Autoimmune Diseases - Understanding diabetes

There are two types of diabetes, insulin dependent and noninsulin dependent. Except for the symptoms, they are unrelated.

Noninsulin dependent diabetes

In noninsulin dependent diabetes, the patient's pancreas stops producing insulin, or produces insulin intermittently. Although the reasons for the pancreatic shutdown are unknown, the suspicion is there is undue stress on the pancreas. Triggers for noninsulin dependent diabetes are weight gain (including pregnancy), bad diet, lack of exercise, and general unfit-ness. Patients with noninsulin dependent diabetes can usually be treated by an oral tablet to boost insulin production and a change in diet and behavior. Patients with extreme stress on the pancreas may have to take injectable insulin. This disease is not assumed to be inherited, although the similar body build and lifestyle of parent and child will make the offspring of a noninsulin dependent diabetic more prone to developing the disease.

Pregnancy-induced diabetes, commonly called gestational diabetes, is usually the result of the stress on the body from carrying the developing fetus. In most women, the disease ends soon after the pregnancy. In some cases, though, the woman will develop insulin-dependent diabetes after the pregnancy. The first course of treatment in pregnant women is usually to control diet. If that is unsuccessful, or the pancreas production of insulin is too low, either pills or injections may be used.

Noninsulin dependent diabetes can occur at any age, but is most common in older adults.

Insulin dependent diabetes

Often referred to as juvenile onset diabetes, diabetes mellitus, and type I diabetes, all are the autoimmune form of diabetes. The disease can develop at any age; it is as common to develop in a 20-year-old as in a 40-year-old. There are no age restrictions for developing diabetes.

By the time a patient experiences symptoms, the area of insulin production in the pancreas has been nearly destroyed by the body's immune system. It is suspected that the initial immune attack on the pancreas can start as early as one year before any symptoms are experienced.

The warning signs of diabetes are excessive thirst, excessive urination, a sweet smell to the breath, and fatigue and lightheadedness. Other possible symptoms can include unexplained weight loss (sometimes rapid), extreme hunger, and disorientation. You can have one or more of these symptoms. But it is unlikely you will have all of them.

If at any point in your life you experience any one of the symptoms you should consult your doctor immediately. There are very simple blood and urine tests to determine if you have excessive sugar levels.

If it is determined that your sugar level is high, it is probable that you will be hospitalized immediately. One reason for this is to get you into a controlled environment where your food intake, sugar levels, and urine can be monitored regularly and frequently for several days. The other and more important reason is that excessive sugar levels in the blood are damaging to the kidneys, eyes, and circulatory system, and can cause death in a matter of days if left untreated.

Once you are in the hospital, you will be trained in giving yourself insulin injections, monitoring your diet, and decreasing your sugar consumption. There is nothing complicated about the diet or the insulin amounts. The blood sugar monitoring devices are quick, accurate, and easy to use. The insulin injections are painless once you learn how to do them. The difficult part for most patients is changing their diet. This takes understanding, determination, and will power. But it is essential that the patient follow the diet guidelines.

Diabetic side effects

The most important side effects to familiarize yourself with are sugar reactions and shock, and insulin reactions and shock. They are caused by either excessive sugar or excessive insulin.

Sugar reaction and shock

Sugar shock is triggered when the insulin in the body is not sufficient to break down the sugar. The excess sugar begins travelling through the blood stream. Since the body is unable to digest the sugar without insulin present, the body must turn to another source of energy. Ketone levels build when the body begins to break down fat cells for energy. The byproduct of the ketones is an acid buildup in the blood.

The earliest stage of the problem is called diabetic ketosis; a slightly later stage is called diabetic acidosis.

The symptoms of this are the same as the onset of diabetes, because the same thing happened when the patient was first diagnosed—early diabetic ketosis or acidosis was setting in. The symptoms are: excessive urination, excessive thirst, disorientation, weight loss, dry and hot skin, and fatigue. Call your physician immediately if you experience any of these symptoms.

When the blood gets too acidic, the body goes into shock. If the patient is left untreated, he or she will go into a coma. This occurs several days after diabetic ketosis starts. The unconscious patient will have deep, labored breathing, and a fruity odor to his or her breath.

Sugar shock resembles an insulin reaction, although they can be distinguish from each other. If you find a diabetic in a coma and you do not know the cause, assume the cause is an insulin reaction and treat him initially with sugar. This will give immediate relief to an insulin reaction but will not significantly affect sugar shock.

Diabetic acidosis and sugar shock occur for many reasons. The patient does not take his insulin or oral drugs for several days. He may take too little insulin. He may overeat or under-exercise for a number of days. Illness can change the patterns of exercise and diet; the patient may need to change doses of insulin. In any case, the patient should be brought to a hospital immediately, where he or she may be admitted for further observation.

Insulin reaction and shock

Insulin reactions are caused when the quantity of sugar is insufficient to burn up the insulin in the blood. When there is not enough sugar, the blood sugar level falls, and the brain is deprived of an essential source of energy. This was commonly known as hypoglycemia, although the term is not currently used in medicine.

Insulin shock can be brought on by excessive insulin injection, excessive exercise, or undereating. Stomach viruses that cause vomiting and diarrhea need to be especially monitored in diabetics because the illnesses change the amount of sugar being absorbed by the body. Less insulin is usually required than normal.

The first sign of an insulin reaction is usually mild hunger. Sweating, dizziness, palpitations, shallow breathing, trembling, mental confusion, strange behavior, and loss of consciousness follow rapidly. The symptoms will appear fairly quickly. There is much less time to treat insulin reactions and shock than there is to treat sugar shock. Insulin reactions should always be treated as an immediate medical emergency.

Diabetics who use insulin should always have sugar or quick dissolving candy on hand for treating insulin reactions. They must learn to recognize the early symptoms of increased insulin levels.

If you find a diabetic unconscious, give sugar to him or her immediately, then call an ambulance. Some shocks need to be treated with intravenous glucose. Notify the medical team immediately that the patient is a diabetic.

Medical bracelets

Because immediate treatment can be lifesaving with a diabetic, it is important that the diabetic have some identification on him or her at all times explaining that he or she suffers from diabetes. If the patient loses consciousness, this ID can save his or her life. Your physician or pharmacist can help you get an ID piece to wear.

Long-term side effects

Long-term side effects are caused by sugar crystals passing through small tubes of the circulatory system. If the sugar crystals are larger than the tubes, as is the case with capillaries, then the tubes are scratched, torn or destroyed by the sugar.

This damage can cause plaque to build up on the inside of the arteries, leading to atherosclerosis and heart disease. It can cause scarring and hemorrhaging in the kidneys, leading to kidney failure and kidney disease. It can cause hemorrhaging in the back of the eyes because of tears to the capillaries and reduction of blood flow to the hand and feet, because of tears in the capillaries that provide blood to the extremities.

This lack of blood flow makes healing take longer, and infections become more likely. With reduced blood flow, the body cannot battle the infection as well, so infections are likely to be worse. Blisters won't heal as well, and scratches and cuts, particularly on the feet, are likely sources of infections.

Since the blood flow to the extremities is reduced, the nerves are not as well nourished and may begin to die off in the hands and feet. This causes unusual sensations and pain as it happens and leads to numbness in the extremities.

With reduced feeling, the diabetic is less likely to notice the small injuries, making him or her even more prone to infections. Particular care must be paid to the condition of hands and feet, and daily visual checks should be made of hands and feet to make sure no injuries go undetected.

Catching injuries early helps immeasurably in preventing serious infection.

The diabetic is at risk of losing arms and legs because of the eventual decreased blood flow to the limbs. As nerve impulse is lost from these regions, the body is unable to recognize when an injury occurs. This becomes a problem for the diabetic because exercise is an important part of the daily health care for the disease. So, the diabetic must consider the types of exercise he or she will do with some care.

Early in the disease, these concerns are minimal, since there is still strong nerve response from the limbs. However, as the disease progresses, it may become important to reassess the types of athletics the patient is involved in. Diabetics should consider swimming over running, since there is less impact on the limbs in non-weight-bearing exercise.

Even with good management, there is some chance that the diabetic may lose eyesight, limbs, or kidney functions. Many years ago, these were considered end-stage complications of diabetes. This is no longer the case. Disease management has allowed diabetics to undergo amputations and still survive years after the surgery. With the improvement of prosthetic devices, the ability to lead normal lives is maintained. Laser surgery for retinal hemorrhaging in the eyes has improved the treatment of eye disease in diabetics. And improved dialysis allows patients regular treatment without the discomfort that was previously associated with dialysis.

Improvements in treatment and management occur regularly, with occasionally dramatic results. Research in autoimmune diseases, and particularly diabetes, is enhancing the understanding of and the treatment of the disease.

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