Reader's Corner

Complete G.T.T. is cumbersome and costly and it is not at all required to monitor the control of blood glucose in a known diabetic. Fasting and post prandial blood glucose values are sufficient. Moreover, G.T.T. is not required in most of the patients for initial diagnosis of diabetes.

Mild diabetics may not pass sugar in their urine throughout the day, as usually sugar appears in the urine when blood glucose is above 180 mg.% Moreover, many long standing diabetics have high renal threshold i.e. they do not pass sugar in the urine even though their blood glucose is higher than 180 mg.% Occasionally we come across a patient whose urine is devoid of sugar even at a time when blood glucose is as high as 225-250 mg.%. From another point of view also, urine examination is inadequate. With the few exceptions, the inference of absence of sugar in the urine is, at that particular time, the blood glucose is below 180 mg.%. But urine examination does not tell us the exact blood glucose value. It could be anywhere from 175 mg.% to 40mg.%. In other words, urine examination alone is not sufficient to differentiate between good control and over-control or inadequate control of blood glucose level and periodic blood glucose examination must be done (every 3 months in well controlled diabetics and more frequently in initial stages and in poorly controlled diabetics.)

When we ask questions regarding history of diabetes, occasionally we get the following answers - "I had diabetes a few years back but last year, I was cured of it and hence I have not kept any follow-up with the doctor".

Barring a few exceptions there is no cure for diabetes and one has to take regular treatment and keep blood glucose under control and verify it from time to time by doing blood glucose estimation.

Some people develop diabetes during the period of extreme stress such as major operation, major accident or severe infections, etc. Their blood glucose values return to normal when the stress is over. These people may claim that they have been "cured" from diabetes. However, they should get their blood glucose checked up regularly even if they have no symptoms. They may develop diabetes in future whenever they are subjected to stress or even otherwise.

In all diabetics except complicated diabetics and Insulin dependant diabetics (less than 2% in our country), doctors always start treatment with dietary restriction and physical exercise. They do not start insulin or pills immediately. The drugs are added subsequently in those patients in whom the above mentioned measures are not sufficient to control blood glucose level. It means that in these patients, blood glucose will go up immediately after stopping insulin or pills and that they will not be able to control their blood glucose "naturally". Hence they should never discontinue their treatment on the day of blood glucose estimation as it would defeat its very purpose, which is to verify whether the treatment is adequate, inadequate or whether the dosage needs reduction. In case they have discontinued their morning dose of pills or insulin, it should be brought to the doctors's attention while showing blood glucose report to him. Some diabetics discontinue pills or insulin after blood glucose level comes down to normal. This should not be done without the doctor's advice.

This common misconception is responsible for poor control in many diabetics. As explained earlier, strict dietary restriction is the mainstay of treatment in every diabetic and it should never be by-passed.

This is an outdated and wrong concept. Chemically there is not much difference between the composition of rice and wheat or many other cereals for that matter. These substances contain complex carbohydrates which are gradually digested and slowly converted into glucose. One can always exchange a wheat preparation with that prepared from equal amount of rice or other commonly used cereals. However, the consumption of cereals should not exceed total daily allowance.

In fact, it has now been proved that foods such as various green leafy vegetables, cereals and fresh fruits are very beneficial to diabetics because they contain undigestable fibres in considerable amount.