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Modern Challenges of Diabetes Management

By Dr. Takira Glasgow BSc., MBBS, MSc Internal Medicine (Distinction), MSc Diabetes (Distinction)

Are you at an early stage of diabetes or have you begun to have symptoms or complications? If the former, you may have an opportunity to reverse diabetes or maintain healthy control with the help of your diabetes physician. If the latter, it is advisable to seek professional medical life and limb-saving advice immediately. In any event, the only way to answer this question definitively, is to do tests that will be interpreted by your physician. However, if you have decided that recommended medications are not doing anything for you, try to find out why. Are you on a low dose of medications and have not followed up? Are you taking your medications on time and continuously? Do you need to be on insulin? Do you have an underlying medical condition?

Coping with your diabetes can be difficult. There are also some emerging post-pandemic challenges:

Misinformation – Reflect on whether you really know what you don’t know and try to fill the gaps with reliable sources. Whether you find your answers online or on in the community, check the source and the background of the researchers/informants. Has the method, supplement or medication worked in large populations of diverse backgrounds? If you choose to follow the latest fad, unorthodox treatment, or diet, have you investigated the long-term effectiveness? The best research consists of systematic review, critically reviewed by peers before publication and if errors are noted after publication, the paper is amended or withdrawn. What is the level of evidence of your choice, and is it accurate and up to date?

Stressors – With an unemployment rate of almost 17%, workdays and night-shifts with long hours cannot always be controlled, and personal stressors are almost inevitable. Useful guidance for stress reduction includes adequate sleep and nutrition, exercise, mindful rest breaks, prayer, and meditation. This increases energy, alertness and motivation, and optimises decisions about seemingly less significant matters during the day, such as choices of snacks, control of portion sizes, duration of sedentary time versus activity.

Weight management – persons with type 2 diabetes may also be persons with obesity. Obesity has been defined as a chronic, relapsing disease, and this increased in prevalence during the pandemic. Fat cells (white) enlarge due to energy surplus from over- or unhealthy eating or decreased physical activity/ greater sedentary behaviour, and genetic predisposition. Unhealthy overweight is associated with enlargement of these fat cells in both the subcutaneous and visceral tissue. When these cells enlarge beyond their capacity, release of inflammatory cytokines (inflammation), insulin resistance (increased blood glucose) and ectopic fat deposition occur.

Weight loss and diabetes management medications are imminent. A quick medical update: GLP1 agonists delay gastric emptying and decrease appetite. The GLP1 oral agonist semaglutide has been shown in the PIONEER trials to assist with weight loss when compared to empagliflozin, sitagliptin and liraglutide. The SURMOUNT-1 trial reported in June 2022, up to a 20% change in body weight from baseline as a primary endpoint with a combination GLP1/GIP dual receptor agonist Tirzepatide, but the drug has not been approved for treatment of obesity at this time.

Too much information – Sifting through online information to get to life and limb-saving tips is tricky. For example, a heart attack can present similar to “heartburn” or can be completely silent. Any acute illness that causes some weight loss should lead to revision of your dose of insulin which is likely now too high. Multiple (symptomatic) low blood sugar episodes or even one requiring help are red flags to see a physician for advice on adjustment of medications, usually insulin.

With a little discernment and help along the way from your diabetes physician, you can manage your diabetes health successfully.