The ‘dos and don’ts’ of diabetes
Type II diabetes is a medical condition where the sugar level in the blood is abnormally raised (hyperglycaemia), due to relative insulin deficiency, resistance, or both. Insulin is a hormone produced in the pancreas gland; its role is to control the storage and the release within the body of the chemical energy available from food.
There are different types of diabetes; the commonest type is type II diabetes. It accounts for more than 80 per cent of diabetic patients and it is one of the commonest chronic diseases, affecting more than 5 per cent of the Irish population.
Epidemiology
The four major determinants of type II diabetes are obesity, ethnicity, family history and increase in age. Public awareness of type II diabetes is crucial, because the disease is on the increase and may present without symptoms for years before diagnosis is made. The symptoms may be accelerated by the stress of pregnancy, drug treatment or obesity.
Populations in developed countries gain an average of 1gm in weight every day of their adult life between the ages of 25-55 years. This is a result of a sedentary lifestyle and reduced exercise. The proportion of obese young adults is rising rapidly and the major concern is that type II diabetes is affecting the younger obese population and that will result in a great financial burden on patients and the health system.
Type II diabetes prevalence increases with age; around 10 per cent of those aged over 70 are diabetic and this figure rises to 30 per cent if there is a family history of the condition.
Clinical presentation
Type II diabetes could be clinically silent for years before symptoms strike. This is why early screening and detection makes a huge difference in treatment and prevention of early complications. The symptoms could be sudden and quite obvious; the classical triad of symptoms are: excessive thirst (polydypsia); passing a considerable amount of urine (polyuria) due to the high level of glucose in the blood and that causes the sugar to pass in urine, with fluids depleting the water and salts from the body; and weight loss.
The losing of weight is due to fluid loss and the breakdown of muscle and fat to gain energy, because the body is unable to utilise sugar to get its energy.
The above symptoms also could be subtle, over months and years. Patients complain of other symptoms too, such as lack of energy, blurred vision, itchiness in the genital area due to thrush, candida infection, etcetera.
Presentation could also be as a complication of type II diabetes, such as recurrent bacterial skin infection, visual impairment (retinopathy), numbness in hands and feet (polyneuropathy), erectile dysfunction, and blood vessel disease resulting in a heart attack or gangrene in feet.
The role of the medical profession and the role of the public
Public awareness is vitally important in managing type II diabetes. Diet and exercise should not only be advised for type 2 diabetic patients, it should be recommended to all adults and children. Food manufacturers should be pressurised to change the recipe of unhealthy foods that contain high fat, sugar and salts.
Obesity is on the increase, particularly among children and adolescents; this means that the incidence of diabetes will increase in the future, together with its complications. So, the life expectancy of future generation will drop compared to recent times, plus the financial impact on the health system will be quite significant.
What to do next
Individuals who are 45 years old or above, and whose body mass index (BMI) exceeds 25, should be screened for diabetes; if the result is normal, the test should be repeated in three years.
Individuals with a BMI of 25 and above — and who have additional risk factors — should be tested at a younger age and more frequently. Risk factors include a family history of diabetes, high blood pressure, high cholesterol, women who have had babies weighing more than 4.1kg (9 pounds), or had diabetes as a result of pregnancy (gestational diabetes), symptoms of fatigue, thirst and loss of weight. Screening for diabetes is done by doing a blood sugar level and/or a glucose tolerance test.
What happens when type II diabetes is diagnosed?
Care of patients is an integrated service between the patient’s GP, diabetologist, eye specialist, clinical nurse, dietician and podiatrist. Patients with type II diabetes should have access to a specialist service if required and that includes psychology, a kidney specialist, blood vessel assessment and heart specialist.
After the initial assessment, follow-up is essential and that includes a comprehensive annual review.
The psychological impact of the diagnosis varies between patients; it is essential to discuss the psychological and physical concerns between the patient and doctor. It is also essential to remember that patients who start on their treatment should live as normal a life as possible. Problems that patients encounter range from not coping to denial and lack of acceptance. Such complications could be avoided or possibly delayed when patients are well aware of their condition and are managing their therapy well.
Treatment options
Treatment varies, ranging from diet control and lifestyle changes to tablets and possibly insulin for uncontrolled cases.
Communication between the patient and the general practitioner is essential in management of diabetes mellitus; a regular arranged visit to the doctor is important. The management is achieved through multidisciplinary teams; the patient will be educated on how to manage diet, exercise, medication and regular blood sugar level checks.
What is the point of going for regular checks?
It is vital to keep the appointments, because diabetes slowly worsens over the years and those patients who are initially well controlled with diet, or diet and a tablet, will need gradual increases of their treatment over time. Early detection and treatment will prevent or delay diabetic complications.
Medical reviews will focus on history and a thorough physical examination: blood pressure and heart examination, chest examination, vision tests and examination of the abdomen, lower limbs, pulse and skin.
Blood tests are performed to check cholesterol, glucose levels over the past three months and this is achieved through a blood test called HBA1C; the level should be below 6.5 for a good sugar control. The examination is important to identify an early diabetic complication and, if warranted, a specialist referral.
It is advisable for diabetics to talk to their GP if they complain of a symptom that is related to their diabetes and not to wait for their yearly visit. Signs such as chest pains, shortness of breath pain, swelling in their legs, visual impairment or abnormally high glucose levels would fall into this category.
It is also worth mentioning that skin conditions are common among diabetics, such as itchy skin, candida infection and skin ulcers in the feet, due to poor skin sensation.
Diabetic male patients should not be embarrassed to talk to their doctor about any sexual problems. Men are typically pushed by their partners when it comes to sexual issues.
Insurance and licensing authorities
For the safety of the patient and the public, it is important to disclose to the licensing authorities all medical conditions that could interfere with driving or operating machinery. It is recommended for diabetic patients to receive the yearly influenza vaccine and preferably a pneumonia vaccine every three to four years.
(Source: IMT)
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