Written by Dr Harold Gunatillake – FRCS,FIACS,FICS, AM (Sing), MB,BS
Diabetes is a condition where the glucose absorbed in the gut through the digestion of carbs, seem to remain in the blood stream, as the hormone insulin responsible for the control of glucose is impaired from the Islet cells of the pancreas resulting in abnormal metabolism of carbs and elevated levels of glucose in the blood.
When you have diabetes, your blood glucose levels tend to be consistently high unless properly controlled with medication, diet and exercise. Overtime, such increasedlevels of blood sugar damage your body and lead to many other problems.
Normally, your blood sugar should be maintained fasting for 8 hours to an average level of about 100mg/dl. When it reaches the upper limit of 126 mg/dl you get into the stage of ‘Pre-diabetes”, a stage you could reverse to normal situation with diet alone. After eating a non-diabetic will reach a level of 140mg /dl and diabetics should aim to keep the blood sugar level at about the same level.
Glucose is a precious fuel like petrol in the case of a vehicle. When the blood sugar is not conveyed to the tissues and the liver for further storage and metabolic activities and remain in the blood can cause changes that lead to a hardening of the blood vessels and the doctors describes it as “atherosclerosis”.
Such changes in the blood vessels deprive sufficient oxygenated blood flow to the organs and various tissues in your body. Your kidneys could be affected leading to failure. If your sugar is not controlled the kidneys go into a stage of ‘end stage kidney failure’ requiring dialysis.
When you have diabetes you need to control your blood sugar levels to reach normal range. If neglected, as most do, the kidney functions start failing and the doctors label the organs as ‘Diabetic kidneys’
Those diabetics who read this article must check their kidney functions through a blood test and urine examination, every six months and take measures to control it. The serum creatinine level is important as this poisonous chemical seem to accumulate in your blood. Another important measure is the eGFR. It stands for estimated glomerular filtration rate. It is a number based on your blood test for creatinine, a waste product in your blood. This result gives how well your kidneys are working. It is considered as the best test to measure your level of kidney function and determine your stage of kidney disease.
According to the National Kidney Foundation, normal results range from 90 to 120 mL/min. older people will have lower than normal eGFR levels, because it decreases with age.
Through not proper disciplined care and lack of education on diabetes your kidneys will start to deteriorate. One consolation is that you don’t have to worry if the values have dropped even to about 40 mL/mn. With disciplined diabetic regime one could maintain your eGFR at a lower rate provided it is consistent every time you measure. The figure should drop to less than 15 mL/min for you to be qualified for dialysis. With proper control, as I said, you don’t have to worry about ending in dialysis because it takes many years for the eGFR to drop if your blood glucose is well controlled.
With diabetic kidneys protein seem to leak from your blood to the urine due to inflammation of the blood vessels in your kidneys. Early stages your reading will say,”microalbinurea” When it reaches the value of 30 you get into a serious situation where more protein is leaked out and the doctors call it’macro-albinurea.
By tightly controlling your blood sugar the protein loss can be stabilized.
Other complications of neglected diabetes are:
Stroke, Heart attacks, Vision loss or blindness, weakened immune system, with greater risk of infections, erectly dysfunction, and Nerve damage called neuropathy in the extremities. In this situation due to degeneration of the outer sheath of the major nerves (demyelination) you could get tingling, pain, loss of sensation in your extremities, and that situation the condition is irreversible and it is your fault for not controlling your blood sugar. Ultimately, you get totally paralyzed and become bed-ridden. For goodness sake, do not get into this situation; you need to control your blood sugar from the time it is diagnosed.
Poor circulation to the extremities due to thickening of the major and minor arteries. In this situation if the blood sugar is not controlled you end up by losing a limb or two.
To avoid these complications, please attempt to keep your blood glucose levels as near normal as possible. The American Diabetic Association’s goal for blood sugar control in people with diabetes is 70 to 130mg /dl before meals and less than 180 mg/dl after meals.
Check your three monthly memory test by getting a test called Hb1Ac. This is a form of hemoglobin in the red cells that gets bound to the serum glucose through a process of ‘glycation’.
In a healthy person, the Hb1Ac level is less than 6% of total hemoglobin. A level of 6-7% signals that diabetes is present. For diabetics the level should be kept below 7%. It is difficult for a diabetic to achieve non-diabetic level of less than 6% because of the fear of going into hypoglycemia. So, keep the average Hb1Ac below 7 %
This would be the best test to assess your diabetic control. You need to get this test in a laboratory at least once in six months.
Controlling diabetes is easy. You are the captain of the ship and the control is in your hands, and the doctors can only advice. The moment you leave the doctor’s surgery, he has forgotten you, and you must take over the control. In a home situation, when other members are non-diabetics you tend to follow their lifestyles neglecting your diabetic discipline.
Please take this advice and control your diabetes, with medication your doctor prescribes, low carb diet, and most of daily exercise and keeping your mind in a relaxed state. You need to check your blood glucose level daily until it is well controlled and you may relax the monitoring when you could assess your situation through education and the sixth sense you develop.
I would say it is the best disease to have, if you are compelled to choose one, because you are in full control of the condition.