Exercise should be a vital part of your daily schedule; (below) regular check ups should be done

Master health check ups” are gaining popularity, sometimes as a prerequisite for a lucrative job, or as a part of the evaluation for medical or life insurance. Widespread testing and awareness has resulted in the discovery of incidental biochemical diabetes in asymptomatic individuals.

Diabetes is treatable. It is possible to have a normal life span if there is cooperation between the patient and the treating physician, no interference with ill timed unscientific advice from friends and well wishers, abstinence from naturopathic unscientific unregulated herbs and powders, regular exercise and a calorie-controlled diet.

Unfortunately, there is no “magic cure” or “universal pill”. Treatment has to be individualised, depending on the type of diabetes and the severity. As long as the pancreas is capable of producing some insulin, it is often possible to maintain adequate control for some time with diet and exercise without taking recourse to tablets.

Once the failing pancreas cannot cope, medication has to be started. Tablets used in the treatment of diabetes belong to several groups, differing mainly in their frequency of dosing and side effects. The earliest drugs belonged to the sulphonyl urea group and its many subgroups, like glibenclamide, glimepride and chlopromamide. Metformin is a popular and widely used drug which has stood the test of time. It has the additional advantage of suppressing the appetite and increasing the sensitivity and efficiency of endogenous insulin. The glitazones are a newer group of drugs which can be given alone or as an “add on” to potentiate the action of other medications.

Diabetes affects so many people worldwide that research and efforts are constantly underway for revolutionary concepts and medication to tackle the disease at different levels. Research has yielded results in the form of “acarbose”, asham sugar that blocks the enzymes responsible for the absorption of carbohydrates. In an obese poorly controlled diabetic, this results in lower sugar levels even after an indiscreet meal. However, undigested starch can then reach the large intestine where it may get fermented, producing bloating.

Diabetes and high blood pressure go hand in hand. A person with one may soon develop the other. All diabetics need to have their blood pressure checked regularly to maintain good control. Also, diabetics need to be prophylactically started on one of the statin groups of drugs even when the lipid profile appears normal. There is no real “safe” level of cholesterol. In addition, the regular use of a low dose aspirin or clopidogrel reduces the risk of stroke and heart attacks.

Death in diabetics is due to heart attacks and vascular complications in 70 per cent of patients, renal failure in 10 per cent and infection in seven per cent. These complications appear 10-15 years after the initial diagnosis of the disease. The incidence of complications is greater with the longer duration of disease in smokers, older patients, those with high blood pressure, abnormal lipids and protein in urine. Complications result from high uncontrolled sugar levels which cause gradual damage to internal organs at the micro and macro vascular level. The microvascular complications affect the eyes, the kidneys and the nerves. The susceptibility is genetic, with many members of the family developing complications consistently in the same organs.

The eyes are more prone to cataract and develop them earlier. Also, the retina is susceptible to new vessel formation and retinopathy. All this can compromise the eyesight, resulting in blindness. Diabetic damages to the kidney can eventually progress to renal failure. Simple infections once acquired are difficult to control and may progress rapidly. Foot problems occur in 50 per cent of diabetes cases because of compromised blood supply, damage to the nerves reducing the protective sensation of pain, trauma and infection. Ulcers may form which though not painful run an indolent course and refuse to heal. They eat into the surrounding tissues and bone, eventually requiring amputation of digits or part of a limb.

Regular check ups prevent complications. This usually means a visit to the hospital or clinic every few weeks or months, preceded by an evaluation of the blood sugar. This is not very satisfactory. It is better to purchase a glucometer and regularly check and record the sugar at home. Otherwise, in a laboratory, the measurement of the glycosylated haemoglobin is a more accurate evaluation. It shows the control over the past six weeks and it should ideally be around seven.

Prevent complications and take care of yourself.

• Maintain a 1,500-calorie diet.

• Exercise for 40 minutes a day.

• Build up muscle strength.

• Invest in a glucometer.

• Avoid alternative systems of medicine.

• Care for your skin and feet.

• Wear comfortable footwear in the house and outside.

• Listen to your doctor and follow instructions.

• Diabetes can be controlled, not cured. Successful treatment lies in your hands.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in