In our indian population , the most commonest health hazard now a days is ‘DIABETES MELLITUS‘. Although specialists are often asked to evaluate& treat patients who have advanced complications or require complex treatment regimens,90% of patients with diabetes can successfully be managed under primary care setting. We have to screen high risk patients for diabetes , initiate anti diabetic treatments & our aim should be to detect & manage microvascular & macrovascular complications. Diabetes is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period .
Symptoms of high blood sugar includes
- Increased hunger
- Increased thirst
- Frequent urination. If left untreated Diabetes can cause many complications like diabetic ketoacidosis & non ketotic hyperosmolar coma.serious long term complications like cardiovascular diseases,stroke,chronic kidney disease,foot ulcers & damage to the eyes.
Types Of diabetes:
1)Type 1 DM- Results from the failure of pancreas To produce enough insulin also known as juvenile Diabetes . Cause is unknown
2) Type 2 DM – Due to insulin resistance in which cells fail to respond to insulin properly as per disease progresses lack of insulin may also develop.. This is adult onset diabetes. Primary cause is obesity and lack of exercise..
3) Gestational Diabetes- Occurs in pregnant woman..
4) Others – Genetically, Chronic pancreatitis, Steroid induced , Viral infections(Congenital rubella, Mumps and coxsackie virusB )
Complications of diabetes
A)Short- term complications
1) Hypoglycemia– Hypoglycemia is sugar fall . It is a serious emergency and if left it can cause death.
***SYMPTOMS– Feeling of hunger, sweating, Weakness, Loss of consciousness, confusion, Seizures
***REMEDY – for conscious patients,take 15-20 g of carbohydrates.repeat blood glucose monitoring after 15 mins.if level remains low,repeat dose of 15-20 g of carbs. glucagon emergency kit should be prescribed to all patients at risk for developing severe hypoglycemia.family members must be instructed on the use of glucagon .
2) diabetic ketoacidosis
3)hyperosmolar non ketotic diabetic coma
B) long –term complications
- microvascvular or neuropathic
Peripheral neuropathy,mono neuropathy
Coronary circulations-myocardial ischaemia,infarction(heart attacks)
Dear patient At first Measure your blood sugar level And know whether you are diabetic or not..And at which stage you are.
|Fasting Blood Sugar Level||HbA1C|
|Diabetes||126<||6.5 or greater than 6.5|
Goals to control Diabetes.
- Regular intake of Anti diabetic therapy as prescribed by your physician..(TypeI DM- Insulin, TypeII Anti diabetic drug/insulin)
- Exercise- Patients of diabetes should perform exercise of moderate intensity for at least 150 min per weak(30 min/day for 5 days) . Activity should be spread over a minimum of three days with no more two consecutive days of inactivity . Patient with typeII DM should be encourage to incorporate resistance training into their regiment. Walking should be your first choice of training( work using a pedometer 10000 steps per day.)
- Diet-The diabetic food pyramid(adapted from the national centre for nutrition & dietetics,the American Dietetic Association, and the American Academy of family Physicians)
- Smoking cessation
- Weight loss recommendetion- 5%to10% with a sustained weight loss of >10% of initial body weight .
- Screen and treat for depression
- Blood pressure target- Systolic target less than 130 mm of Hg
Diastolic target is less than 80 mm oof Hg
**Based on patient characteristics treat should be individualized.
- Target LDL cholesterol – Less than 100mg/dl or less than 70mg/dl in high risk patient.
Target Triglycerides- Less than 150mg/dl
Target HDL cholesterol- Greater than 40mg/dl in men and greater 50mg/dl in women.
- Anti platelet Therapy- (Low dose aspirin 81-325 mg)Used in Primary prevention in most men ageing greater than 50 or women ageing greater 60 with T1DM or T2DM and at list one major list factor( Family history of coronary heart disease, hyper tension, smoking, high cholesterol, urinary protein loss)
- Treatment of complication.
- Glycemic targets For Adults(12)
|Parameter||Target: ADA guidelines||Target: AACE Guidelines|
|Hb A1C||<6%(individual goal)
|Fasting Plasma glucose||90-130 mg/dl||<110mg/dl|
|Protoprandial Plasma glucose||<180 mg/dl||<140mg/dl|
References- 1)Diabetes Management in Primary care by DR. Jeff Unger(Director of Metabolic studies,Chino ,California)