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| | Title: | What is type 2 diabetes? | | Article: | Type 2 diabetes mellitus makes more than 80% of
diabetes cases. The primary sign of this disease is
chronic hyperglycaemia. Hyperglycaemia means increased
sugar (glucose) in your blood. This condition is
caused by resistance to insulin action at the level of
cells and receptors plus inadequate production of
insulin in your body.
There is an epidemics diabetes mellitus in America and
Europe as well as in the rest of the world. The
estimation is that more than 200 million people will
have the condition in 2010.
The main danger of diabetes is increased patient
morbidity and mortality from complications.
The disease affects heart, blood vessels, kidneys and
neurological system. Some prominent compilations
include frequent severe infections and blindness. The
cost of the management of these complications is
staggering.
What is the treatment of diabetes type 2?
The medical treatments of patients with type 2
diabetes mellitus include diet, exercise, and weight
reduction as the first line. The medication includes
oral anti-diabetic medications and insulin therapy
when appropriate.
Current pharmacological drugs are:
1. Sulfonylureas and meglitinides, that increase
insulin secretion,
2. Glitazones, that increase glucose utilization,
3. Metformin, which reduce hepatic glucose production,
4. Alpha-glucosidase inhibitors that delay glucose
absorption in guts.
5. Rosiglitazone (AVANDIA) and pioglitazone (Actose)
are peroxisome proliferator activated receptor gamma
agonists. Their role is to increase the insulin
sensitivity of fat and muscles.
Side effects include hypoglycaemia and
gastrointestinal disturbances in some medications.
Other (like avandia) do not cause hypoglycaemia (low
sugar), but may lead to weight gain and fluid
retention.
How to monitor glucose at home?
Patients get a glucose meter for self-monitoring of
blood glucose levels and diary cards to record of
blood glucose. Patients should check their capillary
glucose levels at least once a day or according to
personal practice.
How to manage hypoglycaemia?
Experimentally medications that lower blood glucose
could produce hypoglycaemia. However medications that
increase insulin secretion are responsible for
hypoglycaemia in majority of cases. The signs of
hypoglycaemia depend on the patients. Some diabetics
experience symptoms with a rapid lowering of glucose
form high to normal. In opposite, other diabetics
with a very low glucose level are unaware of this.
The patient needs a Hypoglycaemic Log where he records
symptoms of hypoglycaemia and when possible,
fingerstick glucose level at the same moment. They
also have Glucose Log for routine recording. Doctor
reviews the logs at the next visit. Your doctor will
adjust the medication dose according to the records.
Because the low blood glucose may cause brain damage,
patient should have some sweets for an emergency
(candy, orange juice, sugar or honey etc). He also
should keep a card with records about his condition
and contact information for doctors and family.
How to manage hyperglycaemia?
This management is done by your doctor. Based on
daily self-monitoring of blood glucose he takes a
decision about adjusting the dose of medication or
adding another drug for the treatment. For example, if
fasting blood glucose is more than 200 mg/dL (11.2
mmol/L) during two consecutive mornings, a sample of
blood should be drawn and taken to the central lab to
confirm the level. Then doctor decides how to change
the medication. The level where doctor is taking
decisions may vary. For example, in majority of
American hospitals the trigger level would be 140. For
surgical patients, especially, for example, for
patients with heart surgery, doctors try to keep very
tight level around 120. Research showed that tight
control of the blood sugar significantly improves
outcome of surgery. In general, doctors try to keep
the level in the range of 90 to 130 in fasting
condition by adjusting patient’s medication. Normal
person has 70 to 120 when fasts and 70 to 140 in 2
hours after meal. Above 140 is considered abnormal
level. | | Author: | Aleksandr Kavokin, MD, PhD | | System: | Endocrine | | Subject: | Diabetes | | Abstract: | The main danger of diabetes is increased patient
morbidity and mortality from complications.
The disease affects heart, blood vessels, kidneys and
neurological system. | | Website: | http://www.kavokin.com | | Time: | 20:32 | | Reference: | http://www.rdoctor.com | | Reference 2: | http://www.sympomat.com |
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Articles by Aleksandr Kavokin, MD, PhD
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