DIABETES - What you must know

Diabetes is a chronic, progressive disease of defective glucose metabolism by the cells due to lack of insulin or defective or decreased production in the body causing a rise of glucose in peripheral blood. Insulin resistance in muscle, liver, and adipocytes also affects glucose metabolism. There is a progressive beta cell failure, pancreatic cells producing insulin, in diabetics and also with increasing age which progresses at a rate of approximately 4% per year.        

High blood sugar can lead to many health problems and also affect your heart, kidneys, nerves, eyes, feet, digestion and sexual functions.

High Blood Sugar is usually defined as a sugar greater than 140 mg/dl before a meal or greater than 180 mg/dl two hours after a normal meal or HbA1C more than 6.5%.

A fasting or premeal blood glucose goal of 80 to 125 mg per dL and a two-hour postprandial goal of less than 180 mg per dL are recommended.

The HbA1C value gives information on average blood glucose level of past 3 months. Its goal should be individualized based on age, life expectancy, comorbid conditions, duration of diabetes, risk of hypoglycemia, adverse consequences related to hypoglycemia, or patient motivation and adherence.

Diabetes occurs when there is inadequate amount of insulin that is not enough for proper utilisation of glucose or due to insulin resistance the cells cannot use insulin properly. 

Treatment usually begins with oral medications, but many a times insulin or other injectable medications need to be used depending on the condition of your illness or health. 

American Diabetes Association recommends use of long-acting (basal) insulin to augment therapy with one or two oral medicines when the HbA1C level is 9% or more, especially if the patient has symptoms of hyperglycemia or catabolism. Insulin regimens should be adjusted every three or four days until targets of self-monitored blood glucose levels are reached. Insulin use is associated with hypoglycemia and weight gain. 

Hypoglycemia is low blood glucose level where the normal brain function of a person is hampered. Hypoglycemia may result from a mismatch between insulin and carbohydrate intake, exercise, or alcohol consumption.

If there is recurring hypoglycemia then the goal for blood glucose level needs to be reviewed and maintained at a higher end.

Do not do strict glycemic control in older adults, since moderate control is better and reduces incidence of hypoglycemia. Hypoglycemia has been associated with poor outcomes, especially brain damage and higher deaths, especially in older patients. You must learn about the symptoms and self-treatment of hypoglycemia with glucose or sweets immediately.

The goals of therapy should be individualized based on many factors, including age, life expectancy, comorbid conditions, duration of diabetes, risk of hypoglycemia, cost, patient motivation, and quality of life.

Insulin replacement therapy is needed when the blood glucose level is more than 300 to 350 mg per dL or more or HbA1C is more than 10%. 

Intensive control of type 2 diabetes with a HbA1C goal below 7% significantly decreases the risk for end organ damage while coexisting chronic illnesses are affected adversely by high blood glucose.

Most important of all is a diabetic person must be proactive to keep his blood glucose level in check by following healthy diet and lifestyle, regular exercises, avoiding addictions, regularly take medicines and insulin, periodic blood tests and regular follow up with diabetes care doctors.