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Old May 19, 2012, 04:34 AM
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mar umpire mar umpire is offline
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Regarding DM
Which one do you want, type 1 or 2 (your scenario is type 1 but 2 is what I would think most people from a bengali background would be interested in from a purely epidemioloical background)

According to Aus guidelines, diabetes is diagnosed via venous plasma glucose being 7 or more for fasting and 11.1 for 2hrs after meal/ OGTT. But again OGTT via a 75g glucose load is indicated in impaired fasting glucose.

Here they emphasise lifestyle modification as being the first line of treatment
Obviously it also depends on the individual patient regarding the action that's taken

By lifestyle measures the indications are treatment targets ,a healthy eating plan
an exercise program (involving preferably resistance i.e body resistance or weight training program), reduce cardiovascular risk factors (eg smoking, blood pressure (prefer 130/75, lipids).

The aim initally would be to lose at least 5-10% of one's body weight and maintain it
Meals and snacks should be low in saturated fat and based on low glycaemic index(but not fatty foods like potatoe chips, ice cream etc).Avoid sweetened drinks (eg coke, juice etc). watch out for preserved foods and drinks with fructose-fructose worsens insulin resistance and interfere with satiety mechanisms as can non-nutritive sweetners such as saccharine (insulin is believed to act in the region of the arcuate nucleus in the hypothalamus to mediate satiety).

But if you can't do weight training, a good place to start is by taking brisk 30 minute walks at least 5 times a week. But the exercise plan depends on your other conditions-if you have problems with your peripheral circulation you might consider a different exercise plan.

Diabetics should also regularly monitor their glucose (if on insulin monitor very closely preferable more than once a day) but again this will be catered according to the individual circumstances. But during illness and peridos of stress/strneous exercise the glucose should be measured.

You should review your progress every 3 months-regarding Blood pressure, glucose, lipids and waist+weight measurements. You might also get your foot examined . But every 6 months you'll want the foot examined and HbA1c seen (seen on a blood test). every year you'd want all the above plus your eye check for retinopathy as well as urine tests for microalbuminuria and plasma creatine/GFR (these are things done to check how your kidneys are going-diabetes stuffs the kidneys up)


Usually lifestyle measures are tried for 3 months-if no improvements or during this time worsening of symptoms start on drug therapy. Usually biguanide (metformin first up), but again check for renal function before that as lactic acidosis howevr rare is a potentially fatal side effect-this drug has GI side effects so watch out for that as well. After this traditionaly the sulfonylureas were used however now there is a push towards Dpp4 inhibitors like sitagliptin. Sitagli[ptin is preferred as it doesn't cause the massive hpos some sulfonylureas can i.e usually safer

If the combo of metformin and sufonylurea don't work add insulin on top of that-may initially reduce the sulfonylurea to prevent hypos and slowly titrate up if needed

Other aspects of management include-education in self-monitoring, adjusting treatment and how to cope with emergencies that affect the patient's blood glucose
screening for, and treatment of, complications of diabetes (like cardiovascular, renal, retniopathy and neuropathies)

Things to watch out for
Hypos-if you are getting hypoglycaemic attacks (sweaty, nauseous, "dizzy", blacking out) etc and you are getting them frequently eg on a monthly basis-consult your doctor quickly as repeated hypos may lead to a desensitisation of your adrenergic response to the point you won't detect future hypos coming on

Feet-check your feet so as they're not cracked/calluses also look for loss of feling in the feet, loss of hair and a loss of colour in the feet/change in colour. Pain on walking esp in the calves-may signal peripheral vascular disease

If you need to get up to go to the bathroom more than twice a night on a regular basis think about getting a renal function test done or if you are going to the toilet more fequently than usual. If you get postural hpotension etc etc

There's a whole myriad of stuff that can happen and I don't have the time to type up everything but add more as I go along

Plus it took me a while to type and I was logged out automatically?
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