Self – Monitoring of Blood Glucose

A home blood glucose meter is a device that analyses the blood sample and gives you a reading of your current blood sugar level. Regular self-monitoring of blood glucose (SMBG) gives a persona uick reading of his blood sugar levels at any given moment.

            Testing and keeping a record of the test results and the circumstances that followed them will help to understand how certain food and activities change the blood sugar. Once you are able to detect patterns in blood glucose changes over time, you can use the information to adjust the treatment accordingly.

SMBG: When to test your blood sugars?

–           Test every day before/after exercise to check the changes in blood glucose.

–           If a patient is on insulin, the SMBG provides an efficient way to test whether his insulin is effective for his line of treatment.

–           SMBG can help one avoid high medical emergencies. Check the blood sugar when you are feeling sick or fainting. The reading on the monitor will tell you of your current blood glucose level and further you can act accordingly.

Insulin

All people with type 1 diabetes require insulin injections to live, and many type 2 patients end up needing insulin to control their disease. Insulin is termed as the wonder drug, since its invention in the 1920s through which diabetics can lead a normal, enjoyable and a productive life.

            Injected insulin imitates the action of the hormone produced by the body. Once the insulin is injected under the skin and into the subcutaneous (below the skin) fat layer, it starts stimulating glucose uptake by both skeletal muscles and fat cells, while at the same time it signals the liver to stop or slow down glucose production.

            Insulin is measured in units. A unit of insulin lowers the blood glucose by a certain amount. The doctor decides how much of insulin a patient needs in a day. Three types of insulin is available. The type varies in how quickly it starts working (lowering blood glucose), time of peak activity (when they work the hardest) and how long it works. The three types are short acting, intermediate acting and long acting.

–           Short acting – This type of insulin begins working quickly, works hardest 2-3 hours after injection but is completely gone after 4-6 hours. Huminsulin R is available commercially as short acting insulin.

–           Intermediate acting – This type works more slowly than short acting. It works hardest 8-12 hours after the injection and still keeps on working to some extent 24 hours later. Hum-insulin L is available commercially for intermediate action of insulin.

–           Long acting – Long acting insulin does not work for 4-8 hours after injecting. Its peak occurs 18-24 hours after injection and continues to work for some extent after 36 hours. Lantus is available commercially for long acting insulin. Usually the doctor prescribes a combination of short and intermediate acting insulin. Long acting insulin are less commonly used.

            Insulin must be injected into the subcutaneous layer of fat. This makes the fatty areas of the body – the butt, abdomen, thighs and back of the upper arms the most appropriate spots for giving injections.

            Insulin can be administered into the body through syringes and insulin pens. The doctor decides with the patient on his preference of the syringe v/s the pen. The decision is usually based in the comfort level of the patient, the insulin prescribed and the budget.

Insulin syringes

            Syringes are less expensive, easily available and are easy to operate. Insulin syringe comes in two different strengths – U100 and U40. This means that if the patient uses a U100 vial syringe, there are 100 units of insulin in each cubic centimetre. Similarly, U40 has 40 units insulin per cubic centimetre. Caution should be taken not to exchange the two syringes. U40 comes with a red colour cap and U100 comes with an orange cap. The patient should know the difference between the two syringes and to use it accordingly.

Insulin pens

Pens cost more but have the benefit of eliminating the step of drawing insulin from the vial. A pen contains a premeasured insulin cartridge which contains either 150 or 300 units of insulin. Pens are either disposable or reusable. The reusable ones allow you to insert and dispose the insulin cartridges, which are bought separately. The insulin is injected through needles which are also disposable. Needles should be used for a period of three days and should then be discarded.

Diet, Exercise and Medicine

The three most important and linked factors in diabetes are

– Diet

– Exercise

– Medicine

            When all these three factors go hand in hand, the blood sugar of a patient will always remain controlled.

            Diet is the most integral part of the three. With diabetes, a change in dietary habits is a must. Also, a change in eating pattern is required. The patient must have six small meals a day as compared to three large meals. Early morning, breakfast, mid-morning, lunch, evening tea and dinner constitute the six meals. For people who take insulin during bed time, then a glass of milk, buttermilk, or a Marie biscuit is required.

Exercise constitutes the second part. It is indeed another important factor needed to keep the sugar stable. A brisk walk in the evening or getting engaged in a sport is all it takes to burn some calories. Ladies also must remember that daily chores can be done walking rather than going in a two/four wheeler. Regular exercise helps maintain weight, stabilizes you sugars, keeps you active physically and mentally and helps you live a stress free life.

            The third part is medicines. Yes, diabetes does involve lifestyle change but diet and exercise alone cannot control the sugars. Medicine is of importance as the chemicals stimulate the insulin to work. Also, skipping the medicine dose causes the sugar level to rise and this could create complications. Again, if an individual is on insulin, he must measure his dose and take it as suggested by the doctor at the right time i.e. before a meal or after a meal. Skipping of insulin can again lead to either rise in blood glucose levels or a fall in them, both of which could be fatal.

The Diabetic Foot

Many people must be wondering that what does diabetes have to do with the feet? Some people might have faced problems with their feet due to diabetes. A lot happens to the feet with diabetes. High blood glucose levels in the body, if present, over a long time can make the nerve endings in the feet dead, a condition we term it as peripheral neuropathy. The nerve endings in the feet become dead due to absence of any sensation in them. Also with diabetes, the healing power of the body becomes slow and thus more prone to infections. Blisters, corns, calluses can turn into serious complications if not treated properly. Hence, let us list down the ponts which help us to prevent diabetic neuropathy.

–           Remember to check your feet daily for any signs of blisters.

–           Keep the feet moisturized to avoid skin problems or cracks.

–           Keep a close eye on the wounds on your feet. If they exhibit signs of infection, then report to your doctor immediately.

–           Cut the nails of your toes regularly. Be sure to cut it straight and not inwards as any injury would lead to foot complications.

–           Wearing the right shoes is another important criteria. Too tight shoes could lead to swelling of the feet and loose one could make you trip while walking at the road.

–           Also wear footwear at all times, whether you are at home or outside. The shoes/sandals protect your feet. Moving around barefoot could expose your feet to infections.

–           Make it a habit to change your socks regularly as the sweat caused by the moisture in the socks becomes a growing place for fungi.

Top Ten Things One Should Know About Diabetes

1.         Eating sugar does not cause diabetes.

2.         The term “insulin dependent” (type 1) and “non-insulin-dependent” (type 2) diabetes are of the past. People with type 2 diabetes do require insulin sometimes.

3.         Adults can develop “juvenile” (type 1) diabetes and kids can develop “adult-onset” (type 2) diabetes.

4.         There is no such thing as borderline diabetes. If you have been diagnosed with diabetes, the condition is irreversible. A fasting blood sugar reading over 120 milligrams per deciliter (mg/dL) ; a random blood glucose reading above 200 mg/dL or an HbA1C of 6.5 percent or higher are all considered diabetes.

5.         There is no “diabetic diet”, only a new and healthier way of eating.

6.         Attending a diabetes education class and meeting with a nutritionist/dietitian are two of the most important ways you can start controlling your diabetes.

7.         People with diabetes should exercise and play sports. Exercise lowers blood glucose levels and is an important component of good diabetes management.

8.         Diabetes is not a death sentence, but it can lead to serious, life altering and life threatening complications, if ignored.

9.         Checking yourself frequently with a home blood glucose monitor can help prevent blood sugar emergencies.

10.       Diabetes is so wide spread that there would scarcely be a person who does not know someone who has diabetes….             AqaMaula Ali QadarMaula TUS is always concerned about the health of a mumin. Many a times we have heard in Vaaz where Maula TUS guides us about small activities to be performed daily which improves our health in the long term. May Allah grant AqaMaula Ali QadarMaula TUS, who is our spiritual doctor, a long, healthy life till the day of Qeyamat.Aameen!

Compiled by SakinaAbdulqadirVadnagarwala (Nutritionist, Kolkata)

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