Diabetes Symptoms and Treatment
Diabetes Mellitus (Sugar Diabetes)
Glucose, a type of sugar, is essential for the efficient working of every cell in the body. It is burned chemically (metabolized) to produce the energy for the cell to operate, and is found in most fruit and vegetables. When glucose is eaten, it is absorbed into the bloodstream from the small intestine. It then travels to all the body's microscopic cells through the arteries and capillaries. Once it reaches a cell, it must enter across the fine membrane that forms its outer skin. This skin is normally impermeable to all substances, but insulin has the ability to combine with glucose and transport it from the bloodstream through the cell membrane and into the interior of the cell, where it can be used as an energy source for that cell.
Insulin is a chemical of very great complexity. It is made in the pancreas, which sits in the abdomen below the stomach. The insulin it produces enters the bloodstream, and is attracted to those cells that are running short of energy and require more glucose. If there is no glucose available to the cells because you have not been eating, because a lack of insulin prevents glucose from entering the cell, or because the cell membrane fails to allow the insulin to work, the cell weakens and eventually stops working altogether. If insulin is the problem, the patient has diabetes mellitus. The physiology of diabetes, and the use of insulin, was discovered by the American doctors Banting and Best in the 1920s.
The early symptoms of diabetes are excessive tiredness, thirst, excess passing of urine, weight loss despite a large food intake, itchy rashes, recurrent vaginal thrush infections, pins and needles and blurred vision.
The earlier diabetes is controlled, the better the outcome for the patient, as side effects and body damage are less likely.
If you suspect that you may have diabetes, your doctor can perform a simple test on your blood or urine to determine the diagnosis within minutes. It is far better to have the disease diagnosed now than to wait for months while the high blood glucose levels cause damage to your body. A glucose tolerance test is the main test performed to determine the severity of diabetes. This test may also be able to tell if you are likely to develop diabetes in the near future. After fasting for 12 hours, a blood sample is taken. A sweet drink is then swallowed, and further blood samples are taken at regular intervals for two or three hours. The pattern of absorption and elimination of blood glucose will give the diagnosis.
There are two totally different types of diabetes - juvenile diabetes (type 1) and maturity onset diabetes (type 2). Diabetes effects approximately 2% of the population, with 90% of diabetics suffering from the maturity onset form. Although they both are caused by the inability to utilize glucose, the cause of the disease in the two types is quite different.
Juvenile diabetes (type 1 diabetes, insulin-dependent diabetes)
People who lack the insulin necessary to take the glucose into the cells have juvenile diabetes, and if the insulin is not supplied, they become steadily weaker because their muscles and other organs cannot work properly. There may be very high levels of glucose in their bloodstream, but because it cannot enter the cells, it cannot help them. These diabetics therefore require regular supplements of insulin to keep them well.
The biggest problem with insulin is that it cannot be taken by mouth as it is destroyed by acid in the stomach. It must be given by injection once, twice or more times a day. This way insulin enters the bloodstream directly and can start transporting the necessary glucose into the cells immediately. Most people who develop diabetes which requires insulin injections do so as a child or in early adult life. They must use the injections for the rest of their lives, as there is no cure for diabetes, only an effective form of control.
Insulin can be injected into any part of the body covered by loose skin. The same site should not be used repeatedly. Commonly used sites are the abdomen, thighs, buttocks and upper arm.
When first diagnosed, patients with juvenile diabetes are often quite ill, and most are hospitalized for a few days to stabilize their condition with frequent injections of insulin.
Insulin from pigs and cattle has been available for many decades, but in the last few years, human insulin has been produced by genetic engineering techniques to enable diabetics to lead relatively normal lives. Human insulin will replace the animal form completely in the near future, as allergy reactions to the animal products do occur in some diabetics.
The newer pen-style delivery systems enable diabetics to easily dial the required dose and inject themselves as necessary with minimal inconvenience. Insulin pumps are another method of introducing insulin. These are small machines that hook onto the belt, and through a fine tube that is inserted into a vein pump small amounts of insulin almost constantly into the blood. These are used mainly in diabetics who are very difficult to control with regular injections.
There are many different types of insulin that vary in their speed of onset and duration of action. Some have a rapid onset and last a short time, others start slowly and last a long time. All possible permutations of speed of onset and duration of action are available, and the doctor will choose whichever will best suit the individual patient.
Diet is essential for all diabetics, because the amount of glucose you eat is not normally constant, and diabetics lack the means of adjusting the amount of glucose in their blood with insulin. As the insulin injections remain at a constant strength, the glucose intake must also remain constant.
A diabetic diet must restrict the number of kilojoules (calories) being eaten. Sugar in all its forms should be eaten only with caution. Fat should not account for more than a third of the total calories, and cholesterol intake should be restricted. Protein should be obtained more from poultry and fish than red meats. Carbohydrates other than sugar can be consumed freely. Grains and cereals with a high fiber content should be the main part of any diabetic diet. Artificial sweeteners such as aspartame (NutraSweet) can be used to flavor food and drinks.
Fat cells can react abnormally to insulin very easily, and so overweight diabetics must lose weight and remain within certain strict limits.
Exercise should be encouraged in diabetics, but on a regular daily basis. Extra exercise will require a greater food intake, while less exercise may require more insulin. Variations between weekdays and weekends must be allowed for.
Once on treatment, diabetics must undertake regular self-testing to ensure that the control of their diabetes is adequate. Both blood and urine tests for glucose are available, but the blood tests are far superior. Most diabetics will test their own blood glucose using a tiny drop of blood that is placed on a sensitized stick. This is then placed in a small instrument called a glucometer which, by reading the color change caused to the sensitized stick by the glucose in the blood, can give a relatively accurate reading of the blood glucose. These glucometers must be calibrated regularly by the patient, using standard solutions of glucose, to ensure that the readings remain accurate.
Blood tests can be performed by doctors to determine not only the level of glucose at that time, but by measuring the amount of glucose in certain blood cells, they can determine what the blood glucose level has been over a couple of months.
There are many complications of diabetes, including an increased risk of both bacterial and fungal skin and vaginal infections, the premature development of cataracts in the eye, microscopic hemorrhages and exudates that destroy the retina at the back of the eye, damage to the kidneys that prevents them from filtering blood effectively, poor circulation to the extremities (hands and feet) that may cause chronic ulcers and even gangrene to the feet, the development of brown skin spots on the shins, and sensory nerve damage that alters the patient's perception of vibration, pain and temperature.
There are also complications associated with treatment. The best known is a 'hypo' in which a diabetic has too much insulin, exercises more than usual or does not eat enough food, and his/her blood glucose level drops (hypoglycaemia) to an unacceptably low level. The patient becomes light-headed, sweats, develops a rapid heart beat and tremor, becomes hungry, then nauseated before finally collapsing unconscious. Glucose drinks or sweets given before collapse can reverse the process, but after collapse, an injection of glucose given by a doctor is essential. In an emergency, a sugary syrup or honey introduced through the anus into the rectum may allow a diabetic to recover sufficiently to take further sugar by mouth. Do not try to give an unconscious diabetic sugar by mouth, as they could choke or inhale the sugar.
Even if they are well controlled, diabetics should carry glucose sweets with them at all times to use in an emergency situation. All diabetics should wear a bracelet or charm that alerts doctors and other health workers to their condition and may allow life-giving treatment to be given in the event of a coma.
Other complications of insulin treatment include adverse reactions to pork or beef insulin, and damage to the fat under the skin if the same injection site is used too frequently.
Maturity onset diabetes (type 2 diabetes, non-insulin dependent diabetes)
Older people who develop diabetes can often have the disease controlled by diet alone or a combination of tablets and diet. This is because there is not a lack of insulin in these patients, but a lack of response by the cells to the insulin. The tablets make the cell membrane respond to insulin again. Commonly used tablets include tolbutamide, chlorpropamide, glibenclamide and glipizide.
The symptoms of the two types of diabetes are similar, but those with maturity onset diabetes have less thirst and urinary frequency, but more visual problems, skin infections and sensory nerve problems than those with the juvenile form. Many patients are totally without symptoms when the diagnosis is discovered on a routine blood or urine test.
Maturity onset diabetes is far more common in obese patients, and weight loss is a vital part of their treatment. If normal weight levels can be maintained, the disease may disappear. High blood pressure is more common in mature diabetics than the average person of their age.
Education of patients with this type of diabetes is very important, so that they understand what they can and cannot eat and drink. Regular testing of blood glucose levels is also necessary for the patients, but normally on a weekly rather than daily basis. Urine tests are often inaccurate in the elderly, as their kidney function may be reduced to the point where glucose cannot enter the urine. The elderly are very susceptible to the complications of diabetes listed above, particularly foot damage and eye damage.
With the correct treatment and careful control, patients with both types of diabetes should live a near-normal life, with a near-normal life span. A diabetic patient's motivation, intelligence and compliance with treatment will determine whether or not he or she develops any of the long-term complications associated with the disease or its treatment.
This is the most severe way in which a patient with diabetes can present to a doctor. It is caused by a build-up of waste products and glucose in the bloodstream because of untreated or under-treated diabetes. Patients who are careless about their treatment, diet and self-testing may develop diabetic ketoacidosis. Almost invariably, it is the juvenile-type diabetics that develop this complication.
The patient is in a mental stupor, nauseated, vomiting, short of breath and may become comatose. If left untreated, death will occur due to kidney, heart or brain damage. Doctors can give injections of insulin when the condition is discovered, but emergency hospital treatment is necessary to control the situation adequately.
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