ABOUT DIABETES

There are three main types of diabetes

Type 1 diabetes (T1DM)

It is usually diagnosed in children and young adults. Exact causes are still unknown, though recent researches revealed that it is mostly caused by an auto-immune reaction resulting in the destruction of Beta Cells which produce Insulin leading to total Insulin deficiency, so the only treatment are the insulin injections. The onset of type 1 diabetes is usually sudden and dramatic.

Type 2 diabetes (T2DM)

Is the most common type of diabetes (90-95%) and occurs mostly in the adult population who has a genetic risk factors coupled with being overweight. In this type the body either does not produce enough insulin or the cells do not utilize the insulin properly. It is treated initially by meal planning and exercise. If that is not enough to control it then medications will be added. The symptoms can often be mild or even absent in people with type 2 diabetes.

Gestational diabetes (GDM)

It is a form of diabetes that develops during the last part of pregnancy in a female that was not a person with diabetes prior to her starting her pregnancy. It is marked by high blood glucose levels during pregnancy. GDM usually disappears after pregnancy but women with GDM and their offspring are at an increased risk of developing type 2 diabetes later in life.

The presence of diabetes is sometimes marked with specific symptoms, but not always as in type 2 diabetes.
These symptoms are:

• Frequent urination
• Excessive thirst
• Increased hunger
• Unexplained weight loss
• Tiredness and lethargy
• A tingling sensation or numbness in the hands or feet
• Blurred vision
• Frequent infections
• Slow-healing wounds

Blood sugar (Hyperglycemia)

When the blood sugar level is over 200 mg/dl (11mmol/l).

Symptoms of Hyperglycemia

• General fatigue
• Frequent urination
• Excessive thirst
• Dizziness and headache

*If not treated can lead to diabetic ketoacidosis (DKA)

Treatment of Hyperglycemia

• Check your blood sugar level
• Check Ketone in urine or blood
• Drink lots of water
• Take your medications in case of skipping a dose after Consulting your doctor or diabetes educator, or go to the hospital

Prevention of Hyperglycemia

• Take your medications regularly as were prescribed by your doctor
• Avoid having unhealthy meals
• Avoid stress

Ketoacidosis

Ketoacidosis occurs with prolonged high blood sugar which indicates acute insulin deficiency in the body. That causes the cells to break down the stored fat to produce energy resulting in the production of Free Fatty Acids(FFA) and ketones. The buildup FFA and ketones in the blood can lead to a life threatening condition known as diabetic ketoacidosis (DKA). This situation occurs more in patients with Type 1 diabetes and requires hospitalization in order to correct it.

Symptoms of Ketoacidosis

• Dehydration
• Sweet, rotten fruit-like smell from the mouth
• Difficult or fast breathing
• Abdominal pain
• Nausea and vomiting
• Dizziness and confusion
• Can lead to unconsciousness

Prevention

• Take the medications on time
• Follow the diabetes management instructions
• Monitor your blood sugar levels

Treatment of diabetes Ketoacidosis

Visit the doctor immediately

Low Blood Sugar (Hypoglycemia)

When the blood sugar levels fall below 70 mg/dl (3.9 mmol/l).

Symptoms of Hypoglycemia

• Dizziness
• Excessive fatigue
• Excessive hunger
• Shivering
• Headache
• Sweating
• Anger
• Increase heart beat

*Hypoglycemia can lead to fainting and unconsciousness.

Treatment of Hypoglycemia

While consciousness

Take 15 gram of simple sugar (half cup of juice or glucose tablets or one tablespoon of sugar dissolved in water). Wait for 15 minutes and measure the blood sugar, if the reading is more than 70mg/dl (3.9 mmol/l) give the patient a snack (to avoid recurrence of hypoglycemia), and if the reading is still less than 70mg/dl (3.9 mmol/l) repeat the process and give another 15 grams of simple sugar.

If unconsciousness

The patient should not be given anything by mouth. Give a Glucagon injection if available or rub the patient’s inner side of cheek with small amount of honey or use the glucose spray, if no response an ambulance should be called.

Prevention of Hypoglycemia

• Take your meals regularly
• Take snacks between main meals
• Take your Medications on time and with the appropriate amount of carbohydrate as advised by your dietitian

There are a lot of tests that you can do to prevent and delay Diabetes chronic complications.

• Nervous system → loss of pain sensation (neuropathy)
• Large blood vessels → strokes or heart attacks
• Eye → damage to the retina which may lead to blindness
• Kidney → kidney failure
• The teeth and gum → gingivitis
• Feet → infections who may lead to amputation
• Skin → Severe dryness (skin infections)

Diabetes is a chronic disease; it can be managed and controlled. That control will help the patients live an active, healthy and normal life, and at the same time reduces the risk of developing long term complications.

1. Healthy Eating:

Diet is the cornerstone of diabetes treatment because food raises blood sugar levels. People with diabetes do have the same nutritional needs as anyone else; they need a well-balanced diet based on body weight with adequate amounts of carbohydrates, protein and healthy fat. What they need to do additionally is control the quantity and the time the meals are eaten.

2. Physical activity:

Being active throughout the day help the patients stay healthy, utilize insulin better and burn calories all at the same time
Some things patients are encouraged to try to increase the amount of activity during their regular day:

• Take the stairs instead of the elevator
• Play actively with the kids
• Carry things upstairs in two trips instead of one
• Park at the far end of the shopping center and walk to the store
• Walk instead of drive whenever possible

3. Self Monitoring of Blood Glucose:

Self Monitoring Blood Glucose (SMBG) is a very important tool to help control blood sugar. Keeping blood sugar within the target range given by the doctor will help in controlling diabetes.

Diabetes management targets

What to do	Targets
Check blood glucose before meal	90 -130 mg/dl
Check blood glucose 2 hrs after meal	< 180
Check HbA1C	Below 7%
Check blood pressure	Below 130/80 mmHg
LDL cholesterol	Below 100 mg/dl
HDL cholesterol	Men: above 40 mg/dl Women: above 50mg/dl
Triglycerides	Below 150 mg/dl

A1C (or “Hemoglobin A1C”) Test

What is it?	A blood test. Gives the average blood glucose over past 2-3 months
Why?	Best way to assist overall glucose control
How often?	2-4 times a year
Target Goal:	Less than 7 %
Action steps:	Check your blood glucose levels; use the result and discuss with your healthcare provider Ask if your medicines need changing. Review your meal plan and activity plan

Blood Pressure Measurement

What is it?	Measures the pressure against the walls of your blood vessels
Why?	High blood pressure is more common in diabetes Having high blood pressure increases the risk of stroke, heart attack, kidney disease and eye disease
How often?	At every check-up or at least once a year
Target Goal:	Less than 130/80mm/Hg. Both numbers should be in target
Action steps:	Increase your physical activity If you are over weight, losing few pounds could help Cut your salt intake  Ask about medications that can help lower your blood pressure

Cholesterol Test

What is it?	A blood test which measures the amount of fat which has built up on artery walls LDL bad cholesterol, HDL good cholesterol
Why?	Diabetes increases your risk of heart disease LDL cholesterol can clog the walls of arteries
How often?	Once a year More often if levels are high
Target Goal:	Cholesterol: less than 200 LDL: less than 100 HDL: more than 40
Action steps:	If you smoke, try to stop Increase your physical activity Eat less saturated and trans fats Lose weight Ask about medicines to lower your blood cholesterol

Microalbuminuria Test

What is it?	A urine test Measure how well your kidneys are working “Micro” means tiny. ”Albumin “is a kind of protein This test measures if there is any protein in your urine
Why?	High blood glucose levels can damage kidneys
How often?	At least once a year
Target Goal:	Less than 30
Action steps:	Keep A1C in target range of less than 7%.Keep blood pressure below 130/80mm/Hg If your readings are high, consult your physician

Eye Exam

What is it?	A special exam to look at the retina of the eye.The eye must be dilated to see inside the whole eye.
Why?	Screening tests to protect the retina, because high blood glucose and high blood pressure can damage tiny blood vessels in the eyes
How often?	Once a year
Action steps:	Schedule an annual eye exam Keep your A1C below 7% or as close to target as possible

Foot Exam

What is it?	A special exam by a podiatrist or other healthcare provider to carefully inspect your feet It is important to evaluate blood flow and nerve function
Why?	Foot problems can occur due to decreased blood circulation and lack of sensation in the foot from high glucose levels
How often?	Once a year
Action steps:	Visit Qatar Diabetes Association Foot Care Clinic

Self Monitoring Blood Glucose

In diabetes management Self Monitoring Blood Glucose plays a major role. The following steps are required for blood glucose testing:

1. You need the following for self-check: blood glucose meter, test strips, lancets and a lancing device.
   *Keep the meter and the strips away from heat and sun shine.
2. Start by washing your hands and dry them thoroughly.
3. Make sure that the code number on the test strips is the same code on the meter, it is very important to ensure accurate readings.
4. Follow the blood glucose meter’s instruction for blood drop application and subsequent blood glucose measurement, because each machine has different way to use.
5. Prepare your lancing device and prick the side of your finger tip. You have to choose a different site each time you prick.
6. To obtain a required sample of blood, press lightly or massage the finger you prick until you have a good drop of blood; if it is not good, do not use it as a sample for testing, but dry the area gently, and try to get a new sample from the same prick or make a new prick elsewhere and apply it to the testing strip.
   Avoid adding more blood after taking the blood sample. Don’t move the test strip from the meter before it give the result.
7. Discard used strips and lancets in a special box and keep it away from children.
8. Wait until the result is displayed and write it down to your diabetes logbook.

   Day	Breakfast		Lunch		Dinner		Bedtime	Remarks
   Date	Before	After 2hrs	Before	After 2hrs	Before	After 2hrs
   Sunday ---/---/---
   Monday ---/---/---
   Tuesday ---/---/---
   Wednesday ---/---/---
   Thursday ---/---/---
   Friday ---/---/---
   Saturday ---/---/---

9. Take your diabetes logbook with you to every appointment with your medical practitioner; it will help in making plan to control your Diabetes.

Insulin

Insulin discovered by Frederik Banting and Charles Best in 1922.
Early preparations of insulin were purified from pancreas tissue extracted from animals. Today insulin is mostly made bio synthetically by recombinant DNA technology to be closely similar to the natural human insulin.

Types of Insulin

1. Rapid acting
2. Short acting
3. Intermediate acting
4. Long acting
5. Mixed insulin (short acting & intermediate)

The usage of insulin

The only way to take the insulin is by injection, because it is a protein that can easily be digested in the stomach. Insulin is normally injected under the skin, but in emergency cases or coma, it can be given intravenously.
Where to inject insulin:

• Abdomen
• Arms
• Thighs
• Buttocks

Factors that affect the insulin absorption:

• Site of injection
• Type of the insulin injected
• Depth of injection
• Physical activity
• Temperature of the site of injecting

Remember:

Insulin works faster if

• Injected in the abdomen, rather than other parts of the body.
• Injected in the upper extremities of the body rather than the lower extremities.
• Injected in the muscles rather than under the skin.
• Physical activity involved in the injecting site.

It is necessary to change the site of injection. Do not inject in the areas of frequent perspiration.

1. It is important to check expiry date of insulin.
2. Make sure that you are using the right insulin syringe.
3. Avoid contaminating injection. Pull back the short acting insulin first (clear), then the long acting one (cloudy).
4. Dispose of the syringe at the designated place.

How to store insulin

• Store in the refrigerator door.
• Store at room temperature in winter or in a cold place for no more than 4 weeks.
• Keep away from sunlight and intense heat.
• Never store in the freezer.
• Never store in the glove compartment of the car or on top of a TV set since vibration affect composition.
• While traveling keep in insulin bag.
• Keep out of reach of children.

Medicine

Type 1 diabetes:

The only available medication now is insulin how ever the method of taking it by syringes or pens or pumps.

Type 2 diabetes:

Once the diet and exercise prove inefficient then oral sugar lowering medication has to be added to the treatment. And if that is not enough then combination of oral with insulin becomes necessary.

Gestational diabetes:

Initially trial for diet control for two weeks, if it didn’t prove inefficient then insulin has to be introduced.