Diabetes and It’s Management

MANAGEMENT OF DIABETES

1. Diet Control:

There are clear evidence that diet control and weight loss in obese Type II diabetics, leads to improved carbohydrate metabolism, thereby reducing the amount of medication required to control glucose levels. Special attention should be paid to periods of illness, exercise and travel. Diet planning by a professional should be sought, but as a general guide:

  • Diet should include foods from each of the basic food groups.
  • Saturated fats less than 10% of total calories.
  • Carbohydrates 50-60% of total calories.
  • Protein 15-20% of total calories.
  • Consume 20-35 g of dietary fibre from a variety of food sources.
  • Diet should contain adequate vitamins and minerals.
  • Cholesterol limited to
  • Sodium intake limited to
  • Abstain from alcohol.
  • Use of artificial sweeteners within safe limits.

2. Physical Exercise and Weight Loss:

Maintain a sensible exercise plan to suit your age, aptitude, fitness and interest. Your doctor will often do a pre-exercise evaluation. If you have not been exercising for a while, start of slowly then build up intensity and duration as your fitness level improves. Guidelines for exercise are as follows:

  • Frequency : 3-5 days per week (daily if exercise of low intensity)
  • Intensity: 60-85% of maximum heart rate (or until you feel warm and sweaty)
  • Duration: 20-60 minutes each time
  • Type: Aerobic exercises such as brisk walking, jogging, cycling, swimming

Precautions for diabetics when exercising:

  • Use proper footwear to reduce chance of blisters and other foot injuries
  • Adequate hydration before, during and after exercise
  • Avoid exercise during periods of acute illness or if severely hyper or hypoglycaemic
  • Dose of medication may have to be reduced prior to exercise. This should be discussed with your doctor
  • In patients with severe diabetic retinopathy, activities such as weight-lifting and heavy competitive sports should be avoided.

3. Avoidance of Smoking

4. Medication

  • Sulphonylurea secretagogues – stimulates pancreatic insulin secretion and release (eg. tolbutamide, glibenclamide, glipizide, gliclazide, glimepiride).
  • Non-sulphonylurea secretagogues – stimulates pancreatic insulin secretion and release (eg. Nateglinide, repaglinide)
  • Biguanides – decreases production of glucose by the liver (eg. Metformin)
  • Alpha-glucosidase inhibitors – decreases carbohydrate absorption by the gut (eg. Acarbose)
  • Thiazolidinediones – increases tissue sensitivity to insulin (eg. Rosiglitazone, pioglitazone)
  • Insulin – replaces the deficient insulin (eg. Rapid-acting or long-acting insulin)

TARGETS FOR CONTROL:

Targets for Glucose control:

  • Non-diabetic levels: HbA1C 4.5-6.4%, Pre-meal glucose 4.0-6.0 mmol/L, 2 hour post-meal glucose 5.0-7.0 mmol/L
  • Optimal (target for most patients): HbA1C 6.5-7.0%, Pre-meal glucose 6.1-8.0 mmol/L, 2 hour post-meal glucose 7.1-10.0 mmol/L
  • Suboptimal (adequate for some): HbA1C 7.1-8.0%, Pre-meal glucose 8.1-10.0mmol/L, 2 hour post-meal glucose 10.0-13.0 mmol/L
  • Unacceptable (action needed in all patients): HbA1C >8.0%, Pre-meal glucose >10.0 mmol/L, 2 hour post-meal glucose >13.0 mmol/L