Diabetes management

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The term diabetes includes several different metabolic disorders which, if not handled, produce a high sugar concentration called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, usually due to the destruction of autoimmune beta cells producing pancreatic insulin. Diabetes mellitus type 2, on the contrary, is now considered to be the result of an autoimmune attack on the pancreas and/or insulin resistance. The pancreas of a person with type 2 diabetes may produce normal insulin or even an abnormal amount. Other forms of diabetes mellitus, such as various forms of young mature onset diabetes, may represent some combination of insulin production and insufficient insulin resistance. Some levels of insulin resistance can also be present in someone with type 1 diabetes.

The main goal of diabetes management is to restore carbohydrate metabolism to its normal state as much as possible. To achieve this goal, individuals with insulin deficiency absolutely require insulin replacement therapy, administered by injection or insulin pump. Insulin resistance, in contrast, can be corrected by diet and exercise modification. Another goal of diabetes management is to prevent or treat many complications that can be caused by the disease itself and from its treatment.

Video Diabetes management

Overview

Goal

Treatment goals are associated with effective blood glucose control, blood pressure and lipids, to minimize the risk of long-term consequences associated with diabetes. They are suggested in the clinical practice guidelines released by various national and international diabetes institutions.

The target is:

• Hb _A1c from 6% to 7.0%
• Preprandial blood glucose: 3.9-7.2 mmol/L (70-130 mg/dl)
• Postprandial blood glucose 2 hours: & lt; 10 mmol/L (& lt; 180Ã, mg/dl)

Goals should be individualized by:

• Duration of diabetes
• Age/life expectancy
• Comorbidity
• known cardiovascular disease or advanced microvascular disease
• Awareness of hypoglycemia

In older patients, the clinical practice guidance by the American Geriatrics Society states "for weakly elderly adults, people with a life expectancy of less than 5 years, and others among whom the risk of intensive glycemic control appears to outweigh the benefits, less strict targets such as Hb _A1c of 8% is appropriate ".

Problems

The main problem that requires management is the glucose cycle. In this case, glucose in the bloodstream is available to cells in the body; a process that relies on the twin cycle of glucose that enters the bloodstream, and insulin allows proper uptake into the body's cells. Both aspects require management. Another problem related to the glucose cycle is to get a balanced amount of glucose into the major organs so that they are not negatively affected.

Complexity

The main complexity comes from the feedback loop nature of the glucose cycle, which is sought to be regulated:

• The glucose cycle is a system that is influenced by two factors: the influx of glucose to bloodstream as well as the level of insulin in the blood to control its transport out from the bloodstream
• As a system, it is sensitive to diet and exercise
• This is influenced by the need for user anticipation because of the delicate effects of time delays between any activity and its impact on the glucose system
• Management is very disturbing, and compliance is a problem, because it depends on changes in user lifestyle and often on regular sampling and measurement of blood glucose levels, several times a day in many cases
• Changes as people grow and expand
• This is very individual

Since diabetes is a major risk factor for cardiovascular disease, controlling for other risk factors that can lead to secondary conditions, as well as diabetes itself, is one aspect of diabetes management. Examining cholesterol, LDL, HDL and triglyceride levels may indicate hyperlipoproteinemia, which may require treatment with hypolipidemic drugs. Checking blood pressure and keeping it within tight limits (using diet and antihypertensive treatments) protects against complications of retina, kidney and cardiovascular diabetes. Follow-up regularly by podiatrists or other foot health specialists is recommended to prevent the development of diabetic feet. An annual eye exam is recommended to monitor the development of diabetic retinopathy.

Initial progress

Late in the 19th century, sugar in urine (glikosuria) was associated with diabetes. Various doctors study the relationship. Frederick Madison Allen studied diabetes in 1909-12, then published a large volume, the Study of Glycosuria and Diabetes , (Boston, 1913). He created a fasting treatment for diabetes called Allen's treatment for diabetes. His diet was an early attempt to deal with diabetes.

The modern approach

The modern approach to diabetes depends mainly on diet and lifestyle management, often combined with regular blood glucose monitoring.

Dietary management allows control and awareness of the type of nutrients that enters the digestive system, and hence allows indirect, significant control over changes in blood glucose levels. Blood glucose monitoring allows this verification, and tighter control, is especially important because some diabetes symptoms are not easy for the patient to see without actual measurements.

Other approaches include exercise and other lifestyle changes that impact the glucose cycle.

In addition, a strong partnership between patient and primary health care provider - general practitioner or internist - is an essential tool in the successful management of diabetes. Often primary care physicians make an early diagnosis of diabetes and provide basic tools to get patients to start a management program. Regular appointments with primary care physicians and certified diabetes educators are some of the best things a patient can do in the early weeks after a diabetes diagnosis. After the diagnosis of diabetes, primary care physicians, specialists, or endocrine experts will perform a complete physical and medical examination. Thorough assessment covers topics such as:

• Medical history
  • Family history of diabetes, cardiovascular disease, and stroke
  • Eating and exercising habits; growth and development in children and adolescents
  • Diabetes education history
  • Review previous treatment regimens and treatment response (HbA1c record)
  • List of current drugs, including:
    • Prescription drugs
    • Free medicine
    • Vitamin, mineral or herbal supplements
  • Smoking history, including the urge to quit (if any)
  • Current treatment plan, including medication, medication adherence and barriers, meal plans, physical activity patterns, readiness for behavior change
  • Results of glucose monitoring and patient data use
  • Diabetic ketoacidosis, severity, and causes
  • Episodes and hypoglycemic awareness
  • History of diabetes-related complications
    • Microvascular: retinopathy, nephropathy, neuropathy
    • Macrovascular: coronary artery disease, cerebrovascular disease, peripheral artery disease
  • Abnormalities of urination, which may indicate kidney disease
  • Signs of pregnancy complications or trying to get pregnant for female patients
• Physical examination
  • Height, weight, body mass index
  • Blood pressure measurement
  • Funduscopy
  • thyroid palpation
  • Skin examination at the insulin shots
  • A thorough examination of hands, fingers, legs, and toes for circulatory disorders
• Additional laboratory evaluation
  • If results are not available in the last 3 months
    • HbA1c
  • If results are not available in the last year
    • Fasting lipid profile: including total cholesterol, LDL, HDL and triglycerides
    • Liver function test
    • Test for urine albumin excretion with spot urinary creatin/creatinine ratio
    • Thyroid-stimulating hormone in type 1 diabetes, dyslipidemia, or women over 50 years
• References
  • Eye care profession for annual fundus dilation examination
  • Family planning for women of reproductive age
  • Dietitians are registered for medical nutrition therapy
  • Diabetes Self-Management Education (DSME)
  • Dentists for comprehensive periodontal examination
  • Professional mental health if needed

Diabetes can be very complicated, and doctors should have as much information as possible to help patients make effective management plans. Doctors may often experience excess data generated from hundreds of blood glucose readings, insulin doses and other health factors that occur between regular office visits that must be described during a relatively short visit with the patient to determine the pattern and establish or modify the treatment plan.

Doctors can also make referrals to various professionals for additional health care support. In the UK, patient training courses are available for newly diagnosed diabetics (see DESMOND). In big cities, there may be diabetic centers where some specialists, such as diabetes educators and dietitians, work together as a team. In smaller cities, health care teams may come together slightly differently depending on the type of practitioners in the area. By working together, doctors and patients can optimize the health team to successfully manage diabetes in the long term.

The 10 countries with the largest population of diabetes patients are China, India, US, Brazil, Russia, Mexico, Indonesia, Germany, Egypt and Japan.

Maps Diabetes management

Blood sugar

Blood sugar levels were measured by a glucose meter, with good results in mg/dL (milligrams per deciliter in the US) or mmol/L (millimoles per liter in Canada and Eastern Europe) of blood. The average normal person has an average fasting glucose level of 4.5 mmol/L (81 mg/dL), with the lowest down to 2.5 and up to 5.4 mmol/L (65 to 98 mg/dL).

Optimal diabetes management involves patients who measure and record their own blood glucose levels. By keeping a diary of their own blood glucose measurements and taking note of the effects of food and exercise, patients can change their lifestyle to better control their diabetes. For patients who use insulin, patient involvement is important in achieving effective doses and time.

Some edible mushrooms are noted for the ability to lower blood sugar levels including Reishi, Maitake Agaricus blazei and several others.

Hypo and hyperglycemia

Levels well above or below this range are problematic and in some cases can be dangerous. Level & lt; 3.8 mmol/L (<70 mg/dL) is usually described as hypoglycemic attack (low blood sugar). Most diabetics know when they will "go hypo" and can usually eat a meal or drink something sweet to raise the level. A hyperglycemic patient (high glucose) may also become hypoglycemic temporarily, under certain conditions (eg not eating regularly, or after strenuous exercise, followed by fatigue). Intensive efforts to achieve near-normal blood sugar levels have been shown to triple the risk of the most severe forms of hypoglycemia, in which patients need help from standers to treat episodes. In the United States, there are 48,500 hospitalizations per year for diabetic hypoglycemia and 13,100 for diabetic hypoglycemia that lead to coma in the period 1989 to 1991, before intensive blood glucose control is widely recommended as it is today. One study found that hospital admissions for diabetic hypoglycemia increased 50% from 1990-1993 to 1997-2000, as strict blood sugar control measures became more common. Among intensively controlled type 1 diabetes, 55% of severe hypoglycemia episodes occur during sleep, and 6% of all deaths in diabetics under age 40 come from nocturnal hypoglycemia in so-called 'dead-in-bed syndrome, 'while the National Institute of Health Statistics shows that 2% to 4% of all deaths in diabetics stem from hypoglycemia. In children and adolescents after intensive blood sugar control, 21% of hypoglycemic episodes occur without explanation. In addition to deaths caused by diabetic hypoglycemia, severe low blood sugar periods can also cause permanent brain damage. Interestingly, although diabetic nerve disease is usually associated with hyperglycemia, hypoglycemia can also initiate or aggravate neuropathy in diabetics who intensively struggle to reduce their hyperglycemia.

Levels greater than 13-15 mmol/L (230-270 mg/dL) are considered high, and should be closely monitored to ensure that they reduce rather than continue to remain high. Patients are advised to seek immediate medical attention as soon as possible if blood sugar levels continue to increase after 2-3 tests. High blood sugar levels are known as hyperglycemia , which is not easily detected as hypoglycemia and usually occurs within days rather than hours or minutes. If left untreated, this can lead to coma and diabetic death.

The long, elevated and untreated blood glucose levels will, over time, produce serious diabetic complications in those who are vulnerable and sometimes even death. There is currently no way of testing for vulnerability to complications. Diabetics are advised to check their blood sugar levels every day or every few days. There are also diabetes management software available from blood testing manufacturers that can display results and trends over time. People with type 1 diabetes usually check more often, because of insulin therapy.

The history of the results of blood sugar levels is very useful for diabetics to present to their doctors or doctors in monitoring and controlling the disease. Failure to maintain a rigorous test regimen can speed up symptoms of the condition, and it is therefore important that every diabetic patient closely monitors their glucose levels regularly.

Glycemic control

Glycemic control is a medical term that refers to the typical blood sugar (glucose) level in a person with diabetes mellitus. Much evidence suggests that many long-term diabetes complications, especially microvascular complications, result from years of hyperglycemia (elevated glucose levels in the blood). Good glycemic control, in the sense of "target" for treatment, has become an important goal of diabetes care, although recent research has shown that diabetes complications can be caused by genetic factors or, in type 1 diabetes, by the sustained effects of autoimmune diseases that first cause pancreas lose the ability to produce insulin.

Because blood sugar levels fluctuate throughout the day and glucose records are an imperfect indicator of this change, the percentage of glycosylated hemoglobin is used as a measure of long-term glycemic control proxies in clinical trials and clinical trials of diabetics. This test, hemoglobin A1c or glycosylated hemoglobin reflects glucose on average for the previous 2-3 months. In nondiabetic people with normal glucose metabolism, glycosylated hemoglobin is usually 4-6% by the most common method (normal range may vary by method).

"Perfect glycemic control" would mean that glucose levels are always normal (70-130 mg/dl, or 3.9-7.2 mmol/L) and indistinguishable from someone without diabetes. In fact, due to imperfections of treatment measures, even "good glycemic control" describes blood glucose levels on average rather higher than normal. In addition, a Type 2 diabetes survey found that they assessed the deterioration in their quality of life from intensive interventions to control their blood sugar as badly as the damage caused by middle-level diabetes complications.

In the 1990s, the American Diabetes Association conducted a publicity campaign to persuade patients and doctors to fight for average glucose and hemoglobin A1c values ​​below 200 mg/dl (11 mmol/l) and 8%. Today many patients and doctors are trying to do better than that.

In 2015 the guidelines called for HbA _1c about 7% or fasting glucose less than 7.2 mmol/L (130 mg/dL); This goal, however, can be changed after professional clinical consultation, taking into account the risks of hypoglycemia and life expectancy. Although the guidelines recommend that intensive blood sugar control is based on a balance of immediate hazards and long-term benefits, many people - such as people with a life expectancy of less than nine years - will not benefit too much and have no clinically significant benefits.

Poor glycemic control refers to elevated blood glucose and glycosylated hemoglobin levels, which can range from 200-500 mg/dl (11-28 mmol/L) and 9-15% or higher for months and years before severe complications occur. Meta-analysis of large studies conducted on the effects of tight or conventional glycemic control, or more relaxed in people with type 2 diabetes have failed to show differences in all causes of cardiovascular death, non-fatal stroke, or limb amputation, but decreased. the risk of a non fatal heart attack by 15%. In addition, tight glucose control lowers the risk of development of retinopathy and nephropathy, and decreases the incidence of peripheral neuropathy, but increases the risk of hypoglycemia 2.4 times.

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Monitoring

Relying on their own perception of symptoms of hyperglycemia or hypoglycemia is usually unsatisfactory because mild to moderate hyperglycemia does not cause obvious symptoms in almost all patients. Other considerations include the fact that, while the food takes several hours to digest and absorb, insulin administration can have a glucose-lowering effect in just 2 hours or 24 hours or more (depending on the nature of the insulin preparation used and the individual patient's reactions). In addition, the onset and duration of the effects of oral hypoglycemic agents vary from type to type and from patient to patient.

Personal glucose monitoring (home)

Controls and outcomes of both type 1 and 2 diabetes may be enhanced by patients using home glucose meters to regularly measure their glucose levels. Glucose monitoring is very expensive (mainly due to the cost of consumable test strips) and requires significant commitment on the part of the patient. Efforts and expenses may be beneficial to patients when they use values ​​to adjust food, exercise, and oral medications or insulin wisely. This adjustment is generally done by the patient himself after training by a doctor.

Regular blood tests, especially in people with type 1 diabetes, are helpful for controlling glucose levels and reducing the likelihood of long-term side effects of the disease. There are many (at least 20) types of blood-monitoring devices available on the market today; not every meter is suitable for all patients and it is a special problem of choice for patients, in consultation with doctors or other experienced professionals, to find meters that they themselves feel comfortable to use. The principle of the device is almost the same: small blood samples are collected and measured. In one type of meter, electrochemical, a small blood sample is produced by the patient using a lancet (a sterile pointed needle). Blood drops are usually collected at the bottom of the test strip, while the other end is inserted into the glucose meter. This test strip contains various chemicals so that when blood is applied, a small electrical charge is made between two contacts. This charge will vary depending on the blood glucose levels. In older glucose meters, a drop of blood is placed on the strip. A chemical reaction takes place and the strip changes color. Meters then measure the color of the strip optically.

Self test is clearly important in type I diabetes where the use of insulin therapy is at risk for hypoglycemic episodes and home testing allows dose adjustment at each administration. But its benefits in type 2 diabetes are more controversial because there is more variation in the severity of type 2 cases. It has been suggested that some type 2 patients may also perform urine tests at home only. The best use of home blood glucose monitoring is being studied.

The benefits of control and reduced hospital admission have been reported. However, patients who use oral medications that do not adjust to their drug dose will lose much benefit from self-examination, and therefore are questioned in this group. This is especially true for patients taking monotherapy with metformin who are not at risk of hypoglycemia. 6 HbA1c monthly laboratory testing routines (glycated hemoglobin) provide some long-term effective control guarantees and allow for adjustment of routine drug doses of patients in such cases. The high frequency of self-testing in type 2 diabetes has not been shown to be associated with increased control. The argument is made, though, that type 2 patients with poor long-term control despite home blood glucose monitoring, either have not been integrated into their overall management, or are long overdue for tighter control by switching from oral drugs to injected insulin.

Continuous Glucose Monitoring (CGM) CGM technology has grown rapidly to provide people with diabetes about the speed and direction of their glucose changes. Although it still requires calibration of SMBG and is not indicated for use in bolus correction, the accuracy of this monitor increases with each innovation.

HbA1c Test

A useful test that is usually performed in a laboratory is measurement of HbA1c levels in the blood. This is the ratio of the hemoglobin to be associated with total hemoglobin. Increasing plasma glucose levels cause the proportion of these molecules to increase. This is a test that measures the average number of diabetic controls over an initial period estimated at about 3 months (average red blood cells for life), but was recently considered to be stronger weighted for the most recent 2 to 4 weeks. In non-diabetics, HbA1c levels range from 4.0-6.0%; patients with diabetes mellitus who managed to keep their HbA1c levels below 6.5% were considered to have good glycemic control. HbA1c test is not appropriate if there is a change in diet or treatment within a period shorter than 6 weeks or there is a red blood cell aging disorder (eg new haemolytic or haemolytic anemia) or hemoglobinopathy (eg sickle cell disease). In such cases, alternative fructosamine tests were used to show average control within the previous 2 to 3 weeks.

Continuous glucose monitoring

The first CGM device available to consumers was the author of the GlucoWatch biography in 1999. The product is no longer sold. It is a retrospective rather than a living tool. Several direct monitoring devices have been produced that provide continuous monitoring of glucose levels automatically during the day.

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Lifestyle modification

Diet

For people with type 1 diabetes there will always be a need for insulin injections throughout their lives. However, Type 1 and Type 2 diabetics can see dramatic effects on their blood sugar through control of their diet, and some Type 2 diabetics can completely control the disease with dietary modification. Since diabetes can cause many other complications, it is important to keep blood sugar as close to normal as possible and diet is a major factor in this level of control.

Recent research shows that the first step in Diabetes management is for patients to undergo a low-carb diet. Patients who are on a high carbohydrate diet find it very difficult to maintain normal blood glucose levels. Patients who use low carbohydrate or limited carbohydrate diet, managed to maintain normal blood glucose levels and A1cs.

Drugs

Currently, one goal for diabetics is to avoid or minimize the chronic complications of diabetes, as well as to avoid acute problems of hyperglycemia or hypoglycemia. Adequate diabetes control may reduce the risk of complications associated with non-monitored diabetes including kidney failure (requires dialysis or transplantation), blindness, heart disease, and limb amputation. The most common form of treatment is hypoglycemic treatment through oral hypoglycemic and/or insulin therapy. There is growing evidence that type 2 diabetes mellitus can be avoided in those with little glucose tolerance.

Patients with type 1 diabetes mellitus require direct insulin injections because their bodies can not produce enough (or even present) insulin. In 2010, there was no other clinically available form of insulin administration other than injection for patients with type 1: the injection may be performed by an insulin pump, with a jet injector, or one of several forms of hypodermic needle. The non-injection method of insulin administration can not be achieved because the insulin protein is damaged in the gastrointestinal tract. There are several mechanisms of insulin application under experimental development in 2004, including capsules that pass to the liver and transmit insulin into the bloodstream. There have also been proposed vaccines for type I using glutamic acid decarboxylase (GAD), but these are currently not tested by pharmaceutical companies that have sublicensed patents to them.

For people with type 2 diabetes, diabetes management consists of a combination of diet, exercise, and weight loss, in a combination that can be achieved depending on the patient. Obesity is very common in type 2 diabetes and greatly contributes to insulin resistance. Weight loss and exercise increase tissue sensitivity to insulin and allow appropriate use by target tissues. Patients who have poor diabetes control after lifestyle modification are usually placed on oral hypoglycemic. Some people with Type 2 diabetes eventually fail to respond to this and should continue to insulin therapy. A study conducted in 2008 found that increasingly complex and expensive diabetes treatments are being applied to an increasing population with type 2 diabetes. Data from 1994 to 2007 were analyzed and it was found that the average number of diabetic drugs per treated patient increased from 1, 14 in 1994 to 1.63 in 2007.

Patient education and medication adherence are essential in managing the disease. Unacceptable use of drugs and insulin can be very dangerous, leading to hypo or hyper-glycemic episodes.

Insulin

Insulin therapy requires strict monitoring and a lot of patient education, because incorrect administration is very dangerous. For example, when food intake is reduced, less insulin is required. A previously satisfactory dose may be too much if less food is consumed causing hypoglycemic reactions if not smartly adjusted. Exercising lowers the need for insulin because exercise increases glucose uptake by body cells that glucose absorption is controlled by insulin, and vice versa. In addition, there are several types of insulin with varying time of onset and duration of action.

Some companies are currently working to develop non-invasive insulin versions, so injections can be avoided. Mannkind has developed a version that can be inhaled, while companies like Novo Nordisk, Oramed and BioLingus have businesses for oral products. Also a combination product of oral insulin and agonist GLP-1 is being developed.

Insulin therapy creates a risk because of the inability to continue to know one's blood glucose level and to adjust the infusion of insulin properly. New advances in technology have overcome many of these problems. Small and portable insulin infusion pumps are available from several manufacturers. They allow a small amount of insulin infusion to be shipped through the skin around the clock, plus the ability to give bolus doses when a person eats or has elevated blood glucose levels. This is very similar to how the pancreas works, but it does not have a sustainable "feedback" mechanism. Thus, the user is still at risk of giving too much or too little insulin unless the blood glucose measurement is done.

The further danger of insulin treatment is that while diabetic microangiopathy is usually described as a result of hyperglycemia, studies in mice show that higher than normal levels of insulin diabetics inject to control their own hyperglycemia can promote small vessel disease. Although there is no clear evidence that controlling hyperglycemia reduces macrovascular and diabetic cardiovascular disease, there is an indication that intensive efforts to normalize blood glucose levels may exacerbate cardiovascular and cause diabetic death.

Driving

Studies conducted in the United States and Europe show that drivers with type 1 diabetes experience twice as many collisions as their non-diabetic partner, indicating an increased risk of driving a collision in a population of type 1 diabetes. Diabetes may jeopardize the safety of driving in some way. First, long-term diabetes complications can disrupt the operation of safe vehicles. For example, diabetic retinopathy (loss of peripheral vision or visual acuity), or peripheral neuropathy (loss of feeling in the legs) may impair the driver's ability to read road signs, control vehicle speed, apply appropriate pressure to the brakes, etc.

Second, hypoglycemia can affect the thinking process, coordination, and state of consciousness. This brain function disorder is called neuroglycopenia. Studies have shown that the effects of neuroglycemias interfere with driving ability. A study involving people with type 1 diabetes found that individuals who reported two or more driving accidents related to hypoglycemia differed physiologically and behaviorally from their colleagues who reported no such accidents. For example, during hypoglycemia, drivers who have two or more accidents report fewer warning symptoms, drive them more disturbed, and their bodies release less epinephrine (a hormone that helps increase BG). In addition, individuals with a history of driving accidents related to hypoglycemia seem to use sugar at a faster and relatively slower rate in processing information. These findings suggest that although a person with type 1 diabetes may be at risk of hypoglycemia interfering with driving, there is a subgroup of type 1 drivers who are more susceptible to such events.

Given the above research findings, it is recommended that drivers with type 1 diabetes with a history of driving accidents should not drive when their BG is less than 70 mg/dl (3.9 mmol/l). Instead, these drivers are advised to treat hypoglycemia and delay driving up their BG above 90 mg/dl (5 mmol/l). The driver should also learn as much as possible about what causes their hypoglycemia, and use this information to avoid future hypoglycemia while driving.

Studies funded by the National Institutes of Health (NIH) have shown that face-to-face training programs designed to help individuals with type 1 diabetes better anticipate, detect, and prevent extreme BGs can reduce the occurrence of future driving accidents associated with hypoglycemia. The internet version of this training also proved to have beneficial results. Additional NIH-funded research to develop specialized Internet interventions to help improve driver safety in drivers with type 1 diabetes is currently underway.

Exenatide

The US Food and Drug Administration (FDA) has approved a treatment called Exenatide, based on the saliva of Gila monster, to control blood sugar in patients with type 2 diabetes.

Other regimens

Artificial Intelligence Researcher Cynthia Marling, from Ohio University's Russ College of Engineering and Technology, in collaboration with the Appalachian Rural Health Institute Diabetes Center, is developing a case-based reasoning system to assist in diabetes management. The goal of the project is to provide automated intelligent decision support to diabetic patients and their professional care providers by interpreting the ever-increasing amount of data provided by current diabetes management technology and translating it into better care without the time-consuming manual effort on the part of a person an endocrinologist or diabetes expert. This type of Artificial Intelligence-based care shows some promise with preliminary testing of a prototype system that yields best practice treatment advice that anaerative physicians deem to have a benefit rate of over 70% of the time and advice from other neutral benefits of nearly 25% of the time.

The use of "Diabetic Coach" is becoming an increasingly popular way to deal with diabetes. A Diabetes Trainer is usually a certified diabetes educator (CDE) who is trained to help people in all aspects of caring for their diabetes. CDE can advise patients on diet, treatment, proper use of insulin injections and pumps, exercise, and other ways to manage diabetes while living a healthy and active lifestyle. CDE can be found locally or by contacting companies providing personal diabetes care using CDE. Diabetes coaches can talk to patients on a pay-per-call basis or through a monthly plan.

Dental care

High blood glucose in diabetics is a risk factor for developing gum and dental problems, especially in post-puberty and aging individuals. Diabetic patients have a greater likelihood of developing oral health problems such as tooth decay, salivary gland dysfunction, fungal infections, inflammatory skin diseases, periodontal disease or taste and oral canker sores. Oral problems in people with diabetes can be prevented with good control of blood sugar levels, regular checkups and excellent oral hygiene. By maintaining good oral status, diabetics prevent their tooth loss due to various periodontal conditions.

Diabetics should raise their awareness about oral infections because they have a double impact on health. First, diabetics are more likely to develop periodontal disease, which causes elevated blood sugar levels, often leading to complications of diabetes. Severe periodontal disease can increase blood sugar, contributing to an increase in the time period when the body functions with high blood sugar. This puts diabetics at increased risk of diabetes complications.

The first symptoms of gum and dental infection in diabetics are decreased salivary flow and mouth or tongue burn. Also, patients may experience signs such as dry mouth, which increases the incidence of decay. Uncontrolled diabetes usually causes gum recession, because plaque creates more harmful protein in the gums.

Tooth decay and cavities are some of the first oral problems that people with diabetes risk. Increased blood sugar levels translate into sugars and larger acids that attack teeth and cause gum disease. Gingivitis may also occur as a result of elevated blood sugar levels along with inappropriate oral hygiene. Periodontitis is a mouth disease caused by untreated gingivitis and which destroys soft tissues and bones that support the teeth. This disease can cause the gums to pull away from the teeth that can finally relax and fall out. Diabetics tend to experience more severe periodontitis because diabetes decreases the ability to fight infections and also slows healing. At the same time, oral infections such as periodontitis can make diabetes more difficult to control because it causes blood sugar levels to rise.

To prevent further complications of diabetes as well as serious oral problems, diabetics should keep their blood sugar levels under control and have proper oral hygiene. A study in the Journal of Periodontology found that patients with less controlled type 2 diabetes were more likely to develop periodontal disease than those with well-controlled diabetes. At the same time, diabetic patients are advised to carry out routine checkups with dental care providers at least once in three to four months. Diabetics who receive good dental care and have good insulin control usually have a better chance of avoiding gum disease to help prevent tooth loss.

Therefore dental care is more important for diabetic patients than for healthy people. Maintaining healthy teeth and gums is done by taking several preventative measures such as regular dental appointments and excellent oral hygiene. Also, oral health problems can be avoided by closely monitoring blood sugar levels. Patients who remain better under the control of blood sugar and diabetes tend to develop less oral health problems when compared with diabetic patients who control their illness moderately or poorly.

Poor oral hygiene is a big factor to consider when it comes to oral problems and even more in diabetics. Diabetics are advised to brush their teeth at least twice a day, and if possible, after all meals and snacks. However, brushing in the morning and at night is mandatory as well as flossing and using anti-bacterial mouthwash. Individuals with diabetes are advised to use fluoride-containing toothpaste as this has proven to be the most efficient in fighting oral infections and tooth decay. Flossing should be done at least once a day, also because it helps in preventing oral problems by removing plaque between teeth, which is not removed when brushing.

Diabetic patients should get professional dental cleansing every six months. In cases where dental surgery is necessary, it is necessary to take some special precautions such as adjusting diabetes drugs or taking antibiotics to prevent infection. Looking for early signs of gum disease (redness, swelling, bleeding gums) and telling the dentist about them also helps prevent further complications. Quitting smoking is recommended to avoid serious diabetes complications and mouth disease.

Diabetics are advised to make an early morning appointment to a dental provider because during this time blood sugar levels tend to be better kept under control. Not infrequently, individuals suffering from diabetes should ensure both their doctors and dental care providers are notified and aware of their condition, medical history and periodontal status.

Non-compliance drug

Because many patients with diabetes have two or more comorbidities, they often require multiple drugs. The prevalence of drug non-adherence is high among patients with chronic conditions, such as diabetes, and noncompliance associated with public health issues and higher health care costs. One of the reasons for noncompliance is the cost of treatment. Being able to detect cost-related noncompliance is important for health care professionals, as this may lead to strategies to help patients with problems paying for their medicines. Some of these strategies are the use of generic or alternative therapeutic drugs, replacing drugs prescribed with over-the-counter drugs, and pill-splitting. Interventions to improve adherence can achieve a reduction in diabetic morbidity and mortality, as well as significant cost savings for health care systems. Smartphone apps have been found to improve self-management and health outcomes in people with diabetes through functions such as special reminder alarms, when working with mental health professionals have also been found to help people with diabetes develop skills to manage drugs and their challenges. self-management effectively.

Psychological mechanisms and compliance

As diabetes self-management usually involves lifestyle modification, adherence can pose a significant self-management burden on many individuals. For example, individuals with diabetes may find themselves confronted with the need to self-monitor their blood glucose levels, adhere to a healthy diet and maintain regular exercise regimens to maintain metabolic control and reduce the risk of cardiovascular problems. Obstacles to compliance have been linked to key psychological mechanisms: knowledge of self-management, beliefs about treatment efficacy and self-efficacy/perceived control. Such mechanisms are interrelated, such as one's thoughts (eg one's perception of diabetes, or one's judgment about how to help self-management) may relate to one's emotions (eg motivation to change), which, in turn, affect one's self. efficacy (one's confidence in their ability to engage in behavior to achieve desired outcomes).

Because diabetes management is affected by one's emotional and cognitive state, there is evidence to suggest that diabetes self-management is negatively affected by the stress and depression associated with diabetes. There is increasing evidence that there is a higher rate of clinical depression in patients with diabetes compared with non-diabetic populations. Depression in individuals with diabetes has been found to be associated with poorer management of symptoms. This suggests that it may be important to target moods in care.

To this end, treatment programs such as Cognitive Behavior Therapy - Compliance and Depression programs (CBT-AD) have been developed to target psychological mechanisms that support adherence. By working on improving the motivation and perception of challenging maladaptive diseases, programs such as CBT-AD aim to improve self-efficacy and increase diabetes-related stress and overall quality of life.

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Research

Diabetes type 1

Type 1 diabetes is caused by the destruction of beta cells sufficient to produce symptoms; These cells, which are found in the Langerhans islands in the pancreas, produce and secrete insulin, a single hormone responsible for allowing glucose to enter from the blood into the cell (other than the amylin hormone, another hormone needed for glucose homeostasis). Therefore, the phrase "cure type 1 diabetes" means "cause maintenance or restoration of the body's endogenous ability to produce insulin in response to blood glucose levels" and cooperative surgery with a counterregulatory hormone.

This section deals only with the approach to cure the underlying condition of type 1 diabetes, by allowing the body to endogenously, in vivo, produce insulin in response to blood glucose levels. This does not include other approaches, such as, for example, closed-loop integrated glucometer/product insulin pumps, potentially improving quality of life for some people with type 1 diabetes, and possibly by some people called "artificial pancreas".

Encapsulation approach

The biological approach to artificial pancreas is to infuse biotechnological tissues containing islet cells, which secrete the amount of insulin, amylin and glucagon needed in response to perceived glucose.

When islet cells have been transplanted through the Edmonton protocol, insulin production (and glycemic control) is restored, but at the expense of further immunosuppressed drugs. Encapsulation of islet cells in a protective layer has been developed to block the immune response against transplanted cells, which reduces immunosuppression burden and the longevity benefits of transplantation.

Stem cells

Research is underway at several locations where islet cells are developed from stem cells.

Stem cell research has also been suggested as a potential path for healing because it can allow the growth of Islet cells that are genetically part of the treated individual, thus possibly eliminating the need for immune suppressants. [48] ​​The new method of autologous transplantation of nonmyeloablative hematopoietic stem cells was developed by a team of researchers drawn up by Brazilian and American scientists (Dr. Julio Voltarelli, Dr. Carlos Eduardo Couri, Dr. Richard Burt, and colleagues) and it was the first study to use stem cell therapy in humans diabetes mellitus It was originally tested in mice and in 2007 there was the first publication of stem cell therapy to treat this type of diabetes. Until 2009, there were 23 patients included and followed for an average period of 29.8 months (ranging from 7-58 months). In trials, severe immunosuppression with high doses of cyclophosphamide and anti-thymocyte globulin was used with the aim of "shutting down" the immunological system, "and then autologous hematopoietic stem cells that were reinfused to regenerate the new ones.In short is the type of" immunological reset "that blocks autoimmune attacks against pancreatic insulin-producing cells Until December 2009, 12 patients remained insulin free on a continuous basis for periods ranging from 14 to 52 months and 8 patients became insulin-free temporary for periods ranging from 6 to 47 months Of the last 8 patients, 2 become insulin-free again after the use of sitagliptin, a DPP-4 inhibitor approved only to treat type 2 diabetics and this is also the first study to document the use and complement of insulin.- depends on humans with type 1 diabetes with this drug.In parallel with the suspension insulin, the indirect measure of endogenous insulin secretion reveals that it increased significantly across the patient group, regardless of the daily use of exogenous insulin requirement.

Gene therapy

Technologies for gene therapy advance rapidly so there are several possible pathways to support endocrine function, with the practical potential of curing diabetes.

• Gene therapy can be used to produce insulin directly : an oral medication, which consists of a viral vector containing insulin sequences, is digested and transmits its genes to the upper intestine. The intestinal cells will behave like virus-infected cells, and will reproduce insulin proteins. Viruses can be controlled only to infect cells that respond to the presence of glucose, so insulin is only produced in the presence of high glucose levels. Due to the limited number of vectors being shipped, very few intestinal cells will be affected and will die naturally within a few days. Therefore, by varying the amount of oral medication used, the amount of insulin made by gene therapy can be increased or decreased as needed. The intestinal cells that produce insulin die, they are encouraged by additional oral medications.
• Gene therapy may eventually be used to cure the cause of beta cell destruction , thus curing new diabetic patients before the beta cell destruction is completed and can not be changed.
• Gene therapy can be used to convert the duodenal and duodenal cells of adult stem cells into beta cells that produce insulin and amylin naturally. By sending the DNA of beta cells to the intestinal cells in the duodenum, some of the intestinal cells will turn into beta cells, and then adult stem cells will develop into beta cells. This makes the supply of beta cells in the duodenum, and beta cells will produce insulin in a proportional response to the carbohydrates consumed.

Diabetes type 2

Type 2 diabetes is usually first treated by increasing physical activity, and eliminating saturated fats and reducing intake of sugars and carbohydrates in order to lose weight. This can restore insulin sensitivity even when moderate weight loss, eg about 5 kg (10 to 15 pounds), especially when in abdominal fatty deposits. A very low-saturated fat diet has been claimed to reverse insulin resistance.

Cognitive Behavior Therapy is an effective intervention to improve adherence to treatment, depression and glycemic control, with significant and clinically meaningful benefits for diabetes self-management and glycemic control in adults with type 2 diabetes and comorbid depression.

Testosterone replacement therapy may improve glucose tolerance and insulin sensitivity in diabetic hypogonadal men. The mechanism by which testosterone lowers insulin resistance is being investigated. In addition, testosterone may have a protective effect on pancreatic beta cells, which may be given by the mechanisms mediated by androgen receptors and the effect of inflammatory cytokines.

It has recently been suggested that this type of gastric bypass surgery can normalize blood glucose levels in 80-100% of patients with severe obesity with diabetes. The exact cause mechanism is being studied intensively; The result may not only be caused by weight loss, as an increase in blood sugar seems to precede any changes in body mass. This approach may be the treatment for some people with type 2 diabetes, but has not been studied in prospective clinical trials. This surgery may have the added benefit of reducing the mortality rate of all causes by up to 40% in very obese people. A small number of normal to moderate obese patients with type 2 diabetes have successfully undergone similar surgery.

MODY is a rare form of genetic diabetes, often misinterpreted as Type 1 or Type 2. Medical management varies and depends on each case.

src: www.pngdown.com

See also

src: care.diabetesjournals.org

References

src: medicalfuturist.com

External links

• American College of Physicians Diabetes Portal - Resources for patients and doctors
• The American Diabetes Association
• Prevent Diabetes Problems: Keep Your Diabetes Under Control - Self-care Tips at the "National Diabetes Information Center" USA

Source of the article : Wikipedia