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Diabetes Mellitus

30 November 2016

 

1-_5dvpcgcp409pxzelllchaManagement of Type 2 Diabetes Mellitus

Diabetes is a chronic disease with no cure. Diabetes is a disease in which the body does not produce or properly use insulin (a type of hormone that is needed to convert sugar into energy for daily activities). There are two major types of diabetes which are insulin dependent (Type 1) and non-insulin dependent (Type 2). Type 1 is an autoimmune system which the body cannot produce any insulin and need injection insulin to control their blood sugar level. Type 2 is the body’s inability to make enough or properly use of insulin which also known as insulin resistance. [2]

How to diagnosis the diabetes disease [1]

There are 3 types of method to diagnose the diabetes:

  1. Fasting Blood Glucose Test.

Reference value for the diabetes diagnostic

  Fasting Random
Venous Plasma Glucose ≤ 7.0 mmol/L ≤ 11.0 mmol/L
  • 1 abnormal glucose value is diagnostic for symptomatic patient.
  • 2 abnormal glucose values are required for diagnostic for asymptomatic patient.
  1. Oral Glucose Tolerance Test (OGTT)

The glucose load in OGTT is based on body weight (1.75 g/kg body weight, maximum of 75 g of glucose.

Reference value for the diabetes diagnostic

OGTT Plasma Glucose Values (mmol/L)
Category 0-hour 2 hours
Normal < 6.1 < 7.8
Impaired Glucose Tolerance 6.1-6.9
Impaired Glucose Tolerance 7.8-11.0
Diabetes Mellitus ≥ 7.0 ≥ 11.0
  1. HbA1c Test

Reference value for the diabetes diagnostic

  Normal Pre-diabetes Diabetes
HbA1c < 5.6% (38 mmol/mol) 5.6-6.2%(38-44 mmol/mol) ≥ 6.3% (45 mmol/mol)

HbA1c test is not suitable for diagnosis of diabetes in: [1]

  1. Adolescents (<18 years old)
  2. Patients taking medicines that may cause rapid glucose rise e.g. steroids
  3. Patients with acute pancreatic damage
  4. Pregnant women
  5. Presence of genetic, hematologic and illness related factors that influence A1c and its measurement
  6. Patients in chronic kidney disease stage 4 or 5 and those on erythropoietin injection

Management of Diabetes Mellitus

  1. Alert to the symptoms of hypo/hyperglycemia and always check the blood glucose

Diabetic patients must alert about the symptoms of hypo/hyperglycemia to prevent the under/overdose or side effects of antidiabetic medications. Besides that, routine check of blood glucose can help to improve the blood glucose control of the patients. Patient should learn how to use the glucometer. Patient can buy a glucometer if the patient affordable.

  1. Bye bye to smoking

Diabetes patient should quit smoking if he/she is a smoker. Diabetic patient who smoking will increase the risk of heart diseases due to high glucose level will caused the development of fatty deposits on the wall of arteries which causes blood more difficult to circulate and resulting heart diseases. [3]      

  1. Compliance to the antidiabetic medications

Diabetes patients should know about the proper way of self-administered of insulin or oral agents as prescribed and the importance of taking medications in the appropriate dose in order to improve the compliance of patients.

  1. Diet Control

Patients with diabetes need to maintain a healthy diet consisting of multiple servings of fruits, vegetables, whole grains, low-fat dairy products, fish, lean meats, and poultry. The patients should also limited or quit alcohol intake. [4]

  1. Exercises

Diabetes patients should have regular exercise to improve the functioning of cardiovascular system, lipid profile, blood glucose control, strength and flexibility of muscles and improve quality of live. Exercises improve the cellular glucose uptake by increasing the number of insulin cell receptors. [5]

  1. Follow up check up

Diabetic patients should have regular check up to have their continuing education and the pharmacist can keep update on the patients’ progress and information.

By Pharmacy Department, Sri Kota Specialist Medical Centre

References:

  1. Clinical Practice Guidelines Management of Type 2 Diabetes Mellitus, 5th edition, 2015, Ministry of Health.
  2. What is diabetes? 28 December 2006, Diabetes Malaysia, ‌‌‍‍‍‍‍‍‍‍‌‌http://www.diab../arti.php?aid=5. Retrieved 17/11/2016
  3. Smoking and diabetes, July 2015. ASH fact sheet, www.ash.org.uk. Retrieved 17/11/2016
  4. Franz, M. 2001. Diabetes Management Therapies: A Core Curriculum for Diabetes Education. 4th Edition. Chicago, IL: American Association of Diabetes Educators.
  5. John O. Hollozy. 2005. Exercise induced increase in muscle insulin sensitivity, Journal of Applied Physiology, Vol. 99 no. 1, 338-343