Wednesday, December 30, 2015

Diabetes Type II.. Therapeutic change of lifestyle and containing sport and the health system to eat



In fact I would like to remind the diabetic last proposed recommendations for the treatment of Type II diabetes, which was discussed and agreed upon by the Association  U.S.   Diabetes (AD A) Association   European for the Study of Diabetes (EASD).. These recommendations have been published "on the Internet" in magazines (Diabetes care) and other (Diabetologia) in October 2008 .. Any of this month .. recommendations before these recommendations were in 2006 and in fact .. has been revised in a simple in the beginning of this year due to the tale (Rosiglitazone) Avandia known .. All .. must be aware that these recommendations are recommendations   For the treatment of increased blood sugar   For people with type II diabetes, and not as stated   In the title of this letter "last U.S. .. European tactic in  Diabetes treatment   Type II.?! "... Because in fact the treatment of diabetes (often) .. need to many drugs for the treatment of increased blood sugar and there is also an increase in blood fats need to treat .. and there is a rise in blood pressure need to be addressed. . and there is an increase portability of the need to treat clots ... and there need to treat obesity .. and there is increasing resistance to insulin needed to treat, etc. ... So the correct address for this message should be "another tactic U.S. .. European  Treatment increased blood sugar for people with diabetes   Type II.?! "... Right? .. So these new recommendations, published in the medical magazines are mentioned  Recommendations for the treatment of increased blood sugar only   For people with type II diabetes. 
  Now we review some of what came to these recommendations ... 
Some principles of these recommendations were: 
● To seek value for a cumulative analysis of blood sugar (A1c) to less than 7%.! 
● To change the therapeutic lifestyle   (TLC), which includes the two main things, namely sports and health system to eat .. Plus tablets   Metformin   .. As before ... Disks should be taken since the beginning of the diagnosis of type II diabetes. (This is the first step in the recommendations) 
● These recommendations recommends .. Like its predecessor .. In that it should not be .. There is no reason to wait ... If you can not get on a cumulative analysis of blood sugar (A1c) to less than 7% after three months of taking the proper treatment, this means  Addition   Another treatment. (This is the second step in the recommendations) 
● In the other case of treatment failure in obtaining a cumulative analysis of blood sugar (A1c) less than 7% after three months .... Do not wait and start   BY Insulin. (This is the third step) 
But even increase in clarifying the three steps and alternatives to these recommendations:
1. The first step:   It is a therapeutic change and metformin .. For the first step must be the doctor to increase the dosage of metformin gradually according to the patient's condition so that up to the upper limit of these discs, namely, (2 to 2.5 grams per day) ..In a period of one to two months ... The doctor then cumulative analysis work three months after taking the top amount of metformin .. If the analysis of the cumulative blood sugar of less than 7% Fujb Switch to the second step. 
2. Second step:   If you do not get a cumulative analysis of blood sugar less than 7% after follow the first step "any change therapeutic lifestyle + metformin" .. Faced with the doctor two options .. 
● The first option   .. Add insulin "key insulin such as BHP (NPH) or (Glargin e) Or (Detemir) " 
● The second option .. Add tablets sulfonylurea. 
In the event that there is increased blood sugar symptoms or the cumulative analysis of blood sugar (A1c) of more than 8.5%, the start insulin is the most appropriate option. 
3. Third step:   If you do not get a cumulative analysis of blood sugar less than 7% after follow the second step "any change therapeutic lifestyle + metformin + (insulin or sulfonylurea " The doctor also two options and two .. 
● The first option:   Increased insulin doses by adding a fast-acting insulin in one or more servings of meals ... And in the case of the patient with diabetes take insulin as a second step. 
● The second option:   Is that the doctor stopped taking Asalafohnaal urea and this in the case of the patient with diabetes taking Asalafohnaal urea as a second step ... Then begins BY Insulin ... Beginning insulin essential. 
Note: the doctor rather than shut down the urea sulfonylurea and start in insulin .. That adds a third disc "any change therapeutic lifestyle + metformin + sulfonylurea + third CD," In fact, the doctors who have agreed to these recommendations pointed out that this tactic is not more efficient than the beginning of insulin then this tactic is more expensive. 
Due   The fear of a drop in blood sugar for those working in dangerous places   These recommendations proposed   An alternative to the second step   And that people with diabetes who need to avoid sugar episodes in particular .. And using (Exenatide) .. Or (Pioglitazone) .. as follows .. Note that (Rosiglitazone) known Avandia in these recommendations do not recommend its use ... Re does not recommend its use nor approved?! .. 
An alternative to the second step:   If you do not get a cumulative analysis of blood sugar less than 7% after follow the first step "any change therapeutic lifestyle + metformin" .. Faced with the doctor two options .. 
● The first option   .. Add (Exenatide) .. Balbaa known ETA .. Byetta .. And especially if the cumulative analysis of blood sugar less than 8%, or that there is a desire to reduction body weight. 
● The second option   .. Add Pioglitazone tablets (Pioglitazone) 
If you do not get a cumulative analysis of blood sugar less than 7% of these medicines can add urea sulfonylurea.. These options on or off (Exenatide and Pioglitazone  and the transition to the use of insulin. 
I have only a simple comment on these recommendations is that the recommendations of such   "Pooped"   .. It really helps the practitioner at the speed of decision more accurate selection and best suited to his patients .. These recommendations are agreed upon that are reviewed every important studies and research important and reliable in this area ..Therefore it save time and effort for the doctor practices, ... Thank all the doctors who have put these recommendations .. However, there is one final point is that these recommendations do not mean requiring doctors to follow where required .. But the doctor practitioner deems appropriate option for each individual case .. There are also some medications not mentioned in these recommendations either to weakness in the cumulative diminution analysis of blood sugar (A1c) or hyperbole for it, but that does not mean they do not use but may be used in some cases to be determined by the treating doctor.