Common Characteristics of Diabetes
Diabetes is a chronic disease in which, because of an insufficiency or total lack of the hormone insulin, the body cannot use the sugars and starches in the diet properly. The disease takes two forms: insulin-dependent (juvenile-onset) and non-insulin-dependent (maturity-onset) diabetes. The latter can usually be controlled without insulin (hence the name) and is the less serious form of diabetes. Non-insulin-dependent diabetes usually affects people 40 years of age or older and is more common among women than among men. Many of those affected are overweight, some seriously so. It seems probable that the condition is due to an inherited predisposition and that some external agent is required to convert the genetic tendency into the disease. What that external agent is, is not known.
Insulin
The hormone insulin is produced by small cells in the islets of Langerhans, scattered throughout the pancreas. Insulin regulates the body’s use of sugar by metabolizing glucose so that it can be used for immediate energy needs or stored for future use in the form of glycogen. (Glucose is the main source of energy for all body cells; it is derived from carbohydrates during the digestive process or from fats or proteins that are converted to glucose.)
Non-insulin-dependent diabetes results from the failure of the islets to produce sufficient insulin to overcome a number of anti-insulin factors that occur in certain individuals.
Symptoms and Diagnosis
The most common symptom of diabetes is thirst, accompanied by frequent urination (as often as once an hour). There may be repeated infections of the skin, gums or urinary tract and fatigue, weakness or apathy. Tingling sensations in the hands and feet, cramps in the legs and blurred vision are further symptoms. Sometimes there are no apparent symptoms at all, and the condition is detected in the course of a routine medical checkup.
The presence of diabetes is confirmed by a simple test in which the fasting blood glucose level is measured; if it is persistently elevated, the patient has diabetes.
Treatment of Diabetes
The purpose of treatment is to relieve the symptoms, reduce the amount of glucose in the blood and urine and lower the risk of complications. For almost a third of non-insulin-dependent diabetics, the disease can be controlled by diet alone. The diet must be designed by a doctor and carefully adhered to by the patient.
In a typical diabetic regimen, calories (800 to 1500 daily, depending on the patient’s excess weight) are distributed in small meals taken at regular intervals, keeping the blood glucose level as steady as possible. Carbohydrates make up 50 to 60 percent of the total intake, with plenty of fibrous foods such as whole grain breads and cereals, fruits and vegetables. Simple carbohydrates are restricted to 5 to 15 percent of all carbohydrate calories and should come from natural sources such as milk and fruit rather than from candies, cookies and so on. Of the total calories, 30 to 35 percent come from fats and 12 to 20 percent (depending on age and activity) from protein. Compared to the average American diet, the diabetic regimen requires reducing the intake of sugar, fat, protein and salt, and increasing the intake of complex carbohydrates and fiber. Key factors are controlling the intake of simple carbohydrates, particularly sugar, honey and other sugars; eating balanced meals and achieving and maintaining an ideal body weight for the control of the disease.
Medication
If diet alone is insufficient to manage the disease, medication will be prescribed to lower the blood glucose. These drugs, generally referred to as oral hypoglycemic agents, appear to work by stimulating the release of insulin and also by increasing its effects on blood sugar. In severe cases, insulin injections may be required, but this is unusual in maturity-onset diabetes, at least in the early stages of the disease.
Occasionally, when too high a dosage of medication is taken, hypoglycemia (a low level of blood glucose) will result. The onset of hypoglycemia is usually gradual, with symptoms that include sweating, nervous irritability and a tingling tongue. In extreme cases, hypoglycemia may cause loss of consciousness. Sugar lumps or some other quick-energy food should always be carried when away from home and taken at the first symptoms. You should also carry a card explaining your condition and detailing what should be done in an emergency. A Medic-Alert bracelet is an additional safeguard.
Testing
The effectiveness of the treatment in keeping blood glucose at an acceptable level must be checked regularly. You may be asked to test your urine daily or twice daily, using specially prepared paper reagent slips. (In the morning, perform the test on the second specimen that is voided; the first is always positive.) If the urine is free or almost free of glucose, the diabetes is under control.
Many doctors prefer that their patients monitor the glucose level in the blood rather than in the urine. Self-monitoring kits are now widely available. A small needle or lancet is used to prick a finger and a drop of blood is squeezed onto a chemically treated strip. The strip is then either compared to color samples or inserted into a meter to identify the glucose level.
Stress
Surgery, trauma or any illness (from a cold to a heart attack) may cause stress and thus increase the body’s demand for insulin. Doctors and dentists should be told about your condition before starting treatment, so that they can take proper precautions.
Summing Up
Once a diagnosis of diabetes is confirmed, and proper treatment is begun, most diabetics are able to lead normal, productive lives. Although self-discipline, especially in weight-control, is vital in managing the disease, it is most important that the fact of having diabetes not be allowed to dominate day-to-day living.
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