Understanding Diabetes, Its Management And The Stigma That Comes With It

Diabetes mellitus is a major chronic disease, consistently ranking amongst the top 10 causes of death and disability worldwide. There are currently an estimated 463 million people with diabetes, making it a serious public health concern. Those living with the condition would know how difficult it is to manage their blood glucose levels and keep it sufficiently low. This can be a large burden for a single individual to carry throughout their life. Rather, management of diabetes should be a shared effort, with others creating a supportive environment for diabetic patients.

Diabetes mellitus is the term broadly used to describe three types of diabetes: Type I, Type II and gestational diabetes. Diabetes is diagnosed if a person's blood glucose levels are too high(hyperglycemia), more than 7mmol/L fasting blood glucose to be precise. Normally, insulin, a hormone secreted by Beta cells in the pancreatic islet, allows glucose from the blood to be taken up by bodily cells. This reduces the glucose concentration in the blood. In diabetes, either the body is unable to synthesise enough insulin or unable to respond to the insulin being produced.

Type I diabetes, is caused by an autoimmune reaction whereby autoreactive T cells in the body recognise beta cells in the pancreas as foreign and attack them. Thus, there is insufficient insulin production leading to a rise in blood glucose concentration. It is sometimes referred to as juvenile diabetes as it can occur in children. Type II diabetes occurs due to the body cells becoming resistant to insulin as well as the pancreas being unable to produce more insulin to overcome this resistance. Type II, more commonly seen in adults, is becoming increasingly present in the younger population. Being overweight or obese is a significant risk factor contributing to Type II. Gestational diabetes is diagnosed specifically during pregnancy in women who did not previously have diabetes. Blood glucose levels usually fall back to normal after birth. However, if it is uncontrolled it could be dangerous both for the mother and fetus and could lead to the development of Type II diabetes in the long run. Diabetes is potentially life threatening because of the complications associated with it. These include diabetic retinopathy, cardiovascular disease and kidney disease. In diabetic retinopathy, the blood vessels supplying blood to the retina, the light sensitive part of the eye, are damaged. Abnormal vision, vision loss and in more advanced stages, blindness, are symptoms of it. Therefore, it is recommended that diabetic patients regularly undergo eye screening. Diabetes also increases the risk of atherosclerosis- the hardening of arteries due to lipid accumulation. Lipid accumulation in the arterial wall leads to narrowing of the lumen and can result in coronary artery disease. Hence, proper management of blood glucose is essential.

Diabetes management can be broken down into 2 parts. The first is lifestyle and daily management and the second is clinical management, consisting of tests that need to be undertaken regularly. Proper food intake is essential and diabetic patients should be wary of the amount of carbohydrates consumed per day. To ensure excess carbohydrates are not consumed, meals should be well balanced, portion sizes should be controlled and carbohydrate counting can be used. Exercising regularly also helps to reduce blood glucose levels, as during exercise the cells in the body require glucose to produce energy, thereby reducing glucose levels in the blood. Moreover, any medications or insulin prescribed by the doctor need to be taken in a timely manner. The haemoglobin 1AC test needs to be taken twice a year. This test measures the percentage of a person’s red blood cells that have glucose bound to them. It is recommended that an eye check up, urine test (to check for a protein called albumin) and foot examination (to check for ulcers, infection and loss of sensation) should be done every year. Additionally, blood pressure readings and blood tests to check for kidney function and cholesterol levels are also recommended. There is clearly a lot of effort that needs to be put in by an individual in order to keep their diabetes at bay.

Managing diabetes throughout the course of a lifetime can be mentally draining. The social environment around the diabetic person could have a significant impact on their management of the illness. Diabetic patients may be stigmatised, whereby they are blamed, face prejudice or unfair rejection on the basis of their disease. Such dicrimination could drive adverse health outcomes including increased feelings of stress, guilt and shame. These have the potential to manifest into depression and increase the risk of complications. Several studies have shown that Type I and II diabetics who use insulin injections are amongst the most stigmatised of the lot. They may take actions such as avoiding injecting insulin, using an insulin pump or monitoring their glucose levels in public which could delay treatment and management. Individuals with Type II diabetes also reported higher rates of weight stigma as compared to the general population. Body Mass Index of diabetic patients correlated with feelings of blame and judgement from others including doctors. Hence a patient’s blood glucose levels are not only the result of their own actions, but the behaviour of those around them.

In conclusion, whether affected by this illness or not, all individuals should play a role in supporting those with diabetes. Increasing public education on the causes of and various types of diabetes is a common suggestion by diabetic patients regarding reducing stigma. Moreover, even doctors have an important role in leading by example and preventing stigma. Physicians should refrain from using demotivating terminology during consultations with diabetic patients. Instead they should remember to acknowledge the efforts currently being put in by their patients and provide a listening ear to find out if patients are facing any troubles which could be barriers in their treatment.