About Diabetes
Insulin is a hormone produced by the pancreas that allows your body cells to use blood glucose (sugar) for energy. Food is converted into glucose before it is absorbed into our bloodstream. The pancreas then releases insulin to move the glucose from the bloodstream into the body cells for use or storage. People with diabetes are unable to fully use the glucose in their bloodstream due to:
- lack of insulin in the body
- insulin is ineffective
There are three major types of diabetes:
Type 1 Diabetes
- no insulin is produced due to damaged pancreatic cells
- usually diagnosed in children or young adults although it can occur at any age
- insulin is needed for treatment
- complications are sudden and life-threatening
Type 2 Diabetes
- insulin produced is not enough or not effective (insulin resistance)
- occurs more frequently in people over 40 years old, particularly those who are overweight and physically inactive
- more younger adults and children are developing Type 2 Diabetes
- can be controlled with proper diet and exercise but most diabetics also need oral medication
Gestational Diabetes Mellitus (GDM)
- Occurs in about 2-5% of all pregnancies. Women who were not diagnosed to have diabetes previously show high blood glucose levels during pregnancy.
- needs specialised obstetric care to reduce serious complications to the unborn baby
Signs & symptoms
The common symptoms of diabetes are:
- frequent thirst despite drinking lots of water
- constant hunger
- constant tiredness
- itchy skin especially around the genital area
- passing excessive urine during day and night
- weight loss despite good appetite
- poor healing of cuts and wounds
Complications
Uncontrolled diabetes can lead to high blood glucose (hyperglycaemia) and low blood glucose (hypoglycaemia).Both situations can cause a diabetic to become very sick very quickly and even go into a coma.
The long-term complications of diabetes include:
- coronary heart disease such as angina, heart attack
- stroke
- eye disease
- kidney disease
- foot disease such as numbness, ulcers and even gangrene
- nerve disease which can lead to problems such as impotence and diarrhoea
Screening & diagnosis
Diabetes can be detected through a blood glucose test.
You have diabetes mellitus if your
- Random Blood Glucose is 11.1 mmol/L or higher
- Fasting Blood Glucose is 7.0 mmol/L or higher
| TEST (mmol/L) | Normal | Diabetic |
|---|---|---|
| Random blood glucose (check anytime of the day) | < 7.8 | ≥ 11.1 |
| Fasting blood glucose (tested in the morning after 8 hours of overnight fast) | ≤ 6.0 | ≥ 7.0 |
Treatment
Diabetes is a life-long disease. It can be controlled if you do the following:
Your diabetes may be controlled through diet or a combination of diet and medication. Follow your doctor's instructions on diet and/or medication.
Oral medication
All medicines must be taken regularly at the correct dosages at the given times as advised by your doctor
- Sulphonylureas (SUs)
- Non-SU Secretagogues
- Biguanides
- Alpha-Glucosidase Inhibitors
- Thiazolidinediones
As in all medicines, sometimes side effects such as skin rashes, eye swelling, vomiting, diarrhoea may occur and these have to be reported to your doctor at once.
Insulin
There are different types of insulin. Some are short-acting and others are long-acting, while still others are a mixture of both. Your doctor will prescribe the exact amount of the specific types of insulin you would need.
- Follow instructions carefully and do not make any changes without consulting your doctor
- Always keep all insulin bottles plus an extra spare bottle in the refrigerator when not in use
- Short acting insulins by themselves or as part of a mixture need to be injected about 30 minutes before a meal
Self-care
A diabetic person has to take extra care of his body to maintain good health.
Foot care
As a diabetic, you have a higher risk of foot problems. In serious cases, it can lead to amputations. Taking care of your feet is very important:
Wash your feet daily with soap and water.
After washing, dry them fully, especially in between the toes.
Keep your toe nails short, trimming them straight across to avoid ingrown toenails.
Moisturise your feet daily to prevent dryness and cracking of the skin.
Examine your feet daily for scratches, cuts, blisters and corns. Use a mirror to check the sole of your feet.
Use shoes that fit well and wear clean cotton socks which have loose fitting elastic tops.
See your family doctor for screening of your feet every year.
If you have any corns or any wounds that are not healing well, seek help from your doctor as soon as possible.
Eye care
Diabetes can cause severe eye problems where the small blood vessels in the eyes become damaged (diabetic retinopathy) and can lead to blindness.
It is important to have regular eye check-ups at least once a year.
You can get your retinae (inside surfaces of your eyes) photographed by a procedure called retinal photography to detect any damage to small blood vessels. The doctor might also perform laser photocoagulapathy, a form of highpowered light and heat energy, to prevent further damage.
Skincare
Avoid skin injury as diabetes makes the skin more prone to many problems such as rashes, infections and colour changes.
- Wash every part of the body while bathing using mild soap and warm water.
- Dry all parts of the body using a clean towel.
- Pay attention when washing and drying skin folds in areas such as under the breasts, abdominal folds and groin area.
- Apply moisturising cream to keep skin moist and soft.
- Treat all cuts and scratches at once, wash with soap and water and then apply mild antiseptic lotion.
- See a doctor if the skin injury does not heal in 2-3 days.
Dental care
Dental care is important as many infections start in the mouth.
- Brush your teeth twice a day – after breakfast and before bedtime.
- Use a soft toothbrush to prevent gum injury.
- Rinse your mouth after every meal or snack.
- Floss your teeth gently after meals to remove food particles between your teeth.
- Dental check-ups: Inform your dentist that you have diabetes and visit him at least once a year.
Prevention
Lead a healthy lifestyle
Have a proper diet
Besides insulin and medicines, eating a healthy diet helps you keep your blood glucose under control. It also helps to maintain your weight at a healthy level. Use the Healthy Diet Pyramid.Engage in regular physical activity
Regular physical activity is an important part of your diabetes control. It helps to prevent the onset of complications. Exercise also helps to control your weight and keeps your heart healthy. Consult your family doctor before starting any exercise programme.Do not smoke
Smoking worsens the narrowing of blood vessels already caused by diabetes. It reduces blood flow to many organs and leads to many serious complications.Limit your alcohol intake
Alcohol interferes with your meal plan and blood glucose control, especially if you are taking insulin or medicines for your diabetes.
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