Insulin-Dependent Diabetes

Diabetes takes two forms: insulin-dependent (juvenile onset) and non-insulin-dependent (maturity onset) diabetes. The former, which usually starts during childhood through young adulthood, is characterized by a failure to produce sufficient or any insulin, the hormone needed to regulate the body's use of glucose or sugar. To control the insulin-dependent form of the disease, diabetics must have injections of insulin on a regular--daily or more often--basis.

Insulin is produced by cells in the islets of Langerhans, which are located throughout the pancreas. In insulin-dependent diabetics, the islets produce little or no insulin. The reasons are not fully understood. Without insulin, or with insufficient insulin, glucose accumulates in the blood. There is normally some glucose in the blood (about one part in 1,000), but in diabetes the amount rises considerably to dangerously high levels, and spills over into the urine.

Symptoms and Diagnosis

The most common symptom of diabetes is thirst, accompanied by frequent urination (as often as once an hour). There is often marked weight loss and there also may be repeated infections of the skin, gums or urinary tract, and fatigue, weakness or apathy. Tingling sensations in the hands and feet, cramps in the legs and blurred vision are further symptoms. the weight loss occurs because fat and muscle are being burned up to provide energy. In insulin-dependent diabetes, the symptoms usually develop rapidly.

Diabetes is usually diagnosed by a simple test in which the glucose level in the blood is measured; if it is persistently elevated, the patient has the disease.

Treatment

As of yet, there is no cure for diabetes, but the disease can be controlled by insulin injections, diet and a program of physical exercise. The goals of treatment are to relieve the symptoms, reduce the amount of glucose in the blood and urine and lower the risk of complications. For insulin-dependent diabetics, treatment consists of injections of insulin, which may be required as seldom as once a day or as often as three times a day. Since insulin is a hormone that is digested if taken orally, it must be administrated by injection. Therefore, it is important to learn to administer the injections yourself. This may seem difficult at first, but with proper instruction and practice, even a child can soon master injections. Your doctor will tell you where and how to give them.

Diet is also important in controlling diabetes. In a typical diabetic regimen, calories (800 to 1,500 daily, depending on the patient's weight) are distributed in small meals taken at regular intervals. Carbohydrates make up 50 to 60 percent of the total intake, with plenty of fibrous foods such as whole grain breads and cereals, fruits and vegetables. Simple carbohydrates are restricted to 5 to 15 percent of all carbohydrates calories and should come from natural sources such as milk and fruit rather than from candies, cookies and so on. Of the total calories, 30 to 35 percent come from fats and 12 to 20 percent (depending on age and activity) from protein. Key factors are controlling the intake of simple carbohydrates (sugars), eating balanced meals and maintaining an ideal body weight.

It is important to keep rigorously to the prescribed timetable of meals and snacks. The diet is designed to keep the blood glucose level steady so that each dose of insulin will have approximately the same amount of glucose to act upon.

Testing

The effectiveness of the treatment in keeping blood glucose at an acceptable level must be checked frequently--in some cases, several times a day. You may be asked to test your urine, using specially prepared paper reagent strips.

Many doctors now prefer that their patients use the relatively new blood test rather than the urine test to monitor glucose levels. These self-monitoring kits are now widely available. A small needle or lancet is used to prick a finger, and a drop of blood is then squeezed onto a chemically treated strip. The strip is then either compared to color samples or inserted into a meter to identify the glucose level.

Stress

Surgery, injuries, pregnancy, emotional upsets, any illness (from a cold to a heart attack) and even changes in the weather cause stress and thus increase the body's demand for insulin. Doctors and dentists should be told about your condition before starting treatment, so that they can take proper precautions.

Complications

In spite of careful management of the diabetes, complications may occur. One of the most common (and one that family members should know how to treat) is hypoglycemia, a low level of blood glucose. It may result from taking too much insulin, failing to keep to the diet or prolonged muscular exertion. The onset of hypoglycemia is usually gradual, with symptoms that include sweating, nervous irritability and a tingling tongue. There is time to counteract it by taking sugar or some other quick-energy food. Sometimes, however, a patient will become confused and even aggressive. Occasionally, the onset is sudden and the diabetic slips quickly into unconsciousness. In such cases, glucose should be quickly injected into a vein. Hypoglycemia may be life-threatening, but in most cases the patient will recover. Because of the possibility of an attack occurring when you are among strangers, you should carry a card explaining your condition and detailing what should be done in an emergency. Wearing a Medic-alert bracelet is an additional safeguard.

Another common complication of diabetes is hyperglycemia, which is excessive sugar in the blood. Hyperglycemia coma comes on slowly, over several hours or even days. It occurs when the body uses fat as a substitute for glucose to provide energy; as a result, acidic compounds (ketones) are formed. Drowsiness, incessant urination and intense thirst are early symptoms.

Arteriosclerosis, or hardening of the arteries, is also somewhat more common in diabetics than in others. There also may be some loss of sensation in the legs and feet, which can result in unperceived injury to the skin or joints. You should take good care of your feet, wear well-fitting shoes and cut your toenails carefully.

The eyes may also be affected by diabetes. Diabetics often suffer repeated bleeding into the retina, leading to the formation of scar tissue. Diabetes also may promote the formation of cataracts. All diabetics should have frequent eye examinations. New treatments, including the use of lasers, are reducing the incidence of blindness resulting from diabetes.

Summing up

Once the diagnosis of insulin-dependent diabetes is confirmed, and proper treatment is begun, most diabetics are able to lead normal, productive lives. Although regular insulin injections and self-discipline are vital in controlling the disease, diabetes should not be allowed to dominate day-to-day living.