Diagnosis and Drug Treatment
Diagnosis and Drug Treatment
When someone's pancreas stops producing insulin, which creates type 1 diabetes, the person will develop signs of the disease in weeks or months. This is what happened to Nick Jonas, one of the three New Jersey brothers who make up the popular Jonas Brothers band.
In 2005, when Nick was twelve, he noticed he was having “the usual symptoms: losing weight, the bad attitude, being thirsty, going to the bathroom all the time,”15 he said. For several weeks, weight practically fell off of him, and “it was just insane,” he explained. “I had a terrible attitude, which was totally odd for me because I'm actually a nice person.”16
He took time out from the band's tour and saw a doctor, who sent him to the hospital. Nick was diagnosed with type 1 diabetes and put on insulin. Until this time, he had always been a healthy person.
On the other hand, type 2 diabetes creeps up slowly over decades. As someone becomes more overweight and less active, and for other reasons, the insulin produced by his or her pancreas becomes less able to help flush excess glucose out of the body. Often, a person can be prediabetic and have this faulty glucose tolerance for many years with no outward symptoms. However, even though the blood glucose level is not high
enough to be in the diabetic range, it is higher than the healthy range and can begin causing damage to every cell in the body. When diabetes is finally diagnosed, harm has already been done to the eyes, kidneys, and other organs.
The symptoms of diabetes are now fairly well known. This is important because the sooner the illness is diagnosed, the sooner treatment can begin.
When the human body senses that something is not working right, it will try to find a way to fix the problem. When the body cannot absorb all the glucose traveling in the bloodstream, it pulls the extra sugar, along with water, out of the blood and puts it in the urine. Then it gets eliminated in large quantities, many times day and night. This means a person with type 1 diabetes will have to urinate a lot.
Then, as a person with diabetes continues to urinate too much, the body loses water and begins to dehydrate, just like a sponge drying up. This is a dangerous condition, since water makes up a large percentage of the human body. The brain is 70 percent water, the lungs are 90 percent water, and so is nearly 83 percent of our blood. As too much water leaves the body, the person becomes very thirsty and keeps drinking more liquid.
Since the body is eliminating a lot of glucose in the urine, its usual source of energy from food is very low. But it knows that plenty of energy is stored in the muscles and fat, so it starts breaking them down as it searches for energy. This extreme breakdown of muscle and fat soon can make a person with diabetes dangerously thin and very sick. Like Jonas, people with uncontrolled diabetes lose weight very fast without trying. Nick lost 15 pounds (7kg) in three weeks. However, since the glucose does not have insulin to help it enter the cells, the body's cells will actually be starving for energy. This makes a person feel very hungry much of the time, despite frequently eating large amounts of food.
Due to all these conditions, a person with undiagnosed or uncontrolled type 1 diabetes will often feel extremely weak.
The muscles and the brain cannot get the energy they would normally get from glucose.
Some people with type 1 diabetes may experience what is called diabetic ketoacidosis—a long name for a dangerous condition that has two causes. First, too much of the fat in their bodies breaks down in order to supply the energy they would normally get from blood glucose. This forms ketone bodies that accumulate in the blood, which can cause nausea, abdominal pain, and vomiting. Then, as their glucose levels rise to very high levels, their blood becomes very thick (remember that water is being taken out of the blood and put into the urine), and it cannot circulate very well through the body. The combination of all these things causes extreme drowsiness and loss of consciousness. If this situation is not quickly remedied, the person could die.
Some people with type 2 diabetes have few or no symptoms for a long time, but they will eventually develop various symptoms. Just as with type 1 diabetes, people with type 2 urinate frequently and have great thirst. They also feel weak and tired. In addition, diabetes harms the white blood cells, which help the body heal and prevent infections. Therefore, having type 2 diabetes means that infections of the skin, gums, and urinary tract heal very slowly. Blurry vision can also occur because as levels of blood sugar rise and fall, the eyes swell and shrink. Since they cannot easily adjust to these changes, the vision blurs as a result. Yeast infections thrive in environments with lots of glucose, such as in a body with type 2 diabetes, so genital itching that lasts for a long time is a common symptom of type 2.
Sixty percent of people with diabetes have some problem with their nervous system. Type 2 diabetes harms the nervous system by causing a condition called neuropathy. When neuropathy damages the nerves in the feet or legs, they can become numb, tingly, or very sensitive to touch. This can lead to serious infections and even amputation of the limbs. Neuropathy takes a long time to develop, often ten years or more, and no symptoms may appear for a long time, even though damage to the
body is already occurring. It can sometimes be reduced or even healed when blood sugar is brought down to normal levels.
A serious complication of type 2 diabetes is cardiovascular disease, or heart attacks and strokes. They strike people with diabetes twice as much as people without diabetes. Diabetes can alter some of the substances in the blood, which can cause the blood vessels to narrow or clog up. This is called hardening of the arteries, which leads to stroke or heart attack.
People with type 1.5 diabetes are usually adult but do not have all the symptoms of type 2, so some doctors and researchers are beginning to call this late onset type 1 diabetes. These people may be thin and active, yet it is difficult for their bodies to control glucose levels. In its early stages, type 1.5 does not require
About 47 million adults in the United States have a group of risk factors, called metabolic syndrome, that can increase the chances of developing diabetes as well as heart disease and stroke. The five conditions, which must occur together to be considered metabolic syndrome, are:
- Obesity in the abdomen, resulting in a body being “apple-shaped.”
- A higher than normal level of the fat in the blood called triglycerides.
- A lower than normal level of “good” cholesterol, called HDL (high density lipoprotein).
- High blood pressure, or taking medicine to control high blood pressure.
- Higher than normal fasting blood glucose, or being on medicine to treat it.
insulin, but it often quickly leads to type 2 and requires insulin. Often, gestational diabetes has no symptoms, or they are mild and not threatening. If a pregnant woman does have symptoms, they may include blurry vision, increased thirst and urination, fatigue, nausea and vomiting, and weight loss even with increased appetite. Typically, blood glucose levels return to normal after the baby is born.
This condition must be treated not only for the mother's sake, but also to protect the baby from developing harmful conditions. Before birth, the baby's heart may experience extra stress. The baby may be born very large and with extra fat, which makes delivery more dangerous for both the baby and the mother. The baby might also have a condition called spina bifida, in which the spine is deformed. Right after birth, the baby may have extremely low blood glucose, and breathing problems may be another complication.
Doctors use several tests to check for diabetes and prediabetes in their patients. All of them require that blood be drawn and tested in a medical lab. The first one is called the fasting plasma glucose (FPG) test. This test measures a person's blood glucose after eight hours of not eating or drinking anything. The FPG is most reliable when it is done in the morning, and it is also the most convenient of the three tests for diabetes or prediabetes. If the fasting glucose level is 99 mg/dL (milligrams per deciliter) or below, the person does not have diabetes. If the level is 100–125 mg/dL, the person has a kind of prediabetes called impaired fasting glucose. This person does not have type 2 diabetes yet but is likely to develop it later.
If the fasting glucose level is 126 mg/dL or higher, the doctor will perform the test again to confirm the results. If the same results appear the second day, the person has diabetes.
The oral glucose tolerance test (OGTT) is another measure of blood glucose after fasting for eight hours as well as two more hours after the person drinks a liquid containing glucose.
After eight hours of fasting, blood is drawn and its glucose level is measured to provide a baseline number. Then the person
drinks a special beverage of glucose dissolved in water. Two hours later blood is drawn again, and the glucose level is checked once more.
A blood glucose level of 140–199 mg/dL two hours after the drink means the person has a form of prediabetes called impaired glucose tolerance and is likely to develop diabetes in the future. If the level is 200 mg/dL or higher, the test will be performed again the next day. If the results are again 200 mg/dL or higher, the person has diabetes.
The OGTT is also used to diagnose gestational diabetes, except that blood glucose levels are checked four times during the test. If levels are higher than normal in at least two of the four checks, the woman has gestational diabetes.
The third test is the random plasma glucose test. The blood glucose level is checked regardless of when the person last ate. This test is only for diagnosing diabetes. A person can have diabetes if the blood glucose level is 200 mg/dL or higher and also has symptoms including increased urination and thirst, weight loss for no known reason, and also is experiencing increased hunger, sores that will not heal, blurred vision, and fatigue. If this is the case, the person should undergo either the FPG or the OGTT to verify the diagnosis.
Successfully treating diabetes requires different strategies for the various types, and people with the illness must do what is best for them within those strategies. But two things are crucial: monitoring blood glucose levels and, in many cases, using insulin and perhaps other drugs.
Even diabetics who are able to carefully control their glucose can experience a wide range in levels, depending on many variables such as what they have eaten, their activity and stress level, illness, and the amount of sleep they get. Therefore, all people with diabetes must check their blood sugar several times a day and monitor its levels closely. First of all, people who can keep their blood glucose levels at ideal levels will feel
better and have more energy, and they can also prevent or hold off diabetic complications longer. According to the National Institutes of Health, ideal blood glucose levels are 70 to 130 mg/dL before meals and less than 180 mg/dL one to two hours after the start of a meal.
A check of blood sugar levels must be done several times a day. The number of times is determined by the type of diabetes, the kind of treatment used, and how stable the person's glucose levels usually are.
People with type 1 or 2 who are taking insulin need to test before each meal and at bedtime. Why? These checks will give them the information they need to adjust their insulin dose. People with diabetes cannot know how well they are controlling their blood glucose, no matter how well they feel, unless they do these frequent checks. For most people with type 2 diabetes, testing just twice daily—before breakfast and dinner—gives enough information if blood glucose levels are fairly stable.
Checking blood glucose can also be helpful at other times—for instance, after trying a food not normally on one's diet—to see how it affects glucose levels. Before exercise is another good time. The test will reveal whether eating before exercising is a good idea or if exercise can be used to bring down the level. Finally, if a diabetic person has been experiencing unstable glucose levels and is about to drive, a test beforehand will reveal if hypoglycemia might be a problem. Hypoglycemia can cause the brain to not function as well as it normally does, which can be dangerous while driving.
Checking one's blood sugar levels requires a tiny sample of blood, usually from a fingertip. It is taken with a lancet, which is similar to a small needle and now often built into blood glucose meters. The lancet penetrates the skin just enough to get a drop of blood. Using the side of a finger is recommended, since the sides are less sensitive than the tips, as well as changing fingers often, so any one finger does not get sore or too sensitive.
Then the sample is placed on a test strip, also stored in the meter, which is coated with special chemicals that react with the glucose. The test strip is placed in the glucose meter for the reading, and the number will show on a small screen.
Another important test for blood glucose is performed by a doctor to show a person's blood sugar levels over the past two or three months. It is called the hemoglobin A1c test.
Hemoglobin, a red protein that carries oxygen in the bloodstream, attaches to glucose to form hemoglobin A1c. By testing for this, a diabetic person and the physician can look back in time and see if blood glucose levels were well controlled or not. If they are well controlled, the person is more likely to avoid complications such as blindness or neuropathy. Also, it will show if treatment is working by showing improvement in glucose levels. If the treatment is not working, the doctor and the person will know it needs to be adjusted.
The major treatment for type 1 diabetics is replacing the insulin that their bodies can no longer make. Several times daily, they receive insulin through injections they give themselves or through a small computerized pump worn at the waist that automatically injects insulin under the skin at the right times. These insulin pumps are already common. In the United States they are worn outside the body on a belt or waistband; in Europe, one version that can be implanted inside the body has been approved for use. In the waistband model, insulin is delivered inside the body through a small tube called a catheter. The implanted version goes under the skin and is refilled with insulin every few months. Some people with type 2 take insulin, too, but often they can regulate their blood sugar by eating healthy foods, exercising, losing weight, and not smoking.
When insulin for use by diabetics was first created, it was made from pig and cow pancreases, so it was not very pure and the quality was often bad. Fortunately, modern medicine can now produce synthetic insulin of the highest quality and purity from genetically engineered bacteria. It is identical to the insulin created by the human pancreas.
This manufactured insulin is also made in four types that act differently in the body in three ways. First is onset, or how long
after injection the insulin begins to work. Second is peak, or how long after injection the insulin reaches maximum effectiveness. Third is duration, or how long the insulin remains effective.
The four basic types of insulin each have their own onset, peak, and duration. It is common for people with diabetes to use these four types of insulin in various combinations to better manage their illness. The rapid-acting type begins working
Are Insulin Pumps Risky for Teens?
Scientists from the Food and Drug Administration (FDA) have found that insulin pumps may pose risks for adolescents. Their review discovered thirteen deaths and more than fifteen hundred injuries related to the pumps over a decade. Sometimes the pump did not work correctly, but teens also took risks with their pumps or were careless, dropping their pumps or not taking proper care of them. Two teens may have tried to commit suicide by giving themselves too much insulin through their pumps.
Teens like the pumps, which are worn on the body and send insulin into the body through a tube inserted under the skin, because they eliminate the need to inject insulin manually several times a day. However, teens using the pumps must still frequently monitor their blood sugar and adjust their insulin in-take through the pump. Doctors are advised to carefully screen their diabetic teen patients to make sure they are able to use and care for their insulin pumps correctly.
in 15 minutes, peaks in 30–90 minutes, and has a duration of 3–4 hours. The short-acting type begins working in 30–60 minutes, peaks in 2–3 hours, and has a duration of 3–6 hours. The intermediate-acting type begins working in 90 minutes to 6 hours, peaks in 4–14 hours, and has a duration of up to 24 hours. Last, the long-acting type begins to work in 6–14 hours and has a duration of 24–26 hours.
Many people with diabetes take oral medications along with insulin or alone to better manage their condition. These medications come in various categories, based on type, and each works differently. They can have side effects, including upset stomach, low blood glucose, weight gain, liver failure, headache, and fluid retention. They must be taken as prescribed and under a doctor's care. Studies have shown that diabetes and its complications might be prevented by these oral medications. This is especially true when the person taking them also eats a healthy diet and gets adequate regular exercise.
Thinking about the possible complications of diabetes can be frightening. No one wants to believe they could go blind or have a foot or leg amputated or suffer from kidney failure. Yet, understanding the complications of diabetes soon after diagnosis is the best way to begin preventing them. Maintaining a healthy, proper diet, exercising regularly, and monitoring blood glucose as often as needed are the best first steps.
Additional steps must be taken to delay or prevent the onset of diabetic complications. No one, including people with diabetes, should smoke. Smoking damages the heart and narrows the blood vessels, which are already under stress from the diabetes. Blood pressure must be kept low. Hypertension, or high blood pressure, puts a strain on the body and can cause eye disease to progress faster. Losing weight and exercising, limiting salt for some people, and medications can all lower blood pressure.
People with diabetes should have annual physicals and regular eye exams to spot early signs of complications. They
should also get good dental care. Gum infections are common in people with diabetes. Flossing, brushing, and regular dental exams can prevent them. Feet can be a victim of diabetes because cuts and blisters can easily become infected and be slow to heal. Feet should be washed daily in lukewarm water, dried gently, and moistened with lotion. They should be checked daily for blisters, cuts, swelling, and redness.
Drinking alcohol in moderation and always with a meal, for those who drink it (and who are old enough), will help prevent highs and lows in blood sugar. Keeping stress levels as low as possible will help the body to keep insulin working properly.
For people with diabetes, the first step in taking care of themselves is receiving a diagnosis with one of the reliable tests available today. Once the diagnosis has been confirmed, the use of insulin and perhaps oral medications, closely supervised by a doctor, will help them keep their illness under control.