Diabetes
Diabetes is a condition in which the person has constant high levels of blood sugar (glucose) content. This may be due to insufficient production of insulin in the body or the body is not responding to the effects of insulin due to several factors and conditions. Glucose in the blood is produced by the liver breaking down food we eat, which gives us energy to perform daily activities. Human body has to maintain the blood glucose level at a very narrow range, which is done with the hormones insulin and glucagon. Insulin is one of the main hormones that regulates blood sugar levels and allows the body to use sugar ( glucose) for energy. Insulin is produced by pancreas, a small organ between the stomach and liver.
Diabetes mellitus is a major form of metabolic disorder characterized by hyperglycemia (increased blood sugar) with or without glycosuria (increased urine sugar). This is one of the most widespread disorder affecting mankind. It is mostly considered as an urban disease. The chance of getting diabetes mellitus is increased with increase in the age of the person. There are genetic factors, which contribute to the susceptibility of an individual to diabetes mellitus. Ethnic differences also occur in the prevalence of diabetes mellitus. The incidence is increasing recently around the world.
Major types of diabetes mellitus:
1. Prediabetes.
2. Type 1 diabetes.
3. Type 2 diabetes.
4. Gestational diabetes.
5. Metabolic syndrome.
1. Prediabetes: It is a common condition related to diabetes whereas the blood sugar level is higher than normal but not high enough to be considered diabetic. Prediabetes is a precursor of developing diabetes and it increases the risk of developing type 2 diabetes, heart disease, and stroke. Pre-diabetes can be reversed without insulin or medication by losing a modest amount of weight and increasing your physical activity. This weight loss can prevent, or at least delay, the onset of type 2 diabetes.
2. Type 1 diabetes: It is also called as insulin dependent diabetes mellitus (IDDM) or juvenile onset diabetes mellitus. The body stops producing insulin or produces too little insulin to regulate blood glucose level. Type 1 diabetes is typically recognized in childhood or adolescence. Type 1 diabetes can occur in an older individual due to destruction of pancreas by alcohol, disease, or removal by surgery. It also results from progressive failure of the pancreatic beta cells, which produce insulin. People with type 1 diabetes require daily insulin treatment to sustain life.
3. Type 2 diabetes: It is also called as non insulin dependent diabetes mellitus (NIDDM). The pancreas secretes insulin, but the body is partially or completely unable to use the insulin. This is sometimes referred to as insulin resistance. The body tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they do not continue to secrete enough insulin to cope with the higher demands. Type 2 diabetes is typically recognized in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non-insulin-dependent diabetes mellitus.
4. Gestational diabetes: It is a form of diabetes that occurs during the second half of pregnancy. Although gestational diabetes typically goes away after delivery of the baby. Women who have gestational diabetes are more likely than other women to develop type 2 diabetes later in life. Women with gestational diabetes are more likely to have large babies.
5. Metabolic syndrome: It is also called syndrome X, which is a set of abnormalities with insulin-resistant diabetes (type 2 diabetes). It is always presenting along with hypertension, hyperlipidemia, elevation of LDL cholesterol, decreased HDL cholesterol, elevated triglycerides, central obesity, and abnormalities in blood clotting and inflammatory responses. A high rate of cardiovascular disease is associated with the metabolic syndrome.
Causes:
In type 1 diabetes, the absolute lack of insulin usually secondary to a destructive process affecting the insulin producing beta cells in the pancreas is the main disorder. Type 1 diabetes is believed to be an autoimmune disease. The body's immune system attacks the cells in the pancreas that produce insulin. A predisposition to develop type 1 diabetes may run in families. Environmental factors, include common viral infections. Its prevalence also runs through certain human races such as Northern Europeans etc.
In type 2 diabetes there is insufficient production of insulin to the body's needs, production of defective insulin, or the inability of cells to use insulin properly and efficiently leads to hyperglycemia and diabetes. Type 2 diabetes has strong genetic links and tends to run in families.
Risk Factors for developing diabetes:
1. High blood pressure.
2. High blood triglyceride levels.
3. High-fat diet.
4. High alcohol intake.
5. Sedentary lifestyle.
6. Obesity or overweight.
7. Gestational diabetes.
8. Ethnicity.
9. Aging.
Symptoms of diabetes:
1. Increased fatigue.
2. Unexplained weight loss.
3. Thirst (polydipsia).
4. Dry mouth.
5. Frequent urination (polyuria).
6. Increased hunger (polyphagia).
7. Blurred vision.
8. Labored and heavy breathing.
9. Poor wound healing.
10. Iinfections.
11. Altered mental status.
12. Blurry vision.
13. Loss of consciousness.
Other symptoms may include slow-healing sores or cuts, itching of the skin, yeast infections, recent weight gain, numbness or tingling of the hands and feet, impotence or erectile dysfunction.
How it is detected and when to seek medical care:
1. When the patient is experiencing above mentioned diabetes symptoms and there is high blood sugar. The patient's blood sugar levels, when tested, are consistently high (more than 200 mg/dL).
2. When the patient's blood sugar level is low (less than 60 mg/dL), hypoglycemia due to over use of insulin. It may also be a sign of infection or other stress on the system such as kidney failure, liver failure, adrenal gland failure, or the concomitant use of certain medications.
3. When the patient has an injury to the foot or leg, no matter how minor. Even the tiniest cut or blister can become very serious in a person with diabetes.
4. When the patient has a low-grade fever (less than 101.5°F). Fever is a sign of infection. In patients with diabetes, many common infections can potentially be more dangerous for them than for other people.
5. The patient is nauseated or vomiting but can keep liquids down.
1999 WHO Diabetes criteria:
Condition 2 hour glucose Fasting glucose
mmol/l(mg/dl) mmol/l(mg/dl)
Normal <7.8 (<140) <6.1 (<110)
Impaired fasting glycaemia <7.8 (<140) = 6.1(=110) & <7.0(<126)
Impaired glucose tolerance =7.8 (=140) <7.0 (<126)
Diabetes mellitus =11.1 (=200) =7.0 (=126)
Complications of diabetes:
1. Hyperglycemia: Diabetes ultimately lead to high blood sugar levels, a condition called hyperglycemia. Over a long period of time, hyperglycemia damages the retina of the eye, the kidneys, the nerves, and the blood vessels.
2. Insulin resistance: In pancreas the beta cells of the islets of Langerhans show reduction in number, degranulation, and hyalinization. Resistance to insulin develops in the target cells due to receptor insensitivity.
3. Vascular changes: Diabetes has a predisposition to develop vascular lesions affecting small and large vessels. In microangiopathy, there is a specific involvement of the small blood vessels, venules, capillaries, and arteries are affected. Microangiopathy affects several organ systems and the main lesions are seen in the retina, kidneys, peripheral nerves, and heart giving rise to diabetic retinopathy, diabetic neuropathy, and cardiomyopathy. Damage to the retina from diabetes (diabetic retinopathy) is a leading cause of blindness.
4. Atherosclerosis: Diabetes accelerates atherosclerosis, (the formation of fatty plaques inside the arteries), which can lead to blockages or a clot (thrombus). Such changes can then lead to heart attack, stroke, and decreased circulation in the arms and legs (peripheral vascular disease).
5. Nerve damage: Damage to the nerves from diabetes (diabetic neuropathy) is a leading cause of foot wounds and ulcers, which frequently lead to foot and leg amputations. Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach (gastroparesis), chronic diarrhea, and an inability to control heart rate and blood pressure during postural changes.
6. Renal lesions: This is seen in patients with advanced diabetes. These changes include vascular changes such as 1) arteriosclerosis of the renal artery, 2) sclerosis of the arteries, and 3) glomerulonephrosis. There is thickening of the glomerular capillary basement membrane. The evidence of glomerulonephrosis is established by the presence of proteinuria. Damage to the kidneys from diabetes (diabetic nephropathy) is a leading cause of kidney failure.
Diabetic emergencies:
In case of an emergency the patient should be accompanied by a companion, bring a list of all medical problems, medications, allergies to medications, and the blood sugar diary to the emergency department.
Diabetic Tests:
1. Thorough medical interview and physical examination: The healthcare questionnaire includes symptoms, risk factors for diabetes, past medical problems, current medications, allergies to medications, family history of diabetes or other medical problems such as high cholesterol or heart disease, and personal habits and lifestyle.
2. Finger stick blood glucose: This is a rapid screening test and may be performed anywhere, including community-based screening programs where the result is available right away. A fingerstick blood glucose test is not as accurate as testing the patient's blood in the laboratory.
3. Fasting plasma glucose: The patient will be asked not to eat or drink for 8 hours before the blood is drawn. If the blood glucose level is greater than or equal to 126 mg/dL after fasting, then they probably have diabetes. If fasting plasma glucose level is greater than 100 but less than 126 mg/dL, then the patient has impaired fasting glucose, or IFG. This is considered to be pre-diabetes. If the result is abnormal, the fasting plasma glucose test may be repeated on a different day to confirm the result.
4. Oral glucose tolerance test: This test involves drawing blood for a fasting plasma glucose test, then drawing blood for a second test two hours after drinking a very sweet drink containing 75 grams of sugar. If the blood sugar level after the sugar drink is greater than or equal to 200 mg/dL, the patient has diabetes. If the blood glucose level is between 140 and 199, then the patient has impaired glucose tolerance (IGT), which is a pre-diabetic condition.
5. Glycosylated hemoglobin or hemoglobin A1c: This test is a measurement of how high the blood sugar levels have been over the last 120 days. Excess blood glucose hooks on to the hemoglobin in red blood cells and stays there for the life of the red blood cell. A hemoglobin A1c test is the best measurement of blood sugar control in people known to have diabetes. A hemoglobin A1c result of 7% or less indicates a good glucose control. A result of 8% or greater indicates that blood sugar levels are too high for too much of the time.
Diagnosing complications of diabetes:
1. The patient should have their eyes checked at least once a year by an eye specialist to screen for diabetic retinopathy, a leading cause of blindness.
2. The patient's urine should be checked for microalbumin on a regular basis, at least one to two times a year. Protein in the urine is an early sign of diabetic nephropathy, a leading cause of kidney failure.
3. Sensation in the legs should be checked regularly using a tuning fork or a monofilament device. The healthcare provider should check the feet and lower legs at every visit for cuts, scrapes, blisters, or other lesions that could become infected.
4. The patient should be screened regularly for conditions that may contribute to heart disease, such as high blood pressure and high cholesterol.
Management of Diabetes:
1. Home treatment: Diabetes can be controlled by a healthy lifestyle, choices of diet, exercise, and other healthy habits at home.
2. Diet: A healthy diet is important in controlling blood sugar levels and preventing diabetes complications. If the patient is obese he can adopt a weight modification program to help reduce his body weight. Eating a consistent, well-balanced high fiber diet, low in saturated fat, and low in concentrated sweets improves the health.
3. Exercise: Regular exercises can help to reduce the risk of developing diabetes. Activity can also reduce the risk of developing complications of diabetes such as heart disease, stroke, kidney failure, blindness, and leg ulcers. As little as 20 minutes of walking three times a week has a proven beneficial effect.
4. Alcohol use and smoking: Use moderate alcohol or eliminate consumption of alcohol altogether. Smoking cigarettes raises the risk markedly for nearly all of the complications of diabetes. Smoking damages blood vessels and contributes to heart disease, stroke, and poor circulation in the limbs.
5. Self-monitored blood glucose: Check blood sugar levels frequently, at least before meals and at bedtime, and record the results in a logbook. This logbook should include insulin or oral medication doses and times, the time and what the patient ate, when and for how long they exercised, and any significant events of the day such as high or low blood sugar levels etc.
6. Medical Management: The treatment of diabetes is individualized depending on the type of diabetes, whether the patient has other active medical problems, whether the patient has complications of diabetes, and age and general health of the patient at the time of diagnosis. Education about diabetes and its treatment is essential in all types of diabetes.
Treatment of Type 1 diabetes:
Treatment of diabetes always involves the daily injection of insulin, usually a combination of a short-acting insulin and a longer acting insulin. Insulin must be given as an injection. When taken by mouth, insulin would be destroyed in the stomach before it could get into the blood stream so it has to be given as an injection. Most people with type 1 diabetes take insulin injections by themselves as it is important that the patient knows how to do it in case the other person is unavailable. Insulin is usually given in two or three injections per day, generally around mealtimes. Dosage is individualized and is tailored to the patient's specific needs by the healthcare provider. Longer acting insulins are typically administered one or two times per day. It is essential that the patient have adequate meals if the insulin is to be administered, as the insulin will lower the blood sugar regardless of whether they have taken meals. If insulin is taken without eating, the result will be hypoglycemia which called an insulin reaction. Maintaining accurate records of blood sugar levels and insulin dosages is very important for the patient's diabetes management. Eating a consistent, healthy diet appropriate for the patient's size and weight is essential in controlling blood sugar level.
Insulins: Human insulin is the only type of insulin that is less likely to cause allergic reactions than animal-derived varieties of insulin. The type of insulin chosen to customize treatment for an individual is based on the goal of providing optimal blood sugar control. Different types of insulin are available and categorized according to their times of action, onset, and duration. Commercially prepared mixtures of some insulins may also be used to provide constant (basal) control and immediate control. According to the duration of action there are rapid-acting insulins, intermediate-acting insulins, and long-acting insulins.
Treatment of Type 2 diabetes:
Depending on how elevated the patient's blood sugar and glycosylated hemoglobin (HbA1c) are at the time of diagnosis, they may be given a chance to lower blood sugar level without medication. The best way to do this is to lose weight if obese and start an exercise program. This will generally be tried for three to six months, then blood sugar and glycosylated hemoglobin will be rechecked. If they remain high, the patient will be started on an oral medication, usually a sulfonylurea or biguanide to help control blood sugar level. It is still important to eat a healthy diet, lose weight if they are overweight, and engage in moderate physical activity as often as possible. It is important to get just the right dose of the right medication to get the blood sugar level in the recommended range with the fewest side effects. The doctor may decide to combine two types of medications to get blood sugar level under control. Even people with type 2 diabetes may require insulin injections to control their blood sugar levels.
Many different types of medications are available to help lower blood sugar levels in type 2 diabetes. Each type works in a different way. It is very common to combine two or more types to get the best effect with fewer side effects.
1. Sulfonylureas: These drugs stimulate the pancreas to make more insulin.
2. Biguanides: These agents decrease the amount of glucose produced by the liver.
3. Alpha-glucosidase inhibitors: These agents slow absorption of the starches one eats. This slows down glucose production.
4. Thiazolidinediones: These agents increase sensitivity to insulin.
5. Meglitinides: These agents stimulate the pancreas to make more insulin.
6. D-phenylalanine derivatives: These agents stimulate the pancreas to produce more insulin more quickly.
Follow up Treatment:
Follow the healthcare provider's treatment recommendations. Keep records of blood sugar levels as often as recommended by the healthcare provider, including the times the levels were checked, when and how much insulin or medication was taken, when and what was eaten, and when and for how long the patient exercised. Call the healthcare provider if in any emergency.
Education:
Attend diabetes education classes at the local hospital. The more educated the patient and their family are about the disease, the better they are likely to do. Recognize low blood sugar levels and know how to treat them. The patient and their family should be taught how to recognize the signs and symptoms of low blood sugar levels.
It is of importance that early detection and treatment of diabetes is essential in treating this disease effectively and reducing its complications. So hope this article will help you in detecting diabetes early in its course and help prevent its prevalence.
Diabetes is a condition in which the person has constant high levels of blood sugar (glucose) content. This may be due to insufficient production of insulin in the body or the body is not responding to the effects of insulin due to several factors and conditions. Glucose in the blood is produced by the liver breaking down food we eat, which gives us energy to perform daily activities. Human body has to maintain the blood glucose level at a very narrow range, which is done with the hormones insulin and glucagon. Insulin is one of the main hormones that regulates blood sugar levels and allows the body to use sugar ( glucose) for energy. Insulin is produced by pancreas, a small organ between the stomach and liver.
Diabetes mellitus is a major form of metabolic disorder characterized by hyperglycemia (increased blood sugar) with or without glycosuria (increased urine sugar). This is one of the most widespread disorder affecting mankind. It is mostly considered as an urban disease. The chance of getting diabetes mellitus is increased with increase in the age of the person. There are genetic factors, which contribute to the susceptibility of an individual to diabetes mellitus. Ethnic differences also occur in the prevalence of diabetes mellitus. The incidence is increasing recently around the world.
Major types of diabetes mellitus:
1. Prediabetes.
2. Type 1 diabetes.
3. Type 2 diabetes.
4. Gestational diabetes.
5. Metabolic syndrome.
1. Prediabetes: It is a common condition related to diabetes whereas the blood sugar level is higher than normal but not high enough to be considered diabetic. Prediabetes is a precursor of developing diabetes and it increases the risk of developing type 2 diabetes, heart disease, and stroke. Pre-diabetes can be reversed without insulin or medication by losing a modest amount of weight and increasing your physical activity. This weight loss can prevent, or at least delay, the onset of type 2 diabetes.
2. Type 1 diabetes: It is also called as insulin dependent diabetes mellitus (IDDM) or juvenile onset diabetes mellitus. The body stops producing insulin or produces too little insulin to regulate blood glucose level. Type 1 diabetes is typically recognized in childhood or adolescence. Type 1 diabetes can occur in an older individual due to destruction of pancreas by alcohol, disease, or removal by surgery. It also results from progressive failure of the pancreatic beta cells, which produce insulin. People with type 1 diabetes require daily insulin treatment to sustain life.
3. Type 2 diabetes: It is also called as non insulin dependent diabetes mellitus (NIDDM). The pancreas secretes insulin, but the body is partially or completely unable to use the insulin. This is sometimes referred to as insulin resistance. The body tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they do not continue to secrete enough insulin to cope with the higher demands. Type 2 diabetes is typically recognized in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non-insulin-dependent diabetes mellitus.
4. Gestational diabetes: It is a form of diabetes that occurs during the second half of pregnancy. Although gestational diabetes typically goes away after delivery of the baby. Women who have gestational diabetes are more likely than other women to develop type 2 diabetes later in life. Women with gestational diabetes are more likely to have large babies.
5. Metabolic syndrome: It is also called syndrome X, which is a set of abnormalities with insulin-resistant diabetes (type 2 diabetes). It is always presenting along with hypertension, hyperlipidemia, elevation of LDL cholesterol, decreased HDL cholesterol, elevated triglycerides, central obesity, and abnormalities in blood clotting and inflammatory responses. A high rate of cardiovascular disease is associated with the metabolic syndrome.
Causes:
In type 1 diabetes, the absolute lack of insulin usually secondary to a destructive process affecting the insulin producing beta cells in the pancreas is the main disorder. Type 1 diabetes is believed to be an autoimmune disease. The body's immune system attacks the cells in the pancreas that produce insulin. A predisposition to develop type 1 diabetes may run in families. Environmental factors, include common viral infections. Its prevalence also runs through certain human races such as Northern Europeans etc.
In type 2 diabetes there is insufficient production of insulin to the body's needs, production of defective insulin, or the inability of cells to use insulin properly and efficiently leads to hyperglycemia and diabetes. Type 2 diabetes has strong genetic links and tends to run in families.
Risk Factors for developing diabetes:
1. High blood pressure.
2. High blood triglyceride levels.
3. High-fat diet.
4. High alcohol intake.
5. Sedentary lifestyle.
6. Obesity or overweight.
7. Gestational diabetes.
8. Ethnicity.
9. Aging.
Symptoms of diabetes:
1. Increased fatigue.
2. Unexplained weight loss.
3. Thirst (polydipsia).
4. Dry mouth.
5. Frequent urination (polyuria).
6. Increased hunger (polyphagia).
7. Blurred vision.
8. Labored and heavy breathing.
9. Poor wound healing.
10. Iinfections.
11. Altered mental status.
12. Blurry vision.
13. Loss of consciousness.
Other symptoms may include slow-healing sores or cuts, itching of the skin, yeast infections, recent weight gain, numbness or tingling of the hands and feet, impotence or erectile dysfunction.
How it is detected and when to seek medical care:
1. When the patient is experiencing above mentioned diabetes symptoms and there is high blood sugar. The patient's blood sugar levels, when tested, are consistently high (more than 200 mg/dL).
2. When the patient's blood sugar level is low (less than 60 mg/dL), hypoglycemia due to over use of insulin. It may also be a sign of infection or other stress on the system such as kidney failure, liver failure, adrenal gland failure, or the concomitant use of certain medications.
3. When the patient has an injury to the foot or leg, no matter how minor. Even the tiniest cut or blister can become very serious in a person with diabetes.
4. When the patient has a low-grade fever (less than 101.5°F). Fever is a sign of infection. In patients with diabetes, many common infections can potentially be more dangerous for them than for other people.
5. The patient is nauseated or vomiting but can keep liquids down.
1999 WHO Diabetes criteria:
Condition 2 hour glucose Fasting glucose
mmol/l(mg/dl) mmol/l(mg/dl)
Normal <7.8 (<140) <6.1 (<110)
Impaired fasting glycaemia <7.8 (<140) = 6.1(=110) & <7.0(<126)
Impaired glucose tolerance =7.8 (=140) <7.0 (<126)
Diabetes mellitus =11.1 (=200) =7.0 (=126)
Complications of diabetes:
1. Hyperglycemia: Diabetes ultimately lead to high blood sugar levels, a condition called hyperglycemia. Over a long period of time, hyperglycemia damages the retina of the eye, the kidneys, the nerves, and the blood vessels.
2. Insulin resistance: In pancreas the beta cells of the islets of Langerhans show reduction in number, degranulation, and hyalinization. Resistance to insulin develops in the target cells due to receptor insensitivity.
3. Vascular changes: Diabetes has a predisposition to develop vascular lesions affecting small and large vessels. In microangiopathy, there is a specific involvement of the small blood vessels, venules, capillaries, and arteries are affected. Microangiopathy affects several organ systems and the main lesions are seen in the retina, kidneys, peripheral nerves, and heart giving rise to diabetic retinopathy, diabetic neuropathy, and cardiomyopathy. Damage to the retina from diabetes (diabetic retinopathy) is a leading cause of blindness.
4. Atherosclerosis: Diabetes accelerates atherosclerosis, (the formation of fatty plaques inside the arteries), which can lead to blockages or a clot (thrombus). Such changes can then lead to heart attack, stroke, and decreased circulation in the arms and legs (peripheral vascular disease).
5. Nerve damage: Damage to the nerves from diabetes (diabetic neuropathy) is a leading cause of foot wounds and ulcers, which frequently lead to foot and leg amputations. Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach (gastroparesis), chronic diarrhea, and an inability to control heart rate and blood pressure during postural changes.
6. Renal lesions: This is seen in patients with advanced diabetes. These changes include vascular changes such as 1) arteriosclerosis of the renal artery, 2) sclerosis of the arteries, and 3) glomerulonephrosis. There is thickening of the glomerular capillary basement membrane. The evidence of glomerulonephrosis is established by the presence of proteinuria. Damage to the kidneys from diabetes (diabetic nephropathy) is a leading cause of kidney failure.
Diabetic emergencies:
In case of an emergency the patient should be accompanied by a companion, bring a list of all medical problems, medications, allergies to medications, and the blood sugar diary to the emergency department.
Diabetic Tests:
1. Thorough medical interview and physical examination: The healthcare questionnaire includes symptoms, risk factors for diabetes, past medical problems, current medications, allergies to medications, family history of diabetes or other medical problems such as high cholesterol or heart disease, and personal habits and lifestyle.
2. Finger stick blood glucose: This is a rapid screening test and may be performed anywhere, including community-based screening programs where the result is available right away. A fingerstick blood glucose test is not as accurate as testing the patient's blood in the laboratory.
3. Fasting plasma glucose: The patient will be asked not to eat or drink for 8 hours before the blood is drawn. If the blood glucose level is greater than or equal to 126 mg/dL after fasting, then they probably have diabetes. If fasting plasma glucose level is greater than 100 but less than 126 mg/dL, then the patient has impaired fasting glucose, or IFG. This is considered to be pre-diabetes. If the result is abnormal, the fasting plasma glucose test may be repeated on a different day to confirm the result.
4. Oral glucose tolerance test: This test involves drawing blood for a fasting plasma glucose test, then drawing blood for a second test two hours after drinking a very sweet drink containing 75 grams of sugar. If the blood sugar level after the sugar drink is greater than or equal to 200 mg/dL, the patient has diabetes. If the blood glucose level is between 140 and 199, then the patient has impaired glucose tolerance (IGT), which is a pre-diabetic condition.
5. Glycosylated hemoglobin or hemoglobin A1c: This test is a measurement of how high the blood sugar levels have been over the last 120 days. Excess blood glucose hooks on to the hemoglobin in red blood cells and stays there for the life of the red blood cell. A hemoglobin A1c test is the best measurement of blood sugar control in people known to have diabetes. A hemoglobin A1c result of 7% or less indicates a good glucose control. A result of 8% or greater indicates that blood sugar levels are too high for too much of the time.
Diagnosing complications of diabetes:
1. The patient should have their eyes checked at least once a year by an eye specialist to screen for diabetic retinopathy, a leading cause of blindness.
2. The patient's urine should be checked for microalbumin on a regular basis, at least one to two times a year. Protein in the urine is an early sign of diabetic nephropathy, a leading cause of kidney failure.
3. Sensation in the legs should be checked regularly using a tuning fork or a monofilament device. The healthcare provider should check the feet and lower legs at every visit for cuts, scrapes, blisters, or other lesions that could become infected.
4. The patient should be screened regularly for conditions that may contribute to heart disease, such as high blood pressure and high cholesterol.
Management of Diabetes:
1. Home treatment: Diabetes can be controlled by a healthy lifestyle, choices of diet, exercise, and other healthy habits at home.
2. Diet: A healthy diet is important in controlling blood sugar levels and preventing diabetes complications. If the patient is obese he can adopt a weight modification program to help reduce his body weight. Eating a consistent, well-balanced high fiber diet, low in saturated fat, and low in concentrated sweets improves the health.
3. Exercise: Regular exercises can help to reduce the risk of developing diabetes. Activity can also reduce the risk of developing complications of diabetes such as heart disease, stroke, kidney failure, blindness, and leg ulcers. As little as 20 minutes of walking three times a week has a proven beneficial effect.
4. Alcohol use and smoking: Use moderate alcohol or eliminate consumption of alcohol altogether. Smoking cigarettes raises the risk markedly for nearly all of the complications of diabetes. Smoking damages blood vessels and contributes to heart disease, stroke, and poor circulation in the limbs.
5. Self-monitored blood glucose: Check blood sugar levels frequently, at least before meals and at bedtime, and record the results in a logbook. This logbook should include insulin or oral medication doses and times, the time and what the patient ate, when and for how long they exercised, and any significant events of the day such as high or low blood sugar levels etc.
6. Medical Management: The treatment of diabetes is individualized depending on the type of diabetes, whether the patient has other active medical problems, whether the patient has complications of diabetes, and age and general health of the patient at the time of diagnosis. Education about diabetes and its treatment is essential in all types of diabetes.
Treatment of Type 1 diabetes:
Treatment of diabetes always involves the daily injection of insulin, usually a combination of a short-acting insulin and a longer acting insulin. Insulin must be given as an injection. When taken by mouth, insulin would be destroyed in the stomach before it could get into the blood stream so it has to be given as an injection. Most people with type 1 diabetes take insulin injections by themselves as it is important that the patient knows how to do it in case the other person is unavailable. Insulin is usually given in two or three injections per day, generally around mealtimes. Dosage is individualized and is tailored to the patient's specific needs by the healthcare provider. Longer acting insulins are typically administered one or two times per day. It is essential that the patient have adequate meals if the insulin is to be administered, as the insulin will lower the blood sugar regardless of whether they have taken meals. If insulin is taken without eating, the result will be hypoglycemia which called an insulin reaction. Maintaining accurate records of blood sugar levels and insulin dosages is very important for the patient's diabetes management. Eating a consistent, healthy diet appropriate for the patient's size and weight is essential in controlling blood sugar level.
Insulins: Human insulin is the only type of insulin that is less likely to cause allergic reactions than animal-derived varieties of insulin. The type of insulin chosen to customize treatment for an individual is based on the goal of providing optimal blood sugar control. Different types of insulin are available and categorized according to their times of action, onset, and duration. Commercially prepared mixtures of some insulins may also be used to provide constant (basal) control and immediate control. According to the duration of action there are rapid-acting insulins, intermediate-acting insulins, and long-acting insulins.
Treatment of Type 2 diabetes:
Depending on how elevated the patient's blood sugar and glycosylated hemoglobin (HbA1c) are at the time of diagnosis, they may be given a chance to lower blood sugar level without medication. The best way to do this is to lose weight if obese and start an exercise program. This will generally be tried for three to six months, then blood sugar and glycosylated hemoglobin will be rechecked. If they remain high, the patient will be started on an oral medication, usually a sulfonylurea or biguanide to help control blood sugar level. It is still important to eat a healthy diet, lose weight if they are overweight, and engage in moderate physical activity as often as possible. It is important to get just the right dose of the right medication to get the blood sugar level in the recommended range with the fewest side effects. The doctor may decide to combine two types of medications to get blood sugar level under control. Even people with type 2 diabetes may require insulin injections to control their blood sugar levels.
Many different types of medications are available to help lower blood sugar levels in type 2 diabetes. Each type works in a different way. It is very common to combine two or more types to get the best effect with fewer side effects.
1. Sulfonylureas: These drugs stimulate the pancreas to make more insulin.
2. Biguanides: These agents decrease the amount of glucose produced by the liver.
3. Alpha-glucosidase inhibitors: These agents slow absorption of the starches one eats. This slows down glucose production.
4. Thiazolidinediones: These agents increase sensitivity to insulin.
5. Meglitinides: These agents stimulate the pancreas to make more insulin.
6. D-phenylalanine derivatives: These agents stimulate the pancreas to produce more insulin more quickly.
Follow up Treatment:
Follow the healthcare provider's treatment recommendations. Keep records of blood sugar levels as often as recommended by the healthcare provider, including the times the levels were checked, when and how much insulin or medication was taken, when and what was eaten, and when and for how long the patient exercised. Call the healthcare provider if in any emergency.
Education:
Attend diabetes education classes at the local hospital. The more educated the patient and their family are about the disease, the better they are likely to do. Recognize low blood sugar levels and know how to treat them. The patient and their family should be taught how to recognize the signs and symptoms of low blood sugar levels.
It is of importance that early detection and treatment of diabetes is essential in treating this disease effectively and reducing its complications. So hope this article will help you in detecting diabetes early in its course and help prevent its prevalence.
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