Saturday, March 3, 2012

Does everyone require a Blood Sugar test

Unless a conscious sustained effort is made to diagnose Diabetes Mellitus early and, if possible, to detect unknown cases of Diabetes and Pre-diabetes, we will continue to be confronted with unfortunate instances of relatively young individuals succumbing to problems like heart attack and only then discovering that they had underlying Diabetes which they were not aware of.

All those who complain of symptoms or show signs commonly associated with Diabetes must have a test done for Diabetes. However, a negative test for Diabetes does not mean that the person will never get Diabetes. It only means that the person does not have Diabetes at the time of testing.

Unless a conscious sustained effort is made to diagnose Diabetes Mellitus early and, if possible, to detect unknown cases of Diabetes and Pre-diabetes, we will continue to be confronted with unfortunate instances of relatively young individuals succumbing to problems like heart attack and only then discovering that they had underlying Diabetes which they were not aware of.

WHO recommends that mass screening to detect Diabetes and even pre-diabetes should include Blood Sugar test for each and every individual. However, for a variety of reasons this may not be feasible in a country like India. Nevertheless, though everybody over the age of 30 years should undergo periodic annual testing for the presence of Diabetes, the following groups of people are at a high risk for Diabetes.

i) All persons manifesting any of the following signs and symptoms like excessive urination, excessive thirst, excessive hunger, weight loss in spite of adequate food intake, undue tiredness and fatigue, tingling or numbness in extremities, burning feet, generalized itching, itching around genital parts in case of women, infection involving genitals in case of men, delayed wound healing, impotence, premature cataracts, visual disturbances etc.

ii) All persons with a family history of Diabetes.
iii) All obese persons, especially those with central obesity, waist-hip (W-H) ratio, approx.>0.95 in men and >0.85 in women, and/ or a Body Mass Index (BMI) >23 to 25 kg/m2
iv) All adults with tuberculosis including atypical presentations, recurrent infections or non-healing ulcers.
v) Those with a history of atherosclerosis and its complications, especially premature heart attacks and brain strokes.
vi) All women with a bad obstetric history, recurrent abortions and those who give birth to large weight babies.
vii) Persons who were large weight babies at birth or very low birth weight babies may also be predisposed to Diabetes.
viii) Persons who show an acute rise in blood glucose levels at the time of physical or mental stress, for example, in situations like acute heart attacks, brain strokes, acute infections, injuries or accidents.
ix) Persons taking drugs which are known to increase blood glucose levels. These include steroids, oral contraceptives, certain diuretics, beta-blockers, etc.

Regarding the methods for detection of Diabetes, it needs to be emphasized that urine test for presence of Sugar should never be taken as an authentic method either for final diagnosis of Diabetes or even for ruling out Diabetes. The diagnosis of Diabetes can only be done by estimating plasma or blood glucose levels in fasting and postprandial/post meal state. In certain cases where the values of blood glucose are found to be higher than those generally expected, an Oral Glucose Tolerance Test (OGTT) may have to be undertaken.

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