DIABETES

Definition

Diabetes is a life-long disease marked by high levels of sugar in the blood.

Causes, incidence, and risk factors

Diabetes can be caused by too little insulin  (a hormone produced by the pancreas to control blood sugar), resistance to insulin, or both.
To understand diabetes, it is important to first understand the normal process of food metabolism. Several things happen when food is digested:

People with diabetes have high blood sugar. 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:

Definition

Type 1diabetes is a chronic (lifelong) disease that occurs when the pancreas does not produce enough insulin to properly control blood sugar levels.

Alternative Names

Insulin-dependent diabetes; Juvenile onset diabetes; Diabetes - type 1

Causes, incidence, and risk factors

Diabetes is a lifelong disease for which there is not yet a cure. There are several forms of diabetes. Type 1 diabetes is often called juvenile or insulin-dependent diabetes. In this type of diabetes, cells of the pancreas produce little or no insulin, the hormone that allows glucose to enter body cells.
Without enough insulin, glucose builds up in the bloodstream instead of going into the cells. The body is unable to use this glucose for energy despite high levels in the bloodstream. This leads to increased hunger.
In addition, the high levels of glucose in the blood cause the patient to urinate more, which in turn causes excessive thirst. Within 5 to 10 years, the insulin-producing beta cells of the pancreas are completely destroyed and the body can not longer produce insulin.
Type 1 diabetes can occur at any age, but it usually starts in people younger than 30. Symptoms are usually severe and occur rapidly.
The exact cause is unknown.

Symptoms

Signs and tests

The following tests can be used to diagnose diabetes:

Treatment

The immediate goals of treatment are to treat diabetic ketoacidosis and high blood glucose levels. Because of the sudden onset and severity of symptoms in type 1 diabetes, treatment for newly diagnosed people may involve hospitalization.
The long-term goals of treatment are to prolong life, reduce symptoms, and prevent diabetes-related complications such as blindness, kidney failure, and amputation of limbs.
These goals are accomplished through education, insulin use, meal planning and weight control, exercise, foot care, and careful self-testing of blood glucose levels.

INSULIN
Insulin lowers blood sugar by allowing it to leave the blood stream and enter cells. Everyone needs insulin. People with type 1 diabetes can't make their own insulin, and they must take insulin every day.
Insulin is injected under the skin or inhaled. In some cases, a pump delivers the insulin continuously. Insulin does not come in pill form.
Insulin preparations differ in how fast they start to work and how long they last. The health care professional reviews blood glucose levels to determine the appropriate type of insulin the person should use. More than one type of insulin may be mixed together in an injection to achieve the best control of blood glucose.
The injections are needed, in general, from one to four times a day. Their health care provider or a diabetes nurse educator teaches people. Initially, a parent or other adult may give a child’s injections. By age 14, most children can be expected (but should not be required) to give their own injections.

DIET
Meal planning for type 1 diabetes requires consistency 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.
The Indian Diabetes Association and the Indian Dietetic Association has information for planning healthy, balanced meals. A consultation with a registered dietitian or nutrition counselor can be helpful.

PHYSICAL ACTIVITY
Regular exercise helps control the amount of sugar in the blood and helps burn excess calories and fat to achieve optimal weight.
Ask your health care provider before starting any exercise program. Those with Type 1 diabetes must take special precautions before, during, and after intense physical activity or exercise.

SELF-TESTING
Checking the glucose content of a small drop of blood does blood glucose monitoring. 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.

FOOT CARE
Diabetes causes damage to the blood vessels and nerves, which can result in a decreased ability to feel injury to or pressure on the foot. A foot injury could go unnoticed until severe infection develops.
Additionally, diabetes affects the body's immune system, decreasing the body's ability to fight infection. Small infections can rapidly progress to death of the skin and other tissues. Amputation may be needed.

TREATING LOW BLOOD SUGAR
Low blood sugar, known as hypoglycemia, can occur from too much insulin, too much exercise, or too little food. Hypoglycemia can develop quickly in people with diabetes. Symptoms typically appear when the blood sugar level falls below 70. Watch for weakness, shaking, sweating, headache, nervousness, and hunger.
If these symptoms occur and you have a blood sugar test kit available, do a blood sugar check. If the level is low, the person with diabetes should eat something with sugar: fruit juice, several teaspoons of sugar, a cup of skim milk, or regular soda. If you don't have a test kit handy, sugar should be eaten anyway - it can't hurt. Symptoms should go away within 15 minutes. If the symptoms don't go away, more sugar should be eaten and the sugar level tested again.
AFTER the symptoms go away, more substantial food can be eaten. Eat simple sugar first to get the situation under control. Even if you or your child is hungry, "real" food should not be eaten until the sugar level comes up - real food won't produce enough sugar and takes too long to digest.
If you are a parent, relative, or friend of someone experiencing these symptoms, monitor the person closely. If symptoms become worse -- confusion, seizures, or unconsciousness -- give the person a shot of glucagon . If you don't have glucagon, call 911 immediately.
You should have some glucagon stored for emergencies. Make sure everyone in your home, as well as babysitters and caregivers, knows how to use it. Periodically remind everyone how to use it, and check the expiration date.
Don't panic. Glucagon works very fast -- usually within 15 minutes. Lay the person on the side to prevent choking. If the person is not better in 15 minutes, call 911.

TREATING HIGH KETONES
When there is not enough insulin to move glucose into cells, glucose can build up in the blood. The body then looks for other forms of energy and uses fat as a fuel source. As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis.
You can check for ketones using a simple urine test available at pharmacies. This test should be done every 4-6 hours anytime a person with diabetes has a blood sugar above 240 or if they are sick, unusually thirsty, has a dry mouth, frequent urination, or vomiting.
The warning signs that ketoacidosis is getting serious might include flushed face, dry skin and mouth, nausea or vomiting, stomach pain, deep, rapid breathing, or fruity breath odor.
If these symptoms occur, call the doctor or go to the emergency room right away. If left untreated, this condition will lead to coma and even death.
MONITORING
Visit your health care provider or diabetes educator at least four times a year. Have your glycosylated hemoglobin (HbA1c) regularly checked. Cholesterol and triglyceride levels should be checked yearly, along with kidney function.
Visit your ophthalmologist (preferably one that specializes in diabetic retinopathy) at least once a year, or more frequently if signs of diabetic retinopathy develop.
See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.
Check your feet every day for early signs of injury or infection. Make sure your health care provider inspects your feet at each visit.
Stay up-to-date with all of your vaccinations and get a flu shot every year in the fall.

EDUCATION
You are the most important person in managing your diabetes. Diabetes education involves learning how to live with your diabetes and helps prevent complications. You should know the basic steps to diabetes management:

Expectations (prognosis)

The outcome for people with diabetes varies. Studies show that tight control of blood glucose can prevent or delay complications to the eyes, kidneys, and nervous system. However, complications may occur even in those with good diabetes control.

Complications

Emergency complications include:

Long-term complications include:

Definition

Type 2 diabetes is a life-long disease marked by high levels of sugar in the blood. It occurs when the body does not respond correctly to insulin, a hormone released by the pancreas. Type 2 diabetes is the most common form of diabetes.

Alternative Names

No insulin-dependent diabetes; Diabetes - type 2

Causes, incidence, and risk factors

Diabetes is caused by a problem in the way your body makes or uses insulin. Insulin is needed to move glucose (blood sugar) into cells, where it is used for energy.
If glucose does not get into the cells, the body cannot use it for energy. Too much glucose will then remain in the blood, causing the symptoms of diabetes.
There are several types of diabetes. This article focuses on type 2, which is usually accompanied by obesity and insulin resistance.
Insulin resistance means that insulin produced by your pancreas cannot get inside fat and muscle cells to produce energy. Since the cells are not getting the insulin they need, the pancreas produces more and more. Over time, abnormally high levels of sugar build up in the blood. This is called hyperglycemia. Many people with insulin resistance have hyperglycemia and high blood insulin levels at the same time. People who are overweight have a higher risk of insulin resistance, because fat interferes with the body's ability to use insulin.
Type 2 diabetes usually occurs gradually. Most people with the disease are overweight at the time of diagnosis. However, type 2 diabetes can also develop in those who are thin, especially the elderly.
Family history and genetics play a large role in type 2 diabetes. Low activity level, poor diet, and excess body weight (especially around the waist) significantly increase your risk for type 2 diabetes.
Other risk factors include:

Symptoms

Often, people with type 2 diabetes have no symptoms at all. If you do have symptoms, they may include:

Signs and tests

Type 2 diabetes is diagnosed with the following blood tests:

Treatment

The first goals are to eliminate the symptoms and stabilize your blood glucose levels. The ongoing goals are to prevent long-term complications and prolong your life. The primary treatment for type 2 diabetes is exercise and diet.

LEARN THESE SKILLS
You should learn basic diabetes management skills. They will help prevent complications and the need for medical care. These skills include:

It may take several months to learn the basic skills. Always continue to educate yourself about the disease and its complications, as well as how to control and live with diabetes. Over time, stay current on new research and treatment.

SELF-TESTING
Regular self-testing of your blood sugar tells you how well your combination of diet, exercise, and medication are working. Tests are usually done before meals and at bedtime. More frequent testing may be needed when you are sick or under stress.
A device called a glucometer can provide an exact blood sugar reading. There are different types of devices. Usually, you prick your finger with a small needle called a lancet, which gives you a tiny drop of blood. You place the blood on a test strip, and put the strip into the device. Results are available within 30 to 45 seconds.
A health care provider or diabetes educator will help set up an appropriate testing schedule for you. You will also be taught how to respond to different ranges of glucose values obtained when you self-test.
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.
Accurate record keeping of test results will help you and your health care provide plan how to best control your diabetes.

DIET AND WEIGHT CONTROL
Meal planning includes choosing healthy foods, eating the right amount of food, and eating meals at the right time. 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.
Managing your weight and eating a well-balanced diet are important. Some people with type 2 diabetes can stop medications after intentional weight loss, although the diabetes is still present. A registered dietitian can be helpful in determining your specific, individual dietary needs.

REGULAR PHYSICAL ACTIVITY
Regular exercise is important for everyone, but especially if you have diabetes. Regular exercise helps control the amount of glucose in the blood. It also helps burn excess calories and fat so you can manage your weight.
Exercise improves overall health by improving blood flow and blood pressure. It decreases insulin resistance even without weight loss. Exercise also increases the body's energy level, lowers tension, and improves your ability to handle stress.
The following should be considered when starting an exercise routine:

MEDICATION
When diet and exercise do not help maintain normal or near-normal blood glucose levels, your doctor may prescribe medication. Some of the most common types are listed below. They are taken by mouth.

If you continue to have poor blood glucose control despite lifestyle changes and taking medicines by mouth, your doctor will prescribe insulin. Insulin may also be prescribed if you have had a bad reaction to other medicines. Insulin must be injected under the skin using a syringe and cannot be taken by mouth.
Insulin preparations differ in how fast they start to work and how long they work. Your healthcare provider will determine the appropriate type of insulin to use and will tell you what time of day to use it.
More than one type may be mixed together in an injection to achieve the best control of blood glucose. Usually injections are needed one to four times a day. Your doctor or diabetes educator will show you how to give yourself an injection.

FOOT CARE
People with diabetes are prone to foot problems. Diabetes can cause damage to nerves, which means you may not feel an injury to the foot until a large sore or infection develops. Diabetes can also damage blood vessels, which makes it harder for the body to fight infection.
To prevent injury to the feet, a person with diabetes should adopt a daily routine of checking and caring for the feet as follows:

CONTINUING CARE
A person with type 2 diabetes should have a visit with a diabetes care provider every 3 months. A complete examination includes:

The following evaluations should be done at least once a year:

THIS IS GENERAL INFORMATION ON DISEASE. PLEASE CONTACT YOUR DOCTOR FOR MORE DETAILS AND TREATMENT.

Compiled by –Santosh  Ghodinde ,Community Pharmacist, Dhanwantari Medical, Panvel.