Are Diabetes and Hypertension overrated?

A man aged 45 was taken to the hospital. The reason was just fall down due to vertigo. It wasn't his first time. Seldom such events were found in the history. The reason could be any serious thing but actually it was pretty simple. He was on antidiabetic medicines for last 6 months. The medicine was started just after two readings of fingertip sugar within 3 days on different time frame after and before lunch. Was it enough data to diagnose a giant one? Actually the diabetic readings were just temporary. Medications worked wrong for him and hypoglycemic shock was the reason of his fainting. Just some sugar cubes or a chocolate could be the treatment of that time for the conscious patient otherwise you just had to drip in plain dextrose infusion.

World is suffering from non communicable diseases (NCD) widely. Lifestyle is the key substance behind this 'NCDemic'. Cancer, hyper or hypothyrodism, obesity, hypertension, diabetes etc are the well-known players of this team. But among them the last two are highly overrated especially in India. Not only in urban areas but the rural population is also affected remarkably. 

In rural areas not only quacks but some qualified practitioners are also defaming diabetes and hypertension by prescribing irrelavent medicines without proper diagnosis. The numbers of the patients are increasing day by day and unfortunately these diseases are defined under controlled category rather than cure. Nobody believes it can be cured and it is right mostly but it's half truth. Because some patients do not possess the permanent problems and still on treatment due to misdiagnosis.

When should one start medicine?

Diabetes and Hypertension can't be predicted at once. Diabetes can be diagnosed by HbA1c reading only which reflects the average sugar attached to Haemoglobin in last three months as the lifespan of a red blood cell is almost 90 to 120 days. Even physician can take help of some other complementary tests besides HbA1c. Fingertip sugar test with gluocometer is used to check the sugar control level of a diabetic patient, not for the final diagnosis of treatment initiation. 

Hypertension can be also temporary. On the spot emergency treatment is necessary but the factors affecting the high blood pressure must be ruled out very soon instead of putting patient on long term treatment. There is also a guideline to initiate the treatment. Multiple options are available to reduce the blood pressure but the decision should be made according to the cause of the hypertension. One can not put a patient directly and daily on beta blockers without confirmed cardiac problems. The same way age is also an important factor to decide the class of the medicine and frequency of dose. Different class of medicines have different mechanism to control the blood pressure so they should be chosen accordingly and wisely. Sometimes clinical blood pressure shows high value due to psychological effect of hospital environment. In such case the average hypertension of some days should be considered for the further investigation if there's no sign of any emergency.

Mostly all medical practitioners forget one thing and that is lifestyle modification. On very first time mostly the diet control should be the first line treatment for diabetes and hypertension if there is no chronic history. Pharmacist should also take interest to explain the hypertesive or hyperglycemic patient to modify the lifestyle and diet instead prescribing medicines. After almost a month patient should be watched out for the further investigation and if it doesn't work, medicine can be started accordingly.

Can we stop medicines?

The most famous myth on hypertension and diabetes is that you have to consume these medicines lifetime. It's just half truth. If the reason for these NCD diseases are modifiable factors, you can be free from the daily medicines once you overcome those factors.

In case of hypertension, modifiable factors are:

• Low activity level

• Alcohol intake

• Smoking

• Stress

• Overweight or Obesity

If your hypertension is lowered by modification in above habits and factors, you may stop the medicine after consulting your doctor.

While having some unmodified factors including

• Diabetes

• Thyroid disorders

• Kidney disorders

• Genetic causes

• Old age

You are not advised to stop medications for above comorbidities even after the controlled readings.

So in early phase if you are able to find the cause and deminish its severity, you can win the battle aginst such NCDs. After stopping the medications you should regularly check the readings of your blood pressure and sugar level by authentic methods and even after stopping the treatment you must stick to the healthy lifestyle and diet control. Remember you have to sacrifice your diet to get rid of the daily medicines.

Besides the normal life if your doctor suggest for the treatment in case of any chronic disorder history or any obvious matter of concern, you should follow the advice.

A red signal for the 'NCDemic' is that lifestyle modification cure rate is becoming helpless day by day due to our substandard nutritional intakes. Now nobody can claim the food from farm without chemically nurtured. The foodgrain is losing its strength just from the land it is grown. It's also a matter of concern attached with Green House Effect. But unfortunately it's a circle of life which is directly connected to the above discussed 'NCDemic'. Cancer is another demon of that team on which we may discuss later on someday.

Final funda: Now a days RBS (random blood sugar) test is becoming as necessary as tetanus shot for a patient with wound.

Excessive unnecessary laboratory tests are the same evil things we can compare with polypharmacy.