A Stitch in time

The clinic keeps me busy all the time. I had never thought this could be so demanding.And then,when you finish the work,there is always this last patient who walks in.
Today was the deadline for submitting an article for a local magazine.It is meant for the general public and so I tried to make it as non professional as it could be.I haven't written much of medical stuff on the blog,so I thought I would share it with you.



“Doctor,can we accept one more patient?”

It was from the reception. I was going to call it a day and they knew too well that I have never refused a patient.

Khan( Not the real name) walked in limping,his belly first,and then the rest of him.

“It is my toe,doctor, he said,while I was flipping through his thick medical file. He had diabetes for more than ten years,hypertension, and lipid disorder, what we could call the ‘triple jeopardy’. A quick look at his file told me that his diabetes was never under control.His toe looked swollen and discolored and lacked blood supply.I was afraid that he might lose that toe.

‘It is because of your sugar,Khan”, I said. “ Your toe is badly infected and the blood supply is poor”.
He had most of the complications of diabetes. He had vasular problems, neuropathy,and kidney dysfunction.

“When did you see the doctor last? I asked him.

“ Six months back. But I bring medicines from home and take them’

He was no exception. Four months in Family Medical Centre,and I realized that the pattern was not different from what I had seen in the Governmental hospital for ten years.We had always argued and discussed why most of our diabetic patients were not properly controlled.

‘I am taking my tablets every day’. There ends the effort. No adherence to diet or exercise,no proper monitoring and follow ups. While at the diabetes clinic,I had noticed that more than sixty percent of our diabeteics didn’t follow the advices on life style changes.Most of them had uncontrolled diabetes.

“ Well,what is the point of taking medicines if your diabetes and hypertension are not controlled?”

This was a question I always asked patients.

Most of them do not realize the fearful complications of diabetes.

Diabetes mellitus is a chronic condition that can lead to dangerous complications over time. These complications can include:
Coronary heart disease, which can lead to a heart attack.
Cerebrovascular disease, which can lead to stroke. 50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke).

Retinopathy (disease of the eye), which can lead to blindness. After 15 years of diabetes, approximately 2% of people become blind, and about 10% develop severe visual impairment.
Nephropathy (disease of the kidney), which can lead to kidney failure and the need for dialysis. 10-20% of people with diabetes die of kidney failure.
Neuropathy (disease of the nerves), which can lead to, among other things, ulceration of the foot requiring amputation and affects up to 50% of people with diabetes.

Many of these complications produce no symptoms in the early stages, and most can be prevented or minimized with a combination of regular medical care and blood sugar monitoring. The long-term complications of diabetes are caused by the effect of high blood sugar levels on blood vessels. For most people, a target for fasting blood sugar and for blood sugar levels before each meal is 80 to120 mg/dl (4.4 to 6.6 mmol/L)

A blood test called A1C is also used to monitor blood sugar control; the result provides an average of blood sugar levels during the previous one to three months. An A1C of 6 percent or less is recommended; this corresponds to an average blood sugar of 135 mg/dL.

Diabetes can decrease the blood supply to the feet and damage the nerves that carry sensation. These changes put the feet at risk for developing potentially serious complications such as ulcers. Foot complications are very common among people with diabetes, and may go unnoticed until the condition is severe. It is said that a diabetic should care for his feet,the way a young woman cares for her face.
People with diabetes should examine their feet every day. It is important to examine all parts of the feet, especially the area between the toes. Look for broken skin, ulcers, blisters, areas of increased warmth or redness, or changes in callus formation. Proper foot wear is of extreme importance.

One out of every four citizens of the United Arab Emirates has diabetes and this is one of the highest prevalences in the world. 70% of the UAEpopulation is at risk for developing diabetes according to current indicators. The UAE's diabetes rate of roughly 20 percent for all residents belittles the global average of 5 percent. Though a genetic predisposition can be given as an excuse, it is the striking change in the life style from hardworking nomadic life to an ultramodern,sedentary way of life which could be equally held responsible.

The change in life style is almost universal. I remember,as a child, our games and activities were always physical and outdoor. Now the young and old alike are getting glued to computer and television,with junk food for company.
It is alarming to see diabetes on the rise at such a rapid rate. While new diabetes treatments continue to be developed, the disease continues to rise at an unprecedented rate.

Simple lifestyle changes are proven to be effective to prevent or delay the onset of type II diabetes and control the diabetes in those who have the disease. These include regular physical activity, a healthy diet, weight reduction and smoking cessation.

Khan was attentive all the while.He appeared a bit apprehensive towards the end.

“But why didn’t they tell me about all this from the beginning?” he asked.

This was another issue. Diabetes education is probably the most important part of its treatment. Like in anything else, we lack the time and patience to educate the patient.

Most of the microvascular complications of diabetes are related to the degree and the length of exposure to hyperglycaemia( high blood sugar levels).New data from studies on Diabetes emphasize the role of glucose control early in the course of the disorder and its value in prevention of later complications.The phenomenon of ongoing beneficial effects on diabetic complications after a period of improved glycemic control ,even if followed by a return to usual (often poorer) metabolic control has been described as representing “metabolic memory” or “legacy effect”.Earlier control of blood sugar is of utmost importance to prevent later complications.

“ I will do as you say, doctor”. Khan had become very submissive after listening to my sermon.

“Well,that is a good start,Khan”. There was now a smile of relief on his face.