#Allin4health #health4all #Minding your wellbeing #Diabetes awareness

By Dr T.W Ngwenya Changamire

As we wind down our series of articles on diabetes I would like to touch on the importance of self-monitoring and adherence to diet and lifestyle in achieving glucose control and attending follow up sessions with your doctor. Control of Diabetes is largely determined by self-care.

Diabetics need to be well equipped to conduct self-care.

Diabetics can be equipped to take care of themselves by comprehensive and continuous patient education sessions on follow up. This brings us to our first reason why diabetics need to comply with follow up visits.

Patient education

Control of diabetes and prevention of complications also requires behavioural changes to be made by the patient. We all know that behaviour change is hard, it is a continuous process and if a patient is followed up frequently with diet, exercise and lifestyle habits being reinforced they are likely to comply and they will also build a desire to achieve optimum control.

Therefore, follow up is good for diabetes education and for reinforcing diabetic lifestyle and aiding in the identification of patients who are not coping.

We will then follow up these patients more closely by having frequent contact sessions to assist them in gaining control over their lifestyle.

Patient education will also teach the diabetic patient on how to recognise low blood sugar levels (hypoglycaemic spells) and high blood sugar levels (hyperglycaemic spells) for the reason that both of these states can be life-threatening.


Hypoglycaemia is when the blood sugar levels go lower than normal, less than 3.9mmol. Hypoglycaemia in a diabetic patient may be caused by high doses of treatment, missed or skipped meals, over-exercising, high consumption of alcohol, underlying kidney or liver problem.

Symptoms may include tiredness, anxiety, hunger, irritability, shakiness, sweating and numbness of the tongue and lips.

If blood sugar continues to drop you may end up developing severe symptoms like confusion, vision disturbances, seizures or even lose of consciousness.

You need to drink fruit juice, soft drink containing sugar or eat candy or glucose tablet immediately to prevent severe symptoms. This will increase the blood sugar to normal levels. Make sure to go and visit the doctor if this happens to you.

Hyperglycaemia is when the blood sugar levels go higher than normal, this is usually above 11.1mmol. Several factors may contribute to this in people who have diabetes.

These factors may include inadequate treatment dosing, poor compliance to the treatment prescribed, poor dietary and physical activity choices, symptoms include tiredness, increased thirst, frequent urination and headaches.

If the high blood sugar levels persist nausea and vomiting develops, weakness, confusion, fruity smelling breadth and loss of consciousness may result. You are also required to go in and see the doctor if this occurs.

Early detection of complication

Follow up sessions are also conducted to look for early signs of disease complications. We want to diagnose them early because most of them are treatable. We want to identify them quickly so that we can prevent further damage to the vital organs.

Timeous detection on follow up visits will allow for early recommendation on how you may adjust your diet and activity levels and the doctor will also be able to amend your treatment.

The complications that may arise from poor blood glucose control include vision disturbances, reduced kidney function, nerve damage which will manifest as digestive system disturbances, sexual dysfunction or reduced sensation in the feet and hands or chronic feet pain. Other complications include skin discolouration or skin infections and recurrent fungal infections.

Screening involves examination of the eyes, feet, kidney function check and heart check.

Eye examinations are safe and they are necessary. Diabetics are referred to an Eye specialist for eye screening. The Eye specialist will check for common complications arising from diabetes. Loss of vision can be prevented with routine eye examinations.



Foot care is important because a simple small cut can produce serious complications.

This is because a diabetic patient may miss injuries to their foot and if this injury is left untreated it may become infected. The reason diabetics may miss these injuries is because of nerve damage resulting from uncontrolled sugar levels.

Nerve damage will result in reduced sensation to the feet.

Foot care involves daily feet inspection of the feet and inspection in-between the toes, also checking for dry cracked skin, using warm water and never hot water to wash your feet, moisturise your feet but not in between the toes, cut your toe nails carefully, wear clean dry socks, never walk barefoot and avoid wearing tight shoes.

Regular self-checks and checks by the doctor will aid in early referral and treatment by a podiatrist.

Kidney function tests are routinely conducted during follow up. This is done because we know that Diabetes is the leading cause of End-stage kidney disease. Spot urine tests have made kidney function screening to be done more frequently because these tests are very affordable.

Persisting the presence of protein in the urine is an early marker of early kidney damage. Again, this is a sign that treatment has to be amended and dietary measures have to be adhered to in order to achieve good glucose control. Urine checks can also help us to check for urinary tract infections(UTIs) which are very common in Diabetics. UTIs may also cause lead to difficulties in controlling blood sugar.

Need to screen for other diseases

There is a need to screen for other diseases that may increase risk of cardiovascular complications. Cardiovascular complications include angina, heart attacks and strokes.

We screen for the following conditions: Blood pressure control: we advise that you control your blood pressure to less than 130/80 mmHg,

Cholesterol; The bad cholesterol known as LDL or Low-density lipoprotein has to be kept below 2mmol,

Smoking cessation is also advised. So patients who smoke may also undergo smoking cessation counselling.

In summary diabetes follow up sessions are important to achieve glucose control. Follow up sessions are also an opportunity to conduct patient education, lifestyle re-enforcement and disease screening activities.

Contact All In 4 Health – By Dr TW Ngwenya Changamire – for General Medical Consultation, health screening, medical check-up, health education and promotion. The Glen Marais Shopping Centre, 57 Veld Street, Glen Marais, Kempton park 1619




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