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Diabetes

What is Diabetes?

 

Checking -blood -levels _223x 176

  

Normally the body breaks down carbohydrates and sugars into glucose from the foods we eat.

Glucose fuels the cells in the body.

Insulin helps to carry the glucose to the cells from the blood stream.

With Diabetes Mellitus either your body is not making enough insulin or it cannot use the insulin it produces or it is a combination of both.

The result of this is high level of blood glucose which damages the tiny blood vessels in the heart, kidneys, eyes or nervous system.

Classification

There are a number of different types of diabetes. Some of which are more prevalent than others. Most of us are very familiar with Type 1 and Type 2 diabetes. However there are few other types of diabetes that must be acknowledged. In essence diabetes can be classified into:

  • Type 1 diabetes (diabetes (β-cell destruction, usually leading to absolute insulin deficiency) Immune-mediated diabetes. 
  • Type 2 diabetes (ranging from predominantly insulin resistance with relative insulin deficiency to predominantly an insulin secretory defect with insulin resistance).
  • Gestational diabetes mellitus (GDM) Deterioration of glucose tolerance occurs normally during pregnancy, particularly in the 3rd trimester.
  • Maturity onset diabetes of youth (MODY) genetic defects affecting β-cell function, insulin action, and mitochondrial DNA.
  • Drug or chemical induced diabetes (mostly from glucocorticoids and beta-blockers).

Other types of diabetes include:

  • Genetic defects of insulin action.
  • Diseases of the exocrine pancreas.
  • Endocrinopathies.
  • Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG).

The difference between type 1 and type 2 diabetes...Read More

References/Source: 
Diagnosis and classification of Diabetes Mellitus 
Merck Manual Professional version –Diabetes Mellitus
WebMD- Types of Diabetes http://www.webmd.com/diabetes/types-of-diabetes-mellitus

Target Audiences: Pharmacists and health professionals
Date produced: 27/10/2015
Date due for review and update: April 2016

 

Signs and Symptoms of Diabetes Mellitus

Learn the warning signs.

Hyperglycemia is the most common symptom of Diabetes Mellitus (DM).

In early diabetes mellitus the Hyperglycemia may be very mild and may remain asymptomatic.

Significant hyperglycemia can lead to glycosuria and result in osmotic diuresis. This may lead to urinary frequency, polyuria and polydipsia.
If left unchecked it may lead to dehydration and orthostatic hypotension.

Insulin -Cycle                           Pancreas -Cropped

The symptoms of diabetes may vary with fluctuating plasma glucose levels.

Hyperglycemia also causes:

• weight loss.
• nausea and vomiting and blurred vision.
• predisposition to bacterial and fungal infections.

Often in type 2 DM a patient may go through these symptoms for days or weeks before seeking medical help. 
Watch the slide show.

Source:
Merck Manual – professional version
Target audience: Pharmacists and health professionals
Produced: 12/10/15
Due for review and update: April 2016

Diagnosis of Diabetes Mellitus

The following blood tests are commonly ordered to diagnose diabetes type 2.

• Fasting plasma glucose (FPG) levels
• Sometimes oral glucose tolerance testing
• Glycosylated Hb (HbA 1c )

Fasting Plasma Glucose (FPG)
Plasma glucose is measured by a blood test after a period of fasting usually over night without eating for 8 hours. The test is done the next morning.  The test result is very reliable . If you have a fasting plasma glucose level of 6.1 to 6.9 mmol/l  you may have pre-diabetes. Which is also known as Impaired Fasting  Glucose Tolerance (IFG) and not diabetes.

Fasting Plasma Glucose Test (FPG)

Fasting -Plasma -Glucose -Test -(FPG)..jpg

This test is repeated on another day to confirm the findings.

Oral Glucose Tolerance Testing (OGTT)
After you have fasted (without eating) for at least 8 hours, and 2 hours after you drink a glucose beverage (75grams of glucose dissolved in water), a blood sample is taken to test for diabetes or pre-diabetes. It has been stated that OGTT is more sensitive to detect Pre-diabetes than FPG test.

Oral Glucose Tolerance Testing (OGTT)

Usually the test is repeated on another day to confirm the findings.

Random Plasma Glucose Test
Sometime your doctor may do a random plasma glucose test. This may not have any relationship to when you may have eaten your meal. The symptoms you present  and the results of the blood test will be seen in conjunction. If you present with symptoms like increased urination, increased thirst and unexplained weight loss , fatigue , blurred vision etc. and a blood test result of 200mg/dl or more the doctor may diagnose diabetes and not pre-diabetes.

Following initial diagnosis of diabetes a doctor may order a ZnT8Ab test (Zinc transporter 8 autoantibody). This test result along with other information available may help to determine if a person has Type 1 diabetes or another type.

Glycosylated Hb (HbA 1c)
(Also known as Glycohemoglobin (HbA1c, A1c)
This test actually checks the amount of sugar bound to the hemoglobin in the red blood cells. When blood sugar bonds with hemoglobin it forms a coat. The concentration of blood sugar will determine how thick the coat gets. The HbA1c test determines how thick the coat has been over a period of three months. Three months is the life of red cells and that is why HbA1c  test reflect the average blood glucose level over the past three months. People who have higher than normal glycohemoglobin may be diabetic or have other conditions that increase their blood glucose levels.

The World Health organization has recently endorsed HbA1c as diagnostic test for diabetes. The Australian Diabetes Society, the Royal College of Pathologists of Australasia, and the Australasian Association of Clinical Biochemists have reviewed the available evidence and confirmed that HbA1c can be used to establish the diagnosis of diabetes.

Click on the link below to have an in-depth understanding of the screening and diagnosis algorithm recommended by the Royal Australian College of General practitioners (RACGP).

Source:
WebMD - How are Diabetes and Pre-diabetes Diagnosed
RACGP-Diagnosis of Diabetes – screening and algorithm

References
1 . d’Emden MC, Shaw JE, Colman PG, et al. The role of HbA1c in the diagnosis of diabetes s mellitus in Australia. Med J Aust 2012;197:220–1. Search PubMed

Target Audiences: Pharmacist and health professionals
Date produced: 10 Nov 2015
To be reviewed and updated: April 2016

Diabetes and Healthy Living

Healthy -Eating

Healthy eating, regular physical activity and weight management are essential elements of diabetes management.

Healthy eating can help:

• maintain general good health,
• better manage ones blood glucose levels,
• achieve target blood lipid (fat) levels,
• maintain a healthy blood pressure,
• maintain a healthy body weight and
• prevent or slow the development of diabetes complications.

Basic Eating Guidelines for Diabetes.
If you have diabetes, follow a simple healthy eating plan. For example:

Healthy -Eating -What -You -Must -Do

Source: Better Health Channel

Carbohydrates and Diabetes.
Carbohydrates are a good source of energy and constitute a major portion of our meals. It is the amount of carbohydrates in the meal that matters as large amounts of carbohydrates in a meal can have a profound effect on blood glucose levels. By eating regularly and eating smaller meals, you can prevent large rises in blood glucose levels. Patients who may be taking insulin or diabetes medications may also need to eat snacks between main meals.

Glycemic Index (GI) and diabetes.

Glycemic Index (GI) And DiabetesGrapgh adapted from: www.gisymbol.com (University of Sydney). Image from Micrsoft Clipart.

By definition, the Glycemic Index refers to the relative ability of a carbohydrate food to increase the level of glucose in the blood. The lower the GI, the slower the rise in blood glucose after food is consumed. Some research has shown that by including low GI foods in the meals, average blood glucose levels can be reduced, thus preventing complications of diabetes.

GI of foods can be divided into:

• low GI 55 or less, 
• intermediate GI (56-69) and 
• high GI over 70.

It is recommended to eat more low and intermediate GI foods, however remember that consuming large quantities of any carbohydrate can increase blood glucose levels. Therefore it is very important to choose appropriate portion sizes. Search for GI of foods
Low GI shopping list. This has been put together by the GI foundation. View The List 

References:
Glycemic index – Diabetes Australia
Glycemic Index Foundation
Baker IDI – Glycemic Index

 

 

Goals for Optimum Management of Diabetes


If you have a patient with diabetes, help them to register with NDSS (The National Diabetes Service Scheme). This is a onetime registration and is free.
It is recommended that people with type 2 diabetes approach or reach the following goals (similar to diabetes cycle of care goals):

  • Diet - normal healthy eating.
  • BMI - a loss of 5-10% weight if overweight or obese.
  • Physical activity – daily moderate physical activity, at least 150mins of walking/week.
  • Cigarette smoking – zero.
  • Alcohol consumption – <2 standard drinks (20g) per day for men and women.
  • BGL 6–8 mmol/L fasting and 8–10 mmol/L postprandial.
  • HbA1c (mmol/mol; %) Needs individualisation according to patient. circumstances. Generally:• ≤53 mmol/mol (range 48–58) • ≤7% (range 6.5–7.5).
  • HDL-C (mmol/L) ≥1.0.
  • LDL-C (mmol/L) <2.0.
  • Non-HDL-C (mmol/L) <2.5.
  • Triglycerides (mmol/L) <2.0.
  • Blood pressure (mmHg) 130/80.
  • Urinary albumin excretion Timed overnight collection (mcg/min): <20. Spot collection (mg/L): <20 Urinary albumin-to-creatinine ratio. Women (mg/mmol): <3.5 • Men (mg/mmol): <2.5
  • Vaccination - Consider immunisation against influenza and pneumococcal disease, and the dTPa vaccine.

Wherever possible, it is important to identify if targets are being achieved by patients. Where the target is not achieved, discuss this further with the patient to encourage compliance to treatments, medications, monitoring and lifestyle changes and/or be referred to a health care professional.

Source:
Diabetes Care Plan