Diabetes

(Diabetes mellitus; Type 1 and Type 2 diabetes)

Diabetes is a chronic metabolic disease in which the body either does not produce or does not fully utilize insulin. As a result, it cannot properly metabolize carbohydrates and, to a lesser extent, protein and fat. Glucose (sugar) builds up in the blood; to rid the body of the excess, the kidneys begin to excrete it in the urine.

Although excessive glucose is circulating, the brain and other tissues that need it for fuel are unable to use it. The body begins to break down fat and protein in an attempt to provide an alternate source of fuel, resulting in serious biochemical imbalances. In the meantime, the high levels of glucose are damaging structures throughout the body, increasing the risk of complications such as heart attack, blindness, kidney failure, stroke, and painful nerve problems. Despite effective treatments, diabetes is one of the leading causes of death in the United Slates.

There are two major forms: Type 1, in which the body stops making insulin completely, and Type 2, in which the body produces inadequate insulin or is unable to use it fully. The first type, also called insulin-dependent or juvenile diabetes, usually develops during the first 20 years of life when islet cells in the pancreas are destroyed and can no longer make insulin. Symptoms are frequent urination, weight loss, unusual thirst, weakness, fatigue, and hunger.

Type 2, also called non-insulin dependent or adult-onset diabetes, is most common among overweight older people, although it can occur in persons of normal weight. It develops more slowly than Type 1; indeed, many individuals have the disease for years without knowing it. In addition to symptoms experienced in Type 1 diabetes, signs may include frequent infections, cramps and tingling sensations, slow healing, impotence in men, and chronic vaginitis in women.

The cause of diabetes is unknown, but researchers believe that Type 1 develops when the immune system destroys the islet cells. The disease lends to run in families, so there may be a genetic component.

Diagnostic Studies and Procedures

Diagnosis is based on a blood test that measures blood glucose levels. Elevated blood glucose doesn't necessarily indicate diabetes, but it does call for more extensive testing. In general, a diagnosis is established if two separate blood tests, done after fasting for eight hours, show glucose levels of 140 milligrams of glucose per deciliter of blood (mg/dl). In borderline cases, a glucose challenge test may be ordered. This involves measuring glucose after fasting, and again after drinking sugar water.

Medical Treatments

There is no cure for either type of diabetes, but the disease can be controlled with a combination of therapies. People with Type 1 need regular insulin injections and a special diet and exercise regimen. They must also measure their own blood sugar.

Most people with Type 2 diabetes can control it with just diet and exercise, especially if they lose weight. In fact, studies show that weight loss alone can produce normal blood glucose levels in more than 80 percent of overweight Type 2 patients. Others may need oral hypoglycemics to increase insulin production and its effectiveness. These drugs include chlorpropamide (Diabinese), glipizide (Glucotrol), glyburide (DiaSeta and Micronase), tolbutamide 4 (Orinase), and tolazamide (Tolinase).

Patients with both types of diabetes require extra medical care and should establish a close working relationship with a specialist, usually an internist or endocrinologist. Because diabetes affects especially the heart, blood vessels, kidneys, nerves, and eyes, other specialists may be needed. For example, an ophthalmologist should be seen at least every 6 to 12 months to check for diabetic retinopathy, a disorder in which blood vessels in the retina overgrow and rupture. If unchecked, this bleeding can lead to blindness.

Cardiovascular complications, such as high blood pressure and coronary artery disease, are particularly common in diabetes. A significant number of patients develop kidney failure, and require dialysis or a kidney transplant. Reduced circulation to the legs and feet may lead to the need for vascular surgery or even amputation.

There is, however, good news for the 13 million Americans who have diabetes. A 10-year study showed that maintaining normal blood sugar levels dramatically slows the progression of complications. More doctors are now encouraging diabetic patients to follow a regimen that maintains blood glucose levels as near to normal as possible. This involves frequent glucose monitoring (at least four times a day), adjustment of insulin or other medication dosages, changes in exercise patterns, and alteration of the timing, frequency, and content of meals and snacks.

To make insulin injections easier, there is now an insulin pump, which is carried in a pocket or worn on a belt. It can be programmed to administer small amounts of insulin at specific times through a syringe left in place in the abdomen or other convenient site.

Alternative Therapies

Alternative therapies are helpful as adjuncts to medical treatment.

Exercise Conditioning. This improves the body's ability to use insulin. Type 1 patients who exercise regularly can usually lower their insulin dosage, and Type 2 patients can often eliminate the need for oral hypoglycemics. Exercise also improves circulation, and may help prevent leg and foot problems.

Homeopathy. Practitioners may prescribe phosphorous to help stabilize blood sugar levels.

Meditation, Self-Hypnosis, and Yoga These and other relaxation techniques can help lower the levels of stress that may elevate blood glucose.

Nutrition Therapy. The basic diabetic diet is described under Self-Treatment. In addition, many dietitians urge eating beans regularly, as they can help blunt the post-meal rise in glucose levels.

Self-Treatment

All patients must learn to test their blood sugar levels at home and adjust their food-exercise-medication regimens on a daily basis. Parents should assume this responsibility for young children; by age 9 or 10. most youngsters can use a self-monitoring device.

People with diabetes, especially children and teenagers, need emotional support and continual education lo accept responsibility for their own care. Joining a group for diabetic patients or sending a child to a diabetes camp can make it easier to cope with the disease.
A diabetes diet is similar to the healthful diets now recommended for all Americans: Obtain most of your calories from complex carbohydrates, such as vegetables, legumes, fruits, and whole grains, and rely less on animal foods for protein. Avoid refined sugars and restrict fat and cholesterol intake to help reduce the risk of heart disease.

When diabetes is first diagnosed, you should consult with a registered dietitian to develop meal plans compatible with your tastes and lifestyle, and learn to follow the exchange lists developed by the American Diabetes Association. These lists provide simple formulas to assure that you get an appropriate number of calories and other nutrients each day. Eventually, you will not need to rely as heavily on them. In fact, with careful self-testing, you can learn to increase or decrease your insulin dosage to accommodate an occasional departure from your usual diet.

People with diabetes often have poor circulation and are susceptible to skin ulcers, especially on the legs and feet. Fit shoes carefully to avoid corns and other foot problems that can develop into a serious infection. Also keep toenails trimmed. If you have difficulty caring for your feet, see a podiatrist.

Carry in your wallet identification indicating that you have diabetes so that you can receive prompt medical care if you are in an accident or have a high or low blood sugar reaction. Also, be alert for signs of an insulin overdose, and carry a source of sugar to use if one occurs.

Other Causes of High Blood Sugar

Certain medications can raise blood sugar. So too can diseases affecting the pancreas. Pregnant women sometimes develop gestational diabetes, which can be detected with a blood glucose test, usually in the second trimester.