Diabetes is a common metabolic disorder seen in a large number of people which is characterized by elevated blood glucose levels and this leads to a variety of changes in various organ systems like the kidneys, nerves, eyes, heart and brain and the blood vessels. Diabetes affects more than 77 million people in India today and this number is projected to increase to more than 150 million over the next 20 years.
Diabetes is mainly a lifestyle disease occurring in people who have an unhealthy lifestyle with very little physical activity, eating a western diet or high fat diet rich in simple sugars and having psychological stress, disturbed sleep etc. Those who have a family history of diabetes in their parents or siblings are more likely to develop diabetes as those who are overweight or those women who had gestational diabetes (diabetes during pregnancy) or those with hypertension, lipid abnormalities and those needing to use medications like steroids.
The Risk
A normal person has a blood glucose which is below 110mg/dl in the fasting state and 2hr after a meal it is generally less than 140 mg/dl, while those with fasting glucose more than 126mg/dl and post meal value greater than 200 mg/dl are labelled as having diabetes. Those individuals with fasting glucose in between 110-126 mg/dl and post meal glucose values between 140-199 mg/dl are labelled as having pre-diabetes. These individuals are at increased risk of developing diabetes and also can develop the cardiovascular disease associated with diabetes.
People with diabetes generally present with increasing hunger, increasing thirst, weight loss, weakness, tiredness, frequent skin and urinary tract infections and poor healing of wounds. But a large proportion of patients who develop diabetes may be totally asymptomatic and may be detected incidentally when a blood glucose test is done. It is during this period of undetected high glucose levels in blood that they are prone to develop the complications of diabetes.
Hence, it is very important for those who are at increased risk of developing diabetes should regularly check their blood glucose levels every 6 months to detected prediabetes or diabetes.
Complications
The problem with diabetes is mainly due to its complications which have made diabetes the leading cause of blindness due to diabetic retinopathy, leading cause of kidney failure due to diabetic kidney disease, leading cause of heart disease due to the coronary artery involvement in diabetes and the leading cause of non-traumatic limb amputations due the diabetic neuropathy leading to diabetic foot ulcers.
The targets of control to be maintained by all people with diabetes to prevent the complications of diabetes or risk of turning oneself into diabetic are
- Fasting glucose < 120 mg/dl
- Post prandial < 160 -180 mg/dl
- HbAic < 7 %
- Cholesterol < 150 mg/dl
- LDL Cholesterol < 100 mg/dl and when they have heart disease < 70 mg/dl
- HDL cholesterol > 45 mg/dl for men and > 50mg/dl for women
- BP < 130/ 80 mmHg
Prevention
However these complications have been shown by large studies conducted across the globe to be preventable. By good control of the blood glucose levels, control of hypertension and cholesterol levels all these complications are preventable. Hence, it is essential that people with diabetes take good care of them and prevent these complications. The four most important pillars of this model for good diabetes care are
- Following a healthy lifestyle,
- Complying with the medications prescribed by the doctor
- Regular monitoring for ensuring adequate control of diabetes and other comorbidities like blood pressure and lipids and
- Increasing the awareness and knowledge about diabetes and its complications
The good news is that all these people who are at increased risk of diabetes can prevent or delay the development of diabetes by following a healthy lifestyle, losing weight, increasing physical activity and consuming a healthy diet rich in fruits and vegetables.
As Team We Can Make The Difference
Dissemination about the knowledge of diabetes and its treatment is very important in proper management of diabetes and prevention of complications of diabetes. This requires a team approach and not only the doctor, (Endocrinologist, physician or diabetologist) but also the other members like the Nurse educator, podiatrist has an important role in achieving this goal.
To highlight the important role played by a Nurse Educator in Education of a diabetic patient about his disease and proper management of the disease, the International Diabetes Federation has selected the theme for World Diabetes Day 2020 as “Nurses Make the Difference”.
The article is written by Dr. Rakesh Sahay, MD, FICP, FACE, FRSSDI, Senior Consultant Endocrinologist, Aster Prime Hospital, Ameerpet, Hyderabad
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