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Perioperative Diabetes Mellitus Management

Perioperative Diabetes mellitus management

Perioperative Diabetes mellitus management

1. PERIOPERATIVE MANAGEMENT OF DIABETES MELLITUS SPEAKER Dr. DHARMRAJ SINGH MODERATOR Dr. SHASHI PRAKASH
2. INTRODUCTION  Patients with diabetes have higher incidence of morbidity and mortality.  Poor peri-operative glycaemic control increases the risk of adverse outcomes.  Treatment of post-operative hyperglycaemia reduces the risk of adverse outcomes.
3. CRITERIA FOR DIAGNOSIS OF DIABETES 1. Symtoms of diabetes plus random plasma glucose level >200 mg/dL (11.1 mmol/L) 2. Hemoglobin A1C ≥ 6.5 % 3. Fasting plasma glucose level ≥ 126 mg/dL (7.0 mmol/L) 4. Two-hour plasma glucose level ≥ 200 mg/dL (11.1 mmol/L) American Diabetes Association
4. METABOLIC SYNDROME At least three of the following  Fasting plasma glucose ≥ 110 mg/dl  Abdominal obesity (waist girth > 40 [in men], 35 [in women])  Serum triglycerides ≥ 150mg/dl  Serum HDL cholesterol < 40 mg/dl (men), <50 (women)  BP ≥ 130/85 mm Hg  Insulin-resistant syndrome is a constellation of clinical & biochemical characteristics frequently seen in pt with or at risk of type 2 diabetes.
5. THE METABOLIC RESPONSE TO SURGERY AND THE EFFECT OF DIABETES Metabolic effects of starvation: 1. Period of starvation induces a catabolic state. 2. It will stimulate secretion of counter-regulatory hormones . 3. It can be attenuated in patients with diabetes by infusion of insulin and glucose (approximately 180g/day). Metabolic effects of major surgery. It causes neuroendocrine stress response with release of counter- regulatory hormones (epinephrine, glucagon, cortisol and growth hormone) and of Continue reading

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Glycemic Load: The Key to a Smarter Diabetes Diet

Glycemic Load: The Key to a Smarter Diabetes Diet

Once you’ve mastered counting carbs, just a little more math will let you fine-tune your diabetes diet plan. Figuring out the glycemic load of a food can help you craft a menu that won’t put your blood sugar on a roller coaster.
Understanding Glycemic Index vs. Glycemic Load
Beyond carbohydrate counting, you might already be looking at the glycemic index (GI) number, which tells you how quickly your blood sugar might spike after eating a certain type of food. The GI of carb-based foods is a measurement of how quickly blood sugar rises after eating in comparison to a slice of white bread, which has a GI of 100. In general, the lower the GI number, the less dramatically the food will affect blood sugar. Low-GI foods are generally 55 or less.
However, calculating the glycemic load (GL) can provide an even more accurate picture of what that food will do to your blood sugar. “Glycemic load accounts for carbohydrates in food and how much each gram of it will raise your blood sugar level,” says Krista Wennerstrom, RD, food and nutrition services director at Thorek Memorial Hospital in Chicago.
To find a food’s GL, multiply its GI by the number of carbohydrate grams in a serving, and then divide by 100. A low GL is between 1 and 10; a moderate GL is 11 to 19; and a high GL is 20 or higher. For those with diabetes, you want your diet to have GL values as low as possible.
As an example, an average cake-type doughnut has a GI of 76 and 23 carbohydrate grams. Multiply 76 by 23 and then divide by 100, and you get 17.48, which is close to the top of the moderate range for glyce Continue reading

Diabetes Skin Care – What You Need to Know and What You Can Do

Diabetes Skin Care – What You Need to Know and What You Can Do

Taking care of our skin is always important, but in diabetes skin care requires more consideration. The skin, our body’s largest organ, is a vital physical barrier between the outside world and everything inside us. Although it seems like a pretty simple thing, there are many blood vessels, nerves and various other structures within it. These all affect the integrity of our skin, and influences how well it does its job.
It’s in Your Blood
One primary cause of medical complications in diabetes is high blood glucose levels, especially if levels are consistently high over a prolonged period of time. High levels of circulating glucose can lead to damage to the body’s blood vessels. Since all organs in the body rely on blood perfusion from these vessels, any damage to them can lead to problems for the respective organs.
People with diabetes may thus be at risk of various complications if their blood glucose levels are not adequately controlled. These may include eye problems (such as retinopathy), kidney damage (nephropathy) and, of course, skin issues. The cells of our skin need good blood flow to maintain its integrity.
Other factors, like high blood pressure and high cholesterol, may also increase the risk of blood vessel damage. For people with diabetes, it’s important for blood pressure and cholesterol to also be monitored regularly. If you have concerns about these, you should talk to your doctor about appropriate monitoring and management.
Nerves Know the Problems
Nerves in the skin detect things like heat and pain to let us know when there are problems or danger Continue reading

Your Habit of Drinking Tea May Keep You Away from Diabetes

Your Habit of Drinking Tea May Keep You Away from Diabetes

For most of us, the morning starts with a cup of freshly brewed tea. It is almost like a ritual that needs to be followed religiously. Tea leaves have numerous health benefiting properties. Popularly known for its caffeine effect, which gives you that instant energy boost, it is also an excellent source of antioxidants. Antioxidants are essential for the body because they help fight against free radicals that are known to increase risks of cancer and heart diseases. The antioxidants found in tea leaves is a compound known as polyphenols. According to a new study, polyphenols can also prove to be beneficial for regulating blood sugar levels. The study states that they can significantly reduce blood glucose in adults, thus keeping a check on diabetes.
Polyphenols - the natural compound in tea tends to block sugar absorption in the blood, as reported by the study. The findings, which appeared in Asia Pacific Journal of Clinical Nutrition, indicated that polyphenols significantly reduce the amount of glucose in adults, who were given sucrose-laden drinks just before. Researchers claim that by consuming tea, it helps to smooth out spikes in blood sugar levels that are triggered by snacking on sweet treats.
Dr Tim Bond of the Tea Advisory Panel said, "After water, tea is the second most commonly consumed beverage in the world and this new research adds to already published studies, which suggest that it is good for health and well-being benefits."
"In effect, these polyphenols seemed to lower the Glycaemic Index - the relative ability of a carbohydrate food to increase the level Continue reading

AskNadia: Going to Stop Taking My Insulin

AskNadia: Going to Stop Taking My Insulin

I have type 2 diabetes and am overweight. I want to get off my insulin and have decided to fast to lose weight and stop taking my insulin. I bought a cleanse and diet package. I don’t want to go to my Doctor because I am scared he will talk me out of it.
Suzanna
Dear Suzanna,
Congratulations on setting a new health goals. People living with type 2 diabetes can go off all medications with the right diet and exercise program. We just featured a man who lost 200 pounds and went off all of his insulin and metformin. What motivated him? His mother’s passing from diabetes complications.
50 to 80 Percent of Patients Do Not take Their Medication
It is estimated that 50% of people who have prescription do not take their medication. In some instances, like hypertension, the percentage of people who have decided not to take their medication, can be as high as 80%. Research data shows that there is a relationship between the quality of your life and marinating a regime that will give you the best outcomes.
Why do we have such a large population that have unilaterally decided to go off their prescriptions?
Sometimes the physician writes a prescription without consulting the patient. This opens up a host of problems from which range from, the timing of the medication, possibly the side affects, medical literacy; understanding the importance of taking the medication, cost to accessibility.
I would highly recommend working with a healthcare professional before starting your fast and throwing away your insulin. You made no mention of any other medication. However, if you are on hyperten Continue reading

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