Dr. RANJIT UNNIKRISHNAN and Dr. V. MOHAN
Control of diabetes and prevention of complications related to the disease involve team work between the doctor and the patient.
No need for strenuous exercise: A brisk walk can work wonders. Photo: N. Sridharan
DIABETES is becoming increasingly more common in India. Once diabetes affects the nerves or blood vessels, it is often not possible to bring the patients back to a normal state. All that can be done is to minimise further damage. Hence the cornerstone of preventing diabetic amputations or other diabetic complications is to prevent the development of these complications.
It has now been conclusively proved that good control of diabetes can prevent most diabetic complications. If you have diabetes, keeping blood sugar values at or below the recommended target values is the most important thing you can do to protect your feet and indeed all the other organs like eyes, kidneys and heart nerves.
Once you find that you have diabetes, what steps can you take to make sure that your blood sugar values remain under control? The most important aspect is to assume responsibility for your health. This involves being regular with treatment, testing and follow-up. Remember, successful diabetes care depends on an equal partnership between patient and the physician. Discuss your treatment plan and targets with your doctor. Do not hesitate to voice your apprehensions, doubts and suggestions.
Even if your blood sugar values are high, it does not always mean that you need to take medicines. Many early and mild cases of diabetes can be controlled with dietary modifications and exercise alone. Ask your doctor for advice. A diabetic diet need not mean a complete departure from a normal one; often, a few adjustments will suffice. Similarly, exercise does not have to be particularly strenuous. A brisk 45-minute daily walk works wonders in many cases. The regularity of exercise and adherence to diet in the long term is more important.
Once you find you have diabetes, check your blood sugar often. Just how often depends upon individual cases; your doctor should be able to guide you. In general, patients whose blood sugars are on the higher side and those in whom wide fluctuations occur ought to check their blood sugars more often. It is also advisable to check the blood sugar more often when you begin medication for the first time or when you change from one medication to another. The purpose of routine testing is to see how your treatment programme is working and to see if any changes need to be made.
Of late, self-monitoring of blood glucose (SMBG) has become an important component in managing diabetes. SMBG implies that the patient checks his blood sugar himself at regular intervals. Today, simple, reliable and affordable home glucose meters are available with which one can measure blood sugar at any time. Keep a record of these readings; it will be of immense help to the doctor in adjusting the medications.
You should normally not rely on urine sugar testing to monitor your diabetes, but you can use it if you have no access to blood testing facilities.
Levels of blood glucose
What level of blood glucose should you aim for? Again, this depends on the individual. Blood glucose levels of less than 110mg/dl before meals and 140mg/dl after meals should be ideal. However, less stringent control is advised in case of patients who are very old, and in certain other situations. Discuss your target blood sugar levels with your doctor.
Remember that your blood sugar levels could vary from minute to minute and day to day. Hence a single blood sugar value or even a number of values obtained on a single day may not be representative of your overall level of control. To overcome this problem, there is a test called glycosylated haemoglobin or HbA1c estimation. This tells you the sugar levels in your body for the previous two to three months. Less than seven per cent indicates good control; at this level you are unlikely to develop most diabetic complications. Your doctor will base most of his long-term treatment decisions on this test. So do this test every three months.
Also try to keep your blood pressure and cholesterol levels at or below target levels. Ask your doctor how often to check your cholesterol. In many cases, cholesterol can be brought down by diet modification alone. If this fails, there are effective tablets to bring down the cholesterol. Your doctor will check your blood pressure at each visit and give you medications if it is found to be high.
It is advisable to undergo a complete check-up in a full-fledged diabetic centre at least once a year. This will help find out if you have any diabetes-related complications of the eyes, kidneys, heart and nerves, in addition to the feet. Simple and relatively inexpensive tests are now available to screen for disease of each organ. If anything is found, treatment can be initiated at the earliest to cure or prevent further progression.
In short, the control of diabetes and prevention of its complications involves a team approach with responsibility being shared by the patient and the doctor. The rewards of good diabetic control in terms of improved quality of life and reduced medical expenses are immense and far outweigh the cost of regular sugar testing and medications.
The authors are Consultant Diabetologists at Dr. Mohan's Diabetes Specialities Centre, Chennai. E-mail: firstname.lastname@example.org Website: www.drmohansdiabetes.com
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