Educating a diabetic patient

Nurse: Mr Brown, your fasting blood tests show that you have diabetes. It’s a common health problem. The main marker is high blood sugar, which we call glucose, that is kept in check by insulin.

Patient: Insulin? What’s that?

Nurse: It’s a hormone created by the pancreas which is a vital part of the digestive system and a critical controller of blood sugar levels.

Patient: What is diabetes related to?

Nurse: First, to the amount of insulin created by your body, and then how well your body’s cells use it. Type-2 diabetes often starts after 40 and runs in families. Do you have any family history?

Patient: Yes, my father had diabetes. Are there any specific symptoms?

Nurse: Usually it’s frequent urination, constant feeling of thirst, skin infections, cuts that heal very slowly or not at all.

Patient: But is diabetes dangerous?

Nurse: If blood sugar is not in control, this can lead to coma. For example, if it drops too fast, you could have hypoglycemia, which may provoke sweating, trembling, dizziness, or even loss of consciousness.

Patient: But what if my blood sugar stays high?

Nurse: Hyperglycemia may lead to long-term problems such as eyes damage, retinopathy, or blindness. But it can also affect nerves, causing numbness, tingling and pain in your feet, legs and arms.

Patient: So what should I do in this case?

Nurse: Keep your blood sugar under control so as to avoid nephropathy, which is a progressive kidney disease. But also coronary heart disease, cerebrovascular disease, or atherosclerosis, that is the narrowing of your arteries.

Patient: That’s scary! Apart from blood tests, how can we tell if one has diabetes?

Nurse: You might feel a slight leg pain while walking. As not enough blood is getting to your feet, you could have foot ulcers and infections. And since ulcers might not heal because of diabetes, tissues can die. We call this gangrene which, in turn, may lead to amputation. But you can also feel chest pain and have a heart failure leading to heart attack or stroke.

Patient: Is there any cure?

Nurse: Unfortunately not. But you can get much better if you keep your body weight within the normal range. You should stop smoking, control your blood pressure and blood fats, have a healthy diet and keep fit. And you might need some medication, like insulin pills or injections, to increase the amount of insulin released by the pancreas, or to lower the amount of sugar produced by the liver to help your body use insulin better, or else to delay the absorption of sugars from the intestine.

Patient: Does that mean that I can never travel again?

Nurse: Of course not! You should however plan for your meals, adjust the insulin injections if you have any, inform the airport security that you have diabetes in case of an emergency, avoid alcohol, keep your medication at hand, and avoid going out barefoot!