THE MANAGEMENT OF DIABETES MELLITUS - Part 1
This is a brief article on Diabetes Mellitus (DM). We are having an epidemic of the disease these past 12 or so years and every diabetic should be on his/her guard. Today, we are seeing double the number of cases that we saw a decade ago.
Diabetes is a disorder resulting from hereditary and environmental factors, and results in poor metabolism of carbohydrates. There is usually an abnormally low secretion of insulin and this causes elevated glucose levels, and subsequent damage to various organs including eyes, nerves, kidneys, heart. This insulin incidentally is secreted by the pancreas, a gland which lies behind the stomach.

Now, there are two major categories of Diabetes:.

1. Insulin dependent diabetes mellitus, (IDDM or type I) where there is a failure of the pancreas to secrete enough insulin to serve the body. This type is the more serious one, but has a prevalence of about 10% of cases.
2. Non-insulin dependent diabetes mellitus (NIDDM or type II) which affects the remaining 90% cases. Since this is the more prevalent one, we shall deal with type II first.

What happens here is that there is some insulin available, but it is usually inadequate to metabolize the carbohydrates in the body. This lack of insulin is very insidious and may not cause significant symptoms for 5 or more years. The patient copes for a while, but the insulin level continues to fall, and naturally, the blood sugar rises. When the blood glucose reaches 200 mg/dL or so, it overcomes the renal barrier and begin to spill in the urine, causing frequent urination and a host of symptoms like dehydration of the body, thirst, weight loss or gain, blurring of vision, yeast infections on the genital organs and a host of other problems. This is type II diabetes (NIDDM or non insulin dependent DM).

Let us retrace our steps a bit. The best time to diagnose DM is before the cat gets out of the bag - in the so called prediabetic stage. To diagnose this, you will need to do a couple of fasting blood sugars then, and an intermediate reading of around 140 - 180 mg/dL will tell you that you are in a prediabetic zone. You can then try to take preventive action in an attempt to ameliorate the blood sugar readings. These are some of the things you would do:

1. Present your meals to your pancreas in 3 - 4 small doses. That is, you would eat 3 - 4 small meals a day which should include breakfast (very important). That would give your pancreas the whole day to come up with the adequate amount of insulin to metabolize the meals.
2. You need to exercise daily for 20 minutes (if possible)
3. You need to get to ideal body weight, which usually entails losing some weight.
4. You need to cut down on sweets/candies as these will further increase your craving for sugar and more. food.
5. You will need to check your blood sugar from time to time to keep track of your progress. (A glucose monitor + strips cost about US$50. and is excellent for keeping track of your blood sugar)

Now, there will come a time when you need more than diet and exercise to control this diabetes. You will need some form of medication. You should therefore consult a physician who will examine you, check on the blood & urine sugars, blood pressure, heart, cholesterol, retina of the eyes plus kidney function and the state of the circulation in the lower extremities. Later on, other investigations especially cholesterol & lipid profile may be necessary. The reason I mentioned those complications is that long standing diabetes may ultimately lead to blindness, stroke, heart attack, kidney failure, leg amputation and impotence.
Next, you will be given specific instructions concerning diet, exercise, weight control and prescription medications. You will be asked to check & record your blood sugar at specified intervals. (Note that some drugs and hormones may be associated with impaired glucose tolerance). The prescribed diets may vary, but usually consists of 50% carbohydrates, 30% proteins and 20% of fats. A low cholesterol diet is usually part of the picture especially if the patient already has an elevated cholesterol and lipid profile.
While you are getting your instructions, please note that smoking, obesity and a sedentary lifestyle should be avoided.

At our next session, we shall discuss some of the medications we use (the names may be different to the ones you know) SULFONYLUREAS: glipizide(glucotrol), glyburide(diabeta) chlorpropamide (diabinese): glimepiride (Amaryl). ALPHA-GLUCOSIDASE INHIBITORS: Arcabose or(precose) Miglitol or (glycet): BIGUANIDES (metformin) or glucophage. MEGLITINIDES (prandin): (THIAZOLIDINE) ( actos)(avandia).

{To be continued}
© Ralph P. St. Luce, M.D., FAAFP