Case of Mr XLet me begin this article by describing two different people with Diabetes who had consulted in the clinic.Mr X is 34 years old with Type 2 Diabetes for the last eight years. His last visit to the clinic was about six years ago. He is not compliant with the medications, does not exercise and does not follow a healthy diet. He has been married for two years and has no children. He was asked to get aclearance from a diabetologist for a surgical procedure on his left ear as he has chronic left ear hearing loss.His medications were insulin twice a day along with anti-diabetic oral medications. He states that he has not been taking medicines regularly and had missed taking insulin several times. At the clinic, he went through an annual Diabetes check-up which showed fasting blood sugar of249 mg/dL, postprandial sugars of339 mg/dL (2 hours after the breakfast) and glycosylated haemoglobin or HbA 1c (three-month sugar average) of12.6 per cent (good control <7 per cent). He had already developed diabetic neuropathy (lack of sensations in the feet). His urine test showed both protein and excess blood sugar. He did not have diabetic retinopathy. His fasting cholesterol was elevated with triglycerides of5000 mg/dL.Case of Mrs XMrs Y is a 64-year-old female with Type 2 Diabetes since 1998. She was recently discharged from the hospital after controlling her fluctuating blood sugar level and erratic blood pressure level. She was discharged with a continuous glucose monitoring (CGM) device.She came to the clinic with the CGM report showing low blood sugar levels in the mornings. Her eye exam showed no retinopathy and her urine routine was normal with no sugar or protein (no spillage of protein in the urine). She walks about2-3 kilometres every day and does Yoga about an hour every day. She follows a proper diet and avoids sweets even though occasionally she eats rice. Her fasting blood sugar was 80 mg/dL, her postprandialsugar was 170 mg/dL and her HbAlc or three-month glucose average was5.8 per cent. She takes her medications regularly. She also regularly takes the once day insulin which was started during the recent hospitalisation.X versus Y approachWhen we see these two case scenarios, it is very clear that following diet, exercising regularly, being compliant with medications and following up regularly with the doctor plays a major role in maintaining good blood sugar levels and preventingDiabetes-related complications like retinopathy (damage to the blood vessels in the tissues at the back of the eye), nephropathy (damage to the kidney whichis indicated with the spillage of protein in the urine) and neuropathy (damage or dysfunction of the nerves, one of the manifestation is loss of sensation or numbness in the feet that sometimes a person is unaware of).Self-care tipsDiabetes self-care activities are aimed at altering the modifiable risk factors of Diabetes like unhealthy eating habits, sedentary lifestyle and smoking. Diabetesself-care activities are behaviours undertaken by people with Diabetes or those who are at risk of Diabetes to successfully manage the disease on their own.There are seven self-care behaviours that predict a good outcome in individuals with Diabetes. They are:Healthy eating habitsEating mostly home-cooked food with more vegetables, nuts, avoiding junk food and eating on time can help reduce blood sugar fluctuations.Physically adivityBesides being active, incorporating about 45 minutes of brisk walking every day will help burn more calories. Taking the stairs instead of the lift and parking the vehicle a little farther from the destination thereby forcing one to walk more steps can help to achieve a target of about 10,000 steps a day.Regular monitoring of blood sugar levelsBlood sugar levels must be monitored habitually to understand any highs and lows. Regular monitoring ensures that fluctuations are caught on time and medical help can be sought to correct them.Compliance with medicationsIt is important to take oral anti-diabetic medicines and administer insulin as prescribed by the doctor.Good problem-solving skillsMental health is of equal importance and should not be neglected. Psychological stressors such as stress and anxiety could worsen blood sugar control. Taking care of mental health effectively helps in keeping the blood sugar levels in the normal range. Seeking guidance and professional help is important to overcome stress and better manage health.Healthy coping skillsGood night sleep of about seven hours is very important in blood sugar management. This not only helps one tostay fresh and alert but also helps to have a productive day. Stress management plays a very important role in maintaining our health. As everyone knows circumstances in life may be beyond our control, however the way we react to any life event is completely in our control.Risk redudion behavioursQuitting smoking and tobacco use and reducing alcohol consumption is necessary to manage sugar levels.Studies have shown that significant predictors of adequate self-care management in people with Diabetes are:• Knowledge about Diabetes• Secondary school education• Diabetes of a longer durationAs per Gurmu et al., predictors of poor self-care behaviours are:• Male gender• Living in a rural area• Poor knowledge about Diabetes• Inadequate accessibility for self-testing blood sugars• Less than 6 years of Diabetes Diabetes self-management educationPeople with Diabetes, who were provided with Diabetes self-management education (DSME), have more likely to prevent the complications of Diabetes and delay the progression of the disease. Diabetesself-management education (DSME) includes imparting knowledge about the disease and its progression including the complications affecting the heart, eyes, kidneys, blood circulation and the nervous system. Any of these can be prevented or delayed by maintaining good sugar control along with healthy lifestyle behaviours.The American Diabetes Association had reviewed the standards of Diabetes medicalcare management and had found that people with Diabetes who have not received any formal education regarding self-care practices are at a four-fold increased risk ofdeveloping the associated complications of Diabetes. The DSME must be converted into action for good sugar control and a better quality of life. It is important to constantly work on improving self-care to have a healthier life.X and YReturning to the two case scenarios - Mr X was given the DSME and his medications were adjusted to help with better blood sugar control. He was asked to follow up in the clinic with self-monitored blood glucose (SMBG) readings in a week. Mrs Y's insulin was stopped as she was developing low sugar levels in the early mornings and her oral medications were adjusted. She was asked to follow up in a week with SMBG and a complete foot evaluation report (to assess for any Diabetes-related neuropathy). Dr Suganthi Kumaran is a Consulting Physician.
Case of Mr XLet me begin this article by describing two different people with Diabetes who had consulted in the clinic.Mr X is 34 years old with Type 2 Diabetes for the last eight years. His last visit to the clinic was about six years ago. He is not compliant with the medications, does not exercise and does not follow a healthy diet. He has been married for two years and has no children. He was asked to get aclearance from a diabetologist for a surgical procedure on his left ear as he has chronic left ear hearing loss.His medications were insulin twice a day along with anti-diabetic oral medications. He states that he has not been taking medicines regularly and had missed taking insulin several times. At the clinic, he went through an annual Diabetes check-up which showed fasting blood sugar of249 mg/dL, postprandial sugars of339 mg/dL (2 hours after the breakfast) and glycosylated haemoglobin or HbA 1c (three-month sugar average) of12.6 per cent (good control <7 per cent). He had already developed diabetic neuropathy (lack of sensations in the feet). His urine test showed both protein and excess blood sugar. He did not have diabetic retinopathy. His fasting cholesterol was elevated with triglycerides of5000 mg/dL.Case of Mrs XMrs Y is a 64-year-old female with Type 2 Diabetes since 1998. She was recently discharged from the hospital after controlling her fluctuating blood sugar level and erratic blood pressure level. She was discharged with a continuous glucose monitoring (CGM) device.She came to the clinic with the CGM report showing low blood sugar levels in the mornings. Her eye exam showed no retinopathy and her urine routine was normal with no sugar or protein (no spillage of protein in the urine). She walks about2-3 kilometres every day and does Yoga about an hour every day. She follows a proper diet and avoids sweets even though occasionally she eats rice. Her fasting blood sugar was 80 mg/dL, her postprandialsugar was 170 mg/dL and her HbAlc or three-month glucose average was5.8 per cent. She takes her medications regularly. She also regularly takes the once day insulin which was started during the recent hospitalisation.X versus Y approachWhen we see these two case scenarios, it is very clear that following diet, exercising regularly, being compliant with medications and following up regularly with the doctor plays a major role in maintaining good blood sugar levels and preventingDiabetes-related complications like retinopathy (damage to the blood vessels in the tissues at the back of the eye), nephropathy (damage to the kidney whichis indicated with the spillage of protein in the urine) and neuropathy (damage or dysfunction of the nerves, one of the manifestation is loss of sensation or numbness in the feet that sometimes a person is unaware of).Self-care tipsDiabetes self-care activities are aimed at altering the modifiable risk factors of Diabetes like unhealthy eating habits, sedentary lifestyle and smoking. Diabetesself-care activities are behaviours undertaken by people with Diabetes or those who are at risk of Diabetes to successfully manage the disease on their own.There are seven self-care behaviours that predict a good outcome in individuals with Diabetes. They are:Healthy eating habitsEating mostly home-cooked food with more vegetables, nuts, avoiding junk food and eating on time can help reduce blood sugar fluctuations.Physically adivityBesides being active, incorporating about 45 minutes of brisk walking every day will help burn more calories. Taking the stairs instead of the lift and parking the vehicle a little farther from the destination thereby forcing one to walk more steps can help to achieve a target of about 10,000 steps a day.Regular monitoring of blood sugar levelsBlood sugar levels must be monitored habitually to understand any highs and lows. Regular monitoring ensures that fluctuations are caught on time and medical help can be sought to correct them.Compliance with medicationsIt is important to take oral anti-diabetic medicines and administer insulin as prescribed by the doctor.Good problem-solving skillsMental health is of equal importance and should not be neglected. Psychological stressors such as stress and anxiety could worsen blood sugar control. Taking care of mental health effectively helps in keeping the blood sugar levels in the normal range. Seeking guidance and professional help is important to overcome stress and better manage health.Healthy coping skillsGood night sleep of about seven hours is very important in blood sugar management. This not only helps one tostay fresh and alert but also helps to have a productive day. Stress management plays a very important role in maintaining our health. As everyone knows circumstances in life may be beyond our control, however the way we react to any life event is completely in our control.Risk redudion behavioursQuitting smoking and tobacco use and reducing alcohol consumption is necessary to manage sugar levels.Studies have shown that significant predictors of adequate self-care management in people with Diabetes are:• Knowledge about Diabetes• Secondary school education• Diabetes of a longer durationAs per Gurmu et al., predictors of poor self-care behaviours are:• Male gender• Living in a rural area• Poor knowledge about Diabetes• Inadequate accessibility for self-testing blood sugars• Less than 6 years of Diabetes Diabetes self-management educationPeople with Diabetes, who were provided with Diabetes self-management education (DSME), have more likely to prevent the complications of Diabetes and delay the progression of the disease. Diabetesself-management education (DSME) includes imparting knowledge about the disease and its progression including the complications affecting the heart, eyes, kidneys, blood circulation and the nervous system. Any of these can be prevented or delayed by maintaining good sugar control along with healthy lifestyle behaviours.The American Diabetes Association had reviewed the standards of Diabetes medicalcare management and had found that people with Diabetes who have not received any formal education regarding self-care practices are at a four-fold increased risk ofdeveloping the associated complications of Diabetes. The DSME must be converted into action for good sugar control and a better quality of life. It is important to constantly work on improving self-care to have a healthier life.X and YReturning to the two case scenarios - Mr X was given the DSME and his medications were adjusted to help with better blood sugar control. He was asked to follow up in the clinic with self-monitored blood glucose (SMBG) readings in a week. Mrs Y's insulin was stopped as she was developing low sugar levels in the early mornings and her oral medications were adjusted. She was asked to follow up in a week with SMBG and a complete foot evaluation report (to assess for any Diabetes-related neuropathy). Dr Suganthi Kumaran is a Consulting Physician.
