Diabetes: Controlling a killer disease

Screening

Diabetes screening is recommended for many people at various stages of life, and for those with any of the many risk factors. The screening test varies according to circumstances and may take the shape of a random blood glucose test, a fasting blood glucose test, a blood glucose test two hours after glucose intake, or an even more formal glucose tolerance test.

Many healthcare providers recommend universal screening for adults ages 40 or 50, and often periodically thereafter. Early screening is recommended for those with risk factors such as obesity, family history of diabetes and high-risk ethnicity.

Prevention at a glance

• While genetics plays an important role, you still have the ability to influence your health to prevent diabetes.

• Obesity and a sedentary lifestyle are the biggest risk factors you can control. Watch your weight, and exercise more.

• Diet is important because it helps with weight loss. There are some foods such as nuts which in small amounts provide health benefits in blood sugar regulation.

• There are tests available to see if you are at an increased risk for type 2 diabetes, but to identify the two main factors simply requires a good family history (genetics) and a bathroom scale.

• Exercise is beneficial even without weight loss in the prevention of type 2 diabetes.

• Exercise is even more beneficial with weight loss in the prevention of type 2 diabetes

• Smoking is bad for those with diabetes and for one's overall health.

• There are medications available that have been shown in large trials to delay or prevent the onset of overt diabetes. Use of these medications requires a detailed discussion of pros and cons with your doctor, as there are side effects to consider.

• The next few years will be very exciting regarding the advances in the field of prevention of diabetes. However, the cornerstone of therapy will likely remain a healthy lifestyle.

Treatment and

management

Diabetes mellitus is currently a chronic disease without a known cure, and medical emphasis must target managing/ avoiding possible shortterm as well as long-term diabetes-related problems. There is an exceptionally important role for patient education, dietetic support, sensible exercise and self glucose monitoring.

Careful control is needed to reduce the risk of long term complications. This can be achieved with combinations of diet, exercise and weight loss

type 2), various oral diabetic drugs (type 2 only), and insulin use (type 1 and increasingly for type 2's not responding to oral medication).

In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications should be undertaken to control blood pressure and cholesterol by exercising more, smoking less (or not at all), following an appropriate diet, wearing diabetic socks, and if necessary taking any of several drugs to reduce pressure.

Prognosis

Patient education, understanding and participation are vital, since the complications of diabetes are far less common and less severe in people who have well-controlled blood sugar levels. Wider health issues accelerate the disease's detrimental symptoms. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise.

- From the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
Blood sugar control

Insulin is a natural substance that your body makes. It helps the sugar from the food you eat can seep from your blood into the body's cells. That way, the sugar you glean from food can be used for energy.

When you have Type 2 diabetes, your body doesn't make enough insulin. Or, it can't use the insulin it does make.

If you have Type 1 diabetes, your body doesn't make any insulin at all. So, the sugar from the food you eat can't get from your blood to your cells.

That's why everyone with diabetes tries to have good blood sugar control. But how do you get control?

For most folks, a great diabetes management plan includes what is commonly referred to as the "Four Ms." That stands for Monitoring, Meals, Moves and Medicine.

• Monitoring -

Keep track of a treatment plan with regular monitoring of your blood sugar.

• Meals - Plan healthy and enjoyable meals to help control

blood sugar.

• Moves - Move (or exercise) to help lower your blood sugar by burning it for energy, reducing the risk of diabetes complications.

• Medicine - Learn about medicines helpful for controlling diabetes when food and exercise just isn't enough.
Prevention medication

Are there medications that can help prevent Type 2 diabetes?

Of course there are.

The first is Metfomin. This drug has been shown in trial tests to prevent diabetes development in persons with impaired glucose tolerance. While not quite as effective as an intensive lifestyle change, metformin decreased the rate of progression in 22 to 29 percent of patients.

Another family of helpful drugs is called the Thiazolidinediones. Drugs in this class have also been studied extensively in patients who have had gestational diabetes, and there is a significant reduction in the annual rates of progression to diabetes.

Acarbose (Precose), a drug designed to reduce small intestinal absorption of carbohydrates, has been used with some success as well.