OTHER NAMES
diabetes; sugar diabetes
DEFINITION
A disorder caused by decreased production of insulin, or by decreased ability to use insulin. Insulin is a hormone produced by the pancreas that is necessary for cells to be able to use blood sugar.
CAUSES, INCIDENCE, AND RISK FACTORS
The cause of diabetes mellitus is unknown, but heredity and diet are believed to play a role in its development. Diabetes results when the pancreas produces insufficient amounts of insulin to meet the body’s needs. It can also result when the pancreas produces insulin, but the cells are unable to efficiently use it (insulin resistance). Insulin is necessary for blood sugar (glucose) to go from the blood to the inside of the cells, and unless the sugar gets into the cells, the body caimot use it. The excess sugar remains in the blood and is then removed by the kidneys. Symptoms of excessive thirst, frequent urination, and hunger develop. The (metabolism) of carbohydrates, fats, and proteins is altered.
Diabetes occurs in several forms.
diabetes; sugar diabetes
DEFINITION
A disorder caused by decreased production of insulin, or by decreased ability to use insulin. Insulin is a hormone produced by the pancreas that is necessary for cells to be able to use blood sugar.
CAUSES, INCIDENCE, AND RISK FACTORS
The cause of diabetes mellitus is unknown, but heredity and diet are believed to play a role in its development. Diabetes results when the pancreas produces insufficient amounts of insulin to meet the body’s needs. It can also result when the pancreas produces insulin, but the cells are unable to efficiently use it (insulin resistance). Insulin is necessary for blood sugar (glucose) to go from the blood to the inside of the cells, and unless the sugar gets into the cells, the body caimot use it. The excess sugar remains in the blood and is then removed by the kidneys. Symptoms of excessive thirst, frequent urination, and hunger develop. The (metabolism) of carbohydrates, fats, and proteins is altered.
Diabetes occurs in several forms.
The most common types are:
Type I, or insulin-dependent diabetes mellitus (IDDM);
Type II, or noninsulin-dependent diabetes mellitus (NIDDM);
and Gestational Diabetes Mellitus.
Insulin-dependent diabetes mellitus (IDDM or Type I) usually occurs in people before the age of 30 requires insulin injections to live. Risk factors for IDDM include autoimmune disease, viral infections, and a family history of diabetes.
Noninsulin-dependent diabetes mellitus (NIDDM or Type II) usually occurs in severely overweight (obese) adults and rarely requires insulin treatment. Treatment includes diet for diabetics and exercise. Risk factors for Type II are obesity, physiological or emotional stress, pregnancy, certain medications, age over 40, and family history.
Gestational diabetes starts or is first recognized during pregnancy. It usually becomes apparent during the 24th to 28th weeks of pregnancy. In many cases, the blood-glucose level retums to normal after delivery. Risk factors for gestational diabetes are matemal age over 25 years, family history of diabetes, obesity, birth weight over 9 pounds in a previous infant, unexplained death in a previous infant or newbom, congenital malformation in a previous child, and recurrent infections. .
PREVENTION
Controlling body weight in individuals at risk may prevent the onset of Type II diabetes.
There may be no symptoms early in the course of the disease.
SYMPTOMS
- increased thirst
- increased urination
- weight loss in spite of increased appetite
- fatigue
- nausea
- vomiting
- frequent infections including bladder, vaginal, and skin
- blurred vision
- impotence in men
- breath odor
- cessation of menses
- poor skin turgor
Additional symptoms that may be associated with this disease:
- gums, bleeding
- ear noise/buzzing
- diarrhea
Insulin-dependent diabetes mellitus (IDDM or Type I) usually occurs in people before the age of 30 requires insulin injections to live. Risk factors for IDDM include autoimmune disease, viral infections, and a family history of diabetes.
Noninsulin-dependent diabetes mellitus (NIDDM or Type II) usually occurs in severely overweight (obese) adults and rarely requires insulin treatment. Treatment includes diet for diabetics and exercise. Risk factors for Type II are obesity, physiological or emotional stress, pregnancy, certain medications, age over 40, and family history.
Gestational diabetes starts or is first recognized during pregnancy. It usually becomes apparent during the 24th to 28th weeks of pregnancy. In many cases, the blood-glucose level retums to normal after delivery. Risk factors for gestational diabetes are matemal age over 25 years, family history of diabetes, obesity, birth weight over 9 pounds in a previous infant, unexplained death in a previous infant or newbom, congenital malformation in a previous child, and recurrent infections. .
PREVENTION
Controlling body weight in individuals at risk may prevent the onset of Type II diabetes.
There may be no symptoms early in the course of the disease.
SYMPTOMS
- increased thirst
- increased urination
- weight loss in spite of increased appetite
- fatigue
- nausea
- vomiting
- frequent infections including bladder, vaginal, and skin
- blurred vision
- impotence in men
- breath odor
- cessation of menses
- poor skin turgor
Additional symptoms that may be associated with this disease:
- gums, bleeding
- ear noise/buzzing
- diarrhea
•depression
- confusion
SIGNS AND TESTS
- urinalysis showing glucose and ketone bodies in the urine
- glucose tolerance test
- fasting blood glucose
- glycosylated hemoglobin (hemoglobin Al C) level
This disease may also alter the results of the following tests:
- visual field
- urine 24h volume
- uric acid
- ophthalmoscopy
- ketones - urine
- serum ketones
- insulin test
- glucose - urine
- euglobulin lysis time
- CSF total protein
- CSF collection
- cholesterol test
- ACE levels
Treatment Options
- confusion
SIGNS AND TESTS
- urinalysis showing glucose and ketone bodies in the urine
- glucose tolerance test
- fasting blood glucose
- glycosylated hemoglobin (hemoglobin Al C) level
This disease may also alter the results of the following tests:
- visual field
- urine 24h volume
- uric acid
- ophthalmoscopy
- ketones - urine
- serum ketones
- insulin test
- glucose - urine
- euglobulin lysis time
- CSF total protein
- CSF collection
- cholesterol test
- ACE levels
Treatment Options
Treatment Strategy
... Control blood sugar levels; helps reduce complications. ... Requires patients to be self-disciplined, able to concentrate, able to maintain a positive attitude, and honest with self and physician. ... Components are diet, exercise, blood glucose self-monitoring, oral hypoglycemic agents (Type II), and insulin (Type I). ... Because diabetes affects so many body systems, treatment planning must include a whole-body approach. Treatment specific to Type I: ... Diet-consistent timing/content (same gram amount of carbohydrates, protein, and fat at each meal); consult dietitian for meal planning. ... Exercise-daily; wear proper shoes and protective equipment; avoid extreme heat or cold; check feet daily and after exercise; suspend exercise when blood glucose control is poor. ... Self-monitoring-teach the patient to use a home glucose meter and make needed adjustments in diet, exercise, and/or insulin. Treatment specific to Type II: ... Diet-use moderation; lose weight by decreasing calories while increasing activity; base choices on USDA Food Pyramid. ... Exercise-as for Type I; do moderate aerobic exercise (50% to 70% of VO2 max) for 20 to 45 minutes at least three days a week; include low-intensity warm-up and cool-down exercises. ... Self-monitoring-as for Type I, with adjustments in diet, exercise, and/or oral hypoglycemic agent as needed.
Drug Therapies
Insulin (used for Type I and occasionally Type II [30% to 40%]). Taken subcutaneously, with dose and type individualized to the patient's condition. Possible treatment regimens: ... Three-injections/day, doses adjusted to variations in control ... Long-acting and short-acting preparations taken at meals for stable background levels ... External insulin pump for tight control ... Single injection/day for those with some pancreatic function Sulfonylureas (Type II only). Oral hypoglycemic agents used when diet and exercise are ineffective or in conjunction with diet and exercise. Doses individualized to the patient's condition. Side effects include hypoglycemia, nausea, heartburn, stomach fullness; intolerance and allergy (<2% of patients). Use with caution in persons with liver or kidney impairment and those with sulfa allergy. Approved agents: ... Acetohexamide (Dymelor)-250 to 1,500 mg; slight diuretic effect ... Chlorpropamide (Diabinese, Glucamide)-100 to 750 mg; very long duration of action, antidiuretic effect ... Tolazamide (Tolinase)-100 to 1,000 mg; slight diuretic effect ... Tolbutamide (Orinase)-500 to 3,000 mg; usually taken in two to three doses/day ... Glipizide (Glucotrol)-5 to 40 mg; take on empty stomach ... Glipizide-extended release (Glucotrol XL)-20 mg; do not break tablet, take once/day ... Glyburide (Diabeta, Micronase)-1.25 to 30 mg ... Glyburide-micronized (Glynase)-12 mg/day; not equivalent in action to glyburide ... Glimepiride (Amaryl)-8 mg/day ... Metformin (Glucophage)-Used as a supplement to or substitute for sulfonylureas. Side effects include weight loss, nausea, abdominal discomfort, and diarrhea. Use with caution in persons with conditions leading to lactic acid buildup (congestive heart failure, severe vascular disease, kidney or liver disease). Discontinue 24 to 48 hours before surgery or radiographic dye study. Dose: 1 to 2.5 g/day in two to three doses; available in 500 and 850 mg tablets; take before meals ... Acarbose (Precose)-Slows absorption of carbohydrate into blood, acts locally in the intestine. Take at the beginning of a meal for immediate action. Major side effect is increased gas production (up to 75% of users). Dose: 50 to 100 mg depending on results and side effects ... Troglitazone (Rezulin)-In trials for use with insulin; liver damage reported ... Repaglinide (Prandin)-Meglitinide class; use in Type II disease
Complementary and Alternative Therapies
Treatments stabilize blood sugars. Also, alternative therapies have an important role in preventing vascular damage and some of the serious complications that may be involved with DM. A combination of herbs and nutrition, along with lifestyle changes, can be quite helpful. Regular exercise is extrememly important. Ten minutes/day of exercise has been shown to have an effect on glucose tolerance, although a minimum of 30 minutes three times/week is required to see significant changes. Extended exercise is desired. Short bursts of activity may actually increase glucose levels.
Nutrition
... Diet: the classic diet for DM is high in complex carbohydrates and fiber. Some people, however, achieve better glucose control with a high-protein diet with very few carbohydrates. If the classic diet does not stabilize blood sugar, a trial of high-protein diet may be indicated. ... Essential fatty acids: anti-inflammatory, decrease insulin resistance, and prevent cardiovascular and neurological complications of DM. Evening primrose oil (2,000 mg bid) or fish oil (1,200 mg bid) rather than flax or borage may be required, since a greater percentage of diabetics are lacking enzymes required for utilization of flax and/or borage oil. ... OPCs (oligomeric procyanidins) such as pycnogenol or grape seed extracts help to support vascular health and prevent oxidation side effects associated with diabetes ... B-complex: biotin (300 mcg), B1 (50 to 100 mg), B2 (50 mg), B3 (100 mg), B6 (50 to 100 mg), B12 (100 to 1,000 mcg), folate (400 mcg/day) help prevent neuropathy, control glucose levels, and prevent nephropathy ... Vitamin C (2 to 3 g/day) may prevent microangiopathy and hypertriglyceridemia ... Vitamin E (400 IU/day) may reduce insulin requirements so should start at 100 IU and gradually increase the dose; enhances healing of ulcers, and is a cardioprotective antioxidant ... Brewer's yeast: contains chromium, which may improve glucose tolerance, and glutathione, an antioxidant (9 g or 3 tbsp. brewer's yeast/day and/or 200 mcg chromium) ... Magnesium: (400 mg/day) low in diabetics, may help prevent the calcium deposition in arterial walls ... Manganese: (500 to 1,000 mcg) low in diabetics, may help stabilize glucose levels ... Zinc: (30 mg/day) may decrease fasting glucose levels and help prevent fatty acid oxidation ... Coenzyme Q10: (50 to 100 mg bid) depleted by oral hypoglycemic agents, prevents fatty acid oxidation ... Vanadium: (5 to 10 mg/day) to normalize serum cholesterol and triglycerides ... Some feel that chromium picolinate (200 mcg) helps normalize sugar metabolism.
EDUCATION
Diabetes education is an important part of a treatment plan. Diabetes educators and health care providers are available in many areas to teach essential skills needed afler initial diagnosis of the disease. Appropriate education teaches people with diabetes how to incorporate the management principles of the disease into their daily lives and minimize dependence upon the health care provider.
Basic principles, called survival skills, include:
- how to recognize and treat low and high blood sugar
- how to select the kinds of food to eat and when to eat them
- how to administer insulin or how to take oral hypoglycemic agents
- how to test and record blood-glucose and urine ketones
- how to adjust insulin, food intake, or both for changes in the usual exercise and eating habits
- how to handle sick days
- where to buy diabetes supplies and how to store them
Afler the patient learns the basic principles of diabetes care and a routine has been established (several months), an education programs is helpful to leam more about the disease process, how to control and live with diabetes, and intermediate and long-term complications of the disease. Annual review of diabetes information is strongly recommended. Continually updating personal knowledge of diabetes is advised, because new research and new and improved ways to treat the disease are constantly being developed.
DIET
Meal planning includes choosing healthy foods, eating the right amount of food, and eating meals at the right time. The American Diabetes Association and the American Dietetic Association developed 6 food exchange lists for the purpose of meal planning for people with diabetes. The 6 lists are: starch or bread, meat and substitutes, vegetables, fruits, milk or dairy, and fat. Every food on the list has approximately the same amount of carbohydrate, fat, protein, and calories for the amount given. Any food on the list can be exchanged for any other food on the same list. The food exchange lists also show the number of food choices that can be eaten at each meal and snack. Using the foods on the exchange list (along with a personal meal plan designed by a registered dietitian or nntritional counselor) will control the distribution of calories throughout the day so that food and insulin will be balanced.
Meal plans differ depending on the type of diabetes. With insulin-dependent diabetes (Type I), consistency in the time meals are eaten and the amounts and types of food eaten is very important to allow food and insulin to work together to regulate blood-glucose levels. If meals and insulin are out of balance, extreme variations in blood glucose can occur. In noninsulin-dependent diabetes, weight control is the most important principle in addition to a well-balanced diet.
Consultation with a registered dietitian or nutrition counselor is an invaluable tool for planning meals and controlling diet for persons with diabetes.
PHYSICAL ACTIVITY
Regular exercise is especially important for the person with diabetes. It helps control the amount of sugar in the blood and helps bum excess calories and fat to achieve optimal weight. Exercise improves overall health by improving blood flow and blood pressure. Exercise also increases the energy level, lowers tension, and improves the ability to handle stress.
Before people with diabetes begin any exercise program, they should obtain medical approval.
Exercise considerations:
- Choose an enjoyable physical activity that is appropriate for the current fitness level.
- Exercise every day and at the same time of day if possible.
- Monitor blood-glucose levels by home testing before and after exercise.
- Carry food that contains sugar in case blood-glucose levels get too low during or after exercise.
- Carry a diabetes identification card and change for a phone call in case of an emergency.
- Drink extra fluids that do not contain sugar during and after exercise.
- Changes in exercise intensity or duration may require diet or medication modification to keep blood glucose levels within an appropriate range.
SELF-TESTING
Blood-sugar testing or self monitoring of blood glucose is done by checking the glucose content of a small drop of blood. The testing is done on a regular basis and will inform the person with diabetes how well diet, medication, and exercise are working together to control diabetes. The results can be used to adjust meals, activity, or medications to keep blood-sugar levels within an appropriate range. It will provide valuable information for the health care provider to suggest changes to improve care and treatment. Testing will identify high and low blood-sugar levels before serious problems develop.
High levels of blood ketones may result in a serious condition called ketoacidosis. Ketone testing is usually done in the
following circumstances:
- when the blood sugar is over 240 mg/dL
- illness
- nausea or vomiting
- ketoacidosis
- extreme stress
- pregnancy
EXPECTATIONS (PROGNOSIS)
The outcome for diabetes mellitus is variable. Good control of blood-glucose levels reduces complications of diabetes. Usually Type T diabetes mellitus is more severe, and the potential for developing complications is greater. Even with good control by diet and medication of both types of diabetes, complications may result.
In gestational diabetes, blood-glucose may retum to normal after the delivery; however, the risk of developing diabetes in the future is greater. Maintaining normal body weight is critical in reducing the risk of diabetes for the future.
COMPLICATIONS
Emergency complications:
- diabetic ketoacidosis
- hypoglycemic coma
- hyperglycemic hyperosmolar coma
EDUCATION
Diabetes education is an important part of a treatment plan. Diabetes educators and health care providers are available in many areas to teach essential skills needed afler initial diagnosis of the disease. Appropriate education teaches people with diabetes how to incorporate the management principles of the disease into their daily lives and minimize dependence upon the health care provider.
Basic principles, called survival skills, include:
- how to recognize and treat low and high blood sugar
- how to select the kinds of food to eat and when to eat them
- how to administer insulin or how to take oral hypoglycemic agents
- how to test and record blood-glucose and urine ketones
- how to adjust insulin, food intake, or both for changes in the usual exercise and eating habits
- how to handle sick days
- where to buy diabetes supplies and how to store them
Afler the patient learns the basic principles of diabetes care and a routine has been established (several months), an education programs is helpful to leam more about the disease process, how to control and live with diabetes, and intermediate and long-term complications of the disease. Annual review of diabetes information is strongly recommended. Continually updating personal knowledge of diabetes is advised, because new research and new and improved ways to treat the disease are constantly being developed.
DIET
Meal planning includes choosing healthy foods, eating the right amount of food, and eating meals at the right time. The American Diabetes Association and the American Dietetic Association developed 6 food exchange lists for the purpose of meal planning for people with diabetes. The 6 lists are: starch or bread, meat and substitutes, vegetables, fruits, milk or dairy, and fat. Every food on the list has approximately the same amount of carbohydrate, fat, protein, and calories for the amount given. Any food on the list can be exchanged for any other food on the same list. The food exchange lists also show the number of food choices that can be eaten at each meal and snack. Using the foods on the exchange list (along with a personal meal plan designed by a registered dietitian or nntritional counselor) will control the distribution of calories throughout the day so that food and insulin will be balanced.
Meal plans differ depending on the type of diabetes. With insulin-dependent diabetes (Type I), consistency in the time meals are eaten and the amounts and types of food eaten is very important to allow food and insulin to work together to regulate blood-glucose levels. If meals and insulin are out of balance, extreme variations in blood glucose can occur. In noninsulin-dependent diabetes, weight control is the most important principle in addition to a well-balanced diet.
Consultation with a registered dietitian or nutrition counselor is an invaluable tool for planning meals and controlling diet for persons with diabetes.
PHYSICAL ACTIVITY
Regular exercise is especially important for the person with diabetes. It helps control the amount of sugar in the blood and helps bum excess calories and fat to achieve optimal weight. Exercise improves overall health by improving blood flow and blood pressure. Exercise also increases the energy level, lowers tension, and improves the ability to handle stress.
Before people with diabetes begin any exercise program, they should obtain medical approval.
Exercise considerations:
- Choose an enjoyable physical activity that is appropriate for the current fitness level.
- Exercise every day and at the same time of day if possible.
- Monitor blood-glucose levels by home testing before and after exercise.
- Carry food that contains sugar in case blood-glucose levels get too low during or after exercise.
- Carry a diabetes identification card and change for a phone call in case of an emergency.
- Drink extra fluids that do not contain sugar during and after exercise.
- Changes in exercise intensity or duration may require diet or medication modification to keep blood glucose levels within an appropriate range.
SELF-TESTING
Blood-sugar testing or self monitoring of blood glucose is done by checking the glucose content of a small drop of blood. The testing is done on a regular basis and will inform the person with diabetes how well diet, medication, and exercise are working together to control diabetes. The results can be used to adjust meals, activity, or medications to keep blood-sugar levels within an appropriate range. It will provide valuable information for the health care provider to suggest changes to improve care and treatment. Testing will identify high and low blood-sugar levels before serious problems develop.
High levels of blood ketones may result in a serious condition called ketoacidosis. Ketone testing is usually done in the
following circumstances:
- when the blood sugar is over 240 mg/dL
- illness
- nausea or vomiting
- ketoacidosis
- extreme stress
- pregnancy
EXPECTATIONS (PROGNOSIS)
The outcome for diabetes mellitus is variable. Good control of blood-glucose levels reduces complications of diabetes. Usually Type T diabetes mellitus is more severe, and the potential for developing complications is greater. Even with good control by diet and medication of both types of diabetes, complications may result.
In gestational diabetes, blood-glucose may retum to normal after the delivery; however, the risk of developing diabetes in the future is greater. Maintaining normal body weight is critical in reducing the risk of diabetes for the future.
COMPLICATIONS
Emergency complications:
- diabetic ketoacidosis
- hypoglycemic coma
- hyperglycemic hyperosmolar coma
Other complications
- complications of insnlin therapy
- eye complications (diabetic retinopathy, diabetic cataracts, glaucoma)
- diabetic nephropathy
- diabetic neuropathy
- gangrene of the feet
- skin and mucous membrane complications
- hyperlipidemia, hypertension, atherosclerosis, and coronary artery disease
- complications of insnlin therapy
- eye complications (diabetic retinopathy, diabetic cataracts, glaucoma)
- diabetic nephropathy
- diabetic neuropathy
- gangrene of the feet
- skin and mucous membrane complications
- hyperlipidemia, hypertension, atherosclerosis, and coronary artery disease
Courtesy:
Compiled and Shared By: Habib Anwar
habib.anwar@hotmail.com
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