What you need to know about diabetes

Dr Vaishali Deshmukh
Tuesday, 13 November 2018

Dr Vaishali Deshmukh busts some common myths and points out how greater awareness is needed to manage the disease

The theme for World Diabetes Day 2018 and 2019 is ‘The Family and Diabetes’. The aim is to raise awareness of the impact that diabetes has on the family and support network of those affected and also to promote the role of the family in the management, care, prevention and education of diabetes. 

That said, awareness of diabetes is poor, so patients and their families must talk to their doctors and endocrinologists to become better aware of the condition and understand how best to manage it. There are also authentic sources of information available on the internet such as the American Diabetes Association (ADA) website; the International Diabetes Federation (IDF) website and the Diabetes UK website.  

When someone in the family is diagnosed with diabetes, other members must rally round and support the patient in small and big ways. Ideally, the entire family should switch to a healthy diet and lifestyle so that the patient does not feel left out while the rest of the family appears to be indulging or enjoying themselves. The spouse, parent or guardian must do their best to ensure that the patient goes for regular check-ups to the endocrinologist; is taking their medication correctly and on time; and is monitoring their levels. 

There is a genetic predisposition to developing type 2 diabetes and hereditary forms of diabetes (MODY). If a parent has diabetes, there is 50 per cent chance that the children will develop diabetes at some time in the future. If both parents have diabetes, the likelihood goes up to 80 per cent. In such a scenario, family members should regularly be screened for diabetes. 

There are also many myths about diabetes and it’s time people were educated. 

MYTH: Eating more sugar causes diabetes
FACT: Calories matter more than sugar alone. For this reason, apart from the sugar intake, other important factors are: total carbohydrate and fat intake; the glycemic index of food items consumed, which indicates whether the food causes a rapid or slow rise in blood sugar; and the carbohydrate load of the meal. That said, consuming a lot of sugar and sugary drinks leads to a sudden rise in blood glucose and weight gain, and their intake must be restricted to prevent diabetes.

MYTH: iabetes occurs in old age
FACT: Diabetes can occur at any age. Neonatal diabetes is seen in newborns; type 1 diabetes (T1DM) can affect children; and type 2 diabetes (T2DM) can affect children, adults, the elderly and even pregnant women (gestational diabetes).

MYTH: f I am diagnosed with diabetes, I will inevitably develop kidney failure and require dialysis  
FACT: No, not all patients with diabetes develop kidney failure. Those who do not control their diabetes/ sugar levels well and have elevated blood pressure and cholesterol for more than 5 to 10 years are more likely to develop kidney disease. This is why early diagnosis and management of diabetes are so important.

MYTH: Diabetes can be cured with herbal treatment and fad diets
FACT: Any treatment that helps a patient lose weight and make healthy lifestyle choices can help control diabetes. Diabetes can only be controlled, not cured, though there are a few cases where early diagnosis of the condition followed by the right treatment have led to some patients being able to reverse their condition. In my clinical experience, however, once a person develops this condition, s/he can have a rise in blood glucose at any time and is therefore never fully ‘cured’. Nonetheless, with good control and the right support, patients can live a long and fulfilling life.

MYTH: nce on insulin, always on insulin
FACT: This is not true for everyone. Some patients require insulin for a short period to control their sugar levels in certain situations such as during surgery or an infection. Once the situation has been resolved, patients can often go back to controlling their sugar levels with oral medication alone. 

MYTH: iabetes is contagious
FACT: Diabetes is a ‘noncommunicable disease’ and cannot be transmitted from one person to another. It is the result of genetic and lifestyle factors such as obesity, lack of exercise and stress.

MYTH: f I am taking my diabetes medicines correctly, there is no likelihood of complications
FACT: If your medicines are not sufficient or effective to control blood sugar levels, you can still develop complications. For this reason, it is important to take your medicines correctly and monitor your sugar levels regularly, so you can check whether your diabetes is under control.

MYTH: f I eat less, my blood sugar level will be controlled 
FACT: Many factors apart from food intake determine blood sugar levels. So, if you eat less, but are stressed, not physically active or do not respond to the medicines, your sugar levels are likely to be high.

MYTH: eople who need insulin have serious or severe diabetes and have failed to control it with a healthy lifestyle 
FACT: Insulin may be needed if the body does not produce insulin, which is related to the disease type (T1DM or T2DM) rather than failure to live a healthy lifestyle. It does not necessarily mean that it is the last or a severe stage of disease.

MYTH: hough my sugar level is high, I do not seem to have any problems
FACT: Uncontrolled diabetes is a ‘silent killer’ which is why diabetes-related complications are usually seen later during the course of the disease. It is therefore important to control sugar levels from the time of diagnosis through one’s entire life.

MYTH: I have no complaints or obvious symptoms, so I cannot have diabetes 
FACT: Diabetes usually presents without any symptoms initially and may be diagnosed accidentally during routine check-up.

MYTH: A patient with diabetes only needs to keep blood sugar levels under control
FACT: Patients with diabetes need to control their blood pressure and cholesterol levels, in addition to blood sugar, to prevent complications.

MYTH: ome tablets and insulin leaves are a suitable alternative to injected insulin
FACT: Insulin is destroyed when it is taken orally and must therefore be taken as an injection. Oral insulin is still in the experimental stages.

(The writer is consultant and head of endocrinology at Deenanath Mangeshkar Hospital, Pune, and  Deshmukh Clinic & Research Centre, Pune, and consultant endocrinologist at Ruby Hall Clinic, Pune)

THE DOS 
- Accept that managing diabetes is teamwork and as much the family’s responsibility as it is the patient’s responsibility. 
- Help your relative keep tabs on what they eat, monitor blood sugar, take medication on time, exercise regularly and avoid getting too stressed.
- Show you care by encouraging and motivating the patient and being a patient listener if they need to share their concerns or apprehensions.

THE DON’TS
- Do not give orders or offend a patient if s/he does not adhere to the doctor’s advice, but motivate them instead. 
- Do not show excessive alarm or make a person feel conscious when they prick their fingers to test their blood sugar or take insulin shots.
- Do not share negative stories about other patients who may have had a bad experience because of diabetes-related complications.
- Do not become impatient when the patient is upset or distressed because of their condition. Instead, be supportive and encouraging.

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