Diabetes Education
KEY POINTS
Importance of diet and managing diabetes
Type I and type II diabetes have different medications treatments, however similar diet plans
Complications of diabetes primarily affect the eyes, nerves, and kidneys.
DIABETES MELLITUS
In this section, we take the opportunity to talk about diabetes. we will start off with the introduction of answer the question what is diabetes, differentiating type I versus type II diabetes, how diabetes is diagnosed, and lastly the complications that can occur if diabetes is not controlled.
INTRODUCTION
Diabetes is a condition where the body loses the ability to regulate the amount of sugar (glucose) in the blood due to not enough insulin in the blood or your body not responding to the insulin that is being produced.
Insulin is a hormone that is made in your pancreas and plays a major role in regulating the amount of sugar in the blood. It is released after we ingest a high carbohydrate meal and functions to take insulin out of the blood and put it into cells. Too much sugar in the blood over a long period of time can result in several problems affecting multiple organs.
Therefore, modern medicine focuses on simulating the body's normal function by removing sugar out of the blood and putting it into our cells so that it can be used to create energy.
TYPE I VS TYPE II DIABETES
The difference between type I and type II diabetes is important as each of these subtypes of diabetes are treated differently.
Type I diabetes is commonly seen in children and teenagers and is due to destruction of the cells in the pancreas that make insulin. Therefore, people with Type I diabetes are insulin-dependent and can only be treated with insulin.
Type II diabetes is commonly seen in older, overweight adults and it is due to our cells not responding to the insulin being produced. Patients with type II diabetes have a normal pancreas that produces insulin, however being overweight causes our cells to become resistant and unresponsive to the insulin being produced. Therefore, people with type II diabetes can be treated with oral medications that are designed to make our cells more sensitive and responsive to the insulin being produced. However, if Type II diabetes is not managed appropriately the pancreas may eventually "burn out" and these patients will also become insulin-dependent, similar to type I diabetics.
HOW DIABETES IS DIAGNOSED
There are many ways in which diabetes is diagnosed, and meeting any one of these criteria is diagnostic for diabetes:
- A blood test measuring your hemoglobin A1c that is greater than 6.5 % is diagnostic for diabetes. The hemoglobin A1c is a marker of how high your sugar levels have been over the past 3 months.
- A fasting blood glucose that is greater than 126 mg/dL is also another way diabetes can be diagnosed. Your fasting blood glucose is your glucose level first thing in the morning before having had anything to eat.
- The oral glucose tolerance test is another way to diagnose diabetes. This is a test where your doctor will have you drink 75g of a sweet drink and then measure your glucose levels after 2 hours. If your levels are greater than 200 mg/dL, this is diagnostic of diabetes.
- The first 3 ways we have mentioned the way diabetes is diagnosed are in people who have no symptoms. An uncommon way diabetes is diagnosed are in people present with symptoms of very high glucose such as increased thirst, urinating often, weight loss, and blurry vision. If you have these symptoms and also have a glucose levels higher than 200 mg/dL this is also diagnostic of diabetes.
COMPLICATIONS
The reason we focus on managing diabetes is to avoid several of the complications that come with having high glucose in our body for a long period of time. Most of the damage from uncontrolled diabetes results in damage to small blood vessels that supply our eyes, nerves, and kidneys.
As a result, diabetes is the most common cause of blindness in adults in the United States. This is why it is recommended for diabetics to see an eye doctor (ophthalmologist) on a regular basis to monitor for signs of eye disease.
In addition, diabetes damages the blood vessels supplying the kidneys resulting in chronic kidney disease. This can result in problems managing electrolytes, which can be life-threatening in some instances. Furthermore, damage to the kidneys means we lose the ability to get rid of toxins in our body allowing them to build up, and making you feel persistently tired, weak, and fatigued. Lastly, when diabetes damages our kidneys the amount of urine that we produce decreases, which means more fluid builds up in the body which can end up in our legs and belly causing them to swell, and also in our lungs resulting in difficulty breathing. Ultimately, if diabetes is not controlled and results in severe damage to your kidneys, you will require dialysis and/or a kidney transplant.
When diabetes damages our nerves it can result in problems with moving food through our stomach and intestines resulting in constant abdominal pain, nausea, vomiting, bloating and constipation. It can also damage the nerves that allow us to urinate, which means you will have trouble passing urine and have increased risk of developing urinary tract infections. Longstanding, uncontrolled diabetes can also damage the nerves in our hands and feet making it difficult to do simple tasks such as walking and picking up small objects. Also, because there is loss of sensation in your feet this can result in cuts, wounds, and infections that you are unaware of that are allowed to get worse. These infections can potentially spread to the bone requiring several weeks of antibiotics and/or an amputation.
All of the complications discussed above usually occur over several years of uncontrolled diabetes. However, there are complications that can be fatal in the short term known as diabetic ketoacidosis (see more commonly in type I diabetic) or hyperosmolar hyperglycemic non-ketotic syndrome (see more commonly in type II diabetics). Both of these conditions occur when patients do not take their insulin or are under severe stress such as from an infection, heart attack, or surgery. In both of these conditions, there are extremely elevated levels of glucose in the blood and electrolyte abnormalities (diabetic ketoacidosis), which can be life-threatening and why treatment of these complications requires admission to the hospital in the intensive care unit.