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:

  1. 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.
  2. 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)
  3. Blood pressure control – diabetes mellitus patients are prone to get cardiovascular disease. Blood pressure goal is 130/80 or less.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. Immunizations – Pneumococcal vaccine should be given to adult patient with diabetes mellitus. Influenza vaccine should be given yearly, especially during this swine flu epidemic.
  11. 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:

  1. CPG Management of Type 2 Diabetes Mellitus. Ministry of Health Malaysia. 3rd edition. 2004.
  2. Tao Le et al. first Aid for the Family medicine Boards. Mc Graw Hill. 2008.

Under Medical, family medicine | Comment now » | Technorati Tags: , , ,