Late detection of diabetes often means that at the time of diagnosis complications have already damaging the eyes, kidneys and nerves. These complications are costly in the physical, financial and psychosocial sense. Early detection and treatment of diabetes may not only improve glycemic control, but also improves blood pressure and lipids. Who should be screened? In general all adults should be screened at regular intervals

•Blood pressure check up, regular at every visit for Hypertension (High blood pressure) - should be <130-80 mm/hg,
•Lipids test (Bad cholesterol(LDL),Low good cholesterol(HDL)& ,high triglyceride) , Check-up : six months once-Should be LDL <100,TGL <150 &HDL >40
•An electrocardiogram (ECG), that provides information about the status of heart
•Chest X ray, information about the lungs and shape of the heart and vascular system (aorta and blood vessels)
•Carotid Intima-media Thickness (IMT), marker of  early atherosclerosis

Diabetic Nephropathy (Kidney Damage): Person with diabetes are several times more prone to kidney disease than the general population. The earliest manifestation of kidney damage is microalbuminuria, (tiny amounts of protein called albumin are found in the urine). Symptoms include Protein in the urine, High blood pressure, burning during urination, frequent urination, puffiness and swelling around the eyes, hand & feet, excessive itching, nausea, vomiting & weakness.

About 20% of type 2 patients show evidence of microalbuminuria upon diagnosis of diabetes, however, only a small percentage of type-2 diabetics eventually develops kidney disease. Microalbuminuria typically shows up in type 2 diabetics who have high blood pressure. Normal: <30;

Microalbuminuria: 30-299 (earliest stage) Macroalbuminuria: ≥300 (progression to End Stage Renal Disease (ESRD)) screening test: Microalbuminuria, Protein (urine) Creatinine, urea (blood) Diabetic Neuropathy: (Nerve damage) All patients should be examined for loss of sensation (neuropathy). The symptoms of neuropathy depend on which nerves and what part of the body is affected. It include: numbness or insensitivity to pain or temperature; tingling, burning, or pricking; sharp pains or cramps; sensitivity to touch; loss of balance and coordination. Symptoms can get worse at night.

Peripheral neuropathy affects the feet and hands and autonomic neuropathy affects the internal organs. Neuropathy is diagnosed by the use of very simple devices like Biothesiometer & Monofilament test, performed by trained technicians. These tests are very simple and in-expensive. ABR index < 0.8 indicates normal.

Diabetic Foot examination: Foot problems are important cause of morbidity in diabetic people and they should be examined for reduced blood flow towards limb (legs & feet). Foot problems such as ulceration, infections, necrosis, gangrene and amputation are quite common. These can be diagnosed through a simple device like monofilament (10gm) - to check the foot sensation and Emed pressure measurement system – to check the amount of pressure at various parts of the feet and to predict the changes of getting callus in the feet & Jerk is observed in the ankle & knee using Knee hammer. These test are performed by trained nurses and qualified podiatrist

Diabetic Vasculopathy: When the arteries & veins are affected due to diabetes it is known diabetic Vasculopathy. It shows reduced blood flow towards the limbs. It is examined by Doppler test, which record the blood pressure and arterial pulsations in the upper & lower limb and Ankle Brachial Index ABI is measured. This test is Simple, quiet and non-invasive assessment. The vascular system is performed by doctors and trained technicians. ABI index <0.9 indicates normal.

Diabetes-Retinopathy (related eye): Of many complications of diabetes, blindness is perhaps the most feared. Diabetic subjects are twice to develop eye problems and 60% of those having diabetes for >15yrs will develop diabetic retinopathy in their lifetime. Who are more prone to Diabetic retinopathy? : Uncontrolled blood sugar, longstanding diabetes, Hypertension with diabetes & Genetic predisposition.

What are the stages of retinopathy? : Mild non proliferative diabetic retinopathy (NPDR), Moderate-non proliferative diabetic retinopathy, severe retinopathy, Maculopathy and Proliferative diabetic retinopathy. Treatment: Retinopathy can be treated through laser photocoagulation. Screening test: Patients with diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist right from the day of diagnosis of diabetes and every year thereafter. Early detection, timely treatment, appropriate screening and care reduce the risk of vision loss & 90% of diabetes related blindness.

All patients should be regularly screened for risk factors and encouraged at each health care visit to pursue a healthy lifestyle that includes a healthy diet, adequate exercise, weight control and stress reduction. ‘Try for good control to be sure, but don’t try for perfection. Perfection lasts for a moment, and diabetes lasts a lifetime’. The main theme is to be focus on to ‘live a Healthy Life Despite Diabetes’.

Radhika. G Research Nutrionist

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