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SOME QUESTIONS AND ANSWERS
Are there medicines to prevent and treat the complications of diabetes?
In type 1 diabetes, the 9-year long US-based
Diabetes Control and Complications Trial (DCCT)
showed that tight control of blood sugar
substantially reduced the risk of developing microvascular complications, especially
retinopathy.
A similar conclusion for type 2 diabetes was
provided by the 20-year long United Kingdom
Prospective Diabetes Study (UKPDS). Each one per
cent reduction in haemoglobin A1C level (a
commonly used marker for blood glucose level)
was associated with a 37 per cent reduction in the
risk of developing microvascular complications.
These and other studies have also shown that
controlling blood pressure using
antihypertensive medication is also important, as it
protects against cardiovascular events (heart
attack, stroke, heart failure) which are not
eliminated by tight glycaemic control. In addition,
controlling blood pressure also has a positive
effect on microvascular complications such as
retinopathy and nephropathy.
There is not space in this booklet for a full
examination of all the steps that can be taken to
minimise the development and impact of diabetic
complications, but some major approaches are
described later.
What is hypoglycaemia and what are its tell tale signs?
Hypoglycaemia is the term used to denote a blood
glucose level that is too low (less than 4 mmol/L).
If the hypoglycaemia is severe, there may be
insufficient glucose in the blood to provide the
energy the brain needs (except in extreme
circumstances, the brain can only use glucose as a
fuel), resulting in recognisable symptoms (often
known as a hypo). If it remains untreated, loss of
consciousness may occur.
Hypoglycaemia is a recognised side-effect of
treatment with insulin and sulphonylureas. During
standard insulin therapy of those with type 1
diabetes, about 10 per cent of people may have
one or more serious episode of hypoglycaemia in
a year, and the rate may be higher where
intensive insulin therapy is used to obtain tight
control of blood glucose levels. The rates are
lower for those with type 2 diabetes - about 2.5
per cent a year of insulin-treated patients and
around 0.5 per cent of those given sulphonylureas
have a hypo.
Hypoglycaemia is a recognised side-effect of
treatment with insulin and sulphonylureas. During
standard insulin therapy of those with type 1
diabetes, about 10 per cent of people may have
one or more serious episode of hypoglycaemia in
a year, and the rate may be higher where
intensive insulin therapy is used to obtain tight
control of blood glucose levels. The rates are
lower for those with type 2 diabetes - about 2.5
per cent a year of insulin-treated patients and
around 0.5 per cent of those given sulphonylureas
have a hypo.
- a raised insulin level (dose mismatch)
- enhanced insulin sensitivity
- increased absorption of insulin into the body
- inadequate carbohydrate intake (e.g. due to
a missed meal)
- a number of other factors, such as the effects
of exercise, alcohol intake and other
medications.
Establishing the right insulin type, dose and timing
for an individual to minimise the risk of a hypo,
while providing the best possible control of
hyperglycaemia, is an important aspect of care for
people with diabetes and goes hand-in-hand with
self-monitoring of blood glucose, adopting regular
eating and exercise habits, and developing
awareness of the warning signs of a hypo.
The symptoms of oncoming hypoglycaemia vary
from one person to another, but typically include
one or more of:
- Sweating
- Pounding heart/rapid pulse
- Shaking (tremor)
- Hunger
- Anxiety/irritability
- Tingling of the lips
- Drowsiness
- Confusion
- Lack of co-ordination
- Blurred vision
- Nausea
- Headache
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