To understand what happens as your blood sugar deteriorates from normal
to pre-diabetes,
and finally, to full-fledged
diabetes you need to first
understand how blood sugar control works in a normal body. Read
More....
It used to be said that having diabetes aged people an additional 20
years. Today, thanks to better
tools for managing diabetes and
preventing and treating its complications, people with
diabetes have the
opportunity to live longer than ever before.
Tight control
means getting as close to a normal (nondiabetic) blood
sugar level as you safely can.
Ideally, this means levels between 70 mg/dl (3.8 mmol/l)
and 130 mg/dl before meals (7.2 mmol/L),
and less than 180 (10mmol/L) two hours after starting a
meal, with a glycated hemoglobin (A1C) level
less than 7 percent. The target number for glycated
hemoglobin will vary depending on the type of test your
doctor's laboratory uses.
In real life, you should set your goals with your
doctor. Keeping a normal level all the time is not
practical.
And it's not needed to get results.
Every bit you
lower your blood sugar level helps to prevent
complications.
Living with tight control
To get tight control, you must do the following:
Pay more
attention to your diet and exercise.
Measure
your blood sugar levels more often.
If you take insulin, change how much you use and
your injection schedule.
Tightly controlling your blood sugar
levels soon after being diagnosed with Type
2 diabetes
can lead to lower risks of
diabetes complications—including heart
disease and death—years later.
Choosing a
healthy lifestyle can help you improve your
health and reduce your risk of heart
disease and
diabetes.
Healthy lifestyles include eating a healthy
diet, maintaining a healthy weight, exercising
regularly, quitting smoking (or not starting),
and minimizing stress. (Note: Specific guidance
for maintaining a healthy lifestyle may change
over time as new scientific recommendations
become available.) Learn more about each of the
factors that affect your lifestyle.
Excess body fat leads to health
problems such as type 2 diabetes, high
blood pressure, and high cholesterol.
Health professionals use a
measurement called body mass index (BMI)
to classify an adult's weight as
healthy, overweight, or obese.
BMI
describes body weight relative to height
and is correlated with total body fat
content in most adults.
Having excess abdominal body fat is
also a health risk. Men with a waist of
more than 40 inches around and women
with a waist
of 35 inches or
more are at
risk for health problems.
More than 60 percent of U.S. adults
are either overweight or obese,
according to the Centers for Disease
Control and
Prevention (CDC). While the number of overweight people has been
slowly climbing since the 1980s, the
number of obese adults has nearly
doubled since then.
Excess weight and physical inactivity
account for more than 300,000 premature
deaths each year in the United States,
second only to deaths
related to
smoking, says the CDC. People who are
overweight or obese are more likely to
develop heart disease, stroke,
high
blood pressure,
diabetes, gallbladder
disease and joint pain caused by excess
uric acid (gout). Excess weight can also
cause interrupted
breathing during sleep
(sleep apnea) and wearing away of the
joints (osteoarthritis).
To lose weight, you must eat less and
move more. Your body needs to burn more
calories than you take in.
Exercise improves heart function, lowers blood pressure and blood
cholesterol, helps manage diabetes, and
helps
control weight.
The National Heart, Lung, and Blood
Institute (NHLBI) at NIH recommends that
adults get at least 30 minutes of
moderate physical activity on
most days
of the week.
Talk to your doctor about what forms
of exercise are best for you.
For more information about exercise
and physical fitness, see:
Tightly controlling your
blood sugar levels soon after being diagnosed
with Type 2 diabetes
can lead to lower risks of
diabetes complications—including heart disease and death—years
later.
Tightly controlling your
blood sugar levels soon after being diagnosed
with Type 2 diabetes can lead to lower risks of
diabetes complications—
including heart disease and death—years
later.
Heart and
Blood Vessels
Education- NDEP Control diabetes by controlling glucose, blood pressure,
and cholesterol
Nearly 65 percent of people
with diabetes will die from a heart attack or
stroke; because of a lack of
available
information,
two out of three people with diabetes are
unaware of their heightened risk.
In order for those with
diabetes to stay heart healthy, having the most
up-to-date information is crucial.
Now,
there's a place
where people can go for the latest resources that can help them
control their
diabetes, as well as monitor their
blood pressure and cholesterol levels.
When those with diabetes take
steps to also ensure good cardiovascular health,
they can live long,
healthy lives.
The
National Diabetes Education Program is a federally
funded program sponsored by the
U.S. Department of
Health and
Human Services'
National Institutes of Health and the Centers
for
Disease Control and Prevention and includes over 200
partners at the federal, state,
and local
levels, working together to reduce the morbidity and
mortality associated with diabetes.
How does your glucose level compare
with your HbA1c
HbA1c %
Average
blood sugar level
mg/dl
Average
blood sugar level mmol/l
13
324 mg/dl
18
mmol/l
12
306 mg/dl
17
mmol/l
11
270 mg/dl
15
mmol/l
10
234 mg/dl
13
mmol/l
9
216 mg/dl
12
mmol/l
8
180 mg/dl
10
mmol/l
7
141 mg/dl
8
mmol/l
6
125 mg/dl
7
mmol/l
5
90 mg/dl
5
mmol/l
HbA1c levels by coincidence nearly equate to glucose levels. So
an HbA1c level of 10%
means the average glucose level for the
previous
10 weeks was 234 mg/dl (13 mmol/l).
But at lower levels there is even less difference, so an HbA1c
of 7% means the average glucose
level was 141 mg/dl (8 mmol/l ).
"My task is to give you an overview of treating type 2 diabetes and of
all the medications
that we have at our disposal. Life has changed a lot through the years in terms of type 2 diabetes.
Twenty-five years ago, all we had was insulin and sulfonylureas.
Consequently, we put
patients on sulfonylureas and when they failed over
time, they all ended up on insulin.
Today we have many more medications
to choose from. These medications work differently and they target
the multiple pathophysiologic defects that we have in type 2 diabetes.
We understand that behind all of this there is the insulin-resistant
liver overproducing glucose.
We have insulin resistance in the
adipocytes.
We have high free fatty acids, worsening insulin resistance, and perhaps
worsening beta-cell function.
We have insulin resistance in skeletal muscles as well. All of these defects are coming into play,
as
well as declining insulin over time because of progressive apoptosis or
programmed cell death of beta cells."
You will need to register at Medscape to read the full article.
by David Kinshuck, Pat Lamb, Urmilla Griffiths (Pat & Urmila: diabetes
specialist nurses, Good Hope Hospital)
Embrace your diabetes
Learning how to control type 2
diabetes...take control
What is happening in type 2 diabetes
First, there is a shortage of insulin
Second, there is insulin resistance.
Third, there are genes
These factors combine to cause type 2
diabetes
Pattern of progression
At the beginning of type 2 diabetes a healthy diet may be
sufficient to lower the sugar and keep the HbA1c below 7%
Later, metformin is needed.
Later still, add Exanatide if overweight or other drug.
Later still insulin may be required
Testing you sugar/glucose level
See
testing.
If you 'embrace' your diabetes, you will gradually learn to control it
and achieve an
HbA1c of 7% or below.
But to
do this, you need to check to see your
fasting
blood sugar levels are
72-126 mg/dl (4 - 7 mmol/l) (when you
wake up)
test your
blood sugar levels before meals between
72-126 mg/dl (4 - 7 mmol/l)
remember, you still need tablets if you are ill; if you
are being sick or cannot swallow the tablets,
|let your
doctor
or nurse know.
occasionally test after meals (preferred levels less
than 180 mg/dl (10 mmol/l)
To achieve very good control (HbA1c 6.5-7.0%) you need a
fasting pre-breakfast glucose
less than 99 mg/dl (5.5 mmol/l), pre-meal levels at other
times less than 108 mg/dl (6.0 mmol/l) and
after-meal levels
(2 hours after a meal) less than 141 mg/dl (8.0 mmol/l).
These levels cannot be achieved in all patients..but if
you are well and are prepared to stick to a healthy
diet and
exercise your medication should be adjusted to achieve these
levels, even if that
means starting insulin.
Knowing which fats
raise LDL cholesterol and which ones don't is the first step in
lowering your risk of heart disease. In addition to the LDL
produced naturally by your body, saturated fat,
trans-fatty acids and dietary cholesterol can also raise
blood cholesterol. Monounsaturated fats and polyunsaturated fats
appear to not raise LDL cholesterol; some studies suggest they
might even help lower LDL cholesterol slightly when eaten as
part of a low-saturated and
trans-fat diet.
The American Heart Association's Nutrition
Committee strongly advises these fat guidelines for healthy
Americans over age 2: read more ......
For example, a sedentary female who is 31–50 years old needs
about 2,000 calories each day. Therefore, she should consume
less than 16 g saturated fat, less than 2 g
trans
fat and between 50 and 70 grams of total fat each day (with most
fats coming from sources of polyunsaturated and monounsaturated
fats, such as fish, nuts, seeds and vegetable oils).
Discussion here that .........post-meal blood sugars of 140 mg/dl (7.8
mmol/L) and higher,
as well as fasting blood sugars over 100 mg/dl (5.6 mmol/L) may cause permanent organ damage,
as well
as contributing to the progression of diabetes.
By
Dr Michael Hutch PhD
