The primary issue requiring management is that of the glucose cycle. In older patients, clinical practice guidelines by the American Geriatrics Society state "for frail older adults, persons with life expectancy of less than 5 years, and others in whom the risks of intensive glycemic control appear to outweigh the benefits, a less stringent target such as Hb A1c of 8% is appropriate". Known cardiovascular disease or advanced microvascular disease.Goals should be individualized based on: 2-hour postprandial blood glucose: Preprandial blood glucose: 3.9 to 7.2 mmol/L (70 to 130 mg/dl).Hb A1c of less than 6% or 7.0% if they are achievable without significant hypoglycemia.They are suggested in clinical practice guidelines released by various national and international diabetes agencies. The treatment goals are related to effective control of blood glucose, blood pressure and lipids, to minimize the risk of long-term consequences associated with diabetes. 4.9 Psychological mechanisms and adherence.Other goals of diabetes management are to prevent or treat the many complications that can result from the disease itself and from its treatment. Insulin resistance, in contrast, can be corrected by dietary modifications and exercise. To achieve this goal, individuals with an absolute deficiency of insulin require insulin replacement therapy, which is given through injections or an insulin pump. The main goal of diabetes management and control is, as far as possible, to restore carbohydrate metabolism to a normal state. Some degree of insulin resistance may also be present in a person with type 1 diabetes. Other forms of diabetes mellitus, such as the various forms of maturity onset diabetes of the young, may represent some combination of insufficient insulin production and insulin resistance. The pancreas of a person with type 2 diabetes may be producing normal or even abnormally large amounts of insulin. Diabetes mellitus type 2, in contrast, is now thought to result from autoimmune attacks on the pancreas and/or insulin resistance. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, usually owing to the autoimmune destruction of the insulin-producing beta cells of the pancreas.
The term diabetes includes several different metabolic disorders that all, if left untreated, result in abnormally high concentration of a sugar called glucose in the blood.
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