|
|
|
|
|
|
|
|
|
|
|
|
||||
|
|
||||||
|
|
||||||
| Complications: | ||
| The most important ways to reduce your risk for developing the complications associated with diabetes are maintaining tight blood glucose control and having regular checkups by a physician. It's no secret that those with type 1 diabetes run a greater risk for other health problems. However, studies have shown that many of these problems can be prevented or successfully treated when identified early. | ||
| Aggressive treatment of diabetes, beginning as soon as possible after diagnosis, reduces complications and prolongs health. The results of such treatment are long lasting, according to a major study, the Epidemiology of Diabetes Interventions and Complications (EDIC). The Diabetes Control and Complications Trial (DCCT), a multi-center study of 1,441 people with type 1 diabetes, compared intensive treatment with conventional treatment. | ||
| Patients on intensive treatment kept glucose levels as close to normal as possible, with at least three insulin injections a day or an insulin pump, and frequent self-monitoring of blood glucose. Intensive treatment was aimed at keeping hemoglobin A1c (HbA1c), which reflects average blood glucose over a two- to three-month period, as close to normal (6 percent) as possible. Conventional treatment consisted of one or two insulin injections a day with once-a-day blood glucose testing. The striking finding of EDIC is that people who received intensive therapy during DCCT continued to have a lower risk of eye and kidney disease than those who had been on conventional treatment. | ||
| Cardiovascular and cerebrovascular disorders | ||
| Coronary heart disease is the number one cause of death in the United States, accounting for more than half of all deaths. With diabetes, heart disease is an even greater threat since two thirds of people with diabetes eventually die of heart or other blood vessel disease. People with diabetes are about five times more likely to have a stroke than their diabetes-free counterparts. | ||
| In addition to controlling their blood glucose levels, people with diabetes must be aware of other measures that can help prevent the cardiovascular and cerebrovascular complications of diabetes. These include not smoking, maintaining normal blood pressure and blood cholesterol levels, eating a low-fat diet, and getting regular exercise. | ||
| Eye disorders | ||
| People with diabetes are at increased risk for developing eye problems. The most serious is a condition called diabetic retinopathy, which is caused by damage to the blood vessels that nourish the nerves within the retina. Retinopathy is the leading cause of blindness in diabetes. Retinopathy often can be successfully treated with laser surgery when it is detected early. All patients with type 1 diabetes should have an annual eye exam. | ||
| People with diabetes have an increased risk for developing cataracts (clouding of the lens of the eye) and glaucoma (caused by an increase in fluid pressure within the eye that damages the optic nerve). Annual eye exams can detect these conditions. Cataracts can be corrected surgically, and glaucoma can be treated with eye medication or surgery. | ||
| Nervous system disorders | ||
| Nerve damage called neuropathy affects up to 65 percent of those with diabetes. Diabetic neuropathy can cause a variety of symptoms including pins and needles sensation and severe pain in the hands and legs, or a loss of pain sensation in the extremities (which can contribute to foot problems). Neuropathy can also affect the bladder, bowel, stomach and skin, and cause erectile dysfunction in men. The most common type is peripheral neuropathy, which affects the arms and legs | ||
| The best way to prevent diabetic neuropathy is to practice tight blood glucose control. The DCCT shows you can reduce your risk of neuropathy by 69 percent if you maintain tight control over your blood sugars | ||
| There are several ways to prevent or treat diabetic foot ulcers, which are open foot sores that lead to thousands of amputations each year in people with diabetes. A good way is wound dressing that is a cellular, bi-layered skin substitute intended to help aid healing by protecting the wound and fostering skin growth. | ||
| Kidney disorders | ||
| Kidney damage called nephropathy occurs commonly with diabetes and can cause end-stage renal disease. The earliest sign of kidney damage is detected when protein begins to spill over into the urine. This can be found with a simple urine test that should be performed yearly as part of regular visits to the physician. | ||
| Although heredity plays a role in the development of kidney problems with diabetes, other factors such as controlling blood pressure, reducing protein intake in the diet and maintaining tight control of blood glucose levels can reduce the risk of kidney complications associated with diabetes. | ||
| Infection | ||
| People with diabetes have an increased risk of developing many types of infections. This risk is directly related to increased glucose levels that provide an ideal environment for many disease-causing organisms and also hamper the immune system's ability to fight off infections | ||
| The best way to avoid infections is to maintain tight control of blood glucose levels. Patients should also closely examine their skin (especially their feet) for any evidence of breakdown or ulceration. Because many people with diabetes have decreased sensation in their extremities due to peripheral neuropathy, they may have foot ulcers without pain. | ||
| Practicing good oral hygiene and visiting the dentist regularly can help those with diabetes avoid infections of the gums and mouth. | ||
| All cuts and open wounds deserve special attention with diabetes. Wash any area of skin breakdown thoroughly with soap and water and monitor the area each day for infection. Redness, warmth, pus or other drainage and fever are signs. Call your doctor immediately if you suspect an infection. | ||
| KETOACIDOSIS | ||
|
|
||
| The reaction in a non diabetic body when there is a lack of insulin are quite logical as long as you remember that the levels of insulin are low only when the blood glucose also low. The body will then mobilize more energy to the blood . The levels of the counter-regulating hormones (adrenaline, glucagon, cortisone and growth hormones) increase and the production of both glucose and ketones increases. The ketones can be as fuel by the brain in situation of starvation. if the diabetes is un treated or undertreated a lack of insulin will occur at the same time as the blood glucose is high. However the body will not "understand" this. Instead it will try to increase the blood's supply of energy in the same way as before having diabetes .The amount of ketones in the blood will increase, and this can lead to ketoacidosis . The blood glucose level will be greatly increased even without eating anything. | ||
| It is another problem frequently encountered in diabetic children, and may be due to (a) recurrent infection or (b) poor care at home. It is now well established that recurrent ketoaccidosis has some psychological background. | ||
| Diabetic Ketoacidosis Overview | ||
| Diabetic ketoacidosis (DKA) is a state of inadequate insulin levels resulting in high blood sugar and accumulation of organic acids and ketones in the blood. It is also common in DKA to have severe dehydration and significant alterations of the body’s blood chemistry. | ||
| DKA is usually seen in people who have type 1 (insulin-dependent) diabetes. Most often, these are diabetics younger than 25 years, but the condition may occur in diabetics of any age. Males and females are equally affected. | ||
| Diabetic Ketoacidosis Causes | ||
| The condition known as diabetic ketoacidosis occurs when the body has no insulin. This leaves the muscle, fat, and liver cells unable to use glucose (sugar) in the blood as fuel. Other hormones such as glucagon, growth hormone, and adrenaline cause fat to break down within the cells of these tissues into glucose and fatty acids. These fatty acids are converted to ketones by a process called oxidation. The body is literally consuming muscle, fat, and liver cells for fuel. | ||
| In diabetic ketoacidosis the body shifts from its normal metabolism using carbohydrates for fuel to a fasting state using fat for fuel. The resulting increase in blood sugar because it cannot be transported into cells for future use causes increased urination and dehydration. Commonly, 10% of total body fluids may be lost. Significant loss of potassium from urination is also common. | ||
| Diabetic Ketoacidosis Symptoms | ||
|
Someone developing diabetic ketoacidosis may have
these symptoms: * Thirst, drinking lots of fluids * Frequent urination * General weakness * Vomiting * Loss of appetite * Confusion * Abdominal pain * Shortness of breath * A general ill appearance * Dry skin * Dry mouth * Increased heart rate * Low blood pressure * Increased rate of breathing * Sometimes a distinctive fruity odor on the breath |
||
| When to Seek Medical Care | ||
|
When to call the doctor * If you have diabetes, contact your doctor if you have very high blood sugars (generally more than 350 mg) or moderate elevations that do not respond to home treatment. * If you have diabetes and develop a fever or start vomiting, contact your doctor for instructions. * If you have home access to urine ketone test strips, and if urine sampling indicates moderate or greater urine ketones, notify your doctor. |
||
| When to go to the hospital | ||
| People with diabetes should be taken to the hospital's emergency department if they appear significantly ill, dehydrated, confused, or very weak. Other reasons to seek immediate medical treatment include shortness of breath, chest pain, severe abdominal pain with vomiting, and high fever. | ||
| Diabetic Ketoacidosis Treatment | ||
| Self-Care at Home | ||
|
Home care is generally directed toward preventing
diabetic ketoacidosis and treating moderately elevated high blood sugar. * If you have type 1 diabetes, you should monitor your blood sugars at least 3-4 times a day. Check these levels more often if you feel ill, if you are fighting an infection, or if you have had a recent illness or injury. * Treat moderate elevations in blood sugar with additional injections of a short-acting form of insulin. Many people with diabetes have previously arranged with their physicians a regimen of extra insulin injections for home treatment if blood sugar levels begin to rise. * Be on the watch for signs of infection and keep yourself well hydrated by drinking non-sugary fluids throughout the day. |
||
| Medical Treatment | ||
| * Intravenous fluid replacement (given through a vein) is the primary and most critical initial treatment of diabetic ketoacidosis. This reverses dehydration and dilutes glucose and acid levels. Many liters of fluid may be required. Potassium is typically added to IV fluids to correct losses. | ||
| * Insulin will be given to lower blood sugar and to prevent further ketone formation. Once blood glucose levels have fallen to 250 mg, additional glucose may be given to allow continued insulin administration without hypoglycemia (low blood sugar). | ||
| * People diagnosed with DKA are usually admitted into the hospital for further treatment and may be admitted to the intensive care unit if their condition warrants. | ||
| * Some people with mild acidosis and fluid and electrolyte losses can be safely treated and sent home. Prompt follow-up must be arranged with the doctor. | ||
| Follow-up | ||
|
* In mild cases of diabetic ketoacidosis, you may be
treated and released from the emergency department providing that you will
promptly follow up with your doctor. * Whether you are released and sent home or monitored in the hospital, it is important that close monitoring of blood sugars be continued at home. Most authorities suggest blood sugars be aggressively monitored and treated with testing done at least 4 times a day. Elevated blood sugars should be controlled with adjustable doses of insulin, and particular attention should be paid to drinking plenty of nonsugary fluids. |
||
| * Long-term follow-up should include periodic follow-up with your doctor to achieve normal control of blood sugars and screen for and treat the complications of diabetes by periodic blood testing of hemoglobin A1C, kidney function and cholesterol, annual eye examination, and regular inspection of the feet for evidence of wounds or damage to nerves. | ||
| Prevention Steps to prevent diabetic ketoacidosis include close monitoring and control of blood sugars, especially during times of infection, stress, trauma, or other serious illness; taking insulin injections on time; and contacting the physician when needed. |
||
