Diabetes mellitus is a metabolic disease characterized by hyperglycemia (high blood sugar). Diabetes is a disease in which the body does not produce insulin or properly use. Insulin is a hormone produced in the pancreas, an organ near the stomach. Insulin is needed to turn sugar and other food into energy. Three major forms of diabetes: type 1, type 2 and gestational diabetes (occurring during pregnancy), which have similar signs, symptoms and consequences, but different causes and population distributions. Ultimately, all forms are due to pancreatic beta cells are unable to produce enough insulin to prevent hyperglycemia. Type 1 is usually due to self-destruction of pancreatic beta cells that produce insulin. Type 2 is characterized by tissue wide insulin resistance and varies widely, but sometimes progressing to loss of function of beta cells. Gestational diabetes is similar to type 2 diabetes, since it involves insulin resistance; hormones of pregnancy cause insulin resistance in those women genetically predisposed to develop this disease.
Diabetes is a chronic disease with no cure as of 2010 but a lot of research is underway. It is associated with an impaired glucose cycle, altering metabolism. Management of this disease may include carefully managing diet, exercising, taking oral diabetes medication, using some form of insulin, maintaining proper circulation in extremities and may be further complicated by other external factors such as stress, illness, menses, injection site scarring, and other physiological factors unique to individual patients.
As diabetes is a prime risk factor for cardiovascular disease, controlling other risk factors which may give rise to secondary conditions, as well as the diabetes itself, is one of the facets of diabetes management. Checking cholesterol, LDL, HDL and triglyceride levels may indicate hyperlipoproteinemia, which may warrant treatment with hypolipidemic drugs. Checking the blood pressure and keeping it within strict limits (using diet and antihypertensive treatment) protects against the retinal, renal and cardiovascular complications of diabetes. Regular follow-up by a podiatrist or other foot health specialists is encouraged to prevent the development of diabetic foot. Annual eye exams are suggested to monitor for progression of diabetic retinopathy.
Late in the nineteenth century, sugar in the urine (glycosuria) was associated with diabetes. Various doctors studied the connection. Frederick Madison Allen studied diabetes in 1909-12, and then published a large volume, Studies Concerning Glycosuria and Diabetes, (Boston, 1913). He invented a fasting treatment for diabetes called the Allen treatment for diabetes. His diet was an early attempt at managing diabetes.
Modern approaches to diabetes primarily rely upon dietary and lifestyle management, often combined with regular ongoing blood glucose level monitoring.
Diet management allows control and awareness of the types of nutrients entering the digestive system, and hence allows indirectly, significant control over changes in blood glucose levels. Blood glucose monitoring allows verification of these, and closer control, especially important since some symptoms of diabetes are not easy for the patient to notice without actual measurement.
Other approaches include exercise and other lifestyle changes which impact the glucose cycle.
In addition, a strong partnership between the patient and the primary healthcare provider – general practitioner or internist – is an essential tool in the successful management of diabetes. Often the primary care doctor makes the initial diagnosis of diabetes and provides the basic tools to get the patient started on a management program. Regular appointments with the primary care physician and a certified diabetes educator are some of the best things a patient can do in the early weeks after a diagnosis of diabetes. Upon the diagnosis of diabetes, the primary care physician, specialist, or endocrinologist will conduct a full physical and medical examination. The management of diabetes is so important for diabetics to understand. For a newly diagnosed diabetic, any management plan can be overwhelming at first, but it is a vital means of controlling this disease as well as preventing complications.
The main items that need to be managed and checked are:
• Height and weight measurements
• Blood pressure measurements
• Thyroid examination
• Examination of hands, fingers, feet, and toes for circulatory abnormalities
• Blood tests for fasting blood sugar, and cholesterol
• Family history of diabetes, cardiovascular disease, and stroke
• Prior infections and medical conditions
• A list of current medications, including:
• Prescription medications
• Over-the-counter medications
• Vitamin, mineral or herbal supplements
• Smoking history, including encouragement to stop smoking (if applicable)
• Signs of complications with pregnancy or trying to get pregnant for women patients
• Eating and exercise habits
• Vision abnormalities, to check for eye health issues
• Urination abnormalities, which can indicate kidney disease
• Teeth and Mouth hygiene
• Regular visits to dentist, ophthalmologist, and primary doctor.
This is when diabetics need to make a life time commitment to doing what is necessary to control diabetes. All of these factors are interconnected. And in the case of Type 2 diabetes, it can be totally controlled in some cases with diet and exercise.
Optimal management of diabetes involves patients measuring and recording their own blood glucose levels. 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.
Glucose monitoring
The home monitoring of glucose levels needs to be done frequently using a glucometer. This is vital as this is the main way to know that your management plan is working.
Diet
For most Type 1 diabetics there will always be a need for insulin injections throughout their life. However, both Type 1 and Type 2 diabetics can see dramatic normalization of their blood sugars through controlling their diet, and some Type 2 diabetics can fully control the disease by dietary modification. As diabetes can lead to many other complications it is critical to maintain blood sugars as close to normal as possible and diet is the leading factor in this level of control.
Weight Control
Weight is a risk factor for Type 2 diabetes, so managing the weight is a critical factor for controlling blood glucose levels.
Exercise
Exercise is important in helping with weight control as well as helping any medication or insulin therapy to work more effectively.
Driving
Studies conducted in the United States and Europe showed that drivers with type 1 diabetes had twice as many collisions as their non-diabetic spouses, demonstrating the increased risk of driving collisions in the type 1 diabetes population. Diabetes can compromise driving safety in several ways. First, long-term complications of diabetes can interfere with the safe operation of a vehicle. For example, diabetic retinopathy (loss of peripheral vision or visual acuity), or peripheral neuropathy (loss of feeling in the feet) can impair a driver’s ability to read street signs, control the speed of the vehicle, apply appropriate pressure to the brakes, etc.
Second, hypoglycemia can affect a person’s thinking process, coordination, and state of consciousness. This disruption in brain functioning is called neuroglycopenia. Studies have demonstrated that the effects of neuroglycopenia impair driving ability.
Dental care
High blood glucose in diabetic people is a risk factor of developing gum and teeth problems, especially in after puberty and aging individuals. Diabetic patients have greater chances of developing oral health problems such as tooth decay, salivary gland dysfunction, fungal infections, inflammatory skin disease, periodontal disease or taste impairment and thrush of the mouth. The oral problems in persons suffering from diabetes can be prevented with a good control of the blood sugar levels, regular checkups and a very good oral hygiene. By maintaining a good oral status, diabetic persons prevent losing their teeth as a result of various periodontal conditions.
Medical Management of Diabetic Complications
Hypertension
Diabetic patients with hypertension should have their blood pressure (BP) lowered to targeted levels, since serious microvascular and macrovascular diabetic complications are strongly linked to hypertension. The optimal treatment goal for non-pregnant diabetics over age 18 is a systolic BP of < 130 and a diastolic < 80 mmHg.
Aspirin Therapy
Clinical trials have demonstrated that aspirin therapy is a cheap and effective intervention for preventing serious cardiovascular events such as myocardial infarctions and stroke among diabetics.
Clinical Precaution: Do not routinely use aspirin in inmates < 21 years of age, due to the increased risk of Reye’s syndrome.
Dyslipidemia
Type 1 and type 2 diabetes are considered coronary heart disease (CHD) risk equivalents, due to the strong association of diabetes and serious cardiovascular disease. Type 2 diabetes is associated with other CHD risk factors such as elevated LDL cholesterol, low HDL cholesterol, and elevated triglycerides. Lipid disorders should be managed aggressively in diabetic patients to reduce the risk of serious cardiovascular events.
Diabetic Nephropathy
Microalbuminuria (30–300 mg/24 hour), the earliest stage of kidney disease associated with diabetes, often progresses to clinical albuminuria (greater than 300 mg/24 hours) with a subsequent decline in renal function over a period of years. Hypertension usually develops during the onset of Microalbuminuria and, if left untreated, can hasten progression of renal disease.
No comments:
Post a Comment