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Diabetes
mellitus is a metabolic disorder that interferes with the body's ability to
convert digested food into energy and growth. When we eat, the body converts
food into glucose, a simple sugar that is our main source of energy. Once
glucose becomes available in the bloodstream, it must enter the cells to provide
this energy. The pancreatic hormone insulin is required to allow glucose to
enter the cells. In a healthy person, the pancreas's beta cells produce exactly
the amount of insulin needed to match the amount of food ingested. Blood sugar
regulation is accomplished by the most finely controlled system in the body;
blood sugar should remain in a very small range of approximately 70 to 120 mg/dl
(milligrams per deciliter) even after a heavy meal.
When
diabetes mellitus occurs, this metabolic process is altered. Depending on the
type of diabetic
symptoms, there is either insufficient insulin or an inability to
utilize the insulin that is produced. In both cases, glucose builds up in the
bloodstream and the cells starve. Once blood sugar levels pass a certain point,
unused sugar spills into the urine as the body attempts to rid itself of the
excess. This causes frequent urination and unquenchable thirst because of the
continual dumping of fluids to transport the extra sugar into the bladder.
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The body is forced to turn
to other sources of energy. Its solution is to break down stored
fats for their small glucose contents. A by-product of this
breakdown, ketone bodies, builds up in the blood and may be extremely dangerous. Ketoacidosis accounts for 10% of deaths due to diabetes.
Besides thirst and
frequent urination, some of the diabetic
symptoms are:
-
Extreme
hunger (because food is not assimilated),
-
Weakness
(because the body lacks cellular energy),
-
Weight
loss (food eaten is just passed through the body). This is not always seen in
Type II diabetes,
-
Tiredness
(both because of the high blood sugar and because energy isn't absorbed),
-
Frequent
infection (partially due to high sugar levels acting as a growth medium for
bacteria),
-
Cuts
and bruises slow to heal,
-
Long-term
complications that may become evident without other obvious causative agents
(impotence, blurry vision, numbness, and pain in the extremities),
-
Sweet-smelling
breath (from ketoacidosis, a result of fat metabolism),
-
Diabetes
has two primary forms, as well as some minor, transient ones.
Type
I (also known as insulin-dependent diabetes mellitus, IDDM)
This form of diabetes was once called juvenile diabetes because it commonly
occurs in younger patients. It is considered an autoimmune disease and results
when the immune system attacks the insulin-producing beta cells of the pancreas,
destroying them. The result is a pancreas that produces little or no insulin.
The exact cause of the attack on the beta cells is not known, but both genetic
and viral factors are believed to be involved.
A person
with Type I diabetes requires exogenous insulin (insulin from an outside source)
to sustain life. This insulin must be injected daily, and often several times a
day. Originally, insulin was obtained from pigs and cows, though today's
purified forms are of recombinant DNA origin. Type I patients constitute only
about 10% of all diabetics, but they often find the condition to be devastating
in its impact, in both short-and long-term damage. There are currently several
experiments in progress involving the prevention of Type I diabetes in those who
have genetic predisposition to the disorder with beta cell antibodies present.
The National Coordinating Center (800) 425-8361 has a list of screening sites
around the country, in case you, or people you know, have an interest in
participating.
Type
II (also known as non-insulin-dependent diabetes mellitus, NIDDM)
This is the most common form of diabetes, affecting approximately 15 million
people in this country alone. There may be an equal number of as-yet-undiagnosed
Type II diabetics, because of the often subtle early signs of the disorder.
It
has been called adult onset diabetes because it commonly occurs after age 40,
most often in the middle 50's and later. In the great majority of cases, the
Type II diabetic is overweight, putting additional demands on an aging organ
system.
Type II
patients usually produce insulin, but for some reason (either insufficient
production or insulin resistance by the cells) their bodies are unable to
process glucose efficiently. The resulting condition is similar to that of Type
I: an excess of glucose in the blood and the lack of fuel for the cells.
Type II
may have varying effects in different people. The extreme levels of high blood
sugar found in Type I are not as prevalent in Type II patients, and the
short-term dangers are not as acute. However, unchecked or poorly controlled
Type II will produce long-term damage similar to that found in Type I. Many Type
II diabetics eventually take insulin because their disorder cannot be controlled
without it.
Gestational
Diabetes - Severe
environmental and situational stressors, such as pregnancy, may produce high
levels of blood sugar. This is similar to the effects of stress on other organ
systems. (For example, temporary hypertension or tachycardia may be found among
those in extreme situations.)
Gestational
diabetes is treated with insulin and
usually disappears post-partum. However,
women with gestational diabetes have a higher incidence of Type II in their
later years.
Complications
of Diabetes
Short-term
complications
The short-term dangers of
diabetes are most common among patients with Type I, though Type II patients
taking the class of drugs known as sulfonylureas (Diabinese and Glucotrol, for
example) may experience problems with hypoglycemia (low blood sugar). This is
because the sulfonylureas act by directly stimulating the pancreas to produce
additional insulin. Type II diabetics do not independently produce enough
effective insulin, or insulin that successfully transports glucose into the
cells.
One way
of solving this problem is to increase the total amount of insulin available.
These diabetics and those on injectable insulin are using treatments that
directly increase the amount of glucose assimilation in the body. Taking too
much insulin or oral medication, or eating fewer carbohydrates, will cause a
precipitous drop in blood sugar. This may result in the body going into shock, a
medical emergency. Shock may be treated through the ingestion of sugar,
preferably in an easy to assimilate form. (This cannot be attempted if the
person is unconscious.) These diabetics should carry glucose tablets or gels or
similar products capable of quickly raising blood sugar.
The
other short-term danger is of the opposite type - coma. This condition comes from
extremely high levels of blood sugar and can result in death if left untreated.
Note: if a diabetic is unconscious, never give insulin; wait for blood sugar
tests given by a health care professional. To give insulin mistakenly to an
unconscious diabetic in shock could be fatal.
Long-term
complications
The cumulative effects of
diabetes are system-wide. Because diabetes causes both vascular and neurological
damage, the end results are enormously significant. This is true for diabetics
of both major types. Be aware that diabetics may feel healthy and unaffected
while these effects are developing. Type I diabetics, because of the greater
number of years with the disease and because of the higher blood sugar levels
often seen, may experience more damage at an earlier age. Poorly controlled Type
II patients may see similar damage, however. Even well-controlled diabetics can
suffer from some degree of these long-term complications:
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Kidney
Failure -- Though most common in Type I cases, circulatory dysfunction may
lead to difficulty or failure of this organ. Diabetes is the leading
cause of end-stage renal disease,
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Stroke
-- Diabetes is the major cause of strokes in the United States,
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Amputation
-- Over 50% of amputations are diabetes related,
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Blindness
-- Diabetes is the number one cause of blindness in the United States,
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Cardiovascular
disease -- Diabetics are 2 to 4 times as likely to have heart disease as
people without diabetes, according to the American Diabetes Association,
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Impotence
-- Among diabetics, both vascular and neurological damage causes high rates
of impotence,
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Neuropathy
-- Peripheral neuropathy (pain and numbness in the extremities, usually in
the feet and legs) is common in diabetes.
Medical
Treatment of Diabetes
The diagnosis of diabetes is made with simple blood sugar (BS) tests. BS tests
are often administered when a person sees a physician because of symptoms that
suggest to the doctor that diabetes may be present. Other types of blood test
are the fasting blood sugar (FBS) performed in the morning before any food is
taken and the two-hour post-prandial BS (performed 2 hours after a meal). Any BS
reading over 140 mg/dl indicates a malfunction in the metabolic system. Besides
these tests, factors that help determine the type and degree of diabetes, as
well as the most appropriate treatment for each patient, include the level of
hyperglycemia, age of onset, other existing medical conditions, and family
history of diabetes or those with diabetic symptoms.
Medicine
also has an excellent measure of long-term diabetes control, superior to any
blood sugar test that reflects only the patient's status at the moment. This is
the hemoglobin A1c test, based on the level of glycosylated hemoglobin, a
substance that accumulates over time in the blood. It is found in excessive
amounts in poorly controlled diabetics. Because it is a test of an accumulated
substance rather than an indicator of a momentary sugar level, the HbA1c
indicates the level of control during the preceding two or three months.
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Dietary Troubles - Obesity & Heart Disease
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Retinopathy Occurs in Pre-Diabetes
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Diabetes, Obesity Seen as
Accelerated Aging |
Diabetic Adult Lifestyles
- Late Onset |
Early Detection - Insulin Resistance
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