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Type 2 Diabetes Mellitus (T2DM) is a condition of elevated glucose (hyperglycemia) and resistance to insulin which causes damage to the blood vessels in the body. The long term effects include heart disease, kidney failure, stroke, loss of limbs and blindness. The condition affects a significant portion of the population and the prevalence is increasing, especially in children. The consequences of diabetes can be prevented; either by preventing the onset of diabetes or by managing diabetes if you have it. This article will focus on the management of diabetes.
Diabetes typically will present with hyperglycemia long before symptoms or damage occur. This can be detected on routine screening by either a fasting serum glucose level, a glucose challenge or a hemoglobin A1C test. The values can be either normal, borderline or in the diabetic range. If they are borderline, the term pre-diabetes is sometimes used.
If you have pre-diabetes the goal is to prevent the onset of diabetes by keeping the blood glucose levels in a normal range. In the pre-diabetes state this can be done through lifestyle changes. Weight loss is paramount in overweight and obese individuals. Effective weight loss typically results from regular exercises and a proper diet. Weight loss and regular exercises improves the body’s ability to utilize insulin and process glucose. A diet low in fat, with the appropriate amount of calories and with complex carbohydrates only also helps with weight loss and glucose control. Education and support are also keys to modifying behavior which is required for long term success. A clinical research study, called the Diabetes Prevention Program, demonstrated a 58% reduction in risk of developing diabetes in those participating in the lifestyle intervention group.
Some people will develop T2DM, despite lifestyle intervention. Effective treatments are available for those who do not respond to weight loss, diet change and regular exercise. Medications are available to treat diabetes. These oral agents are designed to help control the serum glucose levels. The most popular is metformin. It is well studied, helps with modest weight loss and has minimal side effects. In the diabetes prevention program, individuals who took metformin reduced their risk of developing diabetes by 31%. Other agents are also available and can be used in combination with metformin. For those whose diabetes is difficult to control, insulin maybe needed. Remember, the goal of treatment is to make sure the serum glucose levels remain in a normal range all of the time. This is the way to prevent vascular damage.
If you have been diagnosed with diabetes, your doctor should not only treat you for the diabetes but also look for evidence of vascular damage. Tests should be done to make sure the vital organs are not showing any ill-effects from chronic hyperglycemia. An electrocardiogram can evaluate the heart while blood and urine tests can check kidney function. An eye examination, specifically looking at the vessels of the retina can see if there is early damage. Your doctor may recommend an in-depth examination of your feet by a podiatrist.
There are other conditions that can work in concert with diabetes to cause problems. If you have elevated cholesterol (hyperlipidemia) and/or hypertension these conditions should be treated to prevent organ damage. If you smoke, you should quit as this is extremely toxic to the blood vessels of the body. Smoking, hyperlipidemia and hypertension can cause heart disease and stroke alone; imagine what damage can occur when these are present along with diabetes.
Type 2 Diabetes Mellitus is a common problem but it can be managed to prevent chronic organ damage and premature death. You can start by developing healthy habits such as regular exercise and a proper diet. Stop smoking and lose weight. If you have risk factors or symptoms see a doctor and ask about diabetes screening. Take control of your health and do what is needed so you can increase your chance of living a healthy life.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!
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