DIABETESA Serious Condition
Definition
Diabetes mellitus (generally referred to simply as ‘diabetes’) is a metabolic disorder characterized by too much glucose in the blood due to defective insulin secretion, defective insulin action or both. When insulin cannot do its job, glucose builds up in the blood.
Types
The two main types of diabetes are: (a) type 1 that occurs in young people, has an abrupt onset and associated with ketoacidosis, and (b) type 2 that occurs mainly in older persons, is associated with overweight, lack of physical activity, the metabolic syndrome, and will be the main focus of this discussion.
Classification
Diabetes is a serious condition with potentially devastating complications that affects all age groups, and classified broadly into microvascular (small blood vessels) and macrovascular (large blood vessels) disease.
Pathophysiology
It has been suggested that sorbitol (a sugar alcohol) accumulating in cells, causing osmotic stress, is the underlying mechanism for diabetic microvascular complications which include neuropathy (nerve damage), nephropathy (kidney disease resulting in end-stage renal failure) and vision disorders (eg retinopathy, glaucoma, cataract and corneal disease) - diabetes is the leading cause of blindness. Atherosclerosis (waxy, fatty deposit of plaque), which leads to narrowing of arterial walls throughout the body, is the central pathological mechanism in macrovascular disease. Macrovascular complications include heart disease (the leading cause of death in diabetics which occurs 2- to 4-fold more often compared to non- diabetics), stroke, infections, metabolic difficulties, pregnancy,
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impotence, autonomic neuropathy and peripheral vascular disease (which can lead to ulcers, gangrene and amputation).
Risk Factors Risk factors for type 2 diabetes include:
• Overweight people with a Body Mass Index of 25kg/m2 or greater • Abdominal obesity • Age 45 years and older
• Lack of vigorous exercise each week • Diabetes in a first-degree relative • Prior gestational diabetes or having delivered a baby greater than 4 kg (9 lb) • HDL cholesterol 35mg/dL or lower; Triglyceride levels 250mg/dL or greater
• Persons of African or Asian descent • Presence of coronary artery disease and/or hypertension (blood pressure 140/90 mmHg or higher)
Diabetes Management
Effective management of diabetes requires ongoing diabetes education, regular monitoring of blood pressure and cholesterol levels, support in interpreting and acting on the results of self- monitoring of blood glucose, lowering the risk and potential impact of serious complications, making informed management decisions about medication, nutrition, physical exercise activity and other lifestyle issues, including daily preventive practices such as good foot care.
Self-Management Guidelines
Diabetics should understand their condition, what they should do for management and why it is being done. Here are a few guidelines: 1. Ensure you understand the signs, symptoms, causes and
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