Diabetes management
[1] Often, the recommended treatment is a combination of lifestyle changes such as increasing exercise and healthy eating, along with medications to help control the BG levels in the long term.
[10] Regular 6 monthly laboratory testing of HbA1c (glycated hemoglobin) provides some assurance of long-term control and allows the adjustment of the patient's routine medication dosages in such cases.
By keeping a diary of their own BG measurements and noting the effect of food and exercise, patients can modify their lifestyle to better control their diabetes.
[12][13] The targets are: Goals should be individualized based on:[14] In older patients, clinical practice guidelines by the American Geriatrics Society recommend, in frail patients who have a life expectancy of less than 5 years, a target a Hb A1c of 8% is appropriate as the risk of very low blood sugar outweighs the long term benefits of a lower A1c.
It shows than to demonstrate a difference in all-cause cardiovascular death, non-fatal stroke, or limb amputation, but decreased the risk of nonfatal heart attack by 15%.
[18] Some diets that have commonly been used successfully in diabetes management and help with weight loss include Mediterranean, vegetarian, low carb or carb-controlled.
[18] Patients should avoid excess simple carbs or added fat (such as butter, salad dressing) and instead eat complex carbohydrates such as whole grains.
[1] In the long term, it is helpful to eat a consistent diet and amount of carbohydrate to make blood sugar management easier.
[20] Although for certain individuals it may be feasible to follow a low-carbohydrate regime combined with carefully managed insulin dosing, this is hard to maintain and there are concerns about potential adverse health effects caused by the diet.
[26] During the last 20 years, resistance training has gained considerable recognition as an optimal form of exercise for patients with type two diabetes.
[24] Several studies have made it clear that exercise helps with blood sugar control and has shown to lower HbA1c levels by approximately 0.6% in patients with T2D.
[2] There are many benefits of exercise such as a decreased risk of cardiovascular diseases, including blood pressure, lipid profiles, body composition and insulin sensitivity.
[29] Common strategies to help reduce weight many include lifestyle measures such as diet and exercise, behavioral therapy, pharmacologic interventions, and surgery.
[32] Insulin therapy requires close monitoring and a great deal of patient education, as improper administration is quite dangerous.
They allow a continuous infusion of small amounts of insulin to be delivered through the skin around the clock, plus the ability to give bolus doses when a person eats or has elevated BG levels.
[38] Lastly, the medication also slows down the movement of food through the digestive tract and can increase feeling of fullness while eating, decreasing appetite and weight.
In diabetic people who have a body mass index of 35 or higher, and who have been unable to lose weight otherwise, bariatric surgery offers a viable option to help achieve that goal.
[40] The results of this study demonstrated that, five years after bariatric surgery, there was meaningfully significant weight loss in a large majority of patients.
[44] A simpler method proposed by researchers provides a more detailed risk score based on three pieces of information (insensitivity, foot pulse, previous history of ulcers or amputation).
Conducting regular self-management tasks such as medication and insulin intake, blood sugar checkup, diet observance, and physical exercise are really demanding.
[52] This is why the use of diabetes-related apps for the purposes of recording diet and medication intake or BG level is promising to improve the health condition for the patients.
Checking the blood pressure and keeping it within strict limits (using diet and antihypertensive treatment) protects against the retinal, renal and cardiovascular complications of diabetes.
Intensive efforts to achieve blood sugar levels close to normal have been shown to triple the risk of the most severe form of hypoglycemia, in which the patient requires assistance from by-standers in order to treat the episode.
[56][57] Some patients are more prone to hypoglycemia as they have reported fewer warning symptoms, and their body released less epinephrine (a hormone that helps raise BG).
Prolonged and elevated levels of glucose in the blood, which is left unchecked and untreated, will, over time, result in serious diabetic complications in those susceptible and sometimes even death.
Being able to detect cost-related nonadherence is important for health care professionals, because this can lead to strategies to assist patients with problems paying for their medications.
Interventions to improve adherence can achieve reductions in diabetes morbidity and mortality, as well as significant cost savings to the health care system.
[63] Such mechanisms are inter-related, as one's thoughts (e.g. one's perception of diabetes, or one's appraisal of how helpful self-management is) is likely to relate to one's emotions (e.g. motivation to change), which in turn, affects one's self-efficacy (one's confidence in their ability to engage in a behaviour to achieve a desired outcome).
In the case of children and young people, especially if they are socially disadvantaged, research suggests that it is important that healthcare providers listen to and discuss their feelings and life situation to help them engage with diabetes services and self-management.
By working on increasing motivation and challenging maladaptive illness perceptions, programs such as CBT-AD aim to enhance self-efficacy and improve diabetes-related distress and one's overall quality of life.
