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Diagnosis and treatment of diabetes

If diabetes is suspected it is important to visit a doctor quickly so that an accurate diagnosis can be made and appropriate treatment can be given. Early diagnosis and treatment will help to prevent diabetes-related complications.

Diagnosis:-

To assist with diagnosis, blood tests are used to measure the glucose levels in the blood. These include:

Fasting blood glucose test:

A sample of blood is taken to measure the blood glucose levels in the blood after the person has not eaten for several hours (usually in the morning, before breakfast). It is the most common blood test used to assist with diagnosis.

Random blood glucose test:

A sample of blood is taken to measure the glucose levels in the blood – not considering of when the person last ate.

The acceptable range for glucose in the blood is 4.0 – 8.0mmol/L (mmol of glucose per litre of blood) before a meal.

A diagnosis of diabetes can usually be made if there are classical symptoms of the condition and blood glucose levels of greater than 11mmol/L for a random blood glucose test, or greater than 7mmol for a fasting blood glucose test.

Glucose tolerance test:

To further confirm the diagnosis of diabetes, a glucose tolerance test (GTT) may be recommended. This is very sensitive test in which the person drinks a measured quantity of glucose after having a sample of blood taken. Further blood samples are taken at fixed intervals in the two hours following the glucose drink. The results will indicate how the body responds to increased glucose levels in the blood. In a person who does not have diabetes, the blood glucose levels will rise after the drink, then slowly fall as insulin is produced to metabolise it. In a person with diabetes, the levels of glucose in the blood will remain high for a long time, or they may be very slow to fall.

Glycated haemoglobin:

Another test to detect Diabetes is Glycated haemoglobin (Hb A1C).If Glycated haemoglobin (Hb A1C) is ‰¥6.5% that indicate Diabetes mellitus .Glycated haemoglobin is better than fasting glucose for determining risks of cardiovascular disease and death from any cause.

Diabetes diagnostic criteria

Condition

2 hour after glucose

Fasting glucose

HbA1c

mmol/l(mg/dl)

mmol/l(mg/dl)

%

Normal

<7.8 (<140)

<6.1 (<110)

<6.0

Impaired fasting glycaemia

<7.8 (<140)

‰¥ 6.1(‰¥110) & <7.0(<126)

6.0€“6.4

Impaired glucose tolerance

‰¥7.8 (‰¥140)

<7.0 (<126)

6.0€“6.4

Diabetes mellitus

‰¥11.1 (‰¥200)

‰¥7.0 (‰¥126)

‰¥6.5

Urine tests may also be done and will demonstrate high levels of glucose. They are not used in isolation in the diagnosis of diabetes, as the results can be misleading.

If diabetes is suspected the doctor may also check the eyes, kidneys and heart to make sure there has been no damage due to diabetes.

Blood glucose Testing:

To enable blood glucose levels to be tested, a droplet of blood is obtained from a small finger prick test and is measured on a special testing strip. The results will help to determine how much medication is required, how much exercise can be undertaken and what foods should be eaten. This simple home test needs to be performed regularly, in some cases up to several times per day. It is important to follow the guidelines given by the treating doctor as to how often they should be done.

Treatment:-

Management concentrates on keeping blood sugar levels as close to normal as possible, without causing hypoglycemia and to prevent diabetic complications. This can usually be accomplished with diet, exercise, and use of appropriate medications (insulin in the case of type1 diabetes, oral medications, as well as possibly insulin, in type2 diabetes).

Patient education, understanding, and participation is vital, since the complications of diabetes are far less common and less severe in people who have well-managed blood sugar levels.

Management of diabetes-

Lifestyle:

There are roles for patient education, dietetic support, sensible exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.

Diet:

Generally it is recommended that foods containing refined sugars be avoided. This includes foods such as chocolate, jam, soft drinks, sweet biscuits, cakes, pastries and some fruit juices. Natural carbohydrates, which can be converted to energy, are recommended. This includes foods such as fruit, vegetables, wholemeal bread and cereals.

The diet should also be low in fat and high in dietary fibre. Alcohol contains a lot of sugar so intake should be minimised. Having a regular eating pattern is also important as this helps to keep blood glucose levels balanced. In some cases, having snacks between meals may be recommended. Again this helps to balance blood glucose levels.

It is recommended that people with diabetes seek dietary advice from a dietician and that they follow an individualised food plan.

Exercise:

Regular exercise is important in maintaining balanced blood glucose levels. Exercise also helps to maintain a healthy body weight and control blood pressure and blood cholesterol levels. This in turn helps to reduce the risk of related health conditions such as cardio-vascular disease (heart attacks and strokes).

It should be remembered however that excessive and/or prolonged exercise can cause the blood glucose levels to drop too low. It is therefore recommended that any exercise undertaken is regular and moderate.

Other Lifestyle Factors:

When the body is stressed, the blood glucose levels are more difficult to control. It is therefore important that stress is adequately managed.It is recommended that people with diabetes do not smoke. Smoking plays a part in increasing the risk of developing many diabetic complications.Illness can also make blood glucose levels more difficult to control. If blood glucose levels become unstable due to illness, it is important to consult a doctor – particularly if vomiting occurs.

Medications:

Oral medications:

People with Type 2 diabetes may not be able to adequately control their blood glucose levels through diet, exercise and lifestyle changes alone. Therefore, in many cases oral medications are required. This are-

Metformin is generally recommended as a first line treatment for type2 diabetes, as there is good evidence that it decreases mortality. That use to reduce insulin resistance.

Tablets to increase insulin output from the pancreas e.g.: Glipizide, Glibenclamide.

Tablets that stop the absorption of carbohydrates from the bowel e.g.: Acarbose.

Insulin:

In people with Type 1 diabetes and in some people with Type 2 diabetes, insulin injections are required. There are a number of different types of insulin available that vary in the duration of time they are effective. Some are short-acting; meaning they are absorbed quickly by the body and are effective for a short period of time. Others are long-acting; meaning they are absorbed more slowly by the body and are effective for a longer period of time. Often a combination of different types of insulin is required.

In order for a person to effectively control the diabetes, it is important that they are treated and monitored by a doctor.

Health promotion, early detection, knowledge of the condition and effective monitoring of blood glucose levels are also considered to be important.