Subramanian was diagnosed with type 2 diabetes at the age of 35 during a routine examination. He understood the importance of lifestyle modification. He consulted his doctor regularly and also underwent periodic routine investigations. He adhered to the recommended diet. He was told that, for optimal control of blood sugar and blood lipids, he should avoid simple sugars, sweets and excess fatty food. He made it a routine to walk everyday for 30 minutes and maintained correct body weight. During his hospital visits, he performed HbA1c test (an overall estimate of blood sugar for the last three months), cholesterol (once in six months) and also got his eyes, feet, kidneys and heart checked every year. Above all, he strictly complied with the medicines prescribed by his diabetologist. This lawyer is now 75 years old, a proud grandfather who had a successful, happy life, despite diabetes. This is the good face of diabetes.
Result of neglect
Ramasamy was diagnosed with diabetes at the age of 30. He was a self-made man, running a successful textile business. Despite being told about the importance of regular monitoring and screening for complications, Ramasamy's priority was his business and he had no time for his regular walks or visits to the doctor. At the age of 45, Ramasamy was rushed into the hospital with an acute heart attack and underwent bypass surgery. Eventually, due to his prolonged illness, his business started to suffer. He developed kidney disease and became partially blind because of diabetic retinopathy. Now he is undergoing dialysis, his expenditure on medicines is Rs. 25-30,000 a month. He had to sell his shops and his bungalow. This is a real story of a man who had to give up all his assets to meet the bills of his chronic disease and its complications; an example of diabetes neglected. This could have changed if he had been careful and taken appropriate care. This is the bad face of diabetes.
Suresh, a 28-year-old IT professional, accompanied his diabetic mother for her check up. During her consultation, the doctor noticed that Suresh was overweight. When asked if he had ever checked his blood sugar, he said that he was too young. Advised to undergo a Glucose Tolerance Test (GTT) for screening, he was found to have Impaired Glucose Tolerance (IGT or early/borderline diabetes). Suresh was told that he had an opportunity to delay or even prevent the onset of diabetes without any medication by just following a diet and exercise regimen. During his next visit six months later, Suresh was unrecognisable. He had lost eight kg; his blood sugar on testing was normal and has remained so for three years now. This is the bright side of diabetes.
High risk
Diabetes has been termed a “silent killer” because many people remain asymptomatic and tend to neglect the problem until they develop life-threatening complications. People with diabetes are also at high risk for high cholesterol, hypertension, obesity and other cardiovascular risk factors. The latest guidelines say it is not enough to target blood glucose alone. Cholesterol and BP also need to be at normal levels to reduce cardiovascular risk. But high risk people can be identified and primary prevention is the ideal option.
Targets
Hba1c: <7 per cent
BP: below 130/80 mmHg
LDL cholesterol <100 mg/dl
HDL cholesterol > 40 mg/dl
Substantial reductions
Up to 76 per cent reduction in risk of developing eye disease
Up to 50 per cent reduction in risk of developing kidney disease
Up to 60 per cent reduction in risk of developing nerve disease
More than 33 per cent reduction in strokes
Up to 33 percent reduction in death from long-term complications
The writer is a Chennai-based diabetologist. Website: www.ardiabetes.org
