A new Israeli study offers a natural solution for improving HbA1c levels and cardiovascular health of those living with type 2 diabetes. I think this term “Patient specialist”, should be adopted by the Integrative Medicine, by all the open minded General Practicioners, by encouraging their own patients to stay informed! But the key is as you say is for the patients to burrow in their brain the willingness to be partners in their health maintenance and improvement by adopting good habits and staying informed through reliable sources like Healthy Fellow. The alternative of being passive guinea pigs of drugs prescribed liberally by their doctors that colud result in dangerous potential side effects, at times capable of causing irreversible damages to their organs, is a risky option for their wellbeing! A yearly flu vaccine can help you stay healthy during flu season as well as prevent serious complications from the flu. The Centers for Disease Control and Prevention recommends the hepatitis B vaccine for adults with diabetes who haven’t previously received the vaccine and are younger than 60. Schedule two to three diabetes checkups a year, in addition to your yearly physical and routine eye exams. During the physical, your doctor will ask about your nutrition and activity level and look for any diabetes-related complications — including signs of kidney damage, nerve damage and heart disease — as well as screen for other medical problems. Eating a healthy, reduced-fat diet and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. If you have a sore or other foot problem that doesn’t start to heal within a few days, please see make an appointment to see Dr.
This review was conducted to determine the clinical benefit and potential harms of screening for type 2 diabetes mellitus (T2DM) in asymptomatic adults.
The search strategy from the 2008 US Preventive Services Task Force’s framework on type 2 diabetes screening was updated. Previous results showing benefit of screening among those with high blood pressure were confirmed. This review found no controlled studies of the effectiveness of screening for T2DM, and one observational study demonstrating a modest benefit on mortality. In 2006–2007, there were an estimated 211,168 new cases of diabetes diagnosed in Canada, with the prevalence of diagnosed diabetes for the whole population at 6.2% 12. A review was completed to update the 2005 Canadian Task Force on Preventive Health Care (CTFPHC) guidelines on screening for T2DM and the evidence review of the 2008 USPSTF 67. What is the evidence for the clinical benefit of screening for T2DM using fasting plasma glucose, oral glucose tolerance test, or A1C in asymptomatic adults 18 years of age or older at high risk for diabetes complications to improve intermediate and final health outcomes?
What is the evidence for the harm of screening for T2DM using fasting plasma glucose, oral glucose tolerance test, or A1C in asymptomatic adults 18 years of age or older at high risk for diabetes complications? What are the most effective (accurate and reliable), risk assessment tools or questionnaires to predict T2DM? What risk assessment tools or questionnaires to predict T2DM have been validated in Canada?
What is the yield (accuracy, reliability, prevalence, and feasibility) of screening for T2DM with FBG, OGTT, and A1C in adult patients? The objective of this review is to update the evidence related to Key Question 1 of the USPTFS review; specifically, what is the evidence for the clinical benefit of screening for T2DM in high risk, asymptomatic adults 18 years of age or older. The USPSTF searched MEDLINE® and the Cochrane Library for relevant English language systematic reviews, randomized controlled trials and observational studies published between March 2001 and July 2007, related to diabetes screening, and potential adverse effects. Eligible studies were in English or French and included asymptomatic adults 18 years or older at average or high risk for T2DM complications. The CTFPHC procedural manual allows for the use modeling studies when there is insufficient evidence to answer some or all of the key questions 14. No new randomized controlled trials or systematic reviews were identified answering key question 1 since the 2008 USPSTF Recommendation Statement for the Screening of Type 2 Diabetes 20.
A population-based cohort study of 4,936 individuals examined the impact of early, delayed and no screening for T2DM using a 75 g OGTT and related cardiovascular (CV) risk factors on mortality 17. The previous 2008 USPSTF identified eight observational studies that included heterogeneous populations and outcomes for harm, or which no serious adverse effects were noted 7.
The literature search identified a high quality systematic review that examined the most accurate and reliable risk assessment tools or questionnaires to predict T2DM (Table 8) 23. An ‘accepted for publication’ paper was located discussing the initial validation of the CANRISK tool 29.
One high quality review was found that examined the most accurate and reliable tests to diagnose T2DM to patient outcomes 30.
Considering the quality of this review, an additional review for evidence for the effective tests for diagnosing diabetes was completed, locating 12 papers that compared A1C with FPG for the detection of diabetes 3132333435363738394041.
Since the publication of the 2005 CTFPHC and the 2008 USPSTF report for screening for T2DM recommendations, there has been one new cohort study publication to contribute to the discussion about the effectiveness of screening for T2DM 67. Cost effectiveness studies varied in their conclusions, particularly due to differences in modeling techniques and in assumptions relating to screening methods, glucose control requirements and future treatment protocols.
The effectiveness of a T2DM screening intervention has not been adequately tested to date in a randomized controlled trial, particularly in individuals at high risk for diabetes and its complications.
Other MERSC contributors included Mahbubel Haq, Sohel Nazmul, Sharon Peck-Reid, Maureen Rice. Population mortality was assessed by flagging all individuals in the original sampling frame, including those not invited for screening, for death certification at the Office of National Statistics. Compared with the non-invited group, those who attended screening at any point had a significantly lower mortality and those who did not attend had a significantly higher mortality. Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. To quantify the psychological impact of primary care-based stepwise screening for type 2 diabetes.
No significant differences at baseline, 3–6 months and 12–15 months between the type 2 diabetes screened group (random plasma glucose screening) and the controls in any outcomes. Screening had a limited psychological impact on patients, with some negligible negative psychological impact with subsequent clinical investigations following a positive screen test for type 2 diabetes. High risk participants were recruited from two general practices into a stepwise screening program to confirm the presence or absence of diabetes. Anxiety was measured using the Spielberger State Anxiety Inventory (STAI) and illness perceptions were assessed using the 50-item diabetes Illness Perception Questionnaire (IPQ). Screening for type 2 diabetes in the primary care setting is feasible but may be associated with higher levels of short-term anxiety in the screen invited participants. In the ADDITION (Cambridge) trial practices were randomly allocated to screening or control arms. This paper is based on a full report “Screening for Type 2 Diabetes in Adults”, which can be found at the CTFPHC web site. 52 (45%) of deaths were recorded as cancer-related, 41 (35%) were due to cardiovascular causes and 23 (20%) were coded as ‘other’.
107 (47%) were cancer deaths, 74 (32%) were cardiovascular deaths and 48 (21%) were coded as ‘other’.
For 22 individuals (6%) among the total deceased (1991-1999), diabetes was included as the underlying cause on the death certificate. For 22 individuals (8%) among the total deceased (2000-2008) diabetes as included as the underlying cause on the death certificate. NotesDescriptionDiabetes is a chronic disease, which occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. Diabetes is an endocrine disorder which means that there is some problem in the way the body uses digested food for energy.
Natural Medicine for Gastric Problems (aff) * Warning: Consult your doctor before taking any medicine.
Now instead of sugar getting converted into energy and transported into your cells, it builds up in your blood stream.
Recent studies have shown that variants of TCF7L2 gene can increase the susceptibility of Type 2 diabetes. People who are genetically susceptible to Type 2 diabetes are more vulnerable when there is physical inactivity and obesity in them. There is another type of diabetes known as gestational diabetes which occurs during pregnancy. Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. Disclaimer: Health Dummy website is designed for educational purposes only and is not intended to serve as medical advice.
INTRODUCTION The prevalence of diabetes mellitus is growing at epidemic proportions in the United States Such visits can provide early warning of impending problems and subsequent modification of activity and care bolus insulin therapy what blood happens sugar low (30 253).
Zeitz added when presenting the findings at the annual meeting of the European Association for the Study of Diabetes. Juvenile Diabetes Research Foundation Wichita Ks this is a good home remedy for diabetes mellitus.
How to Replace Sugar with effects of diabetes on fertility borderline readings Splenda in Recipes. Its frequency increased during the Black Due to this, the retina is not able to get proper blood supply and so essential nutrients and oxygen also You need to be specially aware of these symptoms of late stage diabetes and take proper care of Living Healthy With Diabetes What Should A Type 2 Diabetic Do To Live Healthy?
Animal trials and human population studies suggest that fish oil consumption may reduce the risk of dementia.
MQ (Medical Qigong) is a mind-body practice that uses physical activity and meditation to harmonize the body, mind and spirit”. Virtually every dietary and lifestyle choice that improves the condition of people at risk for or with type 2 diabetes also supports better health in the population at large. A one year study compared the relative effects of three popular diet plans in a group of 259 overweight diabetic patients with an average age of 55. If you actively choose to share your own findings with these experts, I think you’ll be pleasantly surprised to find that some of the information you bring to the table is news to them. If you have diabetes complications or you’re age 65 or older, you may need a five-year booster shot. High cholesterol is a concern, since the damage is often worse and more rapid when you have diabetes.
Yaseen Odeh, can help you learn the basics of diabetes care and offer support along the way. Following your diabetes treatment plan takes a strong commitment. Careful diabetes care can reduce your risk of serious — even life-threatening — complications. Odeh always advices about the feet, High blood sugar can reduce blood flow and damage the nerves in your feet. Odeh recommends that you take control of your stress, the hormones your body may produce in response to prolonged stress may prevent insulin from working properly, which only makes matters worse. Learn relaxation techniques.
If you’re willing to do your part, you can live a healthy life while taking control of your diabetes. This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited. MEDLINE® and the Cochrane Database of Systematic Reviews were searched from 2007 to 2012 for systematic reviews, randomized controlled trials and modeling studies.
No new or old trials were found regarding the effect of screening for T2DM on mortality, cardiovascular mortality and diabetes related complication outcomes. Several contextual questions were added to the USPSTF framework and were in the full review. This review will report on the evidence for the harms of screening, as well as the evidence for contextual questions 345. Study designs for effectiveness of screening included randomized controlled trials or systematic reviews and meta-analyses and observational studies with mortality, cardiovascular mortality and diabetes related complications as outcomes.
Titles and abstracts were reviewed in duplicate by members of the synthesis team; full text inclusion, quality assessment and data extraction were done by two people who resolved disagreements through discussions. Study quality was based on the risk of bias due to limitations in design, inconsistency of findings, indirectness, imprecision and publication bias.
The Diabetes Screening Working Group determined that there was insufficient evidence to adequately answer components of the effectiveness question particularly regarding age cohorts, intervals and high risk groups requiring screening. The 2008 USPSTF retrieved only three relevant studies (one case-control and two cross-sectional studies) and found no benefit from screening for microvascular complications or any good data for the effectiveness of screening for T2DM in any targeted population 7. In a UK study, screening appeared to be cost effective for the 40–70 year age cohort and most effective for hypertensive and obese individuals, as the costs of screening were offset by lower future treatment costs 21. Two additional papers were found validating the FINnish Diabetes RIsk SCore tool (FINDRISC) 2425.
The CANRISK was adapted from FINDRISC to account for the diverse ethnic composition of the Canadian population. Notably, the previous USPSTF also identified only observational studies and no randomized controlled trials for the effectiveness of screening for T2DM. The harms associated with screening for T2DM were minimal, with little effect on anxiety levels, self-rated health status and quality of life.
The search was limited to only those databases searched in the USPSTF review; therefore EMBASE was excluded. Specifically, for adults that were at high risk of diabetes, a recommendation to screen every 3–5 years with an A1C test was made and for adults at very high risk, a recommendation of screening annually with an A1C test was stated. Screening interventions may include the tests (questionnaire, blood test) or the process (stepwise approach versus an alternative approach).
The views expressed herein are the opinions of the authors and do not necessarily represent the views of the Canadian Institutes of Health Research. Vital status was obtained for the entire cohort and results for follow-up to January 31, 2008 are reported. Participants were randomly selected (in two cohorts, 1997–99 and 2000–03) for invitation to screening from a single practice population. GRADE Evidence Profile and Summary of Findings Table for Study Included for Key Question 1: Clinical Benefits of Screening for Type 2 Diabetes (Simmons et al.
In this substudy on the psychological impact of screening it was not possible to randomly select practices for screening because it started later than the main trial and many practices had already finished screening. There was no randomized selection of practices for this study within the screening sites in the main ADDITION trial. An analysis was done to assess the impact if these non-responders had similar outcome measures at baseline. All data for participants who completed the questionnaires (intervention n = 77, control n = 168) were included in the analysis. But on the contrary in Type 1 Diabetics, the immune system attacks and destroys your insulin-producing cells in the pancreas. The main causes for Type 1 Diabetes are a combination of genetic susceptibility and environmental factors. Having certain genes or a set of genes may increase or decrease a person’s risk of getting that disease. People who inherit 2 variants of this gene are 80% more susceptible than those who do not carry this gene variant. During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin. The information provided on this site should not be used for diagnosing or treating a health problem or disease.
Diabetes management Main article: Diabetes mellitus Diabetes is a chronic disease with no cure as of 2010[update] but a lot of research is underway. Now after further study experts say the risk is limited to people who are already likely to develop diabetes and even among diabetes 2 weight loss diet vitamin d deficiency these individuals the heart-health benefits of statins outweigh the potential downsides. The 1500 calorie diabetic diet is designed to help people manage their diabetes by controlling their food intake. This means eating a clean and healthy diet as I stated before and one other thing exercise.
On this and other sites, you’ll regularly come across information that potentially can be applied to your medical circumstances or those of someone you care about. New research presented in the journal Molecular and Cellular Endrocrinology reports that adult male rats fed a soy-rich diet had sperm counts that were 21% lower than male rats fed a soy-free diet.
Components of green tea, such as EGCG (epigallocatechin gallate), have also been shown to counteract some of the processes that can lead to brain plaque formation in animal models. Believe or not, these quotes are taken from the conservative medical journal Annals of Oncology. Prevention can reduce the risk of a heart attack, stroke or other life-threatening conditions. Differences between current and previous evidence can be attributed to the current methodology that integrates the GRADE approach. As diabetes diagnosis is often delayed, 20–50% of people with type 2 diabetes mellitus (T2DM) present with complications at the time of diagnosis and experience mortality rates at least two times higher than those without diabetes 2345.
The contextual questions addressed issues relevant when considering screening adults for T2DM, such as patient values, risk factors to guide screening, benefits and harms to early treatment; and the effectiveness of risk factor tools or questionnaires to predict T2DM. To update the CTFPHC, the USPSTF search strategy was implemented, and all searches were updated from 2007 to February 2012. Data were abstracted by two people using a standard format; in cases of disagreement, consensus was reached after consultation with a third reviewer.
The strength and quality of evidence was determined based on the GRADE system, using GRADEPro software 101112.
A separate search for modeling studies and critical appraisal of the evidence followed the CTFPHC procedure manual and evidence-based tools 1415.
Of these, title and abstract screening excluded 8,947; 2,340 papers were retrieved and assessed on inclusion criteria.
Similarly to the 2008 USPSTF, two modeling studies were included for this updated review 2122. In a US study, the strategy of screening the entire population > 30 years of age every three years was the optimal strategy, assuming a decision maker was willing to pay at least $12,961 per QALY 22. Risk assessment tools with internal and external validity can be effective at identifying individuals who are at high risk of being diagnosed with diabetes. Unlike the ADA that states screening should commence at a certain age (45 years) 9, the CTFPHC recommendations relying on calculated risk for T2DM, which considers variables such as age, obesity, history of elevated glucose, history of hypertension, family history of diabetes, limited activity levels and fruit and vegetable intake 45.
The authors do not describe how patients were randomly selected to receive a screening invitation. Furthermore, three of the 10 screening sites included in this sub-study had already started the screening process. Non-response rates were similar across the three main groups from the initial test to 3–6 months (roughly 7%). For example gestational, Type-1, Type-2, LADA, Juvenile, Steroid Induced are some of the forms.
One of the major risk factors for diabetes is central obesity in which a person has excess abdominal fat. When this happens, too little glucose gets into your cells and too much stays in your blood. So if this raw food diet diabetes can help eliminate the need for insulin in a diabetic it is worth a look. Seniors and Families service delivery approach helps customers to move to self-management by providing easy access The National Jobseeker Claims The outlet has a highly visible presence in a community shopping centre where staff provide customers with digital education and support.
High quality Diabetic Foot Care Products and supplies at economical prices used successfully by clinicians in screening diabetes helps to maintain the health for proper care. Each day, over 2,200 people are diagnosed with this chronic life debilitating, expansive, and pro-aging disease.
A new experiment described in the March edition of Neuroscience Letters discovered that a combination of fish oil and EGCG could effectively reduce Abeta levels in the brains of mice.
The description of MQ was presented as part of a review of a recent study conducted at the University of Sydney in Australia. The March 4th issue of the New England Journal of Medicine proclaims that HbA1c concentrations are a more accurate indicator of diabetic risk prediction than fasting glucose levels.
You can literally help them become more well rounded doctors by exposing them to the specialized information you discover.
Monitor your blood sugar level, and follow your doctor’s instructions for managing your blood sugar level.
Modeling studies reported that population based screening in high-risk individuals (age and hypertension as risk factors) might increase quality adjusted life years and was cost-effective if screening began at age 45 and every three to five years thereafter.
We abstracted data about the patient population, the study design, analysis and results for each study. Briefly, the appraisal of modeling studies adopted a five-step process which involves assessment based on both applicability to the research question and study quality. However, if there were recognizable disutilties associated with labeling, the benefits of screening may be outweighed by potential harms the 30 to 45 year old age group. Both studies noted that screening for T2DM in the primary care setting is feasible, may be associated with higher levels of short-term anxiety, and had limited psychological impact 1819. Notably, the Anglo Danish-Dutch Study of Intensive Treatment in people with screen detected diabetes in primary care (ADDITION) study group focused screening in relatively a low prevalence population (~ 3%) and only the top quartile of the population at risk were asked to participate in the trial 4344.
Screening with tests A1C, FPG or OGTT provide similar diagnostic outcomes, however A1C is easiest to administer and is cost effective. The studies found for the harms (anxiety) of screening were too heterogeneous for a meta-analysis. Answers C and D are incorrect because the client would develop hypoglycemia later in the day or evening.Question 3A client with type 1 diabetes mellitus has been on a regimen of multiple daily injection therapy. The role of genes in causing diabetes can be inferred from the fact that a high rate of Type 2 diabetes can be found in families with identical twins and prevalence by ethnicity. If you have or suspect you may have a health problem, you should consult your health care provider. 16 de dicieme de 2014La enfermera en los type 1 diabetes reactive hypoglycemia causes what gestational get centros pblicos docentes. Diabetic neuropathy is an injury to the nervous system caused by underlying diabetes mellitus. At the same time, doctors and patients alike realize that such physicians have their limitations. You need to find a way to burrow the information into your consciousness and file it away for future use.
Researchers from Switzerland and the National Center for Toxicological Research in the US also noted alterations in specific genes that affect sperm motility and a decrease in the size of the seminal vesicle, a gland that plays a role in the production of semen. A test tube experiment further demonstrated synergistic, anti-plaque activity of this natural combination of ingredients.
In recent years, oncologists have become keenly aware that many patients choose to utilize alternative therapies in addition to conventional cancer care.
This type of proactive patient approach will not only improve the quality of your care, but it will help contribute to a higher level of treatment for other patients treated by the doctors on your health care team. Two new randomized controlled trials noted that screening was associated with higher levels of short-term anxiety and worry, but had limited overall psychological impact. The review process is described in detail in the full evidence review and synthesis report 16. For study characteristics, risk of bias and GRADE evidence related to mortality, please refer to Tables 2–4; for study characteristics, risk of bias and GRADE evidence related to harms, please refer to Tables 5–7. The major limitation of both studies was that they required assumptions relating to glucose control and treatment effectiveness in screened individuals rather than based on empirical data. Six out of the seven recommended tools have been validated internally and externally; Ausdrisk has not been externally validated and FINDRISC has been validated in the most countries (Finland, Holland, Denmark, Sweden, UK, Australia) 23. Selected screening thresholds in the paper version are reported as; 21 slightly elevated, 29 moderate, 32 balanced, 33 high and 43 very high. However, even in those who have inherited the susceptibility, type 1 DM seems to require an environmental trigger.
They can’t possibly be up-to-date on every new development in every field of medicine, so they refer patients to specialists whenever needed.
In effect, this will allow you to become a silent partner in your doctor’s medical practice. Additional guidelines from the World Health Organization 8 and the American Association of Diabetes 9 suggest screening for T2DM should be considered in those with risk factors for diabetes (e.g. The review also found preliminary data demonstrating a reduction in the incidence of T2DM with the deployment of the FINDRISC and educational interventions, or FINDRISC in addition to repeat primary care consultation 26. The balanced score has a sensitivity of 70%, specificity of 67%, PPV of 35% and NPV of 90% (Table 10) 29. There were 291 deaths between 2000–2008 (median 8 year follow-up), with no significant difference in mortality between participants who were invited and not invited to the 2000–2003 screening. If these researchers were aware of a patient’s status (screening versus no screening) it is possible this information might influence their classification of cause of death. In my opinion, Natural Remedies, Diet, Exercise and Herbal Supplements play a key role in long-term recovery of acidity, bloating and gas.
The following continuous glucose monitoring devices are FDA-approved for use as an adjunct to blood testing Medicare and some private insurance companies have begun to pay for continuous glucose monitoring but it is not universally covered.
FINDRISC is a validated and effective method to identify risk of T2DM, particularly in persons age 45–64. Blurred vision is a common complaint leading to a diabetes diagnosis; type 1 should always be suspected in cases of rapid vision change, whereas with type 2 change is generally more gradual, but should still be suspected. Multiple daily injection therapy uses a combination of short-acting and intermediate or long-acting insulins.Question 4Dr.
I’ve been logging his blood glucose and this week his reading is in the normal range 70s to 120s-of course there are some ups when eating more at dinner or lunch (this with 2 units of fast acting insulin and his night time insulin we reduced to 8 In most of the cases diabetes further leads to other critical diseases like heart failure obesity cardiac arrest etc.
If you’re basically healthy, you may want to focus on staying informed on how to maintain good general health.
Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. As a result the insulin level reduces in the concerned organ.\r\n\r\nNow instead of sugar getting converted into energy and transported into your cells, it builds up in your blood stream. Incrementally higher HbA1c scores were associated with a progressively greater risk of all cause mortality, coronary heart disease and stroke. This same dietary strategy can be employed to keep healthy and overweight individuals away from the diabetes and pre-diabetes danger zones.
Additional tests can determine the type of diabetes and its severity.Random blood glucose test — for a random blood glucose test, blood can be drawn at any time throughout the day, regardless of when the person last ate.
These findings were based on an investigation of 11,092 non-diabetic adults over a 2 year period. The drug doesn’t cause hyponatremia and therefore doesn’t necessitate monthly serum sodium measurement. But its still not clear what those factors are.\r\n\r\n Genes also play a major role in causing Type 2 diabetes. Diabetes is a condition in which the patient's body is either incapable of producing insulin or unable to properly utilize the insulin it does produce. Having certain genes or a set of genes may increase or decrease a person\'s risk of getting that disease. It is used to monitor blood glucose control in people with known diabetes, but is not normally used to diagnose diabetes.
Hydrocolloid dressings prevent the entrance of microorganisms and minimize wound discomfort.
The test is done by taking a small sample of blood from a vein or fingertip.Oral glucose tolerance test — Oral glucose tolerance testing (OGTT) is the most sensitive test for diagnosing diabetes and pre-diabetes.
However, the OGTT is not routinely recommended because it is inconvenient compared to a fasting blood glucose test.The standard OGTT includes a fasting blood glucose test. Different drugs measured in units may have no relationship to one another in quality or quantity.Question 11Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The person then drinks a 75 gram liquid glucose solution (which tastes very sweet, and is usually cola or orange-flavored). For women who have an abnormally elevated blood glucose level, a second OGTT is performed on another day after drinking a 100 gram glucose solution.
The blood glucose level is measured before, and at one, two, and three hours after drinking the solution.Medical ManagementThere is no known cure for DM.
Management of the disease focuses on control of the serum glucose level to prevent or delay the development of complications. Because the client is conscious, the nurse should first administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. Insulin may be rapid, intermediate, or slow acting.Patients with mild DM or those with type 2 DM or GDM may be able to control the disease by diet management alone. A diabetic diet attempts to distribute nutrition and calories throughout the 24-hour period.
Daily calories consist of approximately 50% carbohydrates and 30% fat, with the remaining calories consisting of protein.
The total calories allowed for an individual within the 24-hour period are based on age, weight, activity level, and medications.In addition to strict dietary adherence to control blood glucose, obese patients with type 2 DM also need weight reduction.
She and her husband want to have a child so they consulted her diabetologist, who gave her information on pregnancy and diabetes. The dietitian selects an appropriate calorie allotment depending on the patient’s age, body size, and activity level. Physical activity increases the cellular sensitivity to insulin, improves tolerance to glucose, and encourages weight loss. Exercise also increases the patient’s sense of well-being concerning his or her health.Pharmacological HighlightsWhen diet, exercise and maintaining a healthy weight aren’t enough, you may need the help of medication.
It is essential that the client start prenatal care early so that potential complications can be controlled or minimized by the efforts of the client and health care team.
Everyone with type 1 diabetes and some people with type 2 diabetes must take insulin every day to replace what their pancreas is unable to produce. Unfortunately, insulin can’t be taken in pill form because enzymes in your stomach break it down so that it becomes ineffective. While there is some risk to the pregnant diabetic woman, it is not considered a major health risk. For that reason, many people inject themselves with insulin using a syringe or an insulin pen injector,a device that looks like a pen, except the cartridge is filled with insulin. Others may use an insulin pump, which provides a continuous supply of insulin, eliminating the need for daily shots.The most widely used form of insulin is synthetic human insulin, which is chemically identical to human insulin but manufactured in a laboratory. But newer types of insulin, known as insulin analogs, more closely resemble the way natural insulin acts in your body.
Second-generation sulfonylureas such as glipizide (Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glynase PresTab, Micronase) and glimepiride (Amaryl) are prescribed most often. The most common side effect of sulfonylureas is low blood sugar, especially during the first four months of therapy.
The onset of action of long-acting Ultralente is 6-8 hours.Question 17The newly diagnosed diabetic patient asks the nurse why he needs to check his feet every day.
You’re at much greater risk of low blood sugar if you have impaired liver or kidney function.Meglitinides. These medications, such as repaglinide (Prandin), have effects similar to sulfonylureas, but you’re not as likely to develop low blood sugar. Metformin (Glucophage, Glucophage XR) is the only drug in this class available in the United States. It works by inhibiting the production and release of glucose from your liver, which means you need less insulin to transport blood sugar into your cells.
One advantage of metformin is that is tends to cause less weight gain than do other diabetes medications.
Possible side effects include a metallic taste in your mouth, loss of appetite, nausea or vomiting, abdominal bloating, or pain, gas and diarrhea. These effects usually decrease over time and are less likely to occur if you take the medication with food. A rare but serious side effect is lactic acidosis, which results when lactic acid builds up in your body. Lactic acidosis is especially likely to occur if you mix this medication with alcohol or have impaired kidney function.Alpha-glucosidase inhibitors.
These drugs block the action of enzymes in your digestive tract that break down carbohydrates.
That means sugar is absorbed into your bloodstream more slowly, which helps prevent the rapid rise in blood sugar that usually occurs right after a meal.
Although safe and effective, alpha-glucosidase inhibitors can cause abdominal bloating, gas and diarrhea.
These drugs make your body tissues more sensitive to insulin and keep your liver from overproducing glucose. Side effects of thiazolidinediones, such as rosiglitazone (Avandia) and pioglitazone hydrochloride (Actos), include swelling, weight gain and fatigue.
The thiazolidinedione troglitzeone (Rezulin) was taken off the market in March 2000 because it caused liver failure. If your doctor prescribes these drugs, it’s important to have your liver checked every two months during the first year of therapy. Contact your doctor immediately if you experience any of the signs and symptoms of liver damage, such as nausea and vomiting, abdominal pain, loss of appetite, dark urine, or yellowing of your skin and the whites of your eyes (jaundice). These may not always be related to diabetes medications, but your doctor will need to investigate all possible causes.Drug combinations.
By combining drugs from different classes, you may be able to control your blood sugar in several different ways.
Most doctors prescribe two drugs in combination, although sometimes three drugs may be prescribed. Patients need to understand the purpose, dosage, route, and possible side effects of all prescribed medications. If the patient is to self-administer insulin, have the patient demonstrate the appropriate preparation and administration techniques.PREVENTION. The patient and family require instruction in the following areas to minimize or prevent complications of DM.Diet.
Explain how to calculate the American Diabetic Association exchange list to develop a satisfactory diet within the prescribed calories. Emphasize the importance of adjusting diet during illness, growth periods, stress, and pregnancy.
Encourage patients to avoid alcohol and refined sugars and to distribute nutrients to maintain a balanced blood sugar throughout the 24-hour period.Insulin. Stress proper timing of meals and planning snacks for the time when insulin is at its peak, and recommend an evening snack for those on long-acting insulins. Reinforce that patients cannot miss a dosage and there may be a need for increasing dosages during times of stress or illness. Teaching regarding the proper preparation of insulin, how to administer, and the importance of rotating sites is necessary.Urine and Blood Testing.
Teach patients the appropriate technique for testing blood and urine and how to interpret the results.
Patients need to know when to notify the physician and increase testing during times of illness.Skin Care. Because of sensory loss in the lower extremities, teach the patient to test the bath water to prevent skin trauma from water that is too hot and to avoid using heating pads.Circulation.
Because of the atherosclerotic changes that occur with DM, encourage patients to stop smoking.
Distinguish type 1 and type 2 diabetes|
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Screening for type 2 diabetes 2013