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Diabetes is a chronic disease which mainly affects the vascular system. Now your eyebrows will be little raised. Always it is said to be a disease affecting the pancreas , but the reality is something else. When you look at the natural history of diabetes, the important thing to discuss is that diabetes doesn’t happen over night . It takes years for a person to develop the so called diabetes mellitus.

Glucose is the main source of energy for human body. We get glucose directly or through different forms of carbohydrates , which then metabolized in the body releases glucose molecules. Our cells requires insulin for the uptake of glucose. There are certain cells which takes glucose without the need of insulin, one such example in the muscle . The more glucose and carbohydrate you eat , the more insulin your pancreas secrete . So there will be spike of insulin in your body as soon as you take food. When the frequency and quantity of food increases the insulin surge also increases and can lead to a persistent elevated levels of insulin in your body. Unfortunately the insulin has many other actions including the formation of adipocytes, which means nothing but the fat cells . If we don’t have a good physical activity in daily life the usage of glucose by the muscle cell also become limited, leading to high blood glucose and blood insulin levels. This leads to more and more fat production and accumulation in our body. The more fat , especially the truncal fat deposition , the body will start resisting the insulin. Finally even if the body produces enough or more insulin , there will be more and more resistance towards insulin and our cells will not be able to use it. Till this phase , whoever checks their blood glucose level will be having normal values , due to the increased response in our body.

Once this stage crosses , we will reach to the phase of pre diabetes, where there will be slight elevation in the blood sugar levels on a screening without any signs or symptoms. Identifying the disease at an early stage through investigation and treating appropriately is called secondary prevention. People once diagnosed to be pre-diabetic are given life style modification which they fail to do and continuing their unhealthy lifestyle. Making them a diabetic person which may gradually invite other metabolic disease and the complex phenomena is called Syndrome X or Metabolic syndrome .

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