Diabetes mellitus, which becomes more prevalent each day like an epidemic in all over the globe, negatively affects many body systems. Treatment of diabetes, which can lead to serious health problems from eye diseases and organ failures unless it is taken under control, requires close follow-up. While monitoring the disease, it is crucial that a team comprising of ophthalmologist, neurologist, cardiologist, nephrologist, psychiatrists, dieticians and diabetes training nurses, but especially the endocrinologist who carries out the medical follow-up, works cooperatively. Additionally, a team for diabetic foot, consisting orthopedist, physiotherapist, vascular surgeon, dermatologist and infectious diseases physician, should be involved with the treatment process. Assoc. Prof. Cüneyd Anıl, M.D. from Endocrinology Department of Güven Health Group answered questions on diabetes within the scope of November 14th World Diabetes Day.
What is Diabetes Mellitus? What are Type 1 diabetes mellitus and Type 2 diabetes mellitus?
Diabetes mellitus, publicly known as diabetes, is a chronic and progressive metabolic disease characterized with high blood sugar; which progresses with serious disorders of carbohydrate, protein and fat metabolism, negatively affects quality of life and health and can lower the life expectancy. Type 1 diabetes mellitus is a disease characterized with absolute deficiency of insulin, which usually manifests itself at early youth or childhood. The treatment requires life-long use of insulin starting from the moment of diagnosis. Type 2 diabetes mellitus usually manifests itself after one’s thirties, especially due to weight gain. It is an insidious disease and generally does not show symptoms in early stages. The disease may cause complications at this period.
What is pre-diabetes?
“Pre-diabetes" (latent diabetes), is a transition period between normal glucose metabolism and diabetes mellitus. Prevalence of diabetes mellitus in patients with pre-diabetes is much higher compared to those without pre-diabetes. Moreover, researches demonstrate that pre-diabetes process leads to certain complications over time, similar to diabetes mellitus. Therefore, making diagnosis and starting treatment delay transition into diabetes mellitus and, in certain cases, even prevents the transition. Complications of diabetes mellitus can be prevented for the patients who are diagnosed early in pre-diabetes process.
Does diabetes mellitus show symptoms? What are the symptoms of Diabetes Mellitus (Diabetes)?
Although it is an insidious disease, the main symptoms of diabetes mellitus include dry mouth, excessive thirst (polydipsia), frequent urination (polyuria) and involuntary weight loss. Additionally, less specific symptoms may be seen, including but not limited to fatigue, generalized-mobile pain, cramps, sensation of burning, tingling, numbness in feet, indigestion, irregular bowel movements, dizziness, palpitation, headache, delayed wound healing. All of the above specified symptoms manifest when blood glucose remains above a certain level for an extended period of time. Therefore, it can be said that symptoms of diabetes mellitus are observed after certain complications develop. On the other hand, diabetes mellitus can be diagnosed before symptoms develop. Fasting plasma glucose analysis, which is studied after an overnight fasting period from 8 to 12 hours, is the most simple and basic means of diagnosis. It specific cases, other diagnostic methods and glucose tolerance test may be used.
What are the most up-to-date methods used for treatment of diabetes mellitus?
The basis of treatment of diabetes mellitus consist of training, medical nutrition therapy, exercise, weight management, medication treatment and, if necessary, metabolic surgery. Oral and injectable medications are used for medication treatment. Injectable group includes non-insulin medications and insulin. New medications are developed parallel to rapid scientific advancements and researches for all medications under this main group. These medications can be recommended individually or in combinations for treatment.
Does every patient with diabetes mellitus have to use insulin?
Use of insulin is not necessary for every patient with diabetes mellitus. The most important indication for using insulin is severely unregulated blood glucose. Other specific cases requiring insulin use include but are not limited to unregulated blood glucose despite diet at pregnancy, associating serious kidney and liver problems or operative processes.
What are the optimal levels of fasting and post-prandial blood glucose for patients with diabetes?
Treatment goals and diagnosis criteria in patients with diabetes mellitus are not identical. As a general rule, it is targeted to keep fasting blood glucose level between 70 and 130 mg/dL and post-prandial blood glucose between 70 and 160 (180) mg/dl. Besides, the average level of blood glucose over the past 3 months, called HbA1c, is an important element in the follow up period. The desired level for the average level of blood glucose over the past 3 months is 7 percent or, even a better value of 6.5 percent. The above mentioned threshold values may change in specific situations. For example, for elderly patients with certain irreversible complications due to diabetes mellitus, 7.5 - 8 for the average value of blood glucose over the past 3 months is acceptable.
How should be the diet of diabetic patients? How should a diabetic diet be constructed?
Nutrition plans for patients with diabetes should be made under complete supervision of a dietician and specifically for each individual. Meals and snacks should not be skipped. Meals should be restricted with regard to carbohydrates and fat while containing certain rate of protein. Personalized nutrition plan should be closely monitored and updated when necessary.
Does diabetes negatively affect other systems of the body?
Diabetes mellitus can negatively affect all systems in the body. Unregulated high blood glucose has a destructive effect on organs. After a certain stage, the destruction becomes irreversible. The main organs that are negatively affected by high blood glucose are: heart, kidneys, brain, nervous tissues, eyes and limbs, most remarkably the feet. Hypoglycemia, low blood glucose level, which is a critical condition and is frequently seen in diabetic patients, mainly affects brain and nervous tissues. Closely monitoring patients with a multidisciplinary approach is crucial for minimizing negative effects of diabetes on other organs.
Can patients with type 2 diabetes stop medications or insulin after losing weight?
Patients with type 2 diabetes mellitus who lose weight and maintain their body weight require less of all medications. In certain cases, patients can even completely stop the medication; dose of insulin may be decreased or insulin use can completely be stopped.
How should be the diet of diabetic patients? How should a diabetic diet be constructed?
Nutrition plans for patients with diabetes should be made under complete supervision of a dietician and specifically for each individual. Meals and snacks should not be skipped. Meals should be restricted with regard to carbohydrates and fat while containing certain rate of protein. Personalized nutrition plan should be closely monitored and updated when necessary.
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