Q: I am 50 years old and diabetic for more than last 13 years. My wife is 41 years old and having normal sugar level. We have one daughter (age 16 years) and one son (age 10 years 6 months). When my son was conceived I was diabetic. Of late my son is complaining about pain in the legs and we also observed that his frequency of urination is more. I got his fasting blood sugar tested and found that it is 81 mg/dl. Is it a matter of concern for my son at this age? If yes, then what do we do now and if no, is there any precautions to be taken for his betterment?

A:Diabetes is not just a single disease entity but comprises several diseases that result in high blood sugar levels. As these have a different origin, symptoms and treatment, diabetes is divided into several major categories. The 2 major types are Type 1 diabetes and Type 2 diabetes. Type 1 diabetes occurs when the immune system of the body destroys the beta cells in the pancreas that produce insulin. As no insulin is produced, patients need regular insulin injections in order to control their blood sugar level. This form is generally seen during childhood or puberty, but may occur at any age. Type 2 diabetes occurs when target organs (muscle and fat cells) are unable to use insulin properly and this is thus also known as insulin resistance. Some Type 2 diabetics need insulin to control their blood sugar but most can keep their blood sugar at an acceptable level by changes in diet, regular exercise, or medicines that help use insulin more effectively. This form usually affects adults older than 45 years, though it can occur in adolescents. The inheritance of Type 1 & 2 diabetes is complicated as many genes influence the risk of developing it and they are not inherited in a clearly dominant or recessive manner. This is so as an individual may have one gene that increases their risk while inheriting another that reduces the risk. Two factors that can explain genetic inheritance of Type 1 diabetes are the HLA genes and the insulin gene. HLA genes are involved in the functioning of the immune system while the insulin gene is the region of DNA that codes for this protein. Together, these 20 genes along with environmental factors determine a persons overall risk for developing this form of the disease. Due to this, there is no genetic test for Type 1 diabetes as all the gene mutations that put a person at risk for Type 1 diabetes have not been identified. Even if a genetic test were able to reveal a higher risk of developing the disease, there is still no way to prevent it. Type 1 diabetes is seen to run in families. The inheritance pattern in Type 2 diabetes is further complicated, as along with the many different genes that influence a persons risk of developing the disease, environmental factors and lifestyle (that promotes obesity) too play a major role in the overall risk. Many genes are involved in controlling body’s metabolism and a mutation in any one gene may not lead to diabetes, but mutations in several genes could add up to pose an increased risk. Any two people with Type 2 diabetes may have mutations in a different subset of genes, making it hard to pinpoint high-risk mutations. With so many variables to consider, there is no genetic test for Type 2 diabetes. The risk for the general population is about five percent but individuals having a parent or sibling with the disease have an increased risk of about 10 to 15 percent.