The world is facing a silent but growing crisis. A recent study published in The Lancet reveals that in 2022, more than 1 billion people worldwide are living with obesity^[1]. The situation in India is particularly concerning, with a staggering 40.3% of the population affected by this condition_^[2].

Health Risks Associated with Obesity:

Obesity isn’t just a matter of appearance; it’s a serious health issue with far-reaching consequences. It’s considered a significant risk factor for ischemic heart disease, which is a condition characterized by reduced blood flow to the heart and is the leading cause of death among adults. Moreover, the impact of obesity extends beyond cardiovascular health. To illustrate the severity of this issue, look into the following health risks associated with obesity:

• Type 2 diabetes
• Cardiovascular diseases
• Certain types of cancer
• Osteoarthritis
• Potential contribution to neurological conditions such as Alzheimer’s disease

Defining Obesity:

Defined as a chronic disease resulting from the interplay between genetic predisposition and environmental influences, obesity occurs when excess fat accumulation increases health risks. For Indians specifically, health experts use Body Mass Index (BMI) – a measure that uses your height and weight to work out if your weight is healthy – to classify weight status. Individuals with a BMI between 25.0 and 29.9 kg/m2 are considered overweight, while those with a BMI of 30 kg/m2 or higher are classified as obese.

The Root Causes of Obesity:

The root causes of this growing epidemic are complex and multifaceted. Research indicates that the most significant factors contributing to the increased prevalence of obesity include smoking, unclean cooking fuel, and diabetes. However, there are additional factors to consider when examining the causes of obesity.

The Impact of Economic Growth and Globalization

Economic growth and globalization have played a substantial role in shaping our eating habits. As living standards improve, there’s been a noticeable shift in dietary patterns. Traditional diets rich in vegetables and grains are being displaced by high-calorie processed foods. This dietary transition, coupled with the allure of diverse international cuisines, has led to a significant increase in caloric intake across Indian households.

Modern Lifestyle Challenges:

Furthermore, modern urban lifestyles have introduced a new set of challenges. The lack of physical activity, unhealthy diets and excessive consumption of nicotine and alcohol, has shown a significant correlation with an increased risk of obesity. What’s particularly concerning is how these modern diets, laden with fats and sugars, often mimic the addictive properties of substances like nicotine and alcohol. They trigger dopamine release in our brains, driving cycles of craving and reward that can be hard to break. This dietary pattern not only contributes to weight gain but also fosters hormonal imbalances, perpetuating a constant state of hunger and further fueling the obesity epidemic.

As we unravel the complex web of factors contributing to obesity, it becomes clear that addressing this issue requires a multifaceted approach. Fortunately, adopting healthy eating habits can play a crucial role in combating obesity and improving overall health.

Key Principles for Sustainable Weight Loss:

When it comes to weight loss, two key principles stand out:

1. Find an approach that works for you specifically—one that makes you feel good and keeps you motivated.
2. Practice patience; sustainable weight loss happens slowly but steadily.

Rather than embracing short-term “fad diets,” those who have successfully lost weight and kept it off have usually made a permanent shift toward healthier eating habits.

Characteristics of a Healthy Diet:

A healthy diet favors natural, unprocessed foods over pre-packaged meals and snacks. It’s balanced, providing your body with all the nutrients and minerals it needs to function optimally. Plant-based foods, especially fruits and vegetables, take center stage, complemented by adequate protein sources. Such a diet is typically low in sugar and salt but incorporates “healthy fats” from sources like fish, olive oil, and other plant-derived oils.

ICMR Dietary Guidelines for the Indian Population:

The Indian Council of Medical Research (ICMR^[4])provides specific dietary guidelines tailored for the Indian population:

• Choose a variety of foods in amounts appropriate for age, gender, physiological status, and physical activity.
• Use a combination of whole grains, cereals, pulses, and millets.
• Prefer fresh and locally available vegetables in plenty.
• Include foods of animal origin such as milk, eggs, and meat, particularly for pregnant and lactating women, children, and adolescents.
• Choose nutrient-rich foods such as pulses (lentils, beans, peas), lean meat, fish, and low-fat milk, especially for elders.

Practical Tips for Healthier Eating:

To further refine your eating habits, consider these practical tips:

1. Include non-starchy fresh vegetables and green leafy vegetables in every meal, along with at least 30 grams of fruits.
2. Ensure that at least 50% of your cereals and grains are whole grains (minimally polished) for adequate nutrients and fiber.
3. Pair cereal or millet-based meals with adequate pulses or beans for good quality protein and fiber.
4. Consume adequate quantities of nuts, oilseeds, and fatty fish, while restricting cooking oils to approx. 25-30g per day.
5. Limit meal frequency to two to three times a day.
6. Avoid ultra-processed foods (UPFs) and foods high in fat, sugar, and salt (HFSS).
7. For adults, avoid sugar or restrict intake to approx. 20-25g per day

Three Key Guidelines for Combating Obesity:

To further guide you in adopting healthier eating habits, let’s delve into three key guidelines that can significantly impact your health and help combat obesity:

Eat Plenty of Vegetables and Legumes:

Fresh vegetables and fruits are treasure troves of micronutrients, phytonutrients, bioactive substances, and fiber. Leafy vegetables, in particular, are rich in carotenoids, iron, folate, calcium, and other crucial nutrients. The key lies in variety and color:

• Consume fresh, locally available, and preferably seasonal produce.
• Aim for a rainbow on your plate: include vegetables and fruits of different colors.
• Incorporate commonly consumed leafy greens, tomatoes, berries, and vegetables in yellow, orange, red, deep red and purple hues.
• Choose vitamin C-rich colored citrus fruits to significantly enrich your diet.
• Prefer root vegetables like carrots, radish, beetroot, knol-kohl, and turnip over starchy tubers like potato, yam, Colocasia, and cassava.

Restrict Salt Intake

High salt consumption can have detrimental effects on blood vessels, blood pressure, bones, and the gastrointestinal tract. There’s a strong link between salt intake and hypertension:

• Populations consuming less than 3g of salt per day show a low prevalence of hypertension.
• The usual age-related increase in blood pressure is not observed with such low intakes.
• Be wary of hidden salt in processed foods like snacks, savories, soups, sauces, ketchup, salted butter, cheese, canned foods, papads, and salted dry fish or nuts.
• Limit consumption of preserved meats/vegetables and ready-to-eat foods, which often contain high levels of salt and sodium.
• Be mindful of sodium-rich additives like baking soda, baking powder, and monosodium glutamate in processed foods.

Minimize Consumption of High Fat, Sugar, Salt (HFSS) Foods and Ultra- Processed Foods (UPFs)

Foods high in fat and sugar are energy-dense but often poor in essential nutrients:

• Regular consumption of HFSS foods and UPFs can lead to overweight and obesity.
• These foods can deprive you of essential macronutrients (amino acids and fats), fiber, and micronutrients like vitamins, minerals, phytonutrients, and bioactive substances.
• A diet lacking essential amino acids, fatty acids, and micronutrients can cause anemia, affect cognition, learning ability, and memory, and increase the risk of non-communicable diseases (NCDs).

Conclusion

By incorporating these guidelines into your daily eating habits, you’re not just working towards weight management, but also ensuring your body receives the full spectrum of nutrients it needs for optimal functioning. Remember, the journey to healthier eating is a marathon, not a sprint. Small, consistent changes can lead to significant improvements in your overall health and well-being over time.

The blog has been authored by Dr. Venu Madhav, Bariatric Surgeon. The content is for informational purposes only and should not be taken as professional medical advice. 

References:

https://www.uicc.org/news/lancet-study-reveals-over-billion-people-face-obesity/known-cancer-risk-factor

https://pmc.ncbi.nlm.nih.gov/articles/PMC8455012/

https://www.ncbi.nlm.nih.gov/books/NBK541070/

https://www.nin.res.in/dietaryguidelines/pdfjs/locale/DGI07052024P.pdf

https://timesofindia.indiatimes.com/life-style/food-news/eating-this-much-sugar-daily-is-safe-as-per-icmr/articleshow/110132305.cms

Are you sure you know everything there is to know about dengue? While many of us are aware of the basics—like how dengue is spread by mosquitoes—there are still a lot of myths and misconceptions floating around. These myths can sometimes be more dangerous than the mosquito bite itself, leading people to take the wrong precautions or ignore the real risks. Allow us to clear the air today. You might be surprised by what you learn!

Myths About Dengue Addressed

Myth 1: Dengue Only Occurs During the Monsoon Season
Fact: While it is true that dengue cases tend to rise during the monsoon season, it is a misconception that dengue only occurs during this time. Dengue can be contracted throughout the year, especially in regions with suitable environments for mosquito breeding. The Aedes mosquitoes, which are responsible for spreading dengue, can thrive year-round if there are warm temperatures and water collections, making it possible for dengue outbreaks to happen outside the monsoon season as well.

Myth 2: Only Poor Hygiene Leads to Dengue
Fact: Dengue is not directly caused by poor hygiene. While maintaining cleanliness is crucial, the real culprit behind dengue is the bite of an infected Aedes mosquito. These mosquitoes breed in stagnant water, which can be found in both clean and unclean environments. For instance, dengue mosquitoes can breed in fresh water collected in plant trays, unused tyres, water storage containers, and even flower vases.

Myth 3: Papaya Leaf Juice is a Cure for Dengue
Fact: While some people believe that papaya leaf juice can increase platelet count, there is no concrete scientific evidence to support this claim as a cure for dengue. Dengue is a viral infection, and there is no specific antiviral treatment for it. The focus of dengue treatment is primarily on managing symptoms, maintaining hydration, and monitoring platelet levels under medical supervision. It is crucial to consult a healthcare professional for the treatment.

Myth 4: Dengue Can Be Spread from Person to Person
Fact: Dengue cannot be transmitted directly from one person to another. It is not a contagious disease like the flu or cold. Dengue is only spread through the bite of an infected Aedes mosquito. When a mosquito bites a person already infected with the dengue virus, it becomes a carrier. The mosquito then transmits the virus to the next person it bites. Therefore, protecting yourself from mosquito bites is key to preventing dengue.

Myth 5: Once You’ve Had Dengue, You’re Immune for Life
Fact: Many people believe that once they have had dengue, they will not get it again. This is not true. There are four different strains of the dengue virus (DENV-1, DENV-2, DENV-3, and DENV-4). If you have been infected by one strain, you only develop immunity to that specific strain. However, you are still vulnerable to the other three strains.

Myth 6: All Mosquitoes Can Spread Dengue
Fact: Not all mosquitoes can spread dengue. Dengue is specifically transmitted by Aedes mosquitoes, particularly Aedes aegypti and, to a lesser extent, Aedes albopictus. These mosquitoes are often active during the day, especially during early morning and late afternoon.

Myth 7: Dengue Fever is Always Mild and Non-Life-Threatening
Fact: Dengue can range from mild to severe. While many cases of dengue are mild and may only require rest, fluids, and over-the-counter medications, some cases can become severe and life-threatening. Severe dengue, also known as dengue haemorrhagic fever or dengue shock syndrome, can cause serious complications like bleeding, organ damage, and low platelet count. It can lead to death if not promptly treated.

Conclusion

It is important to understand that dengue is a serious disease that requires proper awareness and preventive measures. By debunking these common myths about dengue, people are better informed and prepared to protect themselves and their loved ones from this potentially dangerous infection.

Reference Links:

https://www.who.int/news-room/questions-and-answers/item/dengue-and-severe-dengue
https://www.mayoclinic.org/diseases-conditions/dengue-fever/symptoms-causes/syc-20353078#:~:text=Mild%20dengue%20fever%20causes%20a,pressure%20(shock)%20and%20death.
https://my.clevelandclinic.org/health/diseases/17753-dengue-fever
https://www.ijidonline.com/article/S1201-9712(12)00838-7/fulltext
https://ncvbdc.mohfw.gov.in/WriteReadData/l892s/52545681531535010918.pdf

Ever wondered about the differences between Hepatitis A and Hepatitis B? These two types of hepatitis might sound similar, but they have unique characteristics that set them apart. If you are curious about how they spread, their symptoms, or the best ways to prevent them, then you are in the right place!

What is Hepatitis A?

It is a viral liver infection that is caused by the Hepatitis A virus (HAV). Hepatitis A is a highly contagious disease that primarily spreads through the ingestion of contaminated food and water. Hepatitis A is generally acute, meaning it does not lead to chronic liver disease. The body typically clears the virus on its own, and most people recover fully without long-term complications.

Overview of Hepatitis A

Transmission: Hepatitis A spreads primarily through the fecal-oral route. Consuming food or water contaminated with feces from an infected person is the most common way of contracting the virus.

Symptoms: Symptoms usually appear suddenly and include fatigue, nausea, loss of appetite, abdominal pain, and jaundice (yellowing of the skin and eyes).
Diagnosis: Blood tests can detect the presence of the Hepatitis A virus or antibodies produced in response to the infection.
Incubation Period: This period ranges from 14 to 28 days.
Treatment: There is no specific treatment. Rest, adequate nutrition, and hydration are recommended for recovery.
Prevention: Vaccination is the most effective and recommended way to prevent Hepatitis A. Good hygiene practices, such as handwashing, are also crucial.

What is Hepatitis B?

Caused by the Hepatitis B virus (HBV), it is a liver infection. Unlike Hepatitis A, Hepatitis B can be either chronic or acute. Chronic Hepatitis B can often lead to severe liver diseases, including cirrhosis and liver cancer. The virus is transmitted via contact with the infectious body fluids, such as blood, vaginal, and semen fluids.

Overview of Hepatitis B

Transmission: Hepatitis B is transmitted through exposure to infectious body fluids. This can take place through unprotected sex, sharing needles, or can be transmitted from mother to child during childbirth.
Symptoms: Symptoms of Hepatitis B can be similar to those of Hepatitis A, including fatigue, nausea, and jaundice. However, Hepatitis B can also cause joint pain and dark urine.
Diagnosis: Blood tests can detect the Hepatitis B virus or antibodies. Specific tests determine whether the infection is acute or chronic.
Incubation Period: This period is typically 30 to 180 days.
Treatment: Acute Hepatitis B usually resolves on its own, while chronic Hepatitis B may require antiviral medications to manage the infection.
Prevention: Vaccination is the best prevention method for Hepatitis B. Safe practices, such as using condoms and not sharing needles, are also important.

Prevention and Vaccination of Hepatitis A and Hepatitis B

Vaccination is available for both Hepatitis A and B and is the most effective prevention method. Maintaining good hygiene practices helps prevent Hepatitis A, while safe sex and avoiding needle sharing are crucial for preventing Hepatitis B.

Importance of Early Diagnosis

Early diagnosis of Hepatitis is vital for effective management and prevention of complications. Recognising symptoms and seeking medical attention promptly can prevent the spread of the virus and improve health outcomes.

Conclusion

While both Hepatitis A and Hepatitis B are serious liver infections, they differ significantly in transmission, symptoms, and long-term effects. By staying informed about hepatitis, practising good hygiene, and getting vaccinated, you can protect yourself and others from these serious liver infections.

Reference Links:

https://www.who.int/news-room/fact-sheets/detail/hepatitis-a
https://www.who.int/news-room/fact-sheets/detail/hepatitis-b

Obesity is more than just a number on the scale; it’s a condition that touches every aspect of our well-being. From physical health challenges to emotional struggles, the impact of obesity is far-reaching and profound. Let’s explore how obesity influences various facets of our health and discover practical steps to manage and prevent it. Whether you’re seeking to understand the risks or looking for motivation to make healthier choices, this article will guide you through the crucial facts and strategies to combat obesity effectively.

Physical Health Impacts

Cardiovascular Diseases: One of the most significant physical health impacts of obesity is the increased risk of cardiovascular diseases. Excess body fat, particularly around the abdomen, can lead to a host of heart-related issues. Obesity also contributes to high blood pressure, elevated cholesterol levels, and atherosclerosis, a condition where the arteries become clogged with fatty deposits. These factors collectively heighten the risk of heart attacks, strokes, and other cardiovascular problems.

Type 2 Diabetes: Obesity is closely linked to the development of type 2 diabetes. The excess fat, especially visceral fat, leads to insulin resistance, where the body’s cells do not respond effectively to insulin. This resistance causes higher blood sugar levels, ultimately resulting in type 2 diabetes. Managing obesity is crucial in preventing the onset of diabetes and controlling its progression in those already diagnosed.

Respiratory Issues: Respiratory problems are another serious consequence of obesity. Excess body weight can put pressure on the chest and lungs, making it difficult to breathe. Obesity is a major risk factor for obstructive sleep apnea, a condition characterized by repeated interruptions in breathing during sleep.

Joint and Mobility Problems: The excess weight places undue stress on joints, particularly the knees, hips, and lower back. This can lead to osteoarthritis, a condition where the protective cartilage that cushions the ends of the bones wears down over time. Joint pain and reduced mobility are common, significantly impairing the quality of life and daily functioning.

Digestive Disorders: Obesity increases the risk of developing gastroesophageal reflux disease (GERD), where stomach acid frequently flows back into the esophagus, causing irritation. Additionally, obesity is associated with an increased risk of gallstones and fatty liver disease. These conditions can cause significant discomfort and complications if not managed properly.

Emotional Health Impacts

Depression and Anxiety: The emotional health impacts of obesity are as significant as the physical ones. The stigma and societal pressure associated with obesity can lead to feelings of inadequacy, isolation, and low self-worth. The chronic stress of dealing with weight-related health issues further exacerbates these emotional problems, creating a vicious cycle.

Self-esteem and Quality of Life: Many individuals with obesity struggle with body image issues, leading to low confidence and self-esteem. This can affect various aspects of life, including personal relationships, career opportunities, and social interactions. The decreased physical mobility and health complications associated with obesity further diminish the quality of life, making daily activities challenging and less enjoyable.

Preventive Measures and Management

Healthy Diet and Nutrition: Adopting a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats is essential. Reducing the intake of processed foods, sugary beverages, and high-fat snacks can significantly contribute to weight management. Portion control and mindful eating practices also play a crucial role in maintaining a healthy weight.

Regular Physical Activity: Engaging in at least 150 minutes of moderate-intensity exercise, such as brisk walking, cycling, or swimming, per week can help maintain a healthy weight and improve overall fitness. Strength training exercises, such as lifting weights or using resistance bands, can build muscle mass, which in turn helps burn more calories. Adding physical activity into daily routines, such as taking the stairs instead of the elevator or walking instead of driving for short distances, can make a significant difference.

Conclusion

Obesity is a complex condition that affects both physical and emotional well-being. Understanding the comprehensive impact of obesity is the first step towards making informed choices for a healthier future. By prioritizing health and well-being, we can combat obesity and lead more fulfilling lives.

Reference Links:

https://www.news-medical.net/health/Obesity-and-heart-disease.aspx#:~:text=Studies%20have%20shown%20that%20abdominal,HDL%20cholesterol%20(good%20cholesterol).
https://www.medicalnewstoday.com/articles/obesity-and-diabetes
https://breathe.ersjournals.com/content/19/1/220263#:~:text=Obesity%20is%20associated%20with%20reduced,apnoea%20and%20obesity%20hypoventilation%20syndrome.
https://obesitymedicine.org/blog/obesity-and-gastrointestinal-impact/
https://www.msdmanuals.com/en-in/home/disorders-of-nutrition/obesity-and-the-metabolic-syndrome/obesity#Treatment_v8487737
https://www.who.int/news-room/questions-and-answers/item/obesity-health-consequences-of-being-overweight#:~:text=Carrying%20extra%20fat%20leads%20to,premature%20death%20and%20substantial%20disability.
https://www.cdc.gov/obesity/basics/consequences.html
https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000973

Have you ever felt unusually thirsty or found yourself making frequent trips to the bathroom? Or maybe you’ve been feeling more tired than usual despite getting a good night’s sleep? These might seem like everyday issues, but they could be signs of something more serious: Type 2 diabetes. As per a WHO study, there are estimated 77 million people above the age of 18 years in India are suffering from Type 2 diabetes. With diabetes affecting millions in India, understanding this condition is more important than ever.

What is Type 2 Diabetes?

This type of diabetes is a condition where the person becomes resistant to insulin, or the pancreas fails to produce enough insulin. Insulin is a hormone which helps regulate blood sugar levels. Type 2 diabetes develops in adulthood and is often linked to lifestyle factors.

Causes of Type 2 Diabetes

Genetic Factors: If your family has a history of diabetes, your risk of developing the condition increases. Certain ethnic groups are also more susceptible to diabetes.
Lifestyle Factors: A diet high in refined sugars and unhealthy fats, combined with a sedentary lifestyle, can lead to obesity and insulin resistance. Lack of physical activity further exacerbates the problem by reducing the body’s ability to use insulin effectively.
Other Factors: As people age, their risk of developing diabetes increases. Additionally, conditions like high blood pressure and polycystic ovary syndrome (PCOS) are linked to a higher risk of Type 2 diabetes.

Symptoms of Type 2 Diabetes

Increased urination: High blood sugar levels lead to frequent urination.
Increased thirst and hunger: Since the body tries to compensate for lost fluids, thirst and hunger increase.
Unexplained weight loss: Despite eating more, the person might lose weight due to inefficient use of glucose.
Fatigue and weakness: Constant exhaustion and lack of energy are common as the body cannot use glucose properly.
Blurred vision: High blood sugar levels can cause the lenses in your eyes to swell, leading to blurred vision.
Slow-healing sores and frequent infections: High blood sugar levels impair the body’s ability to heal and fight infections.
Numbness in hands and feet: Caused by high blood sugar levels, nerve damage can lead to a loss of sensation in the extremities.

Diagnosis of Type 2 Diabetes Through Blood Tests

Fasting Blood Sugar Test: This test measures blood sugar levels after the person has fasted for at least eight hours. Normal levels are below 100 mg/dL. Levels between 100-125 mg/dL indicate prediabetes, while levels above 126 mg/dL suggest diabetes.
HbA1c Test: This test provides an average blood sugar level over the past two to three months. An HbA1c level of 5.7%-6.4% indicates prediabetes. However, a level of 6.5% or higher indicates diabetes.
Oral Glucose Tolerance Test: This test measures blood sugar levels before and two hours after consuming a glucose-rich drink. Levels above 200 mg/dL after two hours indicate diabetes.

Complications of Type 2 Diabetes

a. Short-term Complications:
Hypoglycemia: Low blood sugar levels tend to cause dizziness, confusion, and fainting. It is essential to manage hypoglycemia by consuming quick sources of sugar and adjusting medications as needed.
Hyperglycemia: High blood sugar levels may lead to dehydration, confusion, and, in severe cases, diabetic coma. Managing hyperglycemia involves monitoring blood sugar levels and adjusting the treatment plan.

b. Long-term Complications:
Cardiovascular Disease: High blood sugar levels damage the blood vessels, which increases the risk of heart disease and stroke.
Neuropathy: Nerve damage from high blood sugar levels can result in pain, tingling, and loss of sensation, particularly in the feet.
Nephropathy: Kidney damage is a common complication of diabetes, leading to chronic kidney disease and, eventually, kidney failure.
Retinopathy: High blood sugar levels may damage the blood vessels in the eyes. This leads to vision problems and, in extreme cases, even blindness.
Foot Problems: Poor blood flow and nerve damage in the feet might lead to infections and ulcers.

Managing Type 2 Diabetes

Lifestyle Modifications: Eating a healthy diet, partaking in regular physical activity, and sustaining a healthy weight are crucial for managing diabetes.
Monitoring and Medications: Regular monitoring of blood sugar levels and taking prescribed medications are essential.
Regular Check-ups: These help monitor your condition and make necessary adjustments to your treatment plan.

Prevention of Type 2 Diabetes

Healthy Lifestyle Choices: Eating a balanced diet, staying active, and avoiding excessive consumption of sugary and fatty foods can help prevent diabetes.
Weight Management: Achieving a healthy weight reduces the risk of developing diabetes.
Regular Health Screenings: These can help detect prediabetes and other risk factors early, allowing for timely intervention.

Final Thoughts

Thoroughly understanding Type 2 diabetes is the first step towards managing and preventing this condition. Remember, small changes in your daily lifestyle can make a significant difference in your health and well-being.

Reference Links:

https://www.who.int/india/health-topics/mobile-technology-for-preventing-ncds#:~:text=In%20India%2C%20there%20are%20estimated,developing%20diabetes%20in%20near%20future).
https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193
https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199
https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/symptoms-causes/syc-20371525
https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631
https://my.clevelandclinic.org/health/diseases/21501-type-2-diabetes