Month: October 2025

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Hyperglycemia induced by steroids is a prevalent but sometimes ignored side effect of corticosteroid treatment. When steroids like prednisone or dexamethasone are used to treat If they have inflammation or autoimmune illnesses, they might upset the body’s glucose balance, resulting in high blood sugar levels. Because this illness can manifest in people with and without diabetes, it’s crucial to raise awareness and keep an eye on it. Knowing the causes, signs, and management of steroid-induced hyperglycemia is essential for avoiding problems and preserving general health during steroid treatment.

What Is Steroid Induced Hyperglycemia?

The transient increase in blood glucose levels caused by the use of glucocorticoid drugs is known as steroid-induced hyperglycemia. Regardless of a person’s prior history of diabetes, this can happen. It may occasionally induce steroid-induced diabetes, a form of diabetes that develops for the first time.

How steroids cause high blood sugar

Steroids affect the body’s glucose metabolism by several mechanisms, which increase blood sugar: 

• Steroids cause insulin resistance: It lessens the sensitivity of fat and muscle cells to insulin and thus reduces glucose absorption from the blood. 
• Increasing blood sugar: Steroids stimulate the liver to generate more glucose from its stored glucose (a process called gluconeogenesis), hence raising the amount of sugar in the blood. 
• Large doses of steroids: It may impede the pancreas from producing and releasing enough insulin to regulate the increased blood glucose levels.

Factors that influence the risk

The likelihood and severity of steroid-induced hyperglycemia depend on several factors, including: 

• Steroid dosage: Higher dosages of steroids increase the chance of hyperglycemia. 
• Treatment time: Longer-term steroid usage raises the possibility of blood sugar control issues. 
• Those at a higher risk of getting steroid-induced hyperglycemia include older individuals, those with a greater body mass index (BMI), those who have Have previously had gestational diabetes or have diabetes running in their family. 

Signs and Symptoms to Watch For

Though they may not be apparent in minor cases, typical symptoms and indicators of steroid-induced hyperglycemia are comparable to those of other kinds of diabetes. One important distinction to look for is that these symptoms are usually most severe in the evening and late, when the steroid’s impact on blood sugar peaks.

Key signs and symptoms

These symptoms can begin during steroid treatment and are important to monitor:

• Polydipsia—increased thirst: High blood sugar draws fluids from your tissues, leaving you extremely thirsty. 
• Frequent urination (polyuria): As your kidneys work to clear away excess sugar, you will need to urinate more often, especially at night. 
• Fatigue or weariness: If you lack sufficient insulin to assist your cells in absorbing glucose for energy, you could feel extraordinarily feeble or weary. 
• High blood glucose can cause the lens of your eye to swell, therefore impairing your eyesight. 
• Unexplained weight loss: You could lose weight even if you have a greater appetite, as your body cannot properly utilize sugar for fuel. 
• Headaches: High blood sugar can trigger headaches in some people. 
• Common consequence of excessive thirst and urination is dry mouth. 

Diagnosing Steroid Induced Hyperglycemia

Standard diabetes criteria are used to diagnose steroid-induced hyperglycaemia (SIH), but the patient’s steroid use is taken into account. Frequent blood glucose monitoring underpins the diagnosis because a patient’s glycemic profile on steroids might vary greatly from that of normal diabetes.

Key diagnostic considerations 

• A distinguishing characteristic of SIH is that it mostly causes high blood sugar following meals, especially in the afternoon and evening. Although a morning fasting glucose test could seem normal, it is a bad screening mechanism for this condition. 
• Limitations of Hemoglobin A1c (HbA1c): New-onset SIH’s dependable early diagnostic instrument is hemoglobin A1c (HbA1c). It will not show a recent surge brought on by steroids; rather, it measures average blood glucose over the past two to three months. Still, it can be helpful for long-term surveillance or for differentiating new-onset from pre-existing diabetes.
• Risk factors: High-risk patients should be monitored closely. These factors include:
  • High steroid dosage and longer duration of treatment.
  • Advanced age.
  • Higher body mass index (BMI).
  • Pre-existing impaired glucose tolerance, prediabetes, or gestational diabetes.
  • Family history of diabetes. 

Diagnostic monitoring strategy 

The Joint British Diabetes Societies (JBDS) and other guidelines recommend the following monitoring approach for patients on glucocorticoids: 

Initial screening 

• For patients not diabetic: Daily capillary blood glucose (CBG) testing should be performed. Timing is essential; assess hyperglycemia’s most probable occurrence before or after dinner or meal. 
• For patients with pre-existing diabetes: Right after beginning steroid therapy, four times daily (before each meal and at bedtime), CBG testing should be increased. 

Confirmation of diagnosis

The following glucose readings indicate significant hyperglycemia: 

• Random plasma glucose (any time): ≥11.1mmol/L (≥200mg/dL)
• 2-hour post-75g oral glucose tolerance test (OGTT): ≥11.1mmol/L (≥200mg/dL). 

Treatment and Management Strategies

Lifestyle adjustments include diet and exercise are part of management of steroid-induced hyperglycemia; insulin is the main treatment for persistent elevated blood sugar. With a basal-bolus regimen being flexible or a simpler basal insulin for novices to insulin, the insulin regimen should be customized to the person. Adjustments are essential: the insulin dosage must be lowered as the steroid dose falls to avoid hypoglycemia.

Management strategies 

• Lifestyle modifications:

Initial steps include diet counseling and exercise to help manage post-meal glucose spikes. 

• Particularly levels above 200mg/dL, insulin therapy is the best treatment for persistent hyperglycemia. 
• Flexible choice including basal, prandial, and corrective dosages known as basal-bolus insulin. 
• For those just starting insulin, using a once-daily basal insulin (such as NPH with morning breakfast for once-daily prednisone) is sometimes helpful. 
• The current insulin dose may need to be raised. With a maximum of 0.4, a conventional guideline is to add 0.1 units per kg of body weight for every 10 mg of prednisone equivalent. Units/kg/day, and to lower this extra dosage by the same amount as the steroid dose is decreased. 

Oral agents: Oral hypoglycemic agents may be used, but insulin is often preferred due to the unpredictable nature of steroid-induced hyperglycemia. Sulfonylureas have a risk of hypoglycemia if meals are missed. 

You may also like to read: ADA Diabetes Guidelines

Preventing Steroid Induced Hyperglycemia

Preventing steroid-induced hyperglycemia (SIH) primarily involves proactive monitoring and management of blood glucose levels, especially in patients starting glucocorticoid therapy.

Key Strategies for Prevention

• Pre-steroid screening of at-risk patients (including HbA1c, random blood glucose, and renal function) and encouragement of frequent glucose monitoring during therapy will help. on postprandial glucose following lunch, as steroids commonly cause major post-meal hyperglycemia. 
• Start insulin treatment on the same day as steroid administration for better glycemic results, especially in individuals with high steroid doses or pre-existing conditions. Diabetes. Scheduling insulin kinds to coincide with steroid pharmacokinetics—e.g., NPH insulin with prednisone—helps to include steroid-induced glucose deviations. 
• Oral medications: In mild or outpatient situations, some oral antihyperglycemic medicines like metformin or insulin secretagogues may be utilized with care to enhance insulin sensitivity and Although insulin is still the favored option in hospitalized or severe cases, decrease insulin resistance. 
• Patients should eat consistent meals including starchy carbohydrates, refrain from skipping meals, and restrict sugary foods to lower glycemic spikes, therefore promoting more stable blood levels. 
• Dynamic modification of insulin doses with steroid dose fluctuations—for instance, cut insulin by half the percentage reduction in steroids during tapering to avoid hypoglycemia— 
• Highlight self-monitoring of blood glucose, awareness of hyperglycemia symptoms, and knowledge of insulin adjustment procedures to give patients control over SIH.

Bottom Line

Early detection and appropriate treatment of steroid induced hyperglycemia make it a manageable disease. Proper medical treatment, changes in diet, and consistent blood glucose monitoring can help minimize the hazards associated with steroid consumption. Whether temporary or long-term, managing blood glucose levels during steroid treatment is essential for general health and successful therapy. Consulting a medical professional guarantees secure steroid use and correct control of any blood glucose swings.

FAQs

How long does hyperglycemia last after prednisone?

Commonly ordered corticosteroids include dexamethasone, prednisone, and hydrocortisone. While dexamethasone can last from 12 to 36 hours, prednisone can cause hyperglycemia within four hours and might last up to 12 hours.

Is steroid-induced diabetes reversible?

Often used in cancer therapy, Dexamethasone (a steroid drug) might cause this. Usually, a transient state is steroid induced diabetes. Your blood sugar will typically return to normal once you discontinue Dexamethasone.

What foods are good for steroid-induced diabetes?

Select whole-grain or granary varieties of bread, cereal, rice, and pasta whenever you can; these foods are rich in fibre. Keep sugary foods to an occasional treat (including biscuits, sweets, chocolate, jams, cake, ice-cream, and sugary beverages), as these will cause your blood sugar levels to rise fast.

How to flush prednisone out of your system?

Stay hydrated: Drinking plenty of fluids helps your kidneys as they clear prednisone. Exercise improves blood circulation and metabolism. This aids your system to effectively process and removing medicines. Still, pay close attention to your body.

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Diabetes is a common chronic health problem with millions of people annually across the globe. In order to provide consistent, evidence-based care to people with diabetes, the American Diabetes Association (ADA) issues annual guidelines, referred to as the ADA Diabetes Guidelines. These guidelines act as the cream of healthcare givers, providing current methods of diagnosis, prevention, treatment, and general management of diabetes. With these systematic standards, the patients and the professionals can collaborate to achieve improved blood sugar management, fewer complications, and quality of life.

What Are the ADA Diabetes Guidelines?

The American Diabetes Association (ADA) diabetes guidelines are annual updates published in the “Standards of Care in Diabetes” that cover a wide range of topics, including diagnosis, lifestyle, and medical management. Current lifestyle guidelines are at least 150 minutes a week of moderate-vigorous physical exercise, breaking long sitting, strength training, and six or eight hours of sleep per night. An HbA1c level of 6.5% or greater is the diagnostic threshold, with lower levels not ruling out a diabetes diagnosis through glucose tests. 

Key areas covered by the guidelines

• Diagnosis: An HbA1c of 6.5%or higher is a key diagnostic criterion. 
• Physical Activity:
  • At least 150 minutes of moderate to vigorous physical activity per week. 
  • Avoid prolonged sitting by breaking it up every 30 minutes. 
  • Include strength training, especially when using incretin therapies. 
• Sleep: Aim for six to eight hours of sleep per night. 
• Dietary Modifications: Includes guidance on nutrition for managing blood glucose. 
• Management of Complications: Guidelines address monitoring and managing complications such as hypertension, dyslipidemia, and neuropathy. 
• Medication: Provides guidance on various antidiabetic medications, including Biguanides, SGLT2 Inhibitors, and GLP-1 Agonists. 

Criteria for Diagnosing Diabetes

According to the American Diabetes Association (ADA), a diagnosis of diabetes is confirmed by one or more of the following criteria: an A1C of 6.5% or higher, a fasting plasma glucose (FPG) of 126 mg/dL (7.0 mmol/L) or higher, or a two-hour plasma glucose of 200 mg/dL (11.1mmol/L) or higher during an oral glucose tolerance test (OGTT). A random plasma glucose level of 200 mg/dL (11.1 mmol/L), or higher can also diagnose diabetes in a patient with classic symptoms of hyperglycemia. If test results are not unequivocally high, a second test is required for confirmation. 

Glycemic Targets and Monitoring

Glycemic targets are individualized objectives of blood sugar level, and the typical targets of most adults include an A1C under 7, a post-meal plasma glucose under 180, and a pre-meal plasma glucose range of 80-130. It entails periodic blood glucose monitoring through a finger-prick or continuous glucose monitors (CGMs) to monitor progress, treat and coordinate the care plan with a healthcare team to change the care plan as necessary.

Glycemic Targets and Monitoring

Glycemic targets for most nonpregnant adults

• A1C: Less than 7% (53 mmol/mol)
• Before a meal (preprandial) plasma glucose:  80-130 mg/dL (4.4–7.2 mmol/L)
• 1-2 hours after a meal (postprandial) plasma glucose: Less than 180 mg/dL (10.0 mmol/L) 
• Glycemic Targets and Prevention of Complications

Many professional organizations recommend HbA1c targets between 6.5% and 7%. The American Diabetes Association (ADA) re…

Monitoring your blood glucose

• Self-monitoring: Consistently measure your blood sugar with a finger-prick or a continuous glucose monitor (CGM). 
• Record results: Record your readings and record any circumstances that may have influenced the results, as well as food, activity, and stress. 
• Frequent A1C tests: Have your A1C tested twice or four times a year to determine what is happening with your average blood sugar level in the past three months. 
• Interpret your findings: Thesis: Use your blood glucose diary to determine patterns, including high or low levels at specific times of the day. 
• Managing Diabetes: Monitoring Blood Sugar

Adjusting your care plan

• See your doctor: Meet with your doctor or diabetes educator to interpret your findings and decide whether to change your plan of care.
• Expect changes: It can be slow to achieve the balance of managing diabetes.
• Talk to your doctor: Ask your doctor whether you should report any blood glucose results that are beyond a specific range you should report by phone at once. 

Important considerations

• Individualization: These are broad guidelines. Depending on your personal age, health conditions, among others, more or less stringent objectives could be suitable. 
• Hypoglycemia: Pay attention to hypoglycemia (low blood sugar) and talk about its signs, prevention, and treatment with your medical team. 
• Alternative monitoring: In cases of the hard interpretation of A1C, alternative methods such as fructosamine or glycated albumin are acceptable. 

Lifestyle and Nutritional Recommendations

The healthy lifestyle of diabetes patients should consist of a balanced diet with high levels of vegetables, lean proteins, and whole grains, and have a lower amount of processed foods, sweet drinks, and unhealthy fats. Exercise (150 minutes of moderate aerobic activity each week) is also essential in the control of blood sugar. 

Nutritional recommendations

• Eat more vegetables and fruits: Have a minimum of three daily servings of vegetables and 3 servings of fresh fruit. 
• Select whole grains: It has been shown that consuming whole grains such as breads, brown rice, and whole oats rather than refined whites is a better choice, as it boosts fiber intake. 
• Focus on lean protein: Fish, poultry (skinless), beans, lentils, eggs, and nuts. Reduce red and processed meat, such as bacon, sausages, and ham. 
• Include healthy fats: Select unsaturated fats such as olive oil, canola oil, corn oil, and nuts. Limit saturated fats of butter, ghee, animal fat, coconut oil, and palm oil. 
• Eat healthy snacks: The best alternatives are nuts, a piece of fruit, or plain yogurt. 
• Keep hydrated: Take water, unsweetened tea, or coffee in large amounts. Soda, juice, sports drinks, and alcohol should be avoided, and alcohol intake should be limited. 

Lifestyle recommendations

• Apropos exercise: Get at least 150 minutes of moderate aerobic exercise in a week: walk briskly or swim. 
• Stick with a regular eating routine: Have regular meals and snacks to aid in stabilizing blood glucose levels. It can be healthy to have smaller and more frequent meals. 
• Train practice portion control: Be mindful of portions to aid in controlling blood glucose. 
• Cook healthily: Replace frying with steaming, poaching or boiling. 
• Be conscious of carbohydrates: Learn to keep in mind that the sources of carbohydrates in food, such as fruits, beans, and starchy vegetables, can lead to elevated blood sugar levels. Control carb intake by planning your meals. 
• Label food: When purchasing packaged foods, look at the food label to get low-fat, low-sodium, and low-sugar. 

Pharmacologic Management

The ADA guideline recommends the use of metformin as the initial agent of pharmacologic treatment unless contraindicated. A GLP-1 receptor agonist or SGLT2 inhibitor is advised to add cardiovascular benefit to patients with established atherosclerotic cardiovascular disease (ASCVD), heart failure, or chronic kidney disease (CKD), regardless of the levels of A1C. The treatment must be patient-centered, and the other agents or insulin may be combined with metformin depending on the needs of the patient, his blood glucose level, and other comorbidities. 

Initial pharmacologic therapy

• Metformin: It is the first-line treatment of type 2 diabetes because it is effective, safe, and low risk of hypoglycemia, in addition to its positive impact on A1C. 
• Carry on metformin: Metformin should be continued as long as it is tolerated and not contraindicated, and other agents should be added to it as required. 

Therapy based on comorbidities

• ASCVD, heart failure, or CKD: A glucagon-like peptide-1 (GLP-1) receptor agonist or sodium-glucose cotransporter 2 (SGLT2) inhibitor with established cardiovascular benefit should be included in the regimen of patients with these conditions. This is advised irrespective of the A1C level and it is patient-specific.

You may also like to read: Role of Healthcare Providers in Diabetes Management

Key Updates in the 2025 ADA Diabetes Guidelines

The recent American Diabetes Association (ADA) Standards of Care in Diabetes focus on the continued expansion of the continuous glucose monitoring (CGM) to generalized use, increased recommendations of the GLP-1 receptor agonist, and a more comprehensive approach to patient-centered care. 

Technology and monitoring

The 2025 guidelines introduce several key updates regarding diabetes technology. 

• The enlarged use of CGM in type 2 diabetes: The ADA is the first to suggest CGM should be considered in adults with type 2 diabetes, regardless of whether they are on insulin therapy. It aims to offer more information on the daily glucose pattern, enhance glucose control and minimize complications.
• Time in Range (TIR) measurements: The guidelines identify TIR by CGM as an important measure of glycemic control, particularly in older adults, in addition to the conventional A1C.
• Open-source system support: The ADA is now officially in favor of the use of open-source automated insulin delivery (AID) systems or DIY closed-loop systems to manage diabetes.
• Previous CGM of type 1 diabetes: In individuals with diabetes, the guidelines recommend the use of CGM as early as possible, whether diagnosis or diagnosis, to assist the management of the condition.

Bottom Line

Finally, the ADA diabetes guidelines offer an essential basis of efficient diabetes management with focus on prevention, personalized treatment, and lifelong learning. These evidence-based recommendations will help healthcare professionals provide more effective assistance to their patients, and individuals with diabetes may take active measures to control their disease. By keeping up with the ADA updates, one is bound to be in a position to make healthier and better-informed decisions.

FAQs

What is the latest ADA guideline for diabetes?

Significant changes to the Standards of Care in Diabetes -2025, are: The use of a continuous glucose monitor (CGM) in adults on glucose-lowering agents other than insulin should be considered. Instructions to follow when there are situations of unavailability of medication, like medication shortages.

What are the new guidelines for HbA1c?

An HbA1c of 6.5% is recommended as the cut point for diagnosing diabetes. A value of less than 6.5% does not exclude diabetes diagnosed using glucose tests.

When to repeat HbA1c to confirm diabetes?

National guidance advises a repeat within two weeks. The second result is often lower! Both must be ≥48 mmol/mol to diagnose diabetes; if discordant, the lower result is used.

Can you have a normal HbA1c and still be diabetic?

Yes. A blood glucose test may reveal diabetes in certain individuals when an A1C test does not. This can also be reversed, an A1C test can show diabetes, but not a blood glucose test.

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Diabetes is a lifelong disorder that demands constant attention, lifestyle changes and medical follow-ups. Treatment of diabetes is not just about medication and requires a collaborative approach between different healthcare professionals. Healthcare professionals are instrumental in enabling people to sustain optimal blood sugar levels having prevented complications. They also enhance their overall quality of life through diagnosis and treatment, education, and emotional support.

The Multidisciplinary Team Approach

The multidisciplinary team (MDT) approach is a useful and interactive model of dealing with complex and chronic diseases such as diabetes. It unites a team of multidisciplinary experts to offer comprehensive, patient-centered care. They treat the entirety of the health of a person-medical, physical, psychological, and social. This joint approach will result in improved treatment regimens, health, and quality of life in a person with diabetes.

Key advantages of the MDT approach

• Integrated, multidisciplinary care: An MDT goes beyond paying attention to blood glucose management, and the comorbidities, psychological, and lifestyle influences. The team disseminates the knowledge and expertise to develop a unified, stable plan that minimizes disjointed care and minimizes miscommunication.
• Revenue cycle: insight- The following improvements may be achieved through a coordinated team approach: better glycemic control (lowering HbA1C levels), reduced hospitalization, and decreased risk of diabetes complications such as heart, kidney, and eye disease.
• It improves patient engagement and education: The MDT trains patients and empowers them, allowing them to make better decisions and actively participate in their self-management. Having several professionals on board helps patients to remain active regarding their treatment plan and to resolve any issues.
• Efficient resource utilization: MDT decreases duplication of tests and unnecessary procedures through an optimal use of resources, which is more efficient in terms of resource utilization and, in the long term, the price of health care. 

Members of the diabetes MDT

The patient is the key team member and must be central in all the decisions. The other members usually involve:

Primary Care Provider (PCP): This is the central figure who arranges the treatment, oversees the general state of health and refers to specialists.

Endocrinologist: A specialist in endocrine system who is essential in handling complex cases, e.g. insulin pump therapy or lack of glycemic control.

Registered Dietitian Nutritionist (RDN): A specialist, who gives medical nutrition therapy and assists patients to create and adopt a balanced, healthy meal plan.

·       Certified Diabetes Care and Education Specialist (CDCES): Educates patients on how to manage their own health by monitoring blood sugar levels and taking drugs and assists them in creating a self-care plan.

Registered Nurse: Administrates professional nursing care, organizes patient requirements, and informs patients and families on how to deal with the condition.

Pharmacist: Makes sure that patients know their drug routine and can give advice concerning possible side effects and interactions with other drugs.

Mental Health Professional: A psychologist or a counselor who assists patients to deal with the emotional and psychological weight of having a chronic condition.

Podiatrist: A foot doctor who examines and manages foot and lower limb issues, widespread diabetes complications.

Optometrist/ Ophthalmologist: This is a doctor with eye specialization that screens diabetic retinopathy and other eye conditions that are associated with diabetes.

Enhancing Patient-Provider Communication

Improvement of patient-provider communication in diabetes care is essential to enhance the outcomes of patient self-care, treatment, and patient satisfaction. The application of e-clinical technologies (smartphones, email, and text messages) to stay in constant contact, employing patient-centered communication (focus on active listening, empathy, use of simple language, and motivational interviewing), and ensuring a supportive and trusting relationship (collaborative goal setting and psychological support) are effective strategies.

You may also like to read: Importance of Diabetes Education for Patients and Families

Key Strategies for Improving Communication

• Use of Electronic Communication: A lot of patients with type 2 diabetes are open to communication via smartphones, emails, and texts with their healthcare providers, particularly as a reminder of medication, scheduling appointments, and receiving clinical guidance. This continuous interaction aids in enhancing interaction and management of diseases.
• Patient-Centered Communication (PCC): PCC is caring about the entire patient, who triggers their views, interests, and objectives and participates in mutual decision-making. It helps achieve openness, trust and autonomy, which contributes to improved glycemic control and self-efficacy. Adherence and motivation can be improved with such techniques as motivational interviewing using reflective questions and affirming patient statements.
• Effective Communication Techniques: It is important to listen to active listening, watch body language, give simple and clear information with visual aids, and allow patients to speak. Restating important points and ensuring comprehension by making patients restate what they have heard is clear. Patient-centered language that acknowledges patient work and establishes relationships also promotes compliance.
• Psyological Support: Patients are better able to adhere to treatment plans and lifestyle change, the process of which is enhanced by addressing emotional obstacles by communicating with the patient empathetically using a non-judgmental tone.

Benefits of Enhanced Communication

Enhanced patient-provider communication has been linked to improved self-management diabetes, better glycemic control, higher patient motivation, and satisfaction. Patients who perceive their providers as good communicators tend to have better adherence to medication and lifestyle recommendations, reducing complications associated with diabetes.

Bottom Line

To conclude, healthcare professionals should collaborate to provide holistic, patient-centered care to manage diabetes. All the professionals, physicians and nurses, dietitians and mental health specialists, are crucial in helping patients to achieve more control and healthier results. By working together, learning, and providing ongoing care, the health team helps them to manage their own condition and lead a healthy life with diabetes.

FAQs

Why is a team approach important in diabetes care?

Having a multidisciplinary team means that the medical, nutritional, and emotional components of diabetes are considered to achieve better and holistic care.

How do primary care physicians support diabetes patients?

Primary care doctors diagnose diabetes at an early stage, establish treatment objectives, track health indicators, and direct the patient to specialists in case of need.

What does an endocrinologist do for diabetes management?

Endocrinologists are experts in diseases that are related to hormones and may assist with complex or uncontrolled diabetes that require advanced insulin therapy.

How can diabetes educators and nurses help patients?

They teach patients how to monitor blood glucose, use insulin properly, make lifestyle changes, and stay motivated through continuous support.

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Diabetes is a life-long disease that needs regular attention, consciousness, and lifestyle control. To patients and their families, knowledge of coping with diabetes can be the difference between complications and better quality of life. Diabetes education equips one with knowledge and skills to check blood sugar, eat healthily and stick to treatment plans. In addition, actively engaged families make crucial contributions to ensuring improved health and emotional health.

Understanding Diabetes Education

Diabetes education helps individuals with diabetes along with their families in managing the illness by informing them about the disease, blood sugar, nutrition, exercise, and medication with the result of sustaining self-management and enhancing overall well-being. It discusses the various forms of diabetes, blood sugar monitoring, eating well with healthy eating techniques such as plate method or counting carbs, physical activities, and proper medication use.

What is Diabetes Education?

Empowerment 

It will seek to enable people to know how food, exercise, and medications relate to their blood sugar levels so they can make their own choices regarding their own health. 

Personalized Care

Education can be personalized to the lifestyle, culture and type of diabetes that the individual has (e.g. Type 1, Type 2 or gestational diabetes) and educators strive to create a personalized care plan. 

Key Components of Diabetes Education

Learning about the different types of diabetes (Type 1, Type 2, gestational) and how they affect the body. 

• Blood Glucose Monitoring:  Learn to measure blood glucose levels and manage them, including continuous glucose monitoring (CGM) technologies.
• Nutrition Management: Education on healthy eating, such as a balanced daily consumption of protein, carbohydrates, fats and fiber.
• Physical Activity: The importance of regular exercise in controlling the blood glucose level.
• Medication use: Training on the safe and effective use of prescribed drug and other equipment such as smart insulin pens.
• Modifiable: Skills: Educating against complications of diabetes and preventing complications. 

Goals of Diabetes Education

• Behavior Change: Facilitating positive changes in eating habits and lifestyle. 
• Self-Management: Promoting self-management skills so individuals can actively participate in their diabetes care. 
• Improved Health Outcomes: Reducing disability and mortality by improving glycemic control and lowering cardiovascular risk. 

Role of Families and Caregivers

Unpaid support is essential and delivered by families and caregivers, who can perform activities, such as personal care, medication administration, household chores, and organization of medical care, thereby allowing individuals with illnesses, disability, or age to sustain a good quality of life. Their functions also include providing emotional support, serving as patient advocates, and communication between care recipient and healthcare professionals, whereas they are usually under immense physical, emotional, and financial pressure.

Improved Quality of Life

Their involvement can significantly enhance a care recipient’s overall quality of life. 

Enhanced Autonomy 

Support from family and caregivers help individuals maintain their independence and autonomy. 

Better Care Coordination

Families can enhance communication and coordination between the person, his caregivers, and healthcare professionals. 

Advocacy

They also represent the care recipient and make their needs and preferences heard and respected. 

How to Implement Effective Diabetes Education

To conduct effective diabetes education, there is a necessity to concentrate on patient-centered, culturally oriented, and evidence-based methods to empower individuals to self-manage their diabetes through knowledge and self-care practices. Self-management education (DSME) and adoption (DSMES) represent key elements that enhance diabetes-specific knowledge, life habits including diet and physical activity, medicine adherence, and blood glucose regulation.

Strategies for Implementation

• Determine the level of diabetes knowledge of patients and differentiate the education.
• Create programs to assist in lifestyle changes such as healthy diets, exercise, and frequent blood glucose levels.
• Empower patients and apply problem-based learning in order to make them active participants of their care.
• Grow the reach via digital and online resources, particularly in the resource-constrained or underserved environment.
• Encourage community and family support to support education and self-management behaviors.

You may also like to read: Importance of Lipid Management in Diabetes

Final Thoughts

Effective disease management includes diabetes education which equips patients and families to manage their health. By creating comprehensive comprehension, regular care, and mutual responsibility, patients and their loved ones can collaborate in order to avoid complications and improve their overall health. Through education and awareness, healthcare providers, communities, and families can build a healthy environment that results in healthier and more assertive lives of diabetes patients.

FAQs

Why is it important to educate a diabetic patient?

Understanding nature, treatment, risk factors and complication of illness is important to diabetic patients because it offers appropriate modality to alleviate post-complication.

How does diabetes affect family members?

Adjusting to and managing diabetes in these ways can be very hard for couples and families. For example, some family members may feel resentful about having to change their own everyday diets (or lose their ability to spontaneously eat tasty foods), when they are not the one with the disease.

How do you motivate someone with diabetes?

Diet and exercise are key to managing diabetes. These habits can help control blood sugar levels and prevent other health complications. Offer to exercise together, help prepare diabetic-friendly meals or assist with household tasks to give them a mental break.

What is a positive affirmation for diabetes?

For example: “I manage my diabetes well.” “I choose healthy foods that benefit my body.” “Each day, I become more skilled at taking care of my health.”

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Effective lipid management in diabetes is essential for reducing the risk of cardiovascular disease, one of the leading complications among people with diabetes. Dyslipidemia, which is also called abnormal lipid levels, is a primary cause of heart attacks and strokes. With the help of lifestyle modifications and the right medication, diabetics can significantly enhance their health outcomes in the long-term. Knowledge of lipid management is one of the major steps to complete management of diabetes.

Understanding Diabetic Dyslipidemia

Diabetic dyslipidemia is a typical and serious metabolic disorder which is hyper triglycerides, low HDL (good) cholesterol and excessive power of small, dense LDL (bad) cholesterol. This coexistence mainly because of insulin resistance poses a great risk of cardiovascular disease (CVD) in both types 1 and 2 diabetes.

Pathophysiology

The distinct lipid profile in diabetic dyslipidemia arises from insulin’s reduced effectiveness and availability. 

• Higher Triglycerides: The resistance of insulin in fat tissue causes the greater lipolysis (fat breakdown), which results in the release of more free fatty acids into the blood. These fatty acids are then converted into triglyceride-rich very-low-density lipoproteins (VLDL) by the liver to a greater level. Also, the body cannot clear the VLDL because of the decreased activity of lipoprotein lipase in the blood.
• Reduced HDL cholesterol: Because of the surplus triglycerides in VLDL particles, they are shifted to the HDL with the help of cholesteryl ester transfer protein (CETP). This fatty HDL is then quickly degraded by hepatic lipase resulting in reduced HDL levels in the blood.
• Small, dense LDL: This is the same process which exchanges triglycerides in VLDL and LDL. This triglyceride-enriched LDL is broken down making it smaller and denser. Their size and density make them atherogenic especially since they can easily get their way into arterial walls, are poorly eliminated in the blood and more easily oxidized.

Symptoms and screening

Diabetic dyslipidemia is not usually symptomatic. The main mechanism of detection is lab testing and the symptoms usually manifest only in cases of complications. The screening of dyslipidemia is done by using a fasting lipid panel.

The signs and symptoms of severe dyslipidemia or its complications are:

• Cardiovascular symptoms: Angina (pain in the chest), dyspnea, palpitations, and weakness of the body, because of constricted arteries.
• Neurological symptoms: Slurred speech, visual disturbances and sudden weakness (transient ischemic attacks symptoms or stroke symptoms).
• Xanthomas: Yellowish, waxy, or fatty blisters on the skin, particularly around the eyes (xanthelasma), palm, and tendons.
• Lipemia retinalis: This is a rare disease where the extremely high levels of triglycerides make the retinal blood vessels look creamy white.

Why Lipid Management Matters in Diabetes

Lipid control is of central importance in the management of diabetes due to its leading role in prevention and delay of the cardiovascular catastrophes of this condition. Dyslipidemia (abnormal lipid levels) is a major predisposing factor to atherosclerosis, the pathophysiology behind heart attacks and strokes.

Diabetes drastically increases cardiovascular disease risk

Diabetics face two to four times the risk of heart diseases and stroke as compared to non-diabetics. The etiology of this augmented danger is a complicated mixture of metabolic deviations including:

• High triglycerides: High fat levels in blood are linked to high risk of atherosclerotic cardiovascular disease (ASCVD) and pancreatitis.
• Low good cholesterol (HDL-C): It is commonly low levels of high-density lipoprotein (HDL) that carry bad cholesterol off the arteries caused by diabetes.
• B. big bad cholesterol (small, dense LDL-C): Due to the probable high level of total LDL cholesterol in diabetics, the particles are smaller and denser, which leaves them with more chances to harm the walls of blood vessels and create plaques. 

Aggressive lipid management reduces risk

Diabetics face two to four times the risk of heart diseases and stroke as compared to non-diabetics. The etiology of this augmented danger is a complicated mixture of metabolic deviations including:

• High triglycerides: High fat levels in blood are linked to high risk of atherosclerotic cardiovascular disease (ASCVD) and pancreatitis.
• Low good cholesterol (HDL-C): It is commonly low levels of high-density lipoprotein (HDL) that carry bad cholesterol off the arteries caused by diabetes.
• B. big bad cholesterol (small, dense LDL-C): Due to the probable high level of total LDL cholesterol in diabetics, the particles are smaller and denser, which leaves them with more chances to harm the walls of blood vessels and create plaques. 

The benefits extend beyond blood sugar control

Although managing blood sugar is a primary part of diabetes management, lipid control can be even more effective in the prevention of cardiovascular complications. Indicatively, in one study, the reduction in LDL cholesterol by 35 percent and the increase in HDL by 8 percent may potentially save much more life years in diabetic patients than in non-diabetic patients with established heart disease.

What effective management looks like

Effective lipid management plan consists of lifestyle modification and in most cases, medications:

• Modifications in lifestyle: A low saturated and trans-fat diet, exercise and weight loss can all serve to improve the lipid profile of a person.
• Pharmacotherapy: Most individuals with diabetes should start with statins to lower the LDL-C level and decrease cardiovascular risk. In case additional reduction is required or statin cannot be tolerated, additional drugs such as PCSK9 inhibitor, ezetimibe may be used.
• Holistic Approach: The American Diabetes Association (ADA) suggests routine screening and holistic treatment of all cardiovascular risk factors such as blood pressure and smoking cessation to supplement lipid control.

Target Lipid Levels for People with Diabetes

Based on the

American Diabetes Association (ADA) 2024 Standards of Care, target lipid levels for people with diabetes depend on their individual cardiovascular risk. The recommendations have become more aggressive in recent years to reflect the high risk of heart disease in diabetic patients. 

Target levels for people with diabetes 

How these targets are achieved 

Lifestyle modification is the main approach to lipid management, then pharmacotherapy, mainly using statins.

• Lifestyle changes: This is the initial one and involves weight management, more exercise and a balanced diet that is heart friendly.
• Statin therapy: It is the initial medication of LDL cholesterol reduction. Statin therapy is dependent on age and ASCVD risk.
• Combination therapy: In case of failure of the LDL target utilizing the highest dose of statin, ezetimibe or PCSK9 blockers can be introduced.
• Targeting triglycerides: In patients with extremely high triglycerides, fibrates or high dose icosapent ethyl can be added to statins.

You may also like to read: Managing Cardiovascular Risk in Diabetes

Pharmacologic Management

Managing diabetic dyslipidemia is a critical part of diabetes care and focuses on both lifestyle modifications and medication. 

Lifestyle changes

• Diet: Low consumption of saturated and trans fats, increased consumption of fiber, fruits, and vegetables.
• Weight control: Reduced weight can help to dramatically change lipid profiles, lowering the triglycerides and raising the HDL.
• Exercise: Frequent aerobic exercising is beneficial in increasing insulin sensitivity and lipid profile.
• Glycemic control: Glycemic control is important, because inadequate glycemic control aggravates lipid abnormalities. 

Pharmacological treatment

• Statins: These are the initial treatments of most individuals with diabetes, independent of baseline LDL concentrations, as they greatly minimize cardiovascular occasions.
• Ezetimibe: This is a cholesterol absorption blocker which is frequently combined with statin treatment in high-risk patients that cannot maintain their LDL targets on statin only.
• PCSK9 inhibitors: Very high-risk patients who continue to have high LDL despite statin and ezetimibe can be administered these injectable drugs.
• Fibrates: The medications are mainly prescribed to reduce triglyceride levels that are considerably high, especially when the risk of pancreatitis is high.
• Icosapent ethyl: An omega-3 fatty acid which is purified and can be used to reduce triglycerides in individuals with high levels of triglyceride in their blood and confirmed cardiovascular disease. 

Final Thoughts

In conclusion, lipid management in diabetes plays a crucial role in preventing cardiovascular complications and improving overall health. Monitoring, proper lifestyle, and proper medical treatment can be used to keep the good lipid level and minimize risks in the long run. Through putting lipids management at the forefront of diabetes management, one can attain improved heart health and quality of life.

FAQs

What is the primary target in lipid management for patients with diabetes?

The control of LDL-C is the primary treatment objective of dyslipidemia in diabetic patients when the LDL-C is at target level and the hypertriglyceridemia remains, or when the blood sample is not taken in a non-fasting state.

Does metformin reduce lipids?

Other studies support the fact that metformin lowers lipid profile, and have found a decrease, and the rest have provided conflicting values and results.

Can statins and metformin be taken together?

Metformin and statin used together showed favorable results in nondiabetic mellitus and dyslipidemia.

What drug cannot be taken with metformin?

Steroid tablets, e.g. prednisolone. pills that cause you to pass urine (diuretics), e.g. furosemide. heart and high blood pressure (hypertension) medicine, e.g. testosterone, estrogen or progesterone.

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

High blood sugar levels can damage blood vessels and lead to complications such as heart attacks, strokes, and peripheral artery disease. Managing cardiovascular risk in diabetes involves more than just controlling blood glucose — it requires a comprehensive approach that includes lifestyle changes, medication, and regular monitoring. Understanding how to protect the heart can greatly improve both the quality and longevity of life for individuals with diabetes.

Understanding the Link Between Diabetes and Cardiovascular Disease

Diabetes is one of the significant risk factors of cardiovascular disease (CVD), such as heart attack, stroke, and heart failure, which are independent. The connection is catalyzed by the persistent elevated blood sugar that harms blood vessels and nerves in the long run. The most common cause of death in diabetic people is cardiovascular disease.

How diabetes contributes to CVD

• High blood sugar: The continuous high glucose level may cause illness of blood vessels and nerves that manage the heart and blood vessels. This destruction causes blood vessels to be more susceptible to fatty deposits, which may cause blockages and reduce the blood flow.
• Atherosclerosis: High sugar plus a high level of bad cholesterol and fats known as triglycerides help to build up plaque within the arteries. It is called atherosclerosis or hardening of the arteries and constricts the vessels, limiting the blood flow.
• High blood pressure: Most of the individuals with diabetes have high blood pressure, which imposes additional pressure on the heart and blood vessel walls. This mixture greatly leaves heart disease as a threat.
• Diabetic cardiomyopathy: Diabetes may directly cause damage to the heart muscle, which becomes hard and weak, and may cause heart failure.
• Diabetic neuropathy: Diabetes may destroy the nerves that regulate blood vessels and the heart. It may cause cardiovascular autonomic neuropathy (CAN), or heart rhythm problems and painless heart attacks.

Major Cardiovascular Risk Factors in Diabetic Patients

Along with high blood sugar, the following conditions and habits further increase the risk of CVD for people with diabetes: 

• Obesity, particularly excess abdominal fat
• High blood pressure (hypertension)
• Abnormal cholesterol levels (dyslipidemia), including high triglycerides and low levels of “good” HDL cholesterol
• Smoking
• Lack of physical activity
• Family history of premature heart disease
• Excessive alcohol consumption 

Strategies to Manage and Reduce Cardiovascular Risk

The healthy lifestyle habits applied to control diabetes can also reduce the chances of cardiovascular complications.

• Manage blood sugar: Maintain your average blood sugar level in two to three months, HbA1c, within your target range to avoid complications with your blood vessels.
• Control blood pressure: Keep your blood pressure at less than 140/90 mmHg (or a level prescribed by your physician) by eating low sodium foods and engaging in exercise. Medication may be necessary.
• Improve cholesterol: To decrease LDL levels of bad cholesterol, limit your consumption of saturated and trans fats. Statins or another medication can be prescribed to assist in controlling cholesterol.
• Eat well: Feast on fruits, vegetables, whole grains, and lean proteins; reduce processed foods, salt and sweet beverages.
• Be physically active: Do at least 150 minutes of moderate-intensity aerobic activities weekly. Physical exercise helps in raising insulin sensitivity and enhances blood sugar regulation.
• Stop smoking: Smoking is a risk factor on its own both in diabetes and heart disease. Stopping assists in a drastic reduction of CVD.
• Reduce the consumption of alcohol: High consumption of alcohol may increase blood pressure and blood sugar.
• Maintain a healthy weight: To overweight people, even 5 kg less weight can reduce blood sugar, blood pressure and cholesterol.
• Reduce stress: Stress may raise blood pressure and blood glucose. The practice stress-reducing activities such as deep breathing, meditation, and exercise can help. 

Role of Diet and Nutrition

Diet and nutrition play a critical role in cardiovascular risk management and reduction in diabetic patients. Certain eating habits like the Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet have demonstrated great effectiveness in reducing cardiovascular disease (CVD) risk among people with diabetes. These diets focus on fruit and vegetable consumption, whole grain, legumes, nuts, fish, and healthy olive oil fats and avoidance of red meat, saturated fats, processed foods, and added sugars. These types of nutrition can be used to optimize blood pressure, lipid profiles, and glycemic control, which lower the overall risk of heart disease and stroke in all diabetic patients.

Mediterranean Diet Benefits

Mediterranean diet is a diet that has high intake of plant-based foods, moderate intake of fish and dairy, low intake of red meat, and use of olive oil as the main source of fat. Meta-analyses have found it to reduce cardiovascular risk by 10% and it is linked to reduced mortality and morbidity due to heart disease. Its advantages are probably due to its antioxidant, anti-inflammatory effects and amelioration of metabolic syndrome factors typical of diabetes.

DASH Diet Benefits

The DASH diet emphasizes fruits, vegetables, low-fat dairy, whole grains, and the lean proteins and limits sodium, red and processed meat, sweets, and sweet drinks. It has been found to lower blood pressure considerably and decrease cardiovascular risk by an estimated 20 percent, including in diabetic patients, due to better management of blood pressure and lipids.

Nutritional Strategies in Diabetes to Reduce CVD Risk

Focus on those foods that contain high levels of fiber to delay the digestion process and stabilize blood sugar.

• Prefer unsaturated to saturated fats to enhance lipid profiles.
• Restrict the intake of sodium to manage blood pressure.
• Take in less refined sugars and processed foods to avoid dyslipidemia.
• Include omega-3 fatty acids sources to the heart.
• Eat macronutrients in balance to maximize weight and metabolic health.

These healthy eating habits are a pillar of medical nutrition therapy of diabetes, which helps patients achieve improved glycemic control, better cardiovascular risk factors, and decreased cardiovascular occurrence.

Importance of Regular Physical Activity

Physical activity is key to controlling and lowering cardiovascular risk in diabetic patients by enhancing various metabolic and cardiovascular parameters. Aerobic exercise also contributes to improving insulin sensitivity, cardiovascular fitness, lipids, and blood pressure, all of which play a major role in reducing cardiovascular diseases and mortality in general. Resistance training is also a contributing factor in terms of muscle mass and strength, glycemic control, and cardiovascular health. The combination of aerobic and resistance exercises offers optimal effects in glycemic regulation and cardiovascular risk minimization.

Benefits of Physical Activity in Diabetes

• Aerobic exercise enhances mitochondrial activity, vascularity, and cardiac output, which decrease the risk of death due to cardiovascular processes.
• Exercise benefits systemic inflammation and obesity, which are critical cardiovascular risks factors in diabetes
• Resistance training enhances insulin sensitivity, blood pressure, lipid profiles and increases muscle strength.
• Exercise lowers HbA1c (average blood glucose), triglycerides and blood pressure in type 2 diabetes.

Recommendations and Guidelines

Adults with diabetes ought to maintain a minimum of 150 minutes weekly of moderate-intensity aerobic or 75 minutes of vigorous-intensity aerobic work.

• Resistance exercises should be incorporated at least 2-3 times/week.
• Even less intense exercise can bring quantifiable cardiovascular benefits.
• Daily physical exercise of 60 or more minutes is advised in children and youth with type 1 diabetes to prevent risk factors by building cardiovascular fitness at an early age.

Regular exercise does not only benefit the heart but also elevates quality of life and minimizes diabetes related complications.

You may also like to read: Link between Diabetes and Heart Disease

Medical Interventions and Monitoring

Medical interventions and monitoring are essential components for managing cardiovascular risk in diabetic patients, complementing lifestyle modifications such as diet and exercise.

Key Medical Interventions

• Anti-hyperglycemic drugs: Selective agents such as sodium-glucose cotransporter-2 (SGLT2) inhibitor and glucagon-like peptide-1 (GLP-1) receptor agonist are highly encouraged, particularly during patients with proven atherosclerotic cardiovascular disease (ASCVD), high cardiovascular risk, or chronic kidney disease. These medications have shown a decrease in all-cause and cardiovascular death.
• Blood pressure management: It is essential that hypertension be aggressively treated with first line agents like angiotensin-converting enzyme (ACE) inhibitors and low dose diuretics. Targets of blood pressure are usually less than 130/80 mmHg, but this is due to observational findings.
• Lipid-lowering therapy: Statins are a key to prevention of major cardiovascular events in diabetic patients, as it should be offered to all type 2 diabetic individuals older than 40 years with other cardiovascular risk factors. Stations have demonstrated 17-36 percent decrease in coronary events.
• Anticoagulation and revascularization: Preventive anticoagulation and interventions like percutaneous coronary interventions or coronary artery bypass surgery are applied to the acute cases of coronary syndrome to enhance survival.

Monitoring and Risk Factor Management

Regular checks of blood sugar, blood pressure, and lipid are required to maximize the therapy and minimize the cardiovascular risk.

Multidisciplinary strategies assist in the management of hyperglycemia, hypertension, and dyslipidemia.

Smoking cessation and exercise: regular exercises and smoking cessation are essential interventions.

Only a small proportion of all patients can meet all treatment objectives despite these interventions, which highlights the role of continuous monitoring and compliance with treatment.

Bottom Line

Managing cardiovascular risk in diabetes is essential for preventing serious heart-related complications and ensuring long-term health. With proper blood sugar levels, living a heart-friendly lifestyle and regular doctor visits, diabetes patients can drastically reduce their risk of developing cardiovascular disease. A preventive strategy is the most effective, i.e., medication, balanced diet, and exercise, to safeguard the heart and overall health.

FAQs

What is the primary prevention of cardiovascular disease in diabetes?

Aspirin use, and blood pressure, cholesterol, and glycemia control are the key areas of CVD prevention and patient risk reduction in T2D.

How to assess cardiovascular risk in diabetes?

Age gender residence family history diabetes smoking status blood pressure total cholesterol HDL cholesterol. ‘High risk’ (score 20 or more) indicates a need for further advice or treatment to reduce risk.

When to start statins in diabetes?

Current American College of Cardiology (ACC), American Heart Association (AHA) and American Diabetic Association (ADA) guidelines recommend that diabetic patients between the age of 40 to 75 years with low-density lipoprotein – cholesterol (LDL-C) >70 mg/dl should be started on a statin.

Which drugs are given for CVD health in diabetes?

Currently, both empagliflozin and liraglutide are only approved to treat or prevent heart disease in people with diabetes. If you have diabetes, talk to your doctor about these medications to see if they’re right for you.

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Diabetes is a chronic condition that affects how your body processes blood sugar, and while it is widely known for its impact on the heart, kidneys, and eyes, its connection to stroke is often overlooked. Yet, people with diabetes are up to four times more likely to experience a stroke compared to those without the condition. Stroke, a sudden interruption of blood flow to the brain, is a leading cause of disability and one of the top causes of death worldwide. Understanding how diabetes increases the risk of stroke — and what steps can be taken to reduce that risk — is crucial for anyone managing this condition. In this article, we explore the link between diabetes and stroke, explain why the risk is higher, and outline practical ways to protect your brain and overall health.

How Diabetes Affects the Body and Increases Stroke Risk

Diabetes damages the body by causing high blood sugar levels, which harms blood vessels and nerves throughout the body and leads to an increased risk of stroke. People with diabetes are about twice as likely to have a stroke compared to those without diabetes. 

How diabetes increases stroke risk

High blood sugar levels cause progressive damage that dramatically increases the risk of stroke in several ways: 

• Hardening of the arteries (atherosclerosis): High glucose levels can accelerate the buildup of fatty deposits, known as plaque, on the inside of artery walls. If this occurs in the arteries supplying the brain, it can lead to an ischemic stroke, the most common type.
• High blood pressure (hypertension): A vast majority of people with diabetes also have high blood pressure, which is a leading cause of stroke. High blood pressure further stiffens and narrows blood vessels, increasing the risk of clots.
• Microvascular damage: Diabetes can damage the tiny blood vessels that supply oxygen to the brain, which can lead to a specific type of stroke called a lacunar infarction.
• Poor blood circulation: Nerve and circulation issues, particularly in the legs and feet, are common in people with diabetes. This can increase the likelihood of clots forming that could travel to the brain.
• Worse outcomes after a stroke: For those who experience a stroke, having diabetes is associated with poorer outcomes, including higher mortality rates, a greater risk of disability, and an increased risk of another stroke. 

Understanding Stroke: Types and Symptoms

A stroke is a medical emergency that occurs when blood flow to the brain is interrupted, causing brain cells to die. There are three main types: ischemic stroke, hemorrhagic stroke, and transient ischemic attack (TIA). 

Ischemic stroke

This is the most common type of stroke, making up about 87% of all cases. It occurs when a blood vessel in the brain is blocked by a clot, which can be: 

• Thrombotic: A clot forms in an artery supplying the brain.
• Embolic: A clot travels from another part of the body, often the heart, to the brain.

Key Warning Signs to Watch If You Have Diabetes

Key warning signs to watch for if you have diabetes include frequent urination, excessive thirst, increased hunger, extreme fatigue, blurry vision, slow healing of cuts or wounds, unexplained weight loss (especially in type 1 diabetes), and tingling or numbness in the hands or feet. Additional signs can be itchy, dry skin and patches of darker skin in body folds (acanthosis nigricans), as well as recurring infections such as yeast infections. These symptoms occur due to high blood sugar levels affecting various body functions and tissues, and early recognition is crucial to prevent serious complications like heart disease, kidney damage, nerve damage, and vision loss.

Common Key Warning Signs

• Frequent urination and increased thirst due to kidneys working overtime to get rid of excess sugar.
• Strong hunger despite eating due to glucose not entering cells for energy.
• Fatigue from lack of energy supply to body cells.
• Blurred vision due to changes in fluid levels affecting eye lenses.
• Slow-healing cuts and wounds because high sugar impairs immune function.
• Unexplained weight loss, mainly in type 1 diabetes.
• Tingling, numbness, or pain in hands and feet from nerve damage (neuropathy).
• Dry, itchy skin and recurring infections such as yeast infections.

Importance of Early Detection

Recognizing these signs early can lead to timely diagnosis and management, reducing the risk of severe complications including heart disease, stroke, amputations from chronic ulcers, kidney failure, and vision loss. People with risk factors like family history, obesity, or sedentary lifestyle should be especially vigilant and undergo regular screening even without obvious symptoms.

You may also like to read: Cardiometabolic Disease

Lifestyle and Medical Strategies to Reduce Stroke Risk

Medical and Lifestyle strategies to reduce stroke risk, especially for individuals with diabetes, include a combination of blood pressure control, healthy diet, regular physical activity, weight management, medication adherence, and management of other risk factors like cholesterol and blood sugar levels.

Lifestyle Strategies

• Reduced blood pressure: Maintain systolic blood pressure of 130 mmHg or less with toleration to minimize the risk of stroke.
• Diet: Healthy diet includes lots of fruits, vegetables, low saturated and trans-fat food, and low salt intake contribute to healthy blood pressure and cholesterol.
• Exercise: Moderate aerobic exercises 2.5 hours per week reduce cardiovascular health and insulin sensitivity.
• Weight loss: An excess weight, even small one, reduces risk factors such as hypertension and diabetes.
• Stop smoking and alcohol: Cessation of smoking and alcohol cut down on stroke risk substantially.

Medical Strategies

• Glycemic: Tight blood sugar regulation with drugs such as metformin, GLP-1 receptor agonists, or SGLT2 inhibitors decreases vascular complications.
• Medications: It is important to take antihypertensives when they are prescribed to sustain the target.
• Cholesterol: Statins decrease major cardiovascular events and LDL cholesterol.
• Antiplatelet treatment: Low-dose aspirin may prevent stroke in certain high-risk patients.
• Regular monitoring: Screen for diabetes, check cholesterol, and monitor blood pressure regularly.

Combining these strategies helps reduce inflammatory markers, improve insulin sensitivity, and lower overall cardiovascular risk, thus effectively lowering stroke risk in diabetic patients.

Final Thoughts

Diabetes and stroke go hand in hand yet the positive side is that most of the risks can be alleviated by awareness and preventive measures. With a healthy lifestyle, control of blood sugar, blood pressure, and cholesterol levels, and the close collaboration with medical professionals, people with diabetes can reduce their risk of having a stroke dramatically. Knowledge of this relationship is the initial step, what counts is action, which can save you and your long-term health.

FAQs

Can diabetes cause a stroke?

Diabetes is a risk factor that leads to stroke; stroke may destroy brain tissue and lead to disability or death. To avoid stroke, diabetics ought to control blood glucose, blood pressure, cholesterol and weight. The signs of stroke should be familiar to you and those who are close to you to access prompt medical care.

What is the survival rate for diabetic stroke victims?

Follow-up was done whereby 104 (72) patients experienced a vascular composite end point. Of these, 33 (32) had a repeat stroke, 33 (32) a hard cardiovascular event, and 76 (53) a cardiovascular or diabetes-related death, and the 1-year survival was 76 and 5-year survival was 58.

What is the most common life-threatening emergency in diabetes?

Diabetic ketoacidosis (DKA) is severe and may result in fatality. DKA occurs when there is a lack of insulin in your body to enable blood sugar into your cells to use as energy. DKA predominates in individuals with type 1 diabetes.

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Fungal ear infections, also known as otomycosis, are a common yet often overlooked ear health issue that can cause itching, discomfort, discharge, and even temporary hearing loss if left untreated. One of the most effective ways to treat this condition is by using antifungal ear drops, which are specially formulated to eliminate fungal growth and restore ear health. These drops act at the point of infection, giving direct relief and also helping to prevent recurrence of the condition. Fungal ear infections can be triggered by excess moisture or by frequent swimming or by the poor state of the immune system, but in all cases, there is a need to treat them promptly, and knowing how antifungal ear drops work, in which cases they need to be used and how to properly administer them is the key to the quick and effective treatment of the disease.

What Causes Fungal Ear Infections (Otomycosis)?

Fungal ear infections (otomycosis) are caused by the proliferation of fungi (e.g. Aspergillus and Candida) within a warm and damp ear canal, usually as a result of exposure to water (e.g. swimming, head trauma, or excessive antibiotic consumption). Other factors such as a weakened immune system, skin diseases, and the long duration of using antibacterial ear drops, are also risk factors because they interfere with the natural defenses of the ear.  

Common Causes

• Moisture and Warmth: Fungi thrive in warm areas, and this condition is most likely to occur in an environment with a high level of moisture, which is why swimming or showering associated with keeping water in the ear canal are considered a cause. 
• Injury or Trauma: Ear duct damage by cotton swabs, ear picks or ill-fitting hearing aids can damage the skin, providing an opening into which fungi can enter. 
• Antibiotic Use: Antibacterial eardrops may suppress the normal bacterial flora in the ear, which causes fungi to grow excessively. 
• Weakened Immune System: Individuals that have a weakened immune system are likely to be infected with fungi because of health conditions such as HIV/AIDS or some cancers. 
• Preexisting Skin Issues: Eczema or any other chronic skin issues may predispose to infection. 
• Over-Cleaning the ears: Removal of earwax may destroy the natural protective barrier against the ear canal leaving it susceptible to fungal infections. 

Factors That Increase Risk

• Swimming and Water Sports: Water penetration in the ear brings about humidity and causes fungi to thrive. 
• Tropical/Subtropical Climates: High humidity and temperatures in the areas are favorable to fungi. 
• Diabetes: This disease may impair the immune system and people are more likely to get otomycosis.

How Do Antifungal Ear Drops Work?

Antifungal ear drops are effective because they directly eliminate fungal in the ear canal. The active constituents, including clotrimazole or fluconazole, destroy the fungal cell membrane that leaks its contents and dies. This topical therapy serves to clear the infection, lessen such symptoms as itching and pain, and avoid spread of the infection.  

How They Work

• Destruction of the Cell Membrane: The main action of most antifungal ear drops is to interfere with the outer layers of protection of the fungal cell called the cytoplasmic or cell membrane.
• Heightened Permeability: This is the disruption that makes the membrane permeable by opening holes or making it weak.
• Leakage and Death: Once the integrity of the membrane is broken, the vital internal contents of the fungal cell leak out and the fungus dies.

Common Examples of Antifungal Agents

• Clotrimazole: This is one of the widely used antifungal medications of ear infections. 
• Fluconazole: This is another representative of the antifungal that is administered in ear drops. 
• Nystatin: This is an antifungal drug but can also be taken to treat fungal ear infections. 

Other Treatments Used Alongside Drops

• Ear Cleaning (Ear Toilet): The ear cavity can be cleansed by a doctor first in order to eliminate fungal components, discharge, and debris, thereby making the antifungal drops more effective. 
• Topical Steroids: It can be applied with antifungals to assist in the alleviation of inflammation and itching. 
• Anti-bacterial Agents: There are cases in whereby antifungals are used alongside antibiotics to treat a secondary bacterial infection. 

How to Use Antifungal Ear Drops Safely

You would have to tip your head to give the ear drops safely, straighten your ear canal by pulling on your ear lobes, pour drugs into your ear, and rub the tragus to allow the drugs to go deeper into your ear. Always administer the dose, never place anything in the ear and visit the doctor when the symptoms fail to improve and other conditions like diabetes. 

Preparation and Application

• Warming the drops: To avoid dizziness, hold the bottle in your hand, so that it heats up to body temperature. 
• Position: Lie on your side with the ear that is affected facing upwards. 
• Position the ear: In adults, pull the ear up and back, straightening the ear canal; children pull it down and back. 
• Put the drops on: Squeeze the drops as prescribed in the ear. 
• Massaging the tragus: Pump the tragus (the little flap of cartilage before the ear canal) gently, to get the drops to move further down the ear canal. 
• Keep still: Wait a couple of minutes so the drug can get through the eardrum and into the outer ear. 

You may also like to read: Different Types of Paralysis

Important Safety Tips

• Cleanliness: Clean the visible discharge or earwax with a cotton swab before applying, but do not push anything further inside. 
• Do not stick things: Do not put things such as cotton swabs or hairpins into the ear canal. 
• Check the expiry date: Before using it, make sure that the product has not expired. 
• Take directions: Every time, it is advisable to take directions given by your health care provider or on the package of the product. 
• See the doctor: Use ear drops only after consulting your doctor in case of persistence of symptoms, ear tube is present, eardrum is suspected to be perforated, your immune system is weak or any other chronic health problem. 
• When to consult help: In case of unresponsiveness of the drops or the presence of painful sensations that do not subside, consult a medical expert. 

Final Thoughts

In conclusion, antifungal ear drops play a vital role in effectively treating and preventing fungal ear infections. They offer immediate relief of the symptoms such as itch, discharge, discomfort, and enhance ear health because they disrupt the source of the infection directly. Correct use and medical consultation are, however, the major factors that contribute to the best outcomes. By taking proper ear treatment and ear care, you can have your ears in excellent condition and minimize the chances of further attacks.

FAQs

Is clotrimazole ear drops safe during pregnancy?

Topical application of clotrimazole should not result in any major systemic exposure. No evidence exists that the use of clotrimazole during pregnancy is associated with an increased risk of congenital malformation or any specific malformation.

Can I put antifungal in my ear?

Antifungal solution or powder: It can be done at home by tilting the affected ear upwards, placing approximately 3-5 drops of the solution, and pushing the cartilage at the front part of the ear canal (tragus) against the eardrum, pushing the solution into the eardrum.

How do I know if my ear infection is fungal?

The symptoms of a fungal ear infection include intense itch, earache, fullness or pressure, discharge that can be yellow, gray, or white, loss of hearing, and discoloration of the ear canal. Other symptoms may could be redness, scaling, ear bad smell, and swollen neck lymph nodes.  

Can fungal infections spread?

Yes, fungal infections can spread from person to person, animal to person, or through contact with contaminated objects, surfaces, and environments. Common examples include ringworm, which spreads through direct contact and shared items, and athlete’s foot. While many superficial fungal infections spread easily, deep or systemic fungal infections are less common but can be severe, especially in people with weakened immune systems, potentially spreading to the eyes, brain, or bloodstream. 

Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care

Lyallpur Diabetes Foundation (LDF), in collaboration with Getz Pharma, PSIM, PCDA, and PKNC, successfully organized a Well-O-Gram Obesity Screening Camp at Agriculture University, Faisalabad.

This initiative reflects Getz Pharma’s continued commitment to public health, disease prevention, and community awareness. The activity was conducted to highlight the importance of early screening, lifestyle management, and preventive strategies against metabolic and obesity-related disorders.

The Faculty of Physics Department, Agriculture University, along with Associate Professor Dr. Yasir Javed, extended heartfelt gratitude to Getz Pharma and the medical experts for their active participation and valuable contribution. Special thanks were given to:

• Dr. Ahmad Shahzad
  
• Prof. Dr. Aamir Shaukat
  
• Dr. Ijaz Anwar
  
• Dr. Masood Ahmad
  
• Dr. Muhammad Tariq
  
• Dr. Shahid Iqbal Gill
  
• Dr. Imran Ullah
• 
  

A special acknowledgment goes to Dr. Ahmad Shahzad for delivering an engaging and informative lecture that enhanced the participants’ understanding of obesity and metabolic health.

BMI Screening Results

• Total BMI Tests Conducted: 82
  
• Normal BMI: 65
  
• Overweight: 13
  
• Underweight: 4
  

This initiative serves as another milestone in our mission to reduce the burden of metabolic diseases and raise awareness about maintaining a healthy lifestyle.

Community Impact

The camp not only provided free BMI assessments but also offered personalized counseling sessions to help participants understand their health status. Educational materials were distributed to encourage balanced eating habits, regular exercise, and routine medical check-ups.

This activity is one of many public health initiatives led by the Lyallpur Diabetes Foundation in collaboration with healthcare and academic institutions. By empowering individuals with knowledge and practical guidance, LDF continues its mission to reduce the burden of diabetes, obesity, and related diseases across Pakistan.