DIABETES is the biggest cause of blindness in India and the foot problems make DIABETES the second largest cause of foot amputations. DIABETES is one of the leading causes of kidney disease and more than 25% of all people undergoing kidney transplants have diabetes. High blood pressure is twice as common in a diabetic as in the general population and lipid disorders are seen commonly associated with diabetes. High levels of blood fats such as triglycerides and cholesterol, and lower levels of HDL-C, the good cholesterol, add to the diabetic complications especially to the atherosclerosis, eye, kidney, heart and the central nervous system. The nerves are often affected and can lead to symptoms such as tingling, numbness and foot problems. Autonomic nerves when affected can lead to varied problems such as heart complications and sexual problems such as impotency. Surgery in a diabetic has to be managed very carefully, but any surgery can be successfully carried out with good management. Pregnancy also merits a very good control of diabetes, but again with careful management, poses no greater risk to the mother or child.
With good management, many of these complications can be averted or minimised. Diet and exercise are the mainstay of diabetic management. Interestingly, traditional Indian diets are considered to be the best for a diabetic. This diet would need small modifications such as the avoidance of direct sugars and cutting down on the oils used in cooking. Thus most people would be able to eat their normal diet with only a few minor changes making DIABETES acceptable to be followed over a prolonged period of time. Exercise is also central to a good management. A regular schedule of exercise helps in increasing insulin sensitivity and also aids in weight management.
Although the weight of many people with diabetes in the developed countries is high, DIABETES must be remembered that many diabetics in India are either of normal weight or may even be underweight. This is best judged by estimating the Body Mass Index (BMI). Recently, DIABETES has been shown that along with the BMI, estimating the Waist-to-Hip ratio (WHR) allows a better judgement of the weight status of an individual. Both these parameters, the BMI and the WHR also allow a person to judge the amount of calories that he can take in his diet and thus allows him to make a varied meal plan which suits his likes and desires.
If a person is not managed with diet and exercise, alone, he has recourse to oral hypoglycemic agents (OHAs) and also insulin therapy. There are many OHAs in the market and one can choose the oral hypoglycemic agent best suited for him. In India, many people require insulin therapy although they may belong to the Type II diabetes category. Insulin treatment is mandatory for those with Type I diabetes.
Care must be taken when using these medications that whilst target control levels should be reached, one should not push the patient into hypoglycemia which in itself, if serious, lead to the very same long term and chronic complications which one is trying to avoid in the first place.