KOCHI: One day from today, on November 14, World Diabetes Day is celebrated all over the world since 1991 to educate the public as well as the patients about the disease, treatment, risk factors and prevention. This day marks the birth anniversary of Frederic Banting (Birth - Nov. 14th 1891 and Death - Feb. 21st 1941) who discovered Insulin in 1921 along with Charles Best. Currently there are 382 million people living with diabetes and another 280 million are at high risk of developing diabetes in the world (Pre-diabetics). By 2030, over half a billion (500 million) people are expected to be having diabetes (about 10% of world population). In India there are 70 million diabetic patients and an equal number of Pre-diabetic (not overt Diabetes) patients.
The following 10 commandments (A – J) are to be followed strictly by all Diabetes patients to be free from the complications of this dreadful disease and to have a healthy life.
Awareness: The treatment rule of diabetes is to ‘Teach the patient to treat his/her diabetes’. One should be aware of the status of their disease, the presence of complications or co-morbid conditions, the symptoms of certain complications like hypoglycaemia, heart attacks, the mode of action of the drugs and the drug’s side effects.
Blood Pressure: More than 50% of Diabetic patients have hypertension (BP above 140/90 mm of Hg) and the association of high blood pressure can predispose to heart attacks, stroke, heart failure and renal failure. Blood pressure should be below 135/85 in all diabetics. There are many anti-hypertensive drugs available in the market now and one should know the exact drug he/she is taking since many BP drugs should not be taken in the presence of renal or cardiac complications.
Cholesterol : Different types of cholesterol circulate in the blood, good cholesterol (HDL), bad cholesterol (LDL) and dirty cholesterol (VLDL). 58% of diabetic patients die of myocardial infarction and 15% by stroke. A significant majority of these patients have dyslipidaemia (high LDL, low HDL). Hence control of cholesterol is an absolute necessity and currently anti-cholesterol drugs are recommended for diabetic patients even with normal blood cholesterol levels.
Diet : This year’s theme of World Diabetes Day is ‘Healthy Eating and Diabetes’. Restriction of carbohydrates and foods with high glycemic index, avoidance of fast food items (transfat accumulation), intake of more proteins, fruits in sufficient quantities, punctuality in taking foods especially those who are taking insulin and or oral hypoglycaemic agents. There is controversy regarding the intake of eggs with the yolk; some opine that there is no harm in taking whole eggs.
Exercise : Diet and Exercise are the 2 important things in the management of patients with Diabetes. Obesity is a common association with Type 2 DM and obesity leads to complications like hypertension, heart attacks, respiratory difficulty, edema and osteoarthritis. Half hour of daily walking is compulsory and people who cannot walk, can undertake isometric exercises. Regular exercise of the various joints is found to be very beneficial.
Feet : Diabetic leg ulcer is a disastrous complication of Diabetes and evey 20 seconds one leg is amputated globally. Ulcer is due to insensitivity of the feet (neuropathy), insufficient blood supply and infection.
‘Tend your feet as your face lest you have to bury your feet before your face’
Foot wears are a must to all diabetes patients since insensitivity to pain will lead to trauma, infection and non healing ulcer. Careful cutting of nails, examination of the digits for discolouration or ulcer should be done periodically.
Glucose Control: Self monitoring of blood glucose can be done easily with glucometers now. Hypoglycaemia is a common complication especially in patients on tight blood sugar control. Hypoglycaemia in elderly people leads to dementia, cardiac irregularities and cognitive defects. Every diabetic patient should be aware of the signs and symptoms of hypoglycaemia like blurring of vision, hunger, sweating, tremor and tendency to fall down. If unattended it may even lead to death. Punctuality in eating will help to avoid hypoglycaemia. Carrying sugar cubes or sugar biscuits always help to avoid hypoglycemia.
Haemoglobin A1C: Haemoglobin A1C is a part of circulating haemoglobin in the blood. Glucose combines with Haemoglobin by a non enzymatic process (HbA1C) and normally it does not exceed 5.8% of the total haemoglobin. When the blood sugar is high, HbA1C would also go up and a value above 6.5% is diagnostic of Diabetes Mellitus; this value reflects the average blood sugar in the blood during the preceding 3 months. One should maintain the HbA1C value to below 7%. HbA1C should be checked every 6 months.
Insulin and other drugs: Often patients are very confused with regard to insulin and oral hypoglycaemic drugs because of the multiplicity of these compounds available in the market. Some insulins are short acting and some long acting even upto 40 hrs. Insulin is available in different strengths 40 U/ml. and 100 U/ml. Different types of syringes (40U/100U) are also available in the market. Insulin is to be taken 30 minutes before food, while in the case of insulin analogues (costly insulin), it can be taken along with food. Insulin cartridges are used for insulin pens and each pharmaceutical company has its own cartridges and pens. Similarly oral antidiabetic drugs also has got different duration of action. Insulin inhalers (pulmonary insulin) are also in vogue now in western countries.
Smoking: Smoking should be stopped forthwith, once the disease is diagnosed. All complications of diabetes would be enhanced in smokers especially heart attacks, kidney failure, diabetic ulcers and peripheral vascular disease.
Following these Ten Commandments, one can have a healthy, complication free, life as in the case of a non diabetic.
Dr K P Poulose
Principal Consultant in Medicine and Founder President, Kerala Diabetic Foundation
S U T Hospital, Thiruvananthapuram