Management of Diabetes Mellitus-
As we all know so well that the Diabetes Mellitus is a serious disease, which if not managed efficiently can lead to serious and like-threatening complications. The following are the important steps to manage it properly.
- Stay at the ideal weight- It is a fact that 80 to 90 % of diabetics are overweight or obese. There is a well established link between obesity and type-2 diabetes. Obesity is said to cause insulin resistance in obese individuals so overweight and obese diabetics must try to achieve their ideal weight and try their best to stay at it.
- Exercise- The recommendations of exercise are the same as for the normal individuals albeit some precautions. An exercise program should be made with the help of a fitness expert and it should be followed regularly and consistently. Aerobic exercise for at least 30 to 45 minutes is recommended at moderate intensity on most days of the week. Along with this, at least one set of 8 to 12 repetitions of strengthening exercises using weights, resistance bands or body weight, performing exercises of all major muscle groups, is recommended at least twice a week. Stretching or flexibility exercises are also recommended twice a week. Regular exercise will help diabetics achieve an ideal weight and maintain it. If a diabetic feels dizziness or weakness before the daily exercise schedule, he or she should check up the blood glucose level with a glucometer- a device for self-monitoring. (All the diabetics should have this simple, easy-to-handle device for measuring the blood glucose level at home.) If it is found to be less than 100mg/dl, a snack must be taken before embarking upon the exercise program. Rarely, a condition called hypoglycemia in which the blood glucose level may drop to or below 70 mg/dl may occur in diabetics during exercise. The diabetic will then feel light-headedness, nausea, dizziness and confusion, he or she should immediately take glucose tablets or some sugar cubes, which should be kept handy during exercise.
- Learn to cope with stress- Stress is inevitable in everyone’s daily life. We all must learn different strategies to cope with it such as time management and relaxation or meditation skills. Exercise itself is a very good stress buster. Developing a positive attitude in difficult circumstances will give us courage to sail through them. Cultivating friendship with good people will support us during difficult times.
- Diabetic diet- All diabetics must follow a diet which has been prepared by a dietitian. But at the same time, they should be aware of what dietary items they should eat and what items they should refrain from. The diabetics should not exceed their daily calorie requirements according to their age, sex and level of physical activity. The carbohydrates have different glycemic indices; the diabetics are recommended to consume carbohydrates with low glycemic indices to reduce post prandial glycemia. But the long term effect of the consumption of low glycemic index foods has a modest effect on glycemia and lipids. They should take foods rich in fibers like whole grains, fruits and vegetables as they supply the necessary vitamins, minerals and fibers. It appears that in type-2 diabetics ingestion of large amounts of fibres confers more metabolic benefits of better glycemic control, hyperinsulinemia and plasma lipids. In diabetics too, the amount of protein required is equal to 15 to 20% of their daily energy requirement. The diabetics should limit their consumption of saturated fat and dietary cholesterol; they are more sensitive to cholesterol than persons without diabetes. Four non-nutritive sweeteners – saccharin, aspartame, acesulfame potassium and sucralose are available for public consumption. They are safe in diabetics.
- Control of blood pressure- Since diabetics are more likely to have high blood pressure, they should frequently get their BP measured and if necessary take the medicines after consulting a doctor.
- Manage blood lipids- Since diabetics are more prone to the imbalance of the ratio of the different blood lipids, called dyslipidemia, they should get their lipid profile tested regularly and if necessary, they should manage it with the help of a doctor.
- Stop smoking- The diabetics must stop smoking or chewing tobacco at all costs. The people smoking 15 to 25 cigarettes daily have the risk of developing type-2 diabetes three times than non-smokers. Moreover, smoking increases the risk of development of complications of diabetes.
- Drugs- Diabetics require drugs depending upon the type of diabetes and blood glucose level. They may require insulin or hypoglycemic drugs either singly or in combination. They must be taken only after consultation with a doctor having experience in managing diabetes mellitus. Self-medication can prove to be dangerous. They should always get in touch with their doctor if they experience any untoward symptom during treatment.
Hypoglycemia- It will not be out of place to mention about hypoglycemia here. It is clinical entity which sometimes occurs in diabetics when the blood glucose level falls down suddenly to an abnormal low level of 70 mg/dl and below. There are some important causes for it.
Medications- An overdose of anti-diabetic drugs can cause it. It may be the side-effect of some other drug used concomitantly like quinine.
Heavy drinking- Binge drinking in diabetics may cause it by blocking the release of stored glucose in the liver.
Critical illness- Kidney diseases, long term starvation, and anorexia nervosa may precipitate it in diabetics. Severe hepatitis may affect the excretion of anti-diabetic drugs resulting in their accumulation and thus may cause it.
Tumors of pancreas- Some specific tumors of pancreas like insulinoma may precipitate the condition.
Endocrine diseases- The diseases of adrenal glands and pituitary gland, which regulate the blood glucose through their hormones, may cause it.
Common symptoms of hypoglycemia- The individual feels hungry, jittery, and nauseous with a fast pulse. There is confusion, blurring of vision and unsteady walk. In severe hypoglycemia, the person may have seizures and pass out, leading to coma and death.
The symptoms of hypoglycemia should not be ignored too long otherwise the condition of the person may become serious because the brain needs glucose to function properly.
Mild to moderate cases of hypoglycemia can be managed by taking immediately sugar cubes, glucose tablets, cakes or cookies. Most of the persons will respond to it but if a person doesn’t respond to it or has severe hypoglycemia, the person should be shifted to the hospital immediately.
The individuals having diabetes, who have recurrent hypoglycemia, should wear identification stating clearly that they are diabetics and have recurrent episodes of hypoglycemia. They should abstain from excessive alcohol consumption. They should also take adequate precaution before starting their daily exercise schedule.