Diabetes mellitus – Management of diabetes – One Health
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Diabetes mellitus is a chronic disease, for which no cure is known except in very specific situations. The administration focuses on keeping blood sugar levels as close to normal as possible, without causing low blood sugar levels. This can usually be achieved with a healthy diet, exercise, weight loss and the use of appropriate medications (insulin in the case of type 1 diabetes, oral medications, as well as possibly insulin, in type 2 diabetes).
It is important to know the disease and actively participate in the treatment, since the complications are much less common and less severe in people who have well controlled blood sugar levels. The goal of treatment is a HbA1C level of 6.5%, but it should not be less than that, and it can be set higher. Attention is also paid to other health problems that can accelerate the negative effects of diabetes. These include smoking, high cholesterol levels, obesity, high blood pressure and lack of regular exercise. Specialized footwear is widely used to reduce the risk of ulceration or ulceration in diabetic feet at risk. However, the evidence of the effectiveness of this remains equivocal.
People with diabetes can benefit from education about the disease and treatment, good nutrition to achieve a normal body weight and exercise, in order to keep blood glucose levels in the short and long term within acceptable limits. In addition, given the increased associated risk of cardiovascular disease, lifestyle modifications are recommended to control blood pressure
The drugs used to treat diabetes do so by lowering blood sugar levels. There are several different classes of antidiabetic medications. Some are available orally, such as metformin, while others are only available by injection, such as GLP-1 agonists. Type 1 diabetes can only be treated with insulin, usually with a combination of regular insulin and NPH, or synthetic insulin analogs.
Metformin is generally recommended as a first-line treatment for type 2 diabetes, since there is good evidence that mortality decreases. It works by decreasing the production of glucose from the liver. Several other drug groups, mostly administered orally, can also lower blood sugar in type II diabetes. These include agents that increase the release of insulin, agents that decrease the absorption of sugar in the intestines and agents that make the body more sensitive to insulin. When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while oral medications are continued. Then the insulin doses are increased to that effect.
Since cardiovascular disease is a serious complication associated with diabetes, some have recommended blood pressure levels below 130/80 mmHg. However, the evidence admits less than or somewhere between 140/90 mmHg at 160/100 mmHg; The only additional benefit found for blood pressure targets below this range was an isolated decrease in the risk of stroke, and this was accompanied by an increased risk of other serious adverse events. A 2016 review found potential damage to treat less than 140 mmHg. Among drugs that lower blood pressure, angiotensin-converting enzyme (ACE) inhibitors improve outcomes in those with DM, while drugs similar to angiotensin receptor blockers (ARBs) do not. Aspirin is also recommended for people with cardiovascular problems, however, it has not been found that regular use of aspirin improves outcomes in uncomplicated diabetes.
Occasionally, a pancreas transplant is considered for people with type 1 diabetes who have serious complications of the disease, including end-stage kidney disease that requires a kidney transplant.
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