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Managing Diabetes Mellitus



Most patients have diabetes mellitus and strive hard to maintain their sugar levels .

Here I will provide you with free tips to maintain sugar levels at optimum levels.


    There are two types Diabetes mainly Type 1 which is an inherited one and Type 2 which is an acquired one.


      Type 1 management mainly depends on Insulin as itz ryt from birth while Type 2 is acquired during late adulthood.


    So coming to the diagnosis of Diabetes Mellitus,mostly it is diagnosed through Fasting sugar (FPS) and PostPrandial sugar(PPBS) which is taken 1.5 hrs exactly after having our food. Glucose Tolerance Test(GTT) .


These tests enable us to decide whether you are in Diabetic,Prediabetic,gestational diabetes.


     Now that you have diagnosed as having Diabetes either Type 1 or Type 2 what is the line of treatment?


Mostly Physicians will start with OHA s or Oral hypoglycemic agents as a First line therapy followed up with Add on medicines like 


What is GTT


Glucose tolerance test, a medical test used to diagnose diabetes and other disorders of carbohydrate metabolism.

Glucose Tolerance Test 


A glucose tolerance test (GTT) is a medical test that measures how well your body responds to glucose. Glucose is a type of sugar that your body uses for energy. The test is usually done by having you drink a sugary drink and then having your blood drawn at regular intervals to measure your blood sugar levels.


The GTT can be used to diagnose diabetes, prediabetes, and gestational diabetes. Diabetes is a condition in which your body does not produce or use insulin properly. Insulin is a hormone that helps your body use glucose for energy. Prediabetes is a condition in which your blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes. Gestational diabetes is a type of diabetes that develops during pregnancy.


The GTT is usually done in a doctor's office or a laboratory. You will need to fast for at least 8 hours before the test. You will then be given a sugary drink to drink. Your blood will be drawn at 0, 30, 60, 90, and 120 minutes after you drink the sugary drink.


The results of the GTT will be used to determine whether you have diabetes, prediabetes, or gestational diabetes. If you have diabetes, you will need to start treatment to control your blood sugar levels. If you have prediabetes, you may be able to prevent or delay the onset of diabetes by making lifestyle changes, such as losing weight, eating a healthy diet, and exercising regularly. If you have gestational diabetes, you will need to manage your blood sugar levels during pregnancy to prevent complications for you and your baby.


There are some risks associated with the GTT, including:


Feeling lightheaded or dizzy

Nausea or vomiting

Headache

Low blood sugar

If you experience any of these symptoms, tell your doctor or nurse immediately.


The GTT is a safe and effective test that can help your doctor diagnose diabetes, prediabetes, or gestational diabetes. If you have any concerns about the test, talk to your doctor.

TREATMENT:

There are several different types of oral diabetes medications that work in different ways to help manage blood sugar levels. They include:


Alpha-glucosidase inhibitors slow down the breakdown of carbohydrates in the small intestine, which helps to lower blood sugar levels after meals. Examples of alpha-glucosidase inhibitors include acarbose (Precose) and miglitol (Glyset).


Biguanides work by helping the body use insulin more effectively. Metformin (Glucophage) is the most commonly used biguanide.

Bile acid sequestrants bind to bile acids in the intestine, which helps to lower cholesterol levels. They may also have a modest effect on blood sugar levels. Colesevelam (Welchol) is the only bile acid sequestrant that is approved by the FDA for the treatment of type 2 diabetes.


Dopamine-2 agonists work by increasing the production of insulin and decreasing the production of glucose by the liver. Examples of dopamine-2 agonists include pramlintide (Symlin) and exenatide (Bydureon).


DPP-4 inhibitors block the action of an enzyme that breaks down a hormone called incretin. Incretin helps to increase insulin production and decrease glucose production by the liver. Examples of DPP-4 inhibitors include saxagliptin (Onglyza), sitagliptin (Januvia), and alogliptin (Nesina).


Meglitinides work by stimulating the pancreas to release insulin. Examples of meglitinides include repaglinide (Prandin) and nateglinide (Starlix).


SGLT2 inhibitors work by blocking the action of a protein called sodium-glucose transporter 2 (SGLT2). SGLT2 is responsible for the reabsorption of glucose from the kidneys back into the bloodstream. By blocking SGLT2, SGLT2 inhibitors help to increase the amount of glucose that is excreted in the urine. Examples of SGLT2 inhibitors include canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).


Sulfonylureas work by stimulating the pancreas to release insulin. Sulfonylureas are the oldest class of oral diabetes medications. Examples of sulfonylureas include glipizide (Glucotrol), glyburide (Diabeta), and glimepiride (Amaryl).

Thiazolidinediones work by increasing the sensitivity of cells to insulin. Thiazolidinediones are sometimes called "glitazones." Examples of thiazolidinediones include pioglitazone (Actos) and rosiglitazone (Avandia).


It is important to note that not all of these medications are appropriate for everyone. Your doctor will work with you to determine the best treatment plan for your individual needs.

INSULIN TYPES:


There are five main types of insulin

Rapid-acting insulin


Short-acting insulin


Intermediate-acting insulin


Long-acting insulin


Pre-mixed insulin


Rapid-acting insulin starts working within 15 minutes and peaks at about 1 hour. It is used to control blood sugar levels after meals.


Short-acting insulin starts working within 30 minutes and peaks at about 2 hours. It is also used to control blood sugar levels after meals.


Intermediate-acting insulin starts working within 2 hours and peaks at about 8 hours. It is used to provide basal insulin, which is the background insulin that keeps blood sugar levels stable between meals and snacks.


Long-acting insulin starts working within 4 hours and lasts for up to 24 hours. It is used to provide basal insulin.


Pre-mixed insulin is a combination of rapid-acting and intermediate-acting insulin. It is available in a variety of ratios, such as 70/30 and 50/50. Pre-mixed insulin is used to control blood sugar levels throughout the day.


Insulin can be injected with a needle and syringe, an insulin pen, or an insulin pump. The best way to take insulin depends on your individual needs and preferences.

Here are some of the benefits and risks of using insulin:


Benefits


Insulin can help to control blood sugar levels, which can reduce the risk of diabetes complications, such as heart disease, stroke, blindness, kidney disease, and nerve damage.


Insulin can help people with diabetes to live longer and healthier lives.


Risks.


Insulin can cause low blood sugar (hypoglycemia), which can be a serious condition.


Insulin can cause weight gain.


Insulin can cause allergic reactions.


Insulin can be expensive.


     MANAGING DIABETES MELLITUS:


While Diagnosing Diabetes is a quite simple process Managing diabetes is quite a tedious process as Diabetes medications last life long.




HBA1C


This is the magic test that determines average three month blood glucose levels of a person indirectly by measuring glucose stored in Haemoglobin ie Glycated Haemoglobin.




INTERPRETATION




         HbA1c is a blood test that measures your average blood sugar levels over the past 2 to 3 months. It is used to diagnose diabetes and to monitor how well people with diabetes are managing their blood sugar levels.


The normal range for HbA1c is below 5.7%. A level of 5.7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes.


The higher your HbA1c level, the greater your risk of developing diabetes complications, such as heart disease, stroke, blindness, kidney disease, and nerve damage.


If you have diabetes, your goal is to keep your HbA1c level below 7%. However, some people may need to aim for a lower level, such as 6% or below.


There are a number of things you can do to lower your HbA1c level, including:


Eating a healthy diet

Exercising regularly

Taking your diabetes medication as prescribed

Losing weight, if you are overweight or obese

Quitting smoking

If you have diabetes, it is important to have your HbA1c level checked at least twice a year. This will help you and your doctor track your progress and make sure that your treatment plan is working.




Here is a table that shows the interpretation of HbA1c levels:


HbA1c level    Interpretation

< 5.7%    Normal

5.7% - 6.4%    Prediabetes

6.5% - 6.9%    Diabetes, controlled

7.0% - 7.9%    Diabetes, uncontrolled

8.0% or higher    Very high risk of diabetes complications

 So Hba1c levels reflect how well ur drugs given to you control ur blood sugar levels.


If ur HBA1C Levels are not within the above specified range itz high time u change ur medications.


Common mistakes patients do.

The question many patients ask is why do I get my sugar levels or Hba1c levels high even after I take my medications regularly be it 10 tabs a day or insulin.?


The answer lies in the diet u take.


There are three types of diet u take everyday Carbohydrates, proteins,fats.


While proteins and fats never raise ur blood sugar levels itz carbs that raise your blood sugars drastically.

Herez a simple coversion rate

Say for eg u eat 5 idlies.

 one idly yield 12gms of carbohydrates. 




A gram of carbohydrate yields 4 grams of sugar .

So 12 grams yield 48 mgs/dl of sugar per idly.


For 5 idlies it yields around 150 mgs/dl .per serving.


This is the math for just 5 idlies. For one day of breakfast.

If u eat 10 idlies or dosa or a cup a rice per day just do the math.


 Bottom-line:

Diabetic drugs is not ur cup of tea for controlling sugar levels .

Wind the clock 50 years before and just imagine how many Diabetic drugs existed .

Diet modification and regular exercise will keep u outta medications and hospital visits.

Stay healthy.






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