2. Professor of Veterinary Biomedical Sciences, University of Saskatchewan, Saskatoon, Canada.
The dilemma concerning the prevailing classification of Type 1 and Type 2 diabetes is a serious hindrance to effective diabetes care. Many patients who are classified with Type 2 diabetes have symptoms and require treatment similar to those classified with Type 1 diabetes. In addition, patients are often diagnosed with diabetes as a result of elevated fasting blood glucose instead of 2-hour postprandial glucose levels or oral glucose tolerance tests. The misdiagnosis of diabetes accompanied by prescription of oral hypoglycemic agents or antihypertensive therapy, have caused unwarranted health problems in people who may not have diabetes.
In this article, patients are presented who illustrate the misdiagnosis of diabetes and the need of proper testing to uncover diabetes. Additional case histories indicate the effect that oral hypoglycemic agents and antihypertensive medications may have on patient health. Suggestions are made regarding proper diagnosis and care. In patients with established diabetes, adequate control of glycemia with insulin, diet restriction and weight reduction, fundamental to prevention of microvascular and macrovascular complications, is stressed. Hospitalizations are preventable if professionals spend time explaining details of diabetic care to patients thereby enabling them to take full responsibility of their illness. Glucose control with insulin therapy, concomitantly with means for weight reduction in obese individuals, must be discussed in a repetitive fashion with the patient. Uncontrolled diabetes, resulting in frequent hospitalizations for a variety of complications, has markedly escalated the cost of diabetic care. Patient education and cooperation are the cornerstone of successful diabetes therapy and the mainstay of prevention of diabetes complications. Thereby, the cost of diabetes care will be reduced.
The classification of Type 1 and Type 2 diabetes conveys little to the patients about diabetes which is a potentially devastating disease, nevertheless, with full attention to glucose control, healthy living is attainable. Utmost care should be taken to identify if the person does or does not have diabetes by appropriate testing and attention to proper therapy.
Keywords: Diabetes, insulin therapy, 2-hour postprandial glucose, glycosylated hemoglobin, oral glucose tolerance test