Diabetes / Outpatient experience

When I sit as an observer in the outpatient clinic, i watch through as patients stall through with various faces of diabetes and it's complications. Some people get a new status of a diabetic while some come in to know its progression. I noticed that there are very small nuances involved in the successful management of the disease which help in the long run to live a virtual diabetes-free life.

"Diabetes is a nasty disease",often the doctor remarks, "provided we allow it to be so"!
A small wound in the foot, which doesn't get alright by regular medicine or heals at a very slow rate. If this patient is above 40, he is always under suspicion and sent for a blood sugar test to rule out the encroachment of diabetes in the body. This is how most people get to know about their new status. A very majority present as itching and burning sensation in the genitourinary tract, frequent urination, some come with numbing of foot, shoulder pain. We notice that no patient turns up for a less severe complaint such as general body ache or fatigue.Some unusual presentations include turning up for a sugar test before a planned surgery, episode of unconsciousness, excess hunger. What we need to understand is that the presentation is not a consistent, standard one. So a wise option to diagnose would be to do a once-a-year sugar test after the age of 40, can do the test earlier if symptoms appear, family history present.

An interesting case, a guy, 23, 7'1" tall visited the clinic, with his fasting and postprandial glucose levels above normal clearly suggesting the acquirement of the disease. He had joined as a staff in a restaurant and consumed good amount of pepsi a day. With strong family history, he ended up in what the doctor remarked as "the pepsi disease!" So majority turn out to be adults who are diagnosed type 2 D.M. only above 40, with such exceptions once in a while.

A very common complaint i came across was vertigo, a feeling that the world is spinning when they suddenly get up from sitting or sleeping. Often people mouth the exact picture depicted, autonomic neuropathy it is, the nerves responsible for position sense and balance have been affected by diabetes here.


THE PLAN OF APPROACH
It starts with the blood report, which is the real decider of the treatment plan, so what we need to keep in mind is to get the reading right, most important of all. Select a good diagnostic centre and do it right, one fasting blood sugar test at 7 in the morning, another test 2 hrs after food. For the first timers, it is the same but for the diabetics who check it as a part of follow up, a thing to note is to have the tablet or insulin with food for the post-prandial test. The results err if insulin/medicine is omitted, this is a mistake often people make.

The Diet Plan
If medicine is the engine to work the body, then diet is the fuel, meaning drugs don't work without proper meal plan. A very wrong impression people have about diet is that it is not possible to follow such strict plans in practical life, a more bitter truth is that if you don't follow it, you may suffer like in hell which is not even remotely practical! But it is not as strict a plan as people think, it is all about will power. To put it roughly in another form, it suggests eating everything you like but in limited amount.On the other hand, health conscious ones will start to starve, but that is where it starts getting dangerous. Fasting means there is not going to be any glucose, overeating would mean a lot of glucose which cannot be utilized fully resulting in bad effects. To make it a quote: Fasting and feasting are enemies to Mr D.M. I guess people will be more receptive, if we make them aware of the pathology happening in the body and why the diet plan is the core to the treatment. Lets talk more about it in a while.

The Exercise Plan
The majority of adult population suffer from type 2, which means there is release of insulin which is the hormone responsible for utilization of glucose by cells for energy production, but the function mentioned above is defective. Also as type 2 in the long run involves exhaustion of the very production of insulin due to strain on pancreas because of various reasons like dietary sugar overload, sedentary lifestyle, stress. On the contrary, in type 1, there is destruction of pancreas resulting in less or no production of insulin with the function intact.

There is a common fact around which the exercise plan revolves. Exercise causes burning of glucose stores and also increases efficiency of insulin through complex mechanisms. Hence all patients are advised to do the basic one, walking for at least 30 mins.

Walking is the best exercise for all aged especially elderly group, most economical and causes a whole body workout. Most important issue during walking is to wear a comfortable footwear like Adidas/Reebok shoes.


Essential history
The most essential history to be asked is about smoking, alcohol and intake of pain killers usually bought over the counters.
Smoking and alcohol would interfere with the diabetic medication, independently affect heart, lungs and blood vessels and reduce appetite.
Pain killers themselves when abused can cause kidney damage adding insult to injury done by diabetes.
Family history would give us an idea of the course and progression and chances in the offspring and alert us to prevent it prenatally.
If pregnant, then previous obstetric history becomes very essential.

The medication
Remember, although medicines sound similar, friends and relatives using them may be well and healthy, but do not go by these and self medicate. It is almost a crime as is being ignorant and avoiding medication.
Starting with, all depends on the sugar level when you show up to doctor. Depending on the severity and persistence as known by HbA1c, physician would advice to take a single/combination/power dose/insulin accordingly.

That is not all, each individual is unique in his genetic make up, so the response to the drug alters from person to person. So a second visit is often necessary if there are symptoms of hypoglycemia like excess sweating, trembling, faster heart beats. Or there may be minimal effect on the blood glucose level, so these would necessitate a lowering or increasing the dose, regulating it over a period of a month and this is when the patient is said to have settled with the right pattern of dose.

Diabetes / Quick facts

I am posting some information i came across another blog,

Here are some tricks and tips and general information to deal with what too many of us deal with on an unfortunate daily basis. This is just sharing, do with the information what you will...

The Warning Signs: Here are some signs to look for in diagnosing diabetes. Early detection can save many heartaches in the future. Frequent urination and dehydration (always thirsty), cuts and bruises heal very slowly (more than a few days), heavy dryness on your feet (especially heels), get tired quickly (unable to make it through a normal day), limbs "going to sleep" often and for more extended periods, "spiking" or needle poking sensations in various parts of your body, numbness of finger tips or toes, eye sight slowly degrading. Now, many of these symptoms are related to other factors, but if you do experience several of these "signs", does it really hurt to see a medical professional to have it checked out?



Clothing Preferences: Here are some clothing tips for the diabetic. No tight clothes, especially when you sleep. Since diabetes affects your blood flow through your body, restrictive clothing will inhibit blood flow even more. When you sleep, your blood flow slows with inactivity, so this is a major time period to watch out for. Be aware of the joints; wrist, elbows, shoulders, neck, knee, ankle, waist. These are special areas to watch where clothes binds and cuts off circulation. So for men, boxers are better than briefs.



Diet and the Food we eat: Be aware of what you put in your mouth always. Look at labels when shopping (especially the sugar section VS serving portions). Go "diet this and diet that" though diet drinks and foods have added sweeteners which are mostly bad for your body, right now we are concerned with not getting our sugars too high. Fruits are sugars too, though more easily digested and used by our bodies more effectively we still have to limit how much we consume. Did you know? plain bagels have at least 5 grams of sugars (2 equals 10 grams and add your cream cheese to this, wow!). Sugars hide themselves well so look, read, and compare before you swallow your foods.



The Scary Part: Here are some things to think about. Some of the more severe effects of diabetes, especially from the age of 40 on up are; loss of feeling in limbs (nerve damage are mostly irreversible!), loss of eyesight, loss of limbs due to minor injuries (cut and bruises), loss of energy (losing 12 hours or more a day to sleep periods), impotence, coma, heart attack, stroke, and this is just to name a few. Blood flow is our lay of life and diabetes affects the flow of blood in your body.


These are just some tricks which I have done to make the adventures of diabetes, less adventurous.

1. When selecting a syringe, short needles are easier to work with because you don't have to worry how deep you have to go or not go. Just poke and push all the way in. You don't even have to watch it go in (out of sight, out of mind).

2. Poking the needle at a slight angle and spinning it a little between your fingers helps to get an easier penetration for me.

3. I usually poke lightly first around the area I am planning to inject and find a spot which doesn't hurt as much, then I push all the way in to finish the job.

Diabetes / Diabetes it is!

Dear people, a growing pandemic can anytime knock your doorstep, it is almost inevitable if you have abnormal genetic make-up but surely is controllable, we can delay the progression, complications and disability. Only if you wish to. Only if you take it seriously, only if you knew what actually this disease is, only if you like to stay healthy, only if you will to!

"I am diagnosed as a diabetic, what next?", that is the question millions have in mind. Unfortunately not all are not provided with a satisfactory answer, people end up falling in the trap side of it resulting in amputations, kidney failure, vision loss. If we are aware of the disease before it even attacks us, we can keep it as simple as a common cold, on the other hand, if we are totally unaware, it get as dangerous as death! So I would like to take you through a step-wise approach to get to know about Diabetes.

Before we move on, have a look into the following.




Myth 1: Diabetes is not as serious a health issue as depicted.




Fact 1: If we go by the recent reports, then diabetes is responsible for more number of deaths than breast cancer and AIDS combined. Diabetes leads to a weak heart vulnerable for a stroke. Two-thirds of diabetes patients die from a heart disease or a stroke. On an average, this disease causes six deaths in a minute.

At any given age, the risk of death among people suffering from diabetes is almost double to that of people who are non-diabetic.

Around 3.2 million people are estimated to die because of diabetes or the problems that arise due to it. It’s the cause of one out of every twenty deaths around the world.

According to a recent ranking generated, based on death certificate reports, diabetes stands seventh on the list of leading causes of death in the United States.

This survey is done from the available data. Looking at the other side, diabetes is considered as an under-reported cause. Only 35 to 40 percent of diabetic patients had it listed on their death certificate and only 10 to 15 percent considered and got it noted as an underlying cause of death.

Lets look at some percentage facts.





Myth 2: Excessive eating of sugar and sweets causes diabetes.



Fact 2: Diabetes is usually caused due to genetics and lifestyle factors. Being overweight increases the chances of developing type 2 diabetes. A high calorie diet contributes to weight gain. These calories not necessarily come from sugar or fats. Eating more sugar and sweets leads to overweight when not balanced with healthy meal plan and exercise. If sugar and sweets are part of a healthy diet plan, then consuming more sugar does not lead to diabetes.

Myth 3: Stress leads to diabetes.
Fact 3: Stress doesn’t lead to diabetes. It does cause some hormonal changes, but these changes need not necessarily affect the process of absorption of glucose from blood. However, stress can have other harmful effects on a diabetic.

Myth 4: Diabetic using insulin or anti-diabetic medications can eat everything.
Fact 4: Medicines are no substitute for good balanced diet, exercise and a healthy weight. Even if taking diabetes medication, the diabetic should stick to healthy lifestyle habits. In fact the medicines will work better and more effectively if a healthy lifestyle is followed.

Myth 5: Diabetes is contagious.
Fact 5: Diabetes is certainly not contagious. It does not spread like other viral diseases. You can be assured when around another person with diabetes mellitus that you won’t develop one yourself. This disease is a cause of individual family history, lifestyle and internal problems.

Myth 6: Diabetes patients can’t play sports or actively participate in physical activities.
Fact 6: Let us look at a few names of famous sportsmen suffering from diabetes. The list includes, among numerous others, the following:

Wasim Akram, Missy Foy, Jay Cutler, Scott Dunton, Arthur Ashe, Gary Hall Jr., James ‘Catfish’ Hunter, Chris Jarvis, Billie Jean King, Ham Richardson, Everson Walls, Robert Marella, Ayden Byle and more.

There are many more athletes who suffer from diabetes but carry on their games without any hindrance.

In fact, the truth is that diabetic patients are encouraged to exercise and take part in sports. It keeps them active and healthy. It increases the blood flow and chances of glucose absorption by the tissues. However, there are certain factors that should be considered starting an exercise routine.

Myth 7: Diabetes leads to blindness in later stages.
Fact 7: There are very few recognizable symptoms for gestational diabetes. One of it is blurry vision. Even type-1 and type-2 diabetes are considered as leading causes of sightlessness. But this is minor and does not lead to blindness.

There is a lack of vitamin A in the body as a result of diabetes. This leads to weak eyesight. However, this problem can be easily rectified by good balanced diet. Include vitamin A rich sources of foods in your diet plan.

Keeping the blood pressure, sugar level and body weight in check will help improve the eyesight.

Myth 8: Diabetics should avoid driving.
Fact 8: Diabetes patients who have their sugar levels under control can drive. A high level of sugar in blood affects the eyesight only to a slight level. The other senses too function normally when proper care is taken about diet, exercise and medication. So, there is no problem for diabetics to drive when glucose level is under control.

Myth 9: Diabetics are more likely to get colds.
Fact 9: This is not true. A diabetic patient and a normal healthy person are equally prone to get colds. This myth surfaces when the doctors advise diabetes patients to get a flu vaccination. This advice is given because flu or any other illness can make diabetes more difficult to control. The reason behind this is that any infection can change the glucose levels in blood, which may lead to greater risk for diabetic complications.

Any infection may interfere with a diabetic’s blood glucose management and thus increasing the risk of high blood glucose levels.

For type 1 diabetics, there is an increased risk of ketoacidosis, a serious condition that can lead to a diabetic coma or even death.

Myth 10: Diabetics should limit carbohydrates, not proteins or fats.
Fact 10: Limiting carbohydrates surely helps in keeping the blood sugar levels in check but it’s also important to be sure that your total calorie intake is well balanced. Whether its carbohydrates, proteins or fats, everything should be well-balanced and taken in moderate quantities.

Myth 11: Diabetics should minimize the use of starchy foods.
Fact 11: Diabetics should be very careful about their diet. They should make balanced diet and healthy meal plan, a part of their life. Starchy foods, like whole grain breads, cereals, pasta, rice, and starchy vegetable like potatoes, yams, peas an corn, form part of a healthy meal plan. These should be included as part of your daily diet but care should be taken about the quantity. The portion size should be moderate. Too much of anything is dangerous. So is it about starchy foods too. Keep an eye on the amount of starchy foods you consume regularly.

Myth 12: People with diabetes cannot eat fruits.
Fact 12: All kinds of fruits and vegetables are beneficial for the diabetes patients and in fact have been proved to reduce the chances of heart diseases and cancers. Diabetics are actually advised to take four to five servings of fruits and vegetables daily.

Fruit is a healthy food and contains fiber and lots of carbohydrates, vitamins and minerals. This should be included in your diet plan but consult your dietician about the amount, frequency and types of fruits you should eat