Management and Prevention

 
Prevention of Diabetes
 
While there is no single cause of type 2 diabetes, there are well-established risk factors. Some of these can be changed and some cannot.
You are at a higher risk of getting type 2 diabetes if you:
·         have a family history of diabetes
·         are older (over 55 years of age ) – the risk increases as we age
·         are over 45 years of age and are overweight
·         are over 45 years of age and have high blood pressure
·         are over 35 years of age and are from an Aboriginal or Torres Strait Islander background
·         are over 35 years of age and are from Pacific Island, Indian subcontinent or Chinese cultural background
·         are a woman who has given birth to a child over 4.5 kgs (9 lbs), or had gestational diabetes when pregnant, or had a condition known as Polycystic Ovarian Syndrome.
What outcomes can I change?
Your lifestyle choices can prevent or delay the onset of type 2 diabetes and the good news is that research has shown type 2 diabetes can be prevented in up to 58% of cases.

The lifestyle choices are your key tools of management to prevent development of diabetes these tools or jobs are.
·         Maintaining a healthy weight
·         Regular physical activity
·         Making healthy food choices
·         Managing blood pressure
·         Managing cholesterol levels
·         Not smoking.
 
 
Why are your food choices so important?
What you eat can affect your health in a number of ways. For example, poor food choices may
Contribute to you beinging overweight, having high blood glucose levels if you have diabetes, raised cholesterol and blood pressure, some cancers and heart disease.
A healthy meal plan can help you to:
·         Control your blood glucose levels if you have developed diabetes
·         Control your weight
·         Improve your cholesterol levels
·         Reduce your risk of heart disease
·         Improve your general health and wellbeing.
Changing your eating habits is not easy. Any changes to your food intake should be for the long term.
Short-term diets are not recommended as you will soon return to your
Usual eating pattern. It is best to make small changes which you can continue indefinitely.
If you have developed diabetes the management of your lifestyle is still vitally important  

The aim of diabetes treatment is to maintain blood glucose levels within the normal range, which is between 4.0 and 6 mmol/L before meals and 4.0 and 8mmol/L two hours after meals. This will help prevent possible long-term problems that can affect the heart, blood vessels, eyes, kidneys and nerves.Keeping your blood pressure and cholesterol within the recommended range is very important to help prevent these long-term problems. Healthy eating, achieving and maintaining a healthy weight and doing regular physical activity can help you do this. Sometimes tablets and then insulin may also be needed.
A healthy meal plan and lifestyle including exercise is still your key management tools however often your doctor will prescribe medication to help your body deal with your diabetes.
These medications allow your body to function better with your diabetes but cannot replace a healthy lifestyle no form of diabetes medication cures diabetes.
 
 
 
 
 
Often one of the hardest hitting statements I have seen is this one
·         Diabetes is the leading cause of blindness Kidney disease and Heart disease in Australia?
·         True or False?

 

Think about this one for a second the statement is false poorly controlled diabetes is a leading cause of blindness Kidney disease and Heart disease the two keys with managing your diabetes are reducing the risk of developing it in the first place and managing it well if you do develop it.

 

Diabetes Complications

Persistently high blood glucose levels (BGLs) over a period of time can damage the body’s organs. This damage is referred to as diabetes related complications.
While these complications are serious and can be life threatening, with sustainable lifestyle changes and attention to blood glucose control, people with diabetes can substantially reduce the risk of these complications and manage their disease well.

 

How are my blood glucose levels measured

Blood glucose levels for those with diabetes are measured in two distinctly different ways. Both ways are important for different reasons.

HbA1C_Diabetes_Control

HbA1c
What does it measure?
Haemoglobin (the Hb of HbA1c ) is present in everyone’s red blood cells. It’s what makes your blood red. Glucose sticks to the red cells and the more glucose there is in your blood stream, the more glucose sticks to the red cells. The average life span of a red blood cell is 120 days (three months), and if we measure how many red cells have glucose attached to them, it gives us a guide to the glucose levels in your blood over the last 120 days. It gives us an average level, which in turn indicates your risk of developing problems with your health.

 

What does it not measure? Glycated haemoglobin (HbA1c,) is not a measure of blood glucose as you would get it if you were doing a finger prick and testing your blood with your meter. It doesn’t measure sudden changes
in your blood glucose, or what your blood glucose level is right at the moment of testing.

 

 

HbA1c Units change

 

HbA1c has recently changed the way in which it is represented below is a very good chart compare the old terminology with the new

 

HbA1cConversionTable

 

Blood glucose self-testing

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Testing you own blood glucose levels is also a crucial tool but help understand your disease and its management. If you spend some time researching the topic you will find much disagreement as to how often or even how useful it is however as a dietitian and diabetes educator I believe it is vitally important. There is no argument that it is vitally important when starting out and if you are own medication particularly insulin that can cause your blood sugars to drop but some are questioning if those that are on basic medication gain much from self-testing.

 

In my opinion as well as adding significant value to medication management self-testing particularly for the newly diagnosed is an absolute must. Many a time have I come across someone that is convinced they are fine and don’t have diabetes until they test their blood glucose levels and understand blood glucose levels and food interactions. Don’t go and get one from you chemist or doctor visit a dietitian or Credentialed Diabetes Educator and work through what to do and why.

 

 

Changes to access to blood glucose test strips. 

In 2107 access to subsidized blood glucose testing strips has now been changed

  • People with type 2 diabetes not using insulin will receive an initial six-month supply of subsidised blood glucose test strips under the NDSS. This means registrants will be able to access blood glucose test strips, as required, over a six-month period, starting any time on or after 1 July 2016.

 

  • After six months, registrants will be able to continue to access subsided test strips if their doctor, nurse practitioner or Credentialed Diabetes Educator considers that there is a clinical need for them to continue to monitor their blood glucose levels.

 

Unfortunately, the mighty dollar has won the battle as to justify weather or not self-testing is useful for basic diabetes, personally I would never suggest individuals test without a plan and test often if they are well controlled, but it is worth noting that less than 1/2 of all Australians with diabetes are at target.

 

A word on the studies that have led to reduced testing strip access 

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what all the studies that suggested testing with “stable diabetes” has limited value have in common is that they do not define who is giving the education or what education was given. I believe all these studies are showing is that we give mediocre quality education from those with limited knowledge or limited time and not surprisingly if you do not know why you’re doing something will get very little out of testing. In my opinion we need to see the benefit or not of consistent monitoring in basic cases where they have been educated by Credentialed Diabetes Educators and Dietitians NOT where they have had 30 seconds with the nurse/GP or pharmacy assistant who are at best semi-skilled in this area.

 

Blood glucose monitoring is a valuable diabetes self-management tool, which enables you to check your own blood glucose levels as often as you need to, as recommended by your doctor of Credentialed Diabetes Educator.

Blood glucose level pattern changes can alert you and your health professionals to a possible need for a change in how your diabetes is being managed.

Testing your blood glucose levels will help you to:

  • Develop confidence in looking after your diabetes
  • Better understand the relationship between your blood glucose levels and the exercise you do, the food you eat, other medication you may take, and other lifestyle influences such as travel, stress and illness
  • Find out immediately if your blood glucose levels are too high (hyperglycaemia) or too low (hypoglycaemia)
  • Alert you to seek the advice of your diabetes team about adjusting your insulin, tablets, meal or in-between meal planning when blood glucose goals are not being met.

To test blood glucose levels, you will need:

  • A blood glucose meter
  • A lancet device with lancets
  • Test strips.

It is a simple procedure and the results are displayed within seconds.

Blood glucose meters are usually sold as kits giving you all the equipment you need to start. There are many different types, offering distinctive features and at different prices to meet individual needs. Most of these are available from Diabetes Australia in your state or territory, pharmacies and some diabetes centres.

Your doctor or a Credentialed Diabetes Educator can help you choose the meter that’s best for you. It is important that you talk to your Credentialed Diabetes Educator about how to use your meter correctly so that you can be sure your results are accurate.

 

Diabetes Complications

When diabetes is left undiagnosed or unchecked for too long, it can be responsible for a number of diabetes related complications such as heart disease, kidney disease, blindness, limb amputation, erectile dysfunction and persistent infections. • Diabetes and eye disease

Diabetic retinopathy is the leading cause of blindness in Australians aged under 60. The development of retinopathy is strongly related to the length of time diabetes has been present and the degree of blood glucose control. Regular checks and treatment can prevent blindness caused by retinopathy.

Diabetes and kidney disease

Your kidneys help to clean your blood. They remove waste from the blood and pass it out of the body as urine. Over time diabetes can cause damage to the kidneys which causes them to leak. You won’t notice damage to your kidneys until it’s quite advanced, so it is important you have the recommended tests to pick up any problems early. Information can be found at Kidney Health Australia Kidney health Australia

 

 

  • Diabetes and lower limbs

Neuropathy or peripheral nerve disease and vascular damage may lead to leg ulcers and serious foot problems from which lower limb amputation may result. Personal daily foot checks and thorough annual foot examinations conducted by your doctor or podiatrist will are essential to help to reduce your risk of lower limb complications.

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Diabetes and heart disease/stroke

 

 

 

Those with diabetes are at a higher risk of heart disease and stroke due to raised blood glucose levels (BGLs), in association with high blood pressure and cholesterol. Your best source on information on diabetes and heart disease is the Heat Foundation http://www.heartfoundation.org.au/Pages/default.aspx