Diabetes mellitus
Alternative names:
diabetes; sugar diabetes
Treatment:
The immediate goals of treatment are to stabilize the metabolism, restore normal body weight, and eliminate the symptoms of high blood glucose. The long-term goals of treatment are to prolong life, improve the quality of life, relieve symptoms, and prevent long-term complications through education, careful dietary management and weight control, medication, physical activity, self testing, and foot care.
EDUCATION
Diabetes education is an important part of a treatment plan. Diabetes educators and health care providers are available in many areas to teach essential skills needed after initial diagnosis of the disease. Appropriate education teaches people with diabetes how to incorporate the management principles of the disease into their daily lives and minimize dependence upon the health care provider.
Basic principles, called survival skills, include: - how to recognize and treat low and high blood sugar
- how to select the kinds of food to eat and when to eat them
- how to administer insulin or how to take oral hypoglycemic agents
- how to test and record blood glucose and urine ketones
- how to adjust insulin, food intake, or both for changes in the usual exercise and eating habits
- how to handle sick days
- where to buy diabetes supplies and how to store them
After the patient learns the basic principles of diabetes care and a routine has been established (several months), an education programs is helpful to learn more about the disease process, how to control and live with diabetes, and intermediate and long-term complications of the disease. Annual review of diabetes information is strongly recommended. Continually updating personal knowledge of diabetes is advised, because new research and new and improved ways to treat the disease are constantly being developed.
DIET
Meal planning includes choosing healthy foods, eating the right amount of food, and eating meals at the right time. The American Diabetes Association and the American Dietetic Association developed 6 food exchange lists for the purpose of meal planning for people with diabetes. The 6 lists are: starch or bread, meat and substitutes, vegetables, fruits, milk or dairy, and fat. Every food on the list has approximately the same amount of carbohydrate, fat, protein, and calories for the amount given. Any food on the list can be exchanged for any other food on the same list. The food exchange lists also show the number of food choices that can be eaten at each meal and snack. Using the foods on the exchange list (along with a personal meal plan designed by a registered dietitian or nutritional counselor) will control the distribution of calories throughout the day so that food and insulin will be balanced.
Meal plans differ depending on the type of diabetes. With insulin-dependent diabetes (Type I), consistency in the time meals are eaten and the amounts and types of food eaten is very important to allow food and insulin to work together to regulate blood glucose levels. If meals and insulin are out of balance, extreme variations in blood glucose can occur. In noninsulin-dependent diabetes, weight control is the most important principle in addition to a well-balanced diet.
Consultation with a registered dietitian or nutrition counselor is an invaluable tool for planning meals and controlling diet for persons with diabetes.
MEDICATION
Insulin:
Insulin lowers blood sugar by allowing it to leave the blood stream and enter the cell. Everyone needs insulin. People with type I diabetes cannot make their own insulin and must take insulin injections every day to survive. People with Type II diabetes make insulin, but are not able to use it effectively. They can survive without insulin injections, but many may take insulin shots to more effectively control blood glucose levels. Insulin must be injected under the skin using a needle and syringe, or in some cases, an insulin pump. Insulin is not available in an oral form.
There are several types of insulin preparations that differ in how fast they start to work and how long they work. Choice of the insulin type to use is made by a health care professional based on the patient's blood glucose measurements. Sometimes the types of insulin will be mixed together to provide the best control of blood glucose. Insulin injections are usually needed from 1 to 4 times per day. People needing insulin are taught to give themselves their injections by their health care providers or diabetes educators referred by their providers.
Medications:
Medications (oral hypoglycemic agents) to control blood sugar are pills usually taken once or twice per day. These medications work by preventing the body from sending sugar into the bloodstream when insulin is not working properly, releasing more insulin into the bloodstream, and helping the body's own insulin move glucose from the bloodstream into the cells. Some people need insulin in addition to oral medications. Some people no longer need medication if they lose weight because their own insulin works better without the extra weight, fat, and sugar.
Oral medications are not insulin and will not help a person who needs insulin.
PHYSICAL ACTIVITY
Regular exercise is especially important for the person with diabetes. It helps control the amount of sugar in the blood and helps burn excess calories and fat to achieve optimal weight. Exercise improves overall health by improving blood flow and blood pressure. Exercise also increases the energy level, lowers tension, and improves the ability to handle stress.
Before people with diabetes begin any exercise program, they should obtain medical approval.
Exercise considerations: - Choose an enjoyable physical activity that is appropriate for the current fitness level.
- Exercise every day and at the same time of day if possible.
- Monitor blood glucose levels by home testing before and after exercise.
- Carry food that contains sugar in case blood glucose levels get too low during or after exercise.
- Carry a diabetes identification card and change for a phone call in case of an emergency.
- Drink extra fluids that do not contain sugar during and after exercise.
- Changes in exercise intensity or duration may require diet or medication modification to keep blood glucose levels within an appropriate range.
SELF-TESTING
Blood sugar testing or self monitoring of blood glucose is done by checking the glucose content of a small drop of blood. The testing is done on a regular basis and will inform the person with diabetes how well diet, medication, and exercise are working together to control diabetes. The results can be used to adjust meals, activity, or medications to keep blood sugar levels within an appropriate range. It will provide valuable information for the health care provider to suggest changes to improve care and treatment. Testing will identify high and low blood sugar levels before serious problems develop.
There are two methods of testing blood glucose measurements at home. One method is a visual comparison with small plastic strips. A small drop of blood is placed on the pad of a strip, and the color change is matched with the color code on the test-strip bottle. The results are accurate if small changes in shades of color can be determined. The results are given in a range rather than a specific number. The second method is a meter test that provides a more exact reading of blood glucose. A test strip is used and placed in a meter to read the result.
Testing is easy to do. A health care provider or diabetes educator will help set an appropriate testing schedule. Tests are usually done before meals and at bedtime. More frequent testing may be indicated during illness or stress. Accurate record keeping of the test results will make the testing more useful for planning the care of the diabetic person.
Ketone testing is a second test that is used more frequently in Type I diabetes but is also used in Type II diabetes during stress, illness, or complications. The test is done on a urine sample. Ketones (the end products of fat metabolism) build up in the blood and spill over into the urine when sugar is not available as a fuel for the body, and fat is burned as an alterative fuel source. High levels of blood ketones may result in a serious condition called ketoacidosis. Ketone testing is usually done in the following circumstances: FOOT CARE
People with diabetes are prone to foot problems because of complications caused by damage to large and small blood vessels, damage to nerves, and decreased ability to fight infection. Blood flow to the feet may become compromised, and damage to the nerves may cause a foot injury to go unnoticed until infection develops. Death of skin and other tissue can occur necessitating their removal.
To prevent injury to the feet, diabetics should adopt a daily routine of checking and caring for the feet as follows:. - Check the feet every day and report sores or changes and signs of infection.
- Wash the feet every day with lukewarm water and mild soap, and dry them thoroughly.
- Soften dry skin with lotion or petroleum jelly.
- Protect the feet with comfortable, well-fitting shoes.
- Exercise daily to promote good circulation.
- See a podiatrist for foot problems or to have corns or calluses removed.
- Remove shoes and socks during a visit to the health care provider to remind them to examine the feet.
- Discontinue smoking because it worsens blood flow to the feet.
Support groups:
The stress of illness can often be helped by joining a support group where members share common experiences and problems. See diabetes - support group.
Expectations (prognosis):
The outcome for diabetes mellitus is variable. Good control of blood glucose levels reduces complications of diabetes. Usually Type I diabetes mellitus is more severe, and the potential for developing complications is greater. Even with good control by diet and medication of both types of diabetes, complications may result.
In gestational diabetes, blood glucose may return to normal after the delivery; however, the risk of developing diabetes in the future is greater. Maintaining normal body weight is critical in reducing the risk of diabetes for the future.
Complications:
Emergency complications: Other complications:
Calling your health care provider:
Go to the emergency room or call the local emergency number (such as 911) if symptoms of ketoacidosis are present: Note: This may occur in insulin-dependent diabetics when a dose of insulin is missed or if infection is present.
Go to the emergency room or call the local emergency number (such as 911) if symptoms of hypoglycemic coma or insulin reaction are present:
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