Treatment of Type 2 Diabetes Mellitus

A multi-disciplinary strategy is normally use within the administration of affected person with diabetes. Diabetic sufferers are prone to have vascular problems of diabetes reminiscent of coronary coronary heart ailments, stroke, nephropathy and peripheral vascular problems. Therefore, the goal of therapy is to cut back their dangers of such problems in addition to to reduce signs whereas permitting a standard life.

This could be finished by 2 essential modalities: way of life modifications and pharmological interventions.

1) Lifestyle Modifications:

– Diet:

Control of caloric consumption could be finished by modifying the eating regimen such that 30 energy is given per kilograms of preferrred physique wt: could be elevated to 40 energy per kilograms for an lively individual and 50 energy per kilograms if the affected person does heavy bodily labour. Therefore, Mr Tan preferrred energy consumption must be 30 x 69 = 2070 energy per day. The energy must be distributed as 55% to 60% carbohydrates, 25% to 35% fats, and 15% to 20% protein.

Emphasis must be positioned on advanced carbohydrates relatively than easy and refined starch in addition to polyunsaturated fat as an alternative of saturated fat in a ratio of 2:1. Therefore, Mr Tan must be suggested to eat wholemeal bread, brown rice, margarine, vegetable oil as an alternative of rice, fried meals, and fatty meat.

He must also be educated on the glycemic index of numerous meals. A decrease rise in blood sugar happens after the ingestion of easy sugars in comparison with advanced carbohydrates which is seen after the absorption of glucose.

Fiber (soluble and insoluble) consumption must also be inspired because it delays glucose absorption and have additionally been proven to decrease elevated triglyceride degree.

– Exercise:

He must be suggested to train a minimum of three occasions a day for a minimum of 30 minutes every time.

And if potential, he ought to take the steps as an alternative of the carry. Working as a taxi driver requires him to sit down for lengthy hours, will increase his threat of having deep vein thrombosis. Therefore, he must be suggested to do some gentle workouts each few hours to enhance blood circulation.

2) Pharmological intervention: Oral Hypoglycemic Agents

– Biguanides (insulin sensitizers)

Metformin is the generally used drug on this group.

They work by growing the density of insulin receptors; instantly stimulate glycolysis in peripheral tissues; cut back hepatic gluconeogenesis; lower glucose absorption from the gastrointestinal tract and cut back plasma glucagon degree.

– Sulphonylureas (Insulin secretagogues)

Glibenclamide/ daonil is used on this affected person because it produces a synergistic impact with metformin within the management of diabetes.

They work by closing ATP delicate potassium channels, inflicting depolarisation of islet cells and inflow of calcium ions which stimulates the discharge of insulin.

Other courses of medication reminiscent of thiazolinediones, meglitinide, alpha-glucosidase inhibitors have additionally been show their value in diabetic management. Hence, they can be utilized as additions or subsitiutions to Mr Tan’s present routine if glycemic management is insufficient seen within the subsequent follow-ups.

In all, Mr diabetic sufferers must be educated on the significance of good glycemic and blood strain (ideally lower than 130/80 mmHg) management to stop the problems of diabetes mellitus. Good compliance with eating regimen and drugs in addition to help from household and healthcare personnel will assist to cut back the morbidity and mortality of the illness.