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Diabetes
Diabetes
Alternate Names :
Diabetes
Mellitus
Definition :
Diabetes is a life-long disease marked by high levels of sugar in the
blood. It can be caused by too little insulin (a hormone produced by the
pancreas to regulate blood sugar), resistance to insulin, or both.
Pictures & Images :
(Endocrine Glands)
Endocrine glands release hormones (chemical messengers) into the
bloodstream to be transported to various organs and tissues throughout the body.
For instance, the pancreas secretes insulin, which allows the body to regulate
levels of sugar in the blood. The thyroid gets instructions from the pituitary
to secrete hormones which determine the pace of chemical activity in the body
(the more hormone in the bloodstream, the faster the chemical activity; the less
hormone, the slower the activity).
(Diabetic Retinopathy)
Diabetes causes an excessive amount of glucose to remain in the blood
stream which may cause damage to the blood vessels. Within the eye the damaged
vessels may leak blood and fluid into the surrounding tissues and cause vision
problems.
(Islets of Langerhans)
Islets of Langerhans contain beta cells and are located within the
pancreas. Beta cells produce insulin which is needed to metabolize glucose
within the body.
(Blood Test)
To monitor the amount of glucose within the blood a person with
diabetes should test their blood regularly. The procedure is quite simple and
can often be done at home.
(Pancreas)
The pancreas is located behind the liver and is where the hormone
insulin is produced. Insulin is used by the body to store and utilize
glucose.
(Insulin Pump)
Various styles of insulin pumps may be utilized by people with
diabetes to inject insulin into the body in a controlled, more convenient and
discrete manner.
(Glucose Test)
A person with diabetes constantly manages their blood's sugar
(glucose) levels. After a blood sample is taken and tested, it is determined
whether the glucose levels are low or high. If glucose levels are too low
carbohydrates are ingested.If glucose in the blood is too high, the appropriate
amount of insulin is administered into the body such as through an insulin
pump.
(Insulin Pump)
The catheter at the end of the insulin pump is inserted through a
needle into the abdominal fat of a person with diabetes. Dosage instructions are
entered into the pump's small computer and the appropriate amount of insulin is
then injected into the body in a calculated, controlled manner.
(Type I Diabetes)
In response to high levels of glucose in the blood, the
insulin-producing cells in the pancreas secrete the hormone insulin. Type I
diabetes occurs when these cells are destroyed by the body's own immune
system.
(Diabetic Blood Circulation in Foot)
People with diabetes are at risk for blood vessel injury, which may
be severe enough to cause tissue damage in the legs and feet.
(Food and Insulin Release)
Insulin is a hormone secreted by the pancreas in response to
increased glucose levels in the blood.
(Insulin Production and Diabetes)
Insulin is a hormone produced by the pancreas that is necessary for
cells to be able to use blood sugar.
Overview, Causes, & Risk Factors :
To understand diabetes,
it is important to first understand the normal process of food metabolism. Several things happen
when food is digested:
-
A sugar called glucose enters the bloodstream. Glucose is a source of
fuel for the body.
-
An organ called the pancreas makes insulin. The role of insulin is to
move glucose from the bloodstream into muscle, fat, and liver cells, where it
can be used as fuel.
People with diabetes have high blood glucose. This is because their
pancreas does not make enough insulin or their muscle, fat, and liver cells do
not respond to insulin normally, or both.
There are three major types of diabetes:
-
Type 1
diabetesis usually diagnosed in childhood. The body makes little or no
insulin, and daily injections of insulin are required to sustain life. Without
proper daily management, medical emergencies can arise.
-
Type 2
diabetesis far more common than type 1 and makes up 90% or more of all
cases of diabetes. It usually occurs in adulthood. Here, the pancreas does not
make enough insulin to keep blood glucose levels normal, often because the body
does not respond well to the insulin. Many people with type 2 diabetes do not
know they have it, although it is a serious condition. Type 2 diabetes is
becoming more common due to the growing number of older Americans, increasing
obesity, and failure to exercise.
-
Gestational diabetesis high
blood glucose that develops at any time during pregnancy in a person who does
not have diabetes.
Diabetes affects about 50 million people Worldwise. There are many risk
factors for diabetes, including:
-
A parent, brother, or sister with diabetes
-
Obesity
-
Age greater than 45 years
-
Some ethnic groups (particularly African-Americans and Hispanic
Americans)
-
Gestational diabetes or delivering a baby weighing more than 9
pounds
-
High blood pressure
-
High blood levels of triglycerides (a type of fat molecule)
-
High blood cholesterol level
The World Diabetes Association recommends that all adults be
screened for diabetes at least every three years. A person at high risk should
be screened more often.
Diabetes Symptoms & Signs :
High blood levels of glucose can cause several problems, including
frequent urination, excessive thirst, hunger, fatigue, weight loss, and blurry vision.
However, because type 2 diabetes develops slowly, some people with high blood
sugar experience no symptoms at all.
Symptoms of type 1 diabetes:
Symptoms of type 2 diabetes:
-
Increased
thirst
-
Increased urination
-
Increased
appetite
-
Fatigue
-
Blurred vision
-
Slow-healing infections
-
Impotence in men
Diabetes Prevention :
Maintaining an ideal
body weight and an active lifestyle may prevent the onset of type 2 diabetes.
Currently there is no way to prevent type 1 diabetes.
Diabetes Diagnosis & Tests :
A urine analysis may be used to look for
glucose and ketones from the breakdown of fat. However, a urine test alone does
not diagnose diabetes. The following blood glucose tests are used to diagnose
diabetes:
-
Fasting blood
glucose level-- diabetes is diagnosed if higher than 126 mg/dL on two
occasions.
-
Random (non-fasting) blood
glucose level-- diabetes is suspected if higher than 200 mg/dL and
accompanied by the classic symptoms of increased thirst, urination, and fatigue.
(This test must be confirmed with a fasting blood glucose test.)
-
Oral glucose tolerance test
-- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours
(This test is used more for type 2 diabetes.)
Patients with type 1 diabetes usually develop symptoms over a short
period of time, and the condition is often diagnosed in an emergency setting. In
addition to having high glucose levels, acutely ill type 1 diabetics have high
levels of ketones.
Ketones are produced by the breakdown of fat and muscle, and they are
toxic at high levels. Ketones in the blood cause a condition called "acidosis"
(low blood pH). Urine testing detects both glucose and ketones in the urine.
Blood glucose levels are also high.
Diabetes Treatment :
There is no cure for diabetes. The immediate goals are to stabilize
your blood sugar and eliminate the symptoms of high blood sugar. The long-term
goals of treatment are to prolong life, relieve symptoms, and prevent long-term
complications such as heart disease and kidney failure.
LEARN THESE SKILLS
Basic diabetes management skills will help prevent the need for
emergency care. These skills include:
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How to recognize and treat low blood sugar (hypoglycemia) and high
blood sugar (hyperglycemia)
-
What to eat and when
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How to take insulin or oral medication
-
How to test and record blood glucose
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How to test urine for ketones (type 1 diabetes only)
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How to adjust insulin and/or food intake when changing exercise and
eating habits
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How to handle sick days
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Where to buy diabetes supplies and how to store them
After you learn the basics of diabetes care, learn how the disease
can cause long-term health problems and the best ways to prevent these problems.
People with diabetes need to review and update their knowledge, because new
research and improved ways to treat diabetes are constantly being developed.
WHAT TO EAT
You should work closely with your health care provider to learn how
much fat, protein, and carbohydrates you need in your diet. Your specific meal
plans need to be tailored to your food habits and preferences. People with type
1 diabetes should eat at about the same times each day and try to be consistent
with the types of food they choose. This helps to prevent blood sugars from
becoming extremely high or low. Type 2 diabetics should follow a well-balanced
and low-fat diet.
A registered dietician can be very helpful in planning dietary
needs.
Weight management is important to
achieving control of diabetes. Some people with type 2 diabetes can stop
medications after losing excess weight, although the diabetes is still
present.
HOW TO TAKE INSULIN OR ORAL MEDICATION
Medications to treat diabetes include insulin and glucose-lowering
pills, called oral hypoglycemic agents. The bodies of people with type 1
diabetes cannot make their own insulin, so daily insulin injections are
required. The bodies of people with type 2 diabetes make insulin but cannot use
it effectively.
Insulin is not available in oral form. It is delivered by injections
that are generally required one to four times per day. Some people use an
insulin pump, which is worn at all times and delivers a steady flow of insulin
throughout the day.
Insulin preparations differ in how quickly they start to work and how
long they remain active. Sometimes different types of insulin are mixed together
in a single injection. The types of insulin to use, the doses required, and the
number of daily injections are chosen by a health care professional trained to
provide diabetes care.
People who need insulin are taught to give themselves injections by
their health care providers or diabetes educators.
Unlike type 1 diabetes, type 2 diabetes may respond to treatment with
exercise, diet, and/or oral medications. There are several oral hypoglycemic
agents that lower blood glucose in type 2 diabetes. They fall into one of three
groups:
-
Medications that increase insulin production by the pancreas. These
include Amaryl, Glucotrol, and Glucotrol XL, Micronase, Diabeta, Glynase,
Prandin, and Starlix.
-
Medications that increase sensitivity to insulin. These include
Glucophage, Avandia, and Actos.
-
Medications that delay absorption of glucose from the gut. These
include Precose and Glyset.
Most type 2 diabetics will require more than one medication for good
blood sugar control within three years of starting their first medication.
Different groups of oral medications may be combined, or insulin and oral
medications may be used together.
Some people with type 2 diabetes find they no longer need medication
if they lose weight and increase activity, because when their ideal weight is
reached, their own insulin and a careful diet can control their blood glucose
levels.
Oral hypoglycemic agents are not known to be safe for use in
pregnancy; women who have type 2 diabetes and take these medications may be
switched to insulin during pregnancy and while breast-feeding.
Gestational diabetes is treated with diet and insulin.
SELF-TESTING
Self-monitoring of blood glucose is done by checking the glucose
content of a drop of blood. Regular testing tells you how well diet, medication,
and exercise are working together to control your diabetes.
The results of the test can be used to adjust meals, activity, or
medications to keep blood sugar levels in an appropriate range. Testing provides
valuable information for the health care provider and identifies high and low
blood sugar levels before serious problems develop.
The American Diabetes Association recommends that premeal blood sugar
levels fall in the range of 80 to 120 mg/dL and bedtime blood levels fall in the
range of 100 to 140 mg/dL. Your doctor may adjust this depending on your
circumstances.
You should also ask your doctor how often to check your hemoglobin
A1c (HbA1c) level. The HbA1c is a measure of average blood glucose during
the previous two to three months. It is a very helpful way to monitor a
patient's overall response to diabetes treatment over time. A person without
diabetes has an HbA1c around 5%. People with diabetes should try to keep it
below 7%.
Ketone testing is another test that is used in type 1 diabetes.
Ketones build up in the blood when there is not enough insulin in people with
type 1diabetes, eventually "spilling over" into the urine. The ketone test is
done on a urine sample. High levels of blood ketones may result in a serious
condition called ketoacidosis. Ketone testing
is usually done at the following times:
-
When the blood sugar is higher than 240 mg/dL
-
During acute illness (for example, pneumonia, heart attack, or
stroke)
-
When nausea or vomiting occur
-
During pregnancy
EXERCISE
Regular exercise is especially important for people with diabetes. It
helps with blood sugar control, weight loss, and high blood
pressure. People with diabetes who exercise are less likely to experience a
heart attack or stroke than diabetics who do not exercise regularly. You should
be evaluated by your physician before starting an exercise program.
Here are some exercise considerations:
-
Choose an enjoyable physical activity that is appropriate for your
current fitness level.
-
Exercise every day, and at the same time of day, if possible.
-
Monitor blood glucose levels before and after
exercise.
-
Carry food that contains a fast-acting carbohydrate in case you
become hypoglycemic
during or after exercise.
-
Carry a diabetes identification card and a mobile phone or change
for a payphone in case of emergency.
-
Drink extra fluids that do not contain sugar before, during, and
after exercise.
Changes in exercise intensity or duration may require changes in diet
or medication dose to keep blood sugar levels from going too high or low.
FOOT CARE
People with diabetes are prone to foot problems because of the
likelihood of damage to blood vessels and nerves and a decreased ability to
fight infection. Problems with blood flow and damage to nerves may cause an
injury to the foot to go unnoticed until infection develops. Death of skin and
other tissue can occur.
If left untreated, the affected foot may need to be amputated.
Diabetes is the most common condition leading to amputations.
To prevent injury to the feet, people with diabetes should adopt a
daily routine of checking and caring for the feet as follows:
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Check your feet every day, and report sores or changes and signs of
infection.
-
Wash your feet every day with lukewarm water and mild soap, and dry
them thoroughly.
-
Soften dry skin with lotion or petroleum jelly.
-
Protect feet with comfortable, well-fitting shoes.
-
Exercise daily to promote good circulation.
-
See a podiatrist for foot problems or to have corns or calluses
removed.
-
Remove shoes and socks during a visit to your health care provider
and remind him or her to examine your feet.
-
Stop smoking, which hinders blood flow to the feet.
Diabetes Prognosis (Expectations) :
The risks of long-term complications from diabetes can be reduced.
The Diabetes Control and Complications Trial (DCCT) studied the
effects of tight blood sugar control on complications in type 1 diabetes.
Patients treated for tight blood glucose control had an average HbA1c of
approximately 7%, while patients treated less aggressively had an average HbA1c
of about 9%. At the end of the study, the tight blood glucose group had
dramatically fewer cases of kidney disease, eye disease, and nervous system
disease than the less-aggressively treated patients.
In the United Kingdom Prospective Diabetes Study (UKPDS), researchers
followed nearly 4,000 people with type 2 diabetes for 10 years. The study
monitored how tight control of blood glucose (HbA1c of 7% or less) and blood
pressure (less than 144 over less than 82) could protect a person from the
long-term complications of diabetes.
This study found dramatically lower rates of kidney, eye, and nervous
system complications in patients with tight control of blood glucose. In
addition, there was a significant drop in all diabetes-related deaths, including
lower risks of heart attack and stroke. Tight control of blood pressure was also
found to lower the risks of heart disease and stroke.
The results of the DCCT and the UKPDS dramatically demonstrate that
good blood glucose and blood pressure control, many of the complications of
diabetes can be prevented.
Diabetes Complications :
Emergency complications include diabetic
hyperglycemic hyperosmolar coma.
Long-term complications include:
-
Diabetic
retinopathy
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Diabetic nephropathy
-
Diabetic
neuropathy
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Peripheral vascular
disease
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Hyperlipidemia, hypertension, atherosclerosis, and
coronary artery
disease
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