09/22/2017

Treatment of TYPE 2 Diabetes mellitus

By Live Dr - Sun Mar 25, 4:47 am

Type 2 diabetes is a lifelong (chronic) disease in which there are high levels of sugar (glucose) in the blood. Type 2 diabetes is the most common form of diabetes.Diabetes is caused by a problem in the way your body makes or uses insulin. Insulin is needed to move blood sugar (glucose) into cells, where it is stored and later used for energy.Type 2 diabetes can also develop in people who are thin. This is more common in the elderly.Family history and genes play a large role in type 2 diabetes. Low activity level, poor diet, and excess body weight around the waist increase your risk

Symptoms :

  • Bladder, kidney, skin, or other infections that are more frequent or heal slowly
  • Fatigue
  • Increased thirst
  • hunger
  • erectile disfunction
  • pain and numbness in feet or hands
  • blurred vision

Of these latter three occur during the early stages followed by the the other indicating the progression of this silent deadly disease.

Diagnosis :

Following tests are to be made for the confirmation of the disease in a individual :

  • Fasting blood glucose test(diabetes is diagnosed if it is higher than 126 mg/dL two times)
  • Hemoglobin A1c test(If > 5.7 % DM is suspected and if >6.4% DM confirmed)
  • Oral glucose tolerance test(diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours)

In general as a  preacautionary measure , these diagnosis are to be done in individuals who are at the risk of falling prey to this disease.

  • Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 2 years
  • Overweight adults (BMI greater than 25) who have other risk factors
  • Adults over age 45 every 3 years

Treatment :

The goal of treatment at first is to lower high blood glucose levels. The long-term goals of treatment are to prevent problems from diabetes.

The main treatment for type 2 diabetes is exercise and diet.For effective treatment the victim must be aware of the following facts :

  • How to test and record your blood glucose
  • What to eat and when
  • How to take medications, if needed
  • How to recognize and treat low and high blood sugar
  • How to handle sick days
  • Where to buy diabetes supplies and how to store them

Excercising for control of Type 2 DM :

In patients with type 2 diabetes, a single bout of endurance- and resistance-type exercise has been shown to improve whole-body insulin sensitivity. However, a distinction should be made between the acute effects of exercise and training effects. During an acute exercise session, glucose uptake by the exercised muscle increases through several complementary mechanisms: contraction-induced (and insulin-independent) increase in the muscle glucose transporter system (GLUT-4), decreased muscle and liver glycogen stores, and increased skeletal muscle blood flow. These effects occur during the short term, and wear off between 2 and 14 hours after exercise completion. The glucoregulatory benefit of either type of exercise training is the sum of the effects of each successive bout of exercise. In addition, more prolonged exercise training is accompanied by a more structural adaptive response in glucose transport and metabolism.

There are apparent differences in the long-term adaptive response to endurance- or resistance-type exercise training. Prolonged endurance-type exercise training has been shown to improve insulin sensitivity and insulin responsiveness. In this case, increased insulin sensitivity is attributed to the concomitant induction of weight loss, the upregulation of skeletal muscle GLUT-4 expression, improved nitric oxide-mediated skeletal muscle blood flow, reduced hormonal stimulation of hepatic glucose production, and the normalization of blood lipid profiles. Long-term resistance-type exercise interventions have also been reported to improve glucose tolerance and/or whole-body insulin sensitivity and has been associated with a substantial gain in skeletal muscle mass, thereby improving whole-body glucose disposal capacity. More importantly, combined endurance and resistance training reverses alterations in mitochondrial density and size in the activity of respiratory chain complexes and in cardiolipin content. Combined training increased mitochondrial content to the same extent in both patients with type 2 diabetes and control individuals, in parallel with improved insulin sensitivity. In patients with type 2 diabetes, restoration of mitochondrial function is paralleled by improved insulin-stimulated glucose disposal and by complete restoration of metabolic flexibility and insulin-stimulated substrate oxidation toward control values. It should be noted that the insulin-sensitizing effect of combined exercise training occurs in the absence of major changes in body mass and is not restricted to improved muscle insulin sensitivity but extends to improved hepatic and adipose tissue insulin sensitivity.

At the other end of the spectrum, emerging inactivity physiology studies suggest that inactivity initiates strong specific cellular responses, such as suppression of skeletal muscle lipoprotein lipase activity, which contributes to poor lipid metabolism that may negate the benefits of extra exercise. This suggests that any type of brief muscular contraction throughout the day, breaking sedentary time, may be necessary to short-circuit deleterious molecular signals causing metabolic disease.

Diet control for Type 2 DM :

Weight Control for Type 2 Diabetes:

The American Diabetes Association recommends that patients aim for a small but consistent weight loss of ½ – 1 pound per week. Most patients should follow a diet that supplies at least 1,000 – 1,200 kcal/day for women and 1,200 – 1,600 kcal/day for men.

Even modest weight loss can reduce the risk factors for heart disease and diabetes. There are many approaches to dieting and many claims for great success with various fad diets. They include calorie restriction, low-fat/high-fiber, or high protein and fat/low carbohydrates. Some evidence suggests that people may respond differently to specific diets depending on whether their weight is overly distributed around the abdomen.

Here are some general weight-loss suggestions that may be helpful:

  • Start with realistic goals. When overweight people achieve even modest weight loss they reduce risk factors in the heart. Ideally, overweight patients should strive for 7% weight loss or better, particularly people with type 2 diabetes.
  • A regular exercise program is essential for maintaining weight loss. If there are no health prohibitions, choose one that is enjoyable. Check with a doctor about any health consideration.
  • For patients who cannot lose weight with diet alone, weight-loss medications such as orlistat (Alli, Xenical) and sibutramine (Meridia) may be considered. Sibutramine should not be used by patients with high blood pressure or kidney or liver problems.
  • For severely obese patients, weight loss through bariatric surgery can help in produce rapid weight loss and improve insulin and glucose levels in people with diabetes.

Even repeated weight loss failure is no reason to give up.

Calorie Restriction

Calorie restriction has been the cornerstone of obesity treatment. Restricting calories in such cases also appears to have beneficial effects on cholesterol levels, including reducing LDL and triglycerides and increasing HDL levels.

The standard dietary recommendations for losing weight are:

  • As a rough rule of thumb, 1 pound of fat contains about 3,500 calories, so one could lose a pound a week by reducing daily caloric intake by about 500 calories a day. Naturally, the more severe the daily calorie restriction, the faster the weight loss. Very-low calorie diets have also been associated with better success, but extreme diets can have some serious health consequences.
  • To determine the daily calorie requirements for specific individuals, multiply the number of pounds of ideal weight by 12 – 15 calories. The number of calories per pound depends on gender, age, and activity levels. For instance a 50-year-old moderately active woman who wants to maintain a weight of 135 pounds and is mildly active might need only 12 calories per pound (1,620 calories a day). A 25-year old female athlete who wants to maintain the same weight might need 25 calories per pound (2,025 calories a day).

Fat intake should be no more than 30% of total calories. Most fats should be in the form of monounsaturated fats (such as olive oil). Avoid saturated fats (found in animal products).

WHITE RICE Vs BROWN RICE IN TYPE 2 DIABETES

White rice which has high GI value is the predominant type of rice eaten worldwide. High GI diets are associated with Type 2 Diabetes. According to the results of four studies (2 in Asian countries and 2 in Western countries) done by Harvard School of Public health risk of type 2 diabetes increases with increased intake of white rice.

White rice is taken in large amounts in Asian countries than the Western countries. Intake of white rice varies widely between Asian and Western countries. Chinese take four portions per day whereas western population takes five portions a week. Risk of type 2 diabetes increases by 10% for each serving (158g/serving).

Brown rice is superior to white rice by its fiber content, vitamins and phytochemicals. Milling of brown rice strips most of its fiber which helps to deter diabetes by slowing rush of sugar in bloodstream. White rice is digested much faster and converted into sugar and get into blood much quicker, so body puts a lot more insulin in response to white rice.

If we replace 50 g of white rice by brown rice the risk of type 2 diabetes lowers by 16%.The same replacement by whole grains such as wheat and barley reduces the risk by 36%. In the study done, even though by controlling smoking and other life style changes the risk remained as such in white rice consumption. In recent decades white rice consumption is drastically increased in US and other countries which alarms the risk of type2 diabetes.

So, to conclude diabetes friendly white rice should be replaced by brown rice intake – A More Health Conscious Lifestyle. In addition people who are consuming brown rice are slimmer and physically active.

Credits : Dr.Krty

Link :http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001356

3 Comments

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