The management of diabetes has moved on from just taking medications and injections to lifestyle modifications to reverse the disease.
diabetes mellitus was a lifestyle disease seen among the rich and affluent group. Now with the changing lifestyles, stress and obesity, diabetes is seen in all socioeconomic groups of the population. What was once a disease of the fifth decade has now become prevalent from the third decade on.
The challenge in managing diabetes in older age groups is delayed diagnosis and several cases associated with complications of organ damage. in these age groups management becomes multispeciality based. The aim of managing these patients would include control of sugars, control of complications, recovery of organ damage.
The risks in young diabetics are several fold. They have early onset of kidney , heart, eye and brain damage.not to mention, the side effects of long term consumption of drugs. Hence these groups of patients are targeted for disease reversal rather than just disease control. This group of patients are also aimed at prevention of complications.
Stroke patients with uncontrolled diabetes develop stroke due to thickening of blood vessels caused by injuries in the fine blood vessels of the brain. The outcome of stroke in such patients is very grave, conversely, stroke in a patient with uncontrolled diabetes also has a grave outcome.
Cardiac Disorders diabetic people eventually develop hypertension and heart problems due to the changes in their body. These 3 chronic disorders cause a early cardiac dysfunction leading to negative outcome or a crippled lifestyle.
Kidney Disorders Patients with long term diabetes eventually develop some amount of kidney dysfunction. This is increased more and sets in earlier in people who do not have good control over blood sugars. These group of people develop early kidney disorders leading to kidney infections, kidney failure and requirement of dialysis
Nerve Disorders long term diabetes damages nerves in the hand and feet leading to numbness, swelling, lack of sensation leading to recurrent injuries
Eye Disorders diabetes affects the retina which is an important component of eye involved with clarity of vision and colour. Diabetes damages this layer of the eye leading to blurring of vision and eventually blindness.
Wounds lack of sensation in the hand and feet results in injuries which are painless, which superadded with low blood supply causes delayed wound healing. Continued lack of sugar control results in infections in pre existing wounds.
Diabetes in pregnancy is a difficult task to hanle especially if ignored in initial phases, it affects the mother, baby and the pregnancy. The mother develops weight gain, the baby grows more than its size complicating the pregnancy and the act of labour in addition to developmental deformities in the baby.
Diabetes In Young early onset diabetes especially in childhood has a different mechanism compared to diabetes in adults. If ignored these patients develop accelerated organ failure. If treated well, their recovery is far superior to adults.
surgery alters the balance of blood, body fluids , muscles and sugars. In acute surgical emergencies the primary disease results in uncontrolled sugars, conversely even low or moderate risk surgeries are turned into high risk surgeries in the presence of uncontrolled sugars. Maintaince of sugars is so vital that it can alter the outcome of the surgery. In elective surgeries, sugar control begins with surgical planning. In emergencies, there are techniques to achieve sugar control in short period but it is a short term process and needs to be carried over until complete recovery.
Patients admitted and treated in ICU have infections, organ failures, wounds, parenteral nutrition , multiple antibiotics usage, sometimes post surgery with or without implants. All these factors carry an antagonistic role to sugar control, hence extra precaution needs to be followed. Sugar management is an independent factor that can complicate all the above mentioned factors if not controlled well.
