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.
