan Crawford have suffered from pancreatic cancer and have succumbed to this condition. Hence, as November is observed as the pancreatic cancer awareness month, it is time to shed some light on the importance of raising awareness about this disease and the test available for early detection, and the possible treatment options.

Recent research conducted by The University of South Carolina in the US found that the onset of diabetes was associated with a 2.3-fold greater increase in the risk of pancreatic cancer than long-standing diabetes. This research further highlights that 80 percent of pancreatic patients have either a new-onset of type 2 diabetes or impaired glucose tolerance at the time of their diagnosis. Hence, according to the study if someone has type 2 diabetes then they are at an increased risk of getting pancreatic cancer also.

Based on the evidence from this study, it is extremely important for diabetic patients to take additional care and why they need to understand the link between diabetes and pancreatic cancer, the treatment options, and the precautionary measures which they need to take.

Facts about Diabetes and Pancreatic Cancer

How Type 2 diabetes can cause pancreatic cancer – Type 2 Diabetes requires a higher level of insulin than normal diabetes. This increases the pressure on one’s pancreas to generate more insulin and hence, this is considered as one of the primary reasons for how diabetes can increase the risk of pancreatic cancer among diabetic patients.

Furthermore, pancreatic cancer too can not only lead to insulin resistance by increasing the amount of insulin produced by the pancreas but can also simultaneously lead to a loss in insulin production capacity. In either case, this can increase the risk of type 2 diabetes.

What is the role of duration of diabetes in pancreatic cancer risk? – The duration of diabetes can play a critical role in increasing the pancreatic cancer risk. Many experts have suggested that the longer a person has had diabetes the higher is their risk of pancreatic cancer. People who have had diabetes for more than 5 years are at a much higher risk of pancreatic cancer compared to an average person.

Importance of early diagnosis and treatment – As both the conditions have a cause and effect relationship, early detection and diagnosis becomes extremely crucial and can enable the clinicians to better manage the conditions.

How can pancreatic cancer be detected? 

Diagnosis for pancreatic cancer usually begins when someone visits a doctor after experiencing symptoms for weeks or months. Symptoms of pancreatic cancer frequently include abdominal pain, weight loss, itching, or jaundice (yellow skin).

A doctor will then embark on a search for the cause, using the following lab tests and techniques that may show evidence or other abnormalities –

• Liver Function Test (LFT)
• CT scan of the abdomen and pelvis
• Magnetic resonance cholangiopancreatography (MRCP)
• Endoscopic ultrasound (EUS)
• Biopsy for histology confirmation
• Pet CT scan of the whole body to detect the spread
• Tumour marker test to measure to amounts of certain substances – like CA 19-9 and carcinoembryonic antigen (CEA) – linked to specific types of cancer when found in increased levels in the body

How can diabetes be detected?

The symptoms of type 2 diabetes can often appear suddenly and therefore, for people who are above the age of 45 years or more, anyone who has a BMI (Body Mass Index) of more than 25, women who have had gestational diabetes, and anyone who has been diagnosed with prediabetes it becomes important for them to check their blood sugar levels.

The following tests are used for the diagnosis of diabetes –

• A fasting plasma glucose test – It measures the blood glucose levels after someone has fasted for at least 8 hours
• An oral glucose tolerance test – It measures the blood sugar after someone has gone for at least eight hours without eating and two hours after drinking a glucose-containing beverage.
• A random plasma glucose test – In this a doctor will check your blood sugar levels randomly without considering when you had your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes, but not prediabetes.
• Glycated Hemoglobin (HbA1c)- The American Diabetes Association (ADA) recommends to begin A1c testing at age 45 for overweight or obese people; if the result is normal, the testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results and risk status, or when classical signs or symptoms of increased blood glucose levels are observed. People who are not diagnosed with diabetes but are determined to be at increased risk for diabetes (prediabetes) should have their A1c level tested at least yearly.

What are the treatment options for pancreatic cancer? 

In the early stages, as the cancer is of small size, it can be removed surgically as it has not spread outside or pancreas to nearby tissues or lymph nodes. However, in the advanced stages, there are various treatment options which are used –

• Chemotherapy
• Immunotherapy
• Radiation Therapy

Why one should also seek a second opinion? 

For effective management of pancreatic cancer, a multidisciplinary team approach is required which can help the patients and their families in understanding the complexity of managing the disease. Therefore, patients and their family members can seek a second opinion to expedite the process of treatment decision as further delay in treatment can put the patient’s health in jeopardy and can rapidly progress cancer to an advanced stage.

As the incidences of pancreatic cancer are growing at an alarming rate it has now become a major health challenge. We need to understand that cancer is curable if timely detection and treatment are provided. Therefore, spreading awareness about this disease has now become imperative and people are now required to be aware of the possible therapeutic solutions.

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