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ABC of Diabetes
by Peter J. Watkins
Aims of treatment: a healthy lifestyle
Diabetes is easy to diagnose, but can be managed with
negligent ease by those inclined to do so RB Tattersall,
1990
The first concerns in treating diabetic patients are to save
life, alleviate symptoms, and enhance the quality of an
independent life. Thereafter treatment aims to minimise the
long-term complications and reduce early mortality.
Aims of treatment
Alleviation of symptoms and improvement in quality of
life
This is achieved by reducing hyperglycaemia; patients who
need insulin immediately (those with Type 1 diabetes) were
described in the previous chapter. All others normally begin
on diet alone, moving to diet and oral hypoglycaemic agents,
or diet and insulin as indicated. All treatments must be
adjusted to ensure that patients are symptom-free. Education
of patients plays an important role in enhancing the quality
of life, and needs to be maintained over many years.
Maintainenance of health by reduction of risk factors and
preventing the development of diabetic complications
The needs here are for:
* achievement of optimal blood glucose control
* detection and control of hypertension
* assessment and control of hyperlipidaemia
* assessment of the need for antiplatelet medication
* cessation of smoking
* regular complications screening procedures (described on
page 45).
Management of long-term diabetic complications
Management of other medical problems affecting the patient
The aims of controlling
diabetes
Once diabetes treatment has been established, there is a
need to agree the level of control to be achieved in each
individual patient. Once symptoms have been eliminated,
targets for optimal control (shown in the table) should be
discussed and agreed, but it is not always possible to reach
ideal goals and pragmatic decisions have to be made.
The following criteria need consideration:
* ensure that symptoms have been eliminated
* lean patients should gain weight
* obese patients should lose weight
* children should grow normally
* prevention of long-term diabetic complications.
Healthy lifestyle
People with diabetes can help themselves considerably by
attention to healthy eating, appropriate exercise levels and
weight reduction, and cessation of smoking. These measures
are of great benefit, and may also substantially reduce the
need for medication. Behaviour change strategies may be
needed to help patients to implement them.
Healthy eating
Healthy eating is the cornerstone of diabetic treatment, and
control of the diet should always be the first treatment
offered to Type 2 diabetic patients before drugs are
considered. Eliminating sugar (sucrose and glucose) lowers
blood glucose concentrations in both Type 1 and Type 2
diabetic patients, and although recent dietary
recommendations suggest that eating small amounts of sugar
is of little consequence, this practice is not recommended.
Artificial sweeteners can be used. Good dietary advice is
essential to the proper care of diabetic patients; ill
considered advice can be very damaging or else it is
ignored. I recall one patient who kept to the same sample
menu for many years before she reported it to be rather
boring. The diet needs to be tailored to the patient’s age
and weight, type of work, race, and religion.
Note: The rest of the chapter
is omitted.
 ABC of Diabetes - Table of Contents
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