Treatment of diabetes focuses on keeping blood sugar in normal range, because that is the most important derangement in body metabolism that diabetes causes. But there is much more to treatment of diabetes, find out below

It is a disease of deranged metabolism which lead to significantly higher risk of  CVD (CardioVascular Diseases), which can lead to complications such as heart attack, stroke etc. People with diabetes also have metabolic syndrome mostly, higher than normal blood pressure, cholesterol and body weight

Therefore good management of diabetes should focus on not only blood sugar control but timely detection of complications and management of common co-existing health problems

ABC of in diabetes treatment

The most significant control targets of diabetes are summarized as the ‘ABC’ of diabetes:

A:  HbA1c levels indicating control of blood sugar

B:  Blood pressure

C:  Blood cholesterol levels

However, even this list is incomplete as it does not take into account detection and  monitoring for complications of diabetes and factors such as vaccination etc.

The table below summarizes all parameters for overall good control of diabetes, beyond control of blood sugar levels

Tests and targets for control of risk factors in a person with diabetes
 Test Which level indicates

Optimum control

Which level indicates

Good control

When/how often should this test be done
HbA1c lab test <6.5% for  most people, especially those diagnosed at younger age and in initial years of disease <7%,

  • In people with long standing disease
  • In those with other health conditions
  • In those who get frequent episodes of hypoglycemia on targeting greater control
1. At diagnosis

2. In follow up:

  • If target level achieved: once in six months
  • if not: once in three months
Blood sugar Fasting/pre-meals : <110 mg/dL

Post Prandial/PP <140 at two hours after meal and <180 at 1-2 hour from beginning of the meal

Fasting/pre-meals : 80-130

PP: < 160 at two hours

Diagnosis:

Laboratory testing of fasting and PP blood levels

For follow up:

SMBG monitoring should be done regularly, check

SMBG

for details

Your doctor may suggest the lab tests to adjust treatment if HbA1c rises beyond target level

Blood pressure < 130/85 < 140/90
  • If target level achieved: at least  once in six months,
  • If not: more frequently, as per doctors advice
Blood lipid levels
Target for good control Frequency of monitoring
LDL cholesterol LDL targets depend on yourheart risk level

If risk is high,  target for LDL cholesterol levels is <70 mg/dL

Even if risk is low or moderate, LDL target less <100 mg/dL should be considered

Drug therapy with statins should be considered, if you are more than 40 years of age, discuss with your doctor

  • If target level achieved: once in six months or a year
  • If not: every three months
HDL cholesterol > 50 in women and >40 in men, diet and life-style have at a great impact on this
Triglycerides <150 mg/dL, diet and life-style have at a great impact on this
Weight Lose at least 5-10% of body weight, if you are overweight If you are in normal weight range, once in a month

If you are overweight/obese and trying to lose weight, at least once in a week or ideally everyday

Smoking Quit smoking As soon as possible !
Screening for microvascular complications
  1. Screening for diabetic nephropathy(kidney disease):

Serum Creatinine with eGFR

Test for microalbuminuria/ Urine Albumin Creatinine Ratio

  •  eGFR: >90 ml/mim/1.73m^2 body surface area
  • Microalbuminuria(UACR): <30 mg/gram
  • At diagnosis and yearly thereafter, till no derangement of levels
  • Thereafter, as directed by your doctor
  1. Eye check-up for diabetic retinopathy
Comprehensive eye check-up including dilating the eye and examination of retina by eye specialist should be done
  • Test at diagnosis, if no retinopathy; two yearly thereafter
  • If retinopathy present : at least annually or more often if directed by the doctor
  1. Screening for diabetic neuropathy:especially diabetic foot
  1. Peripheral neuropathy: complete foot inspection
Get examination for neuropathy done by your doctor, which should include

  • Foot structure and deformity
  • Skin integrity (no wounds/ulcers, calluses etc.)
  • Temperature/warmth
  • Pulses of foot
  • At diagnosis and then annually till tests are normal
  • Otherwise more frequently (if directed by doctor)
  1. cardiac autonomic neuropathy
  • Heart rate variability
  • Blood pressure change from a lying to standing position
  • At diagnosis and then annually till tests are normal
  • Otherwise more frequently (if directed by doctor)
  1. Other neuropathies
  • Erectile dysfunction
  • Diarrhea/constipation
  • Persistent feeling of fullness (gastroparaesis)
  • Vaginal dryness
  • Urinary complaints (retention of urine, increased frequency, night time frequency, incontinence )
If you have any of these, discuss with your doctor
Screening for CVD

(Cardio Vascular Diseases)

If you are more than 40 years of age ECG should be done as baseline

Thereafter as advised by your doctor

If you have complaints of:

  1. Pain in the legs or foot on walking a certain distance which resolves on rest
  2. Episode(s) of severe pain in the abdomen of which no cause has been determined
  3. Episode(s) of sudden loss of vision, drooping of mouth, loss of power in limbs or altered behavior which resolved on its own

OR

Diagnosed diabetic nephropathy or neuropathy

ECG should be done and further tests may be needed, consult your doctor
If you do not have these symptoms Get a ‘Risk-assessment for heart disease’ done and you will get further advice on the basis of results
Vaccinations Diabetes may lead to impaired immune response and increased risk of infections, use the advice below  to discuss with your doctor whether you should get any of these vaccines

  1. Pneumococcal vaccine: PPSV 23, or if you are more than 65 years of age PCV23 and PPSV
  2. Td vaccine: All adults with diabetes need  Td booster once in every 10 years
  3. Hepatitis B vaccine:  for diabetics 20-59 years of age, if not taken already
  4. Influenza: annually
Psychosocial assessment
  • Depression affects about 20–25% of people with diabetes and increases the risk for heart attack and even death
  • Diabetes related distress/anxiety affects 18–45% of patients and hampers good control of sugar levels
  • Eating disorders are also commonly found in diabetics
Take a screening test for these and consult your doctor if you are concerned
For women in child bearing age group
  • Uncontrolled diabetes increases risk of deformities in the baby, therefore women with diabetes who want to have children must first aim for adequate control of blood sugar/HbA1c levels
discuss with your doctor if you want to have a baby

CHECK OUT: Our references for diabetes mellitus