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Uncontrollable Diabetes

I am a professional nurse in one of the health care clinics in Ekurhuleni East. Working in the chronic disease department I’ve noticed that certain individuals’ blood sugar is always upwards of 20mmol/L  whenever they come for routine check-up and collection of treatment.
What baffles me is that they come in unaware of their state, with no physical signs or symptoms. Some of them are already on 12 hourly insulin. I want to know what could be the cause, why would diabetes mellitus be uncontrollable sometimes?
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  1. Hi Kobodi

    I got introduced to Diabetes when I started working for a chronic disease management company and we manage diabetic patients. I have been working here for almost a year and my knowledge keeps increasing. What I’ve come to realize is that patients are not educated and are unaware about the dangers this disease poses. Those who are aware, think that it means death, amputation etc. They have not been taught of how to manage this disease and that is the main reason why their blood glucose is out of control.

    The reason that they are unaware of their state is because the body has gotten used to such glucose levels. They do not know that eating 4 slices of bread will take their glucose levels to 15+, they drink fruit juice thinking its healthy for them. They are unaware of the devastating results such foods have on their glucose.

    Bottomline is that the patients are not educated, they probably think that they are doing just fine, so long as they take their medication. What’s worse is that when they do have questions, no one is there to answer these questions.

    i work for Guidepost Direct as a Care Coordinator. We have a team of four diabetic nurses and one dietitian and i know any one of them would have answered your question way better than I did. Take a look at our website for me details…

  2. Gordon Gordon

    I totally agree with the above comment. There is no difference between sugar or carbs. To a diabetic its all glucose. Also, the low GI carbs raise glucose and accumulate over time. Low GI foods may not spike BS but instead cause a sustained high BG reading. “Carbs are not your friends”.

  3. Hi Kobodi

    This is a common scenario, but certainly both explainable and highly treatable.

    The International Diabetes Federation statistics on Diabetes (IDF Diabetes Atlas, 6th Edition, 2013 – 2014 Update) tell us that out of the 1 in 12 people in South Africa who have diabetes, only 1 in 2 are diagnosed (similar to that seen worldwide). While the so-called ‘classic’, osmotic symptoms’ of uncontrolled or undiagnosed diabetes (polyuria, polydipsia, weight loss and fatigue) because of glycosuria are unmistakable, most people (those with type 2 diabetes) do not experience these symptoms until they have had uncontrolled diabetes for many years.

    It all hinges around a physiological concept called the ‘renal threshold for glucose reabsorption’ (RTFGR). Essentially this is the level of blood glucose above which the kidneys cannot reabsorb all glucose from the urinary filtrate. In YOUNG people this threshold exists at a blood glucose of ~10 mmol/l. This means that as long as blood glucose remains below 10 mmol/l (which it will do in the absence of diabetes), no glucose will appear in the urine and the osmotic symptoms of uncontrolled diabetes will not be present. In type 1 diabetes, presentation in the young is usually very rapid and dramatic as the RTFGR is usually quickly exceeded by blood glucose levels in the 20-30 mmol/l range. Diagnosis is this easy.

    Two problems exist in people with type 2 diabetes, which mostly (not always nowadays) affects OLDER people. Firstly in the first few years after developing the condition, blood glucose levels are high enough to result in diabetes and to cause the micro and macrovascular complications of uncontrolled diabetes. But, they are not high enough to exceed the RTFGR – that is to cause any symptoms. This is because secondly, as we age, the RTFGR rises, so that by the time we reach ~50 years, our RTFGR may be 15 mmol/l or more. This means that in the presence of frank diabetes and hyperglycaemia (levels even around 20 mmol/l), the RTFGR may not be exceeded and the patient experiences no symptoms. The important message here is that LACK OF SYMPTOMS DOES NOT MEAN NO PROBLEM EXISTS – We, as health professionals, MUST ACT!

    The only time that diabetes is ever uncontrollable from a healthcare provider point of view is when through some reason a person with diabetes WILL NOT take their medication/s for diabetes (E.g. scared that insulin is a death sentence etc.). Even in this situation, proper counselling and coaching to obtain the patient perspective (Fears, needs, wishes, values, attitudes, beliefs, misconceptions etc.) will usually reveal the reason and this can be addressed.

    The usual and real reason for ‘uncontrolled’ diabetes is healthcare provider inertia and / or lack of knowledge (Healthcare provider training in diabetes worldwide is very poor). Remember that type 2 diabetes is a PROGRESSIVE condition of both insulin resistance and progressive B-cell failure (i.e. declining insulin production). This means that medications to treat both pathophysiologies must be provided (on top of a foundation of education around healthy nutrition, increased physical activity and weight loss [the latter being very difficult in South Africa because of perceived benefits of and desires for weight gain and HIV /TB stigma around weight loss]). It also means that therapies cannot remain static and must be continually revised and intensified as needed to maintain target blood glucose and HbA1c levels advised in our national diabetes guidelines* (ranked as one of the best in the world).

    *2012 Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) Guideline for the Management of Type 2 Diabetes Mellitus:

    You are most welcome to call me for further assistance.

    Kind regards

    Michael Brown
    Diabetes Specialist Nurse / Clinical Consultant
    Centre for Diabetes and Endocrinology, Houghton, Johannesburg
    011 712-6000
    CDE – Your Partner in Diabetes

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