Treatment of diabetes

Treatment, which was not classified as standard, is considered an additional and alternative. These treatments cover a variety of disciplines, which include everything – from diet and exercise to mental health and lifestyle changes. Examples include acupuncture, relaxation by placing the image, chiropractic, yoga, hypnosis, clinical monitoring, aromatherapy, relaxation, herbal medicine, massage and many others.

What types of alternative treatments used for patients with diabetes?

Nutritional Supplements.

Chromium has been widely touted as a treatment to improve control of diabetes. Although some studies have shown good effects of chromium in diabetes, there are currently no recommendations for its use in the treatment of diabetes.

Magnesium has been studied for several years as a therapy to improve glucose control in people with diabetes. Magnesium deficiency is associated with abnormal insulin secretion and diabetic complications.

Plant foods.

The following herbal products help people with type 2 diabetes:
barm
buckwheat
broccoli and other similar vegetables
peas
fenugreek seeds
sage

Most plant foods are rich in fiber, which helps control blood glucose levels.

If you have diabetes and you want to take any of these plant substances, first discuss it with your doctor.

Alternative products for weight loss in diabetes mellitus.

Because the relationship between weight and diabetes has been proven, many people are turning to alternative therapies that may help reduce weight, for example:
chitosan
the fruits of garcinia (HCA)
chrome
germander
momordika (Chinese bitter melon)

In addition, for the alleged decrease in appetite and facilitate weight loss have been developed transdermal (skin patches) systems, as well as oral sprays. One emplastic system consists of 29 different ingredients in homeopathic quantities, used to reduce appetite, but there is currently no published data in the literature on their effectiveness.

Whether these herbs are safe for diabetics?
In December 2003, ephedrine is the first herbal stimulant ever banned by the Office of the Food and Drug Administration United States. Being a popular component of the medicaments used in obesity and non-prescription, ephedrine, showed some positive effects. Nevertheless, the evidence that it may cause harm, were much more convincing. It was known that in high doses it causes insomnia (difficulty falling asleep and in the process during the actual sleep), high blood pressure, glaucoma and urinary retention. This herbal supplement is also linked with a lot of strokes.

Chitosan was illuminated by a large number of recent publications. It is extracted from the shells of marine mollusks and has the ability to bind fat and prevent its absorption. Although it is believed that chitosan promotes weight loss, the results are available at present do not encourage its use.

Others mentioned the so-called anti-obesity medicaments have not been thoroughly studied and have shown disappointing results.

Also, a recent study of plant medicaments used for weight loss, found that many products contain lead, arsenic and other toxic metals. Some also contain other undeclared ingredients. And some have been identified other plants.

What to think before diabetes begin using the herbal preparations.

Before starting the use of herbal preparations in the treatment of diabetes you should:

Before taking any medicament, including plant, which is going to receive, discuss with your doctor.

If you are experiencing side effects such as nausea, vomiting, rapid heartbeat, restlessness, insomnia, diarrhea or skin rash, stop taking the herbal preparation and report this immediately to your doctor.

Avoid taking medicaments made from more than one plant.

Beware of commercial advertising of plant products. Look for evidence-based information sources.

Carefully select brands. Only those brands that indicate common and scientific plant name, the name and address of manufacturer, batch and serial number, expiration date, recommendations for the use and potential side effects.

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All the rest – it’s a beautiful ad, in which wishful thinking. What impresses in this ad, so this quick weight loss and the minimum required for this effort. In fact it is needed to loss weight long and fairly for the work. This is quite a reasonable explanation. The fact that  stocks of glucose in the liver as glycogen is only enough to maintain normal blood sugar levels between meals.

During exercise and fasting blood glucose level is maintained at the expense of another biochemical process in which glucose is formed from lipids and proteins (gluconeogenesis).

But we need to avoid extremes. For example, yesterday we ate cakes pounds, but today sharply limited the use of carbohydrates and fats. It is quite useless, not enough – is harmful. The main thing is that the food was attended by all the necessary nutritional components. The question is, in what proportions.

We can add that too, and proper nutrition. There is good and bad components
supply, there is a disproportionate ratio of proteins, fats, carbohydrates, vitamins and minerals in food consumption.

For the prevention of diabetes, and indeed for adequate and safe food, we can recommend a diet with low glycemic index (This diet, according to leading nutritionists of the world, and is ideal for a healthy person. Avoid rapid weight loss. You can safely lose no more than 1 – 1.5 kg per week, subject to good health.

In larger mass loss occur severe changes in metabolism, which leads to various diseases.

Besides quickly dropped weight very quickly and returned. You should begin to stabilize body weight, and only then take action to reduce it. Keep in mind that the fight against obesity is not a deed and not on race sprint, but a way of life.

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Preventing this type of diabetes can be of two types:

Primary prevention consists of the following events:
Conducting genetic studies in children whose parents suffer from diabetes. In the near future in the developed countries plan to introduce screening of all newborns in order to identify genetic susceptibility to type I diabetes. Currently, such surveys are underway in Finland and in parts of Italy.

Preventing infection in utero as well as in children and adolescents.

Exception of baby food products, which can induce autoimmune processes that destroy the beta cells of the pancreas (cow’s milk, barley, and nitrogenous substances – nitrates, toxins).

Drinking quality water.

Secondary prevention consists of determining the degree of destruction of beta cells of the pancreas, drug therapy aimed at the protection of the autoimmune aggression (nicotinamide treatment), and discharge insular apparatus (low-dose insulin therapy).

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Blood glucose meters are not used to diagnose diabetes, but only to monitor changes in blood sugar levels.

In addition to the instrument itself, the package usually includes a test strip, stick to pierce, battery, manual, carrying case. In selling a large number of blood glucose meters, which differ by the following parameters:

Analysis time (5 to 45 sek);

Amount of blood needed for analysis (1 to 3 ml, or mm3);

Memory on the number of measured results (10 to 200 and more);

The ability to connect to the computer;

Original pen to pierce;

Other devices (such as audio reminders, sound analysis, the backlight, removing the average value of) that make the measurement more convenient.

The method of analysis is reduced to puncture the skin and applying a special device to a special blood test strip is inserted into the blood glucose meter. After a while the display shows the result of measurement.

When choosing a blood glucose meter, note the following:

Price / performance ratio (ie, the measurement accuracy, a set of necessary functions);

Cost, availability and uninterrupted supply of test strips;

The features of the apparatus;

Size and compactness of the set;

Warranty period.

Less accurate but more expensive method is to determine the level of sugar in the urine. For this purpose a special test strips. The principle method for determining based on changing the color intensity of the bar depending on the concentration of sugar in the urine.

This method is less accurate because the sugar in the urine is determined only by raising blood sugar more than 9 mmol / l. Accordingly, lower values can not be determined.

In cases where there is suspicion on the development of ketoacidosis, using special test strips for the determination of ketone bodies in urine. The principle of the method is similar to the definition of sugar in the urine – to change the color intensity indicator depending on the presence of ketones in the urine.

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When deciding whether to change the dose of insulin due to insufficient action of the drug should be necessarily ruled out the error in the technique of insulin administration. Manipulation of the bottle must be carried out in good visibility, if necessary, to use glasses.

Storage of insulin.

Keeping the vial and cartridge initiated pen – at room temperature 20-22 ° C to 28 days.

Storage is not started by the bottle – in a refrigerator at 2-8 ° C. Freezing vial – you can not use it!

If you need to carry insulin in hot weather, it must be stored in a thermos or a “bag-a thermos.”

It is unacceptable to use the drug with an expired shelf life and if there was a violation of rules of storage.

The rules before injection.

The appearance of the liquid should not be changed after previous use.

Temperature prior to administration of insulin should be 20-22 ° C.

It’s important to mix the insulin.

You can not mix incompatible insulin in one syringe.

At a set of insulin in the syringe should not contain air.

An injection.

Subject to the rules of personal hygiene disinfection of the skin with alcohol is not necessary.

If disinfecting with alcohol yet been carried out, not to inject immediately, but must wait to alcohol has evaporated (10-15).

Need to use syringes with graduations corresponding to the number of units of insulin in 1 ml of 40 IU and 100 IU.

During the injection of the skin get into the crease and did not let go until the end of injection, and after the injection, without removing the syringe, wait 10 seconds.

Control the depth of the needle – it should be introduced subcutaneously.

After the injection not massage the injection site.

Selecting the location for the injection.

Zones of insulin include: stomach – anywhere retreated 5 cm from the navel, thigh (antero-external surface of 4 fingers below the start of the thigh and the 4 fingers above the knee), shoulder (outside surface), upper part of the buttocks.

Each zone of introduction has its own rate suction:

Area of the slow absorption – the hip;

Slow absorption – the buttocks;

Average rate of absorption – the shoulder area;

Most rapid absorption – the abdomen.

Depending on the duration of insulin action, recommend short-acting injections in the abdomen, the average length – in the thigh or buttocks.

In order to avoid complications in the skin, it is recommended to adhere to an orderly change of the injection site. There are two options: change the order of all the zones on a daily basis on a “single injection – a zone,” or do all the injections in one zone and change zones to produce a weekly basis.

It is better to use the first option, entering as a function of different types of insulin area.

Between the two places consecutive injections should be a distance not less than 2 cm.

Factors that accelerate the absorption of insulin:

Physical activity after injection;

Elevated body temperature or the environment (sauna, hot-water bottle applied to the injection of insulin).

Intramuscular injection.

Massage the injection site.

Factors that slow the absorption of insulin:

Violation the rules of storage.

Deterioration of the capillary circulation (shock, coma, hypothermia of the body).

Cold insulin (temperature below 20 ° C).

Intradermal introduction of the drug into the affected subcutaneous layer, sealing after previous injections.

Introduction immediately after rubbing alcohol.

Quickly taking out the needle from the skin immediately after injection leads to leakage of the solution and, consequently, to a lack of action of the drug.

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On insulin therapy of type II diabetes become subject to the following indications:

The ineffectiveness of diet and maximum dose glucose-lowering medicaments, resulting in recording the following parameters: НbА1с > 7,5 %.

Fasting glucose> 8 mmol / liter.

The appearance of acute complications of diabetes.

On insulin also mapped by the need for surgery (this is usually a temporary measure).

When and how to go on insulin, decides doctor, deciding this question is strictly individual, taking into account the totality of all the problems.

After transfer to insulin therapy may need another 3-4 months to find an effective dosage and to achieve good compensation of diabetes.

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Tips for reducing salt intake by eating out.

Reducing salt intake can significantly reduce the risk of health problems associated with high blood pressure, which is a risk factor for heart disease and stroke – the cause of death for more than two thirds of people with diabetes.

Here are some tips that will help you reduce the amount of edible salt (sodium) when eating out:

Snacks.

Choose fresh fruits and vegetables.

Avoid soups and broths.

Avoid bread, muffins and toast with salt and butter.

Salads.

Choose fresh fruits and vegetables.

Avoid pickles, canned or pickled vegetables, canned meat, seasoned croutons, cheeses, salted sunflower seeds.

Order salad dressing separately and use them in small quantities.

The main dishes.

Choose simple dishes, including fried, grilled or baked meat, poultry, fish or shellfish.

Choose a simple vegetables, potatoes and pasta.

Ask your waiter about the possibility of choosing from the menu of dishes with low-salt diet and how food is prepared.

Do not go to restaurants that banned special cooking.

Avoid casseroles, mixed dishes, gravies and sauces.

In fast food restaurants do not order the special sauces, seasonings, spices and cheese.

Avoid salty flavors and decorations, such as olives and pickles.

Desserts.

Choose fresh fruit, frozen juices, sorbets, jellies, cakes, and simple.

Control the size of portions in restaurants.

In many restaurants often dish large enough to become dinner for two days.

When you eat out:

Ask for half or smaller portions.

Estimate by eye the size of the portions sufficient for you, put the extra aside and just ask for “a bag for the dog,” in which you can take the rest home.

If you order dessert, share it.

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INTENSIVE INSULIN THERAPY.

Advantages of intensive insulin therapy:

Achieved with the most effective compensation of diabetes mellitus;

Increases significantly during the disease, which takes place without complications, increase life expectancy;

Reduced risk of cardiovascular complications compared with conventional treatment;

Basal-bolus method simulates the activity of the pancreas. At the same basal insulin provides a permanent body’s need for insulin, bolus – peak loads associated with food intake;

Flexible mode of the day.

Disadvantages of intensive insulin therapy:

Requires constant and frequent monitoring of blood glucose;

Require a large amount of training;

There are frequent hypoglycemia.

CONVENTIONAL INSULIN THERAPY.

Advantages of conventional insulin therapy:

Ease of insulin;

Does not require a large amount of training;

There is no need for frequent monitoring of blood sugar.

Disadvantages of conventional insulin therapy:

Hard schedule and strict diet;

Frequent and mandatory meals 5-7 times a day;

Inadequate compensation of diabetes and, consequently, increasing the likelihood of complications in the early stage of the disease;

High risk of hypoglycemia, especially nocturnal;

Does not meet the physiological parameters of the pancreas;

It is impossible to foresee all possible situations that may affect the change in insulin, which increases the likelihood of complications.

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Diabetic foot syndrome

This syndrome occurs in each 8-10th of a patient with diabetes mellitus, and every second is at risk. In diabetes mellitus type II, this syndrome develops in 10 times more frequent than in type I diabetes and may occur at the outset of the disease (and sometimes the first sign of diabetes, which attracts attention). In diabetes mellitus type I syndrome develops this year to 7.10 of the disease.

The reasons that contributes to the diabetic foot.

Direct causes that cause the development of diabetic foot syndrome are the three factors that caused by hyperglycemia:

1) failure of the peripheral nervous system (neuropathy);
2) loss of lower limb arteries (angiopathy), followed by the deterioration of blood flow;
3) adherence to the background of these pathological processes of infection.

Depending on what violations prevail, distinguish several forms of this syndrome:
Nerve damage (neuropathic form), which may be associated with pathology of osteoarticular apparatus or without bone involvement;
The defeat of the vessels (ischemic, form), resulting in reduced blood circulation in the limbs;
Mixed neuroischemic form.
In 85% of the complication occurs in the form of the ulcer.
For neuropathic diabetic foot shape risk factors include the following:
Inadequate compensation for blood sugar levels. The worse is controlled number, the greater is the chance of developing the syndrome and the faster it can occur;
Duration of diabetes. The longer is the disease, the higher is the risk of this complication.
Age. With age, the probability of disease increases.
Excessive alcohol consumption.
The most serious complication of diabetic foot is the development of diabetic gangrene, which contributes to the emergence of the following factors: nonhealing extremity microtrauma, frostbite or a burn, ingrown nails, calloused education, fungal diseases, as well as the severity of angio-and neuropathies.

The clinical picture of diabetic foot syndrome.
Depending on the prevalence of neuropathy or angio-patii in the development of this complication, the clinical picture is different. When there is neuropathy there are two types of clinical manifestations:

Painless form – accompanied by a decrease in pain sensitivity (which is more common and more dangerous, because the wounds and injuries may go unnoticed);

Pain form – manifested by various symptoms:

Tingling, burning, pain, worse at rest.

The skin is dry neuropathic form, in areas of excess pressure formed blisters and painful sores. Pulsation of the arteries in the feet is kept.

Pulsation of the arteries in the feet is lower, or absent.

On the fingertips or the boundary surface of the heel formed sharp painful ulcers. When walking, marked pain in the legs, and therefore produces a characteristic gait, which is called intermittent claudication.

This distinguishes the ischemic form of neuropathy, in which the pain disappeared while walking.

The speed of the initial stage of diabetic foot depends on the degree of compensation of blood sugar levels.

Prophylaxis of diabetic foot syndrome.

Major role in the prevention of this complication is careful monitoring and correction of blood glucose and other metabolic disorders (eg, blood lipids).

Studies have convincingly shown that if blood sugar for several years, is not more than 9 mmol / l, even in the presence of angiopathy and (or) the neuropathy condition is greatly improved – decreases or disappears clinical symptoms, improves wound healing. A very important factor, prevents the development of diabetic foot in patients with diabetes mellitus type II, is the transition to insulin in the absence of the effect of taking tablets of funds. In order to spot the beginning of the diabetic foot, it is imperative to conduct regular inspections by a specialist.

Prophylaxis has primary role in the prevention of amputation. Unfortunately, it neglected and at least half of the patients treatment does not begin on time. It should be noted that the time taken by the vigorous preventive measures can reduce the incidence of amputations in patients up to 90%. Currently, every 30 seconds in the world is lower limb amputations due to diabetes, with a significant number of patients after surgery will know that they have diabetes.

Important role, in addition to normalization of blood glucose, belongs to the timely and adequate correction of other risk factors, as well as an active qualified treatment of ulcers and other defects of the foot.

Every patient with diabetes should know the rules for foot care, and be able to choose and wear shoes and socks.

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Elevated blood sugar is harmful to the kidneys of diabetic nephropathy development.

For 20 years, every second patient with diabetes mellitus (I or type II) developed kidney disease of varying degrees.

The causes of kidney damage.

High blood sugar levels. The worse your blood sugar is controlled, the higher the probability of occurrence of diabetic nephropathy.

Hypertension.

Duration of diabetes. If the disease is longer, the risk of kidney damage is greater.

Violation of lipid metabolism (hyperlipidemia) leads to the deposition of atherosclerotic plaques, including those in the renal vessels, which also impairs their ability to filtration.

Smoking disrupts the blood vessels in the kidneys and increases blood sugar levels.

Genetic predisposition. There is a genetic predisposition to diabetic nephropathy.

How develops renal failure.

Kidneys with small blood vessels carry blood filtration in order to save nutrients and cleanse the body of toxins that are released in the urine. In the long-term elevated levels of sugar in the blood vessel walls kidney filters the burden on. This leads to a change in vascular permeability, and the body begin to be displayed and nutrients. The first starts to leave the protein albumin, initially in small quantities, so this is known as microalbuminuria (30 to 300 mg / day). This is the initial, asymptomatic stage renal disease, which over time becomes symptomatic form, which is manifested already a significant loss of protein. This stage is called macroalbuminuria or proteinuria.

Depending on the amount of protein allocated to distinguish several stages of proteinuria: mild proteinuria in the allocation of up to 1 gram of protein per day, the average degree – 1 to 3 grams of protein per day and heavy – more than 3 grams of protein per day.

Gradually, because of the disruption of the vascular wall permeability of kidney filters bad kidneys purify the blood and the blood begin to accumulate harmful substances. The next stage of diabetic nephropathy – chronic renal failure, which is characterized by the excretion of nutrients and harmful delays.

Treatment.

Treatment of diabetic nephropathy depends on the stage of clinical development process. But at every stage to conduct the following activities:

Compensation for blood sugar, focusing on the level of glycated hemoglobin and trying to make it no more than 6.5-7%;

Correction of lipid metabolism;

Diet with protein restriction and salt;

Reducing consumption or abstinence from alcohol.

Under conservative chronic renal failure, in addition, must:

With an increased number of precautions to comply with creatinine in the process of medicament therapy.

In particular, the dosage of metformin should be reduced. If possible, avoid the use of nonsteroidal anti-inflammatory drugs (they increase hypertension and worsening renal insufficiency) and the use of glibenclamide – it could provoke the emergence of severe hypoglycemia, hard-to-treat;

Carry out the correction of insulin;

Regularly check the level of hemoglobin in the blood – every 6 months.

In end-stageof  renal disease using special methods of blood purification (hemodialysis, peritoneal dialysis) or kidney transplant.

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