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Type 2 Diabetes
Type 2 diabetes is a chronic disease where glucose levels in the bloodstream increases. The elevation of blood glucose is due to body's resistance to insulin and reduction in insulin production. The function of insulin is to regulate the amount of glucose in the blood. When insulin is released glucose moves from the bloodstream into the cells decreasing blood's glucose level. If blood glucose levels are not lowered and levels are chronically elevated it can lead to many serious complications including heart disease, kidney disease, eye disease, and nerve disease.
Obesity, unhealthy eating, sedentary lifestyle puts you had higher risk for diabetes. Patient's with family history of diabetes. Africans, Hispanics and Natives are at higher risk. Females who have polycystic ovarian syndrome or have history of diabetes during pregnancy are also had higher risk.
In the beginning when diabetes is mild, patient's are asymptomatic and typically diabetes is diagnosed with routine blood work. However if not catched on routine blood work patient's may end up with marked hyperglycaemia(high blood glucose) and may present with increase thirst, polyuria, fatigue, blurred vision, and weight loss.
Type 2 diabetes is diagnosed with fasting blood work. When fasting blood glucose is > 7.0 mmol/L or randon glucose is > 11.1mmol/L. A second confirmatory test is almost always needed. Hemoglobin A1c which is the 3 month average of your blood glucose can also be used to help with diagnosis. Hemoglobin A1c of > 6.5% is consistent with diabetes. A second confirmatory test is almost always required. Patients with fasting blood glucose of 6.1-6.9 mmol/L or Hemoglobin A1c of 6%-6.4% fall in the pre-diabetes cateogray.
Management of diabetes needs to be individualized. For most patients goal should be A1C(3 month average of blood glucose) < 7%. For others at risk of hypoglycaemia, advanced age or difficulty reaching the goal A1C of 7.0%-8.0% is appropriate. The importance of lifestyle changes (diet, exercise, weight management, tobacco cessation) needs to be emphasized. Referring new diagnosed patients for diabetic education is recommended. Screening for Retinopathy and foot exam to be done annually. Urine albumin/creatinine ratio to be done annually. Blood chemistry and renal function at least every 6 months. A1C testing every 3-6 months. Check lipids at diagnosis and every few years.
Cardiovascular risk assessment is important because most diabetics die of heart disease. Risk factors include: duration of diabetes, age(men>45, women>55), family history(1st degree relative CAD men<55, women<65), men, smoking, HTN, dyslipidemia. |
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