Diabetes by Dr. Tulloch

Diabetes is a condition in which the body is unable to properly handle blood sugar. There are two circumstances in with this occurs. 

  • Type I Diabetes The body’s immune system damages the pancreatic cells responsible for producing insulin.
  • Type II Diabetes (link to Type II Diabetes (Adult Onset) page) A much more common form seen especially in families in which the body is resistant to the action of normal amounts of insulin and blood sugar rises, especially if subjects are physically underactive or gain weight. This much more common form of diabetes is especially seen over the age of 40.

Your condition of diabetes can be treated to normalize blood sugar, blood fats and body weight. Philosophically, however, there is no permanent cure for diabetes so the medications need to be carefully used daily and their efficacy re-evaluated by your physician at least every three to six months. Good glucose control is of the utmost importance to prevent or retard the onset of diabetic complications which include damage to the small vessels of the eye, the kidney and peripheral nerve.
 
Weight Control
Weight control through diet and exercise is important. If you are overweight, exercise and weight loss are perhaps the earliest steps that will normalize blood sugar. Your physician will give you a diet instruction program and the Clinic has a dietitian to assist you with specific questions in this area. In general, caloric intake should be matched to your requirements. It is important also to take your diabetes medication as instructed.
 
Regular Exercise
You need to exercise regularly, preferably every day for at least 45 minutes. Any form of exercise is good provided it is practical. For example, a regular walking program of three miles in 45 minutes would be a start. If you are a senior, your physician may wish to check the blood supply to your heart and legs at the outset.
 
Check Blood Sugars
You need to check your blood sugars with a home glucose monitor regularly, the most valuable numbers are before breakfast and before supper. Please bring your book or glucose monitor for discussions with the physician at each visit.
 
Periodic Checks
Glycohemoglobin 
Glycohemoglobin is a blood test that gives an estimate of the average blood sugar over the preceding six weeks. It should be checked every three to six months. The American Diabetic Association recommends that the patients diabetic regimen be adjusted to achieve a glycohemoglobin of less than 7%. Any contributing risk factor for vascular disease should be vigorously assessed and treated, including:

  • Cholesterol
  • Triglyceride
  • Low HDL
  • High Blood Pressure
  • Smoking

Your physician will help you understand your prevailing numbers and will give you medication when necessary to treat these conditions. For someone with high blood pressure, some hypotensive medications are more effective in preventing the kidney complications of diabetes and these should be taken regularly.
 
Microalbumin
Microalbumin urine testing gives an index of patients at risk from kidney and vascular disease and should be done yearly to pick up early diabetic involvement in the kidney.

Opthalmologist
Opthalmologist should be seen at least yearly to evaluate any diabetic retinopathy, cataracts and planned treatment accordingly.
A baby aspirin (81 mg daily) is good prophylaxis for stroke and heart disease.

Comprehensive Medical Examination
A comprehensive medical examination should be planned yearly including treadmill exercise test, if necessary, to pick up the possibility of underlying coronary artery disease which can be more common in diabetes. 

Sick Days 
Infection, stress and dietary indiscretions will all raise blood sugar. If you are sick, your blood sugar will rise and even if you are unable to take food, you generally need your usual diabetic medication or insulin and may often need extra doses to bring the blood sugar toward normal. When nauseated, febrile or vomiting, the blood sugar should be checked every four hours and extra treatment given. If in doubt, consult your doctor, since early and appropriate management of sick days will reduce your chance of developing diabetic coma.
 
Authored by: Brian Tulloch, M.D.

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