For well over a generation, the management of diabetes-focused, primarily on bringing blood sugar levels within the normal range to prevent a huge list of complications like blindness, kidney disease and amputations.
The fasting sugar should be about 6mm and less than 11 after a meal.
It was presumed that getting the sugar well-controlled will to prevent major complications like heart attacks and strokes.
Patients with diabetes run twice the risk of getting a stroke or heart attack compared to people without diabetes. This risk is increased considerably when people with diabetes are over-weight, smoke, do not have a proper eating plan, consume large amounts of alcohol and lead a very sedentary lifestyle.
Another factor, rarely ever mentioned by endocrinologists is the role of stress in the management of diabetes.
I have discovered from clients, when they are under a great deal of stress their sugar rises significantly and so does their blood pressure.
If stress is not addressed or taken into account, patients might end up using increasing amounts of anti-diabetic medications, like increasing the dose of insulin.
The problem is when the stress settles, the sugar levels can drop significantly with the higher dose of insulin and lead to a life-threatening coma.
It is important for people with diabetes to check their own blood sugar levels regularly.
My youngest patient, who presented with a right-sided stroke was a young 30 year female on insulin. Her blood sugar levels fluctuate quite a lot, even though her diet was consistent.
We finally managed to control her blood sugar. One night she discovered that someone tampered with her laptop. She got quite upset and this pushed her blood sugar levels into the 30s. Shortly after that, she developed weakness on the entire right side of the body.
This was devastating news for her when she came in for an assessment.
I am pleased that the emphasis on managing diabetes now is to prevent cardiovascular diseases, like heart attacks, strokes and kidney disease. The drugs we have used in the past, including insulin are just not enough.
There are a number of new drugs on the market with overwhelming evidence that they can prevent these complications significantly. Unfortunately, they are quite pricy and many medical aids do not cover them.
The funders are penny wise and pound foolish. To prevent one fatal heart attack, with these newer medications for life, will cost far less than to treat one heart attack in ICU for a week.
Not only will they prevent heart attacks and strokes they can prevent severe kidney disease.
The indirect cost saving of these newer drugs is it will prevent people in the prime of their life from being boarded and relying on the state to provide for them and their families.
In Australia and Europe, these newer agents, SLGT2 Inhibitors and GLP1 analogues are used as part of first-line treatment in diabetes, because they are aware of the cost savings to the country when cardiovascular events are prevented.
Clearly, the shift is from treating sugar levels alone to preventing strokes and heart attacks by using the newer drugs available for over ten years.
I feel these drugs should be made essential drugs on medical aid and the prices should be made more affordable.
With so many companies competing for the market share of the new drugs, the prices will have to come down.
The take-home message for people with diabetes is, low carb diets, regular exercise, quit smoking and drinking, and very importantly, deal with stress if we wish to prevent strokes, heart attacks, blindness, amputations and kidney diseases.
Opinion Editorial for Voices360 by EV Rapiti.
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