Frequently on this blog, we discuss various causes of kidney disease. In fact, as I went through the list of topics I have covered, they all gravitate towards kidney care. The leading causes of chronic kidney disease continue to be diabetes and hypertension. Statistically speaking, these two diseases are on the rise. They will continue being so ad infinitum.

In a Kenyan setup and many an African nation, diabetes especially used to be seen as a disease of the opulent. However, our change in diet and lifestyle has ensured that we catch up with the rich and famous. On the International Diabetes Federation Atlas, Africa is slowly catching up with the rest f the world on matters diabetes prevalence. The sad thing is that we are acquiring what was known as ‘Western Problems’ while we are stuck with the vagaries of our barely breathing healthcare systems. New content but same old software.

It makes no difference whether one has type 1 diabetes which requires insulin all the time or type 2 diabetes which can be treated with insulin and/or tablets. The bottom line is that diabetes management requires us to be vigilant. Part of this alertness involves dietary modifications and weight loss. Research has it that even a 5% weight loss makes a significant change on someone’s risk of developing diabetes complications.

We are starting a Series today of how we can monitor diabetes as people caring for or living with persons with diabetes.

Self-monitoring of blood glucose

Every person living with diabetes needs to know how to monitor their blood glucose. You do not need to go to the hospital all the time for a blood glucose check. I understand however that people that are in resource-constrained setups like in rural Kenya may not be able to afford machines for testing blood sugar. That notwithstanding, it is important that the ones who can afford to buy these hand-held machines do so.

Due to advanced technology, there are newer devices which do not require needles. All you need is a smartphone and a patch placed on your upper arm. An app is installed in your smartphone, and you just need to scan the patch on your upper arm to know the level of blood glucose. These gadgets are available especially for people that use insulin. They are widely used in the United Kingdom especially.

Careful monitoring of blood glucose especially when you are feeling unwell gives you a clue as to how your body is responding. It is important for me to emphasize that in diabetes, any other illness that strikes you will affect your blood glucose. You will not know until you actually test the blood sugar.

It is advisable for every person using insulin injections to first of all measure the level of the blood glucose before injecting the insulin. If you are short of resources, measuring the level at least twice a day would be helpful.

Timing of testing

For every person living with or caring for someone with diabetes, there is a blood glucose test we always ask you for as healthcare providers. This is the fasting blood glucose. What this means is that you take a blood sugar test first thing in the morning after a night of not eating for about 8 hours. That means your stomach is still empty.

This test, called the fasting blood sugar/glucose, helps us to adjust your treatment and to truly tell whether the medication we are giving you is working to lower your blood sugar. To recap a previous lesson, insulin is a hormone produced by your pancreas in response to blood sugar level in the bloodstream. This sugar comes from the food we eat.

In diabetes however, this insulin is either reduced in production, absent, or our body cells refuse to sense it at all. The latter is especially evident if we are obese or have too much fat covering our internal organs. The medication we give either make the body more sensitive to the insulin from the pancreas or just replace the insulin with artificial insulin injections.

Testing the fasting blood glucose paints for us an honest picture of your body and how well it is handling food and insulin. When able, do take one more blood glucose test in the evening before bed.

Diabetes Diary

In nursing, what is not written is not done. It does not matter how well I did it. If I did not write about it, in a court of law I did not do it.  This has haunted all nurses wherever they work. A nurse walks around with several pens and back up for those pens because they realize the importance of writing things down. Nobody can fully rely on their memory. It is an illusion. A fallacy of freedom. You have enough going on in your world and the last thing you want is to forget what your blood glucose was.

Have a blank exercise book and call it your blood glucose diary. Indicate the date and time of your test. Then write the result. This should take less than a minute of your time. For our senior citizens in rural and urban Kenya who cannot read and write, it is the responsibility of the carers or family: Whomever is available, to keep a diary of these results.

Let us say you do not have ability to buy these machines. Still, you go for the outpatient diabetes clinics, carry a small book with you and ask the healthcare worker who will test your blood glucose to write the result for you in your notebook.

This gives you a chance to see how you are responding to treatment. It makes you take a pause and ask yourself what you are eating and whether it is making the blood glucose rise or lower. It is not just us the healthcare providers who need records of the blood glucose, you do too. Diabetes is largely all about taking care of yourself. We call it self-management.

Three Months interval checks

There is a test we carry out every three months for all people living with diabetes. This is called the glycated haemoglobin level. Simply called HBA1C. I am sorry that I have no lay term for this test. This test, friends, tells us exactly how your treatment is working in the long term.

There is no point in putting you on management which we do not monitor. There is no point in living with diabetes for years and your medication has never been reviewed. We will need this test every three months to be able to tell what we are doing.

A high HBA1C test result tells us we are doing badly, and we need to adjust our treatment to lower the blood glucose. High results tell us that you are at a very increased risk of developing complications. The complications I am referring to are led by heart disease, kidney disease, nerve problems, sexual dysfunction, amputations, among others.

Every three months, aim to have a HBA1C test. Further, ask your diabetes care provider what the normal is for you. I could easily type a figure here. However, that will be very misleading. The truth about diabetes is that it must be customised for the individual. There is no one-size-fits all.

I will go into more details of keeping diabetes in check in the coming weeks. I hope this is enough information for today to help you know that Diabetes needs all our hands on deck and our eyes wide open. It one of those silent killers.