Diabetes Protection

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Glucose Tolerence Test (GTT)
Blood Sugar level is checked few times after a glucose containing drink.
*Normal - less than 140mg/dl
*Prediabetes- 140mg/dL-199mg/dL
*Diabetes -above 200mg/dL(confirm by retesting )

Glycosylated Heamoglobin Leve (HbA1C Test)

*Normal 4-6%
*Diabetic Control- less than 7%
*In Pregnancy- less than 6%

The End

NORMAL VALUES;-

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These are in keeping with latest International Guidelines(2003)
Fasting Blood Sugar;-
This is testing blood sugar level after at least an 8 hour fast.
Normal- upto 100mg/dl
Prediabetes- 100-125mg/dl
Diabetes- above 126mg/dl (confirm by retesting)

Random Blood Sugar;-
Normal - up to 100mg/dl
Prediabetes - 100-200mg/dl
Diabetes- above 200 mg/dl (confirm by retesting)

WHAT TO DO IF YOU ARE ACUTELY UNWELL ???

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* Keep taking your insulin or tablets. If the sickness is prolonged your insulin or tablet doses may have
to be changed.Hence consult your doctor.
* Drink water regularly.
* If you can't take food,try taking fruit juice or some drink containing ,etc.
* You need medical attention if you feel sleepier than usual, unable to think clearly, have diarrhoea or
persistant vomiting.
* Try to monitor your blood sugar regularly if you have Glucometer at home. During acute illnesses,
the diabetic control could be more difficult and hence closer monitoring is needed.
* Keep your own record book as follows

Date Fasting Glucose Level Comments*

* comments- Indicate results like Glycosylated Heamoglobin level, kidney functions, other test results like cholesterol etc or hypo attacks and changes to medications.

ARE THERE ANY PROBLEMS IN PREGNANCY ???

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If diabetes is not controlled during pregnancy your baby can have increased risk of congenital
abmormalities or baby can get too big causing major problems with delivery.

Hence strict blood sugar control is vital during pregnancy.

The pregnancy has to be well planned in advance and discussed with your doctor before the
conception. In general all diabetic tablets need stopping and a good control should be achieved with
diet and insulin.

If you get to know that you are pregnant while on tablets, make an early appointment to see your doctor.

Some women who are not known diabetics could show evidence of mild diabetes for the first time
during pregnancy ( gestational diabetes ) which resolves after delivery. They too need strict
monitoring during pregnancy.They may develop true diabetes later in life.

WHAT TO DO IF I GET "HYPO" SYMPTOMS

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As it is due to low sugar, when you get these symptoms you should take something containing sugar-
either glucose,sweets,sugar drink immediately and later eat a carbohydrate like bread or sandwich etc.
It is recommended that diabetics who tend to get these attacks carry a sweet with them regularly.

If this happens on a regular basis you may need to speak to your doctor to alter the doses of medications. Also if these happens when you are driving, please stop driving till your symptoms improve with above measures.

WHAT IS A 'HYPO' ATTACK???

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For our body & brain functioning we need a certain amount of sugar in blood.If our
blood sugar drops below the normal level you could get many symptoms and could even lead to loss of consciousness. Hence all diabetic patients should be aware of these warning symptoms.
These hypo attacks could be due to excess of insulin ortablets, too little food or taking
food later than normal,unusual alcohol intake or due to unusual exercise.
Common warning signs of hypos are ;-
* Sweating or feeling 'hot'
*Trembling
*Weakness/tiredness
*Faintish feelings
*Hunger
*Anger
*Blurred or double vision
*Palpitations( feeling of heart beating)
*Tingling around the lips and toungue.
*At night, may wake with nightmares bathed in sweat.
If you ignore these you may end up being unconscious or even having brain damage
if prolonged.

THE MAIN FEATURES OF MANAGEMENT OF DIABETES ARE;-

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Type 1 - Healthy life style +balance diet +Insulin+/tablets

Type 2- Healthy life style +balance diet OR
Healthy life style +balance diet +tablets OR
Healthy life style +balance diet +insulin +/tablets

Usually the medications need to be gradually increased over the years asthe insulin levels tend to diminis gradually.
As mention above additional measures are needed to reduce your overall risks.

HOW DO INSULINS WORK & HOW IT IS GIVEN ???

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Insulin works by lowering blood sugar.If you take too much it could lower your blood sugar too much causing a`Hypo` attack. (see below)

Insulins have to be injected by the patient or a family member.Though it is an injection
patients generally get used to it.It is commonly injected to the thigh, around your bellybutton or shoulders. It should not be injected in to the same site all the time.
Insulin should be stored in the refrigerator.(not in the freezer compartment) or in a cool
room.It is sensible always to havean extra bottle of insulin in case of breakage.The
number of injections could usually vary from one to three injections a day depending on the type of insulin prescribed.

WHAT ARE THE INDICATIONS FOR INSULIN???

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Daily insulin injections are absolutely essential for Type 1 diabetic patients.
Type 2 patients may need insulin when diet, drugs etc do not work adequately any longer.Also if they suddenly become ill due to any other reason or if they go for surgery, diets or during pregnancy they may need Insulin till they get better.

There are many different types of Insulin as they could be made from cows (beef insulin), pigs (porcine insulin) or human insulin.Action of these types of insulin is
basically the same.

Also they are categorized as short,intermediate,long acting insulin and mixed types according to the duration they act.Hence different combinations of these insulin types could be very confusing!!!. Therefore do not change the type of insulin unless
specifically advices by your doctor.
Insulin as an inhalation could be available in the very near future

WHAT ARE THE MEDICATIONS FOR TYPE 2 DIABETES ???

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For some dietry control,exercise and maintaining ideal body weight alone may be enough.Medication is in addition to above measures and
not "instead of " diet and exercise.Those who need tablets may need
one or more drugs to control sugar levels.Commonly used drug groups are;-
* Metformin-Controls of blood sugar by reducing the amount of sugar released to theblood stream bythe liver and increase the sensitivity
of body tissues to insulin.It is particularly useful for overweight
patients.
*Sulphonylurea-They work by increasing the insulin secretion by your
pancreas.Excess dose could cause low blood-sugar.( hypoglycemia )
Examples are - Chlorpropamide, Tolbutamide,Glibenclemide,Gliciazide,
Glipizide etc.
*Glitazones-Newer class of drugs which improvesthe action of insulin.
*Others- Acarbose- Reduces sugar absorption from your gut

WHAT ABOUT EXERCISE ?

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Exercise helps the muscles to burn off extra energy.Regular exercise not only helps diabetics bu also
reduces the risks of the having heart-attacks ans stroke which are closely associated with diabetes.
If you are able, you should aim to do 30 minutes ofbrisk walking at least 5 times a week. Try to make
it a part of your daily routine like walking to your work place orshop etc.

WHAT IS A GOOD DIET FOR DIABETES ?

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Diet is very important in diabetic treatment.This not only will help to control your blood sugar but also
will control your weight and lower ther risk of heart desease.

* Eat regular meals.
* Eat high fibre starchy foods like whole grain bread or brown rice.(par boiled rice)
* Cut down the facts partcularly animal fats.Change to low fat milk (semi skimmed or skimmed milk)
Use less butter or margerine. Grill,Steam or oven bake than fry. Use oils like Sunflower or Soya
oil if necessary.Eat fewer pastries & cakes.

* Eat plenty of fruit & vegetables.Spread these through out the day.
* Avoid sugar and sugar drinks. Try using artificial sweetners instead if really necessary.
* Use less sal.
* Use alcohol only in moderation ( 2-3 units/day) - A unit of alcohol is either 1/2 pint of beer or 1
small glass of wine.
* Reduce weight if you are over weight.

Diabetes is a life long disease.Hence the dietry changes should also be life long.! It may be necessary to see a dietician to get specific advice depending on your dietry habits.

HOW IS DIABETES TREATED ?

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Good management of diabetes needs a definite long term change to your life style.Management includes dietry control, exercise, maintaining an ideal weight, anti diabetic tablets or insulin or both.
Overall management strategy should also include measures to minimize the heart and circulation risk factors.Hence following additional measures are strongly recommended.
a) Stopping smoking
b) Controlling blood cholesterol levels.Most above 40 years will need a 'statin' anti-cholesterol drug.
c) Strict control of blood pressure (target<130/80>)
d) Aspirin for all above the age of 40 yrs.
( you are advised to meet your family doctor as regards b,c,d.)

What all this means is tha once you are diagnosed a diabetic, you will need a range of measures and
drugs for ideal management.
There are few exciting developments in the field of diabetes which may change the way it is managed in the future and may even be curative.These developments are likely to take many years or even decades to become a reality.

HOW TO KNOW IF THE CONTROL IS GOOD ?

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Improvement in above mentioned symptoms itself indicates reasonable control.But it is important to have more accurate assessment regularly.

URINE TESTING - A strip test on your urine indicates presence of sugar in urine.This is generally
satisfactory if you do not have advanced kidney disease.This is the easiest and cheapest way to monitor at home on a regular basis.

BLOOD SUGAR TESTING;-Fasting, random blood or post-prandial (after meals) blood sugar tests via a lab will indicate your control at that time,(refer to normal values given) Now there are Meters for
home and easy use.See. the picture on to your right side......You could buy Glucometers to tast your blood sugar level instantly at home by pricking your finger and using the stripes and Glocometer to
check your own blood sugar values.

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Kidney Damage (called nephropathy) A very common cause of kidney failure eventually need
kidney transplant to preserve life.Protein in the urine is an early indication of progressive kidney damage.A process called dialysis tratment. (artificial kidney) is needed till a kidney transplant is done once you reach late stages of kidney failure. Both dialysis and kidney transplant are difficult
to organise and are very expensive but absolutely essential to preserve life.

Hardening of blood vessels-Due to this diabetics are more prone to have strokes, heart attacks
and leg pain due to poor blood circulation.If you have associated high blood pressure, high
cholesterol and if you are a smoker these risks are multiplied.

Gut-Rarely-bloating of the stomach, and changing bowel habits could occur.

Impotence-There could be many other causes of this condition.

COMMON TYPES OF COMPLICATIONS ARE;-

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EYE PROBLEMS:- ( Called retinopathy) - This is due to damage to blood vessels inside the eye.
This is a common cause of blindness in diabetics.This could take several years to develop and this
needs to be monitored by eye doctors who can treat this with laser beams.(photocoagulation).
Cataracts are also common in diabetics.

NERVE DAMAGE;- (called neuropathy) could lead to `pins and needles','burning feet' or loss of
feeling in the legs.One of the main problems of this is you may injure your foot (stepping on a pin) etc,
without your knowledge due to loss of feeling. As the wound healing in diabetics is poor, a simple
injury like this could eventually lead to amputation. If you have lost of sensations, do not wear tight
shoes or walk bare foot. and take even trivial foot injuries seriously.Hence make it a habit to check
your feet before going to bed. Sometimes special insoles are needed in the shoe to protect
vulnerable areas in the sole of the foot.

WHY SHOULD YOU NEED TO CONTROLL DIABETES ?

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In the short term if you controll your diabetes you could overcome under mentioned symptoms.
As above, as some do not get symptoms will mean that you could have uncontrolled diabetes for
a long time,if you do not check your blood sugar status. Once diagnosed, it is very important to check yourdiabetic control even if you do not have any symptoms.

If it remains uncontrolled, the adverse effects on various organ systems in the body buid up slowly.
Eg;- Hardening and blockage of blood vessels.

Hence it is very vital to prevent long term serious complications which are disabling and life
threating.These complications can only be controlled or prevented by good diabetic control in the
long term.The earlier you develop diabetes;you are more prone to develop severe complications.
Many of these complications take several years or decades to develop but once developed,they
are usually permanent and difficult to treat.

Pre-Diabetes

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This is a state when a persons blood glucose levels are higher than normal but not high enough for a
specific diagnosis of type 2 diabetes ( refer to normal values given)
If you areover 45 years and overweight, If you have high blood pressure, cholesterol abnormalities or
a strong family history,then you should get yourself investigated.
What are the symptonms of uncontrolled Diabetes ?
1. Some adults may not have obvious symptoms but may be diagnosed on routine testing of
blood and urine.There are a lot of diabetics who do not know that they are diabetics due to
this fact!
2.Pass water(urine) more frequently as sugar overflows from the kidneys.
3.Due to this,they may develop increased thirst and also may wake up at night to pass urine.
4.High sugar levels may cause blurring of vision.May have difficulty in reading and seeing
far away things.
5.Label to get more infections.May produce a fungal infection called 'thrush', seen as white
spots involving the skin,mouth,penis or vagina causing itching and soreness.
6.Cramps and tiredness. Also lose weight despite having a good appetite.May particularly crave for sweets.
7. Slowly healing wounds.
8.In type 1 -lack of insulin could lead to serve dehydration, becomes very ill and even becomes unconscious.

What is Diabetes ???

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Diabetes is an illness when the sugar level in the blood is above normal and hence often shows in the urine.It is commonly due to a partial or total lack of insulin being made in the body.
Insulin is a chemical (Hormone) which , controls the blood sugar with in normal levels.

What are the types of Diabetes ?

There are two main types.

Type-1 - Insulin dependent Diabetes and hence if they do not take insulin they will become unwell very quickly.This type generally develops the disease early in life. It is unusual for this to be inherited.

Type-2 - Non insuli dependent or maturity onset type.This does not depend on insulin treatment but later stages may need insulin for better controll.It is commonly inherited. Some may be due to being
Over-weight.

There are few other causes of secondary Diabetes, but they are very rare.
It is imprtant to note that some drugs ( steroids,some ' water tablets' known as diuretics given for high blood pressure) could also cause secondary Diabetes. Normally once you are diagnosed as a Diabetic, it will remain with you for the rest of your life. So far a permanent cure has not been found

INTRODUCTION

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This blogsite will give basic information on Diabetes.These issues may or may not apply specifically to you but you will be guided in general.This site will be educational not only to the patients, but also to their familie members. This is a long term or lifetime and a serious condition, better understanding by the patient will hopefully help in the overall management.
As it will be a part of rest of your life, it is neccessary for you to be in charge of your health by
knowing the basic facts of diabetes. It may also help to clear some myths and misunderstanding you have.Anyhow this will not prevent you seeing your doctor but will be helpful for you to discuss and clarify issues related to this disease.