Tuesday, August 13, 2013

How Much You Know About Diabetes Mellitus??

Diabetes Mellitus (DM) is a chronic disease whereby the pancreas produce little/ no insulin or decreased insulin sensitivity. This lead to abnormalities in the metabolism of carbohydrate, protein and fat, whereby high blood glucose is one of the major symptom.




STATISTIC

Worldwide, 347 million people are diagnosed with DM. More than 80% of diabetes occur in low- and middle-income countries. In Malaysia, DM was ranked 5th place in the top 10 causes of death for 2008. In 1986, the prevalence of DM in Malaysia was 6.3% in adults above the age of 30 years old. This has increased to 8.3% in 1996 and 14.9% in 2006 respectively, upped by almost 79.5% in the space of 10 years! According to latest statistic from Ministry of Health, 1 in 7 Malaysians diagnosed with DM!

RISK FACTORS

The increase of diabetes has been linked to the raised in prevalence of overweight, obesity, particularly intra-abdominal obesity, improper diet, sedentary lifestyle, family history of diabetes, age, prior history of gestational diabetes and race.



DIAGNOSIS AND PRESENTATION

Normal fasting blood glucose is in the range of 4.4 to 6.1 mmol/L. A fasting blood glucose above 7 mmol/L is sufficient to diagnose diabetes. Increased in thirst and frequent urination are classic symptoms of diabetes. High blood sugar will depress the immune system and also provides a good medium for bacterial growth which lead to frequent infections, with skin abscesses (boils) and urine tract infections being most common. Other symptoms such as polyphagia, tiredness and weight loss can be possible.



COMPLICATIONS

Uncontrolled blood glucose, either blood glucose too high or too low can lead to long term complications such as heart and blood vessel disease, nerve damage, kidney damage, eye damage and infection.



THERAPY

It is clear that uncontrolled blood glucose plays a role in many complications and therefore medical nutrition therapy plays an important role. It involves management of hypertension, dyslipidemia, and overweight/ obesity in order to reduce the risk of complications as well as improve the quality of life.

DIET MODIFICATIONS

Nutrition therapy is an integral part of total diabetes management. Nutrition prescription should be individualized according to nutritional needs, severity of disease, cultural preferences and willingness to change.



PHYSICAL ACTIVITY

Increased physical activity can improve glycaemic control, assist with weight control, and reduce the risk of cardiovascular disease. General recommendations:

  • A minimum of 3 times per week
  • A minimum duration of 30 minutes per session for overweight individuals or 45-60 minutes for obese individuals.
  • Any increase in daily energy expenditure is beneficial such as gardening, walking up stairs, washing car, mopping the floor etc.
  • In order to prevent hypoglycaemia, medication dosage can be reduced or extra carbohydrate can be consumed before or during physical activity. Ask your health care profession for this management.


PHARMACOLOGICAL APPROACH

Oral Anti-Diabetic agents and/ or insulin therapy may be prescribed by the doctor. Any symptoms experienced during the medication and/ or insulin therapy should inform the doctor. Patients are not advisable to adjust the dosage or stop the therapy themselves unless being instructed.






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