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.

Fizikal: Senaman lantai kuat abdomen bawah
Oleh Diyanah Anuar diyanah@bharian.com.my
KEBANYAKAN aktiviti senaman tidak begitu memberi tumpuan kepada abdomen bawah badan. Bagi memastikan bahagian ini tidak mudah sakit atau lemah, anda boleh mengamalkan senaman lantai yang cukup ringkas dan boleh dilakukan berulang kali. Gerakan senaman lantai dapat memberi impak kepada bahagian abdomen bawah kerana bahagian ini paling sukar untuk dibentuk dan dianggap bahagian paling lemah. Menurut jurulatih kecergasan Universal Fitness & Leisure Sdn Bhd, Mohamad Izham Mohlis, abdomen bawah dianggap lemah kerana amat jarang senaman membabitkan bahagian badan ini.

“Senaman bangkit tubi yang biasa dilakukan kebanyakan orang sebenarnya lebih banyak memberi kesan kepada bahagian abdomen atas berbanding bahagian bawah. “Sehubungan itu, senaman lantai adalah senaman paling sesuai untuk menguatkan bahagian abdomen bawah,” katanya memberi panduan senaman lantai seperti berikut:

A1 : Pastikan anda menggunakan tikar senaman bersesuaian. Baring dengan keadaan lengan diletakkan di sisi. Bengkokkan sebelah kaki dan luruskan kaki satu lagi ke atas.

A2 : Lakukan pergerakan ke bawah dan ke atas pada kaki yang lurus dalam kiraan sepuluh. Lakukan pergerakan sama pada kaki yang satu lagi, sebanyak tiga set . Ketika membuat pergerakan ini, pastikan pinggul anda tidak terangkat.

B1 : Baring dengan keadaan lengan diletakkan di sisi. Naikkan kaki ke atas dan bengkokkan 90 darjah. Ketika ini, pastikan anda bernafas secara normal.

B2 : Selepas itu, luruskan kaki ke atas dan bertahan dalam kiraan lima saat. Ketika melakukan pergerakan ini, pastikan anda bernafas secara normal. Ulang pergerakan ini sepuluh kali, sebanyak tiga set.

Chat Diabetes

Kencing Manis

Tumbuhan urus gula darah
KAWALAN diet pemakanan adalah satu keutamaan dalam mengawal diabetes dan mengelakkan komplikasi kelak.
SEMPENA Hari Diabetes Sedunia yang jatuh pada 14 November setiap tahun (untuk memperingati hari kelahiran Frederick Banting, bersama Charles Best yang telah membawa kepada penemuan insulin pada 1922), artikel ini akan tertumpu kepada dua jenis tumbuhan perubatan semula jadi, iaitu Kayu Manis dan Banaba, kedua-duanya telah didapati boleh mengawal takat gula darah yang tinggi.
Ketahanan terhadap Insulin, Pra-Diabetes dan Diabetes
Pra-diabetes dan diabetes jenis kedua biasanya bermula dengan kerentanan (rintangan) insulin. Penyelidik sedar diabetes tidak muncul begitu sahaja tanpa sebab.
Sebelum didiagnosis sebagai pesakit diabetes, anda mempunyai keadaan yang dikenali sebagai pra-diabetes.
Keadaan ini berlaku apabila takat gula darah anda lebih tinggi daripada biasa tetapi tidak cukup tinggi untuk dianggap diabetes dan kebanyakan orang tidak menyedarinya.
Ia bukanlah satu berita baik kerana individu yang mengalami keadaan pra-diabetes bukan sahaja mempunyai risiko diabetes yang tinggi tapi pra-diabetes juga merupakan suatu risiko bagi serangan jantung, strok, kegagalan buah pinggang, kebutaan dan kerosakan saraf.
Cara terbaik untuk melawan diabetes adalah pada peringkat pra-diabetes. Pemakanan yang sihat, senaman dan mengambil suplemen boleh mencegah atau melambatkan masa mulanya diabetes dan mengurangkan risiko komplikasi.
Takat gula darah (glukosa) dalam badan dikawal-atur oleh insulin, iaitu sejenis hormon yang dihasilkan di dalam pankreas.
Insulin membantu dalam pengangkutan glukosa dari darah melalui membran sel dan masuk ke dalam sel-sel badan.
Selagi membran sel masih sensitif terhadap insulin, pengangkutan ulang-alik glukosa ke dalam sel berlaku dengan pantas.
Apabila membran sel menjadi tidak sensitif terhadap insulin (juga disebut kerentanan insulin), pankreas terpaksa mengepam keluar lebih banyak insulin dalam usahanya untuk memaksa glukosa ke dalam sel.
Apabila usaha tersebut tidak begitu berkesan, akibatnya adalah takat gula tinggi yang beredar dalam darah (dianggap sebagai salah satu daripada keadaan pra-diabetes) menjadi satu kebiasaan.
Lama kelamaan pankreas tidak lagi boleh menghasilkan insulin yang cukup untuk mengawal gula darah, dengan itu diabetes jenis kedua terjadi.
Pati kayu manis larut air yang dipiawaikan
Dr. Richard Anderson, ahli kimia di Jabatan Pertanian US (USDA), mencari makanan yang mungkin menyamai tindakan insulin dalam pengawalan takat gula darah (glukosa).
Beliau menemui sejenis kelas bahan larut air dalam Kayu Manis yang dikenali sebagai polimer Polifenol Jenis-A kerana keupayaannya untuk meningkatkan aktiviti insulin lebih kurang sebanyak 20 kali ganda.
Polimer Polifenol Jenis A pati Kayu Manis larut air adalah 70 peratus lebih berkesan daripada kayu manis asli itu sendiri dan ia mengelakkan kesan alahan sampingan berbahaya yang mungkin berlaku akibat pengambilan dos kulit Kayu Manis asli yang tinggi.
Sifat peningkatan insulin Kayu Manis akan mendatangkan faedah kepada individu yang mempunyai takat gula tinggi (pra-diabetes dan diabetes).
Pada bulan Jun 2006, kajian baru menunjukkan pengambilan suplemen pati Kayu Manis boleh membantu dalam peningkatan takat gula bagi individu yang mengalami diabetes jenis kedua.
Dalam kajian itu, 79 orang pesakit diabetes mengambil suplemen (pati kayu manis) tiga kali sehari. Selepas empat bulan, takat gula darah berpuasa mereka bertambah baik sebanyak 10.3 peratus.
Tambahan pula, pesakit diabetes dengan takat awal gula darah yang lebih tinggi memperoleh lebih banyak faedah melalui pengambilan suplemen ini.
Pati Kayu Manis larut air juga mempunyai sifat antioksidan yang sangat baik. Pada bulan Oktober 2006, suatu kajian berbeza, yang dikemukakan pada sidang Kolej Pemakanan Amerika ke-47, menunjukkan pati Kayu Manis larut air mungkin mendatangkan kesan perlindungan antioksidan dalam mengurangkan kerosakan akibat radikal bebas yang berkaitan dengan takat gula darah tinggi.
Selain daripada itu, kajian ini menunjukkan pengawalan gula darah yang bertambah baik. Hasil kajian tersebut seterusnya menyokong peranan pati Kayu Manis dalam membantu individu yang mengalami gangguan fungsi insulin dan pra-diabetes.
Pati Banaba yang dipiawaikan
Beberapa jenis tumbuhan perubatan dari India, China dan Jepun telah digunakan untuk merawat diabetes.
Salah satu daripada bahan paling berkesan yang ditemui adalah asid korosolik pada daun pokok Banaba (Lagestroemic specious).
Dr. Yamazaki, profesor Sains Farmaseutikal, Fakulti Perubatan Universiti Hiroshima Jepun, telah mengkaji kesan-kesan asid korosolik berhubungan dengan sifat seakan insulinnya.
Kajian beliau menunjukkan asid korosolik mengaktifkan pengangkutan glukosa melintasi membran sel ke dalam sel menghasilkan penurunan gula darah.
Asid korosolik bertindak seperti insulin; hormon semula jadi yang meningkatkan aktiviti pengangkutan glukosa melintasi membran sel, oleh itu membantu pengurangan takat gula darah.
Kajian klinikal di Amerika Syarikat dan Jepun turut menunjukkan asid korosolik adalah selamat digunakan dan berkesan dalam penurunan takat gula darah bagi pra-diabetes dan diabetes jenis kedua.
Mengawal Gula Darah Dengan Pati Kayu Manis dan Banaba*
Secara berasingan, pati Kayu Manis dan Banaba menambah tahap sensitiviti insulin yang membantu dalam penurunan takat gula darah. Apabila kedua-duanya digabungkan, ianya adalah lebih berkesan.
Kebanyakan kaji selidik ke atas Kayu Manis melibatkan penggunaan pati larut air yang dipiawaikan untuk mengandungi Trimerik dan Polimer Tetramerik Jenis-A (polimer polifenol Jenis A) dan bagi Banaba, ia dipiawaikan untuk mengandungi satu peratus asid korosolik.
Jika anda mempunyai risiko pra-diabetes, sila berjumpa doktor untuk menjalani ujian darah. Walaupun anda beranggapan tidak mempunyai risiko, pakar menasihatkan individu yang berusia lebih 35 tahun untuk memeriksa takat gula darah mereka setiap tahun.
Akan tetapi, jika anda tahu anda mempunyai pra-diabetes, anda masih boleh melengahkan masa diabetes bermula dan mengurangkan kerosakan kepada badan anda melalui perubahan pemakanan, bersenam dan juga mengambil suplemen seperti pati Kayu Manis & Banaba yang dipiawaikan.
Walaupun banyak faedah diperkatakan mengenai Kayu Manis dan Banaba, anda harus juga mengetahui kepentingan untuk mengambil suplemen multivitamin dan mineral yang baik yang telah diformulasikan khas bagi pesakit dan individu pra-diabetes demi untuk memelihara kesihatan optimum dan mencegah penyakit.
Contoh paling tepat adalah zat makanan utama yang diperlukan dalam kuantiti lebih tinggi oleh pesakit diabetes daripada kuantiti dalam formula multivitamin dan mineral harian biasa.
Ini termasuk vitamin B1, B6,B12, Biotin, Niasinamid, Vitamin C, Vitamin E, Manganese, Vanadium, Zink, Kromium dan Selenium.
Pesakit diabetes juga memerlukan lebih banyak Asid Alfa Lipoik, sejenis antioksidan sejagat yang boleh berfungsi dalam kawasan sel-sel berair dan berlemak.
*Makanan tambahan tersebut mesti diambil bersama dengan ubat-ubatan semasa dan tidak digunakan untuk menggantikan ubat-ubatan dan nasihat doktor.