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Diabetes and its management

With the increasing obesity rate in the world comes an increasing rate of diabetes and pre-diabetes. What is worse, half of the patients with diabetes do not even know that they are suffering from diabetes. As such, it is important to screen for diabetes.

The tests below are common forms of screening for diabetes:
  • Fasting blood sugar – if ≥7.0 mmol/L
  • Glucose tolerance test – where you drink a liquid containing 75g of glucose – 2H ≥11.1 mmol/L

If any of the above are positive, it is likely that the patient will have diabetes.

Medications for diabetes:

There are many different medications out in the market now targeting different areas of diabetes. Hence the best method of treating diabetes is always customised to the particular patient and is comprehensive to be able to ensure that the complications and consequences of diabetes are looked for and managed.

Some of the different classes of diabetes medications include the following:

  • Metformin – decreases the body’s resistance to insulin and should normally be the first line treatment for patients with diabetes
  • Sulphonylureas – stimulates the pancreas to produce insulin
  • DPPIV-inhibitors – prevents the breakdown of a hormone that stimulates the pancreas to produce insulin when the glucose is high.
  • GLP-1 agonist – an injectable. Same action as the DPPIV-inhibitors. It also promotes weight loss
  • SGLT2-inhibitors – promotes the excretion of glucose in the urine. Also has weight losing properties
  • Insulin – injectable. The hormone that diabetics lack relatively or absolutely
Management of diabetes will involve the following:
  • Formal diagnosis of diabetes ( in patients who have not been diagnosed as such)
  • Discussion of the level of control for the particular patient. No two patients are exactly the same. Hence, what diabetic control is suitable for the patient varies.
  • Assessment of the patient to see if they are suffering from:
    • Other chronic conditions that come with diabetes – eg cholesterol disorders, high blood pressure, etc
    • Consequences of diabetes eg heart disease, kidney disease, eye disease, nerve disorder
  • Discussion of the drugs that are most suitable for the patient. The above drug list is not exhaustive and under each class may be different drugs with differing side effects profiles and benefits. As such, which drug or set of drugs are ultimately used has to be decided and discussed with the patient. Many times, a combination of drugs might be used.
  • Discussion of lifestyle changes to be made in order to complement the medications that the patient will be taking. For example- decreasing the intake of carbohydrate intake.