November 18, 2016

Diabetes: What the Docs Ordered

SUGAR, STAY SWEET Keeping your blood sugar levels within a specific 
range when diagnosed with diabetes can be challenging indeed.

Here, four doctors share their prescriptions with Saliha Nasline. The bottomline 
is discipline in diet, exercise and regular monitoring

Dr V Mohan, Chairman, Dr Mohan's Diabetes Specialities Centre, Chennai
The late Ravi Baskaran, one of our oldest patients, who was diagnosed to have 
diabetes in his teenage. He was started on insulin injections several times 
a day which he meticulously took all his life. He maintained good control of 
diabetes in the initial years by painstakingly checking his urine sugar by the 
good old Benedict solution method. After several years, he had moved to blood 
glucose testing using a glucometer. All his life, he maintained very good health 
and did not develop any of the diabetes-related complications. He led an active 
life in the corporate world as he was a management consultant. He was an ardent 
cricketer and had played league cricket at the same level. After over 62 years 
of active diabetic life, Ravi finally died at the age of 76 years, not due to diabetes
but due to some other disease. Ravi is actually a role model of how one can have 
a long and healthy life despite diabetes.

MANAGING DIABETES
We have had many cases of children developing diabetes when they are one or 
two years old. But they have grown up to excel in their professions, get married, 
have children and are still alive after 60 or 70 years of diabetes. All these patients 
have followed a strict discipline by maintaining their exercise schedule, taking 
their medicines or their insulin regularly and visiting the diabetes centre for regular 
check-up and advice.

TREATMENT
The treatment style for a patient diagnosed with diabetes for the first time will 
depend on the type of diabetes. In the case of type 2 diabetes, which constitutes 
90-95% of all patients with diabetes, diabetes can be managed by diet, exercise 
and tablets. In the case of insulin dependent, type 1 diabetes, insulin injections 
would be needed several times a day and in the case of certain other forms of diabetes, 
based on the specific type of diabetes, there could be some variation in the treatment 
given. However, in all cases, discipline is very important to maintaining a strict diet 
schedule, regular exercise, medication and self-monitoring.

Dr Srinivasa P Munigoti, Consultant Diabetologist & Endocrinologist, Fortis Hospital,
Bengaluru

37-year-old Sudeep (name changed) is banking professional from Gujarat. He was
unaware of his condition and could not understand the reason for his excessive 
thirst and increased urination. After check up, he came to realise that he had type 2 
diabetes with high levels of sugar. Even though his family had no history of the 
condition, his weight of over 100 kg added to his problem. He was on strict 
diet to control his diabetes and he had to maintain a healthy intake of 1,200-1,400 
calories on a daily basis coupled with physical exercise. He was able to run close to 
35 km per week. With regular exercise and diet routine, Sudeep has fought the 
disease and is off medications for diabetes today . As an end result, he has not only
taken control of his sugar levels but has also lost 20 kg. He has even participated in
marathons. An early diagnosis, a change in his erratic lifestyle and healthy eating 
helped this young professional re gain control on his life.

MANAGING DIABETES
Diabetes can be managed well by adopting the right lifestyle changes and following 
medical advice that may include various medications, regular tests and follow-up 
with doctors.

TREATMENT
A good diabetes treatment always involves diet, lifestyle modifications and right 
medication. There are plenty of good guidelines from a number of medical 
associations, including some Indian associations which are useful. Individual 
treatment for patients is always specifically tailored to their needs after studying 
their medical background.

Dr Anupama N, Consultant-Preventive Medicine, Dept of Preventive Medicine, 
Sakra World Hospital, Bengaluru

A 52-year-old patient came for a health checkup; she was a known diabetic for four 
years and was on two types of medicines. Her sugar levels were uncontrolled. She was 
also on some medicines for high BP and cholesterol; she was very upset with her 
results and did not want to take anymore new medicines. On talking to her about the 
need to control her sugar levels she admitted that she was not very strict with her 
diet and was not compliant with her medications. After counselling, she was happy 
and motivated to follow the diet chart suggested to her. After six months, it was good 
to see that lady had dropped 7 kg of weight and her sugars were very well 
controlled. She acknowledged that good diet and regular exercise helped her achieve 
her target.

TREATMENT
Treatment of diabetes is a holistic approach, a lot of factors need to be kept in mind. 
A patient has to be assessed based on his lifestyle, socioeconomic background, support 
system, age, etc. However, on the whole, a patient should be educated about what 
diabetes  is, its complications and what measures are to be taken for it. It has to be well 
explained  that it is not a curable disease but only one that can be controlled with diet, 
exercise  and compliance with medicines. Another key factor is identification and 
management of stress.

MANAGEMENT
It is a game of will power for the control of sugars through diet and exercise. A lot of 
them go on very strict diet and exercise when they are diagnosed with high sugars, and 
after some time, they give up on it. Hence it is necessary to understand that it requires a 
great effort, which has to be sustained in the long run. Those who manage to do regular 
exercise and healthy diet bring down their sugars well.

Many a time, when patients come to know about their sugar levels for the first time, 
they are in the state of shock or denial. It is very important to know what to tell the 
patient and how much of information they can take in such a state of mind. The 
treatment, whether it has to be on only lifestyle or medicines depends on the severity 
of the diabetes.

Dr Ankush Gupta, Consultant General Medicine, Docs App
The son of a 60-year-old patient asked about his father's diabetes for second opinion 
on Docs App. One month back he was all normal and suddenly sugar levels were high 
in the recent test. We asked all the details about the patient, understood present 
medication,  types of insulin and quantity of insulin, saw the prescriptions and other 
reports, which  were uploaded on the website.

A doctor suggested some course of medicine, lifestyle changes and diet changes 
and asked the patient to get the test done again after five days. Later, the doctor changed 
the levels of insulin, according to the blood sugar values regularly for two months, 
monitoring his lifestyle changes as well. After two months, the patient's blood sugar 
became normal, he is still continuing the medication without any insulin injection.

He is able to maintain the sugar level, with proper diet and lifestyle changes suggested 
by the doctor.

TREATMENT
There are two types of diabetes mellitus. Type 1 is insulin dependent because 
of absolute  lack of insulin. Type 2 usually occurs in people who are over 40 and 
overweight. There is  no lack of insulin but peripheral cells are resistant to insulin. 
Dietary restriction, exercise  and controlling insulin levels are the cornerstones of the 
management of type 1 diabetes. Weight reduction, dietary restrictions, and exercise 
are also proven ways to increase  insulin sensitivity in type 2 diabetes. If optimal 
control of blood glucose levels is not  achieved with weight reduction programme, 
drug therapy is started.

Diabetes is a lifestyle disease which occurs due to sedentary lifestyle and bad 
dietary habits. So lifestyle changes form an important part of treatment of diabetes. 
Avoiding oily, fried foods, food with high glycemic index (sugar, sweets) and taking 
small regular meals at regular intervals is important. Daily 30 minutes of brisk walking 
five days a week is important to reduce weight.

Drug therapy is started mostly after three months of lifestyle management, if optimal 
control of blood glucose is not achieved. Regular follow-up with at least one follow-up 
for three months is needed to check the blood sugar levels and modify medication 
accordingly.

MANAGEMENT
Regular follow-up is very important. Blood sugar level goes up and down depending 
on the patient's weight gain or loss, dietary changes and sensitivity to medicines. 
Normally,  follow up is done after three months to check if medicines are working and 
whether the  patient is following the suggested lifestyle changes or not.

The dose of the medicine can be increased or decreased depending upon the blood sugar 
level or the medicine can be changed if it is associated with side effects or optimal sugar 
level is not achieved. In essence, maintaining lifestyle changes, weight reduction, 
dietary  changes, taking medicines at regular intervals as prescribed and keeping a 
regular follow-up schedule with the doctor will keep the sugar levels and diabetes in 
control.

Source: The Economic Times

1 comment:

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