Diabetes Mellitus is a metabolic disorder characterized by the presence of a high blood glucose level due to defective insulin secretion, insulin action or both. The high blood glucose levels lead to complications involving the blood vessels of the body which may lead to heart, kidney and nerve disease.
Magnitude of the problem:
Diabetes incidence is increasing dramatically due mainly to lifestyle changes. Half the cases of Diabetes are undiagnosed and there is an even larger group who have Impaired Glucose Tolerance who are not yet diabetic but are likely to become diabetic and who already have an increased risk of diabetic complications, particularly heart disease & stroke. About 1 in 6 to 1 out of 10 Canadians are diabetic, the incidence increases with ethnic group and race, native Canadians have up to a 1 in 2 risk.
Various studies (DCCT,UKPDS) have shown that the risk of complications varies directly with glucose levels in the blood. The goals of treatment are therefore to keep glucose levels below the point at which complications occur. Diabetes is also associated with other diseases and risk factors, these should also be controlled.
- Normal glucose: Between 4 and 7 mmol/L
- Fasting glucose (before breakfast) or before meals: Below 7 mmol/L
- After Meals: Below 10 mmol/L
Glucose levels should be measured at home with a home glucose meter.
A1c: This is a blood test which measures long term glucose control. It should be done every 3 months. The result should be less than 7%. Elevated blood pressure increases the risk of heart disease, stroke and kidney failure. The goal is to keep blood pressure below 130/80. Should be checked at every clinic visit.
Microalbuinuria: Most reliable estimation is the Albumen/Creatinine Ratio which should be less than 2 for men and less than 2.5 for women. (This generally corresponds to a urine albumen of <20 mg/L or <30 mg/day. Should be checked at least once a year.)
Cholesterol level should be less than 5 mmol/L. Elevated cholesterol levels increase the risk of heart disease & stroke.
HDL (good cholesterol) should be more than 1.2 mmol/L
LDL (bad cholesterol) should be less than 2.5 mmol/L
Ratio of Total Cholesterol to HDL Cholesterol should be less than 4
Triglycerides should be less than 2 mmol/L
Clot Prevention: Diabetics have higher levels of clotting factors and lower levels of clot breakdown factors than non diabetics; therefore, they form blood clots more easily. A clot in the heart may cause a heart attack and a clot in the brain may cause a stroke. Taking a small dose of ASA (aspirin) reduces risk of clots by 25%. Dose is 80-325 mg a day.