The goal for managing an IDDM patient is to ensure a physically and mentally healthy, and a socially productive individual. A diabetic child or youth has a right to enjoy life as much as a non-diabetic child and to be as much physically and mentally competent as others. Socially, the diabetic and his/her family need to make adjustments to each other. The family should be supportive but not overprotective. However, there should not be any rejection.
Physical activity has important physiological and psychological benefits for all people. An exercise programme has a key role in the management of diabetes. It helps in utilisation of sugar by the body without additional requirement of insulin. Thus, it reduces the dose of insulin to be taken. Many patients report greater ease in maintaining glucose control when their lifestyle includes consistent and planned exercise. However, inappropriate exercises can be very hazardous. Attention must be paid to minimising potential exercise complications.
State of pregnancy imposes a special change in metabolism of the women, thus ensuring a continuous and steady supply of nutrients to the growing child even if the mother has irregular or deficient intake. It has a special significance for a diabetic woman.
The thought of illness itself causes a state of confusion and fear in the mind of the patient. When an otherwise healthy man suddenly comes to know from the clinical tests that he is diabetic, he gets a tremendous shock. At first he refuses to believe, it, for he experiences neither pain nor any physical abnormalities, and thereafter refuses to accept the disease. Considering himself a diabetic, he feels that his good days of life have come to an end and he has to be always at the mercy of the doctors and dietitians. He considers himself helpless, unproductive and a useless member of the society. Unrealistic and inapproprite feelings work on his mind and he approaches the doctor with innumerable questions.
Education is undoubtedly essential to achieve the high standards of self-management on which good diabetic control depends. Diabetes is a prevalent disorder and needs the involvement of the whole community for successful control measures. The community needs to be made aware of the existing problems and be sensitised to ensure participation, support and resource availability. Like other chronic diseases, diabetes is an expensive disease in terms of loss of income from abstinence and sickness, cost of transportation and medications; and to the community from the increasing burden of health care and rehabilitative facilities.
I have had diabetes for last 15 years. Unfortunately, I was in the habit of taking alcohol, and my job is such that I was unable to take regular morning exercises, weight was going up and up, tried various tablets, of course, under advice of doctors, but could not be regular with it. In between, I developed high blood pressure, took more pills and life became more miserable, till I met some doctor, who really clinched the point. How to overcome this careless attitude?
I am taking two tablets of Glizid 80 mg each, for the last one year and have maintained a reasonable good control of diabetes. I have learnt that there are some new tablets which are still better. How do we know which is the best tablet?
Q5. I have been taking Mixtard 20 u before breakfast and 12 u before dinner. One evening by mistake I took 20 u before dinner. What could be its danger?
Ans. It is a common mistake that you have taken more quantity of insulin or the wrong one like more short acting insulin (Plain or Actrapid), the danger is that you may land up in hypoglycemia. You cannot take it out once it is injected, nor is there any antidote for insulin. You have to watch for hypoglycemea if it is plain insulin, you have to be careful for the next 6-8 hours but if it is more lbng acting, the risk may last for upto 24 hours. One has to be under observation of family members or doctor, and keep on taking some sugar or sweet drinks in-between to avoid hypoglycemia. One may even require intravenous glucose drip if condition becomes serious. Sometimes children take excess insulin deliberately to cause panic and attract attention.
I have been prescribed tablets to control my diabetes. When should the tablets be taken, before or after the meals?
Ans. Sulphonylureas (Daonil, Diabenese, Glizid, Glynase, Amaryl, etc.) should be taken just before meals, whereas Biguanides (Glycomet, Obimet, Gluformin, etc.) should be taken after the meals. In practice, it is immaterial if biguanides are taken along with sulphonylureas just before the meals, unless it causes some gastric side effects. Fibre (Carbotard) or Acarbose (Glucobay) must be taken before meals, as it directly acts in prevention of absorption or digestion of food. Taking tablets before meals, at least ensures its compliance as there are less chances of forgetting it.
Mr A, age 40 years, has diabetes for the last three years. His blood sugar is not only high but quite fluctuating. Recently he found difficulty in reading or writing. He has changed his glasses thrice but none of these suit him.