Dear all,
It has been a while since I wrote anything on this platform. My apologies. Moving forward, I would like to talk about the key strategy in diabetes treatment nowadays. This is what I like to call “hitting hard at the beginning strategy” What do I mean by this?
When a patient who is newly diagnosed with Type 2 diabetes comes to my office, I start asking how can I help my patient? Truly help my patient and not just reduce his discomfort. But overall improve his quality of life which entails looking into the future and understanding how every second this patient is exposed to high blood sugars, his risk of developing complications goes up.
The above need to correct those blood sugars must be balanced by how fast we drop the blood sugars to normal. That’s why it is said all over that diabetes care is an art not a science, and I fully concur!
When looking at blood glucose and hyperglycemia (high sugars) per se, one needs to understand that the old methods of treatment whereby we go slow and decide to be strict at the end of the road is obsolete. How it works now, is you ensure you get maximum control from the beginning.
As this patient continues to come for review, and blood glucose levels start normalizing, medication can be reduced slowly to meet the new needs of the patient. With this said, international guidelines state that, if a patient is newly diagnosed with Type 2 Diabetes and has an HBA1C (3 monthly average) above 9%, low dose basal insulin once a day (24 hour insulin) together with oral medication can be started. As always this is not a blanket statement in diabetes care, individualizing of treatment protocols to fit the needs of the patient always takes precedence.
BENEFITS: LEGACY EFFECT
Several studies have shown the benefits of hitting hard at the beginning for patients with Diabetes. One of the largest trials in Diabetes UKPDS, had a 10 year follow up of its patients who achieved good glucose control early in the disease. The 10 years follow up showed that these patients had a legacy effect to the benefits of early glucose control. Legacy effect means that these patients had lower risk of complications 10 years down the line after achieving good control early on compared to the patients who achieved control later on in their disease process.
Therefore, I hope you now understand the benefits of early glucose control in terms of lowering risk of complications.
Kind regards:
Dr. Salwa Shahbal
#Type2diabetes #hyperglycemia #Diabetesclinicnairobi
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