Diabetes Care

For patients suffering from type II /adult onset diabetes :

In type II diabetes, diagnosis is often late (after the disease has already been present for some time). In early days T2DM (short for the adult type of diabetes) are often without symptoms. Hence the delay in diagnosis. This means complications will be seen early after diagnosis.

Foot Care :

Foot disease in diabetes may lead to difficulty in walking, pain and may lead to infections. If neglected amputation may be required.

Inspect feet with a mirror before going to sleep every night.

Use well fitting shoewear.

Do not walk bare feet even in the house.

Socks should be clean and correct size.

In case of deformities of feet, special shoes can be worn.

Eye Care :

It is nowadays the commonest cause of blindness throughout the world.

Check for refractory error at the time of diagnosis and once sugars are controlled.  In T2DM every year examination for changes in retina are required. If there are already changes, check up is required more often.

Retina is checked after dilating pupil with an ophthalmoscope.

Kidneys :

It is one of the common causes of kidney failure leading to requirement of dialysis and renal transplant. Early treatment may reverse diabetic kidney disease or slow its progression.

In early cases urine is checked for passage of extra amounts of albumin. This can be quantified to see response to therapy. This test is called urine for microalbuminuria, and urine albumin /creatinine ratio. If the disease is already present, USG, S Cr and testing for voiding function (Uroflowmetry) etc may be useful.

In those without evidence of kidney disease these tests are carried out every year. Frequency otherwise may depend on the stage of involvement. More severe involvement necessitates more frequent reviews.

Nerves :

Nerve involvement is checked by touch, pain, vibration sense.

During winters, hot water should be checked with either a thermometer or elbows. If fingers are used for checking temperature, very hot water may lead to burns.

Precautions should be taken to avoid falls.

Sugar Levels :

HbA1C level may be done every 3 months to monitor overall sugar control in blood. In most cases a level of < 7 is desirable.

If hypoglycaemia is frequent , a level of < 8 may be  all that can be achieved safely. In cases of some microvascular complications, a level < 6.5 may help but is difficult to achieve. Home sugar monitoring is done from capillary blood. The levels are different from venous blood levels tested in laboratories. Only sides of fingers should be used and not the areas used for holding functions of the hand. In T2DM once weekly sugars may be enough. In T1DM almost daily or before each meal sugars are required. Levels for control should not be done within 2 hours of meals. Check if there is uncertainty about diagnosis of hypoglycaemia. Do not wait for giving sugars, if testing takes time or symptoms are severe (loss of consciousness, confused talk, fits etc.) Treatment presumptively may prevent permanent damage to the brain. However sugar is not the treatment in diabetics for every small symptom. Record times of sugar checking and dates in a notebook for planning of drugs. Lipids and Statins : If there are more cardiovascular risk factors, age > 50 yrs in man, smoking, lower levels of LDL cholesterol are desirable. Daily 75 or 150 mg  of aspirin or statins may decrease risk of heart attacks. Bleeding complications however increase with aspirin.

Regular exercise, monitoring weight, smoking cessation all are essential parts of diabetic care.

Drugs after Renal Transplant: II

Drugs after Renal Transplant: II

There are a number of other drugs used in transplant recipients after they are discharged from the hospital.

In the initial period these include:

Antibiotics to prevent urinary tract infections. These may need to be continued for 6 months. These (Trimethoprim + Sulfas) may prevent pneumocystis infection of the lungs as well.

A common infection in transplant recipients is due to cytomegalovirus. This can be prevented by a drug called Valgancyclovir. It is usually given for 90 – 100 days. It is a costly drug and the total treatment may cost about 25000 to 45000 ₹ depending on the dose and duration of CMV prophylaxis.

Anti Hypertensive drugs, sugar lowering drugs may be required in cases of Hypertensives and diabetics.

Life After Kidney Transplant

Life After Kidney Transplant

Kidney transplant is preferable to lifelong dialysis as it usually provides a better quality of life. After initial 14 days, the risk of death is less in transplant recipients compared to patients on dialysis.

The human body tries to throw out the transplanted kidney as it is perceived as a foreign body by the tissues.

To overcome this tendency of the body, drugs are required to be taken lifelong by transplant recipients. These drugs are called immunosuppressives.

These drugs also reduce body’s reaction in case an infectious agent gains access to the body. Hence infections can occur more often, with smaller doses of bacteria and viruses. These infections may be severe and life threatening. At times bacteria and viruses which do not cause infections in other healthy individuals may also cause infections in transplant recipients.

These infections have to be suspected more often, investigated more aggressively and treated vigorously with appropriate antibiotics by a physician. In India, most  deaths take place with a functioning graft due to infections. Hence the importance of preventing these.

How to prevent infections in transplant recipients:

Infections spread by food, water, contact and by inhalation of droplets containing pathogens( bacteria, virus, fungi etc). They can also be introduced during surgery, by IV lines, tubes placed in the body and during various medical procedures.

Infections from water are prevented by drinking filtered / RO and clean water only. Tubewells, river, ponds, most municipal water in cities and towns may be having infectious agents. Hence it is not safe to drink untreated water. In case of dire necessity, boiled water as in tea can be consumed.

Food should be fresh, made from clean ingredients in clean utensils and consumed early. Food kept in refrigerator (especially as power cuts are common place) can be contaminated and when consumed may cause infectious diarrhoea.

Close contact of persons with obvious respiratory infections eg common cold, influenza, pneumonia, chickenpox, measles, sore throat etc should be avoided. Good quality masks (as used for preventing the spread of swine flu) are used for prevention of respiratory infections. Vaccines against pneumonia are similarly useful to protect against pneumonia.

Hygiene should be immaculate. In hospitals etc ensure absolute asepsis to prevent any infections during sampling, IV infusions, injections or surgical procedures.

If adequate care is taken a person can lead an active life. He can live a normal long, productive and useful life.

Next coming up

Various drugs after a transplant.