The diabete can be managed by:
1.DIET:
-The patient must fix the time and amount of daily food to allow matching of insulin regim to diet.
-Specify the caloric need to maintain desired body weight(for obese patients 1000-1500 kcal/day;for elderly patients 1500-2000 kcal/day;faor young active patient 2000-3000 kcal/day).
-adjust proporton of food elements to avoid atherosclerosis(5% of calories from carbohydrates,20% of calories from fats,30% calories from proteins).
-Reduce the rate of carbohydrate absorption to avoid glycemia peaks(avoid simple sugars,they are rapidly absorbed;carbohydrates should be taken as starches and other complex sugar;consumption of fibre-rich foods causes slowing of sugar absorption;use food with low glycemic index).
-Advice frequent,relatively small meals to avoid hyperglycemia peaks(for exemple 3 meals and 3 sneaks inbetween meals).
The alcohol consumption has many effects on diabetes!
2.ORAL HYPOGLICEMIA DRUGS:(Only by doctor prescription after an examination and blood test)
-Suplhonylures stimulate the release of insulin from pancreas and decrease insulin resistance
-Biguanides reduce glucose absorption from the gut,reduce the appetite,promote anaerobic glycolysis and increase insulin sensitivity.Is contrandicated in case of severe liver and renal disease and pregnancy.
3.INSULIN.
Available insulins:Actrapid and Humalin S(with short acting),Monotard and Humalin M(intermediate),Ultratard and Humalin Zn(long acting).
Methoda of administration;
-injection by syringes
-pen injection device(zinc insulin cannot be ussed)
-infusion devices(using soluble insuline only)
-artificial pancreas(using soluble insulin only).
Management of Diabetes during pregnancy:
The patient should perform daily home blood glucose levels.Urine test are not useful as renal threshould falls in pregnancy.
The patient has to be seen in the outclinic by obstetrician and physician every 2 weeks.
The fundus examination and urine testing for protein should be done when the patient is first seen,at 28 weeks and before delivery,as retinopathy may deteriorate during pregnancy.
Diet control may be enought in mild cases and pregnancy diabetes.If diet control is not enought the control by insulin is needed.Oral agents should be avoided as they cross the placenta,so there is a potential risk for the baby.
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