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Diabetes Mellitus is a complex, chronic condition where the body is unable to properly use or store glucose because of a lack of or inefficient secretion of the Insulin hormone from the pancreas to control sugar. That lack leads to high blood glucose levels and eventual damage of the arteries supplying every organ in the body. Diabetes affects all areas of a person’s life and requires high quality care. There is a prevalence of incidence of more than 15-30 % in Bahrain that can reach up to 50% for certain ages and genders, a rate considered one of the highest in the world. It is the leading cause of blindness, kidney failure and necessary dialysis, non-traumatic amputations, heart disease, and strokes. A special emphasize on the care of such high-risk population is provided to prevent these complications.
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There are two major types of diabetes.
Type 1 (formerly called juvenile-onset or insulin-dependent) diabetes. Here the body completely stops producing insulin. People with Type 1 diabetes must take daily insulin injections to survive. This form of diabetes usually develops in children or young adults, but can occur at any age. It is genetically predetermined.
Type 2 (formerly called adult-onset or non insulin-dependent) diabetes occurs when the body doesn’t produce enough insulin and/or is unable to use that insulin properly. This form of diabetes usually occurs in people who are older, overweight, and/or have a family history of diabetes. Today it is increasingly occurring in younger people, particularly adolescents. It is a disease of lifestyle that is associated with the obesity epidemic. People with either form of diabetes frequently experience certain specific symptoms. These include:
- being very thirsty
- frequent urination
- weight loss
- increased hunger
- blurry vision
- irritability
- tingling or numbness in the hands or feet
- frequent skin, bladder, or gum infections
- wounds that do not heal
- extreme unexplained fatigue
In some cases, there are no symptoms — especially sometimes with Type 2 diabetes. In this case, people can live for months, even years without knowing they have the disease. This form of diabetes comes on so gradually that the symptoms may not even be recognized.
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- Family History of diabetes
- Overweight and Obesity
- Habitual Physical Inactivity
- Hypertension
- Hyperlipidemia, Low HDL cholesterol or high Triglycerides
- History of gestational diabetes or delivery of a baby ≥ 4 kg
- Previously identified abnormal glucose not at a diabetes threshold (pre-diabetes)
- Polycystic ovary syndrome
- Member of a high risk ethnic or racial group
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Normally, fasting blood sugar is less than 100 mg/dl (5.5 mmol/L) and does not reach 200 mg (11.1 mmol/L) after meals. Classically, diabetes has been diagnosed on the basis of fasting sugar greater than or equal to 126 mg/dl (7 mmol) or with a 2-hour value after a sugar challenge with a 75 gm drink that leads to sugar of 200 mg/dl or higher. Patients with classical symptoms of diabetes in association with any blood glucose level of 200 mg/dl or higher do meet the diagnostic criteria for diabetes. It is wise to repeat any of those abnormal values on a separate day before making the firm diagnosis of diabetes. People who have values above the normal, but less than diabetes range, are considered to be Pre-diabetic and at risk of getting the disease unless something is done to prevent it or delay it.
The diagnosis of diabetes depends solely on the demonstration of high sugar in the blood. One of the following three conditions must be first identified, and then confirmed on a subsequent day:
1) A random blood sugar ≥ 200 mg/dL (≥ 11.1 mmol/L) coupled with classic diabetic symptoms, such as frequent urination, feeling thirsty, and unexplained weight loss.
2) A fasting blood sugar ≥ 126 mg/dL ( ≥ 7 mmol/L) after no intake for at least 8 hours.
3) A blood sugar ≥ 200 mg/dL 2 hours after a sugar load (oral glucose tolerance test of 75 g dissolved in water).
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Treatment of diabetes is individualized to the type of diabetes, age, and the presence of complications. The Center has well- trained Endocrinologists and Diabetologists who provide world-class care for Type 1, Type 2 and Gestational diabetes. The care is comprehensive and includes exercise, weight control, dietary advices, educational material, and booklets that cover all areas of diabetes care backed by the latest technology. |
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You need to take the initiative when it comes to your health if you have diabetes. If you address issues before they happen, you can avoid problems later. Doctors, diabetes nurse educators, and dietitians will supply you with helpful advice, information, and care. But it's up to you to follow through with your personal self-care plan to prevent or at least minimize the extent of possible complications from the disease.
Follow the following strategies to help you enjoy a healthier future:
See an Endocrinologist and specialized Diabetes doctor
Beyond your regular check-ups used to monitor your diabetes treatment, when your doctor knows you have diabetes, he or she will look for signs of emerging problems caused by the disease.
An exam is also an opportunity to screen for other conditions, such as blood pressure, eye, and/or kidney and heart disease, which may not be part of your regular diabetes check-ups. Because you have diabetes, you might become so focused on this one disease that you fail to notice symptoms associated with other conditions, or you might not complete other aspects of preventive care, such as mammograms for women or prostate exams for men.
Regular blood tests
Ask your doctors to do a glucose average of 3 months (A1C), Cholesterol and all lipids, kidney and urine for proteins and thyroid function test.
Get a yearly eye exam
Going to an eye doctor annually will help detect diabetes-related vision problems and catch them early, when they're still treatable. If you have poorly controlled diabetes, high blood pressure, kidney disease or elevated cholesterol, you may need to see your eye specialist more than once a year.
See your dentist
High blood sugar impairs your immune system, limiting your ability to fight bacteria and viruses that cause infection. Because your mouth is loaded with bacteria, your gums provide a common site for infection.
Keep your vaccinations up-to-date and take an annual flu vaccine
No matter what your age, if you have diabetes, you're more likely to get the flu (influenza) than are those who don't have diabetes. High blood sugar weakens your immune system, making you more susceptible to infections. If you also have heart or kidney disease, your risk of catching the flu is even higher and the consequences still more severe. If you do catch the flu, carefully monitor and control your blood sugar levels and adjust your diabetes medication as needed. The flu also puts you at greater risk of developing pneumonia. An annual flu vaccination is your best decision to try and avoid influenza and its related complications.
Take care of your feet
Diabetes is potentially dangerous to your feet in two ways:
Diabetes can damage the network of nerves that are in your feet and reduce the sensation of pain. You can develop a sore or blister or worse without ever realizing it until it is serious.
Diabetes can narrow your arteries, thereby reducing blood flow to your feet. When there’s less blood to nourish the tissues in your feet, it will be harder for sores to heal. An unnoticed cut or sore hidden beneath your shoes and socks can quickly develop into a major problem.
Diabetes is the most common cause of non-traumatic limb amputation.(limb amputation not caused by accidents or war injuries) Here are several self-care strategies to help you avoid an amputation.
- Check your feet every day
Examine your feet thoroughly and look for blisters, cuts, and bruises.
- Keep your feet clean and dry
Wash your feet every day in lukewarm water. You can check the water temperature by touching a dampened washcloth to a sensitive area of your body, such as your face, neck, or wrist. Wash the feet with a gentle massage-like motion, using a soft washcloth or sponge and mild soap. Dry the skin by blotting or patting it, but don't rub. Dry the areas between your toes carefully and completely to prevent fungal infections.
- Moisturize your skin with moisturizer foot creams
People with diabetes sweat less than people who don't have the disease. Thus, the skin can become dry especially the feet. Dry skin can itch and crack and increase your risk of infection. Use a moisturizer regularly, but never use it between the toes, as this might cause infection.
- Wear clean, dry socks and change them daily
Wear socks made of fibers like wool or cotton that will pull sweat away from your skin. Avoid socks with tight elastic bands that an reduce circulation or socks that are thick or bulky. Bulky socks often fit poorly, and a poor fit can cause irritation on your skin. It's also a good idea to avoid wearing mended socks or socks with thick seams. They can rub and irritate your skin. Indentations from the seams in your socks or a fold in your sock aren't a problem for most people, but if you have diabetes, such minor differences in fit and material can cause pressure sores because you can't feel the pressures.
- Use foot soothing products cautiously as it might contain harmful chemical or can cause injury to you foot .
Don't use a file or scissors on any calluses, corns, or bunions. Don't put chemicals like wart removers on your feet. See your regular doctor or a foot-care specialist for any calluses, corns, bunions, or warts. If you have any vascular impairment to your feet, always have a doctor do routine care on your toenails at least four times a year. If you over-trim your nails, you may cause a break in the skin that can lead to serious problems with your feet. ( Always remember-- your feet are further away from the main part of your body, so if you are a diabetic, good circulation will be harder to maintain there. You need to be extra alert about caring for your legs and feet and always alert to any minor changes that can indicate a problem is developing.).
- Always wear shoes
To prevent injury to your feet and toes, always wear shoes. Check them periodically for tears or rough edges, and shake them out before putting them on to make sure something like a small pebble, isn't lodged inside. Select a comfortable and safe shoe style with soft leather tops, a closed to design, low heels and flexible soles made from either crepe or foam rubber.
- Trim your toenails carefully if you don’t have your doctor do that task.
When trimming your toenails, be especially careful not to injure any surrounding skin. If you see any redness around your nails, tell your doctor.
Using Insulin Pumps:
Insulin pumps are miniature, computerized pumps, about the size of a pager, which can be placed on the belt or in the pocket. These pumps deliver a steady, measured dose of insulin through a flexible plastic tube with a small needle inserted through the skin into the fatty tissue and taped in place.
On command, the pump releases a bolus of insulin is the dose of regular or rapid-acting insulin that is injected to cover the food eaten in a meal or a snack; the release is usually done just before eating to counter the rise in blood glucose from food. The pump can also release an incredibly small dose of insulin continuously – a delivery system that most closely mimics the body's normal release of insulin. However, the insulin pump is NOT an artificial pancreas, and patients still have to monitor their blood glucose levels. Many people prefer this continuous system of insulin delivery to injections. The insulin pump lets patients enjoy a more flexible lifestyle. It can: |
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- Improve diabetes self- management:-
- How to start with diabetes
- Adjusting insulin according to well day management
- Adjusting insulin according to sick day rules
- How to fit exercise into daily diabetes management
- How to prevent diabetes complications
We want our patients to take control of their diabetes. We want to know their A1c, blood glucose levels, know what diabetes is, the two types, the signs of low and high blood sugar , how to inject insulin, use a glucometer and interpret the results and how to use blood glucose results to adjust their insulin doses on both well and sick days.
- Training on the Insulin Pump
Patients need to complete comprehensive interesting pump educational sessions related to dietary management and diabetes self management as well as technical and practical sessions related to insulin pump management.
- Nutrition and Diabetes
Nutrition is a basic element in diabetes management, and our patients definitely need to know how to count the carbohydrates in their food, how to match their insulin to their carbohydrate intake, and how to read food labels precisely. Then they will have a better control of their diabetes and a better lifestyle.
- Diabetes and Pregnancy
Our pregnant lady needs to complete different session related to diabetes self –management and learn what is particularly important for her and for her baby.
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The science of hormonal disorders relates to the pancreas, thyroid, parathyroid, pituitary, hypothalamus, adrenal, and sex gonads. Those glands can present with a function problem related to under- or over- secretion of hormones or even development of tumors in the glands. Diabetes, which is the under- secretion of the hormone Insulin , is one of several endocrine disorders.
Our center offers evaluation, diagnosis, and management of hormonal and metabolic disorders, such as diabetes, Obesity, thyroid disorders, high cholesterol, hypertension, osteoporosis and Hirsutism (increased hair on women), and calcium disorders. The endocrinologists also deal with the diagnosis and management of tumors of the thyroid, pituitary gland, gonads, and the adrenal glands.
The endocrine system of the human body which shows the glands that is responsible for secreting the body hormones
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Osteoporosis, means "porous or spongy bones" and is a condition that causes formerly strong bones gradually to thin and weaken, leaving them more susceptible to fractures. The National Institute of Health (NIH) Consensus Conference defined osteoporosis as "a skeletal disorder characterized by compromised bone strength, predisposing to an increased risk of fracture." http://consensus.nih.gov
This is a chronic, prevalent and potentially debilitating condition and a major public health concern in contemporary societies. It is the world’s most common bone disorder and affect one out of three women and one out of five men over 50 Fractures at an older age can produce pain, loss of movement, inability to perform daily chores, and even death. The most common fractures associated with osteoporosis are fractures of the hip and the vertebrae. With the predicted increase in the aging population worldwide, the number of hip fractures could rise from 1.7 million in 1990 to 6.3 million by 2050. It is estimated that 71% of these fractures will occur in developing countries, including the Middle East.
The most devastating consequence of osteoporosis is fractures, especially hip fractures. Up to 90% of all fractures in the elderly can be at least partially attributed to osteoporosis. Adults who have one fracture are 50-100% more likely to have another fracture. Mortality rates among the elderly, one year after a hip fracture range from 14% to 36%. Compared with the general population, elderly women and men are two and three times as likely to die, respectively, after sustaining a hip fracture due to surgeries and its complications , or immobility resulted from the fracture that lead to other complications affecting the general health condition.
Osteoporosis is considered a common disorder in older women, but also in men. It is usually recognized after a bone fracture, but should be diagnosed prior to any incident and treated to prevent those fractures and their associated complications. We have DXA scan technology, and we diagnose and monitor treatment using that technology. Our staff is certified by the highest authority in the field --The International Society of Clinical Densitometry and International Osteoporosis Foundation. We also have pediatric software to help cases of metabolic bone disease. The DXA scan is considered the gold standard to measure total body composition and is used by athletes and for obese cases to measure total fat and lean body mass.
- Family History
Family history is significant for osteoporosis and is associated with increased risk. A history of maternal hip fracture, particularly if suffered prior to age 50, doubles a family member’s risk of hip fracture. The inheritance of osteoporosis is most likely multifactorial, but may also be related to the vitamin D receptor gene.
- Race
Caucasians and Asians experience osteoporosis (with 10% to 20% lower BMDs) more often than do Blacks and Hispanics.
- Body Weight
Body weight is inversely related to the risk of developing osteoporosis. Increased body weight protects against osteoporosis. This effect is most likely due to weight-bearing stress on the skeleton and greater conversion of steroid hormones into estrogen in the peripheral fat/ Both increase bone density.
- Estrogen
Osteoporosis is eight times more prevalent among women than men. Estrogen deficiency (amenorrhea), menopause, surgical oophorectomy, and irregular menstruation are common causes of low bone density. Women can lose from 30% to almost 50% of their bone mass after the onset of menopause. In younger women, amenorrhea is associated with decreased bone density. With estrogen loss, there is an increase in bone turnover rate—bone formation is no longer as effective. Yet bone resorption is enhanced, leading to a negative skeleton balance. Reduced calcium absorption in the intestines is also associated with loss of estrogen.
- Smoking
Smoking stimulates the conversion of estrogen to an inactive form. Thus, females who smoke heavily may benefit less from the protective effects of estrogen replacement therapy, and also less estrogen before menopause.
- Calcium and Vitamin D
Calcium and Vitamin D deficiencies are associated with osteoporosis. Vitamin D is needed for intestinal calcium absorption. With advancing age, intestinal absorption of vitamin D and calcium becomes less efficient. In addition, with increased age, the kidney produces less 1,25-dihydroxy vitamin D (the active form) from the vitamin D that is absorbed. Menopausal women require 1500mg calcium/day if they are not on estrogen therapy and 1200mg if receiving hormone therapy. Foods that contain vitamin D include fatty fish, eggs, and fortified milk and milk products (cheese, yogurt, etc.).
- Treatment Strategies
Since osteoporosis is usually asymptomatic, which mean the patient will not know unless a fracture happened or x-ray taking for other issues meaning educating patients about the disease and its long-term consequences is critical. There are usually three goals for the treatment: Stop or reverse bone loss; increase or stabilize bone mass; and reduce fractures, pain, disability, and mortality. These goals can be achieved through education, patient adherence to the doctors guidelines, and appropriate nonpharmacologic and pharmacologic management.
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- BMI
This diagnosis is often determined from life insurance tables or by calculating the body mass index (BMI, defined as weight in kilograms divided by height in meters squared). Overweight is defined as a BMI of 25 to 29.9 kg/m2, and obesity as a BMI of >30 kg/m2. Severe or morbid obesity is defined as a BMI >40 kg/m2 (or 35 kg/m2 in the presence of comorbidities (which describes the effect of all other diseases on the patient beside the main disease)The mortality and morbidity associated with excess weight depends upon the degree of overweight or obesity.
- Prevalence of Obesity
Obesity has reached epidemic proportions globally, and the situation is likely to get worse. In developed regions, such as Europe, the United States, and Australia, prevalence is high and increasing. More than 60% of the adult population of the United States and Australia are either overweight (body mass index [BMI] of 25-29.9 kg/m2) or obese (BMI >30 kg/m2). More than 20% of adults fall into the obese category. A similar prevalence exists in the developing countries including the Gulf area. The diseases and mortality associated with overweight or obesity have been known to the medical profession for more than 2000 years. (The Greeks were the first to recognize obesity as a medical disorder. Hippocrates states that "Corpulence is not only a disease itself, but the harbinger of others". It was known to the Indian surgeon Sushruta (6th century BCE), who related obesity to diabetes and heart disorder.
- Health Hazards of Obesity
Obesity substantially increases the risk of hypertension, stroke, hyperlipidemia, gallbladder disease, osteoarthritis, sleep apnea, infertility, respiratory problems, and endometrial, breast, prostate, and colon cancers, as well as death from cardiovascular disease and generally a shorter life span. Perhaps one of the most visible and serious public health consequences of obesity is Type 2 diabetes and its many associated complications.
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- Ask your health care provider to examine your feet at your routine visits.
- Discuss foot care issues at each visit to your Gulf Diabetes Specialist Centre, physician or educator.
- Visit a podiatrist at least once a year for nail and foot care, or more often as recommended by your podiatrist or general doctor.
- Inspect your feet daily.
- File your nails ,BUT Do not cut them but trim them in straight way to prevent in growing nails.
- Treat infections or sores immediately.
- Protect your feet from injury. Do not go barefoot either inside the house or outside.
- Keep your blood glucose values within a desired range suggested by your physician.
- Do not smoke!
- Wear sandals and/or shoes that fit properly.
- Take frequent rest periods during the day and elevate your feet if you tend to have swollen feet.
- Exercise. Taking regular long walks, which will help maintain and improve your body’s circulation and overall health. Seek advice from your podiatrist about suitable footwear for walking.
- Do’s and don’ts for the Diabetic Foot
- Do not cut nails down the sides of the toes, do cut nails straight across.
- Do not use scissors to cut nails, use nail nippers or clippers.
- Do not cut cuticles, if needed, gently push then back while the skin is soft.
- Do not soak feet in hot water or apply hot compresses.
- Do not treat bodily ailments by using cautery to the feet.
- Do not apply tight bandages to the toes or feet.
- Do not walk barefoot.
- Do not wear tight shoes and hosiery.
- Do not use metal “graters” or blades or knives on the skin or nails.
- Do check your footwear daily for debris.
- Do wash your feet daily in soap and water.
- Do check your feet every day for any trauma (if you have poor eyesight or cannot reach your feet, have a family member check your feet for you).
- Do dry between your toes.
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