Routine management of diabetes
Diabetes mellitus is defined as carbohydrate metabolism impairment which leads to hyperglycemia. There are a lot of complications of diabetes mellitus. That is proper management of this disease is essential. It is not only about taking care of the blood sugar level, but it is about taking care of the patient as a whole. Here I give some important management of diabetes mellitus:
- Diet and exercise – this is very important. No matter how much medication the patient takes, if he/she does not taking a healthy diet, the blood sugar level will be impossible to control. Diabetic diet is not much different from healthy diet. The patient should take low calorie and low fat diet. Have regular exercise (e.g.: aerobic exercise) at least 30 minutes 3 – 5 times per week.
- Glucose control – no doubt this is very important. Measurement of FBS (fasting blood sugar) is good to see the current blood sugar. However, measurement of HbA1c is used to monitor the glucose level for the past 3 months. In stable patients, twice a year measurement is good enough. Keep the HbA1c <6.5-7.0 (<6.5 by American Endocrine Society and <7.0 by American Diabetes Association criteria)
- Blood pressure control – diabetes mellitus patients are prone to get cardiovascular disease. Blood pressure goal is 130/80 or less.
- Lipid control – healthy diet will help to control the lipid. Other than that, medications (e.g.: statin) can be used. Keep LDL <100mg/dL. In high risk patient, the goal is lower, it is <70mg/dL.
- Aspirin therapy – daily aspirin therapy is recommended for adults with diabetes mellitus and macrovascular disease. It is also advisable to those >40 years of age who have one or more additional risk factors for cardiovascular disease.
- Smoking cessation – A lot of people die every day due to smoking either active smoking or passive. Everybody (not only diabetic patients) should quit smoking.
- Nephropathy screening – kidney screening should be done yearly for stable patient. It consists of microalbuminuria screening with spot urine protein/creatinine or albumin/creatinine ratio. Type 2 diabetic patients should be screened immediately after the diagnosis has been made. For type 1 diabetic patients, the screening can be done after 5 years of diagnosis. ACEIs and ARBs can help to some extent. After initiation, patient usually tolerate up to 15-20% increase in serum creatinine. Tight blood pressure and sugar level will surely delay the progression of renal impairment.
- Retinopathy screening – same as nephropathy screening, patients with type 2 diabetes mellitus need yearly eye examination and the appointment should be scheduled immediately after the diagnosis while in type 1 diabetes mellitus, the screening can be delay until 5 years after diagnosis. Glucose and blood pressure control is good as prevention measures of diabetic retinopathy. In patients with diabetic retinopathy, laser therapy can slow the disease progression and decrease risk of vision loss.
- Foot care – self monitoring of foot should be done daily by the patients or care takers in view of high risk of infection among diabetic patients. This is because diabetic patients prone to get peripheral neuropathy. Annual complete foot examination using a monofilament testing is recommended. Visual inspection should be done during each consultation visit with foot care education for all diabetic patients to increase their awareness.
- Immunizations – Pneumococcal vaccine should be given to adult patient with diabetes mellitus. Influenza vaccine should be given yearly, especially during this swine flu epidemic.
- Tuberculosis testing – In places especially where the prevalence of tuberculosis is high, tuberculosis testing is highly recommended. This is in view of the reason that high risk population has high reactivation rates.
Other related article:
Reference:
- CPG Management of Type 2 Diabetes Mellitus. Ministry of Health Malaysia. 3rd edition. 2004.
- Tao Le et al. first Aid for the Family medicine Boards. Mc Graw Hill. 2008.
Tags: blood pressure, blood sugar, diabetes, management
Technorati Tags: blood pressure, blood sugar, diabetes, management
Diabetes is one of the most fatal disorders confronted by majority of the people these days so we need to share this kind of info to everyone. Thx for this post!
Excellent blog. First time here for me. I think I will be coming here often.
Can herbs or supplements help you control your diabetes? These 10 have shown some promise in lowering blood sugar, boosting insulin sensitivity, reducing high blood pressure and cholesterol, and more. Talk to you doctor before adding any new pill to your regimen, especially if it has the potential to lower your blood sugar. You may need to check your blood sugar more often and possibly have your doctor adjust your medication dosage. If you don’t see results after a month or two, stop wasting your money.
Herbs and Supplements for Diabetes
Talk to you doctor before adding any new pill to your regimen, especially if it has the potential to lower your blood sugar.
1. Gymnema Sylvestre
Main use: Lowering blood sugar
Typical dosage: 200 to 250 milligrams twice daily.
This plant’s Hindi name translates as “sugar destroyer,” and the plant is said to reduce the ability to detect sweetness. It’s regarded as one of the most powerful herbs for blood-sugar control. It may work by boosting the activity of enzymes that help cells use glucose or by stimulating the production of insulin. Though it hasn’t been studied extensively, it’s not known to cause serious side effects.
2. Bitter Melon
Main use: Lowering blood sugar
Typical dosage: 50 to 100 milliliters (approximately 3 to 6 tablespoons) of the juice daily.
The aptly named bitter melon is thought to help cells use glucose more effectively and block sugar absorption in the intestine. When Philippine researchers had men and women take bitter melon in capsule form for three months, they had slight, but consistently, lower blood sugar than those taking a placebo. Gastrointestinal problems are possible side effects.
3. Magnesium
Main use: Lowering blood sugar
Typical dosage: 250 to 350 milligrams once a day.
Magnesium deficiency is not uncommon in people with diabetes, and it can worsen high blood sugar and insulin resistance. Some studies suggest that supplementing with magnesium may improve insulin function and lower blood sugar levels, but other studies have shown no benefit. Have your doctor check you for deficiency before supplementing with magnesium.
4. Prickly Pear Cactus
Main use: Lowering blood sugar
Typical dosage: If you eat it as a food, aim for 1?2 cup of cooked cactus fruit a day. Otherwise, follow label directions.
The ripe fruit of this cactus has been shown in some small studies to lower blood sugar levels. You may be able to find the fruit in your grocery store, but if not, look for it as a juice or powder at health food stores. Researchers speculate that the fruit may possibly lower blood sugar because it contains components that work similarly to insulin. The fruit is also high in fiber.
5. Gamma-Linolenic Acid
Main use: Easing nerve pain
Typical dosage: 270 to 540 milligrams once a day.
Gamma-linolenic acid, or GLA, is a fatty acid found in evening primrose oil. Some research suggests that people with diabetes have lower than optimal levels of GLA, and studies have found that the supplement can reduce and prevent nerve pain associated with diabetes.
6. Chromium
Main use: Lowering blood sugar
Typical dosage: 200 micrograms once daily.
This trace mineral is thought to enhance the action of insulin as well as being involved in carbohydrate, fat, and protein metabolism. Some research shows that it helps normalize blood sugar — but only in people who are deficient in chromium.
7. Bilberry
Main use: Protecting the eyes and nerves
Typical dosage: 80 to 120 milligrams two times per day of standardized bilberry extract.
This relative of the blueberry contains powerful antioxidants in its fruit and leaves. These antioxidants, called anthocyanidins, seem to help prevent damage to tiny blood vessels that can result in nerve pain and retinopathy (damage to the eye’s retina). Animal studies have also suggested that bilberry may lower blood sugar.
8. Alpha-Lipoic Acid
Main uses: Easing nerve pain, lowering blood sugar
Typical dosage: 600 to 800 milligrams a day.
Called ALA for short, this vitamin-like substance neutralizes many types of free radicals. A build-up of free radicals, caused in part by high blood sugar, can lead to nerve damage and other problems. ALA may also help muscle cells take up blood sugar. In a German study, a team of scientists had 40 adults take either an ALA supplement or a placebo. At the end of the four-week study, the ALA group had improved their insulin sensitivity 27 percent. The placebo group showed no improvement. Other studies have shown a decrease in nerve pain, numbness, and burning.
9. Fenugreek
Main use: Lowering blood sugar
Typical dosage: 5 to 30 grams with each meal or 15 to 90 grams with one meal per day.
These seeds, used in Indian cooking, have been found to lower blood sugar, increase insulin sensitivity, and reduce high cholesterol, according to several animal and human studies. The effect may be partly due to the seeds’ high fiber content. The seeds also contain an amino acid that appears to boost the release of insulin. In one of the largest studies on fenugreek, 60 people who took 25 grams daily showed significant improvements in blood sugar control and post-meal spikes.
10. Ginseng
Main use: Lowering blood sugar
Typical dosage: 1 to 3 grams a day in capsule or tablet form, or 3 to 5 milliliters of tincture three times a day.
Known for its immune-boosting and disease-fighting benefits, this Chinese herb has several positive diabetes studies behind it. Researchers have found that ginseng slows carbohydrate absorption; increases cells’ ability to use glucose; and increases insulin secretion from the pancreas. A team from the University of Toronto has repeatedly demonstrated that ginseng capsules lower blood glucose 15 to 20 percent compared to placebo pills.
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