What is Diabetes Mellitus?
Diabetes mellitus is a chronic condition where your body cannot properly regulate blood glucose (sugar) levels. Glucose is the main source of energy for your cells, and the hormone insulin (produced by the pancreas) helps glucose enter your cells. In diabetes, either the pancreas does not produce enough insulin, or the body cannot effectively use the insulin it produces.
Types of Diabetes
Type 1 Diabetes
The immune system destroys insulin-producing cells in the pancreas. Usually diagnosed in childhood or young adulthood. Requires lifelong insulin injections. Accounts for about 5-10% of all diabetes cases.
Type 2 Diabetes
The body becomes resistant to insulin or the pancreas gradually produces less insulin. The most common type (90% of cases). Strongly linked to lifestyle factors, obesity, and genetics. Can often be managed with diet, exercise, and oral medications.
Gestational Diabetes
Develops during pregnancy, usually in the second or third trimester. Typically resolves after delivery but increases the mother's risk of developing Type 2 diabetes later in life. Requires careful monitoring during pregnancy.
Why is Diabetes So Common in Sri Lanka?
Sri Lanka has one of the highest rates of diabetes in South Asia, with an estimated 1 in 5 adults being affected by diabetes or pre-diabetes. Several factors contribute to this:
- Genetic predisposition: South Asians are genetically more prone to insulin resistance, even at lower body weight compared to Western populations.
- Dietary habits: Traditional Sri Lankan meals are high in refined carbohydrates — large portions of white rice, white bread, and sugary foods. Frequent consumption of sweetened tea (with 2-3 spoons of sugar per cup) adds significant hidden calories.
- Sedentary lifestyle: Increasing urbanisation, desk jobs, and reduced physical activity contribute to weight gain and insulin resistance.
- Rising obesity rates: Abdominal obesity (central obesity) is particularly common among Sri Lankans and is a major risk factor for Type 2 diabetes.
- Late diagnosis: Many people remain undiagnosed for years because early diabetes often has no obvious symptoms.
Symptoms of Diabetes
Type 2 diabetes often develops gradually and many people have no symptoms in the early stages. When symptoms do appear, they may include:
- Excessive thirst (polydipsia) — feeling unusually thirsty throughout the day
- Frequent urination (polyuria) — especially at night
- Unexplained weight loss — despite eating normally or more than usual
- Persistent fatigue and lack of energy
- Blurred vision
- Slow wound healing — cuts and sores take longer to heal
- Frequent infections — urinary tract infections, skin infections, or fungal infections
- Tingling or numbness in hands and feet
- Darkened skin patches (acanthosis nigricans) — especially around the neck and armpits
Risk Factors
Non-Modifiable (Cannot Change)
- Age over 35 years
- Family history of diabetes (parent or sibling)
- South Asian ethnicity
- History of gestational diabetes
- Polycystic ovary syndrome (PCOS)
Modifiable (Can Change)
- Overweight or obesity (especially abdominal fat)
- Unhealthy diet (high sugar, refined carbs)
- Physical inactivity
- Smoking
- High blood pressure
- High cholesterol or triglycerides
Diagnosis Criteria
| Test | Normal | Pre-Diabetes | Diabetes |
|---|---|---|---|
| Fasting Blood Sugar (FBS) | Below 100 mg/dL | 100 - 125 mg/dL | 126 mg/dL or higher |
| Post-Prandial Blood Sugar (PPBS) | Below 140 mg/dL | 140 - 199 mg/dL | 200 mg/dL or higher |
| HbA1c | Below 5.7% | 5.7% - 6.4% | 6.5% or higher |
| Random Blood Sugar | Usually below 140 mg/dL | 200 mg/dL or higher (with symptoms) | |
Complications of Uncontrolled Diabetes
Persistently high blood sugar damages blood vessels and nerves throughout the body. Complications include:
- Eye damage (diabetic retinopathy): Damage to blood vessels in the retina. Can lead to blindness if untreated. Annual eye examinations are essential.
- Kidney damage (diabetic nephropathy): Diabetes is the leading cause of kidney failure. Early detection through urine microalbumin tests can help prevent progression.
- Nerve damage (diabetic neuropathy): Tingling, numbness, burning, or pain in the feet and hands. Can also affect digestion, bladder function, and sexual health.
- Heart disease and stroke: Diabetes significantly increases the risk of heart attacks, stroke, and peripheral artery disease.
- Foot problems: Poor circulation and nerve damage can lead to foot ulcers, infections, and in severe cases, amputation. Daily foot inspection is important.
- Skin infections: Increased susceptibility to bacterial and fungal skin infections.
Management: Diet (Sri Lankan Context)
Dietary Guidelines for Diabetic Patients in Sri Lanka
- Reduce rice portions: Limit to 1 cup of cooked rice per meal (about the size of your fist). Switch to red rice, basmati rice, or mix white rice with red rice for a lower glycaemic index.
- Cut sugar in tea: Gradually reduce sugar in your tea and coffee. Aim for no sugar or use a small amount of a doctor-approved sweetener. Drinking 4-5 cups of sweetened tea daily adds a significant sugar load.
- Be cautious with coconut milk: Thick coconut milk (pol kiri) is high in saturated fat. Use sparingly in curries. Opt for thinner coconut milk or limit frequency.
- Increase vegetables: Fill half your plate with non-starchy vegetables — gotukola, mukunuwenna, beans, bitter gourd (karawila, which may help lower blood sugar), brinjal, and salads.
- Choose lean protein: Fish, chicken (without skin), dhal, and eggs. Limit red meat and processed meats.
- Limit fruits high in sugar: Mango, banana (particularly ripe), jackfruit, and pineapple in large quantities can spike blood sugar. Opt for papaya, guava, or small portions of fruit.
- Avoid sugary drinks: Soft drinks, fruit juices (even "natural" ones), and sweetened condensed milk drinks are high in sugar.
- Eat at regular times: Do not skip meals. Eat 3 main meals and 1-2 small snacks at consistent times.
Exercise
- Aim for at least 150 minutes per week of moderate exercise (brisk walking, cycling, swimming)
- Even 30 minutes of walking daily can significantly improve blood sugar control
- Include some resistance exercises (bodyweight exercises, light weights) 2-3 times per week
- Avoid prolonged sitting — get up and move every 30-60 minutes
- Check blood sugar before and after exercise if you are on insulin or sulfonylureas
Medication and Insulin
Your doctor may prescribe one or more of the following, depending on your blood sugar levels and overall health:
- Metformin: The most commonly prescribed first-line medication for Type 2 diabetes. Reduces liver glucose production and improves insulin sensitivity.
- Sulfonylureas (e.g., gliclazide, glimepiride): Stimulate the pancreas to produce more insulin.
- DPP-4 inhibitors (e.g., sitagliptin, vildagliptin): Help increase insulin production and decrease glucose production.
- SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin): Help the kidneys remove excess glucose. Also beneficial for heart and kidney protection.
- Insulin: Required for all Type 1 diabetics and some Type 2 diabetics whose blood sugar is not controlled with oral medications alone.
Never stop or change your diabetes medication without consulting your doctor.
Blood Sugar Monitoring Targets
| Measurement | Target for Most Diabetics |
|---|---|
| Fasting Blood Sugar (FBS) | 80 - 130 mg/dL |
| 2 hours after meals (PPBS) | Below 180 mg/dL |
| HbA1c | Below 7% (individualised by your doctor) |
| Blood Pressure | Below 130/80 mmHg |
When to See a Doctor
Seek medical attention immediately if you experience:
- Very high blood sugar (above 300 mg/dL) that does not come down with medication
- Symptoms of diabetic ketoacidosis (DKA): nausea, vomiting, abdominal pain, fruity-smelling breath, rapid breathing, confusion
- Very low blood sugar (hypoglycaemia): shakiness, sweating, dizziness, confusion, palpitations, inability to eat or drink
- Foot ulcers or wounds that are not healing, especially if red, swollen, or warm
- Sudden vision changes or loss of vision
- Chest pain or difficulty breathing
- Persistent vomiting or inability to keep food or fluids down
- Signs of infection with high fever in a diabetic patient
Important: This information is for educational purposes only. If you are unsure about your symptoms or they are severe, please consult a doctor. Our doctors are available for home visits and telemedicine consultations.