Living with diabetes during and beyond the pandemic
KOCHI: Diabetes has existed for more than 5,000 years. Currently, though modern medicine can efficiently treat diabetes, management of glucose avoiding hyperglycemia and hypoglycemia (very high and very low glucose respectively) remains a challenge. This phenomenon, described as glycemic variability (GV), is now being attributed to the serious complications of diabetes such as retinopathy(eye), nephropathy(kidney), neuropathy(limbs) and even disease where the condition of blood vessels affect the heart.
Covid and diabetes
Covid pandemic has also resulted in an unprecedented increase in the number of patients with diabetes adding to the existing burden of 77 million patients in India. 85 - 95 per cent of Covid deaths are also being attributed to uncontrolled glucose and GV.
Recent data shows 50 per cent of hospitalised patients with severe Covid had at least one comorbidity, with diabetes being the most distinctive, resulting in high mortality among patients. Thus, effective monitoring and management of glucose levels at home are imperative.
What is normal sugar?
Monitoring glucose at home in a structured manner and doing necessary steps to control it has been recommended as the only step which will help patients prevent disabilities due to diabetes. The normal glucose range for each patient needs to be decided by the treating physician based on his type of diabetes, age, and disease status.
In general, the recommendation is to maintain a glucose range between 70 mg/dl and 180 mg/dl, over 70 per cent of the time. If you can increase it to 80 per cent, 90 per cent or 100 per cent safely, that is the best. But avoidance of hypoglycemia (that is below 70 mg/dL) is critical since it can be life-threatening in some patients.
Traditional glucose metrics like HbA1C tests have some limitations, including the inability to capture intra- and inter-day highs and lows, or rapid fluctuations in glucose levels. The laboratory needs to have NGSP standardised device to provide accurate reading which again is a major challenge.
Time in Range (TIR) measures the time spent by the patient in the target glucose range. It summarises information on glucose trends over time and enables easy detection of hyperglycemia or hypoglycemia. This in turn allows patients to take timely action to better manage fluctuations.
What to do with your values?
If your self-monitored glucose value obtained with a Continuous Glucose Monitoring (CGM) device is below or above the described values, the treating physician, diabetes nurse and educator are going to help you reach better goals every time.
How to measure glucose variability?
The International recommendations are to use a CGM device for 14 days. This need to be repeated as frequently as recommended by the diabetes treating team.
With the launch of FreeStyle Libre in India, CGM has become extremely simple, user-friendly, affordable, and pain-free. The sensor is applied over the upper arm and provides glucose values once every 15 minutes for 14 days without the need for any finger pricks. This game-changing technology is proven to be cost-effective for retaining the quality of life of patients.
Every patient with diabetes should remember that apart from a healthy diet and lifestyle, the adoption of advanced and recommended technologies and therapies are meant for preventing the future burden of complications and the cost of treating disabilities. Prevention is the success mantra for those with the right knowledge and common sense in science.
The author is a chairman, Jothydev’s Diabetes Research Centres, Kerala.
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