Showing posts with label Diabetes. Show all posts
Showing posts with label Diabetes. Show all posts
Over the last years, proper guidelines on diabetes management, together with intensive patient health education has resulted to an overall decline in diabetes patients dying from infections and ketoacidosis. However, the number of diabetes patients dying from cardiovascular and other renal related complications continues to rise and it is still a major concern in the modern world. Most of these complications result from uncontrolled high blood sugar, over a long period of time. In some patients the complication is aggravated by high blood pressure.
Diabetic complications can be classified into three different categories;
- Diabetic Macrovascular Complications
- Diabetic Microvascular Complications
- Diabetic Neuropathy
Diabetic Macrovascular Complications
Diabetic macrovascular complications are all diseases and conditions, resulting from diabetes that affect medium and large blood vessels (blood vessel diseases). Diabetes can lead to hardening and narrowing of blood vessels (arteriosclerosis) and obstruction of blood vessels with plaque (atherosclerosis), leading to coronory artery disease.
Coronary artery disease is a condition is which there is an obstruction inside the medium and large blood vessels. This results into impaired blood flow to the heat and without proper medical care, it can lead to a heart attack. The risk of having a heart attack is two times higher in men with diabetes and three times higher in women with diabetes, compared to those without diabetes.
Coronary artery disease is a condition is which there is an obstruction inside the medium and large blood vessels. This results into impaired blood flow to the heat and without proper medical care, it can lead to a heart attack. The risk of having a heart attack is two times higher in men with diabetes and three times higher in women with diabetes, compared to those without diabetes.
Other major diabetic complications that affect medium and large blood vessels include; stroke (cerebral vascular accident) and peripheral vascular disease (obstruction of large arteries outside the heart and brain). People with diabetes are also twice likely to suffer from stroke than those without diabetes.
Diabetic Microvascular Complications
Diabetic microvascular complications are all diseases and conditions that lead to destruction of small blood vessels. Diabetes is believed to cause the thickening of the base membrane of the capillaries (small blood vessels) several times beyond their normal size.
The two major types of diabetic microvascular complications are: diabetic retinopathy and diabetic nephropathy, classified according to the organ that they affect.
The two major types of diabetic microvascular complications are: diabetic retinopathy and diabetic nephropathy, classified according to the organ that they affect.
(a) Diabetic Retinopathy
Diabetic retinopathy (injury of the small blood vessels found in the retina) is the most common type of diabetic microvascular complication. The retina is an important part of the eye with its main function been to receive images and to send the received images to the brain for interpretation.
According to American Diabetes Association, atleast more than 60% of all patients diagnosed with diabetes mellitus type 2 and almost all patients diagnosed with diabetes mellitus type 1 are believed to suffer from some sort of retinopathy after 20 years of diabetes.
Other eye conditions that can result from diabetic complications include;
- Cataracts - opacity of the lens of the eye (light cannot pass through the lens).
- Changes in lens - temporary swelling of the lens of the eye, whenever the blood sugar levels is high.
- Extraocular muscle palsy - Seeing of double vision due to diabetes ocular nerve damage (nerves that control the movement of the eye).
- Glaucoma - loss of eye sight resulting from hemorrhage, retinal detachment or both. If vitreous hemorrhage occurs, the vitreous (a clear liquid found within the eye) may become cloudy, hence blocking the light entering the retina. This leads to vision loss. Glaucoma is more prevalent in people diagnosed with diabetes.
Symptoms of Diabetic Retinopathy
In the early stages of retinopathy, most patients do not have any symptoms and if present, it may only include a blurred vision. However, in the present of vitreous hemorrhage (bleeding inside the retina), symptoms like seeing star or cobwebs along the visual field, hazy vision or even complete loss of the eye sight may occur.
Diagnosis of Diabetic Retinopathy
Retinopathy can be diagnosed by either looking directly at retina through the use of ophthalmoscope (a lighted instrument that is used to examine inside the eye) or by flourescein angiography (a dye is injected through the arm vein and carried to the blood vessels of the retina). The retina blood vessels are then examined in details using special instruments by an ophthalmologist.
Treatment of Diabetic Retinopathy
The treatment and management of retinopathy is directed towards controlling and maintaining the blood glucose level within the normal or near normal levels, in both diabetes type 1 and diabetes type 2. Patients education and intensive insulin therapy (for patients suffering from diabetes type 1) has shown to be effective in the early stage of retinopathy. Other lifestyle changes like; exercises, controlling of blood pressure and cessation of smoking can help in slowing down the progression of the diabetic retinopathy.
For patients with advanced cases of diabetic retinopathy, treatment may include a process known as argon laser photocoagulation (destruction of the leaking blood vessels) and panretinal photocoagulation (burning of the whole retinal by use of a laser) to stop the growth and bleeding of the destroyed blood vessels. In the presence of severe bleeding in the vitreous, a surgical procedure known as vitrectomy may be performed (the vitreous fluid is removed and replaced with another clear fluid to restore the lost vision.
(b) Diabetic Nephropathy
Diabetic nephropathy is the destruction of small blood vessels found in the kidney due to increased blood glucose over a long period of time. When this happens, the kidney filtration mechanism becomes ineffective, resulting to various symptoms. If left untreated, it can eventually lead to kidney failure (an serious irreversible kidney disease that require dialyis or kidney transplant) for an individual to survive.
Diabetic Neuropathies
Diabetic Neuropathies is a term used to refer to all disorders that affect the nerves (peripheral, autonomic and spinal nerves). Peripheral neuropathy and the autonomic diabetes neuropathy are the most common types.
(a) Diabetic Peripheral Neuropathy
This is the damage of nerves, particularly on the legs and feet, resulting from impaired blood flow caused by the diabetes. Signs and symptoms of peripheral neuropathy include; loss of sensation on the legs, tingling sensation, burning sensation and numbness.
Diabetes patients are more prone to injuries due to decreased sensation on the legs (unable to detect when an injury has occured). This is the reason why taking good care of self and inspecting your legs is important to protect yourself from injuries and to check if new injuries have occured. Injuries left untreated can lead to infection and necrosis (death of the tissues) and eventually to toe or leg amputation.
Diabetes patients are more prone to injuries due to decreased sensation on the legs (unable to detect when an injury has occured). This is the reason why taking good care of self and inspecting your legs is important to protect yourself from injuries and to check if new injuries have occured. Injuries left untreated can lead to infection and necrosis (death of the tissues) and eventually to toe or leg amputation.
(b) Diabetic Autonomic Neuropathies
Diabetic autonomic neuropathies is a complication of diabetes that affects the autonomic nervous system. Autonomic is a part of the peripheral nervous system that regulates involuntary functions of the body, such as heartbeat, digestion and renal function.
Some common signs and symptoms of autonomic neuropathies may include;
- A slightly faster heart beat than normal
- Orthostatic hypotension (sudden fall of blood pressure upon standing up).
- Delay in gastric emptying (food remaining longer in the stomach than expected).
- Nausea and vomiting
- Abdominal bloating
- Constipation or diarrhea
- Urinary retention due to decreased sensation of the bladder fullness.
- Urinary incontinence (involuntary leakage of urine).
- Sexual dysfunction and impotence may occurs due to inability of a male to maintain an erection.
- Decrease or absence of sweating on the lower extremities with an increase of sweating on the upper part of the body (sudomotor neuropathy).
- Absence of signs and symptoms of hypoglycemia (low blood glucose) due to autonomic neuropathy effect on the adrenal medulla. The absence of signs and symptoms of hypoglycemia puts a patient at very high risk of having dangerously low blood glucose, without knowing. To prevent this, frequent monitoring of blood glucose level is required.
Diabetes is managed by medication, exercises, dieting and change in lifestyle. However, patient education becomes an integral part of diabetes management since without proper understanding of how to go about taking good care of self, diabetes can still lead to other serious complications. One major challenge that diabetes patients have to deal with is the increased risk of developing an infection.
The injury may start like a small wound after a soft tissue injury (usually on the foot) and since diabetic patients are less sensitive, the injury may go unnoticed until it develops to a serious infection or a gangrene may form and if no timely intervention is done, it can eventually lead to a leg amputation.
All diabetic patients should be taught the importance of taking good care of their feet and especially so, among the high risk diabetic patients. Some of the characteristics of high risk patients include;
- Patients who have had diabetes for more than 10 years.
- Patients older than 40 years.
- Diabetic patients with history of smoking.
- Diabetic patients experiencing decreased sensation and decreased peripheral pulse.
- Patients with calluses or corns on their feet.
- Patients who have previously suffered from a foot ulcer or had a previous leg amputation.
How to Take Proper Care of Your Feet
To minimize the chances of getting an injury, patients should take good care of their feet. If you are not taking good care of your feet, you are at risk of getting injured and maybe, acquiring an infection that could, in the worst case scenerio, eventually lead to an amputation.
Always Wear Foot Wear - Whether you are just walking on your backyard or doing something indoor, make sure you have your feet protected. You never know, something might have dropped on the floor that would injure your foot. Always make sure you are protecting your feet, whether indoors or outdoors.
Inspect Your Feet Daily - Checking your feet daily will help you in noticing an injury that you may not be aware of and to seek medical attention early in the course. Most diabetic patients are less sensitive and an injury may have occured, yet they are are not even aware of it. In additional to daily self- inspection of the feet, your feet need to be inspected by a medical professional during every health care visit.
Dry your Feet Properly - Dry your feet properly after a bath or after applying some lotion to make sure no water or moisture is left, especially in between the toes.
Wear Well Fitting Shoes - Make sure the shoes that you are wearing is not too tight to give room for your toes to breathe and to avoid blisters formation.
Do Not Soak Your Feet - Soaking your feet may make your skin more vulnerable to tear and it may lead to dryness and cracking of the skin.
Exercises - Simple leg exercises may helps in improving circulation and to prevent further complications.
Avoid Smoking and Control Your Blood Sugar - Blood glucose tends to increase with an infection and maintaining blood glucose at an acceptable level is important to promote faster would healing. Smoking only make the infection worse and it puts you at a higher risk of acquiring other serious medical conditions.
Do Not Self Medicate - Avoid home remedies or over the counter medications that claim to treat foot problems and instead, seek medical help if you suspect you are having a leg injury or an infection.
Since diabetes is associated with increased blood viscosity or blood thickness. The thickened blood compromises the transportation of nutrients needed for normal skin growth. Body cells are unable to receive adequate nutrition due to poor circulation leading to various skin disorder. Increased blood sugar also causes nerve injury.
Some of the skin problem from diabetes are;
Some of the skin problem from diabetes are;
Skin Infections
The skin of a diabetic patient is more prone to getting infections due to poor circulation, with bacteria and fungi been the most common cause of infections. Infections from bacteria are more common on the lower parts of the body (the lower abdomen, lower buttocks and lower legs) and they appear as small pimples around the hair follicles. If blood sugar is not properly controlled, the infections take a longer time to heal.
Fungal infections are more common on moist areas such as; under breasts, upper thighs and on the axilla. Dermatophyte infections (Dermatophytes are fungi that cause hair, skin and nail infections) are more scaly, dry and with minimal redness. Infections from candida (yeast) appears like beefy red with small pustules bordering the affected area and the skin appears moist.
Diabetic Dermopathy
Diabetic Dermopathy are shiny spots caused by the breakdown of the small blood vessels found under the skin, occuring in almost 50% of diabetic patients. The lesions are more common on the anterior part of the lower extremities (legs), on forearams, over bony prominence areas and on the thighs. Each spot usually starts as a small dull red bump and it gradually spreads to a bigger size, leaving a brown like scar once it heals.
Stasis Dermatitis
Stasis dermatitis is a common condition in diabetic patients due to venous insufficiency. Blood supply to the lower extremities is compromised hence the skin cannot receive adequate nutrients needed for proper growth. With time, the skin becomes dry, fragile, hyperpigmented and minor injuries heals very slowly. When this happens, ulceration may occur.
Leg and Foot Ulcers
Since diabetes affects the peripheral nerve, diabetic patients are not sensitive to minor injuries especially on the lower extremities. An small infection may begin on the lower extremities and if no proper treatment is done on time, it may leads to ulceration. These kinds of ulceration may become non-responsive to treatment and may lead to diabetic foot and eventually to leg amputation. A major complication of diabetic foot.
Diabetes Mellitus occurs as a result of two things; inability of the body to utilize insulin properly or due to problem in insulin production. There are 2 different types of diabetes mellitus; Diabetes Mellitus Type 1 and Diabetes Mellitus Type 2. Diabetes Mellitus type 1 is also known as insulin dependent diabetes and it more common in younger adults and children. It is believed to occurs due to an autoimmune disorder or as result of an illness that affects the pancreas.
Risk of Diabetes 1
- Pancreas diseases
- Family History of Diabetes
- Other infections that my affect pancreas
Diabetes type 2 is also known as non-insulin dependent diabetes and occurs in older adults. Possible cause of Diabetes Mellitus Type 2 are;
- Body becomes resistance to insulin.
- A medical condition that may lead to abnormal insulin secretion.
- Problem with liver, leading to over production or glucose.
Risk of Diabetes 2
- Family history of the disease
- Obesity or overweight
- Sedentary Lifestyle
- Age
- Hypertension
- Race (some races are more prone to acquiring diabetes than others).
The third type of diabetes is what we call Secondary Diabetes Mellitus, which may occur during stressful situations, as a result of a viral infections like Mumps and Rubella or during pregnancy.
Diabetes Mellitus 1 and 2 Symptoms
- Excessive urination, hunger and thirst (polyuria, polyphagia and polydipsia).
- Weight loss
- Poor skin turgor
- Slow in wound healing
- Prone to getting infections
- Vision problems due to accumulation of sorbitol (a by products of glucose). Excessive sorbitol in the bloodstream absorbs water leading to eye swelling (retinopathy).
- If the patient has a history of renal or peripheral disease, the disease is accelerated by diabetes.
Diabetes Management
Diabetes is managed through medication, diet and exercises. Read our previous article on Diabetes management.
Diabetes Complications
Diabetes Ketoacidosis
This is serious life threatening condition that happens when there is less or no insulin in body. With decreased insulin, the body in unable to use glucose for energy and instead it uses fat. The by products of fat is what we call ketones and building up of ketones in the blood leads to Ketoacidosis. Diabetes Ketoacidosis is more common in patients suffering from diabetes 1.
Diabetes Ketoacidosis Signs and Symptoms
- Severe hyperglycemia ranging from 300-800mg/dl.
- Usually occurs suddenly
- Presence of urine ketones
- Presence of kussmaul breathing (deep, labored breathing that increases in frequency).
- Signs and symptoms of hyperglycemia (discussed above).
- pH - Acidosis (less than 7.35)
Hyperglycemic Hyperosmolar Non-Ketotic Syndrome
This is more common in patients suffering from diabetes 2. It occurs when the blood glucose level is more than 600mg/dl. The body tries to get rid of the excessive glucose through urination but it reaches a point when the kidneys can no longer be able to remove the excessive glucose, leading to dangerously high amount of glucose in the blood. 
When this happens, the blood become more concentrated with glucose, sodium and since electrolytes like sodium attracts water, the water moves out of the cells to the blood stream causing severe dehydration to other important body organs, including the brain. This can eventually leads to coma or death, if no medical intervention is done promptly.
Hyperglycemic Hyperosmolar Non-Ketotic Syndrome Signs and Symptoms
- Usually occurs gradually
- Extreme hyperglycemia ranging from 700-1200mg/dl.
- No presence of urine ketones
- Signs and symptoms of hyperglycemia (discussed above).
- pH - Acidosis (less than 7.4)
Management of Diabetes Complications
Both complication are managed by use of regular insulin, intravenous fluid and electrolytes replacement.
How to Prevent Diabetes Complications
- Frequent monitoring of blood sugar levels.
- Take your medications as prescribed by your physician.
- Incase you are suffering from any other illness, do not self-prescribe any medication, consult a physician.
- Drink as much water as you can, every day.
- Educate your self more about diabetes, so that you can be able to identify possible serious signs of complications.
- Seek medical help promptly or as needed.
The overall goal of Diabetes management is to make sure that the patient's blood glucose level is maintained within a desirable level, inorder to decrease the chances of developing diabetes related complications. To effectively manage diabetes, there is need for a constant or ongoing patient assessment and frequent adjustment of the treatment regimen, whenever appropriate. The patient also need to be reminded of his/her vital role when it comes to self-management of diabetes.
Diabetes management is centered within the following five components;
- Exercises
- Nutritional therapy
- Monitoring
- Treatement (pharmacology)
- Patient Education
Exercises
Exercises is a very important component of diabetes management. When a diabetes patient is exercising, the body muscles increase the demand of glucose and more blood glucose is utilized. This help in lowering the overall blood sugar in the body. Exercising also increases insulin absorption by the cells.
For diabetic patients who are obese or with history of high cholesterol, having a regular exercise routine lowers the bad cholesterol, hence increasing the level of good cholesterol. This is especially important to obese diabetic patients since they are at a much higher risk of developing cardiovascular diseases.
A Diabetic patient should have a regular exercise schedule. The exercises should be done at the same time, every day and most preferably, when the glucose is at the highest levels. This is to help in maintaining a constant glucose level in the blood.
Nutritional Therapy
The nutritional needs of each diabetic patient varies and should always be individualized. One major goal of nutritional management is to make sure the patient receives the adequate calories and his nutritional needs is not compromised in any way. A good nutritonal meal should consists of;
- All the nutritional requirements for a well balanced diet.
- It should not in any way compromise the patient's caloric needs (should be adequate).
- It should be able to maintain the patient's desirable weight.
- The meal should be planned in such a way that the patient is able to eat small frequent meals without skipping. This prevent the patient from eating alot of food at once to avoid sudden increase in blood sugar levels.
- The food should be taken at regular intervals every day to prevent wide fluctuations of blood sugar levels.
- Junk food, sugarly drinks and other fatty food should be avoided as much as possible to minimize the risk of developing cardiovascular diseases.
Monitoring
You can only know whether the regimen given to the patient is working by monitoring. Diabetes monitoring is the cornerstone of diabetes managment and it should be an ongoing process. By monitoring a diabetic patient, health personnel can be able to spot a potential problem before it can lead to serious complications. Monitoring also help in the maintaining patient's blood glucose at a desirable level.
All Diabetic patients should have a target blood sugar level that they need to maintain. With frequent monitoring of the blood sugar level, any deviation is easily noted and corrected. Patients can be able to tell when they need a extra snack, when to exercise and when not. Self-monitoring of blood glucose should be done whenever necessary, before and after an exercise routine.
Treatment for Type 2 Diabetes (Pharmacology Management)
For younger patients suffering from diabetes 1, insulin should be administered for the rest of their lives. This is because, patients suffering from diabetes 1 can no longer produce insulin, hence they are dependent on the insulin injections. On the other hand, patients suffering from diabetes 2 are able to produce some insulin but the cells cannot utilize the insulin produced since they become insulin resistant.
Some diabetes patients are able to control their glucose levels through diet change and exercises alone without medication. Others may require diet change and OHA (oral) medications. Such patients may sometimes experience a spike in blood sugar levels, especially during stressful situations, illness, surgery or during pregnancy (due to increased stress hormone which increases the blood sugar levels). In such situations, the physician may prescribe a temporary insulin to the patient.
Most diabetic patients needing insulin are advised to administer it two to three times a day but this is not a fixed routine. The frequency of administration and the amount of insulin that each patient receives depends on the level of the glucose. This is the reason why proper and frequent monitoring of glucose is required.
Patients should also be able to understand how diabetes medication interacts with other medications. Some medications are known to either lower or increase the blood sugar, affecting the overall blood sugar levels. If a diabetes patient is taking any other medication, it is important to notify the physician. The physician can then decide whether there is a need for medication adjustments or not.
Diabetes Education
Diabetes Mellitus is a long time illness that requires lifetime commitment in self-management and behavior changes. Patients must be ready to adjust to lifestyle related changes in order to prevent developing long term complications associated with diabetes.
Patients must have adequate knowledge on nutrition, exercise, blood glucose monitoring, medication adjustment and other preventive measures. Without proper education, it almost impossible for the patient to maintain the desired blood glucose level which may eventually lead to serious health problems or diabetes complications.
Lastly, to effectively manage diabetes, there is need for a proper education on the side of the patient. The health care personnel should make sure that the patient understands the important of self discipline and he or she is willing to take part in management.
Even though diabetes is a long term illness, there are may patients who have lived with diabetes for many years, yet they have managed to keep their blood sugar levels at desired level without any complications. Diabetes is not curable but with self-discipline, proper education and reliable health care system, it is can easily be managed.
Diabetes is a disease that requires closer monitoring and individual knowledge on how to manage the condition. For diabetes to be successfully controlled, there is need for a stable system of care that can provide early treatment, intervention and proper education to the affected individuals in order to prevent future complications. Patient education is a key component of diabetes management if the battle against diabetes is expected to be won.
Diabetes remains one of the most challenging diseases to manage. One reason been that, most patients are not able to achieve the desired glycemic control and continue to suffer from other conditions that are associated with diabetes or even serious diabetes complications. However, patients with good self-care behaviour and right knowledge when it comes to self-management of diabetes are more likely to maintain a desirable glycemic control.
Diabetes management is geared towards three main components; diet, exercise and medication. We take a closer look at some of the components of diabetes management and how they can negatively hider an individual from attaining and maintaining a desired glycemic level if there are not implemented properly;
Poor Dieting Plan
One important ways of controlling diabetes is to make sure that an individual receive the required amount of calories intake. This help in maintaining the desired body weight, a health glucose level, a good blood pressure and to normalize the lipids levels in the blood preventing heart diseases.
The amount of food that we consume is directly responsible for the glucose levels in our blood. Food rich in refined carbohydrates are metabolized faster than complex carbohydrates raising the glucose level abruptly. Diabetes patients are usually advised to consume food rich in complex carbohydrates since this kind of food tend to raise glucose level slowly and are more likely to keep it at a desired level for a longer time.
In addition to this, eating meal at equal intervals (appropriate intervals between meals) with addition of a snack when needed, help in maintaining an overall blood glucose level under control and prevent hypoglycemia. For obese individuals, weight loss together with proper dieting plan is the key to treatment.
Lack of Exercises
Exercising is another important component of diabetes management since when a diabetic patient is exercising, glucose uptake is increased by muscles lowering the overall glucose in the blood and lowering the cardiovascular risks. Exercises also play a significant role in helping the body to utilize the insulin properly.
However, exercises should not be performed by patients whose urine contain ketones and are experiencing an increased blood sugar level exceeding 250mg/dl or 14mmol/L. Such diabetic patients should wait until when their urine test results is negative for ketones and blood sugar is almost back to normal level.
The reason behind is that, when a diabetic patient exercises with an increased blood sugar levels, the body releases glucogen and growth hormones leading to the liver producing more glucose and eventually increasing the blood sugar. Most diabetic patients are advised to have a regular schedule or time when they can do exercise, preferably when the glucose levels are at the highest. Having a regular exercise schedule help in maintaining a constant level of blood sugar than when the exercises are done sporadically.
Inadequate Knowledge about Medication and How to Use Insulin
Diabetic is a self-managed disease and patients should have adequate knowledge on how to handle medication and insulin. Diabetes medications are directly responsible for increasing or lowering the blood sugar levels. They must be taken as prescribed within the given time interval.
Patient must be taught and understand the importance of adherence. If a patient is taking other medications like corticosteroids which are known to increase the blood sugar in some patients, he or she need to inform the doctor, so that the doctor can adjust the medication or insulin, accordingly. Patients should also be taught the right way to measure and inject insulin.
Illness and Stress
When we are experiencing stress, there is increased release of cortisol hormones to combat stress that is responsible for increasing blood sugar levels. Though, it is almost impossible to avoid daily stressors but having a more active life can reduce your stress level since you will have less time to think about those stressors.
Other Personal Issues or Problems
Effective management of diabetes can only be achieved if we can try to understand the reason why a diabetic patient may not be following the prescribed regimen. There are many factors that would be contributing to poor adherence such as; psychological issues, social issues and lack of motivation towards taking good care of self.
The other reasons may have something to do with financial problems, family conflict, psychological and other factors that may have negative effect on the patient. Patient whose blood glucose level is constantly high should be screened for some of these problems and a different approach should be considered.
When handling patients experiencing these kinds of problems, a patient-centered approach should be more appropriate. Health care personnel should only teach the patient when he/she is ready to listen and deem fit to absorb what is been taught.
Diabetes education can be more effective when the health care personnel is able to respect the patient’s culture, choices and give him the autonomy to air his concerns. This will eventually lead to an effective diabetes self-management behaviour and lifestyle modification on the part of the patient.
