Diabetes
Definition
Diabetes mellitus is a chronic disease caused by the inability of the pancreas to
produce insulin or to use the insulin produced in the proper way.
Diabetes is
the 7th leading cause of death among Americans; over 15 million Americans
suffer from one form or another of this disease.
Description
After a meal, a portion of the food a
person eats is broken down into sugar (glucose). The sugar then passes into the
bloodstream and to the body's cells via a hormone (called insulin) that is
produced by the pancreas.
Normally,
the pancreas produces the right amount of insulin to accommodate the quantity
of sugar.
However,
if the person has
diabetes, either the pancreas produces little or no insulin or the cells do not
respond normally to the insulin.
Sugar
builds up in the blood, overflows into the urine and then passes from the body
unused. Over time, high blood sugar levels can damage:
v nerves -
leading to diabetic neuropathy, foot sores and possible amputation,
possible paralysis of the stomach, chronic diarrhea
v kidneys -
leading to kidney failure
Diabetes has also been linked to
impotence and digestive problems.
It
is important to note that controlling
2. blood glucose levels,
3. plus regular screenings and
4. check-ups,
can
help reduce risks of these complications.
There are two main types of diabetes, Type
I and Type II:
Type I diabetes
or insulin-dependent diabetes (formerly called juvenile-onset diabetes, because
it tends to affect persons before the age of 20) affects about 10 percent of
people with diabetes. With this type of diabetes, the pancreas makes almost no
insulin.
Type II diabetes
or non-insulin-dependent diabetes.
1.
This was previously called "adult-onset diabetes" because in the past
it was usually discovered after age 40. However, with increasing levels of obesity and sedentary
lifestyle, this disease is now being found more and more in adolescents - and
sometimes even in children under 10 - and the term "adult onset" is
no longer used.
2.
Type II diabetes comprises about 90 percent of all cases of diabetes.
3.
With this type of diabetes, either the pancreas produces a reduced amount of
insulin, the cells do not respond to the insulin, or both.
There
are three less common types of diabetes called
2.
secondary diabetes and
3.
impaired glucose tolerance (IGT):
Secondary diabetes
is caused by damage to the pancreas from chemicals, certain medications,
diseases of the pancreas (such as cancer) or
other glands.
Impaired glucose tolerance (IGT) is a condition in which the person's glucose levels are
higher than normal.
Causes
The cause of Type II diabetes is unknown
Medical experts believe that Type II diabetes
has a genetic component, but that other factors also put people at risk for the
disease.
These
factors include:
·sedentary lifestyle
·advanced age
·unhealthy diet
·family history of
diabetes
·improper functioning
of the pancreas
·minority race (higher
risk in Black, Hispanic, American Indian, westernized Asian and native Hawaiian
populations)
·women having given
birth to a baby weighing more than 9 lbs.
·previously diagnosed
gestational diabetes
·previously diagnosed
IGT
Symptoms
Usually, the symptoms of Type I diabetes
are obvious. That is not true for Type II.
Many people with Type II do not discover
they have diabetes until they are treated for a complication such as
4. blindness,
6. kidney problems,
7. nerve trouble or
8. impotence.
The
warning signs and symptoms for both types are:
Type I:
1. Frequent urination,
2. increased thirst,
3. extreme hunger,
4. unexplained weight loss,
6. blurred vision,
Type II:
1. Any Type I symptom, plus:
2. unexplained weight gain,
3. pain,
4. cramping,
5. tingling or numbness in your feet,
7. frequent vaginal or skin infections,
8. dry,
9. itchy skin and
10. slow healing sores.
Note: If a
person is experiencing these symptoms, they should see a doctor immediately.
Diagnosis
Besides a complete history and physical examination,
the doctors will perform a battery of laboratory tests. There are numerous
tests available to diagnose diabetes, such as a urine test, blood test,
glucose-tolerance test, fasting blood sugar and the glycohemoglobin (HbA1c) test.
A urine sample will be tested for
glucose and ketones (acids that collect in the blood and urine when the body
uses fat instead of
glucose for energy).
A blood test is used to measure the
amount of glucose in the bloodstream.
A glucose-tolerance test checks the
body's ability to process glucose. During this test, sugar levels in the blood
and urine are monitored for three hours after drinking a large dose of sugar
solution.
The fasting blood sugar test involves
fasting overnight and blood being drawn the next morning.
The glycohemoglobin test reflects an
average of all blood sugar levels for the preceding two months.
Treatment
A landmark study, the 10-year,
multi-center Diabetes Control and Complications Trial (DCCT), has now shown
that intensifying diabetes management with stricter control of blood sugar
levels can reduce long-term complications.
The results of DCCT are extraordinary in
that they prove that tight control of glucose levels can in fact dramatically
slow the onset and progression of diabetic complications in both Type I and
Type II diabetes.
Additionally, researchers have found
strict attention to diet and exercise also helps in the management of diabetes.
Management of Type I Diabetes
Virtually everyone with Type I diabetes
(and more than one in three people with Type II) must inject insulin to make up
for their deficiency.
Until recently, insulin came only from
the pancreases of cows and pigs (with pork insulin more closely duplicating
human insulin). While beef, pork and beef/pork combinations are still widely
used.
There are now two types of
"human" insulin available:
1. semisynthetic (made by converting pork insulin to a
form identical to human) and
2. recombinant (made by using genetic engineering).
All
insulin helps glucose levels remain near normal (about 70 to 120 mg/dl).
Different
types of insulin work for different periods of time. The numbers shown below
are only averages.
1. The onset (how long it takes to reach
the bloodstream to begin lowering the blood sugar),
2. peaking (how long it takes to reach
maximum strength) and
3. duration (how long it continues to
lower the blood sugar) of insulin activity.
4.
It can vary from person to person
and
5.
even from day to day in the same
person.
Rapid or Regular Activity:
Onset
is within half an hour and activity peaks during a 2 to 5 hour period.
It
remains in the bloodstream for about 8 to 16 hours.
These
fast-acting, short-lasting insulins are useful in special cases: accidents, minor
surgery or illnesses, which cause the diabetes to go out of control or whenever
insulin requirements change rapidly for any reason.
These
are also being used more and more in combination with a long-acting insulin or
alone (prior to meals and at bedtime).
Semilente: A special
type of short-acting insulin that takes 1 to 2 hours for onset, peaks 3 to 8
hours after injection and lasts 10 to 16 hours.
Intermediate-Acting: Reaching the
bloodstream 90 minutes after injection, intermediate-acting insulin peaks 4 to
12 hours later and lasts in the blood for about 24 hours.
There
are two varieties of this type of insulin: Lente
(called L) and NPH (called N).
Long-Acting: These
insulins, which take 4 to 6 hours for onset, are at maximum strength 14 to 24
hours after injection, lasting 36 hours in the bloodstream. Long-acting insulin
is referred to as U (for Ultralente).
Please
be aware of the following problems that exist with insulin intake:
·Hypoglycemia (low blood
sugar) is sometimes called an insulin reaction or insulin shock. It can occur suddenly in people using insulin
if too little food is eaten, if a meal is delayed or in the case of extreme
exercise. Symptoms include feeling cold, clammy, nervous, shaky, weak or
hungry, and some people become pale, have headaches or act strangely.
·Hyperglycemia (high blood
sugar) occurs when too much food is eaten or not enough insulin is taken. The
warning signs are large amounts of sugar in the urine and blood, frequent
urination, great thirst and nausea.
·Ketoacidosis (in its
most severe form - diabetic coma) develops when insulin and blood sugar are so out of balance that
ketones accumulate in the blood.
Symptoms
include
1.
high blood sugar or ketones in the urine,
3.
great thirst,
4.
loss of appetite,
5.
excessive urination,
6.
dry and flushed skin,
7.
labored breathing,
8.
fruity-smelling breath and
9.
possible vomiting,
11.
unconsciousness.
In addition to daily injections of insulin,
regular physical activity
and a controlled diet are essential. The American Diabetes Association (ADA)
recommends the following daily dietary guidelines:
·Up to 70 percent of all calories should be obtained
from carbohydrates and
unsaturated fats. These carbohydrates should be mainly complex carbohydrates
and naturally occurring sugars (simular to those in milk and fruits). Examples
of unsaturated fats are vegetable oils and margarine.
·Between 10 and 20 percent of calories should be
obtained from protein.
·Less than 10 percent of all calories should be obtained
from fat.
·Saturated fats are found in animal
products and in some vegetable oils (such as coconut, palm, and palm-kernel
oils).
For
Type I diabetes, the meal plan should be tailored to the person's individual
needs and is likely to include three meals and two or three snacks a day. A
person with diabetes must eat these meals and snacks at set times each day to
properly balance insulin.
Management of Type II Diabetes
The
ADA recommends diet (see ADA guidelines stated above) and regular physical
activity as the first line of treatment for Type II diabetes. If normal
glycemic levels are not achieved within three (3) months, drug treatment is
recommended.
Currently there are four (4) classes of
prescription drugs available for the treatment of Type II diabetes:
1.
Sulfonylureas stimulate the pancreas to release more
insulin.
1.
Diabinese,
2.
Dymelor,
3.
PresTab,
4.
Orinase,
5.
Tolinase,
6.
Micronase,
7.
DiaBeta,
8.
Glynase,
9.
Glucotrol,
2.
Biguanides
Glucophage
and Metformin),
which keep
the liver from releasing too much glucose.
3.
Alpha-glucoside
inhibitors
(Precose), which slow the digestion of some carbohydrates.
4.
Thiazolidinediones, which
control glucose levels by making muscles more sensitive to insulin and reduce
the amount of glucose that the liver produces.
Clinical trials suggest that oral
antidiabetic agents - particularly the new noninsulin secretagogues (including
Troglitazone and Metformin, which act on the liver and skeletal muscle) - may
be useful in delaying or preventing development of Type II diabetes.
Both
agents, acting primarily by different mechanisms of action, also have
demonstrated potential beneficial effects on serum lipid profiles.
Although these oral medications work in
different ways, they can be combined to work more effectively to manage Type II
diabetes.
When these combinations of oral
treatments are no longer effective (for about 60 percent of people with Type II
diabetes), the doctor will start a regimen of insulin alone or in combination
with an oral medication.
Questions
How
often does the blood sugar need to be checked?
What
are the best monitoring techniques for this? How do you measure glucose levels?
What
type of insulin or insulins will you be prescribing?
Who
would help in learning about and giving injections?
Do
you have a dietitian you could recommend?
How
much can exercise and diet control the diabetes?
Is
there information available or assistance on planning a regular exercise program?
What
is important for family members to learn also?
How
do you recognize a diabetic reaction and when should a doctor be notified?
What
are the signs and symptoms of insulin deficit and excess?
What
measure should be taken for either condition?
Are
there any other signs or symptoms that need to be reported to the doctor?
When
traveling, is an adjustment in the insulin dose needed?
Can OTC medications be taken? If so,
what is the medication and what are the side effects?
Prevention
There is no foolproof way to prevent
diabetes, but steps can
be taken to improve the chances of avoiding it:
·Exercise. Studies of
both men and women have shown that vigorous exercise, even if done only once a
week, has a protective effect against diabetes. Exercise not only promotes weight loss but lowers blood
sugar as well.
·Lose weight. There is
evidence that both men and women who gain weight in adulthood increase their
risk of diabetes. A study conducted at Harvard showed that adult women who
gained 11 to 17 pounds since the age of 18 doubled their risk of diabetes;
those who gained between 18 and 24 pounds almost tripled their risk.
·Fact: 90 percent of diabetics are overweight.
·Diet. The use of a diet low in calories
and in saturated fat is an ideal strategy for preventing Type II diabetes. (See
the ADA guidelines stated in the TREATMENT section).
·Stop smoking. Smoking is
especially dangerous for people with diabetes who are at risk for heart and
blood vessel diseases.
·Use alcohol in moderation. Moderation
for men means no more than two drinks a day; for women, one drink is the limit.
Choose drinks that are low in alcohol and sugar such as dry wines and light
beers. If you use mixers, try to select one that is sugar free, such as diet
drinks, club soda, seltzer or water.
·If you take diabetic pills or insulin, alcohol can
drop blood glucose levels too far. Have the drink with a meal or snack.
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