Management of Diabetes Mellitus

Controlling your blood sugar is very crucial to keep healthy and avoiding late complications of Diabetes Mellitus (DM). Some people are able to control their blood sugar with diet and exercise alone. Others may need to use insulin or other medications in addition to lifestyle changes. In either case, monitoring your blood sugar is a key part of your treatment program.

The development of long-term complications is influenced by hyperglycemia. Poor control of diabetes accelerates their progression. Thus, to prevent complications, good control of diabetes mellitus is essential and the management of diabetes should therefore aim to improve glycaemic control beyond that required to control its symptoms.

Medicine is an ever-changing science and advances and new developments in diabetes mellitus care and clinical practice will continue to take place. Thus revision of the guidelines will be necessary as new knowledge is gained.

General objectives of diabetes mellitus management:

• To correct associated health problems and to reduce morbidity, mortality and economic costs of diabetes
• To relieve symptoms
• To prevent as much as possible acute and long-term complications; to prevent the
• development of such complications and to provide timely intervention
• To improve the quality of life and productivity of the individual with diabetes

Assessment of Diabetes Mellitus :

• Family history of diabetes, cardiovascular disease, and stroke
• Height and weight measurements
• Thyroid examination
• Blood pressure measurements
• Blood tests for fasting blood sugar, A1c, and cholesterol
• Examination of hands, fingers, feet, and toes for circulatory abnormalities
• Prior infections and medical conditions
• A list of current medications, including: Over-the-counter medications, Prescription medications
• Smoking history, including encouragement to stop smoking (if applicable)
• Vitamin, mineral or herbal supplements
• Vision abnormalities, to check for eye health issues
• Signs of complications with pregnancy or trying to get pregnant for women patients
• Eating and exercise habits
• Urination abnormalities, which can indicate kidney disease

Glucose monitoring: Self-blood glucose monitoring allows you to know your blood glucose level at any time and helps prevent the consequences of very high or very low blood sugar. Monitoring diabetes mellitus also enables tighter blood sugar control, which decreases the long-term risks of diabetic complications.

Dietary Management and Physical Activity: In general, the more active you are, the lower your blood sugar. Physical activity causes sugar to be transported to your cells, where it's used for energy, thereby lowering the levels in your blood. Aerobic exercises such as brisk walking, jogging or biking are especially good. But gardening, housework and even just being on your feet all day also can lower your blood sugar. Diet and exercise are basic measures of treatment of diabetes mellitus.

To prevent the development and progression of atherosclerotic disease as well as microangiopathy, diet management of diabetes mellitus should be focused on the reductions of conventional risk factors for atherosclerosis such as hyperglycemia, dyslipidemia, and hypertension. To control the these risk factors, both total energy and fat intake should be reduced.

Exercise therapy is an effective measure for improving glycemic control in Type 2 diabetic patients. A diet designed to lose one to two pounds per week should be instituted in most type 2 diabetic patients and a eucaloric diet in most type 1 diabetic patients. As little as a 5% loss of body weight results in a significant and disproportionate decrease in insulin resistance and improved glycemic control. Every patient will benefit from dietary counseling, not only when diabetes mellitus is diagnosed, but also at regular intervals after diagnosis.

Oral Medications: Normally, people who are suffering from Type 1 diabetes mellitus don't use oral medications. These medications work best in people with Type 2 diabetes who have had high blood sugar for less than ten years and who have normal weight or obesity. It's not uncommon for oral medication to control blood sugar well for years and then stop working. Some people who begin treatment with oral medications eventually need to take insulin. Oral diabetes medications are sometimes taken in combination with insulin.

Insulin Therapy: Insulin is a hormone and is found in even single-celled organisms and has been around for several billion years. Insulin is also a protein just like many other hormones. The pancreas has a group of cells called islet cells. It is the islet cells that secrete insulin. Without insulin, the cells in our bodies would not be able to process the glucose and therefore have no energy for movement, growth, repair, or other functions. Insulin is key to unlocking the door of the cell to allow the glucose on the patient with diabets mellitus to be transferred from the bloodstream into the cell.

People with Type 1 diabetes mellitus produce inadequate amounts of insulin, so insulin replacement is their key treatment. The pancreas secretes little or no insulin (type 1 diabetes) or your body produces too little insulin or has become resistant to insulin's action (type 2 diabetes), the level of sugar in your bloodstream increases. This is because it's unable to enter cells. Left untreated, high blood sugar can lead to complications such as retinophaty, nerve damage (neuropathy) and nephropathy.

There are four major types of insulin:

• Rapid-acting
• Short-acting
• Intermediate-acting
• Long-acting

Managing Diabetes Mellitus is a balancing act between insulin and blood glucose. Finding the right amount of insulin to keep blood glucose levels as close to normal as possible is the key to good control.