APRIL 10, 2016
BY DR MILTON LUM
1 If blood pressure is high, the heart has to work harder. High blood pressure leads to heart attack, stroke and damage to the kidneys and eyes. 2 The cornerstone of good diabetic management is keeping blood glucose levels under control.— Photos: AFP
The management of diabetes is largely dependent on satisfactory blood glucose control, which prevents complications from arising and ensures a healthy life. This can be achieved by being knowledgeable about the condition, knowing the ABCs of diabetic control, learning to live with diabetes and ensuring adequate care.
The most important person in the management of diabetes is the diabetic himself or herself; not family members, doctors or nurses.
There are different types of diabetes. Type 1 diabetics do not make insulin to convert glucose from foods eaten into energy for the body; so insulin is required.
Type 2 diabetics, which is most common, do not produce insulin or use it well; so insulin or tablets are needed for control.
Gestational diabetes occur in pregnant women and goes away after childbirth in most women. These women and their children have an increased risk of diabetes.
Diabetes has to be taken seriously, irrespective of whether it is mild or severe. If untreated or inadequately treated, it will lead to complications involving many parts of the body, including the heart, blood vessels, kidneys, nerves, feet, eyes and brain.
Diabetics need to make healthy food choices, maintain a healthy weight, exercise and take their medicines regularly even when they feel well.
It is advisable to gather knowledge about diabetes from the attending doctor, nurses and other health professionals and find out where one can obtain health education materials on diabetes.
ABCs of diabetic control
The ABCs of diabetic control are A1C, blood pressure, and cholesterol, all of which help to decrease the likelihood of heart attack, stroke, or other complications.
The HbA1C is a blood test that measures the average amount of blood glucose bound to red blood cells in the preceding three months. It is different from daily blood glucose measurements. The HbA1C should not be more than 6.5. The higher the blood glucose levels are, the higher will be the HbA1C.
In terms of blood pressure, if it is high, the heart has to work harder. High blood pressure leads to heart attack, stroke and damage to the kidneys and eyes.
The blood pressure should be less than 140/90 mm Hg.
HDL is the “good” cholesterol and LDL is the “bad’ one. The latter can lead to blockage of the blood vessels, and consequently, a heart attack or stroke. There may be different targets for each individual. In general, the lower the LDL, the better.
Exercise, diet, and sometimes, medications, are necessary to achieve the cholesterol targets.
The doctor will advise on the targets for the ABCs, which depend on the duration of diabetes, other health problems and the difficulties in managing the disease.
Living with diabetes
There is no point being sad or angry with one’s condition. Stress can affect blood glucose levels. Several measures can help address stress, eg breathing exercises, walking, music, or hobbies. If there is an inability to cope, help can be sought from a counsellor, family, friends or support groups, who are good listeners and can provide appropriate advice.
Healthy foods are important in diabetic control. The spacing of meals and their timing are important for type 2 diabetics. Meals taken four to five hours apart permit the post-meal glucose level to return to baseline.
It is important to consume meals of about the same composition at about the same time daily. The amount of total carbohydrate intake consumed has to be about the same daily. This enables the maintenance of appropriate blood glucose levels.
Having knowledge of the nature of food is important. Complex carbohydrates, which are minimally refined like rice, noodles, oats, capati, toosai, etc, take a longer time to digest and do not cause sudden increase in blood glucose.
Fruits should be taken in moderate amounts because of their sugar content. It is advisable to consume green leafy vegetables. Advice from the doctor, nurse or dietician would be useful.
Exercise and a healthy diet help in the maintenance of a healthy weight. Activity for most days of the week would be needed.
Smoking cessation is very helpful in diabetic control. Advice and assistance can be sought from the doctor if there is difficulty in smoking cessation.
Medications have to be taken as advised by the doctor even when one is feeling well. Apart from diabetes medication, other medicines may be prescribed, eg aspirin to prevent a heart attack or stroke. If there are any side effects from the medication, the doctor has to be informed.
A daily check of the feet for cuts, blisters and swelling is necessary for the early detection of injury. Medical attention should be sought immediately if there are any sores that do not go away.
It is important to brush the teeth and floss daily to keep the mouth, teeth and gums healthy.
Keeping a record of blood glucose levels is important. There may be occasions when the doctor advises checks more than once daily. The target daily blood glucose levels are 4.0-6.0mmol/L for fasting, and less than 8.0 mmol/L after meals. Advice should be sought from the doctor on the utilisation of blood glucose results in managing diabetes.
Keeping a record of blood pressure may be advised by the doctor. Should there be any changes in health, medical attention should be sought without delay.
Discussions with the doctor on one’s diabetic control is advised at each consultation.
Ensuring care
If there is good control, there would be at least two consultations with the doctor annually.
If control is unsatisfactory, or there are health problems or one feels unwell, more frequent consultations would be necessary.
It is routine to check weight, blood pressure and feet as well as review diabetic control at each consultation.
The HbA1C will be checked at least twice annually and more frequently if raised. The usual annual checks include cholesterol estimation; detailed examination of the eyes, teeth and feet; and tests for kidney problems.
Annual influenza vaccination is recommended. Other vaccinations include that for pneumonia and hepatitis B.
It is essential to keep appointments with the doctor. If unable to do so, arrangements have to be made for another appointment.
In summary, the most important person in diabetic control is the diabetic himself or herself. All that the doctors, nurses and other health professionals can do is to advise and provide assistance.
http://www.star2.com/health/wellness/2016/04/10/you-can-control-and-manage-your-diabetes/