internal medicine

Internal Medicine Clinic

Internal Medicine Clinic Chronic Disease Diabetes

Chronic Disease
Insulin metabolic disorder “Diabetes”

01

What is diabetes?

Most of food we eat is used as energy sources after going through the process of breaking down into glucose and moving into the blood vessels. During this process, insulin, the hormone secreted form pancreas, act a role of sending glucose into cells. When insulin is not produced or cells don't react to insulin, produced glucose cannot go into cells but stay in the blood, resulting in increasing blood sugar. This condition is called diabetes.

02

What cause diabetes?

  • Genetic factor It is closely related to family history, and recent statistics show that when both parents are diabetic, the chance of developing diabetes for the child is 58%, and when one parent is diabetic, the chance is 28%.

  • Environmental factor ㆍEating high-calorie foods often
    ㆍObesity due to less activity than food intake
    ㆍAcute stress
    ㆍLong-term use of adrenal cortical hormone or oral contraceptives
    ㆍAging

  • Immunological factor When autoimmune disease develops, it may lead to diabetes, and this is common in type 1 diabetes.

03

Weight drops, frequently urinate, eat more, and drink more water... what does it mean?

Since symptoms of diabetes vary and some cases show no symptoms, 20% of diabetes patients are detected during regular health checkups or some are diagnosed when they see a doctor due to symptoms of complications.

04

Most adult cases, type 2 diabetes

Type 1 diabetes · It is caused by the inability to produce inulin at all and most cases are heredity. · As insuling-dependent diabetes, it may develops in any ages, but it usually affects those age under, and is called 'Juvenile diabetes' · Generally it occurs suddenly and insulin is secreted little. Its attack rate is about 10% of total diabetes cases. · It is believed that autoimmune reactions are the causes, and environmental factor plays an important role in diabetes development since the number of new patients increase in winter.
Type 2 diabetes · It is mainly caused by environmental factors such as a high-calories, hign-fat, high-protein diet affected by Westernization, lack of activity, stress, etc., but it is also may caused by defects of certain genes, pancreatic surgery, infection,, and medication. · As it is insulin-independent diabetes, it usually affect those age above 35 . · It progresses gradually, and sometiimes the secretion of insulin is normal or over a normal. · Its attack rate is about 85~90% of total diabetes cases.

05

Subjects for regular checkup

Since diabetes are diagnosed by chance in many cases, no symptoms do not mean no diabetes. If more that one of the followings are applicable, regular checkup for diabetes is needed.

· If there is a patient if your family and close relatives. · Adult over the age of 40 · Person with obesity · Pregnant women especially in 24~24 weeks of pregnancy or women with history gestational diabetes · Those who are under excessive mental, physical stresses for a long time period · Those who have diseases which eaily accompany diabetes as complications, such as hypertension, hronic liver disease, pancreatic disease, endocrine diseases such as thyroid disease, etc. · Those who are taking medications, which may increase blood sugar, for long time such as steroids, diuretics, contraceptives, thyroid hormones, anticancer drugs, some kind of painkillers, anti-tuberculosis, etc. · Women with history of gestational diabetes or has given birth a large baby weighing more than 4 kg.

06

How to diagnose diabetes?

Diagnostic criteria of diabetes normal Disturbed glucose tolerance Diabetes
Fasting blood sugar after 8 hours fasting under 100lmg/dl 100~125mg/dl over 126mg/dl
Oral glucose tolerance test
(blood sugar 2 hours after taking glucose solution)		 under 140mg/dl 140~199mg/dl over 200 mg/dl


* Diagnostic criteria of diabetes(75% oral glucose tolerance): vein serum blood sugar

Perform blood test. In the case of no symptoms, when blood sugar level after 8-hour fasting is over 126mg/dl or blood sugar level 2 hours after taking glucose solution is over 200mg/dl is diagnosed with diabetes. And iit is also diagnosed with diabetes when drink a lot of water, urinate more, lose weight, and blood sugar level (random sugar test) measured regardless of meal intake is over 200mg/dl.

07

Diabetes treatment with dietary
therapy and exercise therapy

Dietary control and regular exercise are needed base on the medication when sugar in unmanageable. The primary goal of diabetes treatment is to maintain normal body weight and relieve symptoms in order to enable normal social activities. And the next goal is to prevent diabetes complications or delay their progression as much as possible.

Dietary Therapy · Have three meals regularly with right amount of various foods. Avoide sweet foods. Avoid simple sugar foods(honey, jelly, jam, candies, ice cream, etc) and greasy foods(fatty parts of meat, butter, cheese, bacon, peanut butter, et.), if possible. · Have a low-salt diet. Salt may increase blood pressure, resulting in increasing risk of cardiovascular disease · Drinking a little alcohol is harmless, but do not exceed 60ml a day. · Avoid doing a folk remeday. Most of them are not proven and may have adverse effects. · Vitamins and minerals are essential for complete function of the body without calories, so eat various foods such as milk, vegetables, fruits, etc. · Maintain standard weight by adjusting obesity.
Exercise therapy · Precautions / Exercise must be begin according to the consultation with your doctor, and it is recommended to exercise in 1~3 hours after meals. · 저Start exercising in comfort clothing and shoes, taking foods against low blood sugar and diabetes recognition card with.. Avoid exercising in too cold or too hot weather.

Blood sugar check before exercise
It is possible to exercise safely when blood sugar level is in between 100-250mg/dl.

Blood sugar level Exercise or not
Under 70mg/dl & symptoms of hypoglycemia Do not exercise
80-100mg/dl Possible after eating snacks
Over 250mg/dl & keton in urine Do not exercise
Over 300mg/dl Do not exercise
· It is proper to exercise 3~5 time a week starting with moderate aerobic exercise such as hiking, jogging, cycling, swimming, skiing, walking, etc. · It is most effective to exercise for 30 min. in one hour after having meals when blood sugar increasesthe highest level. · Those have numb feet should avoid running and jogging, but swmming. is recommended. · Before and after doing main exercise, there must be warm-up and clean-up. · Warm-up(10~15 min. stretching, free exercise) may prevent muscles or joints from getting injured during main exercise(20~40 min. aerobic exercise). · Since muscles use glucose during exercise, blood sugar level may drops sharply. Please do exercise as planned.

Blood sugar check after exercise
When postexercise blood sugar level is under 100mg/dl and there are symptoms of hypoglycemia, take glucose as much as of 3 candies or half a glass of juice. Blood sugar level changes which have been checked before and after exercise can be a reference for the future exercise plan. When there are complications: If there are complications, consult with a doctor beforehand.

  • Retinopathies Prohibit breath holding exercise, high intensity exercise
    Prohibit exercise with head down and shaking
    Prohitbit excessivey heavy load muscle exercise

  • Autonomic disturbance Prohibit exercise when heart rate increses at rest and maximum heart rate decreases
    Be careful for dehydration and hypothermia
    Observe blood sugar level change carefully
    Avoid extreme workout environment

  • Peripheral nerve disorder Caution for foot trauma
    Put on well-fitted shoes
    Prohibit excessive balance exxercise
    Prohibit swimming when have ulcers

  • Kidney disease Prohibit breath-holding exercise, heavy load muscle exercise
    Be careful for dehyration

  • Hypertension Prohibit breath-holding or heavy load muscle exercise

Medicinal therapy

  • Oral hypoglycemic agent It is mainly prescribed for Type 2 diabetes patients who are difficult to be cured only with dietary therapy.
    The medications are sulfonylurea and biguanide.

  • Insulin injection therapy Insulin is classified into 3 types depending on the speed of action in the body; fast-acting, regular, protracted.
    The fundamental effect is same, that is reducing blood sugar level. But 'when become effective after injection', 'when the biggest effect comes' and 'how long the effect lasts' are different by types.
    A combination of a fast-acting and a regular can be available for patients who have difficulty managing blood sugar level.

  • Runnning 24 hours, insulin pump Insulin pump is a device which let insulin be administered into the body 24 hours.
    It continuously injects small amount of fast-acting insulin, adjusting doses of insulin accordingly to meals.