Managing with Diabetes
The person with diabetes has the most central role in the management of his or her own metabolic control.
They make decisions regarding diet, exercise and, with professional input, choice of treatment and the dosing of the treatment agent they are placed on. What are necessary are interest, accurate means of monitoring and controlling Diabetes and simple rules regarding blood sugar measurements and then responding to changing situations.
Monitoring Diabetes
The best thing to do is to keep the blood sugar under control. Achieving this goal is easier said than done! This section will help you to set targets and provide pointers as to how to work towards the ideal objectives.
To monitor blood sugars, the following two measurements are required: Whole blood sugar and Glycated haemoglobin (HbA1c).
Whole blood sugar measurement: This can be done at home using a blood glucose meter. At DiagnoseMeFirst, we have always avoided measuring the clients’ blood sugar in clinic but relied instead on their own records.
When to measure blood sugar
| Circumstance | Frequency |
| Predictable or near predictable activity and meal schedule |
Twice a week :
|
| After intense exercise or symptomatic hypoglycaemia | Once a day |
| Patients taking 4 injections a day | Five times a day:
|
Glycated haemoglobin (HbA1c) This is normally done at a surgery or in a hospital as it requires centrifuge techniques and equipment. Please contact us for further details.
Levels of HBA1c (% of total Hb) as measure of Glycemic control
| HbA1c(%) | |
| 4.7-6.4 | Non-diabetic |
| Less than 7 | Good |
| 7-8 | Acceptable |
| 8-9 | Fair |
| 9-10 | Poor |
| Greater than 10 | Very poor |
How does HbA1c reflect control of diabetes?
The way the timed blood sugars are reflected in overall diabetic control is estimated by the degree to which some proteins, which hang around in the circulation for weeks, are modified by the attachment of glucose. The one most used is HbA1c. This is a subfraction of a minor human haemoglobin and is glazed by sugar when young red cells exit the bone marrow. The higher the sugar at the moment of birth of the red cells, the higher the percent of red cells that are glazed. As red cells ordinarily circulates in the body for 120 days, the percentage glycation of HbA1c reflects overall glucose control for the previous 6-8 weeks.
Discrepancies between HbA1c and self-monitoring results may stem from poor technique, less than candid recording of results or rapid destruction of red cells because of another disease process. Appropriate counselling or the measurement of other glycated proteins would address these issues.
Controlling Diabetes Symptoms
The most important thing to do is to lower your blood glucose and blood pressure. Even a slight reduction will help you become healthier and stay that way.
UK PDS (Prospective Diabetes Study) trials have concluded that Diabetes Type 2 must be controlled as aggressively as diabetes Type 1. Trials show that patients will turn from Life style care to requiring Insulin related medication if diabetes Type 2 is not controlled aggressively.
Diabetes related ill-health and mortality is reduced by the following:
- Drugs - Most people will need drugs. Statins if hypercholestolemia or Fenofibrates if mixed Hyperlipidemia doses.
- Weight Control - Normalising blood fat levels - through good nutrition, regular exercise and if necessary weight loss.
- Cholesterol - Bringing down total cholesterol to 4.2mMol/L or lower again this is achievable through healthy eating. For measuring your Cholesterol you need to take a capillary blood test arranged by your doctor.
- Glucose - Normalising the Glucose in the blood. For some eating guides to help with this please click here.
- Blood Pressure - Unless there are medical reasons not to, at least a baby aspirin (75 mgs) a day should be taken. Aspirin discourages clot formation and is recommended to prevent vascular events. Controlling blood pressure is specially important as high blood pressure contributes to kidney disease, heart disease and stroke. More so with Diabetes than non-diabetes people.
- Prevention of Kidney Disease - The earlier you catch signs of kidney disease the better. You must have your urine tested regularly for early signs of kidney disease. Your doctor may prescribe pills to delay more damage to your kidneys. Controlling the blood pressure is the best way of preventing kidney failure. This determines whether kidney function deteriorates with time in the diabetic patient, more so in the diabetic as opposed to the non-diabetic people.
- Stop smoking - Smoking more than doubles the risk of a diabetic patient for these events as the non-diabetic. If you are a smoker, give it up now!
- Eye Disease Prevention - Have your eyes examined at least once a year, for visual acuity, eye-pressure and the appearances of the back of the eye (retina) after the pupils have been dilated with eye-drops.
- Foot Care - Wear good-fitting comfortable shoes. Please enquire about inserts if you develop calluses or start getting clawing of your toes. Get corns attended to and if you are subject to in-growing toenails seek professional advice. Treat skin breaks and abrasions on your feet with respect. A visit to the chiropodist for initial consultation and advice may be well worth it.
- Nerve Damage - Tell your doctor or health care team if your hands or feet ever feel numb or have "pins and needles."
- Erection - Trouble getting and maintaining an erection is a very common problem in men with diabetes. Do not be shy about talking to your doctor or health care team about it. They may be able to suggest ways to solve the problem.
It must be appreciated that the above are precautionary measure aimed at reducing the risk of vascular events long-term and do not imply that one who is advised to adopt them has a problem. They may, however, run into problems in the future, if they do not pay attention to these lesson learnt through high quality research.
Targets
| Capillary (by home meters) | 7-8 mmol/L before breakfast, 5-7 before meals and less than 10, two hours after meals. |
| Blood sugars | Acceptable Levels:
Pre-meal 5-7 mmol/L Two hours after meals: up to 10 mmol/L |
| Blood pressure |
130-140 systolic (Upper reading) 70-80 diastolic (Upper reading) |
| Cholesterol |
Fasting Cholesterol <= 4.2 Triglycerides <= 1.70 High density (good) cholesterol >= 1.0 mol/L |
| Hb A1c (Glycemic Control) | 7% or less is highly desirable (See Table.) |
| Urine | Free of protein (negative in the microalbuminuria test) |