Medical matters: Yesterday was World Diabetes Day, which this year focused on the foot complications of diabetes, a problem estimated to affect 15-20 per cent of people with diabetes at some point in their lives.
Foot problems arise in diabetes because of two factors. The blood vessels in the leg are prone to develop blockages, a process called peripheral vascular disease, so that the flow of blood to the foot decreases over time. In addition, peripheral nerves can be damaged as part of the disease, causing reduced sensation in the foot, making it more likely to inadvertently bang or burn the lower leg. A foot ulcer may then develop, which can become infected and can be difficult to heal because of the poor blood flow.
The Diabetes Foundation of Ireland estimates there are some 200,000 people with diabetes in the Republic. Technically called diabetes mellitus, the disease gets its name from the Greek for excessive urination (diabetes) and from the Latin for honey (mellitus).
There are two types of diabetes: type 1, usually diagnosed early in life, in which the person is unable to make insulin, and type 2, usually occurring in adults (although with the increasing prevalence of obesity, it is occurring in much younger age groups), in which there is some insulin production, but the cells in the body have become resistant to its action, and so blood glucose levels rise.
The purpose of treatment is to keep blood glucose within a tight range. Research has shown that keeping within this range significantly reduces the likelihood of diabetic complications such as eye, kidney and nerve damage. However, when a person manages to keep their blood glucose low, they have a two-three times increased risk of their blood sugar dropping too far (hypoglycaemia) leading to an unpleasant episode of grogginess, irritability and sweating which, if not reversed by a sweet drink or glucose tablet, may lead to unconsciousness.
So, one of the biggest challenges faced by a person with diabetes is to maintain a normal daily life while doing his best to keep a good, tight rein on the disease.
Travelling by air or changing work patterns are just some of the lifestyle challenges confronting people with diabetes.
Research has shown that people who work regular shifts keep good control of their diabetes. However, when changed to a more rapidly rotating shift pattern, their blood glucose levels fluctuate.
What can be done to help? The first move should be to monitor glucose levels more frequently to see if any patterns emerge. Meal planning is also essential. Try to space out meals at four-five hour intervals and keep breaks to set times.
Working an overnight shift involves the greatest disruption to eating patterns. It may be necessary to slightly increase the late evening insulin dose if extra food is taken late in the day.
Air travel can pose particular problems for people with diabetes, especially those taking insulin. One survey of insulin-dependant patients travelling to the tropics found that some 68 per cent developed problems with their metabolism, while more than a quarter had significant difficulties adjusting their insulin regime. Only 36 per cent had increased how often they measured blood sugar levels - one of the most important preventive measures when travelling.
While adjusting the dose of insulin is rarely necessary when crossing fewer than five time zones, the following rule of thumb applies: If you are travelling eastwards, the day will be shortened and so a temporary reduction in insulin may be required. Travelling in a westerly direction, the day is longer and so the insulin dose may need to be increased.
The usual emphasis on tight blood sugar control should be relaxed during flight. It is far preferable for a person's sugar to go temporarily high, than to face an in-flight episode of hypoglycaemia.
Drugs and Therapeutics Bulletin, an independent review of medical treatment for health professionals, suggests the following list of essential items for air travel for a person with diabetes: blood glucose meter (including test strips) and urine testing strips; enough insulin and syringes for the entire trip; a cool bag for insulin (it must be carried in the cabin); other prescription medication; both rapid acting carbohydrates (sweets) and complex carbohydrates (cereal bars); diabetes identification card or bracelet.
Anna Clarke of the Diabetes Foundation of Ireland says it receives regular calls about a whole range of lifestyle issues, including driving, travel and eating out. It can be contacted on Lo-Call 1850 909 909 or at www.diabetes.ie
Dr Muiris Houston is pleased to hear form readers at mhouston@irish-times.ie but regrets he cannot answer individual queries.