Sunday, May 27, 2012


By Dr. John Vincent Policarpio G. Flores, MD, M.Sc. MBA
Director, ASEAN Medical Affairs
  • Diabetes Essentials
  • Review of the Numbers
    • Ordinary Numbers of Ordinary People
    • Target Numbers of Special People
  • What’s your number?
    • What’s accurate and what’s not?

Human beings are hard-wired with numbers – evidenced by common everyday occurrences such as when asking “How old are you?” and “What is your grade in Math?”

Diabetes Essentials:
  • How our Body Functions

    • In digestion, our body breaks down proteins into amino acids, fats into fatty acids, carbohydrates into glucose.
    • The nutrients (glucose) go through the gastro-intestinal tract, and then are absorbed into the blood.
    • The glucose in the blood is needed by the cells to provide energy; therefore, they must find their way inside the cell.
    • Think of glucose as the body’s fuel and insulin as the ignition key that allows glucose to enter the cell and provide energy for the body.
    • With LACK OF INSULIN, glucose is unable to enter the body’s tissues, leaving the tissues to use up their energy reserves.

  • Most Clinical Types of Diabetes
    • Type 1 – Body is not able to produce insulin because pancreatic beta cells that produce insulin are destroyed.
    • Type 2 –Characterized by decreased insulin secretion or insulin resistance (fat gets in the way of insulin) in the body.
    • Gestational Diabetes - Temporary state of diabetes during pregnancy.

  • Normal Glucose Levels (for ordinary people not yet diagnosed with diabetes)

  • 70-100 mg/dl – glucose levels during fasting state (8 hours without any meal).
  • 140 mg/dl – post-meal glucose after a maximum of 2 hours after eating a meal.
* Take note that the boundaries are different for people who want to know if they are diabetic or not (undiagnosed diabetics) and for those who know they are diabetic and want to regularly monitor their blood sugar levels (diagnosed diabetics).

  • How do you know if you are Diabetic?
    • 126-8-2 = 126 mg/dl or above blood glucose measure during the fasting state (8 hours without any meal) on 2 separate occasions.
    • 200-2-75 = 200 mg/dl or above blood glucose measure two hours after taking in 75 grams of glucose.
    • 200 + Symptoms = 200 mg/dl or above blood glucose measure and experiencing the ff symptoms: extreme thirst, frequent urination, dry skin, hunger, blurred vision, drowsiness, nausea.
If you meet any of these requirements, then you are diabetic.

  • So what? Why is diabetes management important?
Poor diabetes management can lead to:

    • Microvascular complications – such as blindness, kidney failure, nerve dysfunction
    • Macrovascular complications – such as coronary heart disease, cardiovascular heart disease
*Source: American Diabetes Association

    Example: James who had his toes eaten by his dog.
  • Hyperglycemia Risk Factors:

    • Overeating
    • Lack of Exercise
    • Stress
    • Surgery

  • Hypoglycemia Risk Factors:

    • Too much medicine
    • Delayed meals
    • Overly Rigorous Exercise

  • Hypoglycemia Symptoms:

  • Shaking
  • Sweating
  • Anxious
  • Dizziness
  • Hunger
  • Fast Heartbeat
  • Impaired Vision
  • Weakness, Fatigue
  • Headache
  • Irritable

  • How big is the problem?

  • 7 million new cases per year worldwide

  • What can we do about it?

  • Medical Nutrition Therapy (MNT)
  • Exercise
  • Patient Education
  • Drugs/Medications
  • Optimization of Glucose Control through SMBG

  • SMART Goals of Therapy Among People with Diabetes

  • Achieve Blood Glucose Control
  • Blood Pressure Control
  • Cholesterol Control

  • Target Blood Glucose Levels for People with Diabetes

  • Fasting state (8 hours without eating anything, upon waking up from long duration sleep) – 70 -130 mg/dl
  • Measure for 2 hours after meal - < 180 mg/dl
*Source: American Diabetes Association

  • How to choose a good blood glucose meter

  • Accuracy

      • Reflected by how close its readings are to results generated by a reference method (laboratory method)
      • Blood glucose measure samples within zone A of Clarke-Error Grid

  • Precision

      • Refers to consistency or reproducibility of blood glucose readings
      • < 5% coefficient of variation is the accepted ISO standards

  • Conclusion

  • Glucose control is one of the cornerstones of diabetes management.
  • Self-Monitoring of Blood Glucose (SMBG) can help guide therapy towards optimized glucose control.



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