As many people with diabetes now live longer, they may develop complications of diabetes. These are mainly related to the blood vessels and nerves of the body. Some complications are minor; others can have a major impact on patient's lives. Although it is not fully understood how many of these complications are caused; it is clear that high blood glucose (sugar) levels play a significant part in how they develop. It is therefore important that all diabetic patients keep their blood glucose levels as well controlled (that is, as near normal) as possible for as long as possible. The ability to maintain good blood glucose control has been helped over the past few years by the estimation of Haemoglobin A1c in the blood.

Haemoglobin A1c ( HbA1c ) is a protein in the blood whose level is affected by the prevailing levels of blood glucose. If most of your blood glucose levels are normal or near normal then your HbA1c levels will be normal (4.0-6.4%) or near normal; but if your blood glucose levels are mostly high (say, mainly above 10.0mmol / L) then your HbA1c level will be high (e.g. 10.0% or more). HbA1c levels do not change quickly like blood glucose levels but slowly over 6-8 weeks so the level will reflect whether blood glucose control over this time has been good, average or poor. In general HbA1c levels should be measured every 3-4 months in Type 1 diabetes and every 4-6 months in Type 2 diabetes. But your doctor may decide when they should be done. HbA1c levels can not be used to diagnose diabetes.

You should aim to keep your HbA1c levels as near normal as possible but in general terms

HbA1c level less than 7.0% indicates good control;

HbA1c level 7.1-8.0% not so bad control but more care is needed perhaps with diet or exercise;

HbA1c level 8.1-9.0% not so good control and a change in therapy or dose of insulin or drugs maybe indicated;

HbA1c level 9.1-10.0% poor control when a fuller review of current medication, diet and exercise with a change in therapy is probably indicated and

HbA1c levels over 10.0% very poor control and a significant change in therapy is needed such as beginning insulin therapy.

However there are some limitations to HbA1c levels, such as in pregnancy or when you have been unwell with a non diabetic illness. Your doctor will discuss these limitations with you but increased HbA1c levels must not continue for a long time.

At BCDH, HbA1c levels are measured regularly. It is important that your HbA1c levels are measured in the same clinic on a regular basis as levels may vary clinic to clinic. If you attend the BCDH outpatient clinic we can follow any changes or trends in your HbA1c levels and give you advice accordingly.

Complications

There have been a number of studies all over the world to show that keeping blood glucose levels (and HbA1c levels) as near normal as possible will delay and lessen the impact of diabetic complications.

These complications can occur in the small blood vessels of

(1) the eye ― causing failing or even loss of vision; and

(2) the kidney ― causing renal (kidney) impairment or loss;

and in the larger arteries of the

(1) the heart ― causing angina, heart failure and heart attacks (myocardial infarction);

(2) the brain ― causing strokes and

(3) the legs ― causing pain on walking and occasionally gangrene of the toes and feet.

There may also be changes in the nerves of the body which can affect how we feel things, cause pain and weakness of the muscles, and how we unconciously coordinate body functions such as blood pressure control, bowel and bladder function and in men sexual activity such as erection.

It is important that, if these complications begin to occur, they are detected early, for as well as improving blood glucose levels, there are other treatments and drugs which are now available to help patients overcome these symptoms and complications.

Here at BCDH we have the latest equipment to detect these complications as early as possible, such as

(1) a retinal camera to photograph the back of the eye every year to be sure it remains normal;

(2) ultrasound equipment to measure the blood flow in and structure of the major arteries of the legs, and brain;

(3) a CAT Scanner to measure structural changes;

(4) blood tests, X-Ray and ultrasound equipment to assess kidney function;

(5) resting and exercising EKG and cardiac ultrasound to assess heart function;

(6) equipment to photograph the microcirculation (capillaries) in the nail fold; and

(7) nerve conduction equipment to measure how the nerves are working and how they function.

At BCDH all the doctors and technicians using this equipment are experts and can deliver quick results for you and your doctor.

Other treatment for complications

There are other changes in diabetic patients that need to be looked for regularly, such as

(1) high blood pressure;

(2) raised blood fat levels;

(3) increased protein in the urine; and

(4) abnormal blood flow in arteries and veins

Nearly all diabetic complications are made worse by smoking so no diabetic patient should smoke. Also obesity can make some complications worse so weight loss is very important in obese or overweight patients.

All these changes may need active treatment to avoid trouble occurring in the future. Never leave the hospital or clinic without making another appointment to attend for review.

Therefore you can see that advances in treatment are helping diabetic patients live longer and more productive lives. There at BCDH we are dedicated to help patients achieve the best overall control of their diabetes with diet and exercise, adequate antidiabetic drugs and / or insulin therapy and all other modern investigations and treatments available outside China when and if they are indicated by a patient's overall condition. By our national and international cooperation we can also introduce new therapies once they have been shown to be effective, either in China or abroad.

Good diabetes care needs regular review every few months at a Diabetes Clinic or Hospital in which you have confidence. BCDH will give you the best advice available to help you to understand your diabetes and live a long happy life.