Diabetes

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Diabetes

• Andrea Pallone
• Medical Aspects of Disability
• March 30, 2006

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• One of the leading causes of death in the U.S
• Contributed to 224,092 deaths in 2002
• Led to 132 billion dollar economic cost in 2002

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• Leading cause of new cases of blindness in adults
  between the ages of 20 74
• 40 of people who have kidney failure
• Cardiovascular disease is 2-4 times more common
• The risk of stroke is 2-4 times greater
• 60-65 have high blood pressure

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• Over 18 million individuals (6.3 percent) of the
  population in the United States have diabetes
• Only 10 million have been diagnosed(65)
• Approximately 800,000 new cases are diagnosed per
  year
• Age 65 years older 6.3 million,18.4 of all
  people in this age group have diabetes
• Age 20 years or older 15.6 million,8.2
• Under age 20 123,000,16

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Diabetes-Around the World

• The number of adults with diabetes in the world
  will rise from 135 million in 1995 to 300 million
  in the year 2025
• The countries with the largest number of people
  with diabetes are India, China and the U.S
• More common in women than men

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Facts about Diabetes

• Two Types
• Diabetes Insipidus
• Diabetes Mellitus

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Diabetes Insipidus

• .

• Inadequate secretion of ADH from the
  hypothalamus.

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• The most common cause is damage to the stalk
  connecting the hypothalamus to the pituitary
  gland, where ADH is stored

•  

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Causes of Diabetes Insipidus

• Injury to the head or after brain surgery
• Brain tumor
• Hereditary
• 25 of the time, doctors cant find any reason
  for it

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How do you test diabetes insipdus?

• Urine sample
• Blood sample
• CT scan or MRI

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Symptoms of Diabetes Insipidus

• Frequent skin, bladder or gum infections
• Excessive Thirst
• Wounds that dont heal
• Extreme unexplained fatigue

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Treatment

• DDAVP
• Hydrochlorothiazide (water pill)
• Surgery

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Diabetes Mellitus

• Imbalance in supply of and demand for insulin
• Most common of all endocrine conditions
• Leading cause of heart disease, stroke,
  hypertension, blindness, kidney disease,
  amputations and nervous system damage

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Understanding Diabetes

• Blood glucose refers to the amount of sugar in
  the blood
• The brains only food is glucose and blood sugar
  must be maintained at a certain level
• After eating a meal that contains carbohydrates
  or proteins, a persons blood sugar will rise,
  often between 120-130 milligrams per deciliter

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• Hypoglycemia-blood sugar drops too low
• Hyperglycemia-blood sugar is too high
• Individuals with diabetes mellitus have such a
  large amount of glucose in the blood, some
  glucose spills over into the urine (glycosuria)

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• Due to the large concentration of glucose in the
  urine, the kidney excretes large quantities of
  water (polyuria)
• Individuals need to drink water to replace the
  excess fluid lost (polydipsia)
• Food intake increases dramatically in the
  individuals (polyphagia)

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Diabetic Coma

• Having too little or no insulin available for
  food intake
• Gradual
• Confused, drowsy, slip into unconsciousness
• Difficulty breathing
• Experience nausea and vomiting
• Individuals breath may have a fruity odor

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Insulin Shock

• Occurs when there is too much insulin in the
  blood
• Injecting too much insulin
• Engaging in an unusual amount of exercise that
  burns up the glucose
• Failing to eat before insulin is injected

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Insulin Shock

• Individuals going into shock may feel
• Hungary
• Weak
• Nervous
• Perspire profusely
• Confusion and personality changes

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Treatment for Insulin Shock

• If individuals are conscious use
• sugars
• candy
• orange juice
• honey
• If unconscious, glucose must be infused
  intravenously

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Complications

• Circulatory system (heart attack)
• Stroke
• Poor circulation
• Minor injuries are prone to infection and may
  take longer to heal. (amputation)
• Kidney failure requiring dialysis

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Complications

• Changes in blood vessels in the retina
  (retinopathy), can result in blindness
• Peripheral Neuropathy (loss of sensation in
  extremities)
• Higher incidence of surgery

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The Role of Insulin

• Carbohydrates make our blood glucose rise
• To utilize the carbs and low blood sugar,
  insulin opens the doors of the bodys cells
• The glucose enters the cells and is used as the
  energy

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Diagnosis

• Symptoms include
• Thirst
• Fatigue
• Weight loss
• Frequent urination
• In presence of these symptoms, diabetes can be
  confirmed by a random test of blood sugar

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• When classic symptoms are not met, the criteria
  for diagnosing diabetes would be a fasting blood
  glucose test
• Blood glucose is drawn at least 10 hours
  following a meal in the morning
• A random blood glucose higher than 200mg/dl and a
  fasting glucose of 125 mg/dl or more confirms a
  diagnosis of diabetes

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Reasons for Insufficient Insulin

• Failure of Islets of Langerhans to produce enough
  insulin
• Destruction of insulin before used
• Inability to use insulin

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Type 1(Insulin-Dependent)

• Type 1 (IDDM) is most severe
• Insulin is the primary mode of therapy
• Gastric juices inactivate insulin

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Role of Insulin

• More than one insulin injection per day
• Maintain blood sugar levels as close to normal
• Rotate injection site to prevent scar tissue
• Syringe needle
• Insulin Injector

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• Insulin injector is reliable, convenient and
  accurate
• Insulin pump-provides a slow, continuous infusion
  of insulin throughout the day
• More expensive than other methods
• Provides more flexibility to meal timing

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Characteristics

• TYPE 1
• Under 40, most common in children
• Thin to normal body weight
• Quick onset of thirst, frequent urination
• Usually no known family history
• More than one shot of insulin treatment needed
• Difficult to keep fluctuating blood sugar in
  ideal range

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Type II (Non-Insulin-Dependent)

• Control blood sugar levels with diet
• When not controlled by diet, oral medications are
  used
• When oral meds cant control blood sugar,
  supplemental insulin is used

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Characteristics of Type 2

• Over 40, most common in adults
• Overweight, occasionally occurs in people of
  normal weight
• Usually slow onset with thirst, frequent
  urination, and weight loss symptoms, developing
  over time
• Usually runs in families
• Treatment begins with diet and exercise, then
  pills to later insulin
• Easier to control

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Psychosocial Issues in Diabetes Mellitus

• Disease involves lifelong treatment
• Affects daily lives
• Future Implications
• Hidden disability
• Chronic

• Psychological factors may affect the management
  of diabetes.
• Metabolic change can affect individuals ability
  to control blood sugar

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Fears/Complications

• Social Rejection
• Blindness Amputations
• Self-Destructive Behavior (skipping insulin
  injections)

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Necessary Lifestyle changes

• Planned meals
• No skipping meals
• If schedule changes food intake and insulin
  dosage must be changed accordingly
• Activities that involve additional walking,
  comfortable and well fitting shoes should be worn

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• Stress has a direct impact on the blood glucose
  level
• Individuals should learn coping strategies to
  effectively deal with job stress and try and
  avoid stressful situations all together

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Complications

• Reproductive function is not affected in men
• Women with Diabetes Mellitus generally have more
  complicated pregnancies and need special medical
  attention

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Vocational Issues in Diabetes

• Activity level should remain consistent
• Rotating shifts or irregular schedules should be
  avoided
• Avoid jobs that have high risks of minor cuts or
  scratches especially the feet