For most patients, making a diagnosis of diabetes is relatively easy. Most patients present with the classic symptoms outlined in my last article: blurred vision, frequent urination, increased thirst, dry mouth, weight loss, constant hunger, genito-tract/urinary tract infections, pain or numbness in the feet or legs and poor healing of sores. A few patients do not have symptoms and are diagnosed on routine medical check-ups. These are the minority.
The most reliable test is the sugar level in the blood, preferably after an overnight fast. An overnight fast means no food after supper and no breakfast on the morning of the blood sugar test.
A blood taken from the vein or from tip of the finger is checked for sugar. If the fasting sugar level from blood from the vein is equal or more than 7.0 mmol/l, then this means diabetes is present. If the blood test is from the tip of the finger, then a result equal or above 6.1 mmol/l means diabetes is present. If a random blood sugar test is done — that is without fasting or after taking food — then the cut off point for both blood from the vein and from the fingertip is 11.1 mmol/l. This is enough to make the diagnosis. We do not depend on urine tests anymore.
Once the diagnosis is made, the physician has to educate the patient on how the diabetes is best managed.
Management of diabetes is holistic. This means we treat not only the disease, but also the patient and his or her immediate family members. No one wants to get sick. So, when the diagnosis is confirmed, many patients have psychological issues: Why me?; will I lose a limb?; will I go blind?; will I become impotent? etc. Therefore, the first task of the physician is to explain how diabetes comes about. The patient is told about the role of genetics and aging in diabetes. Once the patient understands this they may accept the disease and look after themselves better. The spouse or guardians of the newly diagnosed patients should also be counselled and taught about the disease. If they know about the disease then they are likely to help the patient in managing it.
The next thing is to educate the patient on what can bring about diabetes. Many people have questions and concerns. They want to know why they ot the diabetes. A full medical history is impotant, starting with age. Is there a family history of diabetes? What are dietary habits of t4he patient? Does the patient take alcohol? If female has she given birth o a child above 4kg in weight? Any previous history of high blood sugar which went away? How has been the patient’s weight ove rthe last year? Does the patient do regular exercise? Does the patient have reccurrent infections? What the patients sleep pattern? What is the social history7 at home? – married single divorced widowed etc. What about work? Any stresses that the patient can think of? Very important to know the spiritual beliefs of the patient as this can habe a bearing on adherence to treatment. I usually7, at the very end, ask whether the patient beieves in witchcraft. This is a curved ball, which I introduce and if there is no answer I leave it. If t4he answer is yes, which is very common I try7 and explain that more likely than not this is not due to witchcraft and give the reasons why not.
Then a thorough clinical examination is a must4 and followed by relevant tests. The tests have to be explained to the patient at that time and or at the next review when most of the investigations will be out.
Generally, I start with a broad lecture of risk factors
The next thing is to educate the patient on the lifestyle changes that are needed to control diabetes in light of the history and clinical examination findings. But first the7 must have an idea about insulin resistance in laymans terms. For those with formal education I find that explaining as much as possible these patients appreciate. These are weight control, exercise, and diet control. These are vital for both adult type (type 2) and childhood type (type 1) diabetes. There is formula we use called BMI or body mass index. This calculates the idea weight for someone’s height. The normal range is 19 to 24. If the BMI is more than 24, then that person needs to lose weight. If it is less than 19, then that person needs to gain weight. If the weight is too much for the height, then that puts the person at risk of diabetes. If that person loses weight then the blood sugar goes down and the response to medications, if any, is better.
Exercise is also very important. A person who is physically unfit is likely to develop diabetes compared to someone who is physically fit. When someone develops diabetes, the control is better for those who exercise, and the drug requirements are less in this group.
Diet is cardinal in both types of diabetes. If the diet is not controlled, diabetes can never be managed well. I shall post a separate article on diet. Patients also have to understand that stress will affect their diabetes. This is both mental stress and stress on the body due to illness. This has to be managed.
In type 2 diabetes, depending on how high the sugar levels are, the patient may be started on oral drugs or injections of insulin. In type 1 diabetes only insulin is given.
In summary, it is very important to educate every diabetic patient and immediate family members on the causes of the disease, and how to manage it. Diabetes is managed more by the patient than the health care provider.
In the next article, I shall talk about the importance of self-monitoring and the diet —including alcohol! — in detail.
Ciao!
