Blood Glucose, Lipids and Blood Pressure Control

This is a part of diabetic care.It is important to reach target levels mentioned below.
Failure to do so would lead to a deteriorated lifestyle.

Diabetic Retinopathy

It can result due to some disease or damage to the small blood vessels of the retina.
Eye problems get complicated and can result in retinopathy,premature cataract and
glaucoma.Retina is the area of the eye on which the image( picture of what we see)
is formed by our lens system.People with long standing diabetes often develop this
disease.

Skin Disease
Diabetic Dermopathy; It is the commonest kind of skin disease seen in diabetics.Skin develops brown scars over the shin of legs.This is due to abnormal changes in the small blood vessels on the skin.If diabetes is not kept under control,
the process of aging gets faster.

EFFECTS OF KIDNEY MALFUNCTION

ulcer in the foot

* If kidney damage ( nephropathy) progresses, a person may have to undergo kidney
dialysis.Kidney transplantation might also be an option . High uncontrolled blood
sugar can also lead to neuropathy.
* Nerve problems (neuropathy) may occur, causing a 'pins and needles' sensation in
the hands & legs.
* Diabetes damaging the nerves can also lead to reduced pain or loss of sensation
in the feet. Skin sores or ulcers on the feet can be a result of bad footware.
* Injuries or infections do not heal well. Often an injury on the foot does not heal and
can lead to gangrene.

THE KIDNEY MALFUNCTION

Just as the kidneys lose their ability to discharge wastes, they also lose their ability to
retain protein and sugar. Sugar and protein are detected in urine tests often in large
amounts.Blood tests detect high levels of urea, nitrogen and creatining which indicate damaged kidneys.

DIABETIC COMPLICATIONS

High Blood Sugar
High blood sugar levels over a period of time can lead to major health problems.

* Blood vessels can get affected, leading to heart attack, stroke and circulatory .
problems
* Frequent urinary infection is due to the presence of high sugar ( not well controlled)
which results in the damage of the kidneys.
* Kidney disease (nephropathy) may result, which often leads to end-stage renal
disease and kidney failure.

Studies show that if there is even 1% reduction in HbA1c (glycosylated haemoglobin)
in diabetics then :

* The risk of microvascular complications ( e.g- in kidney,eye ) is reduced by 37%.
* The risk offatal and non-fatal heart attack is also reduced by 14%.

DIABETES MELLITUS AND LDL OXIDATION

In diabetes mellitus, LDL is glycosylated by the process of glycosylation, i.e.attachment
of sugar to LDL-C.This modified LDL-C makes it stick to the arteries,thus enhancing the
process of atherosclerosis and heart disease.

SECONDARY DIABETES
It can occur due to a number of causes:
* Hormonal abnormalities.
* Insulin receptor disorders
* Pancreatic disease
* Drug induced diabetes
* Corticosteroid administration
* Genetic syndrome.

DIABETES MELLITUS AND OBESITY

Overweight and obese people keep producing the hormone insulin,but it cannot
act appropriately.An obese person having a high carbohydrate intake puts a strain on the body's glucose metabolism.Also, obesity reduces the insulin receptors on the surface of the cells. As the uptake of insulin is less by fewer
receptors, the body's sensitivity to the insulin is reduced.

Cells (mainly fat or muscle ) requiring glucose, cannot get it from the blood.There is a famine in the midst of plenty, resulting in diabetes.

In response to the high blood sugar present , the pancreas works more to produce more insulin.Eventually, this constant pumping of the pancreas
exhausts the pancreatic beta cells.Insulin secretion from the pancreas starts becoming inadequate and overweight people become diabetic

* A woman delivering a baby weighing over 9 lbs ( approx. 4 kg) has a tendency to develop type 11 diabetes.
* If a person's blood sugar levels are regularly above normal , then heor she is becoming a prediabetec and will probably become a diabetic within 10 years.
* Continuous stress is today known to be a predisposing factor for developing diabetes
mellitus.
* A family history of Type 11 diabetes (particularly in a first-degree relative) in presence
of other risk factors can precipitate the development of diabetes.
* Ethnic groups (Asians or Afro-Caribbean) are more prune to develop diabetes.
* Previous history of gestational diabetes or previous diagnosis of impaired glucose
tolerance, can both lead to the development of diabetes mellitus.

RISK FACTORS FOR DEVELOPING TYPING 11 DIABETES

* A person having a parent or sibling with type 11 diabetes.
* If a person is overweight or has high blood pressure, he or she is at a greater risk of
developing diabetes.
* A person having high levels of cholesterol and triglycerides is at a greater risk of
developing diabetes.With diabetes and abnormal fat levels, a person increases up
to four times in comparison with the general population.
* A person having a sedentary lifestyle has greater chances of developing diabetes.
This risk can be reduced by exercising regularly.

SCREENING FOR DIABETES

This should be done at 30 years of age. If a history of heart attark, stroke or diabetes prevailsin the family, then a blood sugar test should be done along with lipid profile at 20 years of age to determine
the person's baseline level.The test can be repeated every 3 years if normal.If abnormal or borderline,
test should be repeated annually or as your doctor advises.

URINE TEST

You may also be advised by your doctor to get a routine sample of urine tested for albumin, sugar
and microalbuminurea.

THE SINGLE STICK BLOOD GLUCOSE TEST

The finger is pricked with a needle. The blood samples is placed on a stripe. The stripe is then placed
in the slot of the glucometer machine, which assesses your blood sugar level. This method is to be
used only to monitor your blood sugar levels at home.It is not completely reliable, so a venous sample
should also be assessed in the laboratory as guided by your doctor.

Glycosylated Haemoglobin Test;
HbA1c is a measurement to assess the level of your blood sugar over the past 120 days.An HbA1c reading of over 6.1% is suggestive of diabetes.
Oral Glucose Tolerance Test:
After fasting overnight, you are given water with 75 gm sugar ( in a water-sugar solution).Your blood glucose levels are tested over a 24-hour period.

In a diabetic person, blood glucose levels rise higher than normal and do not fall as
quickly.A normal blood glucose reading, two hours after drinking the solution, should be less than 130 mg/dl. All readings between zero to two hours should be less than
200 mh/dl.

In addition to these ,a random blood sugar reading can be taken any time.A reading
of above 140 mg/dl can be indicative of diabetes.

MEASURE YOUR RISK

A few simple tests can help determine whether you have diabetes.

The Venous Sample Test
This is done in the laboratory.It can be of four types; fasting (F),postprandial (PP),
glycosylated haemoglobin and oral glucose tolerance test(GTT). Except for postprandial, all the other tests should be done 12 hours after an overnight fast, without
even a cup of tea.
Fasting;The normal fasting blood sugar level is less than 100mg/dl.If your reading is
higher than this,a diagnosis indicative of developing diabetes is made.
Postprandial;The postprandial is conducted 2 hours after a heavy meal or after taking
75gm of glucose. A reading of over 130 mg/dl along with other positive tests, is indicative of diabetes.

FACTORS CAUSING LAW BLOOD SUGAR( hypoglycaemia)

*Skipping or delaying a meal.
*Taking too much of insulin or diabetic medications.
* Not taking enough carbohydrates in a meal.
* Sudden increase in exercise.

FACTORS CAUSING HIGH BLOOD SUGAR( hyperglycaemia)

* Eating food containing simple sugars which are rapidly absorbed by the body, e.g: sweets,ice-creams,and pastries.
* Drinking sweetened beverages such as carbonated drinks & juices
* Sedentary lifestyle-not burning the consumed sugar,carbohydrates and other products.
* Not enough administration of insulin or other medication.
* Physical stress (e.g; infections, flu )
* Psychological stress.

SOME COMMON TERMS IN DIABETES

HOW DOES DIABETES MELLITUS DEVELOP

Due to malfunctioning in the production and utilisation of insulin, the amount of glucose
produced remains in the bloodstream, causing high blood sugar or hyperglycaemia.
In turn, the cells do not have enough blood sugar to provide the energy required.

IMPAIRED GLUCOSE TOLERENCE

Impaired glucose tolerence is a term when blood sugar levels are higher than normal.
but do not high enough to be diagnosed as diabetes mellitus.This impair ment is indicated by a fasting glucose reading ranging between 100 and 130 mg/dl.This
symptoms relating to diabetes mellitus are normally absent.If a person reduces his risk
factors, his impaired glucose tolerance may improve.

Blood sugar level therefore may become normal or stabilise.Some people with impaired
glucose tolerence may go on to develop diabetes.

TYPE -2 DIABETES

Type 11 diabetes is often called non insulin dependent diabetes mellitus.
This type of diabetes develops in adulthood.It develops due to less production of insulin or ineffective use of insulin.This form of diabetes is present in 90-95% of diabetes in the world.
Women during their pregnancy can develop a form of Type-2 diabetes called gestational diabetes.40% of women with gestational diabetes during pregnancy develop Type-2 diabetes
within four years.

SYMPTOMS OF KETOACIDOSIS

* Frequent urination

* Great Thirst

*Nausea and vormiting

*Blurred vision

*Drowsiness and disorientation

To Detect Ketoacidosis

Ifyour blood sugar levels are over 200mg/dl for two consecutive tests, test your urine for
ketones. Ketones also known as acetones can be detected in the urine by the acetone
test.

Ketoacidosis and Coma

If a person goes into coma due to ketoacidosis, it is a serious situation .Mild ketoacidosis does not lead to coma.It is only when the ketone bodies are present above certain level that coma occurs. Any of the symptoms mentioned above and the presence of ketones in the urine are an indication of administering insulin when blood sugar is high.

DIABETIC KETOACIDOSIS

Ketoacidosis develop mainly in people with Type 1 diabetes.This disease is the result of persistently
high levels of blood sugar (hyperglycaemia).
Blood sugar builds up in the body as your cells cannot adsorb glucose for energy.The glucose not
available to the body , starts burning body fat as fuel, thus producing waste products called ketones.
This accumulation of ketones in the blood is known as ketosis.

When these ketone bodies are excerted in the urine the process is called ketonuria.The increase of ketones in the body over a course of some days leads to fluid being depleted from the body in the form of urine.This results in dehydration leading to the pH of the blood becoming acidic.The process
of ketoacidosis sets in. Unrecognised and untreated ketoacidosis can lead to coma and death.