Diabetes Mellitus
What AIDS was for the last 20 years of the 20th century, diabetes will be in the first 20 years of this century, by the world’s diabetes experts.
Croatia has from about 170.000-190.000 patients with diabetes, while world’s statistic count about 170 million, with 18.2 million patients in the USA where diabetes is mostly growing.
The reason for such expanding is increased average human weight, and because of that in the next 5 years, for the struggle against diabetes 13.7 billion dollar will be spent, while in the prevention the main goals will be fatness treatment and control.
The experts estimate that the total cost of diabetes treatment in the word by the years 2025 will reach between 213 to 369 million dollar, if the predictions that the number of these kind of patients increases from current 170 to 333 million.
More than 75% people with diabetes till the year 2025 will be living in undeveloped countries, mainly because of the urbanization and fast cultural and social changes.
It is stunning that in some countries with large amount of people with diabetes, the influence of the illness on the economy is larger than by the AIDS.
Croatia has from about 170.000-190.000 patients with diabetes, while world’s statistic count about 170 million, with 18.2 million patients in the USA where diabetes is mostly growing.
The reason for such expanding is increased average human weight, and because of that in the next 5 years, for the struggle against diabetes 13.7 billion dollar will be spent, while in the prevention the main goals will be fatness treatment and control.
The experts estimate that the total cost of diabetes treatment in the word by the years 2025 will reach between 213 to 369 million dollar, if the predictions that the number of these kind of patients increases from current 170 to 333 million.
More than 75% people with diabetes till the year 2025 will be living in undeveloped countries, mainly because of the urbanization and fast cultural and social changes.
It is stunning that in some countries with large amount of people with diabetes, the influence of the illness on the economy is larger than by the AIDS.
WHAT IS DIABETES MELLITUS?It is a chronically state that begins when the pancreases stops completely or partly the insulin production, or the produced insulin is not efficient in the organism. In that case the cells don’t get the food necessary for their life.
WHAT IS INSULIN?
Insulin is a hormone produced by the pancreases – the key which opens the doors on cells and enables them to take over the food (glucose which organism uses as an energy source) form the blood. Glucose in the blood without insulin increases instead of going into cells. That’s why it is important to inject insulin into the organism.
THERE ARE: Type 1, Type 2, Gestational diabetes
- Sometimes called insulin dependent type of diabetes in which it is necessary to inject insulin into the organism.
- This type of illness develops when the immunological system stops recognizing that part of pancreases which produces and extracts insulin as a part of the body. Immunological system destroys that part of the pancreases without destroying the other parts. As a result, it creates less insulin and it slowly decreases till it finally ends. In that case insulin must be taken into with an injection.
- It is more frequently with children and teenagers, but it can appear with adults, too.
- It appears with frequency of about 10% from total number of patients.
SYMPTOMSOrigin of type 1, diabetes is usually sudden and dramatic and it can include following symptoms:
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WHO IS UNDER THE RISK OF DEVELOPMENT OF DIABETES?
Risk factor for the type 1 of diabetes is not defined enough, but the combination of inheritance and the environment (virus infections, stress) can be predispositions for the illness development. Etiology is unclear, probably it is about self immunity.
IS THERE A CURE?
There isn’t a cure but there is a successful treatment. A good regulation of diabetes includes the maintenance of glucoses level that are closer to the normal values. It can be achieved with the following:
Risk factor for the type 1 of diabetes is not defined enough, but the combination of inheritance and the environment (virus infections, stress) can be predispositions for the illness development. Etiology is unclear, probably it is about self immunity.
IS THERE A CURE?There isn’t a cure but there is a successful treatment. A good regulation of diabetes includes the maintenance of glucoses level that are closer to the normal values. It can be achieved with the following:
- Healthy, balanced nutrition
- Regular physical activity
- Self-control of the sugar in the blood
- Taking pills and/or insulin if needed avoiding of stressful way of living
INSULIN
Inzulin is extracted by the pancreases cells in the small amount during the whole day and night. It helps that the glucose gets into the cell and feeds it. It is a protein which is assembled from the amino acids; if it would be necessary to take insulin through the mouth it would disintegrate in the stomach, so it would not enter into the blood. Therefore it must be given with injections into the subcutaneous tissue or into the blood. Insulin is given by syringes, special injections which are pen shaped.
Two Canadians Banting and Best, in 1921 managed to isolate insulin from the pig’s pancreases, and for that won the Nobel Prize because their discovery would mean a turning point in the medical treatment of diabetes.
The first patient was a 12-years-old boy Leonard, and with that discovery they saved his life. Until that all people with diabetes have died soon or a couple of months after the first signs of the illness.
There are couples of basic kinds of insulin that differ towards the speed of absorb into the subcutaneous tissue after the injection, towards the time in which their effect is the strongest and towards the length activities.
There are:
Inzulin is extracted by the pancreases cells in the small amount during the whole day and night. It helps that the glucose gets into the cell and feeds it. It is a protein which is assembled from the amino acids; if it would be necessary to take insulin through the mouth it would disintegrate in the stomach, so it would not enter into the blood. Therefore it must be given with injections into the subcutaneous tissue or into the blood. Insulin is given by syringes, special injections which are pen shaped.
Two Canadians Banting and Best, in 1921 managed to isolate insulin from the pig’s pancreases, and for that won the Nobel Prize because their discovery would mean a turning point in the medical treatment of diabetes.
The first patient was a 12-years-old boy Leonard, and with that discovery they saved his life. Until that all people with diabetes have died soon or a couple of months after the first signs of the illness.
There are couples of basic kinds of insulin that differ towards the speed of absorb into the subcutaneous tissue after the injection, towards the time in which their effect is the strongest and towards the length activities.
There are:
- short effectively or “clear” insulin – effects after 15 to 30 minutes
- medium long effective or “blurred” insulin – effects after 1,5 to 2 hours
- long effectively insulin – effects after 3 to 6 hours
- the conventional therapy - twice a day in the morning and in the evening
- the intensive therapy - the goal is to imitate the extraction of the insulin which is for the healthy person where in the time and after a meal there is a larger extraction of the insulin.
Observation of the sick peron with diabetes
| good | border | bad | |
| Self-control GUK on an empty stomach after the meal | 4,4 – 6,1 5,5 – 8,0 | 6,2 - 7,8 8,1 – 10,0 | > 7,8 > 10 |
| HbA1c (%) | < 6,5 | 6,5 – 7,5 | > 7,5 |
| The total cholesterol (mmol/l) | < 5,2 | 5,2 - 6,2 | > 6,5 |
| Triglicerin on an empty stomach (mmol/l) | < 1,7 | 1,7 – 2,2 | > 2,2 |
| BMI (kg/m ) male female | < 25 < 24 | 25 – 27 24 – 26 | > 27 > 26 |
| Blood pressure | Individually, the lowest acceptable values | ||
HYPERGLICHEMIA - because of irregular eating habits and consuming large amounts of food especially carbohydrates:- because of lack of body activities
- during acute illness (virus infections, higher temperature, acute stress condition)
- because of consuming inadequate amount of drug (tablets or insulin )
- because of irregular self control and control and also because of inadequate care for the self health
 | SIGNS THAT INDICATE HYPERGLICHEMIA:
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HOW CAN AND MUST I HELP?
Measure up the level of glucose in blood and in urine also the level of keton (acetone) in urine. If the hyperglycemia is mild, without keton but with high amount (concentration) of glucose in urine:
- drink larger amount of liquid (1-2 L- tea, mineral water or pure water)
- in the next meal reduce level of carbohydrate
- increase body activities (running, house gymnastics)
If the hyperglycemia is more serious, and there is keton and glucose in urine:
- drink large amount of liquid (2-3 L)
- higher the dosage of drug taken ( larger numbers of tablets or add 4 to 6 units of fast acting insulin )
- take two tablets of sodium bicarbonate with 1 L of tea, if the ketons do not disappear from urine.
- measured the level of glucose in blood every hour, glucose and ketons after every urination monitor the changes and write them down (take notes).
- if the symptoms do not disappear and the glucose in blood does not decrease, inform the doctor .
In case of acute illness (infections and higher body temperature):
Despite lower food needs the level of glucose in blood increases so the prescribed treatment needs to be continued or even increased. If the patient already takes the maximum amount of tablets it is required to include the insulin treatment while infection (is active ).
The insulin won’t be necessary when the acute illness is cured. If the patient is already on insulin treatment the dose needs to be increased according to glucose level in blood. There for the level of glucose needs to be measured every hour.
Measure up the level of glucose in blood and in urine also the level of keton (acetone) in urine. If the hyperglycemia is mild, without keton but with high amount (concentration) of glucose in urine:
- drink larger amount of liquid (1-2 L- tea, mineral water or pure water)
- in the next meal reduce level of carbohydrate
- increase body activities (running, house gymnastics)
If the hyperglycemia is more serious, and there is keton and glucose in urine:
- drink large amount of liquid (2-3 L)
- higher the dosage of drug taken ( larger numbers of tablets or add 4 to 6 units of fast acting insulin )
- take two tablets of sodium bicarbonate with 1 L of tea, if the ketons do not disappear from urine.
- measured the level of glucose in blood every hour, glucose and ketons after every urination monitor the changes and write them down (take notes).
- if the symptoms do not disappear and the glucose in blood does not decrease, inform the doctor .
In case of acute illness (infections and higher body temperature):
Despite lower food needs the level of glucose in blood increases so the prescribed treatment needs to be continued or even increased. If the patient already takes the maximum amount of tablets it is required to include the insulin treatment while infection (is active ).
The insulin won’t be necessary when the acute illness is cured. If the patient is already on insulin treatment the dose needs to be increased according to glucose level in blood. There for the level of glucose needs to be measured every hour.
HYPOGLICHEMIA - Low level of glucose in blood- because of large amount of insulin during a long period of time between insulin injection and meal or fast resumption of insulin, because of irregular injection ( in muscular tissue or in blood vein ).
- low amounts of food ( because of ) caused by inadequate meal or skipped meal or digestion problems. Continuous bowel movement and diarrhea.
- increased body activity caused by activity not planned and insufficient diet with inadequate treatment.
- because of disturbed kidney activity and large glucose loss because of constant urination or higher drug concentration in the body,
- because of large amounts of alcohol.
 | THE SIGNS THAT INDICATE HYPOGLICHEMI:
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HOW TO HELP?:
- measure up the level of glucose in blood -when hypoglycemia is mild eat extra meal rich with carbohydrates (some fruit, a glass of milk or unit of bread)
- with more serious hypoglycemia it is required immediately 2-3 candies or a spoon of sugar and eat extra meal rich with carbohydrates
- when the hypoglycemia is a more serious the consequences are possible as is coma, and assistance is required: lay the patient on the hip and inject the glucagons which are good to move when treated with insulin.
CONCLUSION
The diabetes is not unknown, but at the beginning of 20th century it began to be treated successfully. The Croatian diabetes union helps with encouraging ill people to interact in order to learn how to compete (live) with difficulties of this illness and to defeat them.
Whether you are diabetic or a member of your family, or your friend you must contribute in different ways to preventing or early complication discovery.
The diabetes is not unknown, but at the beginning of 20th century it began to be treated successfully. The Croatian diabetes union helps with encouraging ill people to interact in order to learn how to compete (live) with difficulties of this illness and to defeat them.
Whether you are diabetic or a member of your family, or your friend you must contribute in different ways to preventing or early complication discovery.
| No diabetic level | Good regulation | Bad regulation | |
| guk on an empty stomach | 4,0-5,0 | 5,1-6,5 | >6,5 |
| guk pp | 4,0-7,5 | 7,6-9,0 | >9 |
| guk in the evening | 4,0-5,0 | 6,0-7,5 | >7,5 |
| HBA 1c | <6,1% | 6,2-7,5% | >7,5% |
- u mMol/L
- NOTE: Tension to no diabetic level can be dangerous!
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