- Acute: dangerously elevated blood sugar, abnormally low blood
sugar due to diabetes medications may occur.
- Chronic: disease of the blood vessels (both small and large) which
can damage the eye, kidneys, nerves, and heart may occur
Impacts of diabetes:
diabetes can lead to
Ø nerve damage
diabetes type 1:
The body stops producing insulin or produces too
little insulin to regulate blood glucose level.
involves about 10% of all people with diabetes in the United States.
Type 1 diabetes is typically diagnosed during childhood or adolescence. It used to be referred to as juvenile-onset diabetes or insulin-dependent diabetes mellitus
Factors:
Ø Destruction of pancrease by alcohol
Ø By surgical removel
Ø By destruction of beta cells
Treatment:
People with type 1 diabetes require insulin treatment daily to sustain life.
Type 2
the body of someone with type 2 diabetes is partially or completely
unable to use this insulin. This is sometimes referred to as insulin resistance
onset of type 2:
The pancreas tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they fail to secrete enough insulin to cope with their higher demands
Point to ponder:
At least 90% of adult individuals with diabetes have type 2 diabetes.
Type 2 diabetes is typically diagnosed in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non-insulin-dependent diabetes mellitus. These names are no longer used because type 2 diabetes does occur in younger people, and some people with type 2 diabetes require insulin therapy.
Controlling manuals of type 2:
Type 2 diabetes is usually controlled with
Ø oral medications.
treatment,
more than half of all people with type 2 diabetes require insulin to control their blood sugar levels at some point in the course of their illness.
Gestational diabetes (GDM)
Although gestational diabetes typically resolves after delivery of the baby.
Women with gestational diabetes are more likely to have large babies.
(also referred to as syndrome X) is a set of abnormalities in which
insulin-resistant diabetes (type 2 diabetes) is almost always present
along with :
Ø high fat levels in the blood (increased serum lipids,
Ø abnormalities in blood clotting
Ø inflammatory responses
Prediabetes:
is a common condition related to diabetes., the blood sugar
level is higher than normal but not yet high enough to be
considered diagnostic of diabetes.
Risk factor:
Prediabetes increases a person's risk of developing
Prediabetes increases a person's risk of developing
type 2 diabetes,
TREAMENT:
Prediabetes can typically be reversed (without insulin or medication) with lifestyle changes such as
Ø losing a modest amount of weight
Ø increasing physical activity levels.
Weight loss can prevent, or at least delay the onset of type 2 diabetes.
Point to ponder:
An international expert committee of the American Diabetes
Association redefined the criteria for prediabetes, lowering
the blood sugar level cut-off point for prediabetes. Approximately
20% more adults are now believed to have this condition and may
develop diabetes within 10 years if they do make lifestyle changes
such as exercising more and maintaining a healthy weight.
About 17 million Americans (6.2% of adults in North America) are
believed to have diabetes. AIt has been estimated that about one third
of adults with diabetes do not know they have diabetes.
About 1 million new cases of diabetes is diagnosed occur each year,
and diabetes is the direct or indirect cause of at least 200,000 deaths
each year.
The incidence of diabetes is increasing rapidly. This increase is due to many
factors, but the most significant are the increasing incidence of obesity associated with the prevalence of a sedentary lifestyle
Complications of diabetes
Both type 1 and type 2 diabetes ultimately lead to high blood sugar levels, a condition called hyperglycemia. Over a long period of time, hyperglycemia damages
Ø the retina of the eye,
Ø the blood vessels of the kidneys,
Ø the nerves,
Ø other blood vessels.
Damage to the organs mentioned above are the leading cause of
o Damage to the nerves from diabetes (diabetic neuropathy) is a leading cause of foot wound and ulcers, which frequently lead to foot and leg amputation.
o Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach (gastroparesis), chronic diarrhea, and an inability to control heart rate and blood pressure during postural changes.
o Diabetes accelerates atherosclerosis, (the formation of fatty plaques inside the arteries), which can lead to blockages or a clot (thrombus). Such changes can then lead to heart attack, stroke, and decreased circulation in the arms and legs (peripheral vascular disease).
- Diabetes predisposes people to elevated blood pressure, high levels of cholesterol and triglycerides. These conditions both independently and together with hyperglycemia, increase the risk of heart disease, kidney disease, and other blood vessel complications.
acute (short-lived) medical problems :
Diabetes can contribute to a number of acute (short-lived) medical problems.
1. Many infections are associated with diabetes, because the body's normal ability to fight infections is impaired. To compound the problem, infections may worsen glucose control, which further delays recovery from infection.
2. Hypoglycemia or low blood sugar, occurs intermittently in most people with diabetes. It can result from taking too much diabetes medication or insulin (sometimes called an insulin reaction), missing a meal, exercising more than usual, drinking too much alcohol, or taking certain medications for other conditions. It is very important to recognize hypoglycemia and be prepared to treat it at all times. Headache, feeling dizzy, poor concentration, tremor of the hands, and sweating are common symptoms of hypoglycemia. A person can faint or have a seizure if blood sugar level become too low.
3. Diabetic ketoacidosis (DKA) is a serious condition in which uncontrolled hyperglycemia (usually due to complete lack of insulin or a relative deficiency of insulin) over time creates a buildup of ketones (acidic waste products ) in the blood. High levels of ketones can be very harmful. This typically happens to people with type 1 diabetes who do not have good blood glucose control. Diabetic ketoacidosis can be precipitated by infection, stress, trauma, missing medications like insulin, or medical emergencies such as a stroke and heart attack
Diabetes Causes;
Type 1 diabetes:
Type 1 diabetes is believed to be an autoimmune disease. The body's immune system specifically attacks the cells in the pancreas that produce insulin.
A predisposition to develop type 1 diabetes may
Ø run in families, but genetic causes (a postitive family history) are much more common for type 2 diabetes.
Ø Environmental factors, including common unavoidable viral infections, may also contribute to type 1 diabetes.
Ø Type 1 diabetes is most common in people of non-Hispanic, Northern European descent (especially Finland and Sardinia), followed by African Americans, and Hispanic Americans. It is relatively rare in those of Asian descent.
Ø Type 1 diabetes is slightly more common in men than in women.
Type 2 diabetes:
Type 2 diabetes has strong genetic links, meaning that type 2 diabetes tends to run in families. Risk factors for developing type 2 diabetes include the following: :
Ø High blood triglyceride (fat) levels
Ø Gestational diabetes or giving birth to a baby weighing more than 9 pounds
Ø High-fat diet
Ø High alcohol intake
Ø Sedentary lifestyle
Ø Aging: Increasing age is a significant risk factor for type 2 diabetes. Risk begins to rise significantly at about age 45 years, and rises considerably after age 65 years.
Symptoms of type 1 diabetes: are often dramatic and come on very suddenly Type 1 diabetes is usually recognized in
Ø childhood
Ø early adolescence,
The extra stress can cause diabetic ketoacidosis. Symptoms of ketoacidosis include:
Ø Without treatment, ketoacidosis can lead to coma and death.
Symptoms of type 2 diabetes are often subtle and may be attributed to
Ø aging
Ø obesity.
A person may have type 2 diabetes for many years without knowing it.
People with type 2 diabetes can develop:
ü hyperglycemic
ü hyperosmolar nonketotic syndrome.
Type 2 diabetes can be precipitated by
Ø steroids
Ø stress.
If not properly treated, type 2 diabetes can lead to complications such as
blindness,
Ø heart disease,
Ø nerve damage.
Common symptoms of type 1 and type 2 diabetes
In diabetes, the body is inefficient and sometimes unable to use glucose for fuel. The body switches over to metabolizing fat, partially or completely, as a fuel source. This process requires the body to use more energy. The end result is feeling fatigued or constantly tired.
Unexplained weight loss:
People with diabetes are unable to process many of the calories in the foods they eat. Thus, they may lose weight even though they eat an apparently appropriate or even an excessive amount of food. Losing sugar and water in the urine and the accompanying dehydration also contributes to weight loss.
Excessive thirst (polydipsia)
: A person with diabetes develops high blood sugar levels, which overwhelms the kidney's ability to reabsorb the sugar as the blood is filtered to make urine. Excessive urine is made as the kidney spills the excess sugar. The body tries to counteract this by sending a signal to the brain to dilute the blood, which translates into thirst. The body encourages more water consumption to dilute the high blood sugar back to normal levels and to compensate for the water lost by excessive urination.
Excessive urination (polyuria):
Another way the body tries to rid the body of the extra sugar in the blood is to excrete it in the urine. This can also lead to dehydration because a large amount of water is necessary to excrete the sugar.
Excessive eating (polyphagia):
Excessive eating (polyphagia):
If the body is able, it will secrete more insulin in order to try to manage the excessive blood sugar levels. Moreover, the body is resistant to the action of insulin in type 2 diabetes. One of the functions of insulin is to stimulate hunger. Therefore, higher insulin levels lead to increased hunger. Despite increased caloric intake, the person may gain very little weight and may even lose weight.
Poor wound healing:
High blood sugar levels prevent white blood cells, which are important in defending the body against bacteria and also in cleaning up dead tissue and cells, from functioning normally. When these cells do not function properly, wounds take much longer to heal and become infected more frequently. Long-standing diabetes also is associated with thickening of blood vessels, which prevents good circulation, including the delivery of enough oxygen and other nutrients to body tissues.
Infections:
Certain infections, such as frequent yeast infections of the genitals, skin infections, and frequent urinary tract infections, may result from suppression of the immune system by diabetes and by the presence of glucose in the tissues, which allows bacteria to grow. These infections can also be an indicator of poor blood sugar control in a person known to have diabetes.
Altered mental status:
Agitation, unexplained irritability, inattention, extreme lethargy, or confusion can all be signs of very high blood sugar, ketoacidosis, hyperosmolar hyperglycemia nonketotic syndrome, or hypoglycemia (low sugar). Thus, any of these merit the immediate attention of a medical professional. Call your health care professional or 911.
Blurry vision:
Blurry vision is not specific for diabetes but is frequently present with high blood sugar levels
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Diabetes Diagnosis
The health care professional will take a history including information about the
Ø patient's symptoms,
Ø risk factors for diabetes,
Ø past medical problems,
Ø current medications,
Ø allergies to medications,
Ø family history of diabetes,
or other medical problems such as high cholesterol or heart disease, and personal habits and lifestyle.
A number of laboratory tests are available to confirm the diagnosis of diabetes.
Finger stick blood glucose: This is a rapid screening test that may be performed anywhere, including community-based screening programs.
Although a not as accurate as testing the patient's blood in the hospital laboratory, a fingerstick blood glucose test but is easy to perform, and the result is available right away.
The test involves sticking the patient's finger for a blood sample, which is then placed on a strip. The strip goes into a machine that reads the blood sugar level. These machines are only accurate to within about 10%-20% of true laboratory values.
Fingerstick blood glucose values tend to be most inaccurate at very high or very low levels, so this test is only a preliminary screening study. Fingerstick is the way most people with diabetes monitor their blood sugar levels at home.
Fasting plasma glucose: The patient will be asked to eat or drink nothing for 8 hours before having blood drawn (usually first thing in the morning). If the blood glucose level is greater than or equal to 126 mg/dL (without eating anything), they probably have diabetes.
confirmatory test If the result is abnormal, the fasting plasma glucose test may be repeated on a different day to confirm the result, or the patient may undergo an oral glucose tolerance test or a glycosylated hemoglobin test (often called "hemoglobin A1c") as a confirmatory test.
If fasting plasma glucose level is greater than 100 but less than 126 mg/dL, then the patient has what is called impaired fasting glucose, or IFG. This is considered to be prediabetes. These patients do not have diabetes, but they are at high risk of developing diabetes in the near future.
Oral glucose tolerance test:
This test involves drawing blood for a fasting plasma glucose test, then drawing blood for a second test at two hours after drinking a very sweet drink containing up to 75 grams of sugar.
If the blood sugar level after the sugar drink is greater than or equal to 200 mg/dL, the patient has diabetes.
If the blood glucose level is between 140 and 199, then the patient has impaired glucose tolerance (IGT), which is also a prediabetic condition.
This test is a measurement of how high the blood sugar levels have been over approximately the last 120 days (the average life-span of the red blood cells on which the test is based).
Excess blood glucose hooks itself on to the hemoglobin in red blood cells and stays there for the life of the red blood cell.
The percentage of hemoglobin that has had excess blood sugar attached to it can be measured in the blood. The test involves having a small amount of blood drawn.
A hemoglobin A1c test is the best measurement of blood sugar control in people known to have diabetes. A hemoglobin A1c result of 7% or less indicates good glucose control. A result of 8% or greater indicates that blood sugar levels are too high, too much of the time.
The hemoglobin A1c test is the best test for diabetes follow-up care, than to diagnose diabetes. Still, a hemoglobin A1c result greater than 6.1% is highly suggestive of diabetes. Generally, a confirmatory test would be needed before diagnosing diabetes.
The hemoglobin A1c test is generally measured about every 3 to 6 months for people with known diabetes, although it may be done more frequently for people who are having difficulty achieving and maintaining good blood sugar control. This test is not used for people who do not have diabetes or are not at increased risk of diabetes.
Normal values may vary from laboratory to laboratory, although an effort is under way to standardize how measurements are performed.
Diagnosing complications of diabetes
A person with diabetes should be checked regularly for early signs of diabetic complications. A health care professional can order some of these tests; for others, the patient should be referred to a specialist.
Ø The patient should have their eyes checked at least once a year by an eye specialist (ophthalmologist) to screen for diabetic retinopathy, a leading cause of blindness.
Ø The patient's urine should be checked for protein (microalbumin) on a regular basis, at least one to two times per year. Protein in the urine is an early sign of diabetic nephropathy, a leading cause of kidney failure.
Ø Sensation in the legs should be checked regularly using a tuning fork or a monofilament device. Diabetic neuropathy is a leading cause of lower extremity ulcers in individuals with diabetes, which frequently lead to amputation of the feet or legs.
Ø The health care professional should check the feet and lower legs of the patient at every visit for cuts, scrapes, blisters, or other lesions that could become infected. Adults with diabetes should check the soles of their feet and their legs daily with a hand-held mirror, either by themselves or with the assistance of a relative or caretaker.
Ø The patient should be screened regularly for conditions that may contribute to heart disease, such as high blood pressure and high cholesterol
Diabetes Medical Treatment
The treatment of diabetes is highly individualized, depending on the type of diabetes, whether the patient has other active medical problems, whether the patient has complications of diabetes, and age and general health of the patient at time of diagnosis.
Ø A health care professional will set goals for lifestyle changes, blood sugar control, and treatment.
Ø Together, the patient and the health care professional will formulate a plan to help meet those goals.
Type 1 diabetes:
Treatment of diabetes almost always involves the daily
Ø injection of insulin,
usually a combination of short-acting insulin (for example, lispro [Humalog] or aspart [NovoLog]) and a longer acting insulin (for example, NPH, Lente, glargine [Lantus], detemir [Levemir]).
Insulin must be given as an injection just under the skin. If taken by mouth, insulin would be destroyed in the stomach before it could get into the blood where it is needed.
Most people with type 1 diabetes give these injections to themselves. Even if someone else usually gives the patient injections, it is important that the patient knows how to do it in case the other person is unavailable.
A trained professional will show the patient how to store and inject the insulin.
Insulin dose
is usually given in two or three injections per day, generally around mealtimes. Dose should be given according to glucose levels
Longer acting insulin are typically administered one or two times per day.
Some people have their insulin administered by continuous infusion pumps to provide adequate blood glucose control. Supplemental mealtime insulin is programmed into the pump by the individual as recommended by his or her health care professionals.
Point to ponder:
t is very important to eat after the taking insulin, as the insulin will lower blood sugar regardless of whether the person has eaten. If insulin is taken without eating, the result may be hypoglycemia. This is called an insulin reaction.
There is an adjustment period while the patient learns how insulin affects them, and how to time meals and exercise with insulin injections to keep blood sugar levels as even as possible.
Keeping accurate records of blood sugar levels and insulin dosages is crucial for the patient's diabetes management.
Eating a consistent, healthy diet appropriate for the patient's size and weight is essential in controlling blood sugar level.
Type 2 diabetes:
Depending on how elevated the patient's blood sugar and glycosylated hemoglobin (HbA1c) are at the time of diagnosis, they may be given a chance to lower blood sugar levels through lifestyle changes, without medication.
The best way to do this is to lose weight if the patient is obese, and begin an exercise program.
This will generally be tried for 3 to 6 months, then blood sugar and glycosylated hemoglobin will be rechecked. If they remain high, the patient will be started on an oral medication, usually
Ø a sulfonylurea
to help control blood sugar levels.
Even if the patient is on medication, it is still important to
Ø eat a healthy diet,
Ø lose weight if they are overweight,
Ø engage in moderate physical activity as often as possible.
right dose of the right medication
The health care professional will initially monitor the patient's progress on medication very carefully. It is important to receive just the right dose of the right medication, to regulate blood sugar levels in the recommended range with the fewest side effects.
The doctor may decide to combine two types of medications to achieve blood sugar levels control.
Gradually, even people with type 2 diabetes may require insulin injections to control their blood sugar levels.
It is becoming more common for people with type 2 diabetes to
Ø take a combination of oral medication
Ø insulin injections to control blood sugar levels.
Diabetes Medications
Many different types of medications are available to help lower blood sugar levels in people with type 2 diabetes. Each type works in a different way. It is very common to combine two or more types to get the best effect with fewest side effects.
Ø Sulfonylureas:
These drugs stimulate the pancreas to make more insulin.
Ø Biguanides:
These agents decrease the amount of glucose produced by the liver.
Ø Alpha-glycosidase inhibitors:
These agents slow absorption of the starches a person eats. This slows down glucose production.
Ø Thiazolidinediones:
These agents increase sensitivity to insulin.
Ø Meglitinides:
These agents stimulate the pancreas to make more insulin.
These agents stimulate the pancreas to produce more insulin more quickly.
Ø Amylin synthetic derivatives
Amylin is a naturally occurring hormone secreted by the pancreas along with insulin. An amylin derivative, such as pramlintide (Symlin), is indicated when blood sugar control is not achieved despite optimal insulin therapy. Pramlintide is administered as a subcutaneous injection along with insulin and helps achieve lower blood sugar levels after meals, helps reduce fluctuation of blood sugar levels throughout the day, and improves hemoglobin A1C levels.
Incretin mimetics:
Incretion mimetic promotes insulin secretion by the pancreas and mimics other blood sugar level lowering actions that naturally occur in the body. Eventide (Beta) was the first incretin mimetic agent approved in the United States. It is indicated for diabetes mellitus type 2 in addition to metformin or a sulfonylurea when these agents have not attained blood sugar level control alone.
Insulin:
Synthetic human insulin is now the only type of insulin available in the United States; it is less likely to cause allergic reactions than animal-derived varieties of insulin used in the past. The type of insulin chosen to customize treatment for an individual is based on the goal of providing optimal blood sugar control. Different types of insulin are available and categorized according to their times of action onset and duration. Commercially prepared mixtures of insulin may also be used to provide constant (basal) control and immediate control.
o Examples of rapid-acting insulin
Ø Regular insulin (Humulin R, Novolin R)
o Examples of intermediate-acting insulin
Ø Isophane insulin, neutral protamine Haledon (NPH) (Humulin N, Novolin N)
Ø Insulin zinc (Lente)
o Examples of long-acting insulin
Extended insulin zinc insulin (Ultralente)
Insulin glargine (Lantus)
Nutritional medicines:
Ø Zinc - Zinc has proven to aid in the formation of new skin and soft tissue cells and is particularly helpful in poor healing diabetic ulcers. Zinc also is critical to the synthesis, secretion and utilization of insulin. 70mg three times a day with meals is the recommended dosage.
Ø Fenugreek - Fenugreek seeds have shown to be helpful in improving glucose tolerance. Consult your local health food store for dosage recommendations.
Ø Bitter Melon - Recommended dosage of Bitter Melon is 125mg/day which has shown the ability to lower blood sugar levels.
Ø Vanadium - Studies have shown that cells become more receptive to insulin with a 100 to 150mg/day dose of Vanadium. Vanadium can have a dramatic effect on lowering blood sugar levels acting like an oral insulin.
Ø Gymna Sylvestre - This plant is native to the rain forests of India and has been used in Asian cultures for years as a means of lowering blood sugar levels.
Ø Chromium Polyniacinate - Chromium taken in dosages of 400 to 600 micrograms each day has shown effective reduction in blood sugars by improving insulin efficiency.
Ø L-Carnitine - Taken on an empty stomach, 500mg of L-Carnitine decreases ketones.
Ø Ascorbic Acid - Vitamin C (ascorbic acid) is a well known building block of collagen. Collagen is a precursor to healthy granulation of skin and necessary for proper wound care. Vitamin C may also effect glycosylation.
Ø Vitamin B Complex - B complex vitamins, especially B1 (thiamine) and B6 (pyridoxine) have been shown to aid in the symptoms of diabetic neuropathy.
Ø Alph Lipoic Acid (ALA) - Alpha Lipoic Acid has been shown to act as a potent antioxidant aiding in the care of symptoms of diabetic neuropathy. ALA helps to repair the damage to peripheral nerve caused by oxygen and nitrogen free radicals. ALA is both water and fat soluble and therefore able to have an impact in many organ systems including the kidneys, liver, muscle and bone. The most effective aspect of ALA is its' ability to mediate damage to peripheral nerve tissue. ALA has also shown evidence that it aids in metabolizing glucose more effectively. The recommended dosage of ALA is 100 to 400mg/ day.
Diabetes Follow-up:
Treatment:
Follow the health care professional's treatment recommendations.
Keep records of blood sugar levels as often as recommended by the health care professional and the diabetes care team, including the times the levels were checked, when and how much insulin or medication was taken, when and what was eaten, and when and for how long the patient exercised.
Call the health care professional if the patient has any problems with their treatment or symptoms that suggest poor glucose control.
Education:
Ø The more educated the patient and their family are about the disease, the better they are likely to do.
Ø If the patient takes insulin, they should see the health care professional about every 3 months or more often.
Ø For other people with diabetes, every 3 to 6 months is generally adequate, unless they are having complications.
Ø Recognize low blood sugar levels and know how to treat them
Ø The patient and their family should be taught how to recognize the signs and symptoms of low blood sugar levels. The patient should have a clear plan for treating low blood sugar levels.
Mild symptoms include confusion
Ø sweating. Moreover,
these symptoms can progress to
Ø lethargy,
Ø agitation (sometimes with violent, jerking motions),
Ø even seizures..
Diabetes Prevention:
It is not yet known how to prevent type 1 diabetes. Type 2 diabetes, however, can be prevented in some cases.
Ø Control weight to normal or near-normal levels by eating a healthy low-fat, high-fiber diet.
Ø Regular exercise is crucial to the prevention of type 2 diabetes.
Ø Keep alcohol consumption low.
Ø Quit smoking.
Ø If a person has high blood fat levels (such as high cholesterol) or high blood pressure, take all medications as directed.
Ø Lifestyle modifications and/or certain medications can be used in people with prediabetes to prevent progression to diabetes. Prediabetes can be diagnosed by checking fasting glucose and 2 hours after ingesting up to 75 grams of glucose (dosing is based on the weight of the patient).
Ø If you or someone you know already has diabetes, the focus should be on preventing the complications, which can cause serious disabilities such as blindness, kidney failure requiring dialysis, amputation, or even death.
Ø Tight glucose control: The single best thing a person with diabetes can do is to keep their blood sugar level within the suggested range every day. The only way to do this is through a combination of regular blood sugar checks; a balanced diet low in simple sugars and fat, and high in complex carbohydrates and fiber; a high degree of personal motivation; and appropriate medical treatment. Consult a nutritionist or check with a doctor with questions in regard to diet.
Ø Quit smoking
Ø Maintain a healthy weight
Ø Increase physical activity levels. Aim for moderately vigorous physical activity for at least 30 minutes every day.
Ø Drink an adequate amount of water and avoid consuming too much salt.
Ø The skin should be taken care of; keep it supple and hydrated to avoid sores and cracks that can become severely infected.
Ø Brush and floss the teeth every day. See a dentist regularly to prevent gum disease.
Ø The feet should be washed and examined daily, looking for small cuts, sores, or blisters that may cause problems later. The toenails should be filed rather than cut to avoid damaging the surrounding skin. A specialist in foot care (podiatrist) may be necessary to help care for the feet
Diabetes Prognosis:
Diabetes is a leading cause of death in all industrialized nations.. Prognosis depends on the type of diabetes, degree of blood sugar control, and development of complications.
Type 1 diabetes:
About 15% of people with type 1 diabetes die before age 40 years, which is about 20 times the rate of that age group in the general population.
The most common causes of death in type 1 diabetes are
Ø diabetic ketoacidosis,
Ø kidney failure,
Ø heart disease.
The good news is that prognosis can be improved with good blood sugar control. Maintaining tight blood sugar control has been proven to prevent, slow the progression of, and even improve established complications of type 1 diabetes.
Type 2 diabetes
The life-expectancy of people who are diagnosed with type 2 diabetes in their 40s decreases by 5-10 years because of the disease.
Heart disease is the leading cause of death for people with type 2 diabetes.
Excellent glycemic control, tight blood pressure control, and keeping the "bad" cholesterol (LDL) level at the recommended level of <100 mg/dL (or lower, particularly if other risk factors for cardiovascular disease are present) and the "good" (HDL) cholesterol as high as possible. Use of aspirin when indicated can prevent, slow the progression of, and improve established complications in diabetes
The Foot and Diabetes
Many of the complications of DM effect the foot. As previously mentioned, the impact of DM on health, and in particular the foot, is immense. Subsequently, diabetic foot care is a critical part of overall diabetic care.
Many of the complications of DM effect the foot. As previously mentioned, the impact of DM on health, and in particular the foot, is immense. Subsequently, diabetic foot care is a critical part of overall diabetic care.
The combined effects of diabetic peripheral neuropathy and impaired circulation create a challenge for all diabetics. Many of the irritations of the skin that we would take for granted cannot be felt by a diabetic due to their peripheral neuropathy. Many diabetics fail to notice these problems until significant damage has occurred. The first symptoms for many diabetic patients is when they find blood or drainage on a sock that is the result of a blister or ulceration.
New methods of wound care are always appreciated, but some of the tried and true methods still prevail as the most important. Debridement of diabetic foot wounds and counseling in effective footwear is a must. In addition to basic wound care, many adjunctive therapies have become popular over recent years including
Ø hyperbaric oxygen,
Ø growth factors,
Ø bioengineered tissue equivalents
Ø electrical stimulation.
Another complication of advanced diabetes is a gradual shut-down of the autonomic nervous system. The autonomic nervous system regulates bodily functions such as salivation, bowel motility and perspiration. With advanced diabetes, the autonomic nervous system and its' ability to regulate perspiration of the foot is impaired. As a result, the skin of diabetics becomes brittle and dry. If left untreated, the dryness may progress to fissures of the skin that crack and become infected. Therefore, use of a skin softener on a daily basis is extremely important.
Diabetic foot infections are obviously a challenge to treat. The complexity of impaired wound healing, peripheral neuropathy, poor circulation and dysfunction of the nervous system is a challenge for all physicians.
By far the most important method of caring for foot ulcers and infections is
Ø prevention
Ø careful regulation of blood sugar levels.
The tools of prevention are
Ø education
Ø awareness.
1. Visually inspect the foot when the socks go on and when the socks come off.
With a slow progressive loss of sensation due to peripheral neuropathy, the eyes become the next most effective tool to assess the status of the skin on a regular basis. Use a adjustable magnified mirror specifically designed for diabetic foot inspections on a daily basis.
2. Frequent changes of shoes and socks (2-3 times/day). If you have a pressure point in a particular pair of shoes that could effect the skin, change the shoes. There's no simpler way to be kind to the feet. For over sized or swollen legs, be sure to wear a sock designed for swelling.
3. skin crea on a daily basis to the feet. Whether it's an over-the-counter or prescription skin softener, do it every day. Dryness and cracked skin is a major source of diabetic foot infections.
4. Wash and dry between the toes on a daily basis. The best location for bacteria to congregate on the foot is in between the toes. If you can't reach them, have someone else do it for you on a regular basis. The daily use of soap, water and a wash cloth to debride between the toes is very important. 5. Treat fungal infections.
Many fungal infection look like dry skin and can promote soft tissue infection. If you have a dry skin problem that does not respond to skin softeners, seek the help of a qualified podiatrist. Home care can include the use of an antifungal shoe spray, antifungal soap and topical antifungal cream.
6. Make sure your shoes are your friends.
It's well worth the time, effort and money to be sure that your shoes are not going to cause harm. Blisters and calluses in advanced diabetes can result in significant complications. Don't cheat yourself by buying inexpensive shoes. Seek the help of a certified Pedorthist. 7. When questions arise, don't wait. Act. Seek the help of your family physician or podiatrist.
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