TheFirst Aims of treatment in D.M Is To Get Healthy Lifestyle
Alleviation of symptoms and improvement in quality of life
This is achieved by reducing hyperglycaemia; patients who
need insulin immediately (those with Type 1 diabetes) were
described in the previous chapter.
All others normally begin on diet alone, moving to diet and oral hypoglycaemic agents, or
diet and insulin as indicated.
All treatments must be adjusted to
ensure that patients are symptom-free. Education of patients
plays an important role in enhancing the quality of life, and
needs to be maintained over many years.
Maintainenance of health by reduction of risk factors and
preventing the development of diabetic complications The needs here are for:
• achievement of optimal blood glucose control
• detection and control of hypertension
• assessment and control of hyperlipidaemia
• assessment of the need for antiplatelet medication
• cessation of smoking
• regular complications screening procedures (described on
page 45).
Management of long-term diabetic complications
Management of other medical problems affecting
the patient
The aims of controlling diabetes
Once diabetes treatment has been established, there is a need
to agree the level of control to be achieved in each individual
patient.
Once symptoms have been eliminated, targets for
optimal control (shown in the table) should be discussed and
agreed, but it is not always possible to reach ideal goals and
pragmatic decisions have to be made.
The following criteria need consideration:
• ensure that symptoms have been eliminated
• lean patients should gain weight
• obese patients should lose weight
• children should grow normally
• prevention of long-term diabetic complications.
Healthy lifestyle
People with diabetes can help themselves considerably by
attention to healthy eating, appropriate exercise levels and
weight reduction, and cessation of smoking. These measures
are of great benefit, and may also substantially reduce the need
for medication.
Behaviour change strategies may be needed to
help patients to implement them.
Healthy eating
Healthy eating is the cornerstone of diabetic treatment, and
control of the diet should always be the first treatment offered
to Type 2 diabetic patients before drugs are considered.
Eliminating sugar (sucrose and glucose) lowers blood glucose
concentrations in both Type 1 and Type 2 diabetic patients,
and although recent dietary recommendations suggest that
eating small amounts of sugar is of little consequence, this
practice is not recommended. Artificial sweeteners can be used.
Good dietary advice is essential to the proper care of diabetic
patients; ill considered advice can be very damaging or else it is
ignored. I recall one patient who kept to the same sample
menu for many years before she reported it to be rather
boring.
The diet needs to be tailored to the patient’s age and
weight, type of work, race, and religion.
Recommendations for Type 2 diabetic patients
Diets for overweight Type 2 diabetic patients should aim to
eliminate all forms of sugar and restrict the total energy intake.
Many of the patients are overweight, and their main goal is to
lose weight, although this aim is difficult to achieve. It is
important to try to ensure that when patients reduce their
intake they do not replace it by an increase of fatty foodstuffs,
notably a high intake of cheese.
The present emphasis is on
reducing total calorie intake, with special emphasis on fat
reduction and a proportionately more generous allowance of
carbohydrate than in previous years.
It has been suggested that;
as much as half the energy content of the diet may be derived
from carbohydrate, while the fat intake is drastically reduced,
although these diets in practice require rather difficult and
radical changes in the types of food normally eaten.
The use of polyunsaturated fats is desirable.
These diets are of value and help to reduce blood glucose concentrations if enough fibre
is taken.
Bran, All Bran, wholemeal bread, and beans
have a relatively high fibre content, and are therefore
recommended, but foodstuffs with a very high fibre content,
such as guar gum, are unpalatable.
For some elderly patients it is enough simply to eliminate
all forms of sugar from the diet. Their blood glucose
concentrations then fall and symptoms may resolve
Optimal control may not be needed and it is best to interfere as
little as possible with the patient’s usual way of life
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