Managing the diabetic condition
The Business Times
By Cheah Ui-Hoon
The food that people with diabetes take, their exercise and medication, are integral to the management of the condition. Now, if only more who suffer from the condition would make a point of monitoring their blood sugar levels three to four times a week, and gain a better understanding of what the results reveal, they might be able to improve their condition. Kevin Tan, vice-president of the Diabetic Society of Singapore, notes that it is a challenge to get people with diabetes to self-monitor their blood glucose. "And then there is the issue of diabetics not monitoring blood glucose levels correctly, or having a better understanding what the results mean," he adds. "If patients were properly educated about it, they might better understand how diet, exercise and medication impacts their condition," says Dr Tan.
Despite high blood glucose being the cause of their diabetes, seven in ten diabetic patients don't self-monitor their blood glucose; more than six in 10 don't exercise three times a week for 30 minutes; and only one will consistently take their medication. These are the findings from a local survey on self-management of diabetes among patients taken in 2011. It involved 157 patients above 45 years old.
There are two issues, he says. One is that the majority of diabetic patients don't self-monitor. "Cost of the test strips might be one, because they're not covered by insurance in Singapore," he highlights. But even if they did regularly self-monitor, they may not do it correctly.
As majority of diabetic patients are of the Type 2 variety, self-monitoring doesn't need to be done several times a day. "They could just check their sugar levels two to four times a week, and a box of 50 strips would last them three to six months," he adds.
A better understanding of what their blood tests reveal would improve sugar control, studies have shown. "When the results go through a thought process, that kind of monitoring changes habits and leads to improvement to sugar control," says Dr Tan.
In the HbA1c (glycosylated hemoglobin levels) test, for example, this measures the sugar in the red blood cells which get regenerated every 90 to 120 days. "That is the life span of the red cells churned out by the bone marrow. So it gives a picture of the average blood sugar level of the past three to five months," explains Dr Tan.
Post-prandial glucose (PPG) measures blood glucose after meals - usually taken two hours after meals. And Fasting Plasma Glucose (FPG) measures blood glucose after eight hours of fasting - usually taken before breakfast. The HbA1c level should usually be below seven per cent, and in order to get that target, diabetics have to make sure that their daily sugar levels before or after meals are good.
"Self-monitoring helps them get their daily sugar in the right range, so that when you see a doctor for the blood test, the average can be low," he says. This in turn reduces or prevents long-term complications of diabetes like stroke, blindness or heart attack.
For self-monitoring of three to four times a week, the idea is to have a spread of the blood sugar levels after a breakfast, a lunch and a dinner. The following week, it could be different days of the week. "Checking before breakfast also tells you the impact of the previous night's heavy or late dinner - as this leads to a high morning blood sugar. Also, the diabetes condition itself leads to the blood sugar rising overnight due to over-production by the liver. This has to be addressed by appropriate medication," says Dr Tan.
Patients are encouraged to take notes not only on the blood sugar levels, but what they ate before that. "To show what gives rise to the blood sugar level reading," he explains.
Self-monitoring of blood sugar levels would be easier to monitor the disease, as opposed to the more intricate readings of high blood pressure and cholesterol.
Diabetes remains one of the top ten causes of death in Singapore. The percentage of Singapore residents with diabetes aged between 18-69 years old has increased from 8.2 per cent in 2004 to 11.3 per cent in 2010. Patients can determine their glycemic control if they managed their stress and illness, diet, exercise and adhered to medication. However, even in medication, only 11 per cent tend to take their medication regularly (according to the local survey). A good 40 per cent say they're unsuccessful at taking their medication regularly. In terms of medication, the latest drug - the Kombiglyze XR - now combines two effective diabetes medicines into a simple, once-a-day dose for adult patients who need reduction in all three glucose parameters. Having less pills to take is important to the patients, as it usually means higher compliance, says Nancy Bohannon, clinical professor of Medicine at Tuoro University and Director of Clinical Research at the Cardiovascular Risk Reduction Programme at St Luke's Hospital in San Francisco.
However, harder pills to swallow are restricting one's diet and increasing exercise, people with diabetes might think. Even if those two play an equally, if not more, important role in controlling diabetes.
Blood glucose targets
HbA1c <7 per cent
2h PP <180mg/dl
CPG <10mmol/l (capillary blood glucose, from a finger-prick)
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