Diabetes Treatment:

Diet: A healthy diet is key to controlling blood sugar levels and preventing diabetes complications.

• If the patient is obese and has had difficulty losing weight on their own, talk to a healthcare provider. He or she can recommend a dietitian or a weight modification program to help the patient reach a goal.
  
• Eat a consistent, well-balanced diet that is high in fiber, low in saturated fat, and low in concentrated sweets.
  
• A consistent diet that includes roughly the same number of calories at about the same times of day helps the healthcare provider prescribe the correct dose of medication or insulin.
  
• It will also help to keep blood sugar at a relatively even level and avoid excessively low or high blood sugar levels, which can be dangerous and even life-threatening.

Exercise: Regular exercise, in any form, can help reduce the risk of developing diabetes. Activity can also reduce the risk of developing complications of diabetes such as heart disease, stroke, kidney failure, blindness, and leg ulcers.

• As little as 20 minutes of walking three times a week has a proven beneficial effect. Any exercise is beneficial; no matter how light or how long, some exercise is better than no exercise.
  
• If the patient has complications of diabetes (eye, kidney, or nerve problems), they may be limited both in type of exercise and amount of exercise they can safely do without worsening their condition. Consult with your health care provider before starting any exercise program.

Type 1 diabetes
Treatment of diabetes almost always involves the daily injection of insulin, usually a combination of short-acting insulin [for example, lispro (Humalog) or aspart (NovoLog)] and a longer acting insulin [for example,  NPH, Lente, glargine (Lantus), detemir, or ultralente].

• Insulin must be given as an injection. If taken by mouth, insulin would be destroyed in the stomach before it could get into the blood where it is needed.
  
• Most people with type 1 diabetes give these injections to themselves. Even if someone else usually gives the patient injections, it is important that the patient knows how to do it in case the other person is unavailable.
  
• A trained professional will show the patient how to store and inject the insulin. Usually this is a nurse who works with the healthcare provider or a diabetes educator.
  
• Insulin is usually given in two or three injections per day, generally around mealtimes. Dosage is individualized and is tailored to the patient's specific needs by the healthcare provider. Longer acting insulins are typically administered one or two times per day.
  
• Some people have their insulin administered by continuous infusion pumps to provide adequate blood glucose control. Supplemental mealtime insulin is programmed into the pump by the individual as recommended by his or her healthcare provider.
  
• It is very important to eat if the patient has taken insulin, as the insulin will lower blood sugar regardless of whether they have eaten. If insulin is taken without eating, the result may be hypoglycemia. This is called an insulin reaction.
  
• There is an adjustment period while the patient learns how insulin affects them, and how to time meals and exercise with insulin injections to keep blood sugar level as even as possible.
  
• Keeping accurate records of blood sugar levels and insulin dosages is crucial for the patient's diabetes management.
  
• Eating a consistent, healthy diet appropriate for the patient's size and weight is essential in controlling blood sugar level.

Type 2 diabetes
Depending on how elevated the patient's blood sugar and glycosylated hemoglobin (HbA1c) are at the time of diagnosis, they may be given a chance to lower blood sugar level without medication.

• The best way to do this is to lose weight if obese and begin an exercise program.
  
• This will generally be tried for three to six months, then blood sugar and glycosylated hemoglobin will be rechecked. If they remain high, the patient will be started on an oral medication, usually a sulfonylurea or biguanide [metformin Glucophage)], to help control blood sugar level.
  
• Even if the patient is on medication, it is still important to eat a healthy diet, lose weight if they are overweight, and engage in moderate physical activity as often as possible.
  
• The healthcare provider will monitor the patient's progress on medication very carefully at first. It is important to get just the right dose of the right medication to get the blood sugar level in the recommended range with the fewest side effects.
  
• The doctor may decide to combine two types of medications to get blood sugar level under control.
  
• Gradually, even people with type 2 diabetes may require insulin injections to control their blood sugar levels.
  
• It is becoming more common for people with type 2 diabetes to take a combination of oral medication and insulin injections to control blood sugar levels.

Medications: 

• Sulfonylureas: These drugs stimulate the pancreas to make more insulin.
  
• Biguanides: These agents decrease the amount of glucose produced by the liver.
  
• Alpha-glucosidase inhibitors: These agents slow absorption of the starches one eats. This slows down glucose production.
  
• Thiazolidinediones: These agents increase sensitivity to insulin.
  
• Meglitinides: These agents stimulate the pancreas to make more insulin.
  
• D-phenylalanine derivatives: These agents stimulate the pancreas to produce more insulin more quickly.
  
• Amylin synthetic derivatives: Amylin is a naturally occurring hormone secreted by the pancreas along with insulin. An amylin derivative, such as pramlintide (Symlin), is indicated when blood sugar control is not achieved despite optimal insulin therapy. Pramlintide is administered as a subcutaneous injection along with insulin and helps achieve lower blood sugar levels after meals, helps reduce fluctuation of blood sugar levels throughout the day, and improves hemoglobin A1C levels.
  
• Incretin mimetics: Incretin mimetics promote insulin secretion by the pancreas and mimic other blood sugar level lowering actions that naturally occur in the body. Exenatide (Byetta) is the first incretin mimetic agent approved in the United States. It is indicated for diabetes mellitus type 2 in addition to metformin or a sulfonylurea when these agents have not attained blood sugar level control alone.
  
• Insulins: Human insulin is the only type of insulin available in the United States; it is less likely to cause allergic reactions than animal-derived varieties of insulin. The type of insulin chosen to customize treatment for an individual is based on the goal of providing optimal blood sugar control. Different types of insulin are available and categorized according to their times of action onset and duration. Commercially prepared mixtures of some insulins may also be used to provide constant (basal) control and immediate control.
  • Rapid-acting insulins
    • Regular insulin (Humulin R, Novolin R)
      
    • Insulin lispro (Humalog)
      
    • Insulin aspart (Novolog)
      
    • Insulin glulisine (Apidra)
      
    • Prompt insulin zinc (Semilente, slightly slower acting)
      
  • Intermediate-acting insulins
    • Isophane insulin, neutral protamine Hagedorn (NPH) (Humulin N, Novolin N)
      
    • Insulin zinc (Lente)
      
  • Long-acting insulins
    • Extended insulin zinc insulin (Ultralente)
      
    • Insulin glargine (Lantus)
      
    • Insulin detemir (Levemir)

http://www.emedicinehealth.com/diabetes/article_em.htm

Diagonostic Testing for DM 1 & 2

A urine analysis may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose diabetes.
The following blood tests are used to diagnose diabetes:

• Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on two occasions. Levels between 100 and 126 mg/dL are referred to as impaired fasting glucose or prediabetes. These levels are considered to be risk factors for type 2 diabetes and its complications.
• Hemoglobin A1c test -- this test has been used in the past to help patients monitor how well they are controlling their blood glucose levels. In 2010, the American Diabetes Association recommended that the test be used as another option for diagnosing diabetes and identifying pre-diabetes. Levels indicate:
  • Normal: Less than 5.7%
  • Pre-diabetes: Between 5.7% - 6.4%
  • Diabetes: 6.5% or higher
• Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours. (This test is used more for type 2 diabetes.)
• Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic diabetes symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)

Persons with diabetes need to have their hemoglobin A1c (HbA1c) level checked every 3 - 6 months. The HbA1c is a measure of average blood glucose during the previous 2 - 3 months. It is a very helpful way to determine how well treatment is working.

http://www.nlm.nih.gov/medlineplus/ency/article/003438.htm

What Does Diabetes Do?

Diabetes Mellitus Type I and II Causes and Risk Factors

Diabetes is a serious, lifelong condition that affects an estimated 23.6 million people in the United States. About 5.7 million do not know they have it. Each year, about 1.6 million people find out they have diabetes and probably have had the disease for seven years before it was diagnosed. The two types that we will be profiling are type I and type II.

Types

Type I, previously referred to as juvenile or insulin dependent diabetes usually develops during childhood or adolescence and affects approximately 5 percent to 10 percent of all adults with diabetes. Patients with Type I diabetes typically require daily injections of insulin. Type II diabetes is the most common type that affects 90 to 95 percent of all adults who develop diabetes.

Risk Factors

Some of the risk factors for both type I and II include older age, obesity, family history of diabetes, impaired glucose metabolism, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or Other Pacific Islanders are at particularly high risk for type II diabetes.

Symptoms

The symptoms of diabetes can vary from person to person and often develop gradually. Being very thirsty, excess urination, blurred vision at times, fatigue, sudden loss of weight, dry skin, slow healing sores, increased number of infections, tingling or loss of feeling sensation in the feet, and vomiting.

Next week there will be more information about Diabetes Mellitus

Diabetes

My Name is Kelley Carrillo, and I am an LVN student. My blog will consist of information regarding Diabetes Mellitus.. There are two types of Diabetes-Type I and Type II.   As the weeks progress, we will profile Diabetes and go into more depth about the two types of Diabetes including the causes, signs and symptoms, risk factors, tests, treatment, diet options, and medications. Feel feel to comment on my blog with your input and stories :)