Diabetes is a chronic metabolic disorder that develops with disorders in carbohydrate, fat and protein metabolism as a result of insulin deficiency or insufficient insulin effect, and requires constant medical care. It is necessary to educate patients and follow a proper follow-up protocol in order to reduce the risk of acute complications of the disease and to avoid long-term treatment-expensive and chronic sequelae (heart, kidney, peripheral nerves and vessels, eye, etc.).
After diagnosis of diabetes is made. Follow-up and treatment should be carried out by a team. The fact that diabetes affects many systems and that diet, exercise and psychological elements are especially important in treatment make a team approach necessary. In the team involved in the follow-up and education of diabetic patients; There must be an endocrinologist or a physician specialized in the diagnosis and treatment of diabetes, a diabetes nurse, a nutritionist, a cardiologist, an ophthalmologist, a podologist, and a psychologist. Exercise physiotherapists, neurologists and nephrologists also join this team when needed.
A good history and detailed physical examination are essential in the diagnosis and follow-up of a diabetic patient. At the first examination; signs and symptoms related to the diagnosis of diabetes, eating habits, nutritional status, weight history, details of previous treatment programs, exercise details, symptoms and treatment details related to chronic complications, risk factors for ischemic heart disease (smoking, hypertension, lipid disorders, family history). ), factors that will affect diabetes follow-up and treatment (lifestyle, cultural, psychosocial, alcohol use, economic), reproductive and sexual life, and family history should be questioned in detail. Again, during the physical examination, a detailed physical examination should be performed, including all organ systems related to diabetes and its complications. The phrase "from head to toe" is very suitable for evaluating patients with diabetes. The evaluation begins with a head and neck examination and ends with the evaluation of the feet and nails. After this stage, laboratory tests are performed to evaluate the patient in detail. Here, blood, urine, ECG, chest X-ray and other tests that may be necessary are requested to evaluate the patient's diagnosis, blood sugar control and complications that may affect other organ systems. Are these tests history and physical? It may vary for each patient depending on the findings. In the next stage, a team approach comes into play in the patient's treatment planning. Therefore, for medical nutrition therapy, a nutritionist, diabetes educator, fundus examination, family planning for women of reproductive age, evaluation by a psychologist or psychiatrist (if behavioral therapy is required), foot examination (podiologist) and other specialties deemed necessary (cardiology) are required. , neurology, ophthalmology, nephrology, gynecology, dentistry, etc.) evaluation is requested.
In type 2 diabetes patients, this detailed evaluation should be made during diagnosis. Thereafter, examination and evaluation are recommended every 3-4 months for blood sugar control. Blood sugar control is evaluated by measuring HgbA1c, which shows the average blood sugar of 3-4 months, and daily blood sugar measurements that the patient takes at home. The frequency of self-measurement of glucose at home should be determined according to the patient. While 1-2 measurements per day are sufficient for some patients, sometimes 7-8 measurements per day are required. Continuous glucose measurement systems, which have been introduced with the developing technology in recent years, have significantly facilitated blood sugar monitoring. If blood sugar control is not achieved, the patient continues to be evaluated at more frequent intervals. If no negativity is detected in the initial evaluation of complications, this evaluation should be repeated annually. Otherwise, the evaluation and treatment process related to complications are monitored at more frequent intervals. In type 1 diabetes patients, the evaluation related to complications is made in the 5th year after diagnosis and repeated every year.
To protect patients from the negative consequences of diabetes and to stay healthy with diabetes. It is very important for them to have their medical check-ups on time and completely in order to live a healthy life. For a healthy life in diabetic patients, not only blood sugar but also many factors such as blood pressure, lipids and psychological state need to be evaluated together and treated if necessary. For this reason, it is of great importance to increase the number of diabetes centers in our country that will provide the multidisciplinary approach needed by diabetic patients.
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