Investigations & Prevention - Diabetes Mellitus (DM)

Screening for Diabetes

• Urine examination:
• Urine for glucose, 2 hour after a meal  is commonly used in medical practice for detecting case of diabetes. Glucose is found in the urine in the most severe cases of diabetes. It is often absent in the milder forms of the diabetes. Such cases are likely to be missed by urine test.

Blood sugar testing:

• Fasting Blood Sugar (FBS)
• Post prandial Blood Sugar (PPBS)
• Random Blood Sugar
• Random blood sugar glucose is considered unsatisfactory for epidemiological use. It can give only crude estimate of the frequency of diabetes in population.

Diagnostic values of diabetes mellitus;

• Fasting Venous:    >6.7m mol/l (120mg/dl)     
• Fasting capillary: >6.7m mol/l (120mg/dl)

• 2h after glucose load Venous:    >=10.0m mol/l (180 mg/dl)
• 2h after glucose load capillary: >=11.1m mol/l (200 mg/dl)

Impaired glucose tolerance;

• Fasting venous:    >=6.7m mol/l (120 mg/dl)
• Fasting capillary: >=6.7m mol/l (120 mg/dl)

• 2h after glucose load venous:    6.7-10.0 mol/l (120-180 mg/dl)
• 2h after glucose load capillary: 7.8-11.1 mol/l (140-200 mg/dl)

Prevention of Diabetes Mallitus

Primordial prevention;

• Prevention of emergence of risk factors which they have not appeared.
• Adoption of healthy nutritional habits and physical exercises. 
• Maintenance of normal body weight.

Primary prevention;

Two strategies for primary prevention

1.Population strategy

2.High risk strategy

1.Population strategy: 

• IDDM (Type 1 diabetes); It occurs much less frequently
• It result from autoimmune destruction of beta cells of the pancreas.
• No evidence of role for lifestyle factors which can be modified to reduce the risk.
• NIDDM ; The development of prevention programs for NIDDM based on elimination of environmental risk factors is possible.
• Healthy nutritional habits
• Adequate protein intake
• High intake of dietary fiber
• Avoidance of sweet food
• Elimination protein deficiency and food toxins

Secondary prevention;

• Early diagnosis and treatment
• The aim of treatment are, to maintain the blood glucose level within the normal limits and to maintain ideal body weight.
• Treatment based on;
• diet alone, diet and oral anti diabetes drugs, diet and insulin.
• Good control of blood glucose protect against the complications.
• Proper management of diabetes is most important to prevent complications.

Routine check-ups;

• Blood sugar
• Urine protein and ketones
• Blood pressure
• Visual acuity
• Weight
• Feet should be examine for any defective blood circulation loss of sensation and health of the skin.

Glycosylated hemoglobin;

• Should be estimate of Glycosylated hemoglobin at half yearly intervals. This test provides a long term index of glucose control.

Self care;

• Diabetes should take major responsibility for his own care with medical guidance.
• Diet and drug regimen.
• Examination of urine and blood if possible.
• Self administration of insulin.
• Avoid alcohol.
• Maintenance of optimum body weight.
• Periodic check-ups.
• Recognition of symptoms associated with glycosuria and hypoglycemia.
• Patient should carry an identification card showing his name, address, telephone number and details of treatment he is receiving.
• Education of patients and their families to optimize the effectiveness of primary health care services.

Tertiary prevention;

• Diabetes is major cause of disability through its complications.
• The aim to prevent; 
• Blindness
• Kidney failure
• CHD and stroke
• Coronary thrombosis
• Gangrene of the lower extremities
• Risk of infection

Life can be prolong is possible;

• Life threatening complications can be avoided by effective treatment
• Diet regulation
• Physical exercises
• Regular drugs
• Ensure effectiveness control of diabetes