An Overview of Diabetes and its Management The golfing community does not live in isolation.

There are diseases that afflict some of us and many others have family members or friends who are struggling with difficult health conditions. I hope this article will give you some basic information on the causes of diabetes and how to get it checked by your physician. Many diseases can manifest as diabetes does, hence it always good to go for an annual medical checkup with your doctor. Dr Michael Muwonge Lukoma has gone through defining the disease, who is at risk, symptoms to look out for, the diagnostic approach, and the current treatments available. We also want to encourage you to know that not every diabetic patient will end up using insulin and have to be on life-long injections. There is a lot that you can do at home to control your diabetes. By Dr Michael Muwonge Lukoma,General practitioner at AAR Health services(U) Definition: Diabetes Mellitus is a disease that involves a digestive organ called the pancreas which produces insulin. Diabetes patients usually have problems in their insulin levels. Insulin is a hormone, or chemical that is involved in absorbing the sugars that our body takes in daily. Low levels or inactive insulin leads to high levels of sugar and then later results to the medical problems we see in Diabetes. There are two types of diabetes that we are traditionally aware of. Diabetes Type 1 (Frequently found in younger people such as children and teenagers but it can occur later in life.) Then Diabetes Type 2 which is more common in adults and people who are overweight or have other concurrent illnesses. Epidemiology/ Risk Factors for Diabetes: epidemiology is the study of the patterns in disease spread throughout a population. Typically people at risk of diabetes include those who have family members with diabetes, those who are overweight , individuals with certain chronic conditions and those with low levels of physical activity. Certain drugs such as anti-retrovirals (ARVs) affect the pancreas and may lead to drug-induced sugar problems. Signs and symptoms: There are many ways diabetes may present in a person. Typical symptoms include excessive thirst and drinking of water, excessive urinating and excessive eating. Some patients feel extremely weak or dizzy, and for some women frequent vaginal yeast infections maybe the initial presentation. If diabetes has been hidden for a while the patient may present with wounds that do not heal. Extreme forms of the illness lead to loss of consciousness, coma and fruity smell in the patients mouth, and some difficulty breathing. Physical Exam: Usually the doctor will do a through exam of your eyes, skin, heart and lungs, and check for any changes in sensation in your feet and other extremities. The feet should be examined for any sores that are healing poorly.

Diagnosis: Laboratory diagnosis involves blood tests checking your fasting sugar level, in the morning after an 8 hour fast or an oral glucose test which tests sugar levels after drinking a liquid with a measured amount of sugar. In addition Haemoglobin AIc maybe checked to see if sugar levels have been high in the past 3 months. Urine sugar can also be examined for glucose or ketones which are diagnostic for kidney and sugar problems. Treatment: Depending on the sugar levels found from testing, the doctor may encourage you to do one of two things. Encourage you to either lead a healthy lifestyle involving the right foods and exercising or counsel you about taking the correct drug doses to control your diabetes if your test results are significant. If your sugar levels are borderline, but not yet characteristic of disease, he or she may encourage you to make some dietary changes and include some regular exercise to assist with weight loss. Dietary changes include limiting carbohydrate intake (potatoes, posho, rice, large quantities of matooke) and refined sugars such as in sodas, cakes, biscuits. A simple rule of thumb would be to increase the quantities of vegetables and certain fruits, but decrease the serving portions of the heavy starchy foods. Diet is a sensitive topic and is best handled between you and your general doctor, a specialist physician and a dietician. This is because different doctors have varying philosophies as regards to food. Medications: Include oral hypoglycemics which include drugs such as Metformin and Glibenclamide and Pioglitazone. Which are usually prescribed in Type 2 diabetics. As control becomes more difficult your specialist physician may indicate for you to use injectable insulin. This requires training of both the patient and family members on how best to administer the drug. Most diabetes drugs need to be taken in conjunction with a regular eating schedule as taking the drug when the blood sugar levels are low is lethal. Type 1 diabetics usually require insulin use from the onset, and since the majority of them are children they need careful education and assistance from their parents or caregivers on how to administer their insulin injections. Follow up: Regular follow up with your doctor is required of all patients. In the initial stages it maybe as frequent as weekly, then eventually when the sugar stabilizes on new drugs, a monthly check up of sugar level maybe sufficient. If any of the above symptoms listed in symptoms section show up please turn up at your doctors clinic or the hospital for a thorough review. An annual check up involving a full blood count, fasting blood sugar, liver tests, kidney tests and and electrocardiogram is recommended for most long standing diabetics. This is because diabetes can damage several organ systems such as the heart, eyes and kidneys. Prognosis: With good control through medicines, regular medical check up, and following your doctors advice on diet and exercise, diabetics can lead a fairly

healthy and prolonged life. Unfortunately because of blood vessel damage and nerve damage due to the sugar levels some diabetics develop kidney disease that is incurable leading to dialysis machine treatments. Diabetes also puts you at risk for heart attacks, heart failure and stroke. There is usually damage to the eye vessels, and some nerve damage referred to as neuropathy. All these complications can be handled in advance of time if you make your doctor your friend, and you do your best to stick to the recommended regimens. Disclaimer: You are advised to see a qualified medical doctor if you suspect a medical condition.