Diabetic Dilemmas

Q In diabetes, are the targets for the blood sugar the same for everyone?


A
No. The target blood sugar level for different group of patients varies differently for different groups and also depends on the general condition of the patient. Diabetes, being a metabolic disease, has both acute and long term complications. One needs to find the suitable control which is usually tailor-made rather than a blanket treatment. Broadly speaking, we can categorize them into two groups: group A, where one can be a bit more liberal with the blood sugar control and the second group, group B, consisting of patients who benefit with tight sugar control.


Patients who are acutely sick, who are newly diagnosed older patients, that is, age more than 60 but without any other acute co-morbidities, or patients who have already developed late stage complications, especially kidney disease, can do with less tighter blood glucose control. Patients who need very strict sugar control include most importantly pregnant women; whether they have developed diabetes before or after conception does not change the targets. The baby and the mother both benefit with very tight sugar control.


Young adults who are type 1 or type 2 patients who get diagnosed at an earlier age, benefit substantially with good glycemic control as they can avoid the long term complications of diabetes which involves various organ damage including the eye, kidney and the heart. From the onset of diabetes to getting the long term complications, takes at least a few years, but once the complications develop, it is usually irreversible. After then, good glycemic control can be helpful to prevent further damage. Surgical patients are another group of patients who benefit with good sugar control and decrease their hospital stay and chances of infection.


Q Can diabetic patients have all the food in limited proportion instead of staying away from foods that are normally suggested? Some diabetic and food conscious people I see around seem weak and frail. How can a diabetic patient look fresh and healthy? -?
Ashmita Rana, Balaju


A Yes, other than smoking and chewing tobacco, diabetic patients can consume any kind of food in limited quantities. There are two concepts involved with diet for diabetes. One is calorie. The total calorie intake should match one’s daily activities and energy expenditure. That usually defines the amount of food one should consume.


Once the total calorie intake is established, one strives to derive these from these calories from healthy choices with nutritional value. There is no specific diabetic diet, only healthy diet. Recently, the food pyramid has been replaced by a simpler food plate. One should try to take complex carbohydrates like whole wheat and brown rice rather than refined flour and eat fruits whole rather than juices and take enough vegetables. Oil and fat should be restricted and try to consume dairy products. White meat is a good source of protein and chicken and fish can be consumed daily but one should avoid red meat.


Q What can lead to thyroid problems? Is it mainly food-lifestyle? Hereditary? Or other factors? ?Is it curable? -Kritika Ghimire, Baneshwor


A This has been answered in the previous question but regarding food-lifestyle, we can add—there is no specific diet for thyroid disease except for iodine deficient goiter where one could avoid goitrogens like cabbage, but for other thyroid diseases there is no specific diet. As all our salt is iodinated, we almost never see iodine deficient goiter in our medical practice.

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