Management Of Diabetes Prevention

OBJECTIVES OF MANAGEMENT

In the management of the diabetic patient, the physician has four main objectives:

1. To relieve any symptoms the patient has
2. To maintain the patient in an optimal nutritional state
3. To preserve the insulin-producing power of the pancreas
4. To prevent, postpone, or minimize complications

In the attainment of these objectives three factors must be balanced and standardized: the diet, the amount of insulin or oral hypoglycemic agents, and the amount of exercise.

The diabetic diet should take into account

(a) the attainment of optimal body weight through adjustment of the total caloric intake;

(b) the fact that protein replacement requires approximately 1 gm of protein per kilogram of body weight daily;

(c) the necessity for a fairly even dis­tribution of carbohydrate intake over the day, especially when a long-acting insulin is being given; and

(d) the fact that the diabetic is subject to premature atherosclerosis, and many physicians will advise that his diet include a preponderance of polyunsaturated fatty acids over those that are saturated. The total amount of carbohydrate is relatively unimportant, since any excess can be covered with insulin. What is important is that the daily intake of carbohydrate be kept as constant as possible.

Prevention
Little can be done to prevent diabetes. Married couples who both have diabetes should be cautioned that if they have children there is a good possibility that their offspring will be diabetic. Certainly everything pos­sible should be done to minimize precipitating factors, which for practical purposes implies weight control. There is some evidence that if the preg­nant diabetic is kept in good control throughout pregnancy, the pancreas of the infant will be protected, and diabetes will be postponed, if not pre­vented, in the child.

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