Diabetes mellitus is a chronic disease that is very common in Anguilla. Many people can live successful lives with this disease once it is fully controlled, but in many cases the disease is not well controlled and many preventable complications develop that can have devastating effects for the individual and can have severe financial costs for the health care system of the country.

Types of diabetes
Type 2 diabetes is the most common type of diabetes found in Anguilla, but there are some cases of type 1 diabetes.
Type 2 diabetes is a group of related disorders with distinct pathogenic mechanisms. Hyperglycemia (high blood glucose levels), the common denominator, is associated with obesity, hypertension, and peripheral vascular disease. The primary defect in type 2 diabetes is insulin resistance.
Diabetes is associated with such conditions like coronary heart disease, stroke, blindness and kidney failure especially in individuals who are poorly controlled.

Aims of treatment
Diabetes treatment aims should be the following:
• To alleviate symptoms
• Reduce the effect of long term complications and
• To maintain quality life.

Alleviating symptoms
The vast majority of individuals with diabetes feel better once treatment has started. Many individuals with diabetes do not have any symptoms, and studies indicate that most people will experience symptoms only when their glucose levels are above 12 mmol/L. Individuals do not “know” when their blood sugars are running high. They will only know if they actually measure their blood glucose levels.

Reducing long term complications
Strict long term glucose control is known to reduce the incidence of complications associated with diabetes.
Complications of diabetes are classified as microvascular (small blood vessels) and macrovascular (large blood vessels).
Microvascular complications include retinopathy (disease of the eye), nephropathy (disease of the kidneys) and neuropathy (disease of the nerves).

All individuals with diabetes should aim to lower their blood glucose levels sufficiently to prevent complications associated with chronic hyperglycemia (high blood glucose levels) while also limiting hypoglycemic episodes. Individuals with type 2 diabetes should aim to have the following:
HbA1c concentrations less than 7%
Fasting plasma glucose levels 5.0 to 7.2 mmol/L (90 to 130 mg/dL)
2-hour postprandial plasma glucose levels less than 10mmol/L (180mg/dL).

Management of type 2 diabetes
In all patients with diabetes the first step in mangement is still diet and exercise. Individuals with diabetes must have adequate information on appropriate diets and should be involved in regular exercise. 10% of patients with type 2 diabetes can obtain good control with diet and exercise only, the others will require medications. All individuals with diabetes should have regular medical check-ups and be monitored for complications of this disease. All individuals with diabetes must be encouraged to do blood glucose monitoring. Ideally these should be done two hours after meals. (Testing frequency depends on treatment goals.) Blood glucose monitoring gives patients better glucose control and allows for adjustments in their treatment. Glucose monitoring machines are simple to use and the vast majority of individuals can use them successfully at home. Individuals are encouraged to record their blood glucose results and bring them to their doctor when they come for their check-ups so that treatment goals can be evaluated.

Conclusion
Diabetes mellitus is a very common disorder in Anguilla and the incidence continues to increase. This chronic disease can be successfully controlled and many of the complications associated with this disease such as heart attacks, amputations, kidney failure and blindness can be prevented or decreased if blood glucose levels are lowered to accepted levels.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.

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