Secondary prevention is aimed at preserving the functions of the remaining beta-cells in patients with clinical manifestation of diabetes, its prevention of acute and late complications.
Such prevention is reduced to the proper lifestyle, diet, timely medical treatment (taking tablets lowering drugs or insulin injections), the wise use of exercise as an adjunct to primary therapy using physiotherapy, herbal medicine, spa treatment.
Maintenance of compensation of diabetes mellitus as the 1st and 2nd type - the main way to prevent diabetic complications.
The following rules, following which, it is possible to avoid decompensation, complications of diabetes, or to stop their development:
1. Normalize blood glucose levels. To do this diet, it is reasonable to use the exercise, lead a normal life, to comply with all recommendations of the treating physician must conduct self-control.
Every patient should strive to have a fasting blood glucose level less than 5.5 mmol / L, after eating no more than 7.8 mmol / l, glycated hemoglobin level of 6-7%.
It is important to remember that the value of glycated hemoglobin (or HbA1c) reflects the value of the blood glucose level over the past 3-4 months.
Thus, the level of HbA1c 6-7% in patients with diabetes means that his blood glucose level over the past 90 days was between 4.4 - 6.3 mmol / l during the day. Therefore, achieving normalization of blood glucose, normalizes the level of patient HbA1c!
In one of the reputable international study under the acronym DCCT in the prevention of diabetic complications proved that the desire to normalize the patient's HbA1c levels in diabetes mellitus type 1 reduces the likelihood:
- eye damage by 76%;
- renal disease by 50%;
- nerve damage by 60%;
- damage the cardiovascular system (heart and blood vessels) to 35%.
Another international study by the acronym UKPDS in the prevention of diabetic complications proved that the desire to normalize the patient's HbA1c levels in diabetes type 2 can reduce the risk:
- any complications associated with diabetes by 12%;
- microvascular complications (damage small blood vessels) to 25%;
- myocardial infarction by 16%.
In order to better understand what life to lead, it is recommended to be trained in the "school of diabetes."
These schools are organized at hospitals (specialized endocrine units) and specialized diabetes centers and dispensaries. The school should be trained not only to children with diabetes mellitus type 1, but also adult patients with diabetes mellitus type 2.
2. Need regular medical checkups to detect decompensation and complications begin.
For the prevention of nephropathy (kidney damage) to:
Such prevention is reduced to the proper lifestyle, diet, timely medical treatment (taking tablets lowering drugs or insulin injections), the wise use of exercise as an adjunct to primary therapy using physiotherapy, herbal medicine, spa treatment.
Maintenance of compensation of diabetes mellitus as the 1st and 2nd type - the main way to prevent diabetic complications.
The following rules, following which, it is possible to avoid decompensation, complications of diabetes, or to stop their development:
1. Normalize blood glucose levels. To do this diet, it is reasonable to use the exercise, lead a normal life, to comply with all recommendations of the treating physician must conduct self-control.
Every patient should strive to have a fasting blood glucose level less than 5.5 mmol / L, after eating no more than 7.8 mmol / l, glycated hemoglobin level of 6-7%.
It is important to remember that the value of glycated hemoglobin (or HbA1c) reflects the value of the blood glucose level over the past 3-4 months.
Thus, the level of HbA1c 6-7% in patients with diabetes means that his blood glucose level over the past 90 days was between 4.4 - 6.3 mmol / l during the day. Therefore, achieving normalization of blood glucose, normalizes the level of patient HbA1c!
In one of the reputable international study under the acronym DCCT in the prevention of diabetic complications proved that the desire to normalize the patient's HbA1c levels in diabetes mellitus type 1 reduces the likelihood:
- eye damage by 76%;
- renal disease by 50%;
- nerve damage by 60%;
- damage the cardiovascular system (heart and blood vessels) to 35%.
Another international study by the acronym UKPDS in the prevention of diabetic complications proved that the desire to normalize the patient's HbA1c levels in diabetes type 2 can reduce the risk:
- any complications associated with diabetes by 12%;
- microvascular complications (damage small blood vessels) to 25%;
- myocardial infarction by 16%.
In order to better understand what life to lead, it is recommended to be trained in the "school of diabetes."
These schools are organized at hospitals (specialized endocrine units) and specialized diabetes centers and dispensaries. The school should be trained not only to children with diabetes mellitus type 1, but also adult patients with diabetes mellitus type 2.
2. Need regular medical checkups to detect decompensation and complications begin.
For the prevention of nephropathy (kidney damage) to:
- Normalize blood glucose levels;
- Regular urine for microalbuminuria (small protein) - at least once a year during the first 5 years of disease onset diabetes;
- Conduct urinalysis for proteinuria (large protein) at least 1 time in 3 months;
- Determine the glomerular filtration rate (sample Rehberg) at least 1 time in 6 months;
- Daily to control blood pressure;
- Investigate the level of creatinine and urea in serum (blood chemistry), 1 per 6 months;
- In the presence of elevated levels of albumin or proteinuria should have more control over the carbohydrate metabolism (to normalize blood glucose levels);
Time to begin treatment, that is to see a doctor appointment for medical treatment and normalization of intrahepatic pressure (drugs: Captopril, Capoten, Enalapril, Enap, Renitek, etc.) and treatment of high blood pressure with antihypertensive drugs);
- Regular urine for microalbuminuria (small protein) - at least once a year during the first 5 years of disease onset diabetes;
- Conduct urinalysis for proteinuria (large protein) at least 1 time in 3 months;
- Determine the glomerular filtration rate (sample Rehberg) at least 1 time in 6 months;
- Daily to control blood pressure;
- Investigate the level of creatinine and urea in serum (blood chemistry), 1 per 6 months;
- In the presence of elevated levels of albumin or proteinuria should have more control over the carbohydrate metabolism (to normalize blood glucose levels);
Time to begin treatment, that is to see a doctor appointment for medical treatment and normalization of intrahepatic pressure (drugs: Captopril, Capoten, Enalapril, Enap, Renitek, etc.) and treatment of high blood pressure with antihypertensive drugs);
For the treatment of nephropathy (by appointment doctor!) Angioprotectors used (drugs, "defenders" of blood vessels) - Trental, Pentoxifylline, Actovegin, Sulodexide (Lively Du F), a new drug that is based on nanotechnology (microscopic particle of the drug has the size - 400 nm when comparing the diameter of a human hair is 100 000 nm, red blood cell - red blood cell 1,000 nm) - Traykor (Fenofibrate);
With the appearance of proteinuria is also recommended to limit consumption of animal protein intake (up to 0.6-0.8 g / kg body weight per day) and the number of salt.
For the prevention of retinopathy (eye damage) that
- Normalize blood glucose levels;
- Regular urine for microalbuminuria (small proteins);
- Eye doctor check-ups once in a year in the absence of retinopathy;
- Eye doctor check-ups 2 times a year when there are changes in the fundus;
- Held fundus examination with dilated pupils (eyes buried atropine), which gives a complete picture of the fundus. In this case, considered contraindications to the use of atropine (eg, glaucoma);
- Time to begin treatment.
For the prevention of neuropathy (nervous system) must be:
- Normalize blood glucose levels;
- Conduct regular surveys by a neurologist (sensitivity, reflexes) 2-4 times per year;
- Observe the rules of foot care and regular exercises for the legs.
Rules for the care of their feet. It should be:
- Wash their feet daily with warm soapy water (not steam out feet!)
- After washing, dry with a towel to wipe his feet (especially between the toes carefully);
- Lubricated regularly stops fat cream - it will help prevent cracking and dryness of the skin (but the cream should not fall into the interdigital spaces). Currently, pharmacies appeared in a series of special creams DiaVord (Diaword):
- Diaderm soothing, protective Diaderm, Diaderm regenerating;
- Regularly inspect the feet (including using a pocket mirror);
- Properly and timely treat the nails with nail file 1 - 2 times a week, do not use sharp objects - scissors and forceps, and never round off the corners of the nails;
- Rough skin on heels and corns are regularly removed with pumice stone or nail file special cosmetic;
- Do not cut corns, use special tools to remove them;
- Check the inner surface of the shoe for the presence of foreign bodies, fractures, folds insoles;
- Do not go barefoot and wear no shoes on bare feet;
- Wear warm socks if feet are cold, made from natural fibers with no tight elastic band;
- Not warm feet heaters, a fireplace, batteries;
- Be correct clamping shoes (do not buy a hard, narrow shoes, with a decrease in the sensitivity of the legs to go for buying shoes with cardboard footprints), to avoid open shoes, shoes with heels, narrow nose;
- Properly lace shoes (lace should be parallel);
- Detection of cracks, abrasions, cuts, abrasions, burns, ulcers, discoloration of the skin. Changes in temperature and swelling of the extremities should be immediately consult a doctor;
- When to see a doctor urgently given the opportunity to use to process colorless antiseptic solutions (Miramistin, Aioksidin) not to use iodine as well as handling them can cause irritation.
The following is a special gymnastics for the prevention of lower limb neuropathy and diabetic foot.
- Exercising the legs.
- Every night is very important to take 15 minutes to perform the exercises for the legs. If you experience pain doing the exercises should be stopped and subsequently consulted on this matter with your doctor. Each exercise should be performed 10 times.
Starting position: sit down, keeping your back straight in a chair or stool.
1. Prim toes and straighten again.
2. Then alternately raise socks, then the heel.
3. Feet up and make circular movements toes.
4. Based on the socks, to perform circular motions with your heels.
5. Straighten the leg at the knee. Pick it up parallel to the floor. Toe delay. Bend the leg at the knee. Put your foot on the floor. (Each foot to perform the exercise 10 times.)
6. Raise the leg, straightening it in the knee, parallel to the floor. Pull the sock itself. Lower the leg to the floor, leaning on his heel. (Each foot to perform the exercise 10 times.)
7. Repeat the previous exercise by doing it with both legs simultaneously.
8. Lift, straightening your knees, both legs. Flexion and extension of the foot at the ankle joint.
9. Raise the foot, straightening her knee. Make a circular motion foot (10-fold from right to left, left to right 10 times each leg).
10. Fingers of both feet to crush a single page of the newspaper lying on the floor, then flatten it and break into pieces. Pieces of paper seized, fingers and move to the second page of the newspaper. Then this page to spread out her pieces of paper rolled up into a ball with your toes. (Run 1 times.).
Exercises Ratshou:
These exercises are known to exercise, improves blood circulation in the feet and legs, and are recommended for the prevention of angiopathies of the lower extremities.
1. Lie on your back on the bed or the gym mat.
2. The legs lift up as much as possible straightening of the knees. Hands to support your feet under your knees.
3. Make a circular motion stops at 1 revolution in 2 seconds
4. Perform a circular motion for 2 minutes.
5. Sit on the edge of the bed and sit in this position, his legs dangling, 2 minutes.
6. Alternately repeating these steps within 20 minutes.
7. At the end of exercise a little walk around the room.
8. On the day of repeating this exercise several times.
A few tips for preventing lower limb neuropathy, diabetic foot.
1. Daily walking at a higher pace of 30 minutes to 1 hour is the best exercise for your feet. We must try to increase the distance each day.
2. Also recommends the following exercises you can do at home:
Wuickly up the stairs, using only the rise of the foot; Bend your knees, holding the chair. Squat as deeply as possible 10 times. Back while keeping a straight; Knead calf muscles: in a standing position with his hands rest against a suitable wall. Set legs so that the trunk was tilted forward in some situation. The feet should be fully in contact with the floor surface. Bend your elbows 10 times, while holding his back and legs fully extended position. This exercise helps prevent muscle cramps legs; Rise and fall on your toes to the heel 20. At the same time trying to shift the weight from one foot to another; Sit on a chair and get up with him 10 times. Hands at the same time must be crossed in front of the abdomen;
With the appearance of proteinuria is also recommended to limit consumption of animal protein intake (up to 0.6-0.8 g / kg body weight per day) and the number of salt.
For the prevention of retinopathy (eye damage) that
- Normalize blood glucose levels;
- Regular urine for microalbuminuria (small proteins);
- Eye doctor check-ups once in a year in the absence of retinopathy;
- Eye doctor check-ups 2 times a year when there are changes in the fundus;
- Held fundus examination with dilated pupils (eyes buried atropine), which gives a complete picture of the fundus. In this case, considered contraindications to the use of atropine (eg, glaucoma);
- Time to begin treatment.
For the prevention of neuropathy (nervous system) must be:
- Normalize blood glucose levels;
- Conduct regular surveys by a neurologist (sensitivity, reflexes) 2-4 times per year;
- Observe the rules of foot care and regular exercises for the legs.
Rules for the care of their feet. It should be:
- Wash their feet daily with warm soapy water (not steam out feet!)
- After washing, dry with a towel to wipe his feet (especially between the toes carefully);
- Lubricated regularly stops fat cream - it will help prevent cracking and dryness of the skin (but the cream should not fall into the interdigital spaces). Currently, pharmacies appeared in a series of special creams DiaVord (Diaword):
- Diaderm soothing, protective Diaderm, Diaderm regenerating;
- Regularly inspect the feet (including using a pocket mirror);
- Properly and timely treat the nails with nail file 1 - 2 times a week, do not use sharp objects - scissors and forceps, and never round off the corners of the nails;
- Rough skin on heels and corns are regularly removed with pumice stone or nail file special cosmetic;
- Do not cut corns, use special tools to remove them;
- Check the inner surface of the shoe for the presence of foreign bodies, fractures, folds insoles;
- Do not go barefoot and wear no shoes on bare feet;
- Wear warm socks if feet are cold, made from natural fibers with no tight elastic band;
- Not warm feet heaters, a fireplace, batteries;
- Be correct clamping shoes (do not buy a hard, narrow shoes, with a decrease in the sensitivity of the legs to go for buying shoes with cardboard footprints), to avoid open shoes, shoes with heels, narrow nose;
- Properly lace shoes (lace should be parallel);
- Detection of cracks, abrasions, cuts, abrasions, burns, ulcers, discoloration of the skin. Changes in temperature and swelling of the extremities should be immediately consult a doctor;
- When to see a doctor urgently given the opportunity to use to process colorless antiseptic solutions (Miramistin, Aioksidin) not to use iodine as well as handling them can cause irritation.
The following is a special gymnastics for the prevention of lower limb neuropathy and diabetic foot.
- Exercising the legs.
- Every night is very important to take 15 minutes to perform the exercises for the legs. If you experience pain doing the exercises should be stopped and subsequently consulted on this matter with your doctor. Each exercise should be performed 10 times.
Starting position: sit down, keeping your back straight in a chair or stool.
1. Prim toes and straighten again.
2. Then alternately raise socks, then the heel.
3. Feet up and make circular movements toes.
4. Based on the socks, to perform circular motions with your heels.
5. Straighten the leg at the knee. Pick it up parallel to the floor. Toe delay. Bend the leg at the knee. Put your foot on the floor. (Each foot to perform the exercise 10 times.)
6. Raise the leg, straightening it in the knee, parallel to the floor. Pull the sock itself. Lower the leg to the floor, leaning on his heel. (Each foot to perform the exercise 10 times.)
7. Repeat the previous exercise by doing it with both legs simultaneously.
8. Lift, straightening your knees, both legs. Flexion and extension of the foot at the ankle joint.
9. Raise the foot, straightening her knee. Make a circular motion foot (10-fold from right to left, left to right 10 times each leg).
10. Fingers of both feet to crush a single page of the newspaper lying on the floor, then flatten it and break into pieces. Pieces of paper seized, fingers and move to the second page of the newspaper. Then this page to spread out her pieces of paper rolled up into a ball with your toes. (Run 1 times.).
Exercises Ratshou:
These exercises are known to exercise, improves blood circulation in the feet and legs, and are recommended for the prevention of angiopathies of the lower extremities.
1. Lie on your back on the bed or the gym mat.
2. The legs lift up as much as possible straightening of the knees. Hands to support your feet under your knees.
3. Make a circular motion stops at 1 revolution in 2 seconds
4. Perform a circular motion for 2 minutes.
5. Sit on the edge of the bed and sit in this position, his legs dangling, 2 minutes.
6. Alternately repeating these steps within 20 minutes.
7. At the end of exercise a little walk around the room.
8. On the day of repeating this exercise several times.
A few tips for preventing lower limb neuropathy, diabetic foot.
1. Daily walking at a higher pace of 30 minutes to 1 hour is the best exercise for your feet. We must try to increase the distance each day.
2. Also recommends the following exercises you can do at home:
Wuickly up the stairs, using only the rise of the foot; Bend your knees, holding the chair. Squat as deeply as possible 10 times. Back while keeping a straight; Knead calf muscles: in a standing position with his hands rest against a suitable wall. Set legs so that the trunk was tilted forward in some situation. The feet should be fully in contact with the floor surface. Bend your elbows 10 times, while holding his back and legs fully extended position. This exercise helps prevent muscle cramps legs; Rise and fall on your toes to the heel 20. At the same time trying to shift the weight from one foot to another; Sit on a chair and get up with him 10 times. Hands at the same time must be crossed in front of the abdomen;
Exercise for the toes: holding on to the back of the chair in turn stand on the fingertips of each leg; Stand with one foot on the platform, such as a large book. Holding onto a chair or table to make 10 swings back and forth with one foot. Change the position of the feet and repeat the exercise; Sit on the floor, lean back slightly and press against the floor with his hands behind him. Shake a few times before the feet of a sense of warmth and relaxation; Time to begin treatment (using medications that contain vitamins A, B, C, E, Su, minerals zinc and chromium, for example, "Vitamins for people with diabetes," products containing only vitamins B "Multi-Tubbs B-complex," "Neyromultivit "but the most effective drugs is a derivative of alpha-lipoic acid or thioctic" Tiogamma, "" Valium, "" Tioktatsid ").
For the prevention of angiopathies (micro-and macroangiopathy - vascular lesions of the lower limbs, heart attacks, strokes), you must:
Normalize blood glucose levels; Regularly carry out surveys in the vascular surgeon, cardiologist, neurologist 2-4 times a year (on the testimony and more); Struggle with excess weight, obesity, physical inactivity;
Observe antiholesterinovuyu diet (described in detail in the thematic section of the vital information portal diabetunet.ru, dedicated to diabetes care); Follow the recommendations of the attending physician (not to oppose the appointment of insulin in patients with diabetes mellitus type 2).
Very often patients with diabetes mellitus type 2 for a long time are treated just as diet and physical activity or diet, physical activity and sugar-reducing pills.
There comes a time when these treatments become scarce and there are initial manifestations of complications of hypertension.
These circumstances are required to transfer patients to insulin.
Patients strongly resist insulin, believe that they were "carefully tended, planted" on the insulin that they can be a life-long dependency on medication. This is a mistake.
Insulin can not be used! Inclusion of insulin therapy when complications appeared only delay their progression and prolong life.
It is therefore very important time to begin treatment (on prescription medications are used - and Angioprotectors antihypoxants - eliminating the lack of oxygen in the brain and heart: Meksidol, Mildronate, Coenzyme Q and vitamin antioxidants: vitamin E, A, C, trace element selenium). Antioxidant rich herbs (parsley, onion, dill, etc.), green pepper.
For the prevention of osteoarthropathy (bone and joint destruction) that
Normalize blood glucose levels; Conduct regular surveys by an endocrinologist, surgeon, podiatrist. Independently examine the joints, on a monthly basis to test for hayropatiyu (damage of joints of the hands) to do this, lay your hands in prayer position (palm to palm) is normal, in the absence of joint damage, the fingers and palms are closed tightly to each other, without gaps; Struggle with excess weight, obesity, physical inactivity; About driving articular exercises (described in detail in the thematic section of the vital information portal diabetunet.ru, devoted to physical activities); To avoid situations in which possible fractures obstruction of the house, injuring exercise, limit the movement of heavy ice, etc.); In the diet (if no contraindications) include daily milk and dairy products rich in calcium; Time to begin treatment if there are signs osteoarthropathy.
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