Content on this page requires a newer version of Adobe Flash Player.

Get Adobe Flash player

  Diabetes Diet Chart
  Test Required File
  Latest Research
  History of Diabetes mellitus
  World Diabetes Day
  Prevention
  Diabetic Complications
  Diabetes mellitus type 1 & type 2
  Prevention
 

You can prevent or delay the onset of type 2 diabetes through a healthy lifestyle. Change your diet, increase your level of physical activity, maintain a healthy weight. With these positive steps, you can stay healthier longer and reduce your risk of diabetes. Learn about other steps you can take during

 

Check ups for your diabetes

At the start of your diabetes

Children

Children and parents will be taught how to look after their diabetes by specialist nurses in the paediatric department. This is a very specialist subject, not covered in detail here.

Adults

Adults also need to be taught about their diabetes. General advice includes information about a healthy diet, and advice as to how to reduce weight if overweight. Ask for an appointment with a dietician if you are having problems controlling your diabetes, or need to lose weight but can't. The education courses opposite are invaluable.

Adults need to learn how to test their own blood sugar; everyone should do this unless they are too old or poorly.
A chiropodist should advise you how to look after your feet, and an optometrist expert in detecting retinopathy should check your eyes (and do this every year as below).

Daily....feet

Foot  infections can spread rapidly. Great care is needed, especially if you have neuropathy (reduced feeling in your toes).

Daily ...Sugar/glucose

Everyone wants to know how often they should test their blood sugar. The table below is a guide. Remember urine checks detect a relatively high amount of sugar. Diabetes UK advise that every diabetic should test their own blood sugar. If you do not know how to test, by a kit and ask your nurse to show you how.
However, there is no point in testing if you find your sugar levels are high and take no action. See type 1/type 2 on insulin page, or type 2 page.
If your sugar is high, 'action' includes adjusting your insulin dose (perhaps the next day), eating less (especially if overweight), or exercising more.
If your sugar is low, with a hypoi, you need to drink and eat, perhaps reducing your insulin dose.

glucose testing...how often

not test

if very infirm

every week, at different times of day

very well controlled, diet only

every day, at different times

most non-insulin dependant patients

4 times a day

insulin dependant

6-8 times a day 

insulin dependant, seeking very good control

checks ups for diabetes
Remember, you only notice one out of 3 of your hypos, so if you test and notice a low sugar, you may be experiencing other hypos at different times.
Your nurse will advise you how often it is best to test. You need to test more if you are ill (infections cause sugar levels to rise, needing more insulin), or very physically active or stressed. You need to test less if you have a regular lifestyle and your sugar and long term control is good without hypos (HbA1c < 6.5% preferred, 7.5 accepted for most insulin users).
Generally aim for a sugar level before meals of 5-7 mmols/l, and less than 10 mmols 2 hours after a meal. See the glucose testing page.

the glucose testing and medication adjustment cycle

the glucose testing cycle  Enlarge diagram

1 week-3 monthly tests

 

1 week-3 monthly tests

HbA1c

prefer 6.5% or less if you are well; test every 3 months is aiming for good control See

blood pressure

prefer less than 130/80, but lower still if you have maculopathy or kidney damage.
Check monthly and review medication monthly if trying to get lower. Home testing...results need to be 10mmHg lower, that is less than 120/75, lower still with kidney or serious eye problems like maculopathy

weight

Check weekly at home if trying to lose weight , every 2 weeks clinic if you need help

This is a very rough guide. If you are a type one diabetic who has been recently diagnosed, some checks are not so necessary, but help from your specialist nurse is needed each month as above.
If you are trying to achieve better control, of sugar, blood pressure or weight, then monthly checks with your specialist nurse can be very helpful.
So if you have high blood pressure, and want to achieve a lower pressure to help your eyes, you may need monthly checks, changing or increasing medication at each check until controlled.
Similarly, regarding your sugar if you are not well controlled, most people will benefit from 4-8 weekly advice from their nurse. If your HbA1c is up and you want to lower it, you will need to adjust your dose of insulin (or tablets) regularly until it comes down.
Inevitably you may do this too well and notice hypos, and your nurse will need to advise you how to avoid these.
Excellent control of diabetes is achieved in European countries by this regular patient-nurse contact, every 4-8 weeks.

Yearly review..by doctor & nurse

More than half of diabetic patients are not having the recommended tests (BMJ 2010). And a personal view...when the results are high the results are often not acted on, so the result is often largely ignored.
Again, this is a very rough guide. If you are a type one diabetic who has been recently diagnosed, some checks are not so necessary, but help from your specialist nurse is needed each month as above.
Your doctor and nurse need to check how you are coping with your diabetes. Trying to achieve good control can be hard work.
Is the diabetes making you feel depressed? If so, tell your doctor. Trying to enjoy life is the best way to control your diabetes, as long as you don't eat, drink, or smoke to much!
Yoga and Tai chi can help you relax, and walking, cycling and swimming are amoungst the exercise that can make your diabetes much easier to control. An hour's walk a day to keep the doctor away, as they say.
Type 1 patients are more prone to coeliac disease, and should be checked if anaemic or iron deficient.

Yearly check ups

eyes

at optometrist

feet, with instructions for self care

doctor will check circulation and feeling

diet

advice yearly;
more often eg. if overweight and trying to lose weight

weight

2 weekly if trying to lose weight

tests for neuropathy and heart

by doctor

blood pressure, thyroid, electrolytes, cholesterol, tests

statin treatment for most non-pregnant patients, especially if cholesterol is more than 5.

full blood count

type 1 diabetes

if you have fluctuating blood sugars (insulin users)

test for thyroid disease, Addisons, Cushing's,
coeliac disease. Consider depression and needle phobia.

kidneys

protein in urine (microalbumenuria)

Annual educational review

These issues should also be covered in your annual review . Make sure these are covered , and insist that you have the educational training that you need.

  • diet
  • lifestyle & exercise & smoking
  • education about diabetes
  • insulin doses and regime
  • how to adjust insulin
  • how to test blood glucose
  • blood pressure and cardiovascular risk factors
  • not everyone is able to read leaflets etc
  • patients should have attended the relevant educational program, eg DAFNE for insulin dose adjustment
  • contact details of support groups

 

Diary & Targets

diary

Keeping a diary is important. Remember, some doctors and nurses will look at you diary, and do not know what a 'good' blood pressure, sugar, HbA1c, or cholesterol level is. However, your main specialist nurse will be able to tell you how you are doing.
Write down your day to day sugar levels and problems, and the results of your checks (HbA1c, Blood pressure, cholesterol).
To prevent or significantly delay retinopathy and most other diabetic problems, it would be ideal if you could achieve

  • blood pressure about 130/80, but less if you have maculopathy (serious eye problems) or kidney damage
  • HbA1c of 6.5%, although 7% is very good for many people.
  • Recent publications advise all adults with diabetes (if not pregnant) may benefit from statin treatment, whatever the cholesterol level. See immediately below.
  • walking...5000-10000 steps a day to keep your ophthalmologist away.

 Cholesterol

New evidence highlights the importance of lowering lipids to prevent retinopathy, from the DCCT study here. Generally all type 2 patients age >40 y should use a statin if well tolerated, and many younger patients also unless they have a very low risk of cardiovasular disease. See the CARDS study.
See here for a pilot study, and here for more details. Statins should generally be used (if there are no side effects) in all patients with diabetic maculopathy
But if your triglyceride level is elevated (>2.2mmol/l) and HDL level low (<1.0mmol/l) , you probably all need a fibrate such as Supralip.

 Depression

People with diabetes often become depressed. Discuss the situation with your doctor if you thinks this is happening to you, if you cannot sleep, do not want to go out, feel unhappy, do not want to meet new people and go to new places. 

Using the internet...support

Using the internet may improve contact between patients and professionals can be very helpful and improve diabetic control, here also. Patients feed in their results to their nurse/doctor, and received advice as how to lower the levels further and avoid hypos. This author believes this should be introduced in the UK.

Summary

 

Your Risk

Who is at Greater Risk for Type 2 Diabetes?

  • People with impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG)
  • People over age 45
  • People with a family history of diabetes
  • People who are overweight
  • People who do not exercise regularly
  • People with low HDL cholesterol or high triglycerides, high blood pressure
  • Certain racial and ethnic groups (e.g., Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives)
  • Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth

 

Prediabetes

Before people develop type 2 diabetes, they almost always have "prediabetes"—blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. There are 79 million people in the United States who have prediabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during prediabetes.
How to Tell if You Have Diabetes or Prediabetes
While diabetes and prediabetes occur in people of all ages and races, some groups have a higher risk for developing the disease than others. Diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population. This means they are also at increased risk for developing prediabetes.
There are three different tests your doctor can use to determine whether you have prediabetes:

  • The A1C test
  • The fasting plasma glucose test (FPG)
  • or the oral glucose tolerance test (OGTT).

The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have prediabetes or diabetes.
If your blood glucose level is abnormal following the FPG, you have impaired fasting glucose (IFG); if your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT). Both are also known as prediabetes.
Blood Glucose Tests
The American Diabetes Association Risk Test for Diabetes can help you determine if you are at increased risk for diabetes or prediabetes. A high score may indicate that you have prediabetes or at risk for prediabetes. Take the test and find out for sure. 
Prediabetes FAQs

Q: What is prediabetes? 
A: Prediabetes is when a person's blood glucose levels are higher than normal but not high enough to be type 2 diabetes. People with prediabetes are more likely to develop type 2 diabetes and may have some problems from diabetes already.
Q: If I have prediabetes, will I definitely develop type 2 diabetes? 
A: No. Research shows that you can lower your risk for type 2 diabetes by 58% by:

Don't worry if you can't get to your ideal body weight. Losing just 10 to 15 pounds can make a huge difference. For some people with prediabetes, early treatment can actually return blood glucose levels to the normal range.
Q: How do I know if I have prediabetes? 
A: Doctors can use a fasting plasma glucose test (FPG), oral glucose tolerance test (OGTT), or an A1C test to detect prediabetes:
FPG

  • Requires a person to fast overnight. The blood glucose is measured first thing in the morning before eating.
  • Normal FPG is below 100 mg/dl. A person with prediabetes has a fasting blood glucose level between 100 and 125 mg/dl. If the blood glucose level rises to 126 mg/dl or above, a person has diabetes.

OGTT

  • Also requires a person to fast overnight. The person's blood glucose is checked after fasting and again 2 hours after drinking a glucose-rich drink.
  • Normal blood glucose is below 140 mg/dl 2 hours after the drink. In prediabetes, the 2-hour blood glucose is 140 to 199 mg/dl. If the 2-hour blood glucose rises to 200 mg/dl or above, a person has diabetes.

A1C

  • A blood test that gives the average amount of glucose in the blood over the past 3-4 months.
  • An A1C 5.6% or below is normal. In prediabetes, A1C levels range between 5.7%-6.4%. If the A1C is 6.5% or above, a person has diabetes.

The American Diabetes Association’s Diabetes Risk Test can you determine if you are at increased risk for diabetes or prediabetes. A high score may indicate that you have prediabetes or at risk for prediabetes.
Q: Who should get tested for prediabetes? 
A:People in these groups should be tested:

  • If you are overweight and age 45 or older, you should be checked for prediabetes during your next routine medical office visit.
  • If your weight is normal and you're over age 45, you should ask your doctor during a routine office visit if testing is appropriate.
  • For adults younger than 45 and overweight, your doctor may recommend testing if you have any other risk factors for diabetes or prediabetes, including:

Q: How often should I be tested? 
A: If your blood glucose levels are in the normal range, get checked every three years, or more often if your doctor recommends it. If you have prediabetes, you should be checked for type 2 diabetes every one or two years after you are told you ahve prediabetes.
Q: What is the treatment for prediabetes? 
A: Treatment consists of losing a modest amount of weight (7% of total body weight) through healthy eating and moderate exercise, such as walking, 30 minutes a day, five days a week.
Don't worry if you can't get to your ideal body weight. Losing just 10 to 15 pounds can make a big difference.
If you have prediabetes, you are at a 50% increased risk for heart disease or stroke, so your doctor may wish to treat or counsel you about cardiovascular risk factors, such as tobacco use, high blood pressure, and high cholesterol.
Q: Will my insurance cover testing and treatment? 
A: All insurance plans are different. However, Medicare and most insurance plans cover diabetes testing for people suspected of having diabetes. People at risk for diabetes are also at risk for prediabetes. Since the test is the same and the risk factors are the same for both conditions, a prediabetes test may be covered. Talk to your doctor and health insurance company to be sure.
Q: Is prediabetes the same as Impaired Glucose Tolerance or Impaired Fasting Glucose? 
A: Yes. Doctors sometimes refer to high blood glucose levels as Impaired Glucose Tolerance (IGT) or Imapired Fasting Glucose (IFG), depending on what test was used to detect it.
Q: How many people with prediabetes go on to develop type 2 diabetes? 
A: One major study, the Diabetes Prevention Program, showed about 11% of people with prediabetes developed type 2 diabetes each year during the average three years of follow-up. Other studies show that many people with prediabetes develop type 2 diabetes in 10 years.
Q: Could I have prediabetes and not know it? 
A: Absolutely. People with prediabetes don't often have symptoms. In fact, millions of people have diabetes and don't know it because symptoms develop so gradually, people often don't recognize them. Some people have no symptoms at all. Symptoms of diabetes include:

  • unusual thirst
  • frequent urination
  • blurred vision
  • extreme fatigue
  • frequent infections
  • cuts/bruises that are slow to heal
  • tingling/numbness in the hands/feet
  • recurring skin, gum, or bladder infections

 What to Do If You Have Prediabetes


Prediabetes is a serious medical condition that can be treated. The good news is that the recently completed Diabetes Prevention Program (DPP) study conclusively showed that people with prediabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. They may even be able to return their blood glucose levels to the normal range.
While the DPP also showed that some medications may delay the development of diabetes, diet and exercise worked better. Just 30 minutes a day of moderate physical activity, coupled with about a 7% reduction in body weight, produced a 58% reduction in diabetes.
The American Diabetes Association is developing materials that will help people understand their risks for pre-diabetes and what they can do to halt the progression to diabetes and even to, "turn back the clock" In the meantime, we have a wealth of resources for people with diabetes or at risk for diabetes that can be of use to people interested in prediabetes.

Nutrition

Making Healthy Food Choices
American Diabetes Association's statement for health professionals on nutrition
The American Diabetes Association bookstore has award-winning books on nutrition, recipes, weight loss, meal planning and more.

Fitness and Exercise

Tips on how to include a healthy amount of physical activity into your daily routine:
Fitness, Exercise and Diabetes
American Diabetes Association's statement for health professionals on exercise
You can get fit, reduce your risk for type 2 diabetes, and support the American Diabetes Association by participating in Step Out: Walk to Stop Diabetes.

Weight Loss

Being overweight or obese increases your risk for type 2 diabetes. Losing just a few pounds through exercise and eating well can help with your prediabetes and can reduce your overall risk.

Treatment & Care

                     Contact Info : Anwar RIyaz-i-Qadeer Diabetes Institute- 1-Faish Road Islamia Park Lahore. Phone: +92-42-35244067 , Fax: +92-42-35244067
Copyrights 2015 © Riyaz-i-Qadeer Diabetes Institute - All Rights Reserved.
Powered By: Webgini.co.uk