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DIABETES MELLITUS Diabetes
= running through Mellitus = sweet Diabetes is a disorder of the metabolism, which occurs
when there is insufficient insulin activity in the body. Food is broken down in the normal way. Glucose is absorbed into the
bloodstream in the normal way, but there is not enough insulin or insulin action. With little insulin action, glucose can
not get into most cells. Blood glucose levels rise leading to hyperglycemia (high blood sugar). During food metabolism, most of the carbohydrates is broken down into glucose and other simple sugars. The glucose is then absorbed into the bloodstream to be used for energy. Blood glucose rises promptly after food is eaten. Insulin, a hormone that regulates glucose metabolism is released from the beta cells in the pancreas in response to the elevated blood glucose levels. Cells have receptor sites on the outside. When insulin attaches to the receptor sites, a passageway is made and glucose goes into the cells. Insulin "opens" the cells like a key. Because glucose goes out of the blood and into the cells, blood glucose levels stay in the normal range and the cells receive glucose for energy production. TYPES OF DIABETES There are several types of diabetes. The two most common types are Type 1 and Type 2. In Type 1 (insulin dependent diabetes; formerly called juvenile-onset diabetes mellitus), the pancreas makes little or no insulin due to the autoimmune destruction of the insulin producing cells in the pancreas. Type 1 diabetes can begin at any age, but usually occurs in children and young adults. In Type 2 (non-insulin dependent diabetes; formerly called adult-onset diabetes mellitus), there is resistance to the action of insulin generally due to being overweight or obese. Type 2 diabetes accounts for 85% of the cases of diabetes. RISK FACTORS FOR DEVELOPING DIABETES Heredity is a factor in both types of diabetes, but is more often associated with Type 2. Immunologic factors (antibodies working against the beta cells of the pancreas that produce insulin) and viral factors (post mumps, rubella, or coxsackie) are thought to be involved in the development of Type 1 diabetes. Being overweight is the most common precipitating factor in developing Type 2 diabetes. At the time of diagnosis, 80-90% of people are obese. Stress, both emotional and physical, may precipitate or aggravate Type 1 and Type 2 diabetes. Incidence of Type 2 diabetes increases with age, with certain medications and injury to the pancreas. Native Americans, Hispanic Americans and African Americans have a higher incidence of Type 2 diabetes. TREATMENT OF DIABETES MELLITUS There are six components of a treatment plan that can help keep blood glucose levels in an acceptable range. LIFE STYLE MODIFICATIONS 1.) MEAL PLANNING (Medical Nutritional Therapy) Nutrition intervention is one of the cornerstones of treatment for any person who
wants to improve his/her health, especially those with diabetes. The general goal is to guide the person with diabetes in
making appropriate food choices and behavioral changes that will aid in improvement of blood glucose levels and overall nutritional
status. There are several natural nutrients that can lower blood sugar that are frequently deficient even in a good nutritional
program. (see Blood Sugar Support). Vital Nutrients If purchasing register and use patient code: 10138 (2.)
EXERCISE PLAN Exercise lowers
blood glucose because exercise increases the rate of burning of blood glucose (metabolism). In Type 2 diabetes, exercise will
also cause cells to be more sensitive to the effects of insulin. A history and physical exam is needed before engaging in
an exercise program. A stress EKG is recommended for people over 35 with diabetes because of the increased risk of heart problems
in persons with diabetes. Even a small weight loss (10-20 lbs) can lower blood glucose significantly. (3.) MEDICATION Many people with diabetes use manufactured insulin to take the place of insulin they can no longer make on their own. The treatment of Type 1 diabetes always includes insulin. People with Type 2 diabetes often take insulin but may be treated with oral medication. There are many different types of oral medication which can be tailored to an individual's lifestyle and medical condition. (4.) MONITORING DIABETES Monitoring diabetes provides information about blood glucose levels and the effects of meal pattern, food intake, medication, activity and stress. Monitoring schedules and methods will be determined after examination and discussion with a health care provider. (5.) SELF-MANAGEMENT Most (95-99%) of the daily care of diabetes is self-care. One of the most important things a person can do is learn about diabetes and how to manage blood glucose levels. Many studies have shown that people can greatly reduce or eliminate the risk of blindness, kidney failure, heart attacks, nerve damage, amputations and other related risks with proper control of diabetes. (6.) STRESS MANAGEMENT
It is a known scientific fact that distress (negative stress: not all stress
is negative) can raise blood sugar faster and higher than a pint of ice cream. The major stress hormones adrenaline and cortisol,
as well as other bodily responses, to the "fight or flight" response raises blood sugar so that if you do need to
"fight or flight" you will have the sugar (fuel) in your blood for energy. We no longer have to escape from
wild animals, attacking barbarians, etc. as did our ancestors for thousand of years. Our distress, though not as threatening
can have an impact on our health if we not prepare ourselves physically (exercise), mentally (faith, hope, compassion etc.)
and emotionally (we are never given more then we can deal with, get help when that seems not to be the case).
Self management is no less true on the ground than at 30,000 feet high in a airplane. You are told before take-off
if the cabin pressure drops, oxygen masks will fall, if you are traveling with someone who can not help themselves, you are
instructed to put your mask on, then help them. Your self-care; may save the life of your loved ones and without it, you
both may perish. Oral
Diabetes Medications (Diabetes Pills)
Oral diabetes medications -- diabetes pills -- help control blood sugar levels in people whose bodies still produce some insulin (the majority of people with type 2 diabetes). These diabetes drugs are usually prescribed to people with type 2 diabetes along with recommendations for making specific dietary changes and getting regular exercise. Several of these diabetes pills are often used in combination to achieve optimal blood sugar control. Remember that people with type 2 diabetes tend to have two problems that lead to increased sugar (glucose) in the bloodstream: They don't make enough insulin to move glucose into cells where it belongs. The body's cells become "resistant" to insulin ( insulin resistance), meaning they don't take in glucose as well as they should. In time, people with type 2 diabetes develop what's called "beta-cell failure." This means that the cells in the pancreas that make insulin no longer are able to release insulin in response to high blood sugar levels. Therefore, these people often require insulin injections, either in combination with their diabetes pills, or just insulin alone to manage their diabetes. What Types of Diabetes Pills Are Available? Diabetes pills are grouped in categories based on type. There are several categories of diabetes pills -- each works differently. Sulfonylureas - These diabetes pills lower blood sugar by stimulating the pancreas to release more insulin. The first drugs of this type that were developed -- Dymelor, Diabinese, Orinase and Tolinase -- are not as widely used since they tend to be less potent and shorter-acting drugs than the newer sulfonylureas. They include Glucotrol, Glucotrol XL, DiaBeta, Micronase, Glynase PresTab, and Amaryl. These drugs can cause a decrease in the hemoglobin A1c (HbA1c) of up to 1%-2%. Biguanides - These diabetes pills improve insulin's ability to move sugar into cells especially into the muscle cells. They also prevent the liver from releasing stored sugar. Biguanides should not be used in people who have kidney damage or heart failure because of the risk of precipitating a severe build up of acid (called lactic acidosis) in these patients. Biguanides can decrease the HbA1c 1%-2%. An example includes metformin (Glucophage, Glucophage XR, Riomet, Fortamet and Glumetza). Thiazolidinediones - These diabetes pills improve insulin's effectiveness (improving insulin resistance) in muscle and in fat tissue. They lower the amount of sugar released by the liver and make fat cells more sensitive to the effects of insulin. Actos and Avandia are the two drugs of this class. A decrease in the HbA1c of 1%-2% can be seen with this class of oral diabetes medications. These drugs may take a few weeks before they have an effect in lowering blood sugar. They should be used with caution in people with heart failure. Your doctor will do periodic blood testing of your liver function when using this diabetes medicine. Alpha-glucosidase inhibitors - Precose and Glyset. These drugs block enzymes that help digest starches, slowing the rise in blood sugar. These diabetes pills may cause diarrhea or gas. They can lower hemoglobin A1c by 0.5%-1%. Meglitinides - Prandin and Starlix. These diabetes medicines lower blood sugar by stimulating the pancreas to release more insulin. The effects of these diabetes pills depend on the level of glucose. They are said to be glucose dependent. High sugars make this class of diabetes medicines release insulin. This is unlike the sulfonylureas that cause an increase in insulin release, regardless of glucose levels, and can lead to hypoglycemia. Dipeptidyl peptidase IV (DPP-IV) inhibitors -The DPP-IV inhibitors (Januvia) work to lower blood sugar in patients with type 2 diabetes by increasing insulin secretion from the pancreas and reducing sugar production. These diabetes pills increase insulin secretion when blood sugars are high. They also signal the liver to stop producing excess amounts of sugar. DPP-IV inhibitors control sugar without causing weight gain. The medication may be taken alone or with other medications such as metformin. Combination therapy - There are several combination diabetes pills that combine two medications into one tablet. One example of this is Glucovance, which combines glyburide (a sulfonylurea) and metformin. Others include Metaglip, which combines glipizide (a sulfonylurea) and metformin, and Avandamet which utilizes both metformin and rosiglitazone (Avandia) in one pill. Studies have been done showing that some diabetes pills may help prevent diabetes and diabetes-related complications. Both metformin and Precose have been shown to reduce a person's risk of developing type 2 diabetes, particularly when combined with lifestyle changes such as a proper diet and regular exercise program. Actos has been shown to reduce the risk of heart attack, stroke, and premature death in those with type 2 diabetes. Researchers continue to look into the preventative benefits of other medications. ( Excerpt from WebMD.Com ) |