Diabetes HED\ED:NS-BL 037-3rd
Diabetes Diabetes mellitus is an epidemic disease and based on a recent study published on 2011, the estimated number of affected people is 366 million worldwide and the number expected to reach 552 million by year 2030. There are multiple factors for this steady increment including physical inactivity and unhealthy dietary habits. If not controlled the diabetes has major health complications. The prevalence of diabetes mellitus (DM) in the Saudi population is high and 90% of diabetics suffer from Type II DM. An epidemiological study of Saudi subjects aged 15 years or older, from different regions of the kingdom found that the age-adjusted prevalence of DM (using WHO criteria) was higher in urban areas (males 12%, females 14%) than rural areas (males 7%, females 7.7%). The highest prevalence was in urban females aged 51 60 years (49%). In rural females of similar age the prevalence was 29%. 56% of those found to be diabetic in this survey had no prior knowledge that they had DM. Diabetes mellitus is a group of diseases characterized by high blood sugar resulting from defects in insulin secretion, action or both. Types of diabetes Type 1 diabetes: In type 1 the pancreas can not make any insulin in the body. People with type 1 diabetes must take insulin shots to live. This type of diabetes is seen primarily in younger people, including children, usually before 30 years of age. Type 2 diabetes: In type 2 diabetes, the body may make insulin, but it is not enough or can not use the insulin it makes. This type of diabetes is used to be seen mainly in adults however; with increased prevalence of obesity it is now not uncommon to see it in young people or even in children. GDM Gestational diabetes is another kind of diabetes that starts in some women when they are pregnant. Because of the hormonal changes of pregnancy. Signs and symptoms of diabetes There are known risk factors that increase the individual chance for having diabetes and by increasing the public awareness of these factors the diabetes can be prevented (Type 2). For the people who are affected, there are few tips that can help them keeping their diabetes under control and subsequently prevent the complications. This booklet may help you to understand your disease and prevent complication. Diabetes mellitus is a group of diseases characterized by high blood sugar resulting from defects in insulin secretion, action or both. Always tired. Always thirst. Extreme hunger. Irritability. Sudden weight loss. Blurred vision. Numbness and tingling of feet. Frequent urination. Nausea and vomiting. Itching of the skin. Slow healing of cuts and bruises. 2 Diabetes Mellitus Diabetes Mellitus 3
In many cases, there are no signs and symptoms until very late. Risk factors of diabetes Family history of diabetes. Overweight. Older than 40 years. Having HTN and high cholesterol. History of GDM Causes Too little food. Extra activity Too much insulin or diabetes medications. Hypoglycemia (low blood sugar) What can you do? Signs and Symptoms: Fast heart beat. Sweating Blurred vision Drink ½ glass of sweet juice or eat some soft candies. Within 15 minutes if no improvement repeat the treatment again, after that, test your blood sugar. if it s ok eat a snack. Sudden Hunger Headache Weakness, Fatigue Hyperglycemia (high blood sugar): Signs and Symptoms: Extreme thirst. Frequent urination, Sugar in urine. Fainting, Confusion Irritability Tremble 4 Diabetes Mellitus Diabetes Mellitus 5
Lack of appetite Drowsiness Shortness of breath Treatment plan Nausea and vomiting Dry skin Acetone smell Diet and weight reduction. Diet and weight reduction. Physical activity Medication (pill or insulin). Monitoring Physical activity Medication (pill or insulin). Monitoring Diet Causes Too little insulin. Too much food. Less exercise than usual. Stressful condition (emotional stress, social stress etc). What can you do? Drink too much water. Test your blood sugar and ketones: - If the sugar is high and no ketones, give yourself correction dose of insulin and recheck your blood sugar in one hour to make sure the blood sugar is going down. - If your blood sugar high and there is ketones go to the hospital. Follow these general guidelines: Try to follow schedule of meal plan. Avoid over weight. Cut down on fat. Eat less food which is high in cholesterol. Avoid refined sugar. Increase fiber in your diet. Use salt in moderation. Exercise Try to make exercise a part of your daily life. To be of benefit in diabetes management, exercise needs to be as regular as your meals and medication, not just something you do in your spare time. Some point you should follow before doing exercise: Chose a physical activity that you enjoy and consult your doctor before starting any kind of exercise. Exercise every day, if you can for 20 to 30 minutes. Wear cotton socks and good supportive shoes that it fit. Check your blood sugar level before, during and after your exercise. Stop exercising and call your doctor if you start to have chest or leg pain. Check your feet for cuts, blisters, and reddened areas before and after each exercise session. T ake with you juice or something sweet you can eat it when you feel symptoms of low blood sugar. 6 Diabetes Mellitus Diabetes Mellitus 7
Insulin and oral medication Call your doctor when The people with type 1 diabetes do not produce the insulin that their bodies need. They must have daily injection of insulin. Your physician will determine the proper prescription and amount of insulin required. The amount and kind of insulin must be balanced with food and activity. People having type two diabetes can be treated with oral medications. In some cases of type2 diabetes, insulin injections may be necessary. Vomiting persist for more than 4 to 6 hours. Your illness persists for more than 24 hours. Your temperature is over 38 C. High blood sugar continues for more than 6 hours and persist signs of dehydration (dry mouth, headache, lethargy). Complication: special care Monitoring You need to check your blood sugar regularly. This test lets you see how your meal, exercise, and medication are working together to control your diabetes. With regular testing you can see if you often have blood sugar that is too high or too low. Sick day management When you are sick, your blood sugar may go up. Take extra steps to control your diabetes during sickness: Always take your insulin or diabetes pills. Reduce the doses if you cannot eat, and if in doubt consult your doctor. T est your blood sugar every 4 hours, at least before each meal and at bedtime. Rest as much as you can. Drink plenty of water to avoid dehydration. Follow your normal meal plan if your stomach is not upset. If you can not keep food down, try to eat enough soft food or liquid. Test your urine for ketenes. Test more often if: Your blood sugar level is over 240 mg/dl. You throw up. You have symptoms of high blood sugar. People with diabetes have to keep the three hyper under control: Hypertension (high blood pressure). Hyperlipidemia (high blood fat). Hyperglycemia (high blood glucose). Complication: special care People with diabetes have to keep the three hyper under control: Hypertension (high blood pressure). Hyperlipidemia (high blood fat). Hyperglycemia (high blood glucose). High blood pressure, glucose or fat can cause problems with: 1- Foot problem: Watch for: pain, numbness, swelling, tenderness, sores that will not heal, high blood pressure, heavy callus formation, change in foot shape. Foot care: Wash your feet daily with warm water and mild soap. Dry your feet thoroughly specially between toes. Inspect your feet carefully. Cut toenails straight. Wear well fitting shoes. Inspect inside of shoes daily for foreign objects, nail points and torn lining. Wear proper socks made from cotton. Do not wear tight socks. Use cream for dry skin, do not put between toes. Do not walk bare foot. Do not use hot water bottle. Do not remove thick skin, corns or performs any surgical operation by yourself. Do not ignore wound even minor injuries. Do not wear tight narrow high heel shoes. If you smoke, stop. See your physician regularly and be sure that your feet are examined at least every 6 months. 8 Diabetes Mellitus Diabetes Mellitus 9
2-Nerve (neuropathy) 5- Heart (cardiovascular) Watch for: problem with sex, numbness in hands or feet, tingling, burning, diarrhea, constipation, nausea and vomiting. Tell your doctor about any problem. Control your blood sugar level. 3- Eye care (retinopathy) Watch for: blurring vision, double vision, narrowed field of vision, seeing a floating black spot, feeling a pressure or pain in the eyes, difficulty seeing in dim light. Take these steps to further reduce the risk and the danger of eye problem: Have a complete eyes exam every year, remember, eye damage has no symptoms in the early stage, good control will prevent DR and it will retard its development by few years. Visit an ophthalmologist, a medical doctor who specializes in eye care, if you have any signs that mentioned above. Stop smoking. 4-Kidneys (nephropathy) Watch for: swelling of the ankles, feet, hands and eyes, nausea or vomiting, poor appetite, depression, dry, itchy skin, irritability. Control your blood glucose. Control high blood pressure. Control urinary tract infections by treating them promptly. Control diet by restricting protein and dietary phosphorous under the advice of physician. Watch for: chest pain, shortness of breath, swollen ankles. Tell doctor about any problem. Lower blood pressure if high. Avoid salt. Start an exercise program. (check with doctor). Lower blood fats if high. Lower cholesterol in diet. Lower glucose to acceptable range. 6- Dental care Watch for: pain or bleeding. Brush after meals and at bed time. Floss between your teeth every day. Do not smoke. See your dentist twice a year at least. Lower glucose to acceptable range. Final reminder Follow your meal plan. Follow your activity routine. Follow your medication routine exactly. Test your blood sugar regularly. Check feet and skin daily. Get yearly eye and kidney function exam. Get twice yearly dental exams. Keep blood pressure near normal. Keep blood fat near normal. Do not smoke. Meet often with your doctor, your diabetic educator, and the other members of your health care team. Keep learning about your diabetes and its treatment. Take charge of your health. You can do it. You should remember when you learn to keep your exercise, food, and medication in balance, you will find it s easy to keep blood sugar levels where they should be. 10 Diabetes Mellitus Diabetes Mellitus 11
Go to the hospital when You are sick. Your blood sugar is very high or very low. You have a sore that doesn t heal or is infected. You have frequent low blood sugar reactions or you pass out. For further information, please contact Nursing Services (OPD) Tel: 03 8431111 Ext: 1103 For comments and suggestions, please contact: Health Education Department Tel: 03 8431111 Ext:1242\1939 E-mail: HealthEducation@kfsh.med.sa 12 Diabetes Mellitus