DIABETES: HOW DO I MANAGE IT?

Diabetes mellitus (DM) is one of the severe metabolic disorders found in all types of people’s lives in lower, middle, and high-income countries it is characterized by elevated levels of blood glucose (hyperglycemia) resulting from either insufficient production of insulin by the pancreas or the body's inability to effectively use the insulin (hormone) produced. Insulin is a hormone significant for regulating blood sugar levels. Globally, more than half a billion people were living with diabetes in 2023, affecting men, women, and children of all ages in every country and that number is projected to be more double in the next 30 years, with every country seeing an increase. Diabetes is one of the leading causes of death and disability worldwide, regardless of age group, country, or sex. Moreover, 43% of those deaths happened before the individual reached 70 years of age.

        There are four different types of diabetes, including type 1, type 2, gestational, and specific types of diabetes. Type 1 and type 2 are the most common of the disorders and are diagnosed through well-established criteria where type 1 diabetes often develops during childhood, while type 2 diabetes has a strong genetic component and a robust association with obesity and a sedentary lifestyle. 

        The independent physical realities of type 2 diabetes occurring only in adults and type 1 diabetes only in children are no longer accurate, as both diseases occur in all age groups. Children with type 1 diabetes typically present with the hallmark symptoms of polyuria/polydipsia, and approximately one-third present with diabetic ketoacidosis (DKA). 

The onset of type 1 diabetes may be more variable in adults, and they may not present with the classic symptoms seen in children. Occasionally, patients with type 2 diabetes may present with DKA, particularly ethnic minorities.

DIABETES RISK FACTORS

You are at risk of having diabetes if you have prediabetes, are overweight, are 45 years or older, family history of diabetes, are physically active less than 3 times a week, or have ever had gestational diabetes (diabetes during pregnancy). Consult a healthcare professional for a proper diagnosis, management, and prevention.

HOW CAN I MANAGE MY DIABETES?

Understanding your diabetes ABCs will help you manage your blood glucose, blood pressure, and cholesterol.

A for the A1C test 

The HbA1C, hemoglobin A1C test shows your average blood glucose level over the past 3 months. The A1C test goal for many people with diabetes is below 7%. It varies among individuals.  

B for Blood pressure 

The blood pressure goal for most people with diabetes is below 140/90 mm Hg. The normal blood pressure is 120mmHg/80mmHg and a further increase of this results in various stages of hypertension. 

C for cholesterol 

You have two kinds of cholesterol in your blood: The bad cholesterol which can build up and clog your blood vessels and the good cholesterol helps remove the “bad” cholesterol from your blood vessels.

S for Stop smoking 

As a diabetes patient or not, smoking narrows the blood vessels. Quitting smoking cuts your risk of developing type 2 diabetes by 30- 40%. People with diabetes need to stop smoking because it makes the heart work harder which is very detrimental. E-cigarettes are not a safe option either. 

Not smoking does a lot of improvement to your overall health.  It can be difficult, nevertheless you need to stop. Ask for help so that you do not have to do it alone. Abstaining from smoking cigarettes:

1. Will lower the risk of heart attack, stroke, amputation, eye disease, and kidney disease.
2. May improve your blood pressure and cholesterol levels.
3. Your blood circulation will improve.
4. You may have an easier time being physically active.

Follow Your Diabetes Meal Plan 

Follow a healthy diabetes meal plan with the help of a Dietician or Nutritionist. Adhering to this meal plan will enable you to properly manage your blood glucose level, blood pressure, and cholesterol level. Choose fruits and vegetables, beans, whole grains, chicken or turkey without the skin, fish, lean meats, and nonfat or low-fat milk and cheese. Drink water instead of sugar-sweetened beverages. Choose foods that are lower in calories, saturated fat, trans fat, sugar, and salt.

Be Physically Active 

Set a goal to be more physically active. Try to engage in 30 minutes or more physical activity on most days of the week. Brisk walking and jogging are good ways to move.

Take Your Medication 

Take your medicines for diabetes and any other health problems, even when you feel good or have reached your blood glucose, blood pressure, and cholesterol goals. These medicines help you manage your ABCs. Speak to your healthcare professional if you have further challenges.

Check Your Blood glucose level 

Checking and recording your blood glucose level each day is an important way to manage diabetes. Monitoring your blood glucose level is most important if you take insulin. The results of blood glucose monitoring can help you make decisions about food, physical activity, and medicines.

What is Continuous Glucose Monitoring?

A continuous glucose monitoring system use a tiny sensor that you insert under your skin. This CGM is mostly useful for people who use insulin and have problems with low blood glucose.

What should be my target blood glucose level?

Before a meal: 80 mg/dl - 130mg/dl

About 2 hours after a meal starts: less than 180mg/dl. 

Be sure to inform your healthcare team if your blood glucose level often goes above or below your target range.

What happens if I have a very low blood glucose level?

When blood glucose drops below where it should be it is known as hypoglycemia. For people with diabetes, a blood glucose level is too low if it is below 70mg/dl. This condition can be life-threatening and needs to be treated right away. Symptoms of low blood glucose tend to come on quickly and can vary from person to person and range from mild to severe. As part of severe symptoms of hypoglycemia, your brain may stop working as it should. You may lose consciousness and, have a seizure. For mild symptoms, you may feel tired, hungry, shaky, your heart beating fast, dizzy, and have a headache. If your meter shows that your blood sugar is below 70mg/dl, do one of the following to improve your glucose level at that moment and make sure to consult your health care professional for proper follow-up:

1. Drink 4 ounces of fruit juices 
2. Chew 4 glucose tablets 
3. Drink 4 ounces of regular soda, not diet soda, or 
4. Chew 4  pieces of hard candy 

After doing one of the above wait 15 minutes, and check your blood sugar using a glucose meter.

If it's still below 70 mg/dL, have another portion of fruit juice or 4 pieces of candy, and repeat until your blood sugar is at least 70 mg/dL.

What happens if I have an elevated blood glucose level?

High blood glucose level is known as hyperglycemia. Symptoms that your blood glucose levels may be too high include: 

1. Feeling tired 
2. Feeling thirsty 
3. Headaches 
4. Urinating often 
5. Blurred vision 

If you often have high blood glucose levels or symptoms of high blood glucose, talk with your health care professional. You may need a change in any of the diabetes management plans.

How do I Cope with diabetes in healthy ways?

Finally, coping with your diabetes in healthy ways will help you live a healthier life free of complications. Feeling stressed, sad, or angry is common when you live with diabetes. Stress can raise your blood glucose levels, but you can learn ways to lower your stress. Try deep breathing, gardening, taking a walk, doing yoga, meditating, doing a hobby, or listening to your favorite music. Consider taking part in a diabetes education program or support group that teaches you techniques for managing stress. Try to get 7 to 8 hours of sleep each night. Getting enough sleep can help improve your mood and energy level.  Depression can get in the way of managing diabetes. Ask for help if you feel down. 

Remember, managing diabetes isn’t easy, but it’s worth it.

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Reference 

https://www.tandfonline.com/doi/full/10.1080/21691401.2019.1652625

https://medlineplus.gov/ency/article/000320.htm 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2643014/#R15

https://www.healthdata.org/news-events/newsroom/news-releases/global-diabetes-cases-soar-529-million-13-billion-2050#:~:text=

https://diabetesjournals.org/care/article/45/Supplement_1/S17/138925/2-Classification-and-Diagnosis-of-Diabetes 

https://www.cdc.gov/diabetes/prevent-type-2/index.html