Unstable and Brittle Diabetes (Advances in Diabetes)
In contrast, some patients experience debilitating pain and hyperesthesia , with loss of deep tendon reflexes. Other problems related to the destruction of nerve tissue are the result of autonomic nervous system involvement. These include impotence, orthostatic hypotension, delayed gastric emptying, diarrhea or constipation, and asymptomatic retention of urine in the bladder. Although age of onset and length of the disease process are related to the frequency with which vascular, renal, and neurologic complications develop, there are some patients who remain relatively free of sequelae even into the later years of their lives.
Because diabetes mellitus is not a single disease but rather a complex constellation of syndromes, each patient has a unique response to the disease process. There is no cure for diabetes; the goal of treatment is to maintain blood glucose and lipid levels within normal limits and to prevent complications.
In general, good control is achieved when the following occur: fasting plasma glucose is within a specific range set by health care providers and the individual , glycosylated hemoglobin tests show that blood sugar levels have stayed within normal limits from one testing period to the next, the patient's weight is normal, blood lipids remain within normal limits, and the patient has a sense of health and well-being.
The protocol for therapy is determined by the type of diabetes; patients with either type 1 or type 2 must pay attention to their diet and exercise regimens. Insulin therapy may be prescribed for patients with type 2 diabetes as well as any who are dependent on insulin. In most cases, the type 2 diabetes patient can be treated effectively by reducing caloric intake, maintaining target weight, and promoting physical exercise. In general, the diabetic diet is geared toward providing adequate nutrition with sufficient calories to maintain normal body weight; the intake of food is adjusted so that blood sugar and serum cholesterol levels are kept within acceptable limits.
Overweight diabetic patients should limit caloric intake until target weight is achieved. In persons with type 2 diabetes this usually results in marked improvement and may eliminate the need for drugs such as oral hypoglycemic agents. The patient, physician, nurse, and dietician must carefully evaluate the patient's life style, nutritional needs, and ability to comply with the proposed dietary prescription.
There are a variety of meal planning systems that can be used by the patient with diabetes; each has benefits and drawbacks that need to be evaluated in order to maximize compliance. Two of the most frequently used ones are the exchange system see accompanying table and the carbohydrate counting system.
In the exchange system, foods are divided into six food groups starch, meat, vegetable, fruit, milk, and fat and the patient is taught to select items from each food group as ordered. Items in each group may be exchanged for each other in specified portions. The patient should avoid concentrated sweets and should increase fiber in the diet. Special dietetic foods are not necessary. Patient teaching should emphasize that a diabetic diet is a healthy diet that all members of the family can follow. The carbohydrate counting system focuses on matching the unit of insulin to the total number of grams of carbohydrate in food eaten.
This system is the most accurate method for calculating insulin to food intake.follow
Brittle Diabetes: As Knowledge Advances, Aging Term Loses Favor
It is especially important that persons with diabetes who are taking insulin not skip meals; they must also be sure to eat the prescribed amounts at the prescribed times during the day. Since the insulin-dependent diabetic needs to match food consumption to the available insulin, it is advantageous to increase the number of daily feedings by adding snacks between meals and at bedtime. A program of regular exercise gives anyone a sense of good health and well-being; for persons with diabetes it gives added benefits by helping to control blood glucose levels, promoting circulation to peripheral tissues, and strengthening the heart beat.
In addition, there is evidence that exercise increases the number of insulin receptor sites on the surface of cells and thus facilitates the metabolism of glucose. Many specialists in diabetes consider exercise so important in the management of diabetes that they prescribe rather than suggest exercise. Persons with diabetes who take insulin must be careful about indulging in unplanned exercise.
Strenuous physical activity can rapidly lower their blood sugar and precipitate a hypoglycemic reaction. At this range, the levels of insulin are too low and the body would have difficulty transporting glucose into exercising muscles. The result of exercise would be a rise in blood glucose levels. Insulin Therapy. Exogenous insulin is given to patients with diabetes mellitus as a supplement to the insufficient amount of endogenous insulin that they produce.
Pancreatic islet transplant allows patient with brittle type 1 diabetes to become insulin-free
In some cases, this must make up for an absolute lack of insulin from the pancreas. Exogenous insulin is available in various types. It must be given by injection, usually subcutaneously, and because it is a potent drug, the dosage must be measured meticulously. Commonly, regular insulin, which is a fast-acting insulin with a short span of action, is mixed with one of the longer-acting insulins and both types are administered in one injection. Human insulin Humulin is produced by recombinant DNA technology. This highly purified biosynthetic insulin reduces the incidence of allergic reactions and the changes in subcutaneous tissues lipodystrophy at sites of injection.
Common diabetes terms :: SA Health
Recently, battery-operated insulin pumps have been developed that can be programmed to mimic normal insulin secretion more closely. A person wearing an insulin pump still must monitor blood sugar several times a day and adjust the dosage, and not all diabetic patients are motivated or suited to such vigilance. It is hoped that in the future an implantable or external pump system may be perfected, containing a glucose sensor. In response to data from the sensor the pump will automatically deliver insulin according to changing levels of blood glucose.
Oral Agents. Oral antidiabetic drugs see hypoglycemic agents are sometimes prescribed for patients with type 2 diabetes who cannot control their blood glucose with diet and exercise. These are not oral forms of insulin; they are sulfonylureas , chemically related to the sulfonamide antibiotics.
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Patients receiving them should be taught that the drug they are taking does not eliminate the need for a diet and exercise program. Only the prescribed dosage should be taken; it should never be increased to make up for dietary indiscretions or discontinued unless authorized by the physician. Patient Education. Successful management of diabetes requires that the patient actively participate in and be committed to the regimen of care.
The problem of poor control can cause serious or even deadly short-term and long-term complications, with devastating effects on the patient's longevity and sense of well being.
There are many teaching aids available to help persons with diabetes understand their disease and comply with prescribed therapy. In general, a patient education program should include the following components: 1. Monitoring of blood glucose status. In the past, urine testing was an integral part of the management of diabetes, but it has largely been replaced in recent years by self monitoring of blood glucose. A day that will be made possible with the continued dedication of JDRF, its many partners, our charitable supporters, the research teams and the support of the diabetes community across the globe.
Please note, this article will appear in issue 9 of Health Europa Quarterly , which will be available to read in April Saturday, September 21, Contact Us Press Releases. Health Europa. Recommended Related Articles. Cardiovascular disease related to Type 2 diabetes can be vastly reduced. A way of detecting pancreatic cancer at its earliest stages has been found. A platform for pancreatic cancer. Time to move forward with replacement therapy in type 1 diabetes. Are e-cigarettes really an effective way to quit smoking?
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The condition can lead to other serious medical problems, including seizures, hormonal imbalances, quality-of-life issues and shortened life expectancy. Morrison was diagnosed with type 1 diabetes in , when he was 16 years old. He did what he could to manage, but often had difficulty controlling his blood sugar.
Two years ago, he started having swings in glucose levels that came on without warning.
His insulin pump sensor went off as many as six or seven times a day. Morrison went on the list for a whole pancreas transplant. While waiting for the organ, Morrison read about islet transplant studies at the University of Chicago Medicine. The medical center has been at the forefront of refining this treatment since it began conducting clinical trials in Twenty patients with brittle diabetes have been transplanted.
As with whole organ transplant, patients who receive donated islets need to take immunosuppressive drugs to prevent rejection. In , Witkowski initiated a clinical trial testing an anti-inflammatory medication that may boost donor islet survival during and after infusion. The University of Chicago Medicine was the only site in the United States participating in the international multicenter trial.
The study showed promising results. Several patients were able to stop taking insulin completely, including Morrison, who became insulin free after one islet infusion. Morrison describes the change in his life since the transplant as "unbelievable.
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After the transplant, Morrison became more physically active and started running. He recently completed his first half marathon. UChicago Medicine is one of the few hospitals in the country performing islet transplants. Islet transplants are intended to treat advanced Type 1 diabetes by replacing destroyed islets with new ones. Witkowski is a leading expert in islet transplantation. He was instrumental in developing an optimized islet isolation technique that greatly improved success in clinical transplants.