TC is a 59-year old man with a 10-year history of diabetes mellitus. He has been fairly regular with his medications. He noticed recently a sore on his right heel. He could not remember sustaining injury to his foot. He had never paid attention to his feet. He consulted his physician who counseled him on other measures in the management of diabetes mellitus in addition to use of medications. “Everything has to be done right,” the physician said.
Central to the management of diabetes mellitus are several lifestyle modifications that need to be adhered to. Many individuals use their medications accordingly, yet the blood sugar remains poorly controlled. Some may even have complications of diabetes mellitus despite their use of medications. A comprehensive approach to the management of diabetes mellitus reduces associated diseases and death. The following are a few additional measures which help maintain quality of health among diabetic persons who use their medications.
1. Weight control: Very important in the management of diabetes, especially type 2 diabetes mellitus, is weight management. Weight loss by itself significantly reduces the requirements of antidiabetic medications – insulin and oral medications. In some cases, diabetes has been managed solely by simple weight loss. The major link to losing weight lies in reducing intake and increasing exercise.
2. Blood pressure control: Hypertension is a well-known ‘twin’ of diabetes and they tend to go hand in hand. Any diabetic person who also has hypertension should ensure that their blood pressure is well controlled. This can be achieved through use of antihypertensive medications, reduction in salt intake, and other measures. It is important to note that major organ damage from diabetes can be exaggerated by hypertension.
4. Foot examination: Due to the poor sensation in the feet that some diabetics experience, it is important that they do a regular examination of their feet to pick up small ulcers or infections which could be managed quite early. Poorly managed leg ulcers could result in amputation of the affected leg. In advanced stages, it could be life threatening. Proper and comfortable foot wear must be worn at all times.
5. Diet: It is wrong to suggest that staple meals cannot be eaten by a diabetic person. However, refined sugars, junk food, and processed carbohydrates have a high tendency to quickly increase the blood sugar. These refined food items can make the control of blood sugars difficult irrespective of the medications used.
6. Regular health check: This involves eye check to look at the blood vessels and ensure adequate vision, urinalysis to detect presence of protein in urine which could be an indicator of kidney injury and the need for more aggressive treatment. Also a special blood test that shows adequacy of sugar control can be done every 3 months during follow up.
7. Exercise is very important. In addition to its role in weight loss, it also helps control diabetes and cardiovascular health as well.
8. Self-monitoring of blood sugar is central to the management of diabetes and every diabetic needs to understand how to use a glucometer to check the blood sugar at home. An appointment to see the doctor should be made if the control of the blood sugar becomes erratic.
Dr Femi Afolayan obtained his medical degree at the University of Ilorin, Nigeria. He had a stint in internal medicine residency programme at Abubakar Tafawa Balewa University Teaching Hospital, Bauchi state and later National Hospital, Abuja before he relocated to Australia and started out in emergency medicine training as a registrar for 2 years and later a fellowship program in internal medicine about 3 years ago. He is currently a senior registrar in acute care and intensive medicine, general medicine, and geriatrics. He is also an honorary lecturer with the medical school, Deakin University, Geelong, Australia. He enjoys teaching, cooking and playing video games. He can be reached on firstname.lastname@example.org.