Mrs M, the 36 year old Bangladeshi diabetic lady, smiled sweetly at me and said that she had not been very good at taking her tablets this month or indeed looking after her diet. In fact she had been to a lunch party with her friends and sweets and samosas were on the menu. What did it matter? All her friends were diabetic and they did not seem to care. At the end of the day, Mrs M told me, it was all down to Allah. She'd take the pills but was far too busy to do this 'lifestyle stuff' or come in for regular check ups for her feet, blood pressure, eyes or blood tests. She then proceeded to tell me how her eyesight was getting worse, she was numb in several of her toes and she was getting this strange tightness across her chest when walking
the commonest reason for diabetics dying prematurely is through heart attacks
You may recall that last month we looked at diagnosing Diabetes Mellitus, the two forms and that the commonest is Type 2 Diabetes which is strongly linked to obesity. We also touched on the treatment of Diabetes. This month I want to discuss why the optimal treatment and monitoring of Diabetics is so important.
Mrs M was actually rather foolhardy. Diabetes kills, but as is characteristic of a number of chronic conditions, more often maims and kills very slowly over a long period of time. Essentially diabetes leads to a high blood sugar; the presence of high sugar in the blood stream results in damage to a number of organs. I will elaborate on a few of these.
Diabetes is most strongly linked with hardening and blockages of the arteries or atherosclerosis. In fact the commonest reason for diabetics dying prematurely is through heart attacks. Other effects on the arteries can lead to a blockage of the blood supply to the limbs (causing the loss of a limb), kidneys (causing kidney failure), neck (causing strokes) amongst others. Because diabetes is one of several risk factors, for these blockages, it makes sense that a lot of effort goes into both controlling the diabetes AND the other factors. This involves keeping a close eye on and if necessary treating high blood pressure and/or high cholesterol. It is critically important for smokers who are diabetic to stop smoking immediately. Please remember that the treatment of cholesterol and blood pressure both involve getting more exercise and eating healthily as well as possibly medication. The only risk factor for atherosclerosis that is not controllable is a family history. However, although we are unable to pick our parents we are able to work harder to compensate in other areas.
It is exceptionally important for Diabetics to have at least an annual eye test. Diabetes is currently the commonest cause of being registered blind in the UK and can attack the lens at the front of the eye causing a cataract that `mists up' the eye. In addition, Diabetes attacks the back of the eye and affects the nerves. A good diabetic eye check should always include, the optician placing drops into the eye to gain an adequate view of the back of the eye. The tragedy is that Diabetic eye disease is treatable and preventable through early identification and treatment. Check with your GP or Diabetic Clinic as to which opticians are trained to do Diabetic eye checks: not all are, so check.
Diabetes affects the nerves, and can damage them. In the feet especially this can lead to a loss of sensation and damage as the feet cannot register pain anymore. The result is foot ulcers and tragically, combined with the poor circulation of atherosclerosis even gangrene. I urged Mrs M to see the chiropodist and choose her shoes very carefully for fit.
Finally, Diabetes unfortunately is now the commonest reason to suffer from kidney failure and be on a dialysis machine. Regular review of kidney function again leads to early identification of problems which can lead to effective treatment.
Lots of horrible things can happen to Diabetics, if they do not look after themselves. Most of these are preventable and treatable by regular check ups with various health professionals including your GP, optician , chiropodist and diabetic nurse and acting appropriately upon the results of tests and check ups. All too often people are very happy to be endlessly investigated but then don't act upon adverse results. It goes without saying that it is very important to make long term changes in the way we all live and I will discuss the most important part of diabetes management, changing lifestyle, next month.
Please remember to visit, read and join the website www.diabetes.org.uk