Manage Diabetes Effectively to Prevent Health Complications

The main theme during the management of diabetes is mostly to control blood sugar level. Management of diabetes requires awareness on part of patient. In order to lead a long and healthy life one has to keep his blood sugar level within his target range.

4 main methods to manage diabetes effectively are

a. Diet and lifestyle
b. Oral anti-diabetic drugs
c. Insulin
d. Other factors

About 50% of new cases can be controlled adequately by diet alone, 20-30% will need an oral anti-diabetic drug, and 20-30% will require insulin.

The ideal management for diabetes would allow the patient to lead a normal life, not only symptom free but in good health, to achieve a normal metabolic state and to escape long term complications.

Diet and lifestyle

Dietary management aims at –

1. Achieving good glycemic control
2. Assisting weight management
3. Reducing risk of micro vascular and macro vascular complications
4. Avoiding “atherogenic” diets
5. Assuring adequate nutritional intake
6. Avoiding hypoglycemia

Recommended composition of diet for people with diabetes –
% of energy intake
Carbohydrate – 45-60%
Sucrose – upto 10%
Total fat – less than 35%
N-6 polyunsaturated – less than 10%
Mono saturated – 10-20%
Saturated – less than 10%
Protein – 10-15%

Weight management is a key factor, as a high percentage of people with type 2 diabetes are overweight or obese and also many anti-diabetic medications and insulin encourage weight gain. Obesity, particularly abdominal obesity predicts insulin resistance and increased cardiovascular risk.

The importance of lifestyle changes such as taking regular exercise, observing a healthy diet and reducing alcohol consumption should not be under-estimated in improving glycemic control.

Oral anti-diabetic drugs

Varieties of drugs are quite effective in reducing hyperglycemia in patients with type 2 diabetes. Most of these drugs depend on supply of endogenous insulin.

Following are the groups of oral anti-diabetic drugs used –

a. Sulphonylureas
b. Biguanides
c. Alpha-glucosidase inhibitors
d. Thiazolidinediones
e. Meglitinides and amino acid derivatives
f. Incretin mimetics

Effects of hypoglycemic drugs –

a. Reduction of basal glycemia
b. Improvement in lipid profile
c. Increase body weight
d. Raised plasma insulin
e. Reduced post prandial glycemia

Insulin

Diabetic medications are designed to lower blood sugar level. Timing and size of dose have an important effect on effectiveness of these medications.

Many insulin preparations have been prepared to control diabetes. They are –

1. Rapidly acting e.g. lispro, aspart, glulisine.
2. Short acting e.g. soluble regular insulin.
3. Intermediately acting e.g. isophane, lente.
4. Long acting e.g. bovine ultralente.
5. Long acting insulin analogues e.g. glargine, detemir.

Other factors

Other factors include namely Alcohol, Salt and Diabetic foods and sweeteners. Alcohol consumption should be moderate unless there is a coexisting medical problem that requires abstinence.
Sodium intake should be no more than 6 g daily. In hypertensive patients it should not be more than 3 g daily.
Low calorie and sugar free drinks are very useful in diabetes.

Precautions to be taken –

1. Stick to your diabetes meal plan.
2. Exercise and weight management is necessary.
3. Co ordinate your meals and medication.
4. Be cautious with new medicines.