Chronic care diabetes
How to manage diabetes Image Credit: Shutterstock

Three cornerstones of good diabetes treatment are medication for effective control of blood sugar, cholesterol and hypertension, lifestyle changes including stopping smoking, a healthy diet and regular physical exams, and regular screening to assure early diagnosis of organ complications.

Cardiovascular disease

High blood sugar levels damage blood vessels in your heart as well as nerves that control the organ.

Reduce the risk by managing your ABC

HbA1c: A parameter that measures blood sugar control over the past three months, HbA1c should be kept below 7 per cent. It can be controlled by medicine, diet and exercise

Blood pressure: In diabetics, hypertension plays a critical role in the development of cardiovascular disease. So keep it below 140/80mmHg

Cholesterol: High levels of fats in the blood may cause narrowing of the blood vessels that feed your heart and brain

Diabetic retinopathy

Diabetic retinopathy involves changes to the retinal blood vessels that can cause them to bleed or leak fluid, impairing vision. It is the most common reason for vision loss among diabetics and the leading cause of blindness among adults. Once symptoms appear, they are irreversible.


Spots or dark strings floating in your vision (floaters)

Impaired colour vision

Dark or empty areas in your vision

Complete blindness

Annual eye screening is advised for early detection. Careful management of diabetes is the only way to prevent or limit eye complications. Early detection, timely treatment and rigorous follow-up can reduce the risk of blindness by 95 per cent.

Stay on TRACK to protect your vision

Take your medication as prescribed by your doctor

Reach and maintain a healthy weight

Add more physical activity to your daily routine

Control your HbA1C, blood pressure, cholesterol levels

Kick smoking to lower the risk

the risk

Diabetic nephropathy

Caused by the damage of blood vessel clusters (glomeruli) and other specific cells in the kidney, the condition develops slowly over many years, successively impacting the function to the level of end-stage kidney failure. Early diagnosis is critical to avoid or at least delay the onset of severe, often irreversible, complications.

Early and late symptoms

Increase in the level of urine albumin (microalbuminuria)

Rise of blood potassium (hyperkalemia)

Worsening of blood pressure control

Less need of insulin or diabetes medicine

Fatigue, confusion, difficulty concentrating

Loss of appetite

Nausea and vomiting

Increased need to urinate

Persistent itching

Fluid retention (swelling in arms and legs)

Pulmonary oedema (fluid retention in the lungs)


Irreversible damage of the kidney function with the need for dialysis or kidney transplant

Gum disease

Increased blood sugar levels in the saliva promote plaque build-up. Acids in the plaque attack surrounding tissue and lead to cavities. If plaque is not removed with regular brushing, it will harden under the gum line and build tartar. Over time, the gum gets swollen and bleeds easily, causing gingivitis. If left untreated, gingivitis can lead to a serious infection called periodontitis, destroying the soft tissue and bone that support the teeth. Severe periodontitis may also cause blood sugar levels to rise, which makes diabetes more difficult to be controlled.

A vicious circle begins with the risk of loss of tooth. Pregnant diabetic women are at a particular risk of this complication.

Action plan for dental health

Rigorous commitment to diabetes management

Use a smooth toothbrush and dental floss

Have annual consultation with your dentist to remove all plaque and treat inflammation and cavities

to remove all plaque and treat inflammation and cavities

Diabetic foot

Symptoms of diabetic foot can range from cool, pale feet, blue discoloured toe and pain or cramps in the feet when walking, to the development of chronic ulcers and gangrene. Every diabetic should have a daily self-care regime to protect the feet. Annual screening consultations by a specialised dermatologist can identify the smallest signs of a complication at an early stage. It can allow the immediate start of treatment to prevent more severe complications.


Examination of foot circulation (checking foot pulses, Doppler ultrasound)

Sensitivity assessment

for pressure and vibration (using a tuning fork) and heat and cold

Assessment of nerve function, skin and nails

Inspection of the foot skeleton for malformation


General physical activities (fitness for your feet)

Medication (anti-inflammatory and vasodilatation, infection control)

Dressing of chronic wounds

Revascularisation (surgically or through interventional radiology)

Surgical debridement, skin craft and amputation


Diabetes can also lead to diabetic encephalopathy, a substantial impairment of the functioning of the brain, which depends on oxygen and blood sugar to function.


Low blood sugar levels can impact mood and thinking or more severely lead to dizziness, unconsciousness or a coma. However, the condition usually can be reverted immediately by glucose intake.


High blood sugar levels over a long period can damage the blood vessels of the brain. This can lead to mental impairment, ranging from mild cognitive impairment to the development of end-stage dementia. Stick to the principles of a modern holistic diabetes management programme to prevent this complication.