Kuidas hoida oma tervist kui olete juba haigestunud 2 t pi diabeeti

1. Kuidas hoida oma tervist kui olete juba haigestunud 2 t��pi diabeeti? Verner Fogel 2010

2. Teemad Veresuhkru head v��rtused Mis on HbA1c? Mida see anal��s n�itab? Milliseid anal��se tuleks patsiendile teha? Milliseid uuringuid tuleks patsiendile teha? Kokkuv�te K�simused patsientidele

3. Kui k�rged peaksid olema Teie veresuhkrud?

4. Head veresuhkru v��rtused

5. Kui tihti tuleks veresuhkruid m��ta? Kui 2 t��pi diabeet on alles diagnoositud v�i veresuhkrud ei ole normipiirides M��tke veresuhkrut �le p�eva Hommikul enne s��ki Enne l�una-ja �htus��ki 2 tundi peale s��ki Enne uinumist Veresuhkru v��rtused kirjutage p�evikusse P�evik v�tke alati arsti vastuv�tule kaasa, sest veresuhkru v��rtustest s�ltub Teie edasine ravi

6. Kui tihti tuleks veresuhkruid m��ta? Kui Teie veresuhkrud on normipiirides M��tke veresuhkrut 1-2 korda n�dalas Hommikul enne s��ki Enne l�una-ja �htus��ki 2 tundi peale s��ki Enne uinumist Veresuhkru v��rtused kirjutage p�evikusse P�evik v�tke alati arsti vastuv�tule kaasa sest veresuhkru v��rtustest s�ltub Teie edasine ravi

7. T�hjak�hu k�rgete veresuhkrute t�htsus diabeedi kompensatsioonis This study analysed the diurnal glycaemic profiles of 290 patients with T2DM investigated at different levels of HbA1c. The patients were treated with diet or oral hypoglycaemic agents (not acarbose). Plasma glucose (PG) concentrations were determined at fasting and during postprandial and post absorptive periods. The areas under the curve above fasting PG concentrations and >6.1 mmol/l (110 mg/dl) were calculated for further evaluation of the relative contributions of postprandial and fasting PG increments to the overall diurnal hyperglycaemia. The value of 6.1 mmol/l (110 mg/dl) was chosen because this threshold has been defined as the upper limit of normal PG at fasting or preprandial times by the American Diabetes Association. The data were compared over quintiles of HbA1c. The main contributor to overall hyperglycaemia in patients with poorly controlled T2DM was found to be fasting hyperglycaemia. Fasting hyperglycaemia was the dominant factor in patients who were furthest from HbA1c target. Monnier L, et al. Diabetes Care 2003;26:881?5.This study analysed the diurnal glycaemic profiles of 290 patients with T2DM investigated at different levels of HbA1c. The patients were treated with diet or oral hypoglycaemic agents (not acarbose). Plasma glucose (PG) concentrations were determined at fasting and during postprandial and post absorptive periods. The areas under the curve above fasting PG concentrations and >6.1 mmol/l (110 mg/dl) were calculated for further evaluation of the relative contributions of postprandial and fasting PG increments to the overall diurnal hyperglycaemia. The value of 6.1 mmol/l (110 mg/dl) was chosen because this threshold has been defined as the upper limit of normal PG at fasting or preprandial times by the American Diabetes Association. The data were compared over quintiles of HbA1c. The main contributor to overall hyperglycaemia in patients with poorly controlled T2DM was found to be fasting hyperglycaemia. Fasting hyperglycaemia was the dominant factor in patients who were furthest from HbA1c target. Monnier L, et al. Diabetes Care 2003;26:881?5.

8. Suremus ja s��gij�rgne veresuhkur In this study, PPG was found to be an independent and progressive risk factor for mortality. 1. DECODE Study Group. Lancet 1999; 354: 617�21.In this study, PPG was found to be an independent and progressive risk factor for mortality. 1. DECODE Study Group. Lancet 1999; 354: 617�21.

9. Mis asi on gl�kohemoglobiin?Mida see anal��s n�itab?

10. Mida n�itab HbA1c? A1c n�itab kui palju veresuhkrust on seotud punalibledes hapnikku transportiva valguga N�itab 2-3 kuu keskmist veresuhkru taset A1c tase s�ltub hommikusest t�hjak�hu veresuhkru v��rtusest A1c on hea, siis tuleks veresuhkruid kontrollida ka 2 tundi peale s��ki Ei anna informatsiooni madalate veresuhkrute ja l�hiaegsete veresuhkru muutuste kohta

11. HbA1c ehk anal��s mis n�itab Teie 3 kuu keskmist veresuhkrut Diabeet on h�sti ravitud HbA1c on antud juhul alla 7% Kontrollitakse 2 korda aastas

12. HbA1c ehk anal��s mis n�itab Teie 3 kuu keskmist veresuhkrut Diabeet on halvasti ravitud HbA1c on antud juhul �le 7% Kontrollitakse 4 korda aastas

13. HbA1C ja v�ikeste veresoonte t�sistuste tekkimise risk Good glycaemic control is essential to reduce the risk of diabetic complications Based on the Diabetes Control and Complications Trial data, the relative risk for microvascular complications such as diabetic retinopathy, nephropathy, neuropathy, and microalbuminuria increases with increasing levels of A1C1-3 The relative risk of complications is set to �1� for an A1C of 6%1 It is important to note that the risk gradient is continuous, with no glycaemic threshold for developing complications1Good glycaemic control is essential to reduce the risk of diabetic complications Based on the Diabetes Control and Complications Trial data, the relative risk for microvascular complications such as diabetic retinopathy, nephropathy, neuropathy, and microalbuminuria increases with increasing levels of A1C1-3 The relative risk of complications is set to �1� for an A1C of 6%1 It is important to note that the risk gradient is continuous, with no glycaemic threshold for developing complications1

15. HbA1c langetamine v�hendab t�sistuste riski Data from the UKPDS demonstrated the substantial impact of good glycemic control on microvascular and macrovascular complications. In an analysis of these data, it was estimated that a 1% decrease in HbA1c, which reflects a measure of glycemia over the past 2�3 months, correlates with: 21% reduction in the risk of deaths related to diabetes (P < 0.0001)? 37% reduction in the risk of microvascular complications (P < 0.0001)? 14% reduction in the risk of myocardial infarction (P < 0.0001). These striking reductions in risk form the basis for diabetes management guidelines recommending aggressive targets for HbA1c in individuals with type 2 diabetes. Stratton IM, et al. BMJ 2000; 321:405�412.Data from the UKPDS demonstrated the substantial impact of good glycemic control on microvascular and macrovascular complications. In an analysis of these data, it was estimated that a 1% decrease in HbA1c, which reflects a measure of glycemia over the past 2�3 months, correlates with: 21% reduction in the risk of deaths related to diabetes (P < 0.0001)? 37% reduction in the risk of microvascular complications (P < 0.0001)? 14% reduction in the risk of myocardial infarction (P < 0.0001). These striking reductions in risk form the basis for diabetes management guidelines recommending aggressive targets for HbA1c in individuals with type 2 diabetes. Stratton IM, et al. BMJ 2000; 321:405�412.

16. Milliseid anal��se tuleks veel teha diabeeti p�devatele patsientidele?

17. Teised vajalikud anal��sid Kolesteroolid Valk hommikuses uriinis Vajadusel mikroobide anal��s uriinist

18. Kolesteroolide kontroll

19. Teised vajalikud anal��sid Kolesteroolide v��rtused 2 t��pi diabeetikul: �ldine kolesterool alla 4,5 mmol/l Hea kolesterool ( ehk HDL) �le 1,1 mmol/l Halb kolesterool ( ehk LDL) infarkti v�i insuldi anamneesita alla 2,5 mmol/l Halb kolesterool ( ehk LDL) infarkti v�i insuldi anamneesiga alla 1,8 mmol/l Trigl�tseriidid( ehk rasvhapped) alla 1,7 mmol/l

20. Teised vajalikud anal��sid Kolesterool koguneb veresoonte seintesse Tekivad naastud, mis halvendavad verevarustust Suured naastud l�hevad katki ja sinna piirkonda tekib tromb Trombi tekkimine p�hjustab infarkti, insulti ja jalgade gangreeni

22. Teised vajalikud anal��sid Kui Teie kolesteroolid on raviga v�i ravita normipiirides, siis korratakse anal��se 1 kord aastas Kui Teie kolesteroolid ravil v�i ravita on k�rged, siis korratakse anal��se 3 kuu tagant Kui kolesteroolid ei ole normipiirides, siis tuleks ravi muuta v�i ravi alustada

23. Neerude kontroll

24. Teised vajalikud anal��sid Valk uriinis n�itab, kas Teil esineb neerude kahjustust v�i mitte Diagnoosimiseks peab olema 2 anal��si �le normi Albumiini kreatiniini suhe meestel peaks olema alla 2 ja naistel alla 3

25. Teised vajalikud anal��sid Kui esimene anal��s ei ole korras, siis tuleks teha teine anal��s 2-3 kuu p�rast Kui 2 anal��si olid korras v�i juba varasemalt neerude kahjustus teada, siis korratakse anal��si 1 kord aastas

26. Teised vajalikud anal��sid Kuidas parandada v�i �ra hoida valgu sattumist uriini Teie veresuhkrud peavad olema normipiirides Teie verer�hk peab olema normipiirides P�letiku ravimine neerudes v�i kusep�ies

27. Teised vajalikud anal��sid 1 kord aastas tuleb kontrollida neerude anal��se verest ( kreatiniin ja uurea)

28. Teised vajalikud anal��sid Mikroobide kontroll uriinist Kui esinevad kaebused sagedale urineerimisele, seljavalule, k�rvetustundele urinineerimisel Anal��si tuleks korrata kaebuste taastekkimisel Raviks kasutatakse antibiootikume

29. Milliseid uuringuid tuleks teha 2 t��pi diabeetikul?

30. Vajalikud uuringud Igal vastuv�tul tuleks m��ta verer�hku Neerukahjustuseta patsiendil peaks verer�hk olema alla 130/80 mmHg Neerukahjustusega patsiendil peaks verer�hk olema alla 125/75 mmHg

31. Vajalikud uuringud 1 kord aastas tuleb k�ia silmaarsti juures Silmaarst vaatab, kas Teil on muutusi silmap�hjades Silmaarst vaatab, kas Teil on kaed v�i silmasisese r�hu t�usu

32. Vajalikud uuringud 1 kord aastas katsutakse pulsse jalgadel ja kontrollitakse haavandite olemasolu jalgadel Vajalik veresoontes olevate ahenemiste varajaseks leidmiseks Vajalik n�rvikahjustuse uurimiseks Vajalik haavandite varajaseks avastamiseks ja gangreeni ning amputatsiooni �rahoidmiseks

33. Soovitused patsiendile Kui tulete arsti vastuv�tule, siis V�tke oma kingad v�i saapad jalast V�tke kaasa oma koduste verer�hkude n�idud R��kige oma kodustest probleemidest ( jalad, verer�hk, silmad)

34. Kokkuv�te Hoidke veresuhkrud normipiirides Hoidke verer�hk normipiirides K�ige regulaarselt arsti juures kontrollis Kui veresuhkrud v�i verer�hud on �le normi, siis p��rduge perearsti v�i endokrinoloogi juurde K�ige regulaarselt silmaarsti juures

35. K�simused Kui k�rged peaksid olema Teie veresuhkrud, et diabeet oleks h�sti ravitud? Kui k�rge peaks olema Teie HbA1c, et diabeet oleks h�sti ravitud? Kui tihti peaksite k�ima arsti juures, kui HbA1c on alla 7%? Kui tihti peaksite k�ima arsti juures, kui HbA1c on �le 7%?

36. K�simused Mida n�itab HbA1c? Milliseid anal��se ja uuringuid tuleks teha 2 t��pi diabeetikul? Kui tihti tuleks k�ia silmaarsti vastuv�tul? Kas k�rget kolesterooli on vaja ravida?

37. K�simused Milleks on vaja kolesterooli ravida? Kui kolesterool ei ole korras ravil, millal tuleks uuesti kontrollida? Kui k�rge v�iks olla diabeetikul verer�hk, et lugeda seda normipiirides olevaks? Kui tihti tuleks teha neeruanal��se? Kas peaksite arsti juurde minnes kaasa v�tma kodused veresuhkrud ja verer�hud?

38. Hoidke oma tervist!Teie elate ainult �he korra!

39. T�nan!