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How Can I Get My Father to Start
Treating His Diabetes?

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.
This article originally appeared on page 17 in the June 14 - 15, 2003 issue of
The Mississauga News under the feature: Health & Wellness, Doctor's Corner.
Dr K

I find diabetes to be a misunderstood concept, and many people still shudder at the mere mention of the word. They associate diabetes with an endless task of sticking needles into oneself several times a day. One common myth that exists is the link between sugar in our diet and the development of diabetes. Any refined sugar in your diet is unhealthy, but there is little evidence that it is the cause of diabetes. Blood sugar levels are used to track diabetic control. Diabetes is referred to as "starvation in the midst of plenty." Their cells are starving for glucose and keep calling for more, yet the blood is brimming with glucose. The problem is that glucose cannot be transported into the cell without insulin. The medical definition of diabetes has been changed over the last number of years. Officially, a fasting blood sugar greater than 7.0 mmole/L is diabetes. Levels close to this are now called carbohydrate intolerance.

Diabetes is divided into several types. Not all require insulin. Many people considered diabetics are still able to produce insulin. Having high levels of blood sugar can lead to problems such as cataract formation and heart attacks, but kidney failure is the most significant. Failing to control blood sugar often leads to kidney problems. Once these filters fail, dialysis or transplant is required. There is good news for your father. There are now at least five classes of medication that are employed to help control diabetes before insulin is needed. Because they work in different areas of our body, we can now mix combinations which may further delay the onset of insulin. And even with insulin there is progress in terms of implantable pumps, islet cell transplantation and sleek self-injecting pens.

Confusion is arising with the advent of new medication classes. Biguanides such as Metformin decrease the glucose released by the liver, while Thiazolidinediones such as Pioglitazone and Rosiglitazone increase the ability of muscle cells to take up glucose. In both cases, effectiveness is measured by testing a drop of blood for glucose levels. Sulfonylureas such as Glyburide, Glimepiride and Gliclazide increase the ability for the pancreas to release insulin. Repaglinide and Nateglinide are non-sulfonyureas which have recently appeared and seem to increase pancreatic insulin secretion. Insulin injections are usually started when the pancreas can no longer produce natural insulin. Of interest is another drug called Acarbose which works in the small intestine to block an enzyme that promotes carbohydrate absorption. Early recognition and intervention are paramount to successful control. Your question is difficult, since you don't specify whether your father is in denial of the diagnosis or simply has an aversion to medications. If your father is exercising regularly, drinks only on occasions, has quit smoking, and has taken radical steps to improve his diet then I would say that he has indeed taken the first steps to treatment!

Related Resources:

Diabetes Basics. Type 1 Diabetes, Type 2 Diabetes, Gestational, Prevention, Symptoms, Diabetes Statistics, Tips, Common Terms, Diabetes Myths.
American Diabetes Association: Information you can trust from the diabetes experts.
Diabetes.com from WebMD Health - Facts About Diabetes, Type 2 Diabetes, Type 1 Diabetes.
Diabetes from National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK): Introduction, Treatment of Diabetes, Complications of Diabetes, Statistics.
About Diabetes from Canadian Diabetes Association: Diabetes - Facts, Living with Diabetes, Banting House, Nutrition, Insulin and Diabetes Medications, Complications, Children and Diabetes, Research, Clinical Trials.
About Diabetes: Types, Care, Testing, What to Eat, Insulins, Medications.
Diabetes Control Tips: 500 Rule, 1800 Rule, Unused Insulin Rule, Long Acting Insulin, High Blood Sugar, Low Blood Sugar, Food & Diet, Exercise.

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