Classic Clock

Senin, 28 Desember 2015


Berikut merupakan kutipan ilmiah kedokteran yang bermanfaat sehingga disusun dan digunakan sebagai referensi pribadi.


The issue of self-monitoring for people with type 2 diabetes is a topic I feel particularly strongly about.
I’ve seen the news reports saying that self-testing for type 2 diabetics is not cost effective and I’ve thought to myself, really?!
Also I’ve watched how many people with type 2 diabetes on the diabetes forum have made a huge amount of progress thanks to a bit of education and intelligent blood testing. So why should the research contradict this?
The DiGEM study
The most authoritative study on the subject of self-testing for people with type 2 diabetes is the DiGEM study.

The report here concludes that:
“This trial does not provide convincing evidence to support the routine use of SMBG for non-insulin-treated patients with reasonably well controlled type 2 diabetes.”

‘Reasonably well controlled’ here refers to the participants whose collective HbA1c numbers averaged 7.5%.
What did the DiGEM study involve?
The study involved three approximately equally-sized groups, of around 150 participants with type 2 diabetes and not using insulin. One group was a control group who were not encouraged to self test. A second performed self-testing with training from a clinician. The third performed self-testing and were given additional training to interpret results, apply changes and to aid motivation.

Over the 12 month period, both the intensively trained self-testers and less intensively trained testers were averaging 5 tests per week.
What were the results of the study?
The results were sadly disappointing. The group with less intensive education scored an average improvement in A1c results of 0.14% and the more intensively trained group achieved an average improvement of 0.17%.

Having read this, I start to question, so what might be causing the improvement in these groups to be small?
Who were excluded from taking part in the study?
The first clue is offered in the exclusion criteria –ie which people were excluded from taking part in the trial:

“Exclusion criteria were: the use of a blood glucose monitor twice a week or more often over the previous 3 months”
So it’s fair to say that the study excluded anyone who was already significantly pro-active in self-testing.
Average participant was aged 66 years old
It’s worth noting that the average participant’s age was 66 years old. Therefore, if I were say a 50 year old type 2 diabetic and I’d had my test strips withdrawn by my GP as a consequence (indirectly or otherwise) of this study, I’d feel disgruntled on this basis as well.

It stands to reason that participants aged 70 plus would be less likely to adapt and cope with a significantly new lifestyle change compared with those who are notably younger.
Was the intensive training any good?
The report of the study provides a wealth of anecdotal evidence about the study itself, featuring a number of interesting comments from the participants.

Based on the anecdotal comments featured in the report, it does seem as though the training received may have been of questionable quality.
As an example, one participant from the intensively trained group noted:
“my readings very, very rarely alter, they’re all between 7 and 10, depending which time of day I take them.”

So clearly this patient’s training failed to educate him that the difference between sugar levels of 10 mmols/l and 7 mmols/l over the long run is actually very significant.
Unwilling to learn
When you look at some of the attitudes of some of the patients, it just goes to show how significant a bearing the exclusion of pro-active testers may have been on the study outcomes:
“… a sort of reminder of the fact that you know that I’ve got something wrong with me…I don’t like to be reminded particularly.”

This response appears to be fairly typical of the attitude of the participants. It seems that for a proportion of these non-pro-active testers, denial is preferred to the truth.
Given that there was a significant amount of disaffection towards self-testing in the participants, it is therefore not so surprising that the improvements in HbA1c were as low as they were.
So what does the study show?
The study indicates that encouraging people with type 2 diabetes to self test as a matter of course may not be viewed as cost effective.

And what does the study not show?
The study excluded any testers who had recently shown a concerted commitment to self test. Therefore, the study cannot draw any conclusions about people with type 2 who are actively keen to self-test their blood sugar levels.

Protect Yourself from Nerve Damage

Nerve damage from diabetes—or diabetic neuropathy—can be serious. You might not feel small injuries, such as a cut or a blister on your foot. That means you may not treat foot injuries as soon as you should. Or you might have symptoms that make it hard to stand, walk, or do other everyday activities. Protect your health and try these self-care tips to prevent or manage your diabetic neuropathy and your diabetes in general.

1. Keep Your Blood Sugar Under Control

Controlling your blood sugar is one of the most important things you can do to prevent or limit nerve damage. Staying on target means eating a healthy diet, exercising regularly, and following your schedule for testing your blood sugar and taking your medications. Work with your diabetes care team to understand what to do if your level goes too high or too low.

2. Be Aware of Symptoms

Know the symptoms of diabetic neuropathy and call your doctor at the first sign. Symptoms range from numbness to pain or tingling, often in your feet, or feeling weak when you try to stand up. But neuropathy can affect just about any nerve and system in your body. So talk to your doctor about any changes in digestion, bowel movements, urination, and even sexual function, or any sudden nerve pain in one area.

3. Do Daily Foot Self-Checks

With diabetic neuropathy, you might not feel a cut or blister on your foot or realize it needs treatment. This can lead to infection. Do a self-check every evening to look for foot woes—check the tops, soles, and between each toe. If you can't easily see the bottom of your feet, use a mirror or ask someone to help. Never ignore a problem you find, and if there's any delay in healing, see your doctor right away.

4. Be Proactive with Foot Care

Wash your feet in lukewarm water with a gentle cleanser at least once a day. Dry thoroughly, especially between your toes, where trapped moisture can cause problems. Moisturize your feet to prevent cracks, but avoid the area between your toes. Trim your toenails with a straight edge to prevent ingrowth (more details to come). Always wear shoes, and make sure they won’t rub and cause blisters. Check with your insurance or Medicare about coverage for special shoes. Always wear socks to create a protective barrier between your feet and your shoes.

5. Resist the Urge to Go Barefoot

Never walk around without shoes or slippers, even at home. Going barefoot invites injury, especially when the feeling in your feet is impaired. Forget flip-flops, slides, and shoes with pointy toes. Before you put your shoes on, give them the once-over—look for wear-and-tear, especially on the inside, and rough seams that could irritate or injure your feet. Break in new shoes gradually, starting with only an hour of wear.

6. Trim Your Nails With Care

Trimming toenails will keep them from snagging hosiery and cutting into adjacent toes. Try a schedule of every six to eight weeks. When clipping nails, cut them straight across, but always follow the nail's natural curve. Use a nail file to smooth any rough edges. Never clip or cut down into the corners. If you have an ingrown toenail, or if a toenail has broken the skin on your foot, see a podiatrist promptly.

7. Talk to Your Doctor About Medications

Several medications are useful for treating diabetic neuropathy. Some of them are medicines that treat other diseases, but they also relieve nerve pain. These include antidepressants and antiseizure medications. Pain medicines, such as narcotics, can also help. Ask your doctor if one of them is right for you. Be sure to follow your doctor’s instructions for taking the medicine and call your doctor if you have any side effects.

8. Don’t Smoke

Not smoking is the best advice for many health issues, and diabetes is one of them. Smoking is a risk factor for diabetic neuropathy. It increases your risk for dangerous foot problems with diabetes because of its harmful effects on circulation. Get help if you have trouble quitting on your own. Your diabetes care provider may be able to prescribe medication to help you quit, or suggest a smoking cessation program to boost your motivation.

Have you heard that eating too much sugar causes diabetes? Or maybe someone told you that you have to give up all your favorite foods when you’re on a diabetes diet? Well, those things aren’t true. In fact, there are plenty of myths about dieting and food. Use this guide to separate fact from fiction.

1. Eating Too Much Sugar Causes Diabetes.

MYTH. The truth is that diabetes begins when something disrupts your body's ability to turn the food you eat into energy.

2. There Are Too Many Rules in a Diabetes Diet.

MYTH. If you have diabetes, you need to plan your meals, but the general idea is simple. You’ll want to keep your blood sugar levels as close to normal as possible. Choose foods that work along with your activities and any medications you take.
Will you need to make adjustments to what you eat? Probably. But your new way of eating may not require as many changes as you think.

3. Carbohydrates Are Bad for Diabetes.

MYTH. Carbs are the foundation of a healthy diet whether you have diabetes or not.
They do affect your blood sugar levels, which is why you’ll need to keep up with how many you eat each day. Some carbs have vitamins, minerals, and fiber. So choose those ones, such as whole grains, fruits, and vegetables. Starchy, sugary carbs are not a great choice because they have less to offer. They’re more like a flash in the pan than fuel your body can rely on.

4. Protein Is Better Than Carbohydrates for Diabetes.

MYTH. Because carbs affect blood sugar levels so quickly, you may be tempted to eat less of them and substitute more protein. But take care to choose your protein carefully. If it comes with too much saturated fat, that’s risky for your heart’s health. Keep an eye on your portion size too. Talk to your dietitian or doctor about how much protein is right for you.

5. You Can Adjust Your Diabetes Drugs to ‘Cover’ Whatever You Eat.

MYTH. If you use insulin for your diabetes, you may learn how to adjust the amount and type you take to match the amount of food you eat. But this doesn't mean you can eat as much as you want and then just use additional drugs to stabilize your blood sugar level.
If you use other types of diabetes drugs, don't try to adjust your dose to match varying levels of carbohydrates in your meals unless your doctor tells you to. Most diabetes medications work best when you take them as directed. When in doubt, ask your doctor or pharmacist.

6. You'll Need to Give Up Your Favorite Foods.

MYTH. There’s no reason to stop eating what you love. Instead, try:
  • A change in the way your favorite foods are prepared. Can you bake it instead of deep-frying it?
  • A change in the other foods you usually eat along with your favorites. Maybe have a sweet potato instead of mashed potatoes?
  • Smaller servings of your favorite foods. A little bit goes a long way.
  • Not using your favorite foods as a reward when you stick to your meal plan. Do reward yourself, but with something other than food.
A dietitian can help you find ways to include your favorites in your diabetes meal plan.

7. You Have to Give Up Desserts if You Have Diabetes.

MYTH. You could:  
  • Cut back. Instead of two scoops of ice cream, have one. Or share a dessert with a friend.
  • Consider using low-calorie sweeteners. Keep in mind, there might be a few carbs in these.
  • Expand your horizons. Instead of ice cream, pie, or cake, try fruit, a whole wheat oatmeal-raisin cookie, or yogurt.
  • Tweak the recipe. For instance, you can often use less sugar than a recipe calls for without sacrificing taste or consistency.
8. Low- and No-Calorie Sweeteners Are a No-No.
MYTH. Most of these sweeteners are much sweeter than the same amount of sugar, so you can use less.
Opinions about them are conflicting, but the American Diabetes Association approves of the use of:
  • Saccharin (Sweet'N Low, Sweet Twin, Sugar Twin)
  • Aspartame (NutraSweet, Equal)
  • Acesulfame potassium (Sunett, Sweet One)
  • Sucralose (Splenda)
  • Stevia/Rebaudioside A (SweetLeaf, Sun Crystals, Steviva, truvia, Pure Via)
You can ask a dietitian which ones are best for which uses, whether you’re drinking coffee, baking, or cooking.

9. You Need to Eat Special Diabetic Meals.

MYTH. The foods that are good for people with diabetes are also healthy choices for the rest of your family.
With diabetes, you do need to keep a closer watch on things like calories and the amounts and types of carbohydrates, fats, and protein you eat. A diabetes educator or dietitian can show you how to keep good records.

10. Diet Foods Are the Best Choices.

MYTH. You might be paying more for "diet" food that you could find in the regular sections of the grocery store or make yourself.
Read the labels to find out if the ingredients and number of calories are good choices for you. When in doubt, ask your doctor, diabetes educator, or a dietitian for advice.

Knowing how diabetes affects your body can help you look after your body and prevent diabetic complications from developing.
Many of the effects of diabetes stem from the same guilty parties; namely high blood pressure, high cholesterol levels and a lack of blood glucose control.

Signs of diabetes

When undiagnosed or uncontrolled, the effects of diabetes on the body can be noticed by the classicsymptoms of diabetes, namely:
Diabetes has a substantial effect on the body

Long term effects of diabetes on the body

In addition to the symptoms, diabetes can cause long term damage to our body. The long term damage is commonly referred to as diabetic complications.
Diabetes affects our blood vessels and nerves and therefore can affect any part of the body.
However, certain parts of our body are affected more than other parts.
Diabetic complications will usually take a number of years of poorly controlled diabetes to develop. Complications are not a certainty and can be kept at bay and prevented by maintaining a strong level of control on your diabetes, your blood pressure and cholesterol.
These can all be helped by keeping to a healthy diet, avoiding cigarettesand alcohol, and incorporating regular activity into your daily regime in order to keep blood sugar levels within recommended blood glucose level guidelines.

The effect of diabetes on the heart

Diabetes and coronary heart disease are closely related.
Diabetes contributes to high blood pressure and is linked with high cholesterol which significantly increases the risk of heart attacks and cardiovascular disease.

Diabetes and strokes

Similar to how diabetes affects the heart, high blood pressure and cholesterol raises the risk of strokes.

How diabetes affects the eyes

A relatively common complication of diabetes is diabetic retinopathy.
As with all complications, this condition is brought on by a number of years of poorly controlled or uncontrolled diabetes.Diabetic retinopathy has a number of symptoms.
Retinopathy is caused by blood vessels in the back of the eye (the retina) swelling and leaking. High blood pressure is also a contributing factor for diabetic retinopathy.
Diabetic retinopathy can be treated so it’s best to catch it as early as you can. The best way to do this is to attend aretinopathy screening appointment, provided free on the NHS, once each year.

Effect of diabetes on the kidneys

The kidneys are another organ that is at particular risk of damage as a result of diabetes and the risk is again increased by poorly controlled diabetes, high blood pressure and cholesterol.
Diabetic nephropathy is the term for kidney disease as a result of diabetes.
Damage to the kidneys takes place over a period of years and can picked up by nephropathy screening before it gets too serious. Treatment includes lifestyle changes and may include medicine to treat high blood pressure and cholesterol.

Diabetes and its effects on the nerves

The effects of diabetes on the nerves can be serious as the nerves are involved in so many of our bodily functions, from movement and digestion through to sex and reproduction.
The presence of nerve damage (neuropathy) is commonly noticed by:
  • Numbness or tingling in the hands or feet
  • Lack of arousal in the penis or clitoris
  • Excessive sweating or
  • Diagnosis of delayed stomach emptying
Treatments for neuropathy concentrates on reducing pain but medication such blood pressure lowering drugs may also be prescribed to help prevent development of the condition.

Diabetes and its effect on digestion

Diabetes can affect digestion in a number of ways. If diabetes has caused nerve damage, this can lead to nausea, constipation or diarrhoea.
An alternative cause of disturbed digestion can be the result of diabetes medication.
Some type 2 diabetes medications for instance are prone to causing digestive issues, although these tend to settle down after the body gets used to them.
It’s no fun having diabetes. It can feel like diabetes increases your risk of almost every major health condition, while diabetes management can take hours out of your day on a consistent basis.
Medication can keep diabetes in check, but without decrying the benefits medication has, it can be exhausting to stick to a regimen, especially one that requires self-adjustment. All in all, it is very easy for people with diabetes to feel down on any given day.
This is why it is so important to make sure you have a good quality of life. By having a high quality of life, you’ll focus less on the negative aspects of diabetes and feel happier in yourself.
This may sound easier said than done, but here are some straightforward ways of improving your quality of life if you have either type 1 or type 2 diabetes.
1. Set yourself achievable targets
There’s nothing worse than when your doctor tells you that your HbA1c, diet, weight or other lifestyle choices are not up to scratch, and then sets you daunting targets to get back on the right track.
If your blood sugar levels have recently been quite erratic, aim to assess why this is the case and what could be causing these fluctuations. Taking this extra time to work out why you may be having regular highs or lows can help regulate your glycemic control. Once you have found the cause, you can then focus on trying to keep your blood sugar levels within thetarget range.
Similarly, if you have been recently struggling with weight loss, or certain aspects of dietary and/or lifestyle changes, focus on small improvements in the short-term. Small improvements are more attainable if you’ve hit a stumbling block, and can give you a necessary boost before resuming your long-term target.
2. Be in control
A 2013 survey of our Diabetes Forum members found that those with type 1 diabetes who felt more in control had fewer hypos and less anxiety over complications. There is no reason why these findings can’t be applied to type 2 diabetes.
As mentioned earlier, being told by your doctor that your diabetes management needs to improve can be depressing. It’s easy to think “I’m a failure”. However, forcing yourself to take a more positive outcome – such as “I will improve” – can be much more effective in improving your diabetes control. Start with those aforementioned small steps to reinforce your new attitude, as results will be easier to achieve in the short-term.
3. Eat a healthy diet
Processed foods aren’t good for anyone. While the excess sugar in some processed foods can provide a short-term sense of pleasure, they are linked with poor long-term health and can be packed with harmful additives.
healthy diet is essential for someone with diabetes – processed foods should feature as little as possible. If you regularly eat processed foods, set an achievable target to wean yourself off them.
One diet that many people find useful for controlling blood sugar levels and aiding weight loss – both of which can make you feel much better about yourself, and your diabetes – is the low-carb diet.
Research is continually backing the low-carb diet’s benefits for people with diabetes. We recently released the Low-Carb Program to enable people to take control of their diabetes and improve their health and wellbeing in the short and long term.
4. Get regular exercise
We get it. Unless you enjoy exercise, it feels like more of a chore than normal household chores do. We’ve also heard all the reasons people don’t exercise: “I don’t have the time”, “Exercise doesn’t work for me” etc.
The bottom line, though, is that exercise is very good for you. It can improve blood sugar levels, help you lose weight and reduce the risk of cardiovascular diseases.
If you struggle for time, do short bursts of exercise. This has been shown to improve HbA1c levels in type 2 patients, which can make you feel much better about yourself. Furthermore, exercising three times a week can improve the quality of life for overweight people with type 2, whilesupervised walking using a pedometer can also make people feel better about their diabetes.
For people with type 1, exercising can improve insulin sensitivity. If your insulin is more effective, you may end up needing less medication. If you’ve recently been bogged down with your insulin regimen, doing some exercise could prove to be a useful boost. Why not try a new sport? Exercise can have more purpose for some people when playing sport. You can read all of our guides to sports and diabetes here.
5. Mindfulness
Mindfulness training can lead to greater quality of life for people with diabetes by addressing depression, stress and anxiety. It is a coping technique that can be particularly effective if you have recently been feeling overwhelmed regarding your diabetes management, and can help steer you in a more positive direction.
Mindfulness has also been clinically linked with improved blood sugar control as well as better psychological health.
What tips would you recommend to other people with diabetes to improve their quality of life? Let us know in the comments section below.

Sumber : Internet

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