Sam’s Story – part 2

Managing Diabetes – continuing Sam’s Story part 1 from April 18th 2018

I gave Sam a request form to get some tests done – a blood test to measure HbA1C and kidney function and a urine test to assess if there was any kidney damage – and asked him to maintain a Food Diary. All this required was for him to write down over a period of seven days exactly what he ate for breakfast, lunch and dinner plus what he had for snacks between meals , and bring this information for me to see.

Sam I must say was true to his word – and a week later turned up with his test results and his food diary. I found that his results were not as bad as I feared – but certainly worse than I would have liked.

A person’s normal HbA1C should be less than 6. A diabetic who is well controlled has his or her HbA1C between 6 and 6.9, an inadequately controlled diabetic has it between 7 and 7.9 – while anything over 8 shows poor control of diabetes.

Sam’s HbA1C was 10.6, indicating that his blood sugar was inadequately controlled – in other words, his blood was far too sugary for his own good.

His blood test for kidney function was normal, indicating that the kidney was performing one of its functions (getting rid of toxins from the body) properly. His urine test however showed that the other function of his kidney (preventing the loss of proteins from the blood) was not being performed well.

In simple terms, I explained to Sam, our kidneys are like a tea strainer whose job, when the contents of a teapot are poured into it, is to keep the tea leaves WITHIN the body and allow the clear tea to flow OUT. If we take the tea strainer analogy further, expecting the kidneys to keep our proteins in and allow our urine to flow out, we can consider diabetes being a condition that damages the tea strainer by causing its holes to enlarge – allowing vital protein to leak out with the urine.

We can measure the amount of protein (termed ALBUMIN) in a sample of urine. Sam’s urine had far too much albumin, indicating that the straining function of his kidney was compromised. Fortunately, this can be repaired in the early stages of kidney damage – by getting the blood sugar down into the normal range and ensuring that the blood pressure (the force with which blood is pushed through the kidneys) is maintained at a not too high level.

Regarding Sam’s food diary, there was much to be desired. His usual breakfast was two slices of bread or toast with butter and cheese. For lunch he had rice and curry, and for dinner some stringhoppers, pittu, noodles or rice together with a chicken or beef curry followed by a dessert of ice cream or curd with honey. Interestingly, Sam’s diary showed that he ate virtually NO vegetables! Significantly, although Sam does not take any alcohol, on at least four days of that week he had consumed a bowl of chips (his favourite snack) or some pastries at tea time.

I sat down with Sam and went through his diet in detail. While not unsatisfactory from a nutritional point of view, his diet was overloaded with high glycaemic carbohydrates – in other words, foods that are easily absorbed after being rapidly converted to sugar within the intestine.

To be continued

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