Download Treatment of Diabetes - KSU Faculty Member websites

Kind Saud University
Applied Medical Science College
Clinical nutrition department
Educational plan for diabetic patients in
KFSH
Done by:
Mashael Bint Mansour AL-Sultan
Supervised by:
Mrs. Iffat Brazey
Mrs. Ohoud al Hammad
Diabetes is a very big topic! To make the diagnosis, complications and
treatment of diabetes more understandable, we have broken
"diabetes" into several dozen diabetes topic pages which go into more
and more detail. Our search engine will help you find specific diabetes
information, or you can come back to this introduction page to see each
of the diabetes topic pages listed.
Diabetes is a disorder characterized by hyperglycemia or elevated blood
glucose (blood sugar). Our bodies function best at a certain level of
sugar in the bloodstream. If the amount of sugar in our blood runs too
high or too low, then we typically feel bad. Diabetes is the name of the
condition where the blood sugar level consistently runs too high.
Diabetes is the most common endocrine disorder. Sixteen million
Americans have diabetes, yet many are not aware of it. AfricanAmericans, Hispanics, and Native Americans have a higher rate of
developing diabetes during their lifetime. Diabetes has potential long
term complications that can affect the kidneys, eyes, heart, blood
vessels, and nerves. A number of pages on this website are devoted to
the prevention and treatment of the complications of diabetes.
Types of Diabetes
Although doctors and patients alike tend to group all patients with
diabetes together, the truth is that there are two different types of
diabetes which are similar in their elevated blood sugar, but different in
many other ways. Throughout the remainder of these web pages we will
be referring to the different types of diabetes when appropriate, but
when the topic pertains to both types of diabetes we will use the general
term "diabetes".
Diabetes is correctly divided into two major subgroups: type 1 diabetes
and type 2 diabetes. This division is based upon whether the blood
sugar problem is caused by insulin deficiency (type 1) or insulin
resistance (type 2). Insulin deficiency means there is not enough insulin
being made by the pancreas due to a malfunction of their insulin
producing cells. Insulin resistance occurs when there is plenty of insulin
made by the pancreas (it is functioning normally and making plenty of
insulin), but the cells of the body are resistant to its action which results
in the blood sugar being too high.
Type 1 diabetes is all about insulin—a lack of the hormone insulin. If you
have type 1 diabetes, then your body doesn’t produce enough insulin to
handle the glucose in your body. Glucose is a sugar that your body uses
for instant energy, but in order for your body to use it properly, you have
to have insulin.
Having too much glucose in your body can cause serious
complications. In order to avoid those, people with type 1 diabetes must
take insulin to help their bodies use glucose effectively. Learn more
about the hormone insulin and how it works.
Type 1 diabetes used to be called juvenile diabetes because so many
cases were noticed when patients were children. However, it is possible
to develop type 1 diabetes later in life.
Here’s another reason “juvenile diabetes” isn’t exactly accurate
anymore: type 1 diabetes isn’t the only type of diabetes that can affect
children and young adults. Type 2 diabetes is becoming more prevalent
in younger people, and the treatments and causes of type 1 and type 2
are very different. It can be misleading and confusing to talk about
“juvenile diabetes” when there are two distinct types that can affect
children and young adults.
Hearing that your child has type 1 diabetes—or that you have it—can be
an overwhelming thing to take in. You’re suddenly in a new world with a
new vocabulary and new requirements: hemoglobin A1c, blood glucose,
insulin pumps, carb counting, diabetic ketoacidosis, etc.
Type 1 diabetes develops gradually, but the symptoms may seem to
come on suddenly. If you notice that you or your child have several of
the symptoms listed below, make an appointment to see the doctor.
Here’s why symptoms seem to develop suddenly: something triggers
the development of type 1 diabetes (researchers think it’s a viral
infection—read this article on what causes type 1 diabetes, and the body
loses its ability to make insulin. However, at that point, there’s still
insulin in the body so glucose levels are still normal.
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Over time, a decreasing amount of insulin is made in the body, but that
can take years. When there’s no more insulin in the body, blood glucose
levels rise quickly, and these symptoms can rapidly develop:
Extreme weakness and/or tiredness
Extreme thirst—dehydration
Increased urination
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Abdominal pain
Nausea and/or vomiting
Blurry vision
Wounds that don’t heal well
Irritability or quick mood changes
Changes to (or loss of) menstruation
There are also signs of type 1 diabetes. Signs are different from
symptoms in that they can be measured objectively; symptoms are
experienced and reported by the patient. Signs of type 1 diabetes
include:
Weight loss—despite eating more
Rapid heart rate
Reduced blood pressure (falling below 90/60)
Low body temperature (below 97º F)
There is an overall lack of public awareness of the signs and symptoms
of type 1 diabetes. But there are people working to promote knowledge
of type 1 diabetes. And Jay Cutler, quarterback for the Chicago Bears, is
one of them. To learn more about his type 1 diabetes awareness efforts,
read EndocrineWeb's interview with Jay Cutler.
Making yourself aware of the signs and symptoms of type 1 diabetes is
a great way to be proactive about your health and the health of your
family members. If you notice any of these signs or symptoms, it’s
possible that you have (or your child has) type 1 diabetes. A doctor can
make that diagnosis by checking blood glucose levels.
Type 1 Diabetes Causes
It isn’t entirely clear what triggers the development of type 1
diabetes. Researchers do know that genes play a role; there is an
inherited susceptibility. However, something must set off the immune
system, causing it to turn against itself and leading to the development
of type 1 diabetes.
Genes Play a Role in Type 1 Diabetes
Some people cannot develop type 1 diabetes; that’s because they don’t
have the genetic coding that researchers have linked to type 1
diabetes. Scientists have figured out that type 1 diabetes can develop in
people who have a particular HLA complex. HLA stands for human
leukocyte antigen, and antigens function is to trigger an immune
response in the body.
There are several HLA complexes that are associated with type 1
diabetes, and all of them are on chromosome 6.
Different HLA complexes can lead to the development of other
autoimmune disorders, such as rheumatoid arthritis, ankylosing
spondylitis, or juvenile rheumatoid arthritis. Like those conditions, type
1 diabetes has to be triggered by something—usually a viral infection.
What Can Trigger Type 1 Diabetes
Here’s the whole process of what happens with a viral infection: When a
virus invades the body, the immune system starts to produce antibodies
that fight the infection. T cells are in charge of making the antibodies,
and then they also help in fighting the virus.
However, if the virus has some of the same antigens as the beta cells—
the cells that make insulin in the pancreas—then the T cells can actually
turn against the beta cells. The T cell products (antibodies) can destroy
the beta cells, and once all the beta cells in your body have been
destroyed, you can’t produce enough insulin.
It takes a long time (usually several years) for the T cells to destroy the
majority of the beta cells, but that original viral infection is what is
thought to trigger the development of type 1 diabetes.
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Not every virus can trigger the T cells to turn against the beta cells. The
virus must have antigens that are similar enough to the antigens in beta
cells, and those viruses include:
B4 strain of the coxsackie B virus (which can cause a range of
illnesses from gastrointestinal problems to myocarditis—inflammation
of the muscle part of the heart)
German measles
Mumps
Rotavirus (which generally causes diarrhea)
There have also been some controversial studies into the connection
between drinking cow’s milk as an infant and the development of type 1
diabetes. Researchers don’t all agree on this, but some believe that the
proteins in cow’s milk are similar to a protein that controls T cell
production called glycodelin1. The baby’s body attacks the foreign
protein—the cow’s milk protein—but then also attacks glycodelin,
leading to an overproduction of T cells. And too many T cells in the
body can lead to those T cells destroying the beta cells.
Researchers have made significant progress in understanding the cause
of type 1 diabetes, and they’re still hard at work to figure out why certain
viruses trigger it and why T cells turn against beta cells. The medical
community wants to better understand the cases of diabetes in order to
prevent it.
Type 1 Diabetes Risk Factors
There are several risk factors that may make it more likely that you’ll
develop type 1 diabetes—if you have the genetic marker that makes you
susceptible to diabetes. That genetic marker is located on chromosome
6, and it’s an HLA (human leukocyte antigen) complex. Several HLA
complexes have been connected to type 1 diabetes, and if you have one
or more of those, you may develop type 1. (However, having the
necessary HLA complex is not a guarantee that you will develop
diabetes; in fact, less than 10% of people with the “right” complex(es)
actually develop type 1.)
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Other risk factors for type 1 diabetes include:
Viral infections: Researchers have found that certain viruses may
trigger the development of type 1 diabetes by causing the immune
system to turn against the body—instead of helping it fight infection and
sickness. Viruses that are believed to trigger type 1 include: German
measles, coxsackie, and mumps.
For more details on how viral infections increase your risk of diabetes,
read this article on the causes of type 1 diabetes.
Race/ethnicity: Certain ethnicities have a higher rate of type 1
diabetes. In the United States, Caucasians seem to be more susceptible
to type 1 than African-Americans and Hispanic-Americans. Chinese
people have a lower risk of developing type 1, as do people in South
America.
Geography: It seems that people who live in northern climates are
at a higher risk for developing type 1 diabetes. It’s been suggested that
people who live in northern countries are indoors more (especially in the
winter), and that means that they’re in closer proximity to each other—
potentially leading to more viral infections.
Conversely, people who live in southern climates—such as South
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America—are less likely to develop type 1. And along the same lines,
researchers have noticed that more cases are diagnosed in the winter in
northern countries; the diagnosis rate goes down in the summer.
Family history: Since type 1 diabetes involves an inherited
susceptibility to developing the disease, if a family member has (or had)
type 1, you are at a higher risk.
If both parents have (or had) type 1, the likelihood of their child
developing type 1 is higher than if just one parent has (or had)
diabetes. Researchers have noticed that if the father has type 1, the risk
of a child developing it as well is slightly higher than if the mother or
sibling has type 1 diabetes.
Early diet: Researchers have suggested a slightly higher rate of
type 1 diabetes in children who were given cow’s milk at a very young
age. You can read more about the possible connection between cow’s
milk and type 1 diabetes in this article on type 1 diabetes causes.
Other autoimmune conditions: As explained above, type 1
diabetes is an autoimmune condition because it causes the body’s
immune system to turn against itself. There are other autoimmune
conditions that may share a similar HLA complex, and therefore, having
one of those disorders may make you more likely to develop type 1.
Other autoimmune conditions that may increase your risk for type 1
include: Graves’ disease, multiple sclerosis, and pernicious anemia.
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Diagnosing Diabetes
In diagnosing diabetes, physicians primarily depend upon the results of
specific glucose tests. However, test results are just part of the
information that goes into the diagnosis of type 1 or type 2 diabetes.
Doctors also take into account your physical exam, presence or
absence of symptoms, and medical history.
Some people who are significantly ill will have transient problems with
elevated blood sugars which will then return to normal after the illness
has resolved. Also, some medications may alter your blood glucose
levels (most commonly steroids and certain diuretics, such as water
pills).
The two main tests used to measure the presence of blood sugar
problems are the direct measurement of glucose levels in the blood
during an overnight fast and measurement of the body's ability to
appropriately handle the excess sugar presented after drinking a high
glucose drink.
Fasting Blood Glucose (Blood Sugar) Level
The gold standard for diagnosing diabetes is an elevated blood sugar
level after an overnight fast (not eating anything after midnight). A value
above 140 mg/dl on at least two occasions typically means a person has
diabetes. Normal people have fasting sugar levels that generally run
between 70-110 mg/dl.
The Oral Glucose Tolerance Test
An oral glucose tolerance test is one that can be performed in a doctor's
office or a lab. The person being tested starts the test in a fasting state
(having no food or drink except water for at least 10 hours but not
greater than 16 hours).
An initial blood sugar is drawn and then the person is given a "glucola"
bottle with a high amount of sugar in it (75 grams of glucose or 100
grams for pregnant women). The person then has their blood tested
again 30 minutes, 1 hour, 2 hours, and 3 hours after drinking the high
glucose drink.
For the test to give reliable results, you must be in good health (not have
any other illnesses, not even a cold). Also, you should be normally
active (for example, not lying down or confined to a bed like a patient in
a hospital), and you should not be taking any medicines that could
affect your blood glucose. The morning of the test, you should not
smoke or drink coffee. During the test, you need to lie or sit quietly.
The oral glucose tolerance test is conducted by measuring blood
glucose levels five times over a period of 3 hours. In a person without
diabetes, the glucose levels in the blood rise following drinking the
glucose drink, but then they fall quickly back to normal (because insulin
is produced in response to the glucose, and the insulin has a normal
effect of lowing blood glucose).
In a diabetic, glucose levels rise higher than normal after drinking the
glucose drink and come down to normal levels much slower (insulin is
either not produced, or it is produced but the cells of the body do not
respond to it).
As with fasting or random blood glucose tests, a markedly abnormal
oral glucose tolerance test is diagnostic of diabetes. However, blood
glucose measurements during the oral glucose tolerance test can vary
somewhat. For this reason, if the test shows that you have mildly
elevated blood glucose levels, the doctor may run the test again to make
sure the diagnosis is correct.
Glucose tolerance tests may lead to one of the following diagnoses:
Normal Response
A person is said to have a normal response when the 2-hour
glucose level is less than or equal to 110 mg/dl.
Impaired Fasting Glucose
When a person has a fasting glucose equal to or greater than 110
and less than 126 mg/dl, they are said to have impaired fasting
glucose. This is considered a risk factor for future diabetes, and
will likely trigger another test in the future, but by itself, does not
make the diagnosis of diabetes.
Impaired Glucose Tolerance
A person is said to have impaired glucose tolerance when the 2hour glucose results from the oral glucose tolerance test are
greater than or equal to 140 but less than 200 mg/dl. This is also
considered a risk factor for future diabetes. There has recently
been discussion about lowering the upper value to 180 mg/dl to
diagnose more mild diabetes to allow earlier intervention and
hopefully prevention of diabetic complications.
Diabetes
A person has diabetes when oral glucose tolerance tests show
that the blood glucose level at 2 hours is equal to or more than
200 mg/dl. This must be confirmed by a second test (either one)
on another day. There has recently been discussion about
lowering the upper value to 180 mg/dl to diagnose more people
with mild diabetes to allow earlier intervention and hopefully
prevention of diabetic complications.
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and exercise tips, plus advice from leading
specialists.
Gestational Diabetes
A woman has gestational diabetes when she is pregnant and has
any two of the following: a fasting plasma glucose of more than
105 mg/dl, a 1-hour glucose level of more than 190 mg/dl, a 2-hour
glucose level of more than 165 mg/dl, or a 3-hour glucose level of
more than 145 mg/dl.
Type 2 Diabetes
Type 2 Diabetes is more common than Type 1 Diabetes.
Whereas type 1 diabetes is characterized by the onset in
young persons (average age at diagnosis = 14), type 2
diabetes usually develops in middle age or later. This
tendency to develop later in life has given rise to the term
"adult onset diabetes," although the prevalence of type 2 diabetes in
younger people is rising, making this term somewhat inaccurate and
outdated.
The typical type 2 diabetes patient is overweight ,although there are
exceptions. In contrast to type 1 diabetes, symptoms often have a more
gradual onset. Type 2 diabetes is associated with insulin resistance
rather than the lack of insulin, as seen in type 1 diabetes. This often is
obtained as a hereditary tendency from one's parents. Insulin levels in
these patients are usually normal or higher than average but the body's
cells are rather sluggish to respond to it. This lack of insulin activity
results in higher than normal blood glucose levels.
Incidence of Type 2 Diabetes
Type 2 diabetes is the most common type of diabetes. This disease
exists in all populations, but prevalence varies greatly, ie, 1% in Japan,
and greater than 40% in the Pima Indians of Arizona. In Caucasians, the
figure is somewhere between 1-2% of the entire population. The high
incidence of type 2 diabetes in certain groups such as the Pima Indians
appears to be a relatively recent development that followed a change in
the type of food intake (from relatively little food to plenty of food). With
this came the development of obesity within their culture which results
in diabetes developing in those that are genetically predisposed. This
"urbanization phenomenon" has been most carefully studied in nonwhite populations, but is probably ethnically and racially nonspecific. In
other words, obesity tends to promote diabetes in those genetically
predisposed regardless of where you live and what your racial
background is.
Hereditary Aspects of Type 2 Diabetes
Type 2 diabetes tends to be fairly hereditary in contrast to type 1
diabetes. Approximately 38% of siblings and one-third of children of
people with type 2 diabetes will develop diabetes or abnormal glucose
metabolism at some point. The degree of obesity also seems to be a
factor, with a larger percentage of diabetes developing in those who are
more obese. Studies with identical twins showed that 90-100% of the
time when diabetes developed in one it would also develop in the other
compared with 50% in type 1 diabetes.
Causes of Type 2 Diabetes
Development of type 2 diabetes seems to be multi-factorial; that is, there
are a number of issues to blame. Genetic predisposition seems to be the
strongest factor. Obesity and high caloric intake seem to be another.
Twenty percent of people with this type 2 diabetes have antibodies to
their islet cells which are detectable in their blood resulting in the
expected low levels of insulin, suggesting the possibility of incomplete
islet cell destruction (see discussion about autoimmune diabetes in the
type 1 diabetes section). These patients often tend to respond early to
oral drugs to lower blood sugar but may need insulin at some point.
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More about Type 1 Diabetes
Making the Diagnosis of Diabetes
How Insulin Regulates Blood Glucose Levels
Treatment of Diabetes
Assessing how well Glucose is Controlled in a Diabetic
The Symptoms of Hyperglycemia
More about the production of hormones by Islet Cells of the
Pancreas
Back to Diabetes Introduction
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and exercise tips, plus advice from leading specialists!
Complications
The parts of the body that can be most affected by diabetes
complications are the:
eyes
kidneys
nerves
heart and blood vessels
gums
feet
Eye Problems
People with diabetes have a greater risk of developing eye
problems, including:
Cataracts: A cataract is a thickening and clouding of
the lens of the eye. The lens is the part of the eye
that helps you focus on what you see. Cataracts can
make a person's vision blurry or make it hard to see
at night.
Doctors think that people with diabetes are more
likely to develop cataracts if they have high blood
sugar levels over a long period of time. If cataracts
get in the way of seeing properly, a person can have
surgery to remove them.
Retinopathy: Another eye problem, called diabetic
retinopathy (pronounced: reh-tih-nah-puh-thee),
involves changes in the retina, the light-sensitive
layer at the back of the eye. These changes happen
because of damage or growth problems in the small
blood vessels of the retina. Usually, changes in the
retinal blood vessels don't appear before a person
has reached puberty and has had diabetes for
several years. Retinopathy is more likely to become
a problem in people with diabetes if they have high
blood sugar levels over a long period of time, if they
have high blood pressure, or if they use smoke or
chew tobacco.
One reason why teens with diabetes need to have
regular yearly eye exams is because people with
retinopathy may not have any problems seeing at
first. But if the condition gets worse, they can
become blind. If a person develops retinal problems,
he or she will need to visit the eye doctor more
often. A person with diabetes may be able to slow or
reverse the damage caused by retinopathy by
improving blood sugar control. If retinopathy
becomes more advanced, laser treatment may be
needed to help prevent vision loss.
Glaucoma: People who have diabetes also have a
greater chance of getting glaucoma. In this disease,
pressure builds up inside the eye, which can
decrease blood flow to the retina and optic nerve
and damage them. At first, a person may not have
trouble seeing. But if it's not treated, glaucoma can
cause a person to lose vision. The risk increases as a
person gets older and has had diabetes longer.
People with glaucoma take medications to lower the
pressure inside the eye and sometimes need
surgery.
Your doctor will probably check your eyes for early signs of
these problems during routine exams. He or she may also
recommend that you see an ophthalmologist (pronounced:
opf-thul-mah-luh-jist, a doctor who specializes in treating
diseases of the eye) or optometrist (pronounced: op-tahmuh-trist, a person who examines your eyes and tests your
vision).
Keeping your blood sugar and blood pressure levels under
control and avoiding tobacco may also help you avoid eye
problems associated with diabetes.
Kidney Disease
When blood sugar is high, it can cause damage to the blood
vessels in the kidneys, leading to kidney disease. This is
sometimes called diabetic nephropathy (pronounced: nehfrah-puh-thee).
Kidney disease is more likely to happen in people who
haven't controlled their blood sugar levels over a long period
of time. If a person develops kidney disease, it can get worse
if he or she has high blood pressure or uses tobacco.
In its early stages, kidney disease doesn't cause symptoms.
Over time, though, kidney disease can cause kidney failure,
which means the kidneys stop working. So kidney disease is
a serious health problem.
If a person has gone through puberty and has had diabetes
for several years, doctors will probably test for kidney
disease about once a year. Doctors may do a urine test to
measure the amount of protein called albumin (pronounced:
al-byoo-mun) in the urine. If the amount of protein in the
urine increases beyond a certain point, or if there are other
signs of kidney disease, doctors may look at a piece of the
kidney under a microscope to make sure a person really has
kidney disease.
If doctors detect kidney disease early enough, the damage
can sometimes be reversed with proper treatment. Doctors
may tell a person with diabetic nephropathy to eat less
protein. They may also prescribe medications.
If the kidney disease gets worse, a person may develop
kidney failure, which requires dialysis (regular use of a
machine to clean the blood as the kidneys normally would)
or a kidney transplant. The good news is that these days
kidney disease is less likely to end up as kidney failure
because of earlier detection and better treatment than in the
past.
The best way to help prevent diabetic kidney disease is to
keep your blood sugar levels under control by following your
diabetes treatment plan. It's also important to get regular
blood pressure checks and urine albumin tests — your
diabetes health care team will tell you when you need these.
In addition, steer clear of smoking, which can increase the
risk of kidney problems and other diabetes complications
and health problems.
Nerve Damage
Another complication that people who have had diabetes for
a long time may develop is a type of nerve damage called
diabetic neuropathy (pronounced: noo-rah-puh-thee).
Diabetic neuropathy can affect nerves in many different
parts of the body. The most common early symptoms of the
condition are numbness, tingling, or sharp pains in the feet
or lower legs.
If it's not treated, nerve damage can cause a number of
problems. For example, because of the numbness, people
with nerve damage might not realize that they have a cut,
and it could become seriously infected before they discover
it. Because nerve damage can happen anywhere in the body,
problems can occur in almost any organ system, including
the digestive tract, urinary system, eyes, and heart.
Doctors usually diagnose nerve damage by giving a person a
physical exam. A biopsy of nerve tissue or other special tests
may also be necessary. The doctor might recommend that
the patient see a nerve specialist (neurologist).
Doctors believe nerve damage is linked to high blood sugar
levels over time. So controlling blood sugar levels by
following a diabetes treatment plan can help reduce a
person's risk of developing this complication.
Heart and Blood Vessel Diseases
People with diabetes have a higher risk of developing certain
problems with the heart and blood vessels. (These are called
cardiovascular diseases.) Some of these problems are:
heart attack (caused by a blockage of the blood
vessels supplying blood to the heart)
stroke (caused by a blockage of the blood vessels
supplying the brain)
blockage of blood vessels in the legs and feet, which
can lead to foot ulcers, infections, and even loss of a
toe, foot, or lower leg
How well a person controls his or her blood sugar probably
plays a role in heart and blood vessel problems, too. And if a
person smokes, is obese, has abnormal levels of blood lipids
(triglycerides or cholesterol), high blood pressure, or a
family history of heart attack or stroke before age 50, he or
she definitely has a higher risk of these problems.
One thing you can do to reduce your risk of cardiovascular
diseases is to be a healthy weight. If you're overweight, your
doctor can suggest ways to help you lose weight and stay
there. The doctor may also check your blood lipid levels
(cholesterol and triglycerides) and blood pressure regularly
to be sure they're in a healthy range. Following your
diabetes meal plan, getting regular exercise, and taking
diabetes medications as prescribed may also help prevent or
delay the development of heart and blood vessel problems.
In addition, smoking increases the risk of heart and blood
vessel problems, as well as other diabetes complications.
Gum Disease
People with diabetes are more likely than others to develop
gum disease (also called periodontal disease) because they
may have:
more plaque and less saliva (too much plaque on the
teeth and not enough saliva can contribute to tooth
decay)
higher blood sugar levels (a person has more sugar
in their mouth, which can also lead to tooth decay)
some loss of collagen, a protein that's in gum tissue
poor blood circulation in the gums
All of these factors can contribute to gum disease. Signs and
symptoms of gum disease include bleeding, sensitive, and
painful gums. A person's gums may also recede (receding
gums is a term that means the gum tissues no longer cover
the root surfaces of teeth), or be discolored. Dentists can
diagnose gum disease during regular checkups.
Fortunately, you can prevent gum disease by managing your
blood sugar levels, taking good care of your teeth by
brushing and flossing daily, and getting regular dental
checkups.
Foot Problems
After a person has had diabetes for many years, he or she
can develop foot problems because of poor blood flow in the
feet and nerve damage.
Starting at puberty, your doctor will check your feet for any
signs of problems. You should tell your doctor about any foot
problems you're having, such as ingrown toenails, calluses,
and dry skin. Even if your feet just feel irritated because
you've been wearing certain shoes or because you've had a
minor sports injury, you should tell your doctor.
To prevent foot problems, wear comfortable shoes that fit
properly and keep your toenails trimmed to the shape of the
toe. Exercise, which increases blood flow to the feet, can
also help keep feet healthy.
Smoking can increase the risk of foot problems or make
them worse.
Staying Healthy for the Long Haul
Some complications of diabetes occur after years — even
decades — of having the disease, and sometimes people
don't even have any noticeable symptoms. That's why it's so
important to follow your diabetes management plan and
taking an active role in your health by getting regular
medical care and checkups with your diabetes health care
team. They can detect many diabetes problems before they
start causing symptoms and help you get the treatment you
need.
Treatment of Diabetes
There are several aspects in the treatment of diabetes, each one with a
very important role.
The mainstays of diabetes treatment are:
1.
2.
3.
4.
Working towards obtaining ideal body weight
Following a diabetic diet
Regular exercise
Diabetic medication if needed
Note: Type 1 diabetes must be treated with insulin; if you have type 2
diabetes, you may not need to take insulin. This involves injecting
insulin under the skin for it to work. Insulin cannot be taken as a pill
because the digestive juices in the stomach would destroy the insulin
before it could work. Scientists are looking for new ways to give insulin.
But today, shots are the only method. There are, however, new methods
to give the shots. Insulin pumps are now being widely used and many
people are having great results.
Working towards obtaining ideal body weight
An estimate of ideal body weight can be calculated using this formula:
For women:
Start with 100 pounds for 5 feet tall. Add 5 pounds for every inch over 5
feet. If you are under 5 feet, subtract 5 pounds for each inch under 5
feet. This will give you your ideal weight.
If you have a large frame, add 10%. If you have a small frame, subtract
10%. A good way to decide your frame size is to look at your wrist size
compared to other women's.
Example: a woman who is 5' 4" tall and has a large frame.
100 pounds + 20 pounds (4 inches times 5 pounds per inch) =120
pounds.
Add 10% for large frame (in this case 10% of 120 pounds is 12 pounds).
120 pounds + 12 pounds = 132 pounds ideal body weight.
For men:
Start with 106 pounds for a height of 5 foot. Add 6 pounds for every inch
above 5 foot.
For a large frame, add 10%. For a small frame, subtract 10%. (See above
for further details).
The Diabetic Diet
Diet is very important in diabetes. There are differing philosophies on
what is the best diet but below is a guideline with some general
principles.
Patients with type 1 diabetes should have a diet that has approximately
35 calories per kg of body weight per day (or 16 calories per pound of
body weight per day).
Patients with type 2 diabetes generally are put on a 1500-1800 calorie
diet per day to promote weight loss and then the maintenance of ideal
body weight. However, this may vary depending on the person's age,
sex, activity level, current weight and body style. More obese individuals
may need more calories initially until their weight is less. This is
because it takes more calories to maintain a larger body and a 1600
calorie diet for them may promote weight loss that is too fast to be
healthy.
Men have more muscle mass in general and therefore may require more
calories. Muscle burns more calories per hour than fat. (Thus also one
reason to regularly exercise and build up muscle!) Also, people whose
activity level is low will have less daily caloric needs.
Generally, carbohydrates should make up about 50% of the daily
calories (with the accepted range 40-60%). In general, lower
carbohydrate intake is associated with lower sugar levels in the blood.
However the benefits of this can be cancelled out by the problems
associated with a higher fat diet taken in to compensate for the lower
amount of carbohydrates. This problem can be improved by substituting
monounsaturated and polyunsaturated fats for saturated fats.
Most people with diabetes find that it is quite helpful to sit down with a
dietician or nutritionist for a consult about what is the best diet for them
and how many daily calories they need. It is quite important for diabetics
to understand the principles of carbohydrate counting and how to help
control blood sugar levels through proper diet. Below are some general
principles about the diabetic diet.
Understanding Food Groups
There are three basic food groups: fats, proteins, and carbohydrates.
The carbohydrates are the foods that can be broken down into sugar. It
is essential to have all three food groups in your diet to have good
nutrition.
1. Why Count Carbohydrates?
Carbohydrates make your blood glucose level go up. If you know how
much carbohydrates you've eaten, you have a good idea what your
blood glucose level is going to do. The more carbohydrates you eat, the
higher your blood sugar will go up.
2. Which Foods Contain Carbohydrates?
Most of the carbohydrate we eat comes from three food groups: starch,
fruit, and milk.
Vegetables also contain some carbohydrates, but foods in the meat and
fat groups contain very little carbohydrate. Sugars may be added or may
be naturally present (such as in fruits).
The nutrient term for sugars can also be identified by looking for -ose at
the end of a word ( i.e, glucose, fructose, and sucrose are all sugars).
Look for these on food labels to help identify foods that contain sugar.
2. Goal:
Improve nutritional status among diabetic patients in
KFSH.
3. Objectives:
 Patients will be able to list nutritional related problems
related to his condition
 Patients will be able to list 5 food items low in suger.
 Patients will be able to list the 5 foods to avoid.
 Patients be able to explain the right way to prepare food.
 Patients will be able to list nutritional related problems
related to his condition.
 Patients will be able to identify food that raises blood
glucose level.
 Patient will be able to do blood glucose test.
4. Target Group:
Diabetic patients in KFSH male and female.
5. Location:
King Faisal Specialist Hospital
6. Time:
Feb. 2010 – Feb. 2011
7. Plan:
I'm going to implement my program by individual teaching
and group teaching. And patients will be given written material
and will see visual display of the given information. So at the
end of the program the goal will be fulfilled.
8. Individual Teaching:
a. Objectives:
 Patient will be able to list the food allowed in every
stage of his diet.
 Patient will be able to explain the importance of good
nutrition on her status.
 Patient will be able to list 5 food to avoid
 Patient will be able to identify the foods that raises
blood glucose level
 Patient will be able to do blood glucose test.
b. Session plan:
3 sessions and 4 follow-ups in the giving time. Lab
results and physical diagnoses will be included.
Session 1:
Location: in patient room
Introduce myself and explain why am seeing the pt.
Address pt's concerns and worries and his health status.
His labs and blood glucose level.
Give him an idea about the diet he will follow.
Low sugar low fat diet, high fiber.
What is a good life style?
Session 2:
Location: in patient room
Ask pt about his appetite, if he is liking the food or not.
Healthy food habits, blood glucose level.
If he has any kind of complications or questions.
Explain the importance of exercise.
Schedule next appointment in out patient clinic with the doctor
appointment.
Session 3:
Ask pt. about the diet he is following, and if he is
having any nutritional related problems, his blood
glucose level.
And check on pt lab results. And discuss it with the
patient.
c. Follow up sessions:
4 Check ups on paints lab results and compliance by testing
patient. Monitor his labs and weight change. If pt is having any
nutritional deficiency.
d. Time:
First session first day patient is admitted (10 min
maximum)
Second session before discharge (15-30 minutes)
Third session is out patent clinic with doctor’s
appointment (15-30 minutes)
Follow up with doctor’s appointment every 3
months.
e. Location:
Dietitian's office and in patient room at KFSH.
f. Material:
Food samples, presentations, brochure, menu
g. Evaluation:
Pre/post test in every session. Lab results and weight
change.
h. Documentation:
In dietitian's note in the pt's file.
9.Group Teaching:
a. Objectives:
 Group will be able to do blood glucose test.
 Group will know the importance of exercise and
healthy life style, and loosing weight if needed.
 Group will be able to name to avoid food high
sugar high fat.
 Group will be able to identify nutritional related
problems to their condition .
 Group will share experiences and successful
strategies .
b. Session plan:
Introduce myself and then explain what is
Diabetes.
c. Time:
Every 1st Monday of every month.
d. Location:
Waiting area of the Diabetic clinic
e. Material:
Presentation.
f. Evaluation:
Self-administered questioner
g. Documentation:
In my program file.
10.Material:
Presentation, Food models, menus, brochures and displays
11.Tools:
Computer, printer, phone.
12.Referral:
My pager No. Clinic extenuation
13.Health Care:
Lab workers, doctors and nurses
14.Final Evaluation:
Lab results and questioners
15.Documentation:
 Report to the administration.
 Publish results in the hospital journal.