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Diabetes (Type 1 and Type 2)
People with Type 1
diabetes has a condition
where the pancreas fail
to produce any insulin
due to congenital
defects, virus
infections or auto
immunological
suppression. The
sugar (glucose) in the
blood cannot be
controlled after
consuming food
containing
carbohydrates. To
control the blood sugars
in the blood stream,
people with Type 1
diabetes has to be put
on insulin therapy.
They have to give
themselves insulin
injections accordingly
as prescribed by their
diabetologist.
In Singapore, about 90%
of the people with
diabetes are Type 2
diabetes. In type 2
diabetes, the pancreas
is still able to produce
insulin but the body
does not use it
effectively to lower the
blood glucose that are
formed in the blood
stream after eating
carbohydrate. Glucose starts
to accumulate in the
blood stream
(hyperglycemia) and
begins spilling into the
urine when the blood
glucose level exceeds
10mmol/l (kidney
threshold level).
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Modification of
Dietary Intake |
Modification of dietary
intake helps to control
blood glucose levels:
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Eat the right amount
as advised by your
dietician.
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Keep fruits and
vegetables intake to
2 servings a day.
Examples of 1
serving: 1 fist size
apple or orange; 1
wedge of watermelon
or papaya; 1 handful
of grapes (if small
8 - 10, if big 6 in
numbers).
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Add fibers to main
meals as they will
help to slow down
the absorption of
glucose releasing
into the blood
stream
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Reduce salts, sugar,
oil, fats intake.
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Drink plenty of
fluid. One
should take at least
2 litres of water
per day unless
contraindicated.
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Avoid drinking
alcohol as it
disturbs blood
glucose control.
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Look at the contents
of each meal. Ask
if the meal is too
high in fats, too
little fibers, too
much of
carbohydrates, too
oily, too salty, too
sweet, or too much
gravy added?
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Eat at regular times
each day.
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Check with your
dietitian how to do
Carb (carbohydrate)
counting for each
meal.
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Have the meal plan
review by your
dietitian at least
once a year.
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Regular exercise is
important in diabetic
control. Besides
helping in weight loss
and lowering blood
glucose level, it
improves one’s fitness
level, strength, well
being, blood pressure,
and cholesterol level.
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Exercises include
brisk walking,
jogging, cycling,
swimming and racquet
games.
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Choose an exercise
that is suitable for
the age, physical
fitness and the
person enjoys doing
it on a regular
basis.
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It is advisable to
exercise at least 3
times a week with 20
minutes of
resistance exercise
(such as *weight
lifting at home
while watching TV
program) and 10
minute of aerobic
exercises (brisk
walking, cycling,
jogging, swimming).
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Exercise must not be
excessive but
consistent and
continuing.
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Consult your doctor
before starting any
new exercise
programme. He may
need to review the
medicine dosage or
adjust the meal
plan.
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Adopt
an active lifestyle
instead of just
sitting down all the
time. For examples
do some light
housework, go for
walks with friends,
etc.
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*You can fill-up 2 one-litre
water bottles with water
or sand and use them as
weights.
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Medication for
Type 1 Diabetes |
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People with Type 1 diabetes need insulin therapy
to correct their blood sugar levels.
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When giving insulin
injection, be sure
that it is
administer in the right
dose of the right
types at
the right time to
the right place of
the body.
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There are various
types of insulin
used for people with
Type 1 diabetes. The
person should take
the insulin
according to the
doctor’s
prescription and
according to the
pharmacist’s
instruction, e.g. to
inject half an hour
before food, to take
just before a meal
or at bedtime.
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As a caregiver, you
must know:
- how soon the
insulin starts to act?
- when the
insulin has the greatest effect?
- how long does
the action lasts?
- what are the
side effects of insulin? |
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Medication for
Type 2 Diabetes |
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Medications should
be taken according
to the doctor’s
prescription and
pharmacist’s
instruction. For
examples, some
medicine is to be
taken half hour
before food while
others to be taken
immediately after
food.
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Take the medicine
regularly at the prescribed times.
Examples to take only in the morning; 2 to 3
times a day or at bedtime only.
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If the person
missed his morning
medications, do
serve them
immediately once you
remember. DO NOT
serve the missed
dose together with
the next dose as
this will result in
over dosage.
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As the medicine
lowered blood
glucose level, it is
important to have
regular meals and
exercise to prevent
hypoglycaemia (low blood glucose).
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Insulin therapy may
be needed if the
anti-diabetic drugs
fail to work in
maintaining normal
blood glucose
levels.
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As a caregiver, you
must know:
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how soon the
medicine starts
to act?
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when the
medicine has the
greatest effect?
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how long does
the action
lasts?
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what are the
side effects of
the medicine? |
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Monitoring
of Blood Glucose |
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It is recommended to
have
the person's
blood glucose check
frequently
especially when he
is sick or unwell.
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Keep a record book
or plot a graph to
see the pattern of
the blood glucose
level. Knowing the
blood glucose state
will enable your to
take appropriate
actions to better
the person's
diabetes. In this
way, you will help
to discover how
food, exercise and
insulin can
significantly impact
the person's blood
glucose level.
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Bring along this
record book each
time you visit your
doctor. This is
important in helping
the doctor to
monitor the
effectiveness of
treatment.
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The target of a well
controlled blood
glucose level should
read:
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4 to 6 mmol/l
for fasting
blood test.
This is the
normal range and
diabetic person should keep
within this
range or as near
normal as
possible.
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Less than
10mmol/l for
2-hour post meal
test. A
non-diabetic
person should
read between 6
to 8 mmol/l. |
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The main goal of taking
good care of the feet is
to prevent losing them,
the digits or even the
lower limbs. Have
the person's feet screened
at least once a year by
a professional
(Podiatrist or Foot
screening nurse).
The following points are
important to note:
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Always maintain foot
hygiene. Remember
to change the socks,
wash and dry the
feet daily.
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Footwear with
toes covered,
especially
bedroom slipper,
helps to protect
the toes from
kicking any
objects
unknowingly. At
home, one may
accidentally
kick his toes
against the leg
of the furniture
or the door may
slam on the
unprotected
feet.
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Wear appropriate
foot wear (with
socks) for
sports or long
distance
walking.
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Avoid Japanese
slippers (the thongs may cut the
toe-web upon constant rubbing),
high heels (the heels may cause
stress to the feet), and
slippers without straps (give no
support to the feet when
walking). |
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Prevent injury of
the lower limbs.
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Apply
moisturiser to
cracked heels or
dry lower limbs.
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Proper technique
of cutting toe
nails is
important. Cut
them straight
across because
cutting it curve
with round
corners may
induce ingrown
toe nails.
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Treat any
cuts/wounds
immediately.
Wash it with
normal saline
and dress it
daily. If there
is any signs of
inflammation and
infection, such
as redness, pus
and fever,
consult your
doctor
immediately. |
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What if the
2-Hour Post Meal
Blood Glucose >
10mmol/l? |
If the 2-hour post meal
blood glucose is
>10mmol/l, you may need
to ask the following
questions:
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Have the person
eaten too much of
carbohydrates (rice,
noodles, biscuits,
fruits/fruit
juices)?
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Have the person
taken food that is
high in fats (deep
fried; too oily)?
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Have the person
been sedentary
(sitting around at
the computer/ TV
set/desk or lying
around) after his
meals?
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Are you or the
person checking his
blood glucose too
soon, that is, less
than 2 hours after a
meal?
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Have the person
drank enough water
that day? At least
2 litres of water is
required per day
unless
contraindicated.
Water helps to
eliminate toxic,
waste products and
excessive sugar
through urination.
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Reflecting on these
questions will enable
you to make adjustments
in your diabetic care
plan and that will sure
bring a change to the
person's blood glucose
level. Document the
adjustments you have
made and the effects.
Discuss them with your
doctor or nurse in your
next appointment with
them.
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Type 1 or 2 diabetes
increases the risk for
many serious
complications.
A. Acute (short term)
Diabetes complications:
B. Chronic (long term)
Diabetes complications:
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Stroke
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Eyes- blindness
(retinopathy)
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Heart-disease
(cardiovascular
disease)
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Kidney damage
(nephropathy)
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Nerve damage
(neuropathy) – in
the lower limbs,
impotency
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Amputation
Studies have shown that
good control of diabetes
can prevent or reduce
the risk of these
complications.
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People with diabetes
should:
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Know the signs and
symptoms of low
blood glucose and
its management.
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Always carry some
kind of sugar, such
as glucose tablets,
raisins or sweets.
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Wear or carry
Diabetes
identification
information, such as
a medical alert
bracelet or a
Diabetes Medical
Alert card that
emergency medical
staff can find.
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Among the different
races, the Indians
are most prone to
the disease,
followed by the
Malays and then the
Chinese.
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In Singapore, about
90% of the people
with diabetes are
Type 2 diabetes.
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About 40% of people
are able to control
their diabetes by
simply controlling
their diet and
exercise regularly.
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If your urine test
shows both ketones
and glucose it may
mean that your
diabetes is out of
control.
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