Diabetes

第二章 Diabetes

What is diatetes

• Diabetes is a serious chronic disease that occurs when
  • Pancreas not producing insulin (not enough insulin)
  • Insulin not effectively used (cells stop responding to insulin)
• Too much blood sugar (gluose) stay in your bloodstream
• How insulin works
  • Insulin is a hormone secreted by pancreas into the bloodstream
  • Enable sugar to enter your cells

Symptons of diabetes

• Depending on how much your blood sugar levated
  • Polydipsia (increased thirst)
  • Polyuria (frequent urination)
  • Polyphagia (extreme hunger)
  • Unexplained weight loss
  • Fatigue
  • Blurry vision
  • Slow-healing sores
  • Frequent infections
  • Ketones in the urine

Types of diabetes

Type 1 Diabetes (less common)

• Previously called insulin-dependent diabetes or juvenile diabetes)
  • Usually diagosed in children, teen and young adults
• Insulin helps sugar enter the cells and is used for energy $\rightarrow$ Without insulin, blood sugar builds up in the bloodstream

Type 2 Diabetes

• Type 2 diabetes is an impairment in the way the body regulates and used sugar as a fuel
  • Insulin resistance: cells don’t respond normally to insulin $\rightarrow$ Pancreas makes more insulin to try to get cells to resopnd $\rightarrow$ Eventually pancreas can’t keep up $\rightarrow$ Blood sugar rises

Gestational Diabetes

A type of diabetes that can develop during pregnancy in women who don’t already have diabetes

• More hormones
• Other changes: weight gain
• Using insulin less effectively $\rightarrow$ insulin resistance
• Increase need for insulin

Prediabetes

• Higher than normal but not high enough yet for a diabetes diagnosis
• Can be reversed

Complications of diabetes

Long-term complications $\leftarrow$ years of high blood sugar levels in the blood vessel

• Heart and vessel disease
  • The most common long-term complications
  • Atherosclerosis - a buildup of cholesterol in the blood vessel

$$Atherosclerosis = \begin{cases}\text{Narrowing the blood vessel}\\\text{Blocking the blood vessel}\end{cases}$$

• Kidney disease

  • Diabetes nephropathy:
    • High blood sugar damage the blood vessels $\rightarrow$ Fail to filter waste $\rightarrow$ Causing kidney failure

• Eye complications

  • High blood sugar $\rightarrow$ Block off blood vessels $\rightarrow$ Vision blurry $\rightarrow$ Scar tissue builds up $\rightarrow$ Glaucoma or cataract

• Nerve damage

  • Diabetes neuropathy: affect the ability of the nerve to send signals $\rightarrow$ pain and temperature

  • 4 types of diabetes neuropathy

    • Peripheral neuropathy
      • Feet, legs, hands, arms
    • Autonomic neuropathy
      • Heart, bladder, stomach, intestine
    • Focal neuropathy
      Hands, head, torso, or leg
    • Proximal neuropathy
      • Hip, buttock, thigh

• Foot complications

  • High blood sugar $\rightarrow$ Nerve swelling and scarring $\rightarrow$ Numb in feet $\rightarrow$ Wounds become ulcers $\rightarrow$ Infection and amputation

• Mental problems

  • Caring for diabetes $\rightarrow$ Left people feeling overwhelmed and worn out

Short-term complications $\leftarrow$ hyperglycemia or hypoglycemia

• Emergency complications

  • Hyperglycemia

  • Hypoglycemia

    • Insulin dose increase
    • Skipping meals
    • Heavy exercise

• Diabetes ketoacidosis (DKA)

  • A serious, sometimes life threatening complication of type 1 diabetes
  • Not enough insulin $\rightarrow$ Break down fat as fuel $\rightarrow$ Build up of acid $\rightarrow$ Ketones

Diagnosis

• BMI>25, with additional risk factors

  • Such as high blood pressure and heart disease

• Age>45, every 3 years

  • Anyone older than age 45 is advised to receive an initial blood sugar screening, and screening every three years therea

• Gestational diabetes, every 3 years

  • Advised to be screened every 3 years

• Prediabetes, every year

  • Advised to be tested every year

Test

• Glycated hemoglobin (A 1 C) test
  • A blood test, which doesn’t require fasting
  • It indicates average blood sugar level for the past two to three months
  • It measures the percentage of blood sugar attached to hemoglobin
  • An A 1 C level of 6.5% or high on two separate tests indicates that you have diabetes
• Fasting blood sugar test
  • Fasting blood sugar is the amount of sugar present in your blood after fasting (typically after 8 hours)
  • Level of 126 mg/dL or higher indicates diabetes
• Oral Glucose Tolerance Test (OGTT)
  • Fast overnight
  • Drink sugar liquid, and blood levels are tested periodically for the next two hours
  • Less than 140 mg/dL $\rightarrow$ normal
  • Between 140 and 199 mg/dL $\rightarrow$ prediabetes
  • More than 200 mg/dL $\rightarrow$ diabetes

Treatments

Insulin Theragy

• Can’t take orally $\leftarrow$ stomach enzymes initerfere with insulin’s action
• Insulin injection
  • Using syringe or insulin pen
• Insulin pump
  • A tube attached to catheter inserted under the skin

Medication

• Stimulate pancreas to produce/release more insulin
• Inhibit the production of glucose
• Block the actions of breaking down carbohydrates

Healthy Diet

• No specific diabetes diet
• Center more on fruits, vegetables, lean proteins, whole grain $\rightarrow$ High in nutrition and fiber, and low in fat and calories
• Cut down on saturated fats, refined carbohydrates, sweets

Exercise

• Lower blood sugar level $\leftarrow$ Moving sugar into cells
• Increase sensitivity to insulin