The ravages of diabetes are due primarily to blood sugar levels that remain high for a long period of time, so it is important to diagnose the disease as early as possible, and keep the levels as near to normal as possible after that.
The ravages of diabetes are due primarily to blood sugar levels that remain high for a long period of time, so it is important to diagnose the disease as early as possible, and keep the levels as near to normal as possible after that. For people with T1DM this is entirely reliant on strictly managing diet, exercise and insulin to keep blood sugar levels from being too high or too low. Low blood sugar can cause a person to feel bad, have a seizure or pass out and fall or have some other accident.
Insulin may be managed with a pump (about the size of a deck of playing cards) worn continually, or by shots of insulin, multiple times each day with short-acting and long-acting insulin. The short acting insulin is usually given just prior to meals, and I tell patients to have their food in front of them before they take their insulin. Occasionally something will happen that prevents them from eating after they have taken their insulin, resulting in an episode of low blood sugar.
Of course T2DM can also be treated with insulin; it is very effective at controlling blood sugar, but it does so by driving glucose into the fat cells of the body, increasing the person’s weight and worsening their insulin resistance. The class of drugs known as sulfonylureas, such as glipizide and glyburide, are oral medications that work by increasing insulin levels and have the same drawbacks, including frequent episodes of low blood sugar. There are now many types of oral medications that can be used to treat T2DM that do not have these drawbacks. Metformin is the most important. It is cheap, does not cause low blood sugar, promotes weight loss and is the only drug that has been shown unequivocally to improve outcomes in T2DM. These are the things to look for in a T2DM drug: at a minimum it should not cause weight gain or low blood sugar, and preferably there should be evidence that people’s lives, not just their numbers, are improved by using the drug. It must also be affordable. In addition to controlling blood sugar, diabetics should also be especially vigilant to control their cholesterol, take medications – including aspirin – exactly as prescribed, and get regular eye exams as Dr. Robbins suggested in an earlier column in this space.
Finally, recall that there are millions of people in our country, and hundreds in our community who are suffering the ravages of uncontrolled, undiagnosed T2DM.
These people often believe that they are healthy, and the fact that they have not been to see a doctor in years is one of the pieces of evidence that they rely on to convince themselves and others that they are healthy. The best way to find these cases is for them to break with type and actually establish care with a PCP (primary care provider) just as was suggested in a previous column in this space, written by Michelle Aguilar, RN. However, this requires a change in behavior and people do not change their behavior without good cause. Therefore, the second best way to find these undiagnosed diabetics is to provide free and convenient screening tests. That is one reason why Lions International has added diabetes to their areas of focus, complementing ongoing efforts to combat hunger and blindness, with Strides: Lions for Diabetes Awareness, to provide direction and tools for screening.
The Health and Wellness Coalition of Runnels County is also taking an active role in education and is looking for partners with whom to conduct screening programs. When I was in private practice I would tell people who wanted to know if they were diabetic to eat a large meal of pancakes and syrup just before their next appointment and we would check their blood sugar. If that is normal then diabetes is excluded, but if not normal then they need further evaluation. The same goes for screening at a fair after funnel cake or cotton candy. As is shown by the examples already cited, community involvement is essential to improving the health of the community. For this reason, the next series of columns will focus on strengthening the ties of community in Runnels County.
This article is intended to provide general information only, and is not to be taken as medical advice. For advice about a particular case or situation, consult your own physician or other trusted health professional.
Bradly Bundrant, MD, MPH is the chief of staff of Ballinger Memorial Hospital. The Health and Wellness Coalition of Runnels County will meet March 8 in the conference room adjacent to Keel Drug to discuss emergency preparedness, planning and coordination in Runnels County.