A) Medical Surveillance
The medical examinations periodically request that the information about:
The metabolic control of diabetes;
The existence of disorders associated with a risk of worsening cardiovascular risk;
The existence, severity and scalability of degenerative complications.
Monitoring of blood pressure is essential. Any increase in numbers (BP greater than 140/80, for example) means an increased risk of suffering eye and kidney. His finding led the doctor to prescribe lifestyle modifications (such as weight correction and removal of alcohol) and antihypertensive drugs (angiotensin-converting enzyme). converting enzyme).
Biological markers of metabolic control are available:
The glycated hemoglobin (HbA1C) provides information on glycemic control over the last 120 days. This is the gold standard. The normal result is less than 6% A1C. In case of insufficient treatment, the result is greater than 7.5% and up to 12%;
Fructosamine information on glycemic control during the previous two weeks.
The lipid profile is an integral part of monitoring the diabetic:
The poorly controlled diabetes promotes hyperlipidemia (cholesterol and triglycerides);
High cholesterol is a risk factor for vascular whose effects combine with those of hyperglycemia and high blood pressure for the emergence of cardiovascular disease;
Any reduction in blood cholesterol levels results in decreased vascular morbidity and even regression of atherosclerotic plaques;
Total cholesterol should be less than 2 g / l (especially LDL-cholesterol). If its value is slightly supetieure threshold (between 2 and 2.60 g / l), the atherogenic risk is best appreciated by measurement of apolipoprotein B by the determination of HDL-cholesterol. Any hyperlipidemia should be treated with lipid-lowering drugs and food with tips.
The search for traces of albumin (microalbuminuria) is critical because the identification of the latter indicates a risk of progression for sure. Microalbuminuria is not only the first sign of diabetic nephropathy (kidney damage) but also cardiovascular mortality is highly increased when proteinuria. Microalbuminuria reflects a urinary excretion of albumin between 20 and 200 micrograms / ml. It is then sufficient to strip a bright side. However, Albustix but reflects a pathological glomerular hyper filtration. This abnormality is reversible with improved glycemic control.
We can summarize the monitoring:
Every 3 months, taking blood pressure, blood glucose, glycated hemoglobin or fructosamine, total cholesterol, triglycerides (apolipoprotein B or HDL-cholesterol), microalbuminuria and urine cultures;
Every year, electrocardiogram, chest radiography, ophthalmologic examination;
At spaced intervals and as needed, retinal fluorescein angiography, exercise electrocardiogram, myocardial scintigraphy, Doppler of lower limbs and carotid Doppler, etc....
B) monitoring the patient.
The best monitoring of diabetes is the patient himself. Only he can adapt his treatment daily. Monitoring based on control of blood glucose in capillary blood. The research of sugar and acetone in the urine also have an interest as these parameters provide information about the melting of lipids (lipolysis) and thus the risk of ketoacidosis (acetonuria) in case of severe hyperglycemia greater than 3 g / l. Self-monitoring of blood glucose is the preferred method due to recent advances: lancets, test strips, electronic readers.
The lancing pens allow, with a very mild pain, getting a drop. These lancets are reimbursed at the rate of inter-health services (TIPS). The patient pricks his middle, ring and little fingers, preferably at the side faces slightly innervated. A levy on the earlobe is also possible. Gout blood is then deposited on a strip or electrode. Various e-readers are available. They allow to automatically determine the blood glucose from the color on the strip or after the current produced by the electrode.
Practical realization of self-monitoring
Control of blood glucose before the meal is the most important. Control postprandial (after meals) helps regulate the insulin administered before meals. The number of daily checks is the number of insulin injections and blood-glucose targets.
Adjustment of insulin doses
The patient should be able, from capillary blood glucose, modify insulin doses that must be injected. He must analyze the evolution of blood glucose on a time slot of the day to determine the dose of insulin to inject the same day. It must also take account of glycemia at the time of injection to modulate slightly the planned dose. This education is part to the role of the medical team.
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