DIABETES: FACTS vs MYTHS
Article by Dr Gilford Mutwiri,a board certified Internal Medicine specialist at Consolata Nkubu Teaching & Referal Hospital
'' The management of diabetes mellitus(DM) is marred by deeply rooted beliefs, practices and misconceptions. So entrenched are they that it’s often mentally fatiguing to engage the affected.
Often, you encounter people with diabetes who are shocked that they are unwell. To them, they simply feel nothing. That they even don’t know what they are supposed to feel is equally worrying. On this sole basis, they vehemently oppose the diagnosis and seek multiple opinions. Currently, out of the four criteria used in the diagnosis of DM, only one requires the presence of symptoms. It therefore possible to have DM without symptoms. It’s also true that the absence of symptoms doesn’t mean no harm is happening. To avoid such shockers, it is crucial that one adopts a screening approach.
The traditional daily monitoring of fasting blood sugar. One challenge I find with this is the assumption that since the fasting sugar is okay, your blood glucose control is okay. Certainly, monitoring of fasting sugars is essential. It’s however not the only component in this. It is crucial that even blood sugar after meals is monitored. This seldom happens. In addition, there is little use of an essential test called HbA1C. This gives one an estimate of how their blood sugar control has been in the preceding three months.
That insulin (Sindano) is the drug of last result and implies that one is now terminal. I’m my opinion, this was reinforced in our health care institutions. Traditionally, one would be put on multiple tablets until they fail. I feel that during this period, organ damage must have been happening. At the point they are being initiated on insulin, they have had significantly organ damage. It is factual that insulin is the only diabetic drug that you can bet on to lower blood sugar. Currently, insulin can be initiated at any stage including at diagnosis. It is actually the recommended drug in those with type 1 diabetes.. It is important to note that diabetes care is highly individualized. This is a discussion one should have with their provider.
The focus of glucose management only. Whereas glucose control is a key component of DM care, the scope should certainly go beyond this. The reason we are concerned about glucose is because prolonged exposure to elevated blood sugar can predispose one to organ and blood vessels damage. The risk is often modified by other factors that are frequently overlooked. It’s therefore imperative that we manage the overall risk of this damage in addition to optimizing blood glucose control. Therefore one has to check on their weight, smoking status, exercise, blood pressure, cholesterol levels etc etc.
That high blood sugar is a medical emergency. Indeed, I get many distress calls on this. Usually, high blood sugar in isolation is not a medical emergency Per se. However high blood sugar in association with high levels blood acid or osmolality is a dire medical emergency. To establish this, one has to do some test in a hospital. Once the two conditions are excluded, the management isolated high glucose is gradual. There’s simply no hurry in bringing down the sugar. Indeed, a low sugar is acutely (in the short term) more dangerous that an isolated high sugar. The mantra is therefore to gradually lower the blood sugar while avoiding a low blood sugar, a situation known as hypoglycemia.
There is over dependence on care takers, care givers and spouses (This is particularly amongst men and those on insulin). Often, some people equate DM to disability and delegate care. There is a lot of resistance on training particularly on injection technique. Indeed, some people have to get calls from spouses to take drugs. The role of self-care can’t be overemphasized. It’s important that one takes ownership of this as much as possible.
There’s an established association between obesity, age and incidence of type 2 DM, the development of DM is a complex interplay of many factors. It is therefore not surprising to have a young and lean person develop DM. Certainly; type 1 DM mostly presents in childhood.
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