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Diabetes Mellitus

more about Diabetes Mellitus

Sugar diabetes

  • The body requires glucose (a type of sugar) to provide the energy needed to perform its functions.  In fact, all body tissue, especially the brain, needs continuous glucose.  Hormones in the body carefully control blood sugar levels.  Insulin prevents the blood sugar from becoming too high.  Since insulin is produced by the beta cells in the pancreas, diabetes occurs when the pancreas does not produce enough insulin, or the cells and tissues cannot utilize that insulin properly (insulin resistance).
  • Diabetes is often categorized into two types: Type I (Insulin-dependent) and Type II (non-insulin dependent).  Type I is sometimes called juvenile onset diabetes.  In general, the onset of diabetes in those below 25 years of age is generally diagnosed as Type I diabetes, and is caused by the pancreas' not making enough insulin.  Type I has two peak age groups: 5-7 years of age, and puberty.  In general, the onset of diabetes in those above 40 years of age (Type II), is due to insulin-resistance with varying degrees of a lack of insulin secretion.
  • Occasionally, younger obese children will have insulin-resistance type diabetes.
  • When the blood sugar becomes high, the body tries to get rid of the excess sugar by trying to urinate it out.  This leads to Dehydration and is the reason diabetic symptoms are usually excessive thirst and urination.

  • Type I diabetes:
    1. Excessive thirst
    2. Frequent and large volume urination
    3. Dehydration
    4. Rapid weight loss
    5. Weakness, lack of energy
    6. Increased eating
    7. Skin Infection
  • Type II diabetes:
    1. Thirst
    2. Frequent urination
    3. Dehydration
    4. Frequent female yeast infections
    5. Sometimes, there are no symptoms

  • Strong genetic component (family history) especially Type II diabetes
  • Type I Diabetes can be caused by an autoimmune mechanism.  It is associated with like autoimmune disorders, such as Addison's disease, Hashimoto thyroiditis, and pernicious anemia and viral infection (i.e., Mumps, congenital rubella, coxsackievirus).
  • Pancreatic tissue damage, such as Cystic Fibrosis, Cushing syndrome, and ingestion of certain drugs or poison (rare cause)

  • One definition of diabetes (there are others):
    1. Classic symptoms of excessive thirst, large volume of urine
    2. Fasting plasma glucose over 126 mg/dl or 2-hour  plasma glucose during the oral glucose tolerance test over 200 mg/dl
    3. Abnormal hemoglobin A1C measurement

  • Follow diabetic diet guidelines -- avoid concentrated sugars such as sodas, juices, deserts, and high sugar fruits such as grapes.
  • The proper calories and nutrients -- 55-60% carbohydrate, 25-30% fat, and 15-20% protein.
  • Exercise
  • Psychological support
  • Medications:
  • Insulin injections -- various short and long acting forms available to supplement insulin.
  • Note: Current medical studies show that controlling blood sugars with proper diet and medication decreases the chance of complications.  In addition, controlling blood pressure and cholesterol if they are elevated also helps decrease the risk of diabetic complications.

  • Retinopathy -- eye damage and blindness may occur
  • Higher risk of Glaucoma
  • Higher risk of Cataracts
  • Nephropathy -- kidney damage
  • Neuropathy -- damage to nerves occurs, especially in the lower legs.  In addition, neuropathy may affect the nerves to the heart so that a diabetic may not feel chest pain from a heart attack.  Another form that affects the heart is called autonomic dysfunction, in which the heart does not increase its rate when it needs to.  Also, the stomach, intestines, and colon may be affected, and not function properly (gastroparesis).  See section on diabetic neuropathy for a more detailed explanation.
  • Heart disease -- angina, heart attacks, and "silent heart attacks"
  • Vascular disease -- hardening and blockages of various arteries of the body
  • Low Blood Sugar due to diabetic medications can lead to coma and Seizures.

  • Diabetes insipidus (similar symptoms, but a completely different disease)

  • Diabetic Monitoring:
  • Blood sugar monitoring as prescribed by your doctor.  Remember, blood sugar checks are usually done before meals and at the time of the evening snack before bed, unless your doctor gives you different instructions.
  • Proper monitoring of blood pressure, heart, and cholesterol levels are very important
  • Eye exams by an ophthalmologist yearly (diabetic retinopathy can be treated especially if found early)
  • Regular foot exams by your doctor or a podiatrist
  • Urine -- 24 hour collection for protein should be done every 1-2 years
  • Hemoglobin A1C blood test usually every 4 months -- assess sugar control over this time
  • Emergency Conditions:
    1. Diabetic ketoacidosis occurs in Type I diabetics when their blood sugar becomes elevated, large amount of ketones appear in the blood, and excess acid accumulates in the blood.  You can suspect this if your child has vomiting, an odor of acetone on his breath, abdominal pain, and/or a change in consciousness.  This occurs when the blood sugar becomes elevated, causing such stress on the body that muscle  forms waste products  known as ketone bodies (hence the name ketoacidosis).  This condition is a medical emergency.
    2. Hyperosmolar coma is a complication of diabetes, which is characterized by severely high blood sugar, acid in the blood, Dehydration, but little to no ketones in the blood.  Hyperosmolar coma is more common in Type II diabetes.  This is also an emergency medical condition.
  • What Happens If My Child's Blood Sugar Drops Too Low?

- Diabetic medications sometimes cause blood sugars to drop dangerously low.  Symptoms include sweating, heart pounding, and clammy hands.  In this instance, your child needs sugar immediately--give him orange juice or a sugar-containing drink if he is fully alert.  If he is unable to feed himself, he will need emergency treatment with an IV containing glucose.  Low Blood Sugar can cause Seizures, stroke, or coma.  If symptoms do not improve rapidly, you need immediate emergency medical treatment.  It is best to measure the blood sugar urgently to see if you are dealing with low blood sugar or high blood sugar.

more about Diabetes Mellitus

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