When diabetes struck, patient motivation and diabetes education are the keys to success. This aims at reducing the chances and avoiding diabetes complications which include low blood sugar – hypoglycemia as well as the long term complications of hypoglycemia. Diabetes patient education is also vital in order to ensure tight blood sugar control in order to reduce diabetes complications of the kidney (renal neuropathy), central nervous system damage (CNS) and diabetic retinal damage.
In diabetes control, it is quiet medically important to strike a balance for each diabetic patient between lower blood glucose readings and the risk of hypoglycemia. It is quiet of interest to note that, tight blood pressure control is as effective in reducing micro-vascular disease, but also reduces macro-vascular disease and mortality among the diabetics. This underscores the benefit and gains of a global assessment of a individual risk in diabetes such as – glucose, blood pressure, cholesterol, and smoking history. It is always good to note that DM – diabetes mellitus should never be treated in isolation. The best medical care or treatment approach to DM is giving it a systemic approach.
The basic investigations needed to diagnose diabetes include checking the blood plasma for the amount of circulating or free glucose, lipids, HbA1c, cholesterol, while the urine of the diabetics should be checked for urinary protein excretion and detailed urine analysis. Fundoscopy and foot examination should be carried out in the diabetics in order to assess the feet for diabetes foot and check for neuropathy.
The first line treatment approach if diabetes is diagnosed is to check for ketone bodies in the urine, ketonuria. If ketonuria is present alongside with dehydration, or the patient is ill, hospital admission is required. Children with diabetes are liable to become ketotic rapidly, so prompt pediatric referral becomes compulsory. If the diabetes subject is pregnant as well, care should be given alongside with an interested obstetrician, and the need for special pre-conception counseling should be made well known to the diabetic patient.
Diabetes education becomes imperative on drug therapy of diabetes. The diabetes education/negotiation becomes crucial on diabetes drugs, diet, and the following diabetes education outline should be covered: monitoring blood or urine glucose and adapting treatment accordingly, explain to the diabetic patient the need for insulin when ill more, not less, recognition and treatment of hypoglycemia with sweets or sugars, introduce the diabetic patient to a specialist nurse or dietician, chiropodist, and diabetic association, educate the diabetic patients on the health benefits of regular medical checkup, follow-up and regular physical exercise which helps to reduce the risk of insulin resistance, also educate the diabetic patient to inform their driving license authority, and above all, guide the diabetic patient on healthy eating: reduce saturated fats, reduce sugar, moderately increase starchy carbohydrates – healthy carbs (bread, potato, pasta) is taken at each meal. If there is renal impairment or micro-albuminuria, then restrict protein intake.
Diabetes treatment borders on the correct use of bio insuling and a combination of oral anti diabetic medications or oral hypoglycemic agents such as sulfonylureas (increases insulin secretion)- the drugs here are tolbutamide-short acting, useful in elderly as hypoglycemia, which is short acting, while the medium acting is glibenclamide.
Other oral anti-diabetic medications include metformin (a biguanide) which acts by increasing insulin sensitivity, decreasing liver (hepatic) gluconeogenesis, and have been seen to decrease mortality in obese diabetic patients. Metformin is not recommended to be used in renal or liver impairment. Other anti diabetic medications are acarbase (an alpha-glucosidase inhibitor) and thiazolidinediones, effects and actions of which will be discussed in detail in the next diabetes guide to be published here.
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