Therapy of Diabetes Patients

- Combination therapy: do when blood glucose control could be better, that way of working is different but the medicine gave a synergy effect.
- Therapy Advanced: especially for patients with type 1 diabetes pancreas transplant can be a small part or whole.
- Therapy accompanying diseases: blood sugar control drugs can be given concurrently with the hypertensive drugs and drug hipokolesterolemia

Monitoring Medications
Monitoring blood sugar levels is an important part of diabetes treatment.
The presence of glucose from the urine of known bias, but examination of urine is not a good way to monitor treatment or adjust the dose of medication. Currently blood sugar levels can be measured easily by patients themselves at home. People with diabetes should record their blood sugar levels and report to the doctor so that dose of insulin or hypoglycemic medications can be adjusted.

Non-Insulin Diabetes Treatment

Treatment of diabetes type 2 diabetes primarily consisted of: control of blood glucose (diet therapy, exercise, medication), treatment of disease (hypertension, obesity, hyperlipidemia), and the detection or treatment complications. Eating arrangements generally have a maximum effect after 2-4 weeks. Similarly, the administration of drugs, generally provide a maximum effect within 1-2 weeks.

There are some things that need attention in the treatment of diabetes using oral hypoglycemic drugs, among others:
- Diabetes type 2 with normal body weight or more
- People with diabetes aged over 40 years
- Diabetes lasted less than five years
- Requires insulin dose less than 40 units a day

1. Sulfonylurea
Sulfonylurea group of drugs that are especially useful in diabetic patients is only about five years or less. Because drugs (glipizide, gluburide) can improve insulin rapidly, this drug can be taken immediately after eating, so there is no hypoglycemia. The following types of more secure the sulfonylurea glimepiride. There are drugs other than sulfonylurea class of repaglinide and nateglinide, which stimulates insulin secretion by working directly on pancreatic beta cells. This last class of drug groups is given before meals, with the aim of reducing hyperglycemia after a meal. These drugs work quick and fast, so the impact of lower hypoglycemia.

This group of drugs should be administered cautiously in renal, liver, pregnant and lactating women and stressful. Can not be given in patients with type 1 diabetes.

2. Alpha-glucosidase inhibitors
Examples of this drug class is acarbose. Acarbose reduce postprandial hyperglycemia by slowing the absorption of glucose in the intestine. Acarbose did not affect the intake of glucose and insulin secretion. This drug is taken before meals. Side effects include flatulence, diarrhea, flatulence.

3. Biguanid
Examples of these drug classes is metformin. Biguanid working mechanism by lowering the production of glucose in the liver and slightly improve the intake of glucose in peripheral tissue. Besides these drugs also lower blood glucose and insulin levels during fasting, improved lipid profile, and help you lose weight. Given metformin in obese diabetic patients. The side effects are diarrhea, nausea, decreased appetite, and bitter tongue. Should not be given to patients with liver disorders, kidney and alcohol drinkers.

4. Thiazolindione
Group of drugs that includes this new type of drug works by lowering insulin resistance and increase insulin sensitivity, increase intake of glucose in peripheral tissue, as well as reduce production of glucose in the liver. This group of drugs including troglitazone, rosiglitazone and pioglitazone. Thiazolindione should not be given to patients with liver disease and severe congestive heart failure. Giving pregnant women is not recommended.

Elementary Forms of Insulin

Insulin has three basic forms, each with a speed and duration of different work.
1. Rapid acting insulin
An example is regular insulin, which works the fastest and most briefly. Insulin was started lower blood glucose within 20 minutes, reaching a peak within 24 hours, and work for 6-8 hours.

Rapid acting insulin is often used by the patients who underwent multiple injections each day and injected 15-20 minutes before eating.

2. Acting insulin was
An example is insulin zinc suspension or suspension of insulin isofan. Begin work within 1-3 hours, reaches a maximum peak within 60-10 hours and work for 18-26 hours. Insulin can be injected in the morning to meet the needs for a day and can be injected at night to meet the needs throughout the night.

3. Acting insulin long
An example is insulin zinc suspension has been developed. The effect emerging after six hours and work for 28-36 hours.

Insulin supplies stable at room temperature for months so that you can take them everywhere.

Selection of insulin to be used depends on:
- The desire to control diabetes sufferers
- The desire to monitor the patients blood sugar and adjust the dose
- Daily Activities patient
- The ability of patients to understand and study the disease
- Kedtabilan blood sugar levels throughout the day

Most are easy to use once-daily injections of insulin are working, but this provides control of blood sugar at a minimum.

Tighter control can be obtained by combining two types of insulin, which is fast acting insulin and the insulin is working. The second injection is given at the dinner table or when going to sleep tonight. The most stringent control is obtained by injecting rapid acting insulin and insulin is working in the morning and evening along with an additional fast acting insulin injections during the day.

Some adult patients require the same dose of insulin every day. Other patients need to adjust the dose of insulin depending on the food, sports and the pattern of blood sugar levels. Insulin needs vary with changes in diet and exercise.

Some sufferers experience for insulin resistance. Insulin is not entirely the same as the insulin produced by the body. Because the body can form antibodies to insulin replacement. These antibodies affect the activity of insulin, so patients with insulin resistance should increase the dose.

Injecting insulin can affect the skin and underlying tissues at the injection site. Sometimes the allergic reaction that causes pain and burning sensation, redness, itching and swelling around the injection site for several hours. Inject often cause damage to precipitate fat or fat.

These complications can be avoided by replacing the injection site and replace the type of insulin. On the use of synthetic human insulin resistance and allergies are rare.

Diabetes Treatment with Insulin

Initial therapy with insulin is given consideration in patients who are underweight (due to the drastic weight loss), patients with sick hearts, kidneys, and severe pain. Another indication of insulin:
- People with type 1 diabetes
- Diabetes Pregnancy
- Diabetes with ketoacidosis
- In the treatment of hyperglycemia nonketosis hyperosmolar syndrome
- Type 2 diabetes who can not handle blood sugar levels, such as surgery, trauma.

The types of insulin based on the peak effect and duration of works:
- Work quickly (insulin regular): peak 2-4 hours of work, long hours of work 5-8
- Work is (NPH): peak 4-12 hours of work, working long hours 8-24
- Working length (PZI): peak 6-20 hours of work, long hours of work 18-24
- Insulin combination: peak work 2-4 hours, 6-12 hours, and working long hours 8-24

In type 1 diabetes, the pancreas can not produce insulin, so insulin must be given a replacement. Giving insulin can only be done by injection. Insulin is destroyed in the stomach so it can not be taken orally. New forms of insulin (nasal spray) is under study. At this time, this new form of insulin that can not work properly because of different absorption rates cause problems in the determination of the dose. Insulin injected under the skin into the fat layer, usually in the arm, thigh, or abdominal wall. Used needles are very small so as not too painful.

Diabetes Treatment

The main goal of diabetes treatment is to maintain blood sugar levels under normal circumstances. Blood sugar levels normal is really difficult to maintain. But getting closer to normal, the possibility of temporary or long-term complications will decrease.

Treatment of diabetes include weight control, exercise and medication and diet. An obese type 2 diabetes do not need treatment if they lose weight and exercise regularly. However, most patients find it difficult to lose weight and exercise regularly. Because it was given insulin replacement therapy or the oral hypoglycemic drug.

Ordering diet is very important. Patients should not eat too many sweet foods and should eat a regular schedule. People with diabetes tend to have high cholesterol levels, because it is recommended to limit the amount of saturated fat in food. But the best way to lower cholesterol is to control blood sugar levels and body weight.

All patients should understand how diet and exercise to control the disease. Patients must understand how to avoid the occurrence of complications. Patients should also pay special attention to foot infections. It is important to examine the eye so that the bias is known that changes occur in blood vessels in the eye.

Diabetes Diagnosis

Diabetes diagnosis based on symptoms such as polidipsi, polifagi, poliuri, and the results of blood tests that showed high blood sugar levels.

To measure blood sugar levels, blood samples are usually taken after the patients fasted for 8 hours or can also be taken after meals. At the age above 65 years old, is best done after fasting examination. Because after eating the increased blood sugar is higher.

Other blood tests can be done is a glucose tolerance test. This test is mainly performed in certain circumstances, such as in pregnant women. Patients fasted and blood samples taken to measure fasting blood sugar levels. Then the patient drinks a special solution containing glucose. 2-3 hours later another blood sample taken for examination. Examination to detect diabetes for normal adults glikosa done by checking blood levels during fasting. Especially for those who have a risk factor as above.

Criteria of diagnosis of diabetes according to American Diabetes Association is based on examination of plasma glucose levels in a state of fasting (without food for eight hours) and after oral glucose tolerance test.

Classification of diabetes on the examination of fasting blood sugar levels as follows:
- <110 mg / dL is normal
- 110-126 mg / dL is fasting hyperglycemia (impaired Fasting Glucose)
-> 126 mg / dL is diabetes

In glucose tolerance tests are checked after two hours were classified as follows:
- <140 mg / dL is normal glucose tolerance
- 140-200 mg / dL is disturbed glucose tolerance
-> 200 mg / dL is diabetes

Diagnosis of diabetes can also be based on if a person shows symptoms of diabetes with a fasting blood sugar levels without amounting to> 200 mg / dL. Examination of urine can also be used to detect diabetes, although less convincing. Hyperglycemia which occurs only after oral glucose tolerance test is a condition in a state between normal and diabetes.

Diagnosis of diabetes by ADA in 1998, are:
- There are symptoms of diabetes with blood glucose> 200 mg / dL
- Fasting blood glucose> 126 mg / dL and the glucose tolerance test after 2 hours of fasting is> 200 mg / dL.

Severe Diabetes Symptoms

Other symptoms are blurred vision, dizziness, nausea and decreased endurance during exercise, often feel tired, feel itchy and inflamed skin. Patients with poorly controlled diabetes are more susceptible to infection.

Severe diabetes symptoms:
- The occurrence of weight loss
- Occur itching or pain in your feet
- Occur at the foot of the difficult wounds healed
- Loss of consciousness or coma

Because of severe insulin deficiency, before treatment, patients with type 1 diabetes almost always lose weight. Most type 2 diabetics do not experience weight loss. In type 1 diabetes, symptoms occur suddenly and can quickly develop into a state of diabetic ketoacidosis. In blood sugar levels high, but since most cells can not use glucose without insulin, these cells take energy from other sources. Fat cells is broken down fields produce ketones, which is a toxic chemical that can cause blood to become acidic (ketoacidosis).

The early symptoms of diabetic ketoacidosis is thirst and excessive urination, nausea, vomiting, fatigue and abdominal pain. Breathing becomes faster because the body attempts to improve levels of blood acid. Patient breath smell like acetone.

Without treatment, diabetic ketoacidosis bias developed into a coma, sometimes within just a few hours. Even after starting insulin therapy, patients with type 1 diabetes may develop ketoacidosis if they do not to injections of insulin or experiencing stress from infections, accidents or serious ill.

Patients with type 2 diabetes may not show symptoms for several years. If the more severe insulin deficiency, frequent urination symptoms emerge and often thirsty. Ketoacidosis is rare. If blood sugar is very high (more than 1000 mg / dL), usually occur because of stress, infection or drugs, then the patient will experience severe dehydration, which can cause mental disorders, dizziness, seizures, and a condition called coma hiperglikemik -non-ketotik hiperosmolar.

Diabetes Symptoms

Symptoms of diabetes can occur in children or young adults and in adults over 40 years. Sometimes it is felt only mild symptoms. Diabetes is usually found during a general medical check up). Patients with type 1 diabetes is usually found in children and young adults and badanya thin. Instead of type 2 diabetes found in those of normal weight or overweight.

Generally, symptoms and signs of diabetes were divided into two groups: early symptoms and chronic symptoms.
1. Early symptoms of diabetes include:
- Weight loss and feeling weak or tired
- Frequently urinating (poliuri) at night with the number of lots
- Drink plenty of water (polidipsi)
- Many food (polifagi)
2. Chronic symptoms of diabetes include:
- Impaired vision, blurred vision
- Peripheral nerve disorders, often feel pain in your feet
- Itching and boils
- Thick skin
- Impaired sexual function, erectile disorder, impotence
- Leucorrhoea, female patients often whitish and feels itchy

The early symptoms of diabetes associated with the direct effects of high levels of sugar blood . If blood sugar levels up to above 160-180 mg / dL, glucose will not come into the urine. If levels are higher, the kidneys will get rid of extra water to dilute a large amount of glucose is lost. Because the kidney produces excessive amounts of urine, the patient became frequent urination in large quantities (poliuri). Poliuri symptoms especially at night, when our blood sugar levels relatively higher than during the day. Poliuri result, patients feel excessive thirst so much to drink (polidipsi).

Symptoms of the less prominent is a lot to eat (polifagi). Because a large number of calories lost, the patient experienced weight loss. To overcome this, patients often feel hungry so much eating (polifagi).

The occurrence mechanism of Diabetes

Everyday we eat foods that contain carbohydrates, fats and proteins. Which will be metabolized and the body to produce energy used for physical activity and brain.

Glucose obtained from food would enter into pancreatic beta cells through GLUT2 transporter molecules. So that stimulates insulin secretion. In these cells, glucose will be burned into energy to perform daily activities. When there is insulin resistance, a series of reactions that activate the GLUT4 in muscle cells, heart and fat does not happen, so the sugar remains in the blood.

In the first hours after a meal, blood sugar increases and then decreases again due to the insulin work the muscle to turn it into sugar, and after two hours of blood sugar is normalized. When disturbed insulin work and not working properly, then two hours after a meal blood sugar remained high. This condition is called diabetes. Indeed the cause of insulin resistance in type 2 diabetes mellitus is not known with certainty.

Expenditure insulin regulated by glucose levels in the blood that occurs after eating. Glucose level above 70mg/dL been influential in the release of insulin by pancreatic beta cells. If this situation continues, the insulin will continue to be produced and enter the blood, so the hyper-insulinemia. Then the pancreas will be no longer able to produce enough insulin. As a result, blood sugar levels remain high, called the disturbance of glucose tolerance (IGT). IGT with hyperglycemia was found after eating (postprandial) and at the time of fasting. Failure of pancreatic beta cells to produce insulin was also influenced by genetic and elevated levels of free fatty acids in the fat and diabetic.

Diabetes Mellitus is not a contagious disease, but heredity. But that does not mean the child of two parents with diabetes will suffer from diabetes as well. Someone likely to suffer from diabetes when experiencing the following conditions:
- Both or one parent or sibling had diabetes
- A body fat
- Age above 40 years
- Hypertension and cholesterol
- There are disorders of glucose tolerance
- Women with gestational diabetes
- History class using corticosteroid drugs
- History of measles virus infection

Diabetes Causes

Diabetes occurs when the body does not produce enough insulin to maintain normal blood sugar levels, or the cells do not provide an appropriate response to insulin.

Patients with type 1 diabetes mellitus produces little insulin or produces no insulin at all. The majority of type 1 diabetes mellitus occurs before the age of 30 years. The scientists believe that environmental factors (viral infections or nutritional factors) causes the immune system destroys insulin-producing cells in the pancreas. This occurs because of genetic predisposition. In type 1 diabetes mellitus, 90% of insulin-producing pancreatic beta cells permanently damaged. The result is a severe shortage of insulin, so patients must get regular insulin from outside.

In type 2 diabetes mellitus, the pancreas still produces insulin. Sometimes the levels are higher than normal. However, the body develops immunity to its effects, resulting in relative insulin deficiency.

Diabetes mellitus type 2 can be in children and adults. But usually occurs after age 30 years. Risk factors for type 2 diabetes mellitus are obese. Because 80% -90% of patients are obese. This type of diabetes also tend to heredity.

Other causes of diabetes:
- High levels of corticosteroids
- Pregnancy (gestational diabetes)
- Medicines
- Poisons that affect the formation or the effects of insulin

Diabetes Definitions

Diabetes Mellitus is a disease marked by high glucose in the blood, because the body is unable to release or use insulin adequately. Diabetes is a group of metabolic diseases characterized by increased blood sugar levels (hyperglycemia) cause amount or disturbed insulin function. Because the disease known as diabetes mellitus and patients often sweet urinating. This occurs because excessive sugar content exceeds the limit in the blood, urine with removed through the kidneys.

Blood sugar levels in the body varies throughout the day. Blood sugar will rise after a meal and return to normal within two hours after eating. Normal blood sugar levels on the morning of 70-110 mg / dL. Blood sugar levels less than 120-140 mg / dL two hours after eating or drinking liquids that contain sugar other carbohydrates. Sugar levels tend to increase, but progressively after age 50 years, especially those who are less active or less exercise.

Insulin is a hormone released by the pancreas organ, located in the abdominal cavity near the intestine. Is the main substance responsible for maintaining normal blood sugar levels. Insulin works to change blood sugar into muscle and stored into a cell or tissue, which is used to produce energy or stored as energy reserves in the form of muscle sugar.

Elevated levels of blood sugar after eating or drinking stimulates the pancreas to produce insulin. Thereby preventing the increase in blood sugar levels and cause more blood sugar levels have declined steadily. At the time of physical activity, blood sugar levels can also be decreased because the muscles use glucose for energy.

According to the American Diabetes Association / World Health Organization (ADA / WHO) there are four types of diabetes, which are grouped according to cause:
1. Type 1 diabetes mellitus: beta cell damage caused by the pancreas due to autoimmune reaction. In this type of insulin is not produced.
2. DM type 2: for insulin resistance, the number of insulin receptors on the cell surface is reduced, although the amount of insulin is not diminished. This causes glukosa can not enter the cells although insulin is available. This situation is caused by obesity, especially central type, a diet high in fat and low carbohydrate, less exercise, heredity.
3. DM specific types: for specific genetic abnormalities, pancreatic disease, other endocrine disorders, because the effects of drugs, chemicals, viral infections.
4. Gestational diabetes: diabetes that occurs only during pregnancy.

The classification in any other way is based on the history of the disease. Than normal blood sugar levels (normoglikemia) until there was an increase in blood sugar levels (hyperglycemia). Ie disturbance of impaired glucose tolerance (IGT), impaired Fasting Glucose (IFG), which does not need to be controlled hyperglycemia insulin, hyperglycemia that need to be controlled by insulin, hyperglycemia requiring insulin for survival.

Sugar and Functions

The food we eat is generally contain three main elements namely kerbohidrat, fat and protein. Of the three elements that are the source of energy is karbohidat such as sugar, starch and cellulose. Sugar in the body serves as the main source of energy to move, a source of energy for brain cells and nerve tissue, forming the muscle sugar as reserve energy body, also to form protein and fat.

Sugar in the blood primarily derived from carbohydrate fraction contained in food. Carbohydrate sugar molecules can be divided into two main sections:
1. Single sugar / monosaccharide, a sugar with a single sugar molecule. Included here are glucose and fructose.
2. Sugar compound, consisting of two groups:
- Disaccharide or carbohydrates with two molecules of sugar, eg sucrose and lactose
- Polysaccharide, a carbohydrate consisting of more sugar molecules, eg
starch, cellulose and glycogen

The process of absorption of sugar from food sources can be divided into two stages.
- Phase one: the food you eat into the digestive tract of the stomach and intestines, where the sugar compound modified with a single sugar
- Phase 2: single sugar from sugar mejemuk result changes through capillary blood vessels penetrate the bowel wall and into the venous blood vessels. That's why a single sugar will have a direct effect on improving blood sugar when consumed.

Consumed sugar levels will be kept in balance by the hormone insulin produced by pancreatic beta cells in the stomach. Insulin will alter the single sugar is absorbed into the body of the sugar compound. Some are stored in the liver and a small portion of the brain as a major energy reserves. If blood sugar is still excessive, it will be converted into protein and fat, then stored as a second reserve for the body.

In a healthy condition, when fasting blood sugar levels ranging from 80-120 mg%, while 1 day after eating will reach 170 mg% and two hours after a meal will decrease until it reaches 140 mg%. If low blood sugar called hypoglycemia, and if high blood sugar is called hyperglycemia.

Introduction Of Diabetes (2)

Diabetes Mellitus has been known since long. The name diabetes was first recognized by the Greek health experts, namely Celcus and Areteus. The name at that time due to diabetes in people who drink a lot and urinate a lot. In the world of medicine known as Diabetes Mellitus term.

Diabetes mellitus is known as a chronic disease caused by disturbances in the system metabolism of carbohydrates, fats and proteins in the body. Metabolic disturbances caused by the lack of production or resistance of body cells to insulin. The hormone insulin was discovered by Dr. Frederick Banting and Prof.. Charles Best from England in 1921.

The role of insulin in the process of metabolism is to convert sugar into energy and fat synthesis. Low insulin state body, resulting in an excess of sugar in the blood, called hyperglycemia. Excess sugar is removed from the body through the urine, because it is called diabetes. And produced substances to excess ketones and acids. Substances ketones and acids that cause excessive thirst constantly, lots of urine, weight loss.

In normal conditions, pancreatic efficiently regulate blood sugar levels on an ongoing basis. If the pancreas produces little insulin only, arising from diabetes. Type 1 Diabetes Mellitus can be helped to overcome with good treatment, good nutrition and healthy living.

In type 2 diabetes, many things we can do to control it, but few realize it. Type 2 diabetes can be prevented or can be well controlled through healthy diet and healthy lifestyle choices.

Introduction to Diabetes (1)

Currently, health care becomes very important to the community. Health information is very important for general masyarakay is informasri of Diabetes Mellitus. The public needs to know the causes, symptoms, isk factors and ways of prevention of diabetes mellitus. Because if not then the complications can do, arise and threaten the safety of the soul.

Diabetes is a chronic disease caused by disorders of carbohydrate metabolism, fat and protein. Diabetes is marked by an increase in blood glucose in a sudden and very risky heart disease, stroke, kidney disease and nerve dysfunction. Diabetes occurs because the organ pancreas does not produce enough insulin or when cells of the body resistant to insulin.

Insulin is a hormone that works to absorb the blood glucose into body cells. If insulin levels are low or the body's cells less sensitive to insulin, so blood glucose can not enter the cells and remained high in the blood. Continuing high blood sugar can cause various complications that can threaten the safety of the soul.

There are many fundamental questions about the general gannguan diabetes, physical activity, type of food and eating habits, medications, how to control blood sugar levels, and complications from diabetes. Everything will be explained in this blog.