For some people with diabetes, long-term control ‘is difficult, if not impossible, to achieve', a consultant has warned.

According to Dr Poochellam Muthalagu, a consultant endocrine physician working in hospitals in Cavan and Monaghan, the treatment of diabetes is complex. It involves a number of oral and injectable medications and patient education and lifestyle modification are key.

However, while huge strides have been made in relation to control of the condition, Dr Muthalagu warned that long-term control is difficult, if not impossible, ‘in a sizeable minority of patients, perhaps even a majority'.

He noted that one of the most common problems seen with diabetes is when a person is not even aware they have it. This often occurs because the condition can be asymptomatic ‘until well after long-term complications have occurred'.

Another common problem is ‘overeating and underexercising'. It is essential that patients get the balance between these correct. Dr Muthalagu noted that the most common cause of hyperglycaemia (high blood sugar) ‘is excessive intake of carbohydrates'.

He also pointed out that a lack of exercise ‘leads directly to increased insulin resistance and hyperglycaemia'.

Patient education is also an area where problems can occur. Mr Muthalagu emphasised that every patient needs to be properly educated about the disease and ‘a meticulous review of medications is important during every visit'.

He also pointed out the major effect that psychological issues can have on a person with diabetes. The prevalence of eating disorders among people with type 1 diabetes is thought to be higher than the rate among people without the condition.

Dr Muthalagu noted that eating is a ‘complex process with deep psychological and emotional overtones'.

"Psychological factors may contribute to pathological eating habits and a loss of diabetic stability. Patients may attempt to control their weight by omitting or reducing their insulin dosage," he explained.

Depression can also be an issue. While depression is not usually listed as a diabetic complication, ‘it may have dangerous consequences if left untreated and the rate of major depression in persons with diabetes is greater than that in the general population'.

Dr Muthalagu noted that depressed patients are at greater risk for repeated episodes of hypoglycaemia, therefore ‘prompt diagnosis of this complication is necessary'.

He made his comments in Modern Medicine: The Irish Journal of Clinical Medicine.