Diabetes bukan halangan puasa

Oleh Hafizah Iszahanid dan Suzan Ahmad
bminggu@bharian.com.my

Penghidap bijak kawal pemakanan, pengambilan ubat teratur mampu teruskan ibadat

MENGAWAL kadar gula dalam darah, terutama pada Ramadan sememangnya cabaran paling besar untuk mereka yang disahkan menghidap diabetes atau kencing manis. Malah, ada kalanya jika kandungan gula terlalu tinggi atau terlalu rendah, pesakit dinasihatkan tidak meneruskan puasa.

Namun, kata Pakar Runding Endrokologi, Hospital Putrajaya, Dr Zanariah Hussein, jika pesakit bijak mengawal kadar gula dalam darah, berpuasa bukanlah halangan besar. Malah dengan nasihat doktor dan ubah suai dos yang perlu diambil, pesakit sebenarnya masih mampu menjalani ibadat puasa.Malah, tidak ramai yang menyedari, bagi pesakit yang sudah lama didiagnos dengan diabetes, bulan puasa adalah waktu yang dinanti-nantikan kerana lebih mudah sebenarnya bagi mereka mengawal tahap gula dalam darah.

“Pesakit yang sudah lama didiagnos dengan diabetes, mereka sudah tahu perubahan pengambilan dos insulin selain pemakanan. Bagaimanapun, pesakit kanak-kanak yang baru didiagnos dengan diabetes, Ramadan memang bulan yang mencabar,” katanya.

Lebih 1.2 juta warga Malaysia ialah pesakit diabetes dengan anggaran kes baru sekitar 650,000 setiap tahun, manakala Pertubuhan Kesihatan Sedunia (WHO) pula menganggarkan menjelang 2030, ada seramai 180 juta pesakit diabetes di seluruh dunia.

Di Malaysia, 95 peratus pesakit diabetes adalah daripada Jenis Dua. Namun, kebanyakan pesakit diabetes Jenis Satu pula ialah kanak-kanak dan remaja.

“Diabetes Jenis Satu paling sukar kerana pesakit langsung tiada insulin dalam badan, jadi jika kurang menerima suntikan, mereka berisiko berdepan masalah gula naik secara mendadak.

“Lazimnya pesakit diabetes Jenis Satu ialah mereka yang sudah disahkan menghidap diabetes sejak bertahun-tahun lamanya. Jadi mereka sudah tahu melakukan perubahan terhadap pemakanan. Mereka tidak sukar menempuh Ramadan melainkan ubat-ubatan mereka sudah bertukar atau baru mendapat suntikan insulin, mereka secara khusus perlu dinasihatkan dan dimaklumkan bagaimana mengelak gula turun atau naik secara mendadak,” katanya.

Dr Zanariah berkata, selain itu pemakanan juga antara faktor penting bagi menguruskan diabetes ketika Ramadan. Lebih mudah katanya, diet pesakit diabetes tidak sama, selain keperluan ubat-ubatan juga tidak sama. Namun, secara umum kebanyakan pesakit akan makan lebih ketika berbuka puasa dan sahur pula ringan, justeru pemberian dos juga perlu diterbalikkan.

Panduan bagi pesakit diabetes yang dibenarkan berpuasa

Diet - Elak makan berlebihan ketika berbuka puasa dan pada waktu malam. Karbohidrat dan makanan berlemak boleh menambahkan berat badan serta menyukarkan kawalan diabetes.

Senaman - Melakukan aktiviti fizikal yang ringan ketika berpuasa tidak akan mendatangkan kemudaratan. Perubahan diet dan ubat-ubatan ketika bersahur harus dibuat (mengikut nasihat doktor) bagi mengelakkan kadar gula dalam darah turun mendadak.

Ubat - Dapatkan nasihat doktor mengenai pengubahsuaian dos serta waktu pengambilan ubat. Sebagai panduan, dos ubat-ubatan yang diambil pada sebelah pagi pada hari tidak berpuasa ditukar masa pengambilannya ke waktu berbuka puasa. Dos yang diambil sebelum makan malam sewaktu tidak berpuasa, pula perlu diambil sebelum bersahur. Pengurangan dos yang diambil mungkin perlu untuk mengelakkan kadar gula dalam darah turun atau naik mendadak.

Insulin - Dos dan waktu insulin disuntik harus diubahsuai mengikut arahan doktor berdasarkan ujian tahap gula dalam darah yang dilakukan pada permulaan bulan puasa, seperti berikut:

Tiga kali suntikan insulin: Dua dos insulin yang bertindak segera (short-acting insulin) ketika berbuka dan sebelum bersahur. Ini diikuti dengan satu dos insulin yang bertindak lama (intermediate acting insulin) sebelum tidur.

Dua kali suntikan insulin: Satu dos insulin yang sudah dicampur (premixed insulin) ketika berbuka puasa. Dos yang diperlukan ialah sama seperti dos yang diberikan pada waktu pagi pada hari tidak berpuasa. Satu dos insulin yang bertindak segera pula diberi sebelum bersahur (0.1 - 0.2 unit insulin/kg berat badan)

Bagaimana pula dengan pesakit yang berdepan dengan masalah diabetes ketika hamil?

Kata Dr Zanariah, umumnya wanita hamil tidak digalakkan berpuasa, namun jika pengurusan diabetesnya baik wanita itu masih boleh berpuasa.

“Bagi wanita yang didiagnos dengan diabetes sebelum hamil, apabila sudah berbadan dua, dia perlu mengambil insulin berbanding ubat biji. Penggunaan insulin berisiko tinggi untuk berdepan dengan masalah gula rendah. Jadi sewaktu mengandung, risikonya lebih ketara. Pada tempoh kehamilan, kawalan gula sangat penting untuk memastikan perkembangan janin,” katanya.

Bagi mereka yang menghidap diabetes ketika hamil, biasanya diabetes yang dialami tidak teruk dan mereka hanya perlu mengawal diet untuk terus berpuasa.

“Jika kawalan gula yang baik dan mengikut garis panduan mereka boleh puasa,” katanya.

Fakta: Peringatan umum pesakit diabetes berpuasa

1) Jangan melengahkan berbuka tetapi melambatkan bersahur.

2) Bagi pesakit yang baru berpuasa digalakkan mengukur gula dalam darah supaya mereka boleh nilai tindak balas kadar gula dalam darah waktu berpuasa. Tahap gula diuji pada, sebelum bersahur antara dua ke empat jam selepas bersahur, sebelum berbuka puasa dan antara dua ke empat jam selepas berbuka.

3) Makan ubat/menyuntik insulin mengikut nasihat doktor.

4) Makan berpada-pada ketika berbuka serta kurangkan hidangan yang manis.

5) Mengawasi penyakit diabetes dan kesihatan mereka secara umumnya.

6) Mengenali tanda-tanda hipoglesemia (kekurangan gula dalam darah), hiperglisemia (gula berlebihan dalam darah) dan dehidrasi.

7) Segera berbuka apabila mengalami masalah sama ada hipoglesemia, hiperglisemia atau dehidrasi. Haram untuk pesakit meneruskan puasa kerana ia boleh memudaratkan mereka.

8) Mengubahsuai dos ubat atau insulin dan waktu ia harus dimakan /disuntik mengikut syor doktor.

Simptom hipoglisemia, hiperglisemia dan dehidrasi:

Tanda-tanda hipoglisemia:

Menggigil

Terlalu lemah

Amat lapar

Berpeluh

Pucat

Berdebar-debar

Gelisah

Koma (tak sedarkan diri)

Tanda-tanda hiperglisemia:

Kerap buang air kecil

Terlalu dahaga

Sangat letih

Tanda-tanda dehidrasi:

Amat dahaga

Kulit dan lidah yang terlalu kering

Fikiran terganggu

Pesakit diabetes tidak dibenarkan berpuasa sekiranya:

Penyakit diabetes yang dihidapi tidak stabil. Bimbang ia akan mengakibatkan pelbagai komplikasi seperti dehidrasi (kekurangan air), jangkitan kuman dan koma.

Tidak mematuhi nasihat penjagaan diet, pengambilan ubat-ubatan dan insulin.

Mengalami komplikasi diabetes yang serius seperti penyakit jantung koronari dan tekanan darah tinggi yang tidak terkawal.

Kerap mengalami koma diabetik ketoasidosis.

Kerap mengalami koma hipoglisemia (kekurangan gula dalam darah).

Mengalami jangkitan kuman.

Warga tua dan tinggal bersendirian.

Wanita hamil yang memerlukan suntikan insulin.

Berusia bawah 12 tahun.

sumber http://www.bharian.com.my/Current_News/BH/Sunday/Sihat/20090906074356/Article/

Diabetes ibu segala penyakit

Oleh Hafizah Iszahanid
hafiza@bharian.com.my

komplikasi termasuk jantung, buta, strok

DI sebalik kempen meraikan Hari Diabetes Sedunia yang disambut semalam, ada fakta lain yang harus dititikberatkan ramai apabila membicarakan kewajaran pelbagai program dan usaha kesedaran bahaya kencing manis ini.

Faktanya - setiap 10 saat, dua orang disahkan menghidap diabetes di seluruh dunia manakala empat juta lain maut akibatnya setiap tahun. Tidak cukup dengan itu, diabetes juga berada di tangga keempat penyakit membawa maut.
Menggerunkan bukan? Hakikatnya, di Malaysia sendiri, kira-kira 1.2 juta rakyatnya disahkan penghidap diabetes atau kencing manis. Malangnya, apa yang menyedihkan, separuh daripada jumlah itu tidak menyedari mereka menghidap diabetes sehinggalah dirawat kerana berdepan salah satu komplikasi diabetes.

Setiausaha Am Persatuan Diabetes Malaysia, Datuk Rahimah Ahmad berkata, faktor Malaysia yang diketahui kaya pelbagai jenis hidangan yang lazat, sedikit sebanyak menjadikan ramai leka dengan kandungan gula dan kalori makanan yang diambil.

“Faktor ini digabung pula dengan gaya kehidupan moden kurang aktif yang menyumbang kepada peningkatan kes diabetes yang ketara di negara ini,” katanya ketika merasmikan acara kempen kesedaran diabetes kepada orang awam anjuran persatuan itu, baru-baru ini.

Selain penyakit maut, diabetes juga kerap dirujuk sebagai ibu segala penyakit kerana memungkinkan pesakitnya berdepan pelbagai komplikasi kesihatan seperti masalah jantung termasuk kegagalan fungsi jantung. Malah, risiko serangan angin ahmar sememangnya lebih tinggi di kalangan pesakit diabetes berbanding bukan penghidap penyakit itu.

Bukan itu saja, pesakit diabetes juga berisiko hingga empat kali ganda terhadap penyakit jantung atau yang berkaitan kardiovaskular.

Pensyarah Perubatan dan Pakar Runding Kanan Endokrinologi, Hospital Universiti Sains Malaysia (USM), Prof Datuk Dr Mafauzy Mohamed, pula menegaskan, diabetes adalah penyakit seumur hidup yang setakat ini tidak boleh disembuhkan.

Namun, usaha mengawal pemakanan, melakukan senaman dan mengambil ubat-ubatan mengikut keperluan adalah kaedah pengurusan diabetes yang baik.

Gengran antara komplikasi akibat diabetes.

“Diabetes yang tidak dikawal dengan baik boleh memendekkan hayat seseorang sehingga 10 tahun,” katanya.

Biarpun diabetes dikenali sebagai penyakit orang dewasa, namun kebelakangan ini diabetes Jenis Dua terbukti semakin meningkat di kalangan kanak-kanak dan remaja. Ia dikaitkan dengan masalah terlalu gemuk atau obesiti, kurang bersenam dan diet tidak sihat.

“Gaya hidup dan pemakanan menjadi punca kegemukan yang membawa kepada diabetes. Malah hari ini, tidak menghairankan jika anda mengenali seorang pesakit diabetes yang hanya berusia 12 atau 10 tahun,” katanya.

Jelas Dr Mafauzy, berdasarkan Kajian Morbiditi dan Mortaliti Kebangsaan pada 2006, menyenaraikan Negeri Sembilan dan Melaka sebagai negeri yang mencatatkan kadar peratusan pesakit diabetes tertinggi di Malaysia manakala kadar diabetes terendah adalah di Sabah.

“Faktor genetik sememangnya penyumbang besar masalah diabetes. Di Malaysia, majoriti pesakit diabetes berketurunan India diikuti Melayu dan Cina.

“Namun perlu diingat, jika seseorang itu lahir dalam keluarga yang ada sejarah penyakit itu maka risiko untuknya menghidap diabetes sangat tinggi. Oleh itu, langkah pencegahan yang boleh diamalkan adalah pemakanan sihat dan lakukan senaman,” katanya.

Dr Mafauzy berkata, tidak ramai yang tahu, tetapi hakikatnya hampir 90 peratus pesakit diabetes di seluruh dunia adalah daripada Jenis Dua. Selain faktor genetik, diabetes jenis ini turut dikaitkan dengan obesiti dan tidak aktif secara fizikal.

Diabetes Jenis Dua ini juga satu masalah kronik yang menjejaskan kaedah tubuh menangani glukos. Ini disebabkan diabetes jenis ini menyebabkan tubuh menolak kesan insulin atau tubuh tidak menghasilkan kadar insulin mencukupi bagi mengekalkan tahap glukos normal.

Diabetes Jenis Dua juga tidak memerlukan insulin sepanjang hayat tetapi anda boleh mengawal glukos dalam darah dengan diet, bersenam atau kombinasi pengambilan ubat-ubatan atau di kalangan sesetengah pesakit mungkin perlu mengambil sedikit insulin.

“Ada kala pesakit menunggu simptom datang sebelum mendapat rawatan. Namun, ada kala mereka langsung tidak sedar simptom yang ditunjukkan tubuh mereka. Ia menyebabkan mereka hanya tahu diserang diabetes secara tidak sengaja selepas terjadinya komplikasi kesihatan,” katanya.

Kadang kala, jika ada simptom pun, ia sangat minimum. Secara umum simptom diabetes adalah kerap membuang air kecil (polyuria), kerap dahaga (polydipsia), kerap lapar (polyphagia) dan hilang berat badan tanpa sebab yang khusus, rasa kebas yang ekstrim, rasa sakit pada kaki (disesthesias) dan penglihatan kabur.

Bagi jangka masa yang lama, diabetes menyebakan komplikasi pada jantung, salur darah, mata, ginjal juga saraf. Retinopati misalnya adalah sebab utama buta dan ia terjadi kerana jangka masa panjang. Retinopati menyebabkan kerosakan pada salur darah kecil di retina.

Secara umum tanpa pengurusan diabetes yang baik, selepas 15 tahun menghidap diabetes, dua peratus pesakit menjadi buta manakala 10 peratus berhadapan dengan masalah penglihatan.

Secara lebih teknikal pula, komplikasi diabetes terbahagi kepada komplikasi mikrovaskular (membabitkan salur darah kecil) seperti buah pinggang (nephropathy), saraf rosak (neuropathy), penglihatan terjejas (retinopati, katarak atau glaukoma).

Manakala komplikasi makrovaskular (membabitkan salur darah besar) menyebabkan masalah seperti jantung, angin ahmar, gangrene dan akhirnya kaki dipotong (amputasi) selain masalah metabolik, mati pucuk dan masalah waktu hamil.

INFO: Faktor Risiko Diabetes Jenis Dua

Usia dan bangsa - semakin anda berusia semakin tinggi risiko diserang diabetes. Apatah lagi jika anda dari keturunan kulit hitam, Asia Selatan dan kaukasian. Dalam satu kajian di United Kingdom didapati mereka yang berketurunan kulit hitam dan Asia Selatan (India, Pakistan, Bangladesh) adalah lima kali lebih berisiko diserang diabetes berbanding mereka yang berkulit putih.

Genetik - jika ada lahir dalam keluarga yang memiliki sejarah diabetis. Risiko anda lebih tinggi jika ahli keluarga itu adalah emak atau ayah malah bapa saudara sama ada sebelah ibu atau ayah.

Obesiti - kebanyakan mereka yang menghidap diabetes Jenis Dua adalah obes. Lebih gemuk seseorang itu lebih tinggi risikonya. Apatah lagi jika tidak aktif bersenam.

Diabetes waktu hamil - wanita yang diserang diabetes waktu hamil berisiko untuk menghidap diabetes.

sumber http://www.bharian.com.my/Current_News/BH/Sunday/Sihat/20091115091201/Article/

Medicinal herb for diabetes

Misai Kucing (Orthosiphon Stamineus) is a medicinal herb found mainly throughout South East Asia. It is believed to have antiallergic, antihypertensive, antiinflammatory and diuretic properties. It is used as a remedy for arteriosclerosis (capillary and circulatory disorders), kidney stones and nephritis. It is trusted for many centuries for treating ailments of the kidney, bladder stone, urinary tract infection, liver and bladder problems, diabetes, rheumatism and gout. It is also used to reduce cholesterol and blood pressure.

Mengelakkan jangkitan

Mengelakkan jangkitan

Pesakit kencing manis lebih mudah mendapat jangkitan daripada orang biasa. Oleh itu, anda perlu menjaga diri sendiri melalui langkah-langkah tersebut :

Selalu menjaga kebersihan diri

Tiap-tiap hari, cucikan kaki dan jari-jari kaki dengan menggunakan sabun dan air, keringkan kaki dan sapukan bedak

Mandilah selalu

Sapukan bedak di bahagian-bahagian kulit yang berpeluh berlebihan

Jaga kebersihan gigi

Menjauhkan diri dari kecederaan

Jangan berjalan tanpa kasut atau selipar

Berhati-hatilah semasa memotong kuku jari dan jari kaki

Bersih dan balutkan mana-mana luka yang ada

Berhati-hati semasa bercukur

Three Natural Cures For Diabetes

Three Natural Cures For Diabetes

If you are like most people who have been diagnosed with diabetes and are still struggling to get your blood sugar under control, you are probably beginning to look for more information to try to decrease your dependence on medications, insulin, and seemingly never-ending finger-pricking. That is only natural, and anyone can tell you that the more you can control your diabetes through diet and exercise, the better off you are likely to be. Well, have no fear, there are ways to help cure your diabetes symptoms that don't involve taking more drugs, and there are ways to help your medications have to work less.

The first natural cure for diabetes symptoms is - believe it or not - cinnamon. Research has shown that cinnamon can help regulate blood glucose, so adding cinnamon to your diet on a regular basis is an easy, inexpensive way to help yourself live with diabetes. More research is being done on this cinnamon-diabetes connection, also. Please, though, don't get your cinnamon from that gigantic, gooey roll from the store at your local shopping mall.

The second of the three natural cures for diabetes symptoms is - drum roll, please - broccoli. The President of the United States may not have to eat his broccoli, but if you are diabetic, you may just want to give it a go. Sulphorophane, an ingredient found in broccoli, has been shown to have a positive effect on the blood vessels. Diabetes is known to have an adverse effect on the blood vessels; so basically, broccoli shows promise as a natural "cure" for diabetes' harmful effect on the cardiovascular system.

The third of the three natural cures for diabetes symptoms is - get ready for this - getting exercise and altering your lifestyle, especially diet. Your doctor or nutritionist can help you to learn how to eat properly to control your diabetes symptoms. There are natural supplements that show promise, as well, and as long as it is okay with your doctor, you can take a natural diabetes remedy supplement.

Learn More About Blood Glucose Levels

Article Source: http://EzineArticles.com/?expert=Rachel_Bedford

After a Diabetes Diagnosis

Having diabetes is like being in charge of an octopus. There isn't just one cut and dried way of coping with the disease because of all of its different parts. At first, it might seem like an overwhelming amount of information is thrown at you. There are medications, food plans, and schedules. You have to learn how to operate medical equipment such as a glucometer, or maybe an insulin pump. You may need to learn how to give yourself insulin injections.

Cancer will overtake heart disease as the world's top killer by 2010

By MIKE STOBBE,AP Medical Writer AP - Wednesday, December 10

ATLANTA - Cancer will overtake heart disease as the world's top killer by 2010, part of a trend that should more than double global cancer cases and deaths by 2030, international health experts said in a report released Tuesday. Rising tobacco use in developing countries is believed to be a huge reason for the shift, particularly in China and India, where 40 percent of the world's smokers now live.

So is better diagnosing of cancer, along with the downward trend in infectious diseases that used to be the world's leading killers.

Cancer diagnoses around the world have steadily been rising and are expected to hit 12 million this year. Global cancer deaths are expected to reach 7 million, according to the new report by the World Health Organization.

An annual rise of 1 percent in cases and deaths is expected _ with even larger increases in China, Russia and India. That means new cancer cases will likely mushroom to 27 million annually by 2030, with deaths hitting 17 million.

Underlying all this is an expected expansion of the world's population _ there will be more people around to get cancer.

By 2030, there could be 75 million people living with cancer around the world, a number that many health care systems are not equipped to handle.

"This is going to present an amazing problem at every level in every society worldwide," said Peter Boyle, director of the WHO's International Agency for Research on Cancer.

Boyle spoke at a news conference with officials from the American Cancer Society, the Lance Armstrong Foundation, Susan G. Komen for the Cure and the National Cancer Institute of Mexico.

The "unprecedented" gathering of organizations is an attempt to draw attention to the global threat of cancer, which isn't recognized as a major, growing health problem in some developing countries.

"Where you live shouldn't determine whether you live," said Hala Moddelmog, Komen's chief executive.

The organizations are calling on governments to act, asking the U.S. to help fund cervical cancer vaccinations and to ratify an international tobacco control treaty.

Concerned about smoking's impact on cancer rates in developing countries in the decades to come, the American Cancer Society also announced it will provide a smoking cessation counseling service in India.

"If we take action, we can keep the numbers from going where they would otherwise go," said John Seffrin, the cancer society's chief executive officer.

Other groups are also voicing support for more action.

"Cancer is one of the greatest untold health crises of the developing world," said Dr. Douglas Blayney, president-elect of the American Society of Clinical Oncology.

"Few are aware that cancer already kills more people in poor countries than HIV, malaria and tuberculosis combined. And if current smoking trends continue, the problem will get significantly worse," he said in a written statement.

source http://malaysia.news.yahoo.com/ap/20081210/twl-med-global-cancer-1be00ca.html

Manage your diabetes, save your kidneys

By Dr SUNITA BAVANANDAN

Managing your diabetes properly can prevent or slow down kidney disease.

ANDY, a diabetic, is a well-educated man with a demanding job. He thought he had things under control when he decided to turn to self-medication for his condition since he was so busy.

So, he defaulted on his follow-up visit to the doctor and decided to buy over-the-counter medications. He continued this for many years until he experienced increasing lethargy and early morning nausea. A check-up confirmed he had kidney failure and his diabetes control was poor.

In hindsight he wished he had taken the time to seek professional help for his diabetes management.

Anna is a 40-year-old who had everything; a wonderful husband, a high-paying job and a house to call her own. Fifteen years ago, she developed diabetes during her pregnancy and was treated for it. She thought she was alright after that so she subsequently never went for any tests, and never saw a doctor except for minor ailments like the flu.

Little did she know, many years after this episode of diabetes during pregnancy, her blood sugar levels had started to rise and she had become pre-diabetic. Only after her elder brother was diagnosed to have diabetes did she go for a medical check-up herself. By then she was diagnosed to already have type 2 diabetes..

Anna and Andy are just a few out of the many people suffering from diabetes and kidney disease. Some do not even realise that they are at risk of having diabetes or that their kidneys are failing.

Here is what you need to know about diabetes and kidney problems.

How diabetes affects kidneys

The kidneys function to cleanse blood from any waste products and excess fluid by filtering blood to produce urine. When the kidneys are unable to filter normally, dangerous accumulation of fluid and wastes occurs in the body.

It usually takes 10 to 20 years for diabetic patients with kidney disease to develop kidney failure. This provides a big window of opportunity for kidney failure to be prevented.

However, in many instances, diabetes has already been present many years before it is detected, and organ damage may already exist at the time of diagnosis. This is why early detection of diabetes is important. Early preventive measures must be taken to control your diabetes and prevent kidney failure.

What is diabetes mellitus?

Diabetes mellitus is a condition where there is insufficient insulin produced by the pancreas or the body is unable to respond to the insulin normally. Blood glucose levels will then rise and cause damage to organs, including the kidneys.

Did you know that diabetes mellitus is the leading cause of end stage kidney failure in Malaysia? According to the 14th Report of the Malaysian Dialysis and Transplant Registry 2006, 57% of kidney failure patients had diabetes mellitus.

Kidney care for people with diabetes

Manage your diabetes

Managing your diabetes well can prevent or slow down the progress of your kidney disease, especially if your diabetes was detected early.

Achieve and maintain your targeted blood glucose and blood pressure. High levels of these are the main factors that contribute to kidney damage. In addition, if there is already kidney damage with protein leaking into urine, it is important to minimise this protein leak because it will cause further injury to the kidneys. This is usually achieved with good blood pressure control and appropriate medication.

Patients with diabetes and kidney disease are at an increased risk of heart attacks and strokes so it is also important to achieve good control of lipid levels, exercise and control weight, as well as stop unhealthy habits such as smoking. The following shows the targets to achieve:

Blood glucose: 4.0mmol/L to 6.0 mmol/L (fasting); and less than 7-8 mmol/L after food

HbA1c: Less than or equal to 6.5%

LDL cholesterol: Less than 2.6 mmol/L

Triglycerides: Less than 1.7 mmol/L

HDL cholesterol: More than 1.02 mmol/L

Blood pressure: 130/80 mmHg or lower

Don’t default on follow-ups

As tempting as it is, defaulting follow-ups can lead to further deterioration of your diabetes and diabetic complications, which include kidney disease. The problem is that complications such as diabetic eye and kidney disease are usually silent until in advanced stages. Because of this lack of early physical signs or symptoms, you may not be convinced of the need to see a doctor.

However, your doctor would be able to monitor your condition and help you control the disease. You would also have the opportunity for your kidneys to be checked routinely. To screen for kidney complications, the doctor only needs to check your blood pressure and do some simple urine and blood tests.

Remember – diabetes has the potential to damage many different organs in your body, not just the kidneys. Regular follow-up helps protect your heart and blood vessels, brain and nerves, eyes and skin also.

Medications help, not make you worse

Medications are prescribed to you by your doctor to help in controlling your diabetes, blood pressure and also other conditions.

Many patients worry that taking too many medications may be harmful but they need to understand that the probability of any permanent serious harm from medications is exceedingly low.

It is far more dangerous to allow their diseases to go untreated or uncontrolled. Avoid drugs other than the ones prescribed to you. Do also avoid traditional medications and certain types of pain-killers as these may damage your kidneys further.

Eat healthily

If you are diabetic, you need to watch your diet. You can eat normally but control your carbohydrate and fat intake. If you already have kidney damage due to diabetes, controlling what you eat can avoid excessive accumulation of wastes in your kidneys since your kidneys are not able to function normally.

Control your intake of protein, sodium, potassium and phosphorus according to your doctor or dietitian’s dietary plan.

Prevent diabetes

People with pre-diabetes have blood glucose levels higher than normal but not high enough to be classified as type 2 diabetes. The Diabetes Prevention Programme (DPP) was a landmark study conducted in the United States more than five years ago. It showed that about 11% of pre-diabetics may develop type 2 diabetes each year. Therefore, it is important to detect pre-diabetes early.

Like Anna, there are many out there going about their daily lives, not knowing they are suffering from pre-diabetes as the symptoms may develop gradually or not surface at all.

If you are in the high-risk group of getting diabetes, you should go for screening to check whether you have pre-diabetes or diabetes. Those who should go for screening are:

·Those with a family history of diabetes

·Overweight

·Age over 40 years old

·Those with high blood pressure

·Those with high cholesterol

·Women who had diabetes during pregnancy

Embark on a healthy lifestyle

Leading a healthy lifestyle can prevent pre-diabetes from developing into type 2 diabetes. This in turn helps prevent end stage kidney failure. The Diabetes Prevention Program found that people with pre-diabetes can prevent or delay type 2 diabetes by losing just 5 to 10% of excessive body weight through exercise, and a lower calorie and fat diet. It is recommended that you exercise 30 minutes a day, 5 days a week.

Chronic kidney disease and diabetes are common and harmful. However, most importantly, they are treatable, especially when detected early. It is important for you to work together with your doctor to prevent or manage diabetes appropriately.

> Dr Sunita Bavanandan is a consultant nephrologist. This article is courtesy of NKF Kidney Care, a community education programme by National Kidney Foundation of Malaysia. For more details, please call NKF at the NKF Hotline: 1-300-88-3110 or log on to www.nkf.org.my.

Sweet cuts

Bringing high sugar levels down to normal levels rapidly is increasingly found to confer long-term benefits for people with diabetes.

AFTER a year on medication, Amir*, 50, was taken aback when his endocrinologist suggested insulin injections to control his blood sugar. Anxiety crept in as he remembered, “wasn’t insulin only for those with very serious cases of diabetes?”

Anticipating his reaction, the endocrinologist then explained that the insulin is used to make up for the insufficient production of insulin in his body, which is not enough to bring his blood glucose levels down.

“With the doctors explanation I felt more assured. Now I’m happy my blood glucose level is under control after about a year on insulin,” says Amir.

With adjustable dials and micro-fine needles, reusablee and disposable insulin pens today are less painful and easier to use than the good old needle and syringe method of insulin administration in the past.

In the past decade, the treatment and management of diabetes have evolved. From just reaching lower blood glucose targets to recommended screening for cardiovascular diseases in people with diabetes, a more aggressive management of diabetes is advocated as the numbers ballooned in Malaysia over the years.

One of the latest developments is the increasing use of insulin earlier after the diagnosis of diabetes. “Insulin used to be the last resort in treating type 2 diabetes, but now it has changed,” says consultant endocrinologist Prof Datuk Dr Anuar Zaini.

The rationale behind this can be traced to the pancreas, an insulin-producing gland shaped like a thin pear lying behind our stomach.

A landmark study, the UK Prospective Diabetes Study (PDS), reveals that when diagnosed, a lot of the patients with type 2 diabetes show high insulin levels. This indicates insulin resistance, where the body needs to produce more insulin to maintain blood glucose at the same level.

In the same study, most patients had high blood glucose even before diagnosis, but it is not high enough to cause symptoms typical to diabetes patients. Hence it is not easily detected because most people are not even aware of it.

“This is the dangerous part, when people do not know that they have diabetes because their blood glucose levels are still not providing symptoms although they are abnormal,” says Dr Anuar.

Because the insulin levels are already high, the pancreas is working very hard to maintain the glucose levels at normal levels. But there is a limit to how much insulin a pancreas can produce, Dr Anuar explains.

As it is estimated that a person’s pancreas has already lost 50% of its function upon diagnosis, it is important to identify diabetes early so that a higher percentage of pancreatic function can be preserved.

So, if you identify diabetes when your pancreatic function is still 80%, chances are you can preserve the function by lifestyle changes and treatments better than people who are diagnosed when their pancreatic function is 50%. “Even with treatment, the pancreatic function will still continue its steady decline,” says Dr Anuar.

“If the pancreatic function decreases to a dangerous level (10 - 20%), a person may require full-time insulin to help control his or her sugar levels,” says Dr Anuar. “So what we have to do is to bring down the glucose levels fast to let the pancreas rest and recover,” he adds.

Introducing insulin

The management of the patient depends on the status of the patient when he comes to see the doctor. If the diabetes is detected late and the blood glucose level is very high, insulin is often used as a temporary measure to bring down the glucose level, says Dr Anuar.

Otherwise, doctors follow the clinical practise guidelines for diabetes management, which starts with continuous lifestyle intervention followed by oral drugs to get blood glucose levels under control.

“But if they do not reach glucose targets with those interventions, we have no choice but to use insulin and bring the glucose down to normal levels,” says Dr Anuar.

Animal studies have been done to show that when the blood glucose is brought down fast, the pancreas is also allowed to recover fast. That is the reason why there are doctors who advocate the rapid control of blood glucose with insulin, says Dr Anuar.

“By doing that, you try to reverse the injury to the pancreatic cells,” he adds.

However, the recommendation of insulin use is often perceived by patients and their family members as the progression of diabetes to a serious stage.

“We tell our patients that insulin is not the end of the road. We are using insulin now because your pancreas is already halfway ‘gone’, so we want to make sure the better survival of the pancreas,” says Dr Anuar.

Although we need more data to prove that by using insulin we can prolong pancreas survival, what we are saying is if we can get the patient to achieve their glucose targets, so be it, he adds.

While some may need insulin for a long period of time to control their blood glucose levels, some may only need it for a short duration to get their glucose levels down and stabilised within acceptable targets.

Studies have revealed that people who achieved good blood glucose control early in their diabetes are conferred benefits in preventing complications longer compared to people who did not.

So, there is incentive for us to get patients’ blood glucose under control earlier so the effects of the early control could be felt longer,” says Dr Anuar.

Pens in treatment

With the advent of disposable insulin pens and micro-fine needles, injection pain is no longer a hindrance to the use of insulin.

Amir, for instance, injects insulin every night before he goes to sleep without much trouble. “It is not that painful as the pen comes with one of the smallest needles,” he says.

Shaped like a large marker, insulin pens are also easy to carry around for those who are constantly on the move.

One of the problems with insulin injections is the risk of hypoglycaemia (low blood glucose), which may cause seizures, loss of consciousness and even death in severe cases.

There have been studies that report higher morbidity and mortality when higher doses of insulin is administered, but those communities are from the higher age group and they may be more prone to hypoglycaemia, says Dr Anuar.

“Our community involves a younger age group, and they may be a little more resistant to insulin. The incidence and complications of hypoglycaemia may be less (in this community) when you start insulin early, but we need more data to find out.

“That is why (in this community), hypoglycaemia should not be a disincentive to start insulin,” he adds.

He concludes that lifestyle intervention is still the cheapest and most effective, it needs to be sustained, which is easier said than done. So, when that fails, early diagnosis and appropriate treatment – insulin included – saves lives. – By Lim Wei Wen

Symptoms

Symptoms

At first, your blood sugar level may rise so slowly that you may not know that anything is wrong. One-third of all people who have diabetes do not know that they have the disease.¹

If you do have symptoms of type 2 diabetes, they may include:

• Feeling thirsty.
• Having to urinate more than usual.
• Feeling more hungry than usual.
• Losing weight without trying to.
• Feeling very tired.
• Feeling cranky.

Other signs of type 2 diabetes may include:

• Infections and cuts and bruises that heal slowly.
• Blurred vision.
• Tingling or numbness in your hands or feet.
• Trouble with skin, gum, or bladder infections.
• Vaginal yeast infections.

Some people have already developed more serious health problems by the time they are diagnosed with type 2 diabetes. Over time, diabetes can lead to problems with the eyes, kidneys, heart, blood vessels, and nerves. Signs of these problems may include:

• Numbness, tingling, burning pain, or swelling in your feet or hands (diabetic neuropathy).
• Blurred or distorted vision or seeing flashes of light; seeing large, floating red or black spots; or seeing large areas that look like floating hair, cotton fibers, or spiderwebs (diabetic retinopathy).
• Chest pain or shortness of breath. This may be a sign of heart or blood vessel problems.

1.4j hidap diabetes

1.4j hidap diabetes
Oleh Mohamad Hussinmohamad@hmetro.com.my

KUALA LUMPUR: Kanak-kanak seawal usia sembilan tahun kini berisiko menghidap kencing manis atau diabetes jika tidak mengamalkan pemakanan seimbang, kata seorang pakar penyakit itu.Ketua Unit Endokrinologi dan Diabetes Hospital Putrajaya, Dr Zanariah Hussein, berkata trend global menunjukkan peningkatan penyakit itu kerana faktor pemakanan yang tidak berkhasiat di kalangan kanak-kanak terutama tidak mengawal tabiat makan dan minum.“Penyakit diabetes sama seperti darah tinggi dan sakit jantung akan meningkat ke tahap membimbangkan jika rakyat Malaysia tidak mengubah tabiat mereka yang suka makan dalam kadar kerap,” katanya kepada pemberita selepas perasmian sambutan Hari Diabetes Sedunia 2008 peringkat Hospital Putrajaya oleh Pengarah Kesihatan Wilayah Persekutuan, Dr Ismail Abu Taat di perkarangan KLCC di sini, semalam. Dr Zanariah berkata, selain faktor genetik dan persekitaran, masalah obesiti meningkatkan risiko menghidap penyakit itu.
Beliau berkata, ibu bapa perlu mendidik anak-anak pemakanan seimbang bagi mengelak obesiti serta mengamalkan gaya hidup sihat.
Beliau berkata seramai 1.4 juta penduduk negara ini yang berumur 30 tahun ke atas menghidap diabetes dan dijangka meningkat kepada 2.4 juta pada 2030.Hari Diabetes Sedunia bertemakan Diabetes Di Kalangan Kanak-kanak dan Remaja diraikan pada setiap 14 November iaitu hari kelahiran Frederick Banting yang menemui insulin bersama rakannya, Charles Best.Lebih 2,000 penghidap diabetes, pengamal perubatan dan orang awam menghadiri sambutan itu yang menyediakan kemudahan mengesan diabetes seperti pemeriksaan kandungan gula dalam darah oleh pasukan pakar dari Hospital Putrajaya. Sementara itu di PETALING JAYA, Pengarah Urusan Farmaseutikal Merck Sharp & Dohme (MSD), Ewe Kheng Huat, berkata diabetes berada di tangga keempat dalam senarai penyakit paling bahaya yang boleh membawa maut, menunjukkan peningkatan iaitu lebih 1.4 juta rakyat negara ini menghidapnya dan 98 peratus daripada mereka menghidap kencing manis jenis dua.Katanya, data global yang terkini menganggarkan 246 juta penghidap kencing manis di seluruh dunia menjelang 2025 dan anggaran itu dijangka meningkat kepada 380 juta orang.“Apa yang membimbangkan di kebanyakan negara, terdapat 50 peratus pesakit kencing manis tidak tahu mereka menghidap penyakit ini. Kencing manis jenis dua ini yang dikatakan berlaku apabila badan mengandungi paras gula atau glukosa darah yang tinggi,” katanya.