Introduction
Diabetes is a terminal disease that is caused by increased sugar levels in the blood. It leads to a rise in blood glucose (sugar) levels. The food that we eat gets converted into simple sugar i.e. glucose. Insulin is a hormone that is secreted by the beta cells of the pancreas, makes glucose available to the body cells. If there is lack or less than enough insulin, the body will fail to utilize the glucose to produce energy. This increases the levels of glucose in the blood leading to the condition known as diabetes mellitus.
Types of diabetes
There are different types of diabetes mellitus depending on factors such as
- cause,
- age of onset,
- Treatment, etc.
Type 1 diabetes mellitus or insulin dependent diabetes mellitus is a hereditary disease. It is characterized by inability of the pancreas to produce insulin. It occurs suddenly especially in the younger age groups. The disease requires injection of insulin to regulate blood glucose levels. Type 2 diabetes mellitus or non-insulin dependent is caused by obesity and insulin insensitivity whereby there is excess deposition of fat on body cells making them insensitive to insulin.
This often impairs glucose utilization. The disease can also be hereditary. Infections and other medical illnesses can also cause this type of disease. Gestation diabetes is a type of diabetes that is caused by pregnancy because of the hormonal changes taking place during this period. It mostly affects women of childbearing age (18-35 years). The disease usually disappears after delivery.
Symptoms of diabetes
Symptoms of diabetes may begin gradually and can be hard to identify at first. However, the most classic symptoms include:
- Polyuria-excessive urination
- Polydipsia-excessive thirst
- Polyphonies-increased hunger
- Weight loss (type 1) or obesity (type 2).
Other symptoms are fatigue, blurred vision, aches, dry mouth, dry or itchy skin, vaginal yeast infections (in females) due to excretion of excess glucose in urine, poor healing of cuts and scrapes, excessive or unusual infections, and the tingling or numbness in the hands or feet.
Complications
Diabetes can be accompanied by emergency complications.
- Diabetic hyperglycemic hyperosmolar coma is one of the complications
- Diabetic ketoacidosis
There are also long term complications that accompany diabetes.
- Atherosclerosis
- Coronary artery disease
- Diabetic nephropathy
- Diabetic neuropathy
- Diabetic retinopathy
- Erection problems
- Hyperlipidemia
- Hypertension
- Skin infection
Diagnosis of diabetes
Diagnosis of diabetes is established solely by documentation of abnormal glycemic values.
There are three criteria used to make a diagnosis of diabetes: elevated fasting glucose, abnormal OGTT, or symptoms of diabetes with hyperglycemia.
Criteria for the diagnosis of diabetes mellitus
- Urine analysis
- Fasting blood glucose level
- Hemoglobin A1c test whereby patients monitor how they control their blood sugar levels.
- Oral glucose tolerance test
- Random blood sugar level.
Glucose tolerance test
They are performed by providing either 75 or 100 g of glucose. This test is more sensitive that fasting glucose alone. The disadvantage is that it is lengthy and cumbersome. Test is done in the morning after an overnight fast and at least 3 days of unrestricted diet, rich in carbohydrates. The subject should remain seated and not smoking throughout the test. Two or more values must be met or exceeded for a diagnosis. The international committee advises that anyone with a reading of 6.5 % or greater should be considered diabetic.
Management of diabetic people
Management of people with diabetes in hospitals is often difficult because of cor-mobidities because people with diabetes are rarely hospitalized just for their diabetes except for people with newly diagnosed type 1 diabetes mellitus. Adults are usually hospitalized because of heart diseases, surgery, pneumonia, chronic obstructive pulmonary disease, pregnancy, and so on. Diabetes constitutes of 38 % of all hospital admissions as a primary diagnosis or as co morbidity. When diabetes, or hyperglycemia is listed in a hospital as a problem, the mortality increases. Surprisingly, the mortality is higher for people admitted to the hospital that are found to have an elevated blood sugar level but without known diabetes, than for people with known diabetes.
Hyperglycemia
Results when there is too much glucose and less than enough insulin present. Causes of hyperglycemia are numerous but the major difficulty is a lack of available insulin either because of a lack of insulin making capability or resistance to insulin use. A lack of insulin may result when an insulin injection or the oral hyperglycemic (secretagogue) agent is forgotten or purposefully omitted. The condition may also develop when someone who is diabetic deviates from the diet by ingesting large quantities of carbohydrates such as sweet desserts or starches. One of the primary causes of sever hyperglycemia is infection. This causes an elevation in blood glucose levels. Infection and fever also increase blood glucose levels by activating the adrenal medulla and cortex, which produce epinephrine and cortisol, respectively.
The condition may also develop when someone who is diabetic deviates from the diet by ingesting large quantities of carbohydrates such as sweet desserts or starches, or increased calories over and above the meal plan or desired intake. One of the primary causes of sever hyperglycemia is infection. This causes an elevation in blood glucose levels. Infection and fever also increase blood glucose levels by activating the adrenal medulla and cortex, which produce epinephrine and cortisol, respectively.
Treatment of diabetes
Insulin
Replacement of insulin is important for this type of diabetes in order to achieve optimum glucose control. A continuous subcutaneous insulin infusion (CSII) device or a multiple daily insulin injection regimen can be used. Pramlintide can be administered primeval with insulin to further enhance postprandial glucose control. There are a number of types of insulins present in the market today. These types include the long-acting insulins eg lantus.
Insulin pens
Available for most insulin formulations. Benefits of using insulin pens are that accuracy and consistency in dosing are improved when patients use them. The use is increasing in the United States as people are learning about the convenience of using a pen, and there is more insurance coverage than in the past.
Insulin pumps
A subcutaneous insulin infusion pump may offer a more precise way of mimicking normal insulin delivery. This decreases the occurrence of severe hyperglycemia. The pump provides the potential of a variable basal insulin rate throughout a 24 hr period. Any of the rapid-acting insulin can be administered continuously through a patient-placed subcutaneous needle.
Teaching others
- Many health professionals feel uncomfortable when they have to teach patients how to administer insulin. The following guidelines should be helpful.
- Learn as much as possible- this can be done by reading and taking to others about insulin injection practices
- Have self-confidence- the health professional knows more about insulin injection than the patient.
- Be positive- assure the individuals that they will be able to give the injections.
- Give directions each step of way- do not just hand syringes to the patients and expect them to use them. Show how to select injection site and help them pinch up the skin and wipe it off.
- Teach patients to inject in the thigh first unless the area is contraindicated.
- Begin teaching early.
There is no cure for diabetes
- Long term goals of treating diabetes are meant to do the following
- To decrease the effects of the symptoms
- To maintain high life expectancy
- To buffer the patients from complications arising due to diabetes.
The above goals are achieved in a number of ways, notable among them being:
- The control of blood pressure together with the amount of cholesterol.
- Doing exercises.
- Getting enough information on diabetes.
- Taking in the correct diet at designated times.
- Taking care of the feet.
- The use of insulin.
- Support groups
Challenges of diabetic care
Excessive centralized system of insulin distribution. Dependency on multiple visits to different levels of the health system thus obstructing access to insulin. Adults with diabetes are not provided with free syringes and related supplies in most hospitals. The requirements to admit people suffering from complications of diabetes to hospitals render such care essentially unaffordable in many cases, thus leading to pressure on family finances. The current data collection techniques of people suffering from complications of diabetes do not permit reliable assessment of outcomes or routine monitoring.
Solutions to these problems
- Countries should embark on ambitious health system reforms,
- They should emphasize primary care, purchasing and contracting for care according to needs.
- Countries should procure and distribute drugs on a competitive basis.
- They should reform social protection systems.
Conclusion
- Diabetes has no cure.
- Early diagnosis for better management.
- Correct diet and medication.
- Importance of education.
- Prevention better than cure.
References
Brown, M. (2008). Diabetes: Good food choices. Sally Milner Publishing Pty Ltd., NSW, Australia.
Dalal, T (2008). Good food for diabetes, Ed. 3, Sanjay & Company, Mumbai.
Guthrie, D. & Guthrie, R. (2009). Management of diabetes mellitus: a guide to the pattern approach. Ed. 6, Springer Publishing Company NY.
Poretsky, L. (2009). Principles of Diabetes Mellitus. Ed. 2, Springer, NY.