2^nd International Conference on Diabetes and Diabetic Nurse Education and Practice September 28-29, 2018 Montreal, Quebec, Canada

The term “Clinical Diabetes Management” means to maintain optimal carbohydrate level. For maintaining this condition patients with an absolute deficiency of insulin requires insulin replacement therapy, which is administered via injections or an insulin pump. Insulin resistance, in contrast, can be cured by dietary modifications and exercise. Diabetes management requires awareness about blood sugar level which can elevate it level and it also requires to control its level by simply modifying the lifestyle.

Key factors to maintain an optimal carbohydrate level and living a healthy life style :

• Exercise regularly
• Meditate
• Avoid Grains and Sugars
• Avoid use of processed meats
• Avoid use of alcohol
• Take Vitamin D
• Take plenty of omega-3 fat
• Regularly monitor your insulin level by portable devices or go to clinic for blood sugar test

Type 1 diabetes is an autoimmune disorder in which own immune system destroys the insulin-producing cells. People having type 1 have to depend on insulin for the rest of life or they have to need pancreatic transplantation at present this is the only possible cure.

The most common form of diabetes is type 2 affecting about 95 percent of people. In this case your body secretes insulin but is unable to recognize and use it properly. This insulin resistance allows glucose in your body to increase and causes different complications.

Symptoms of type 2 includes, fatigue, frequent urination, obesity and itchy skin. If type 2 is not managed, it can lead to complications like glaucoma and cataracts, hypertension, gum diseases, erectile dysfunction in males, infections and also wound healing problems.

Prevention of diabetes for living healthy life style

• Exercise regularly
• Avoid Grains and Sugars
• Avoid use of processed meats
• Take plenty of omega-3 fat
• Regularly monitor your insulin level

The term “Pre Diabetes” refers to pre-diagnosis of  diabetes when you see pre- diabetic symptoms  which can’t be neglected. The sugar level is higher than the optimal sugar level range which can be considered as a borderline for diabetes  but still the person is not having diabetes . So to avoid the further complications one should change his / her lifestyle for maintaining proper glucose level in the blood.

Pre-Diabetic Symptoms :

• Loss of weight in spite of eating more
• Frequent urination
• Feeling more thirstier than normal level
• More tired than normal

Risk factors for type 1 diabetes

• Family history - If a parent or sibling has type 1 diabetes chance of being diabetic is quite possible.
• Environmental factors - Circumstances such as exposure to a viral infections  make person more prone to be type 1 diabetic.

Risk factors for prediabetes and type 2 diabetes

• Weight - Insulin resistance property is more shown by fatty tissue.
• Family history - Risk factor of being prone to type 2 increases if any of the family member is suffering from diabetes type 2
• High blood pressure -  Blood pressure over 140/90 millimeters of mercury (mm Hg) is linked with an increased risk of type 2 diabetes.
• Cholesterol and triglyceride levels -  Low levels of high-density lipoprotein  increases and high level of TAG          ( Triglycerides )  increases risk of having type 2 diabetes.

Current challenges in endocrinology and diabetes include:

• Optimizing the use of currently available therapies to ensure adequate glycemic level, blood pressure, and lipid control and to reduce complications.
• Educating patients on diabetes care management. 
• Improving patient adherence to lifestyle and pharmacologic interventions.
• Novel discovery is needed to avoid early use of insulin doses.
• Improving drug delivery system for chronic patients.
• Cost effective treatment of type 1 is required.

Diabetes is a disease which not only affects the insulin producing cells but it also affects the whole immune system of body making it weak as a result of which the body becomes prone to different complications. Heart disease or a stroke, high blood pressure, high cholesterol level, nerve pain, kidney related disease, eye problem (glaucoma),dermal problems are some  major likely complications which develops in more likely in diabetic patient. The only cure to all above complications is preventing diabetic conditions by changing the lifestyle. 

Key points for maintaining healthy lifestyle :

• Exercise regularly
• Meditate
• Avoid Grains and Sugars
• Avoid use of processed meats
• Avoid use of alcohol
• Take Vitamin D
• Take plenty of omega-3 fat
• Regularly monitor your insulin level by portable devices or go to clinic for blood sugar test

Gestational diabetes is a condition in which a woman without diabetes develops a diabetic condition which increases the   risk of pre-elampsia. Geastational diabetic condition because of certain risk factors like overweight, family history  (anybody previously suffering by diabetes) , having polycystic ovarian syndrome. Diagnosis is carried out by blood sugar test within 24-28 weeks of gestation period

 Treatment of Gestation diabetes within gestation period :

• Eating balanced meals.
• Regular excersie
• Monitoring sugar level
• Monitoring fetal growth
• Regular checkups
• Taking insulin doses and diabetes pills

Diabetes is one of the most epidemic disease worldwide. Chronic Hyperglycemic conditions is responsible for the appearance of various organ and tissue damage in diabetic patients. Kidneys, eyes  and peripheral nerves are frequently damaged due to diabetes-specific alteration in microvessels. Furthermore, large vessels are also damaged causing other diseases such as myocardial infarction, cerebral infarction and gangrene. The pathogenesis of these alterations in small and large vessels has been studied and different metabolic abnormalities induced by hyperglycemia are proposed to play a major role in the development of these diabetic vascular complications. 

Diabetes Type 2 is commonly diagnosed on routine screening. High risk factors, also indicate the need for screening, include: older age, obesity, family history of diabetic patient  polycystic ovary syndrome; hypertension; dyslipidemia; or known cardiovascular disease. 

Following approach is used for screening of diabetes : 

• Fasting plasma glucose (FPG) >125 mg/dL (most common test)
• Random plasma glucose ≥200 mg/dL with diabetes symptoms such as polyuria, polydipsia, fatigue,  weight loss
• Two hours post-load glucose ≥200 mg/dL on a 75 g oral glucose tolerance test
• HbA1c ≥6.5%.

Novel technology for treatment of diabetes

• Stem Cell Technology
• Gene Therapy
• Monoclonal Antibody
• Telemedicine
• Artificial pancreas

Antidiabetic drugs are medicines developed to optimize the glucose level in the blood in the diabetic patient. Antidiabetic drugs are commonly used for  diabetes management.

There are a number of different types of antidiabetic drug including:

• Insulin
• Pramlintide (Amylin)
• GLP-1 receptor agonists (such as Byetta and Victoza)
• Oral hypoglycemics (tablets)

Oral Medications

Oral medication involves taking of medicines orally which helps you to maintain normal glucose level. They are made for those people whose insulin producing cells have capability to produce insulin, but not enough insulin for maintaining optimal blood sugar level

Some of the oral medicines are mentioned below :

• Biguanide (Metformin)
• Sulfonylureas
• Thiazolidinediones
• Meglitinides
• Alpha-glucosidase inhibitors
• Sodium-glucose transporter 2 (SGLT2)
• Dipeptidyl peptidase-4 (DPP-4) inhibitors

Nurses have a major role and responsibilities in treating people with diabetes. Nursing teams of different spectrums including occupational health nurses, nurses working in public health and school nurses are likely to come into contact with people who have diabetes or are having tests to diagnose diabetes. Practice nurses have a particularly main role as they are often the one who carry out the annual diabetes and foot check.

Roles and responsibilities of the nursing team in diabetes care management :

• Screening and early detection of type 2 diabetes
• Advocating self-care
• Awareness of how mental health issues can affect people with diabetes
• Meeting the patient’s nutritional need
• Urine, blood and glucose monitoring
• Oral and injectable therapies

Diabetic Nutrition and Obesity

A proper balanced nutrition is really mandatory for all of us to avoid obese conditions which can further develop into diabetic conditions. So in order to prevent the diabetic condition and also for people having diabetes it is compulsory to get a proper food chart from their dietician or could avoid those foods which are unhealthy. These slight modification in the diet can prevent further major complications in diabetes.

Recommended foods                                              

• Healthy carbohydrates - Take carbohydrates like fruits, vegetables, legumes (beans, and low-fat dairy products.
• Food rich in fiber - Rich sources of fiber are vegetables, fruits, nuts and whole-wheat
• Health Fish -  Eat heart healthy fish like salmon, mackerel, tuna, sardines as they are rich source of  omega-3 fatty acid.
• "Good" fats -Take foods which have mono and polysaturated fatty acids as it helps to lower cholesterol level such as almonds, pecans, walnuts and olives

Foods to be avoided - Avoid high fatty products , trans fats, cholesterol and take less amount of sodium if you have hypertension to remain healthy.

Physical activity and exercise is an alternative to which helps you to control your blood sugar level. Type 2 diabetic patient have higher glucose level in their blood, either because their body doesn’t produce enough insulin to process it, or because their body doesn’t use insulin properly.

Physical exercise can also help type 2 diabetic patient to avoid chronic complications, especially heart problems. Type 2 patient are more are susceptible to arteriosclerosis, which can further cause heart attack. Excess calories and cholesterol level get reduced during physical activity which prevents further major complications in both diabetic and non-diabetic people.

Key benefits of physical exercise:

• Maintains blood pressure
• Avoid pre-obese conditions
• Level of goods cholesterol increases
• Muscles and bones get stronger
• Help in stress management
• Improved mood and sound sleep

Diabetes education is vital way for controlling blood sugar control level and avoiding long-term major healthcare complications. Diabetic people needs to have knowledge that what to do if something unusual happens, how they can adjust their diet, exercise, lifestyle, medication

People having diabetes needs to know what to do if something goes wrong, how to adjust their diet, exercise, lifestyle, medication or insulin. There are lot of other things regarding diabetes that one needs to know such as nutritional management, physical exercise, medications, glucose monitoring and physcological adjustments. Diabetes education and self-care management is done in team and a team should ideally consist of:

• A physician understanding diabetes
• A certified educator
• A dietician
• Exercise physiologist

If the diabetic patient is not accessible to these facilities then they can easily contact to their prescribed endocrinologist not just for routine checkups but also to gain some knowledge on diabetes and self-caring management.

Clinical trials is an advanced way to carry out research work and simultaneously improving the medical care of type 2 diabetic patient. Different trials around the globe is being carried out  in development of cost effective technology to cure diabetes.

U.S Trials

Type 1 Diabetes - Recent trial is being carried out by ViaCyte Inc. which is a private organization in regenerative medicine. The organization has launched first phase of clinical trial for a stem-cell deficient product patient(VC-01™)  and developed by us of two novel technologies : stem cell combined with novel delivery device called Encaptra® used to deliver a dose of cells in different body locations.

Type 2 Diabetes - This research work is NIH-funded for type 2 diabetes and focuses on diabetic patients who rely on metformin medication. The trial name is GRADE. The main purpose is to find an optimal combination of diabetic drugs for optimal glycemic control for prolong treatment of type 2 diabetes populations.

U.K Trials

Type 1 Diabetes - A collaborative U.K research team for the first time is using a peptide with memory to for testing the safety of type 1 vaccine.

Type 2 Diabetes - A French organization Pharmaleads for the first time will be carrying out investigation to know the potential level of a novel have ability to cure diabetic neuropathy.