Iam a Diabetic.How low should be my Cholesterol

People with diabetes are at high risk for heart disease.Unfortunately, many people are unaware of their risk. Heart disease is one of the most serious diabetes complications, accounting for the majority of diabetes-related deaths.In fact, heart attacks occur at an earlier age in people with diabetes and often result in premature death.Keeping your Cholesterol level with in the specified target is the best way to prevent Heart attack.

A diabetic patient should measure total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides at least once a year.If the levels are high more frequent testing may be needed to see the effect of treatment. LDL cholesterol is more important than total cholesterol for telling whether someone has unhealthy fat levels.
Targets for Lipids are:-

LDL cholesterol should be below 100 mg/dL.

HDL cholesterol should be greater than 50 mg/dL in women and 40 mg/dL in men.

Triglyceride levels should be less than 150 mg/dL.

Action should be taken when LDL cholesterol levels are 100 mg/dL or higher. Generally, lifestyle changes such as losing weight, becoming more active and improving diet will help. If LDL cholesterol is still too high, the person should continue with these steps and start taking a cholesterol-lowering drug.

However, people who already have heart disease or who have high LDL cholesterol levels (200 mg/dL or higher) may have to be started on drugs along with lifestyle changes.

Apolipoproteins

Lipoproteins are complexes of fat and protein, whose main function is to transport lipids. . There are many different apolipoproteins, including:

Apo A1: the major apoprotein of HDL and is a relatively abundant plasma protein

Apo B: the main apolipoprotein of chylomicrons and low density lipoproteins

Apolipoprotein B is a measurement of the total number of atherogenic particles and is therefore thought to be a better marker of risk of Heart Attack and Stroke and a better guide to the adequacy of Cholesterol lowering treatment than any cholesterol index
Apo B should be less than 80mg/dl

The ratio of apolipoprotein B/apolipoprotein A-1 seems superior to the ratio of total cholesterol/HDL cholesterol as an overall index of the risk of heart attack and stroke
The ratio should be less than 0.5

Insulins and other Injections to control blood sugar

What is Insulin and how it works?

Inside the pancreas, beta cells make the hormone insulin. With each meal, beta cells release insulin to help the body use or store the blood glucose it gets from food. In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been destroyed and they need insulin shots/injections to use glucose from meals.
People with type 2 diabetes make insulin, but their bodies don't respond well to it. Some people with type 2 diabetes need diabetes pills or insulin injections to help their bodies use glucose for energy.

Insulin cannot be taken as a pill. The insulin would be broken down during digestion just like the protein in food. Insulin must be injected into the fat under your skin for it to get into your blood.

There are many different insulins for many different situations and lifestyles and there are more than 10 types of Insulin in the market. These insulins differ in how they are made, how they work in the body, and price. Insulin is made in labs to be identical to human insulin or it comes from animals (pigs/Cows].

Types of Insulin
Different types of insulin preparations are distinguished by the speed at which the injected insulin is absorbed from the layer under the skin into the blood (onset of action) and by the time it takes for all the injected insulin to be absorbed (duration of action).
It is important to note that the duration and absorption times described below are only approximate. Absorption of insulin always depends on individual factors.

Insulin analogues

Rapid-acting insulin analogue

Onset: 10-20 minutesMaximum effect: 1-3 hours Duration: 3-5 hours
Eg;insulin lispro (Eli Lilly), insulin aspart (Novo Nordisk), or insulin glulisine (sanofi-aventis),

Long-acting insulin analogue



Onset: 1 hour Duration: 24 hours
Eg;glargine[Lantus] and detemir[Levemir]

Biphasic insulin analogue



Onset: 10-20 minutesMaximum effect: 1-4 hours Duration: up to 24 hours
Eg; Novomix,Humalog

Human insulins

Short-acting insulin(soluble human insulin)

This insulin comes in a clear solution, and is intended to be given at meals. An injection should be followed by a meal or snack containing carbohydrates within 30 minutes.



Onset: within 30 minutesMaximum effect: 1-3 hours Duration: 8 hours
Eg;Actrapid,Humisulin R

Intermediate-acting insulin(isophane human insulin, NPH)

An insulin formulation that contains a substance, which delays the absorption of insulin. The combination of insulin and a delaying substance usually results in the formation of crystals that give the liquid a cloudy look. The insulin crystals must be homogenised (mixed) evenly before each injection. Intermediate-acting insulin takes approximately 1 1/2 hours before it begins to have an effect. The largest effect occurs between 4 and 12 hours after the injection, and after approximately 24 hours, the whole dose has been absorbed.



Onset: within 1.5 hours Maximum effect: 4-12 hours Duration: 24 hours
eg;Human Insulin N,Insulatard
Premixed insulin(biphasic human insulin consisting of e.g. 30% soluble and 70% isophane insulin)
Insulin containing a combination of a short-acting and an intermediate-acting insulin in standard proportions. These products eliminate the difficulty some individuals have while mixing insulin. The products come in several different premixed combinations containing 10-50% short-acting insulin and 90-50% intermediate-acting insulin, with the ratio of 30% short acting and 70% intermediate acting being the most used.



Onset: within 30 minutes Maximum effect: 2-8 hours Duration:24 hours
eg; Human Mixtard,Huminsulin 30/70

Two new injectable drugs that are not Insulins recently been approved for use in Diabetes
Pramlintide (brand name Symlin) is a synthetic form of the hormone amylin, which is produced along with insulin by the beta cells in the pancreas. Amylin, insulin, and another hormone, glucagon, work in an interrelated fashion to maintain normal blood glucose levels.
Pramlintide injections taken with meals have been shown to modestly improve A1C levels without causing increased hypoglycemia or weight gain and even promoting modest weight loss. The primary side effect is nausea, which tends to improve over time and as an individual patient determines his or her optimal dose.
Because of differences in chemistry, pramlintide cannot be combined in the same vial or syringe with insulin and must be injected separately. Pramlintide has been approved for people with type 1 diabetes who are not achieving their goal A1C levels and for people with type 2 diabetes who are using insulin and are not achieving their A1C goals.
Exenatide (brand name Byetta) is the first in a new class of drugs for the treatment of type 2 diabetes called incretin mimetics. Exenatide is a synthetic version of exendin-4, a naturally-occurring hormone that was first isolated from the saliva of the lizard known as a Gila monster. Exenatide works to lower blood glucose levels primarily by increasing insulin secretion. Because it only has this effect in the presence of elevated blood glucose levels, it does not tend to increase the risk of hypoglycemia on its own, although hypoglycemia can occur if taken in conjunction with a sulfonylurea. The primary side effect is nausea, which tends to improve over time.
Like pramlintide, exenatide is injected with meals and, as with pramlintide, patients using exenatide have generally experienced modest weight loss as well as improved glycemic control. Exenatide has been approved for use by people with type 2 diabetes who have not achieved their target A1C levels using metformin, a sulfonylurea, or a combination of metformin and a sulfonylurea.

Modified and adapted from ADA and Novo Nordisk websites

Hypoglycemia

If you are a diabetic and is taking medicines to reduce your blood sugar, you should know about Hypoglycemia (low blood sugar).
Hypoglycemia (also known as an "insulin reaction," or just "low blood glucose") occurs when blood glucose goes too low. Hypoglycemia can be caused by many things: too much insulin, too much tablets, not enough food, too much exercise, eating late, or eating too little carbohydrate. In short, it happens when insulin and blood glucose are out of balance.

People without diabetes usually don't get hypoglycemia. Their body can tell when it has enough insulin and stops releasing it automatically, but people with diabetes have to figure out how much insulin or how much Insulin-secreting tablets they need. Once the insulin is injected, or tablet is taken, it keeps working until it's gone, even if the blood glucose goes too low.

Mild or moderate hypoglycemia is pretty common for children and adults who take insulin or Insulin-secreting drugs like Daonil, Glimepride, Glipizide, or Gliclazide, but it can be dangerous if it's not treated right away. Mild or moderate hypoglycemia can get dangerously low pretty quickly. Severe hypoglycemia could lead to coma. So knowing about hypoglycemia is very important, not just for you, but for family, friends, co-workers etc.
Each person reacts to hypoglycemia differently. You may only have a few symptoms. It's important for you and your family to observe what symptoms are unique to you. That way, you can recognize it sooner, and treat it before it becomes serious.
Most common triad of symptoms of hypoglycemia are

Shivering

Excessive Sweating (clothes drenched with sweat)

Unusual Hunger

If this three happens together, especially just before your next meal and if the symptoms reverse quickly on eating, then you are having a mild hypoglycemia.
Other symptoms include

Nervousness
Irritability, sadness, or anger
Impatience
Chills and cold sweats
Fast heartbeat
Light-headedness or dizziness
Drowsiness
Lack of coordination
Blurred vision
Nausea
Tingling or numbness of lips or tongue
Nightmares or crying out during sleep
Headaches
Strange behavior
Confusion
Personality change
Passing out
Treating Hypoglycemia

When you notice symptoms of hypoglycemia, it's important to treat it right away. If you're feeling a little "off" but not too bad, you should do a blood glucose check first. A blood sugar value below 70mgs means it is hypoglycemia, but if you feel fairly sick and is not able to check, go ahead and treat for hypoglycemia. Here's how.

Step 1
Eat food or drink fluid that is easily digestible that contain at least 10 to 15 grams of carbohydrate.For example you can eat Iddly, Rice, Kanji, Roti, Glucose biscuits, toffees, Bun, Sweet Bread, Honey, Glucose tablets or powder, or you can drink a sugary tea or a sugary fruit juice ,or even a soft drink.

Step 2
Wait for 15 minutes and if possible check your blood sugar again. If you feel better and sugar is rising up take a complete meal so that it wont become low again.

Step 3
If blood sugar is not rising up or if you don't feel better eat another 15 grams of carbohydrate. If you feel better with this eat a complete meal.

Step 4
If your blood glucose is still too low (or you don't feel better), go to a hospital directly and tell the duty doctor or nurse that you are a diabetic on Insulin/tablets, and you think it is hypoglycemia.Don't wait for an appointment to see the doctor who is treating you.

Don't use fear of hypoglycemia as an excuse to eat your favourite sweet stuff. You will have the opposite problem - high blood glucose - later in the day. Also, stick to sugary foods that don't have a lot of fat. Fat slows down the movement of sugar into your blood. So oily sweets are not the best choices for treating hypoglycemia, unless they're the only high-carb foods nearby.


If mild or moderate hypoglycemia is not treated promptly, it can turn into severe hypoglycemia. People with severe hypoglycemia have so little glucose in their system that it affects their brain. When that happens, they pass out.

The best way to avoid severe hypoglycemia is catch it early. Be alert to any symptoms of hypoglycemia. Check your blood glucose if you have any doubt. Always carry some glucose tabs or other carbohydrate with you to treat hypoglycemia.

If you do develop severe hypoglycemia, you will need help from the people around you. You cannot drink juice or chew glucose tablets when you're unconscious. Glucagon is useful here, but is not widely available in India. Glucagon is a substance that makes the liver release sugar into your bloodstream. It can be injected to treat severe hypoglycemia.If no glucagon is available you must be taken to the hospital right away.

Do not forget to wear a medical ID bracelet or necklace that says you have diabetes and take insulin/tablets. You cannot tell anyone about your diabetes if you're unconscious or confused, but the medical ID can.

Keep something containing sugar like glucose powder or toffees with you at all times to treat hypoglycemia.

Tips to prevent hypoglycemia.
1.Always take the correct dose of Insulin/tablets.
2.If you plan to do some unusual physical activity, eat an additional snack before doing that.
3.If you feel unwell or have some illness like loose motions or vomiting and is not able to consume your usual calories, reduce the dosage of Insulin/tablets.
4.Never delay your meal