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Diabetes: Symptoms, Treatment and Latest Research
#11
Intarcia Therapeutics Inc. has emerged with an implantable drug-delivery pump which is suggested to have been proved superior to currently existent Merck's Januvia drug.

Sized of a matchstick, this pump called ITCA 650, comes loaded with a whole year of supply of commonly used diabetes drug Exenatide.


Quote:ITCA 650 is implanted in abdominal tissue and can release the medicine continuously in minute quantities ensuring a steady state of medicine availability in the body and keeping the blood sugar levels in check.



The results have come post a year-long study involving 535 patients with Type 2 diabetes. Intarcia expects to publish the trial results in a journal and exhibit in medical meetings.
Sunil Nagpal
MS(Research) Scholar, IIT Delhi (Alumnus)
Advisor for the Biotech Students portal (BiotechStudents.com)
Computational Researcher in BioSciences at a leading MNC


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#12
Surya namaskar is the best among all the asans. it has 12 asans which include whole body exercises.
#13
Let us first understand the basis of the research that driven the invention of the drug that actually 'Mimics Exercise' and helps controlling blood sugar levels and hence diabetes:

Quote:When ever you exercise, your body cells get depleted of energy and hence the glucose uptake into the cells from blood takes place and ATP (energy) is produced. So, the researchers from University of Southampton (England) ended up finding a pathway (alternative to the conventional one) to activate an important protein (enzyme) required for glucose uptake by the cells, thereby successfully mimicking the effects of exercise (some, if not all effects though).

This research was published in the Cell journal on July 23rd 2015. They have named the drug as "Compound 14". Following is a graphical abstract to their research followed by the 'verbatim abstract from the journal'. You may read the full article in PubMed or Cell.
[Image: fx1.jpg]

Note the following is taken exactly from the original article:

Quote:Summary

5-Aminoimidazole-4-carboxamide ribonucleotide (known as ZMP) is a metabolite produced in de novo purine biosynthesis and histidine biosynthesis, but only utilized in the cell by a homodimeric bifunctional enzyme (called ATIC) that catalyzes the last two steps of de novo purine biosynthesis. ZMP is known to act as an allosteric activator of the cellular energy sensor adenosine monophosphate-activated protein kinase (AMPK), when exogenously administered as the corresponding cell-permeable ribonucleoside. Here, we demonstrate that endogenous ZMP, produced by the aforementioned metabolic pathways, is also capable of activating AMPK. Using an inhibitor of ATIC homodimerization to block the ninth step of de novo purine biosynthesis, we demonstrate that the subsequent increase in endogenous ZMP activates AMPK and its downstream signaling pathways. We go on to illustrate the viability of using this approach to AMPK activation as a therapeutic strategy with an in vivo mouse model for metabolic disorders.

Highlights

•AICAR transformylase is targeted in cells with an ATIC homodimerization inhibitor
•The resulting increase in endogenous ZMP is sufficient to activate AMPK
•Downstream AMPK signaling is also activated, significantly altering cell metabolism
•A mouse model of metabolic syndrome is used to show therapeutic viability

The original article is an open access article available at: http://www.cell.com/chemistry-biology/fu...%2900234-3
Sunil Nagpal
MS(Research) Scholar, IIT Delhi (Alumnus)
Advisor for the Biotech Students portal (BiotechStudents.com)
Computational Researcher in BioSciences at a leading MNC


Suggested Reads:
Top Biotech Companies | Top places to work
Indian Biotech Companies and Job Openings
Aiming a PhD in Top Grad School? | These are the Important Points to Consider
Careers in Biotechnology | A list of various Options
Biotechnology Competitive Exams in India
#14
Lifestyle changes have been shown to reduce the risk of both cardiovascular diseases and diabetes. Lifestyle changes includes such things as introduction of daily exercise, quitting smoking, moderation of alcohol and diet modification with less fat, red meat, salt and sugar. It has been shown that yoga has been beneficial with fasting and postprandial blood glucose levels, in that it reduces the amount. However do not think yoga alone in high risk persons is sufficient alone to prevent diabetes, it does decrease free fatty acids, increase lean body mass and decrease body fat percentage.

1. Sahay BK. 2007. Role of Yoga in Diabetes. J Association Physician India. Vol34:645-648. [Internet] Available from http://www.japi.org Accessed on 28th August 2015.

Maureen
[+] 1 user Likes maureen_dass's post
#15
Such a Informative post I have just read, thank you for the information.
#16
I wonder what makes the treatment of Diabetes so difficult. Given the fact that we have at our disposal so many great techniques like Genetic engineering, Immune modulation, artificial devices etc, what makes diabetes (a simple hormonal deficiency/ resistance disease) so elusive?

I was thinking about the following being probable options to cure diabetes. Can anyone help me out in quantifying their merit?:


A. Insulin producing transgenic bacterial strains could be utilized as probiotics. This would enable a growth of such bacteria in our gut, and insulin will be produced right in our gut. Why can't we do that?

B. Can't we clone the cells that produce insulin and implant them in Pancreas?

C. If we eat Bitter gourd and Ridge gourd daily, (proven helpful for Type 2 diabetics), can't we prevent diabetes? or even keep it at the bay?

D. Why don't we develop a device that can be implanted inside our body with 2-4 years of insulin stock in it, and program it to release the dosage as and when needed? It would atleast make the life less miserable. Only 10-15 refillings using minor surgeries should be more comfortable than punching holes in the skin everyday!


Looking forward to getting good opinions and suggestions and advices.

Thank you

Rajan
#17
Hello Rajan how are you?

I am going to be the devil’s advocate here and ask why do you say diabetes is a simple disease? And as you rightly said if it was a simple disease then why is it so difficult to manage? And if so why is there consequent organ damage from uncontrolled diabetes?

I personally believe that we should transfer our focus from treating the disease and focus on preventing the disease. As you know diabetes is a lifestyle disease and we know that certain populations are at a higher risk of contracting the disease. I think we should start with that premise and strengthen our primary care facilities to manage diabetes or keep it at bay as you say. Why should we wait for renal damage before starting aggressive treatment? Simple daily exercises and reducing the amount of carbohydrates in our diet can go a long way.

With that being said I am going to zero in on the point about bitter gourd being helpful to type 2 diabetes. Research using bitter gourd (Momordica charantia) as a single dose on animals have shown to reduce blood glucose levels and Hba1c levels. The juice form of the fruit has been more effective than the dried food products. Children drinking bitter gourd tea resulted in headaches and hypoglycemic episodes and coma.

On the otherhand, research on bitter bottle gourd (Lagenaria siceraria) or locally known as lauki, ghia or dudhi in India has shown to cause toxicity and in extreme cases death. More than half of the persons drinking the bottle gourd was shown to have hypotension after consumption. It was recommended after the research to ban the consumption of bottle gourd as it can cause abdominal discomfort, bleeding and vomiting.

One may ask if bottle gourd and bitter gourd the same? For clarification purposes, bottle gourd is bitter gourd mixed with juice.

Hence based on research bitter gourd does have some healing properties but in what doses? Before considering its use you should consult your physician.

I think more thorough research should be done in bitter gourd and other natural fruits and vegetables before venturing into genetic research and cloning. Maybe instead of developing insulin storage devices which the body may reject, we need to develop products that will stimulate glycogen storage and increase hepatic glycogen synthesis.

Happy reading and do feel free to reply and comment on my posting.

Maureen.

1. Arachchige, NW. 2014.Bitter Gourd and its antidiabetic properties. Available at http://www.daa.asn.au/wp-contents
2. Sharma SK et al. 2012. Assessment of effects on health due to consumption of bitter bottle gourd (Lagenaria siceraria) juice. The Indian Journal of Medical Research. Available at http://wwwncbi.nlm.nih.gov/pmc/articles/PMC3307184/
#18

Foods to control Diabetes Naturally: A Must Read!

Life time dependency on insulin and other drugs to manage blood sugar can at times be pain staking, and rather depressing. But rarely do people know that there are certain fruits and vegetables that actually help in keeping the blood sugar under control (Food for Diabetes).

In this brief article, I would like to shed some light on the natural food based remedies for diabetes control.

a) Bitter gourd: The not so good looking vegetable! (Magic Food for Diabetes)
Bitter gourd (known as Karela in India), scientific name: Momordica charantia, is known as a wonder vegetable for Diabetic patients. Its juice is particularly known to lower and control blood sugar in hyperglycemic people (those with high blood sugar levels). Diabetics rather call it God's Magic!.
   
Bitter Gourd: The Magical Vegetable for Diabetes Control
(Source of this image is mentioned in the image: Let us Respect IP)

Following are the best / ideal ways to consume Bitter Gourd in Diabetes condition:
a) Consume the fresh juice (avoid canned/ preserved juices). Early morning consumption, empty stomach, helps a lot.
b) Boil the raw bitter gourd and consume it with little salt and / or black pepper for flavor.
c) Bitter gourd seeds may also be consumed with water like a tablet. This has been known to reduce blood sugar levels as well.

Mode of Action of Bitter Gourd in Controlling Diabetes: How Bitter Gourd Controls Diabetes?

Charantin is a chemical compound which is found in abundance in Bitter Gourd (hence the scientific name). Charantin is known to favorably influence glucose metabolism across the body of the consumer (unlike the targeted medicinal drugs which are often tissue/organ specific). This helps in controlling diabetes.
Quote:Did you know??:
Karela has anti-cancer effects too!! Both seeds and fruit of Bitter gourd prevent proliferation of cancer cells and in fact has been known to control leukemia and other blood irregularities. Blood pressure problem is also controlled by this not so good looking vegetable!
So, everything that looks ugly, is not necessarily bad!!

2. Raw Garlic: a spice that helps (a great food for diabetes)
Yes, you read it right! Garlic buds have this power to control diabetes. Now, you must have been wondering as to why it didn't control your diabetes till date (just in case you have been a regular consumer of the garlic)??
Well, the answer is: 'It is indeed controlling your diabetes, you are just unaware of the fact'. Garlic is blessed with some beneficial sulfur containing phytochemicals that can do wonders to your body by keeping you aloof of all the ailments.

Following are the best / ideal ways to consume Garlic in Diabetes condition:
1.Chop the buds very well, finely mince them whenever you wish to use garlic in regular preparations. This is crucial for the release of the phytochemicals.
2. Early morning, empty stomach, consumption of just 2 garlic buds (gulped like tablets with water) can be very beneficial. The same may be done before sleep as well.
3. The best way is to finely mince 2 garlic puds into a paste and then consume them raw with some water, early in the morning (empty stomach). This is the most beneficial mode of consumption. But, many people find it too pungent to consume, hence the above mentioned methods may also be followed.

   
Image is self-captured: Original
Mode of Action of Garlic in Controlling Diabetes: How Garlic Controls Diabetes?
As mentioned earlier, it is the naturally bestowed sulfur-containing phytochemicals that make Garlic such a useful spice. The most important and potent of all the phytochemicals in garlic are : Allicin, ajoene and alliin, which detoxify a person's body and modulate the circulatory, digestive as well as the immune system. This leads to well regulated blood pressure, controlled blood sugar and a stress-free body.
Quote:Did you know??:
Garlic, also called Lehsun in Hindi or Allium sativum scientifically, is one of the richest source of Selenium (a trace nutrient for our body). Our body needs selenoproteins to fight DNA damage (which is crucial for keeping various types of malformations and Cancers at bay!), to keep the thyroid gland working well and also to keep the immune system up and running. Given the fact that Garlic has it in enough quantity that's needed by our body, exploit it to the maximum!!
Exposure to Garlic might bring you tears, but it makes your body happy! Smile

3. Bottle Gourd: the magical bottle! (a magical food for diabetes)
Bottle Gourd has myriad of shapes (mostly variants of a bottle, hence the name), and so are its benefits. Indians popularly know it as "Lauki" or another variant "Ghia". Scientifically it is known as Lagenaria siceraria. If one checks into the nutritional content of this vegetable, he/she would find that it is 92% water!!, very low in carbohydrates (hardly 1%) and zero in fat! The nutritional contents therefore must have told you how good it could be for someone who is trying to wave-off the extra calories and sugar from his/her body.

Following are the best / ideal ways to consume Bottle Gourd in Diabetes condition:
1. Juice preparations early in the morning or in the evening.
2. Boil it, and make a curry preparation with a pinch of epsom salt. You may substitute your lunch with a boiled-dried form of bottle gourd to keep extra calories at bay.
   
Self-captured photograph: Original

Mode of Action of Bottle Gourd in Controlling Diabetes: How Bottle Gourd Controls Diabetes?
It's the nutritional content of bottle gourd that actually makes it such a useful food to control diabetes. It is zero in fats, very very scarce in carbohydrates, rich in water and minerals (especially sodium, potassium, magnesium, calcium). It is also very rich in fibers. The fibrous content of Bottle gourd further help in absorbing extra sugars in digestive tract and wade them off the absorption process.

Quote:Did you know??:
Because of its nutritional treasure, Bottle Gourd not only helps in fighting diabetes, but it is a potent natural remedy for fighting fatigue, blood pressure problem, stress, obesity, baldness, dental problems, constipation and much more!

Warning: Research has indicated the presence of a toxin (Tetracyclic Triterpenoid Cucurbitacins) that imparts a bitter taste to some Bottle gourds. So, taste it well before you consume it whole, as this tocxin can cause vomiting, nausea, GI bleeding and in some cases even death. Bitter bottle gourds should be discarded.

Advisory: Don't blindly prepare the juice of this boon of nature. Taste it before making the juice. And avoid mixing its juice with any other fruit/vegetable juice (which could mask it's bitter taste if it is there).

Consume it, but with awareness!


4. Cinnamon: the magical spice! (great food to control diabetes)
Cinnamon, popularly known as 'daal-chini' in India, and Cinnamomum verum scientifically is another magical spice. It is in fact a major ingredient of most ayurvedic drugs used for controlling diabetes.
Being a spice, it is often added in vegie preparations, but the sad fact is that most of the urban population is unaware of it's existence as a spice, let alone its benefits.
So, in this case, I would like to shed some light on Cinnamon first of all:
Cinnamon is available or can be used in three forms:
a) Solid sticks b) Dried powder c) Dry flowers (indicative image from wikipedia is displayed below):
   

It tastes bit sweet, but that doesn't mean it would cause diabetes! It rather helps in fighting diabetes and a lot of other diseases!
Following are the best / ideal ways to consume Cinnamon in Diabetes condition:
1. Don't use it in huge amounts, it's spice, a condiment and should be used in pinches only.
2. If preparing some vegetable, just add 2-3 cm long bark of cinnamon to it, or if you use powder form, then sprinkle a pinch of it in your vegetable/ toast/ sandwich/ curd.
3. Excess quantities would not only overpower all other spices, but might also lead to nausea.

Mode of Action of Cinnamon in Controlling Diabetes: How Cinnamon Controls Diabetes?
Whereas Cinnamon's phytochemical ingredients responsible for managing diabetes have eluded the scientific community till date, but studies (recent being in 2013), have indicated a lowering of blood cholestrol as well as resistance to insulin in subjects who consistently consume about 1 gram (which is around 1/6th of table-spoon) of cinnamon powder. In addition, Ayurvedic, Chinese and Egyptian ancestors have consistently reported the utility of cinnamon in fighting diabetes and heart related ailments.

Quote:Did you know??:
There are two types of Cinnamon namely Ceylon and Cassia. Many people claim that it's the Ceylon type that actually helps in fighting diabetes.
Caution: Some people might be allergic to Cinnamon, and those who have Liver problems, should avoid its use.

It's sweet, but it fights diabetes (almost certainly!) Wink

5. Ginger: The bitter one that keeps the sweet away! (a very common yet effective food for diabetes)
Ginger is popularly known as Adrak in India, and scientifically it is called as Zingiber officinale. It is infact a household vegetable that is used in a variety of ways: as a vegetable, as a spice, as a condiment, as a juice flavoring agent and more. Health benefits of Ginger in managing cold and cough are long known in Ayurveda (the Natural Medicine System of India). But very few people are aware of the fact that Ginger can prove very useful for managing Diabetes as well.

Following are the best / ideal ways to consume Ginger in Diabetes condition:
1. The best way to add ginger to your diet is by including it in every food you prepare. Add just half spoon of grated fresh raw ginger into your daily vegetable preparations; and it will do its magic!
2. Another ideal way is to add it to your daily juice preparations. Please note that you are not supposed to take Ginger Juice!! It would be too pungent as well as irritating for mucous linings. All you need to do is just add 3-5cm thick bud of ginger into your juicer, alongwith other fruits. The extracted juice will be more than sufficient.
3. Those who are diabetic should avoid sweet juices, and rather prefer addition of ginger in their daily boiled vegetable preparations.
   
Image is self captured: Original

Mode of Action of Ginger in Controlling Diabetes: How Ginger Controls Diabetes?
Ginger has recently been proven to improve insulin sensitivity (thereby leading to greater control over glucose levels in blood) and some has also been shown to reduce bad-fats/lipids like cholesterol and some triglycerides that are often associated with complications in Diabetes. In addition, a recent study conducted in 2014 by Tahereh Arablou (Titled: The effect of ginger consumption on glycemic status, lipid profile and some inflammatory markers in patients with type 2 diabetes mellitus) suggested that the subjects who regularly consumed 1.6 gram of Ginger exhibited reduced CRP and PGE2 in type 2 diabetic patients, apart from increased sensitivity to Insulin (as compared to the placebos).

Quote:Did you know?:
Ginger belongs to the same family as Turmeric, and Curcumin is the potent phytochemical in the plants of this family, which has been well established as an effective immune-modulator, apart from its antibacterial and anti-inflammatory properties.

So, Ginger is indeed bitter, but not for your Health! Smile

I hope it interests you and more importantly, I hope it Helps you!

Thanks
Rajan


References:

1. http://nutritionreviews.oxfordjournals.o...1.abstract
2. http://care.diabetesjournals.org/content.../3215.full
3. http://pubs.acs.org/doi/abs/10.1021/jf10...jafcau&
4. http://www.ncbi.nlm.nih.gov/pubmed/18361751
5. http://onlinelibrary.wiley.com/doi/10.15...5/abstract
6. http://www.indiaenvironmentportal.org.in...008---.pdf
7. http://link.springer.com/article/10.1023...4.97809.b6

#19
Our body is designed to regulate the blood sugar levels. When the blood sugar regulation is not what it is supposed to be, it gives rise to the metabolic disease known as “Diabetes”. Diabetes affects people on the long run. This particular condition has to be controlled for a lifetime as there is no cure for it. 
Diabetes has many causes. It was classified into two major types at one point of time. Now, it has been identified that there is more to the type and the cause as well. The two major types of diabetes are discussed in detail below.

TYPE 1 DIABETES

[Image: 42943_type1diabetes.jpg](Source: medicinenet)
This type is also known as diabetes mellitus type 1. The insulin cells are produced in the pancreas. Insulin is secreted by these cells. The hormone insulin plays a vital role in monitoring the blood sugar in the body. Type 1 diabetes is where the insulin cells are targeted and destroyed by the immune system. This auto-immune disorder makes it impossible for the patient to survive without a regular dose of insulin as there is a massive increase in the blood and urine sugar due to the body lacking insulin. Globally type 1 diabetes accounts for 5-10% of the population.

SYMPTOMS

Increased thirst (polydipsia) and increased urination (polyuria) and also increased hunger (polyphagia) are the common symptoms seen. Due to increased thirst, dry mouth is also commonly observed in people. Diabetic ketoacidosis is very common and this also leads to dry skin, abdominal pains and vomiting. People also exhibit rapid breathing. About 12% of the people with type 1 diabetes have also been diagnosed with clinical depression.

CAUSES

The genetic makeup of an individual determines whether this condition is dominant or recessive. A total of 50 genes is responsible. The gene IDDM1 is a strong factor for one to develop type 1 diabetes. The presence of IDDM1 is on the chromosome 6 and this locus is associated with increased risk of type 1 diabetes. Apart from these genes, heredity also plays a key role. If the father has diabetes, the child has a 10% higher chance of developing the disease in a later stage. Identical twins have more similar genetic makeup. This gives them a higher probability of developing the disease. If one twin is diagnosed with diabetes, the other twin has a 30-50% chance of being diagnosed with the same.
Apart from genetic factors, the environment has a role to play. People living in certain parts of the world have been seen to have a higher risk than the others. For example, Caucasians in different parts of Europe show a 10-fold difference in the risk of developing the disease.
Certain drugs used in the treatment of pancreatic cancer are known to affect the insulin production. Streptozotocin is one such drug which is used during chemotherapy for pancreatic cancer.
[Image: 1.d.jpg]( Source: Diabetes Education Online)
DIAGNOSIS

Persistent hyperglycemia is seen in people with type 1 diabetes. And the new cases of this type show diabetic ketoacidosis. The plasma sugar level is more than 11 mmol/L two hours after a 75g oral dose of sugar. Autoantibodies like islet cells autoantibodies and insulin antibodies are present in the serum. Glutamic acid decarboxylase is also targeted by autoantibodies. Looking for such autoantibodies is also a part of the diagnosis. Immunofluorescence and radiobinding assays are performed for the antibody detection.

PREVENTION

People with type 1 diabetes can continue to have a normal life as long as they undergo insulin therapy. Immunosuppressive drugs are to be taken to keep the autoimmune reactions in check. Vitamin D is administered and this is known to decrease the risk factor. Managing the lifestyle of the individual and controlling the dietary habits are the ways to prevent this condition from becoming adverse. Islet cell transplantation and pancreas transplantation are tedious. Though the islet transplant is successful, the compatibility between the donor and the recipient and the survival of the islet cells in the body require monitoring. Pancreas transplantation is possible if the type 1 diabetes is very mild. Above all, physical activity is very much advised and this helps in reducing blood sugar levels.

TYPE 2 DIABETES
Diabetes mellitus type 2 is the non-insulin dependent type of diabetes. When compared to type 1 diabetes, type 2 diabetes is more common amongst people. The life expectancy is reduced by 10 years. Though the condition itself is non- fatal, there are secondary factors which cause complications. Heart diseases are often associated with diabetes type 2.

SYMPTOMS
[Image: diabetes-symptoms.gif](Source: diabetesdietcures)
Like type 1, polydipsia, polyuria, and polyphagia are seen. Weight loss is also one of the most common symptoms. Blurred vision and peripheral neuropathy also accompany this condition. In people lacking proper care, blindness and kidney failure are two of the many complications that arise. Cognitive neuropathy and dementia are also seen in some people. Alzheimer’s disease and vascular neuropathy follow in severe cases.

CAUSES
[Image: diabetes1.png](Source: 8020wellnessplan)
Like type 1 diabetes, type 2 diabetes is affected by the genetic makeup of the individual. Apart from genetics, lifestyle is considered to be the major factor in developing this condition. In rare cases, diabetes is caused by an abnormality in a single gene. Obese individuals are more prone to diabetes type 2. Consuming sweetened beverages and products increase the blood sugar levels and when the accumulation is more than the regulation, the risk factor increases. Fatty food having a higher concentration of polyunsaturated fatty acids also are considered as risk factors.
Certain predisposed medical conditions also lead to diabetes type 2. Hyperthyroidism and Cushing’s syndrome are two such health conditions. Medications like beta blockers, glucocorticoids, thiazides and atypical antipsychotics. Testosterone deficiency is also associated with diabetes.

DIAGNOSIS

The diagnosis is similar to that of type 1 diabetes where the level of plasma glucose is the basis of determining whether the person is positive for diabetes or not. Oral glucose tolerance test and plasma glucose test is performed.
Hemoglobin A1C or the HbA1c measures the percentage of hemoglobin cells with glucose molecules attached to them. This test is of importance in detecting and managing diabetes. Lipid profiling also helps in identifying diabetes.

PREVENTION
[Image: diabetic-ketoacidosis-low-blood-sugar-in...a-6056.jpg](Source: savoir-diabete)
Proper diet and regular exercise prevent the onset of this condition. Diabetes has no cure as such. The onset or the prevention takes effect based on the individual’s lifestyle choices. Once diagnosed with diabetes, one has to    follow healthy lifestyle practices, consume more green leafy vegetables and reduce intake of sugar based products. High blood pressure and high cholesterol also affect diabetes. Decreasing blood pressure can help in increasing life expectancy.
Medicines are available for helping in the regulation of the blood sugar. Some of these medicines belong to the flowing classes: sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, SGLT2 inhibitors, and glucagon-like peptide-1 analog. Apart from medicines, oral and injectable doses of insulin also help in the management of diabetes. Angiotensin-converting enzyme inhibitors are prescribed to prevent kidney disease. 
#20
According to the International Journal of Diabetes in Developing Countries India has been witnessing an alarming rise in incidence of diabetes. An estimated 3.4 million deaths are caused due to high blood sugar, says WHO fact sheet on diabetes. In India, about 5 per cent population suffers from diabetes!

The WHO also estimates that 80 per cent of diabetes deaths occur in low and middle-income countries and projects that such deaths will double between 2016 and 2030.
  


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