Rules To Play Double Frustration

Diabetes Surveillance (I)

It is practiced regularly by the doctor and daily by the patient himself.

a) Medical surveillance

The medical examinations periodically asks us with information on:

- The metabolic control of diabetes;
- The existence of disorders associated with a risk of aggravation of vascular risk;
- L existence, severity and scalability complications degenerative.

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 correcting the weight and the elimination of alcohol) and antihypertensive drugs (angiotensin converting enzyme).

Biomarkers of metabolic control are available:

The glycated hemoglobin (HbA1c) provides information on glycemic control during the last 120 days. It the gold standard. The normal result is less than 6% hemoglobin A1C. In case of insufficient treatment, the result is above 7.5% and up to 12%;

Fructosamine information on glycemic control during the previous two weeks.

The lipid is an integral part of monitoring of diabetes:

- 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 hypertension to promote the development of cardiovascular disease;
- Any reduction in blood cholesterol 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 supétieure threshold (between 2 and 2.60 g / l), the atherogenic risk is best assessed by measurement of apolipoprotein B by the determination of HDL-cholesterol. Any hyperlipidemia should be treated with lipid-lowering drugs and through dietary advice.

The search for traces albumin (microalbuminuria) is essential for the detection of the latter indicates a certain risk of progression. Microalbuminuria not only represents the first sign of diabetic nephropathy (kidney disease), but cardiovascular mortality is also greatly increased when proteinuria. Microalbuminuria reflects a urinary excretion of albumin between 20 and 200 mcg / ml. It is then sufficient to strip positiver Albustix but however, a reflection of a pathological glomerular hyperfiltration. This anomaly is reversible with improved glycemic control.

can be summarized as Oversight:

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, X-ray chest, ophthalmologic examination;
at spaced intervals and as needed, retinal fluorescein angiography, stress ECG, myocardial scintigraphy, Doppler of lower limbs and carotid Doppler, etc..