Management of Diabetes
Diabetes is a chronic disease with no cure
(except experimentally in
type 1 diabetics) as of
2004.
Management of
diabetes may include lifestyle
modifications such as achieving and maintaining
proper weight,
diet, exercise and foot care.
The
most important is the hypoglycemic treatment with
either
oral hypoglycemics and/or insulin therapy.
Nowadays, the goal for diabetics is to avoid or
minimize chronic diabetic complications, as well as
to avoid acute problems of hyperglycemia or
hypoglycemia.
Adequate control of
diabetes leads to a lower
risk of the complications of uncontrolled diabetes
which include kidney failure (requiring dialysis or
transplant), blindness,
heart disease and limb
amputation. Recent studies show that use of statins
might be needed in primary and secondary prevention
of
cardiovascular complications and mortality.
Ideal control of
hypertension plays a pivotal
role in preventing both diabetic nephropathy and
cardiovascular disease.
There is emerging solid evidence that full-blown
diabetes mellitus type 2 can be evaded in those with
only mildly impaired
glucose tolerance.
Patients with
type 1 diabetes mellitus require
direct injection of insulin as their bodies cannot
produce enough (or even any) insulin. As of 2004,
there is no other clinically available form of
insulin administration other than injection for
patients with type 1: injection can be done by
insulin pump, by jet injector, or any of several
forms of hypodermic needle. There are several
insulin application mechanisms under experimental
development as of 2004. There have also been
proposed vaccines for type I using glutamic acid
decarboxylase (GAD), but these are currently not
being tested by the pharmaceutical companies that
have sublicensed the patents to them.
For
type 2 diabetics,
diabetic management
consists of a combination of diet, exercise, and
weight loss, in any achievable combination depending
on the patient. Patients who have poor diabetic
control after lifestyle modifications are typically
placed on
oral hypoglycemics. Some
Type 2 diabetics
eventually fail to respond to these and must proceed
to insulin therapy.
Patient
education and compliance with treatment is very
important in managing diabetes. Improper use of medications and insulin can
be very dangerous causing hypo- or hyper-glycemic
episodes.
Insulin therapy requires close monitoring and a
great deal of patient education, as improper
administration is quite dangerous. For example, when
food intake is reduced, less insulin is required. A
previously satisfactory dosing may be too much if
less food is consumed causing a hypoglycemic
reaction if not intelligently adjusted. In addition,
exercise decreases insulin requirements as exercise
increases glucose uptake by body cells whose glucose
uptake is controlled by insulin. And vice versa. In
addition, there are available several types of
insulin with varying times of onset and duration of
action.
Monitoring
Diabetes
An older style portable blood glucose meter. A
blood sample is applied to an inserted strip (see
image below) and color changes caused by reaction
with blood glucose are measured by the meter.
Optimal management of
diabetes involves patients
measuring and recording their own blood glucose
testing at home. By keeping a diary of their own
blood glucose measurements and noting the effect of
food and exercise, patients can modify their
lifestyle to better control their diabetes. For
patients on insulin, patient involvement is
important in achieving effective dosing and timing.
Relying on their own
perceptions of symptoms of hyperglycemia or
hypoglycemia is usually unsatisfactory as mild to
moderate hyperglycemia causes no obvious symptoms in
nearly all patients.
Other
considerations include the fact that, while
food takes several hours to be digested and
absorbed, insulin administration can have
glucose
lowering effects for as little as 2 hours or 24
hours or more (depending on the nature of the
insulin preparation used and individual patient
reaction). In addition, the onset and duration of
the effects of oral hypoglycemic agents vary from
type to type and from patient to patient.
A useful test that can be done in a doctor's
clinic is the measurement of blood HbA1C levels.
This is the ratio of glycosylated red blood cells in
relation to the total number of red blood cells.
Persistent raised plasma glucose levels causes the
proportion of these cells to go up. This is a test
that measures the average amount of
diabetic control
over a period of about 3 months (the average red
blood cell lifetime). In the non-diabetic, the HbA1C
level ranges from 4.0-6.4%; patients with diabetes
mellitus who manage to keep their HbA1C level below
7.0% are considered to have good glycaemic control.
Regular blood testing especially more so in
type
1 diabetics is essential to keep a tight reign on
the symptoms of diabetes. There are many (at
least 20+) different types of blood monitoring
devices available on the market today,
not every
meter suits all patients and it is a specific matter
of choice for the patient to find a meter that they
personally find comfortable to use. The principle of
the devices is the virtually the same, a small blood
sample is collected by the patient by
self-production using a lancing device (a sterile
pointed needle) the blood is usually collected at
the end point to a test strip. This test strip
contains various chemicals which when the blood is
applied creates a small electrical charge between
two contacts. This charge will vary dependent on the
glucose levels within the blood and its effect on
the chemicals contained within the strip. In older
glucose meters, the drop of blood is placed on top
of a strip. A chemical reaction occurs and the strip
changes color. The meter then measures the color of
the strip optically.
It is this level that is measured and a result in
either mg/dL (milligrams per deciliter in the USA)
or mmol/L (millimoles per litre in Europe) of blood.
The average normal person should have a glucose
level of around 4.5 to 7.0 mmol/L (80 to 125 mg/dL).
In the diabetic patient, more specifically type 2
patients, it is important to maintain good glucose
control, with a before meal level of <6.1 mmol/L
(<110 mg/dL) and a level two hours after the start
of a meal of <7.8 mmol/L (<140 mg/dL)13.
A level of <3.8 mmol/L (<70 mg/dL) is usually
described as a hypoglycaemic attack. Most diabetics
'know' when they're going to go hypo and usually are
able to eat some food or drink something sweet to
raise levels. It is important to remember though,
that a patient who is hyperglycaemic (high glucose)
can also have a hypo under certain conditions i.e.
not eating regularly, or strenuous exercise,
followed by fatigue.
Levels greater than 13-15 mmol/L (230-270 mg/dL)
should be monitored closely and the patient is
advised to seek urgent medical attention as soon as
possible if this continues to rise after 2-3 tests.
Hyperglycaemia is not as easy to detect as hypoglycaemia and usually happens over a period of
days rather than hours or minutes. If left untreated
this can result in diabetic coma and death.
A blood glucose test strip for an older style (ie,
optical color sensing) monitoring system
Prolonged and elevated levels of glucose in the
blood, which is left unchecked and untreated will,
over time, result in
serious
diabetic complications
and sometimes even death. It is therefore highly
important that a diabetic patient checks their blood
levels either daily or every few days to see what
levels they are achieving over a given period of
time. There is also computer software for the PC
which is available from blood testing manufacturers
which can display results and trends over time. Type
1 patients will have to check on a more regular
daily basis due to insulin therapy which is a fine
art to master. The US Food and Drug Administration
has also approved a non-invasive blood glucose
monitoring device.
This allows checking blood glucose levels, while
puncturing the skin as little as twice a day. Once
calibrated with a blood sample, it pulls body fuilds
from the skin using small electrical currents,
taking six readings an hour for as long as thirteen
hours. It has not proven to be reliable enough, or
convenient enough to be used in lieu of conventional
blood monitoring. Other non-invasive methods like
radiowaves, ultrasound and energy waves are also
being tested.
These results are especially useful for the
diabetic to present to their doctor or physician in
the monitoring and control of the disease.
Failure
to maintain a strict regimen of testing can
accelerate symptoms of the condition, and it is
therefore imperative that any diabetic patient
strictly monitor their
glucose levels regularly.
By: The
Medical Symptoms Database
Do YOU OR A
LOVED ONE HAVE DIABETES?
WANT TO DISCOVER "SECRETS"
ABOUT VITAMINS AND MINERALS THAT MOST
DOCTORS CAN'T OR WON'T REVEAL TO THEIR PATIENTS WITH DIABETES ?
WOULD YOU
LIKE TO LEARN MORE ABOUT VITAMINS THAT MAY HELP YOUR BODY TO
BECOME "SYMPTOM" FREE?
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