Diabetes Mellitus

INTRODUCTION

The classic symptoms of uncontrolled diabetes are:

• polyuria (every hr or so)

• polydipsia

• loss of weight (type 1)

• tiredness and fatigue

• propensity for infections, esp. of the skin and genitals

Note: For every diagnosed diabetic there is at least one undiagnosed diabetic.

Diagnosis

• Fasting venous plasma glucose ≥7.0 mmol/L on two occasions or once if symptomatic

• Random venous plasma glucose ≥11.1 mmol/L on two occasions or once if symptomatic

• HbAlc >6.5% (>48 mmol/mol).

• In asymptomatic or mildly symptomatic patients, the diagnosis is made on two separate elevated readings, either a fasting test or 2 or more hrs postprandial (or the 2 values from an oral glucose tolerance test)

If random or fasting VPG lies in uncertain range (6.0–11.0 mmol/L) in either a symptomatic patient or one with risk factors, perform an OGTT.

Management

The three key tasks:

1. Achieve strict glycaemic control (HbA1c ≤7%)

2. Achieve BP ≤140/90 mmHg (≤130/80 if proteinuria)

3. Achieve control of blood lipid levels

Both type 1 (IDDM) and type 2 (NIDDM):

• patient education, reassurance and support

• consider diabetic educator, dietitian

• dietary control vital

• exercise also very important

• referral to ophthalmologist

• goals of management (Table D2)

Diet

• Type 1 patients often require three meals and regular snacks each day.

• Type 2 patients usually require less food intake and restriction of total intake.

Principles of dietary management

• Keep to a regular nutritious diet (follow GI index foods)

• Achieve ideal body weight

• Reduce calories (kilojoules), i.e. added sugar, dietary fat

• Increase proportions of vegetables, fresh fruit, cereal foods

• Follow a low carbohydrate, healthy fat diet

TYPE 1 DIABETES MELLITUS

Preferred insulin regimens: (Fig. D4)