A Message from the Heart to the Heart
Synopsis on Diebets Millitus
Prepared by:
Dr. Fernando Cordova,
MD Registrar,
All Saints University School of Medicine, Toronto, Canada

Revised by
Dr.Abdulwahab Arrazaghi.MBBCH,FDABIM,FRCPC
Specialist of internal medicine and cardiovascular diseases

What is diabetes? What causes diabetes?

Diabetes is a disease in which your blood glucose (“Blood sugar”) is above the normal range (4.4 to 6.1 mmol/L  or 82 to 110 mg/dL). Glucose is needed for energy purposes in our tissues. A constant elevation of glucose in our blood stream, may seriously affect our health.

After eating, food is broken down in our digestive system into sugars, which are finally absorbed into our blood stream. In order to remain healthy, our blood sugar should not be too high or too low.

Glucose needs an hormone called Insulin, which is produced in the pancreas, an organ located just below the stomach. This Insulin allows the cells of our body to take glucose from the blood stream.

Some of this glucose is used by the cells as energy, and part of this energy is stored as glycogen or fat.

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If the blood glucose levels begins to fall (for example, while fasting), the level of insulin also falls. Some of the stored energy (Glycogen and fat) is converted back into glucose and then released into the blood stream.

Diabetes is produced when there is not enough insulin or if this amount of insulin does not work properly on the body cells.

Diabetes is the third leading cause of death in North America after heart disease and cancer.

What are the Different types of Diabetes

Type I Diabetes: Also known as Insulin Dependent Diabetes Mellitus or Juvenile Diabetes. This can occur at any age, but it is most common in children and  young adults. In this Type of Diabetes, the pancreas produces little or no insulin, so Insulin Therapy is compulsory.

Type II Diabetes: Also known as Non-insulin dependent Diabetes, it is the most common type of Diabetes Mellitus. Occurs usually in adults above 40 years of age. Here, the pancreas does not produce enough insulin, or the body cells (fat, muscle, liver cells) do not use it properly.

Overweight can increase the risk of developing Diabetes Type II. These patients may require oral tablets, insulin or both in order to maintain normal levels of blood sugar.

What are the Symptoms

Most of the patients with Diabetes Mellitus do not present any symptom of their high blood sugar. If there is any symptom, these are the most commonly observed:

  • Increased thirst and water consumption
  • Frequent Urination
  • Weight loss despite an increase in appetite
  • Fatigue
  • Impaired healing of wounds
  • Blurring vision
  • Tingling sensation of extremities

How to diagnose and monitor Diabetes

The usual blood test that your doctor may ask for to diagnose  your diabetes may include:

  • Random Blood sugar (RBS): blood taken at any time
  • Fasting blood sugar (FBS): Blood taken before eating early in the morning
  • Post prandial Blood sugar (PPBS): blood taken 2h after lunch.
  • Other tests: (Hb1Ac) and Ketone tests

To monitor your Blood sugar, you may need to use a glucometer to measure your blood glucose level at any given time.

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Source: Canadian Journal of Diabetes, July 2011

How can you manage Diabetes


In most cases, Diabetes can be controlled by lifestyle modification only:
Exercise: at least 3 times per week for at least 20-30 minutes each time, uninterrupted.  
        
Recommended exercises:  Aerobic exercises: Walking, swimming, dancing, cycling, etc.

 

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Source: Adam

Diet: Control overweight (BMI  below the range of 25-30)
Cut down fat (specially unsaturated fat), sugar, red meat
Increase Fiber intake (grains, vegetables)

 

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Smoking: Quit smoking (Please visit our link about Smoking effects by Prashanthi Gopal)

6. Medications: Insulin:
For all Type I diabetes patients (and some Type II as well). The best sites for injection sites are:

- The front and outer sides of the thigh
- The abdomen
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Table 2. Diagnos

2. Other Drugs:  For type-II Diabetes patients, some of the oral hypoglycemic agents (OHAS) are:

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Source: Med mark

If you are taking OHAS it is strongly recommended to:

  • Do not skip meals at any time
  • Follow regular eating patterns
  • In order to avoid Hypoglycemia, always take these drugs with food.
  • Beware of drug`s side effects: loss of appetite, nausea, vomiting, cramps, abdominal pain, diarrhea, etc. Always discuss these symptoms with your doctor.
  • Complications:

    If Diabetes is not properly treated, you may develop the following medical conditions:
  • Diabetic Neuropathy: this means nerve damage. This can lead to loss of pain, especially to the feet.
  • Diabetic Retinopathy: This occurs in most of patients with Diabetes. You may complaint of blurry vision, seeing black spots, flashing lights, etc. Diabetes is the leading cause of blindness.
  • Diabetic Nephropathy: This can lead to Renal (kidney) impairment that is a life-threatening condition.
  • Infections: Many infections are commonly seen in Diabetic patients, especially if there is a poor control on the blood sugar levels. Infections can lead to sepsis, a life-threatening condition.
  • Precautions to keep in mind

a. Hypoglycemia: This is caused when blood glucose drops too low, probably caused by the same diabetes medications (or any other medication), skipping a meal, alcohol intake, etc. Its symptoms include: hunger, sweating, blurred vision, headache, dizziness, etc. It might be crucial to check your blood glucose. If you are taking Insulin or a Diabetes pill that can cause Hypoglycemia, always carry some sweets in case of an emergency (Severe Hypoglycemia)
b. Take care of your eyes: You should have an eye exam every year.
c. Take care of your feet: Use comfortable shoes, wash your feet frequently and dry them well, try not to walk barefoot, since you must avoid any kind of foot injury.

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Source: Diabetic Foot Treatment in Fort Walton Beach, FL

Take care of your heart and kidneys:  If you have high blood pressure, you must take your medications as indicated by your doctor. Maintain your blood pressure as normal as possible. See your doctor if you have signs of urinary infections: cloudy or bloody urine, pain or burning while urinating, and having to urinate often (even at night time). Try to avoid smoking and smoking areas. e. Dental Health: The most common complication is Gum (periodontal) disease. Early signs include: bad breath, swollen red bleeding gums or pus, etc.

Frequently asked questions about diabetes:

Why are wounds of diabetic patients more difficult to heal? In diabetic patients the body immunity is reduced. Hence body cannot defend itself against the infections in the wound. Thereby it takes more time to heal.

2. Is it possible for a diabetic woman to become pregnant and bear children like Normal women?

About one million women in the world around childbearing age have diabetes. A diabetic woman can have babies similar to that of non-diabetic woman. Early diagnosis and treatment of diabetes is very much required at this time.

3. What is an insulin pen?

This is a device by which insulin can be administered without much pain. It also does not require storage in refrigerator and can be carried easily. Insulin pen is becoming more popular nowadays.

4. What is meant by insulin allergy?

Some patients who are taking insulin may develop allergy to insulin. The patient May have fever, cough, skin rashes etc. If any of these things occur, the patient Should reach the hospital immediately. However, nowadays due to the availability of newer insulin preparations, allergy is not common.

5. Is diabetes curable?
A complete cure for diabetes is not possible with current medications. However on proper management, a diabetic patient can have a normal life.

6. Which is the best method to test diabetes? Urine or blood glucose?
Blood tests measure the exact level of glucose, so it is the most accurate method.

7. I don’t have a refrigerator in my house. How can I store insulin?
It is not essential to store insulin in fridge. Ideal storage conditions can be maintained even by keeping it in a glass of water.

8. Can I stop medicines when my diabetes is controlled?
In most of the cases diabetic patients require medicines throughout the life. Hence you should never stop the medicines even after blood glucose is controlled. Always take medicines according to the doctor’s advice.

9. Is consuming alcohol a problem in diabetic patients?
The best advice to a diabetic is to abstain from alcohol. Consuming alcohol can lead to several problems. Some of them are diabetic neuropathy, hypoglycemia,lipid abnormalities etc.

Important Quote:

“The 21st century ushered in an era of Internet transactions, “smart” phones and social networking, reducing “incidental” physical activity and contributing to escalating rates of obesity and its detrimental consequences—diabetes, hypertension and, ultimately, arterial disease. Activities that required some minimal amount of walking (e.g. mailing a letter, withdrawing money from the bank, shopping) may now be done with a few keystrokes. The loss of these daily steps is of importance not only in terms of diabetes risk, but also in terms of vascular disease risk among individuals with established  type 2 diabetes. The happy corollary is that higher walking levels offer the potential for vascular risk reduction. For example, as demonstrated in the National Health Interview Survey by Gregg and colleagues and the Nurses’ Health Study , the independent effects of higher walking levels accounted for a >30% reduction in mortality among patients with diabetes and/or hypertension”.

Source: DIABETES AND SOCIETY