Diabetes Awareness and management of diabetes

diabetes

1. Diabetes Awareness
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Type 2: Overview
Type 2 is the most common form of diabetes (DM).
In this form, the body does not produce enough insulin
or the cells ignore the insulin that is produced.
Insulin is required by the body in order to use sugar.
Insulin takes the sugar from the blood into the cells.
When glucose builds up in the blood instead of going
into cells, it can cause some problems:
•In the short-term, your cells may be starved for energy
•In time, high blood glucose may hurt your eyes, kidneys,
nerves, or heart.

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Insulin
Inside the pancreas, beta cells make the hormone insulin.
Beta cells release insulin to help the body use or store blood glucose from food.
In people with type 1 diabetes, the pancreas no longer makes insulin.
The beta cells have been destroyed and insulin shots are the only way to keep
blood glucose levels down.
People with type 2 diabetes make insulin, but their bodies don't respond well to it.
Only some people with type 2 diabetes need diabetes pills or insulin shots to help
their bodies use glucose for energy.

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Who Gets Diabetes?
Although diabetes occurs in people of all ages and races, some groups have
a higher risk for developing type 2 diabetes than others:
•African Americans
•Latinos
•Native Americans
•Asian American/Pacific Islanders
•Aged population

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Conditions that can arise from Type 2 DM
Hypoglycemia
Hyperglycemia
Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

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Hypoglycemia
Hypoglycemia or low blood glucose (sugar) is a
problem that happens from time to time to
everyone who has diabetes.
It is sometimes referred to as “insulin reaction.”
Although it may be unavoidable at times, it is
important to know how to recognize and treat the
condition immediately before symptoms worsen.

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Symptoms of Hypoglycemia
Shakiness
Dizziness
Sweating
Hunger
Headache
Pale skin color
Sudden moodiness or behavior
changes, such as crying for
no apparent reason
Clumsy or jerky movements
Seizure
Difficulty paying attention,
or confusion
Tingling sensations around
the mouth

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Low Blood Glucose
You should check your blood glucose level according to
the schedule you work out with your doctor.
In addition, you should check your blood glucose any
time you feel low blood glucose coming on.
If you check and observe a low blood glucose level, then
treat for hypoglycemia quickly.
A good rule if you are unable to check is:
“When in doubt, treat.”

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Treating Hypoglycemia
The quickest way to raise your blood glucose and treat hypoglycemia is with
some form of sugar, such as:
•3 glucose tablets
•½ cup of fruit juice
•5-6 pieces of hard candy
Once you have checked your blood glucose and treated the hypoglycemia,
wait 15 to 20 minutes and then recheck your blood again.
If your blood sugar is still low and symptoms of hypoglycemia
haven’t went away, repeat treatment.

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Hyperglycemia
Hyperglycemia is the technical term for high blood glucose.
It happens when the body has too little or not enough insulin or when the
body can’t use insulin properly.
A number of factors can be the cause of hyperglycemia, including:
•Eating more than planned
•Exercising less than planned
•The stress of an illness, such as a cold or flu
•Other stresses, such as family conflicts or dating problems

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Symptoms of Hyperglycemia
•High blood glucose
•High levels of sugar in the urine
•Frequent urination
•Increased thirst
It is important to monitor blood glucose levels frequently.
If hyperglycemia is detected, treatment should begin immediately.
Failing to treat hyperglycemia could lead to a condition called
ketoacidosis
Ketoacidosis occurs when the body doesn’t have enough insulin.
Without insulin, the body can’t use glucose for fuel, so it is left
breaking down fats for energy.

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Hyperglycemia Leading to Ketosis
Waste products (ketones) are generated as your body breaks down fats.
Large amounts of ketones cannot be tolerated by the body.
So, your body will try to excrete these ketones through the urine.
However, not all will be excreted, causing the remaining to build up in the blood.
This buildup leads to Ketosis.

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Symptoms of Ketosis
Shortness of breath
Breath that smells fruity
Nausea and vomiting
A very dry mouth

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How to Treat Hyperglycemia
Exercise is often effective in lowering blood glucose levels.
However, if your blood glucose is above 240 mg/dl, check your urine for ketones.
If they are present, do NOT exercise.
This can actually lead to higher blood glucose levels than prior to beginning
the exercise.
You will need to work with your doctor on finding the best way to lower your blood
glucose level.

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Importance of Monitoring Blood Glucose
Keeping your blood glucose in your target range
can help prevent or delay the start of diabetes
complications such as nerve, eye, kidney, and
blood vessel damage.
Once an individual learns that he/she had diabetes,
it is important to work with your health care team to
create a diabetes care plan.
The plan aims to balance the foods you eat
with your exercise, and, possibly, with diabetes pills
or insulin.
There are two types of checks that you can do to
help keep track of how your plan is working:
•Blood glucose checks
•Urine ketone checks

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Blood Glucose Monitoring Checks
This is the main tool you have to check
diabetes control.
The check can tell you your blood glucose
level at any one time.
Keeping a log of results is important.
You can present this log to your health care
provider
The log provides your health care provider
with a good picture of your body’s response to
your diabetes care plan.
Allows to make needed changes, if necessary

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Urine Checks
Not as accurate as blood glucose checks
Should not be done unless blood testing is impossible
A urine check for ketones is another matter.
This is an important check when your diabetes is out of
control or when you are sick.
When the body is burning fat instead of glucose, you could
expect to find moderate or large amounts of ketones in urine.
Everyone with diabetes should know how to check their urine
for ketones.

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Tight Control and Diabetes
The benefit of tight control of blood glucose can
be in the prevention or slower progression of
many complications of diabetes, giving you extra
years of healthy, active life.
Tight control is not for everyone, and it involves
hard work.

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Tight Control and Type 2 Diabetes
Much of the previous research on the benefits of tight control
and diabetes has involved type 1 diabetes.
Doctors believe that tight control can also prevent complications in people
with type 2 diabetes as well.
Most people with type 2 diabetes do not take insulin, so it may not be
apparent how such tight control could occur.

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Tight Control and Type 2 Diabetes
One way is to lose weight.
•Shedding excess pounds may bring your glucose levels down to normal.
•The key to losing weight and to keeping it off is behavior change.
•Your doctor should work with you to find an eating and exercise plan right for you.
Exercise
•Even without a weight loss, exercise proves beneficial
with blood glucose control.
•It makes your cells take glucose out of the blood.

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Tight Control and Type 2 Diabetes
Blood glucose will need to be checked regularly.
You and your doctor should decide how often.
Once a day or even once a week may be enough for
individuals with type 2 diabetes.
If exercise and eating habits still aren’t enough to keep
glucose in check, your doctor may prescribe pills.
Insulin is prescribed only when diet and exercise, along
with pills prove to be not enough to keep blood glucose
levels under control.
Most importantly, people with type 2 diabetes should talk
with their doctors before starting tight control.

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Diabetes Medications
In type 2 diabetes, when the initial treatment options fail
(meal planning, weight loss, and exercise) to control blood
glucose levels, the next step is taking a medicine that
lowers blood glucose levels.
All diabetes pills sold today in the United States are
members of five classes of drugs:
•Sulfonylureas
•Meglitnides
•Biguanides
•Thiazolidnediones
•Aplha-glucosidase inhibitors

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How They Work
Sulfonylureas:
•Work by stimulating the beta cells of the pancreas to release more insulin
•Have been around since the 1950’s
•Are generally taken one to two times a day, before meals
•All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in
side effects, how often they are taken, and interactions with other drugs.
•Diabinese, Glucotrol and Glucotrol XL, Micronase, Glynase, Diabeta, and Amaryl are
examples of brand names on the market.
Meglitinides
•Also work by stimulating the beta cells to release insulin
•Prandin and Starlix are some examples of brand names on the market.
Because sulfonylureas and meglitinides stimulate the release of insulin, it is
possible to have hypoglycemia.

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How They Work
Biguanides:
•Lower blood glucose by decreasing amount of glucose made in the liver
•An example is Metformin, brand name Glucophage.
•Metformin also helps to lower blood glucose levels by making muscle tissue more
sensitive to insulin so that glucose can be absorbed.
•Usually taken two times a day.
•A side effect of Metformin may be diarrhea, but is improved when taken with food.
Thiazolidinediones
•Helps insulin work better in muscle and fat and reduces glucose production in the liver.
•Taken once or twice a day with food.
•Avandia, Rezulin, and ACTOS are some examples of brand names on the market.
•Although effective in lowering blood glucose, thiazolidnediones can have a rare but
serious effect on the liver.
•Therefore, your doctor will have to perform blood tests regularly to monitor the liver.

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How They Work
Alpha-glucosidase inhibitors
•These drugs help the body to lower blood glucose levels by blocking the
breakdown of starches, such as bread, potatoes, and pasta in the intestine.
•They also slow the breakdown of some sugars, like table sugar.
•Their action slows the rise in blood glucose observed after meals.
•They should be taken with the first bite of a meal.
•Side effects include gas and diarrhea.
•Precose and Glyset are examples of brand names on the market.

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Overview of Diabetes Medications
Only people with type 2 diabetes can use pills to manage their diabetes.
The pills work best when combined with meal planning and exercise.
Diabetes pills aren’t necessarily for everyone, although most see improvements.
Diabetes pills may stop working after months or years.
This does not mean that your diabetes is worse.
Usually the cause is unknown as to why they quit working.
When this occurs, oral combination therapy usually works best.
If you become pregnant, you will need to control your blood glucose with diet
and exercise, or with diet, exercise, and insulin.
It is not safe for pregnant women to take oral diabetes medications.