Diabetes: How to diagnose and treat it

First published in Beyond India, October 2016 edition

Dr Rahul Barmanray

Dada, not so much sugar in your cha. I’ll have to send you to the doctor for diabetes blood test!

A doctor may test someone for diabetes if they are unwell and in hospital, have symptoms that might be due to diabetes, have a family history of diabetes (like most of us South Asians!) or are just having a health check. Diabetes can be tested for in multiple ways including:

  • Fasting blood sugar levels
  • Random blood sugar levels
  • HbA1c – A 3-month ‘average’ of your sugar levels
  • Oral glucose tolerance test

The first three are one-off blood tests. The last is a 2-hour test that gives your doctor more information about how your body manages sugar. Once diagnosed a person with diabetes will have their HbA1c checked at least yearly to see if their medicines need to be changed. The more severe or advanced the diabetes, the more often they will test.

People with diabetes check their sugar using a fingerprick sugar meter. If they are not taking any diabetes medicines they may only need to check weekly. A person taking insulin may need to check four times every day, or even have a monitor that continuously checks their sugar throughout the day.

Oh ho! Doctor said I have diabetes! No more mithai, injections every day, I can’t do this!

It is important to remember that diabetes is very different from person to person. Some people will never need medicines while others will need insulin four times a day. Doctors design individual plans for patients, which may include:

  • Low sugar diet, weight loss and exercise – This are the most important ways to manage diabetes. Reducing sugar intake directly reduces blood sugar. Being overweight is the main (but not the only) cause of diabetes so losing weight can greatly improve and even cure diabetes. A dietician can help with both of these. Exercise also improves the body’s handling of sugar, even without losing weight.
  • Oral tablets – Tablets might work by increasing insulin levels, increasing sensitivity to insulin, reducing sugar absorption, or increasing sugar elimination. In the last 5 years there has been an explosion of options, each with their own benefits and side-effects. If one doesn’t work for you or gives you side-effects, let your doctor know early as there are many other options to choose from. The brand and chemical names can be confusing so if you are ever unsure about which medicines you’re supposed to be taking and when, check with your doctor or pharmacist.
  • Injections – Some diabetes medicines, including insulin, can be given as an injection into the skin around the lower abdomen (below the bellybutton), or the thigh. These are stronger than tablets and more difficult to give, so doctors usually prescribe these to patients with more severe or advanced diabetes.

With diabetes it is important to remember that each person’s disease is different and will require different sets of medicines at different times so what’s right for one person won’t be right for another.

Since diabetes is a problem of high blood sugar, the medicines used to treat it lower blood sugar. This can mean that a person taking diabetes medicine is at risk for low blood sugar, so-called ‘hypos’ (short for hypoglycaemia, which just means ‘low sugar in the blood’). Symptoms of low sugar include sweating, dizziness, shaky hands (tremor), and even fainting. This is why many diabetes patients carry some sugar with them in case they have a ‘hypo’.