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Diabetes: What you need to know |
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For our bodies to work properly, we need to convert sugar into energy. A hormone called insulin is essential for the conversion of sugar (glucose) into energy. With diabetes, insulin is no longer produced in sufficient amounts by
the body, or the insulin produced is not working properly.
There are two main types of diabetes: type 1 and type 2. According to the Ministry of Health, diabetes is becoming a common disease and a major
concern to healthcare professionals here in Malaysia.
More and more
diabetic patients are being admitted into government hospitals. There were
21,872 admissions in 1995; this increased by 80 percent in 2004 (39,358
admissions). |
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What are the tell-tale signs? |
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The symptoms of type 1 and type 2 diabetes (which can exist simultaneously) are: |
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• Being constantly tired
• Feeling extremely thirsty
• Passing more urine than normal
• Unexplained weight loss
• Weakness and fatigue
• Blurred vision
• Itching of the skin or genital area
• Slow healing of infections
• Numbness and tingling at the hands or feet
These symptoms can develop suddenly or gradually. If you experience any of these, see your doctor, who can test you for diabetes. |
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How is diabetes treated? |
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People with type 1 diabetes require insulin replacement therapy. Insulin preparations may be ultrashort acting, short acting, intermediate acting or long
acting. A combination of these is often given repeatedly each day, depending on
the prescribed regimen.
Many people with type 2 diabetes can be managed through diet and exercise alone. However, others require the addition of an oral hypoglycemic (blood-sugar lowering) agent. |
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There are several types of oral hypoglycemic agents, and some of these can be combined for added effect.
• Biguanides, such as metformin
• Sulfonylureas, such as glibenclamide, gliclazide, glipizide and glimepiride
• Alpha-glucosidase inhibitors, such as acarbose
• Thiazolidinediones, such as rosiglitazone and pioglitazone
• Meglitinides, such as repaglinide
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When hypoglycemic therapy fails to control blood sugar levels, insulin injections are required. |
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Ensuring that your diabetes is monitored |
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Your target blood sugar level depends on many factors, including your age, overall health, level of understanding, social support system, personal preferences, and
whether you have type 1 or type 2 diabetes mellitus.
It's important that people with diabetes stabilize their blood glucose levels. What is considered "acceptable" blood glucose levels can vary slightly, but as a rule of
thumb, fasting blood glucose levels should be less than 6.0 mmol/L, while nonfasting levels should be 4.0 to 8.0 mmol/L.
It has been shown that keeping your blood glucose as close to normal as possible reduces the risk of long-term complications of diabetes.
Most people with type 1 diabetes and many who are taking oral hypoglycemic medications are advised to monitor their blood sugar levels frequently. Even blood glucose monitoring in type 2 diabetes controlled by diet and exercise is useful to find out if treatment goals are being met. Blood glucose monitors usually provide a digital reading of your blood glucose
level, and models are available to suit people who have poor eyesight or other
disabilities. Many blood glucose monitors store the readings. These data can be
downloaded onto a computer and analyzed to aid your doctor in making treatment
decisions about your diabetes.
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What is hypoglycemia? |
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Hypoglycemia is a condition where the level of glucose in the blood drops too low (below 3.0 mmol/L). This can cause dizziness, sweating, fatigue, confusion and
blurred vision, which will usually go away 10 to 15 minutes after eating sugar. A
hypoglycemic spell is an emergency. |
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What do you do for a hypoglycemic spell? |
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Most people experience the aforementioned symptoms as a warning of hypoglycemia. But for some, hypoglycemia may cause little or no symptoms, and
then they suddenly become unconscious or get convulsions. This is common if
you've had diabetes for many years already.
Mild hypoglycemia is treated by drinking a cup of Milo, sweetened juice or milk,
or by taking glucose tablets. In the case of more serious hypoglycemia, someone
should call an ambulance. The paramedic will then give glucose intravenously or
will inject a glucose-increasing hormone. |
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Controlling your diabetes |
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Controlled diabetes means keeping the amount of sugar in your body as closely as possible within the normal range. |
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American Diabetes
Association
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International Diabetes
Federation |
Malaysian Clinical
Practice guidelines |
Fasting (mmol/L) |
5.0-7.2 |
<5.5 |
4.4-6.1 |
2 hours after meal (mmol/L) |
<10 |
<7.5 |
4.4-8.0 |
HbA |
<7.0% |
<6.5% |
<6.5% |
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Apart from regularly checking your own blood glucose level, your doctor may also recommend that you have your glycosylated hemoglobin (HbA1c) level measured
every 3 to 6 months. Hemoglobin is a protein contained within red blood cells that
will combine with glucose molecules - becoming increasingly 'glycosylated' - if an excess of glucose is present in the blood when new red blood cells are formed.
Red blood cells last for several months in the bloodstream, making HbA a very
useful indicator of how tight your blood glucose control has been over the last
2 to 3 months. Your HbA measurement is taken from a simple blood test and
should ideally be 7 percent or less. Talk to your doctor or pharmacist for more
information. |
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Home blood glucose testing |
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Deciding when to test depends on discovering when and why your blood sugar
goes out of range. Here’s when you can begin home-testing:
• When you wake up. A fasting blood sugar test tells you how well your medications
have been working overnight, whether you may be eating too much for dinner,
or if you need to adjust a bedtime snack. For most people, your level should be
between 80-120 mg/dL (4.4-6.7mmol/L).
• Before a meal. Testing before each meal can help you decide what and how
much to eat, and, in some cases, how to adjust your medication. You should
typically aim for less than 110 mg/dL (6.1mmol/L).
• Two hours after a meal. You'll learn whether you ate too many carbohydrates or
if you should cut back or substitute different foods next time. Your goal should
be less than 140 mg/dL (7.8mmol/L).
• Exercise. Exercise usually uses up blood glucose, so it makes sense to test before, during and two hours after exercise. If your result is less than 100 mg/dL (5.6mmol/L) eat at least one carbohydrate of choice (for example, one slide
of bread) before exercising. However, your glucose may rise if you exercise
when you are above 250 mg/dL (13.9mmol/l).
• Bedtime. Your last chance of the day to adjust diet or medication so that you
can stay in range during the night. |
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Other Times to Test. Consider additional short-term testing if you feel the signs of
hypoglycemia (low blood sugar), illness, changes in physical activity or nutrition,
stress resulting from a major life change, worsening HbA1c results, and changes
or adjustments in medication (including a number of medications not related to
diabetes treatment). |
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