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| Volume 1, Issue 6 | APRIL 2002 |
| Inside This Issue | |||||
| 1 | Diabetes | ||||
| 2 | Updates and Announcements | ||||
| 3 | Drug Fact Sheets | ||||
Medical Information Fact Sheet
Diabetes mellitus is a disease of the pancreas (an organ behind the stomach). Normally the pancreas releases a hormone called insulin that helps your body store and use the sugar and fat from the food you eat.
Diabetes occurs:
- When the pancreas does not produce any insulin, or
- The pancreas produces very little insulin, or
- When the body does not respond appropriately to insulin, a condition called "insulin resistance".
To understand why insulin is important one must understand how the body uses food for energy. The body is made up of millions of cells. To make energy, these cells need food in a very simple form. When you eat or drink, much of your food is broken down into a simple sugar called glucose. Glucose ("sugar") provides the energy the body needs for daily activities.
The blood stream transports glucose both from where it is taken into the body after eating (the intestines) and where it is manufactured (in the liver) to the cells where it will be used (muscles, brain etc.) or stored (in the liver) or converted to fat (in the liver).
When the amount of glucose in the blood reaches a certain level, your pancreas releases insulin. The insulin carries the glucose into the appropriate cells. As more glucose enters the cells, the level of glucose in the blood stream drops.
Without insulin, the glucose can't be stored -which allows the level of glucose in the blood to rise. Too much glucose in the blood is called "high blood sugar". By definition, diabetes is having a blood sugar level of 126 mg/dL or more after an overnight fast.
Type 1 diabetes:
Type 1 diabetes occurs because the insulin-producing cells of the pancreas (called beta cells) are damaged. People with type I diabetes produce little or no insulin. People with type 1 diabetes must use insulin injections to control their blood glucose.
The damage to the insulin-producing cells in type 1 diabetes occurs over a period of years. However, the symptoms of type I diabetes may occur over a period of days to weeks. Type 1 most commonly starts in people under the age of 20, but may occur at any age.
Unlike people with type 1 diabetes, people with type 2 diabetes produce insulin. However, the insulin they produce is either not enough or doesn't work properly in the body. When there isn't enough insulin or the insulin is not used as it should be, glucose can't get into the body's cells.
Type 2 is the most common form of diabetes mellitus. It usually starts in people over the age of 40 who are overweight. But the rise in obesity in young people has caused a rise in type 2 diabetes in that age group. Some people can manage their type 2 diabetes by controlling their weight, watching their diet, and exercising regularly. Others may also need to take a pill that helps them use their insulin better, or take insulin injections. Type 2 can also occur in individuals who are not obese.
Gestational diabetes is triggered by pregnancy. Hormone changes during pregnancy can affect insulin's ability to work properly, resulting in high blood glucose levels.
Pregnant women who have increased risk of developing gestational diabetes are those who are over 25 years old, are above their normal body weight before pregnancy, have family history of diabetes or are Hispanic, African-American, Native American, or Asian.
Usually, blood glucose levels return to normal after childbirth. However, women who have gestational diabetes have an increased risk of developing type 2 diabetes later in life.
The symptoms of type 1 diabetes often occur suddenly and can be severe. They include:
- Increased thirst
- Increased hunger (especially after eating)
- Dry mouth
- Frequent urination
- Unexplained weight loss (even though one is eating and feeling hungry)
- Fatigue (weak, tired feeling)
- Blurred vision
- Numbness or tingling of the hands or feet.
- Loss of consciousness (rare)
The symptoms of type 2 may be the same as those listed above. Most often, there are no symptoms or very gradual development of the above symptoms. Other symptoms may include:
- Slow-healing sores or cuts
- Itching of the skin (usually in vaginal or groin area)
- Yeast infections
- Recent weight gain
Although the cause of diabetes is unknown, the following risk factors may increase your chance of getting diabetes:
Family History. If a parent or sibling has diabetes, risk is increased.
Race or ethnic background. The risk is greater in Hispanics, African-American, Native Americans and Asians.
Being overweight. If one is 20% or more over optimal body weight, your risk is increased.
Hypertension (high blood pressure).
Abnormal cholesterol levels. Low HDL "good" cholesterol less than 35mg/dL and/or triglyceride level over 250mg/dL increases your risk.
Age. Your risk increases as you get older.
Use of certain drugs:
- Blood pressure medications, such as thiazides.
- Steroid medicines, such as prednisone or decadron.
- Hydantoin medicines such as Dilantin.
- Medicines for transplant recipients, such as cyclosporine.
Alcohol use. Years of heavy alcohol intake increase your risk.
Smoking. Smoking increases your risk.
History of gestational diabetes or of delivering babies over nine pounds.
Autoimmune disease. Your body's defense system (immune system) attacks healthy insulin-producing beta cells in you pancreas.
Viruses. Some viruses are thought to play a part in diabetes development.
It is important to note that eating a lot of sugar, in and of itself, does not cause diabetes, but it can lead to tooth decay and obesity.
If one suddenly experiences symptoms of increase thirst, frequent urination, or unexplained weight loss, your doctor may suspect diabetes. To confirm diagnosis, a fasting plasma glucose test or a casual plasma glucose test will be performed.
The preferred method of diagnosing diabetes is the fasting plasma glucose test (FPG) because it is easy to do, convenient for patients, and less expensive than other tests, according to the American Diabetes Association. The FPG measures your blood glucose level after you have not eaten anything in 10-12 hours.
Normal fasting blood glucose is between 70 and 115 mg/dL for people who do not have diabetes. The standard diagnosis of diabetes is made when two separate blood tests show that fasting blood glucose level is greater than or equal to 126 mg/dL.
Some people have a normal fasting blood glucose reading, but their blood glucose rises rapidly as they eat. These people may have glucose intolerance. If their blood glucose levels are high enough, they may have diabetes.
The casual plasma glucose test is another method of diagnosing diabetes in which blood glucose is tested without regard to the time the person's last meal. A glucose level greater than 200 mg/dL may indicate diabetes, especially if the test is repeated at a later time and shows similar results.
The oral glucose tolerance test is another method used to detect diabetes, but it is usually only done during pregnancy.
At the present time, diabetes can't be cured, but it can be treated and controlled. The goals of managing diabetes are to:
- Keep your blood glucose levels as near to normal as possible by balancing food intake with medication and activity.
- Maintain your blood cholesterol and triglyceride (lipid) levels near their normal ranges as possible by decreasing the amount of fat to 30% or less of your total daily calories and by reducing saturated fat and cholesterol.
- Control your blood pressure. Your blood pressure should not go over 130/85.
- Slow or possibly prevent the development of diabetes related health problems.
You hold the keys to managing your diabetes by:
- Planning what you eat and following a balanced meal plan.
- Exercise regularly
- Taking medicine, if prescribed, and closely following the guidelines on how to take it.
- Monitoring your blood glucose and blood pressure levels at home.
Treatment also can include taking pills for diabetes or by insulin injections besides the management strategies listed above.
- Eye problems including cataracts, glaucoma and retinopathy. Increased glucose levels lead to hardening of the basement membrane in the small vessels of the eye causing decreased blood supply.
- Dental problems. Diabetics have decreased immune function making them more vulnerable to the germs that live in their mouths.
- High blood pressure
- Heart disease and other blood vessel problems
- Stroke
- Nerve damage. Diabetics experience loss of feeling possibly due to blood vessel damage. They feel less or no pain.
- Kidney damage. Excess glucose levels stress the kidney filtration system and causes increased pressure in the vessels causing the vessels to become damaged.
- Hypoglycemia. Decreased levels of sugar in the blood.
- Hyperglycemia. Increased levels of sugar in the blood.
- Ketoacidosis. A serious illness that may arise if there is little or no insulin present in the body. Life threatening.
- Diabetic Coma or hyperglycemia nonketonic syndrome. Similar to Ketoacidosis, it results from ineffective insulin
- Infections. Glucose levels alter immune system effectiveness.
- Blurred vision
- Skin & Foot complications. Skin and foot problems occur often in those with diabetes due to loss of pressure sensation and pain, poor circulation and decreased immune function. The feet are often involved because diabetics can step on things and sustain injuries they don't know they have. These injuries sometimes go unnoticed and do not heal fast. The result may often be amputation.
HCPCFC PROGRAM UPDATES and ANNOUNCEMENTS!!!
During the month of March, William Chavez and Kristen Thompson obtained health and education information at the detention hearings on children that are in foster care in Indio court. The experience has been positive and we look forward to having a PHN cover that area on an ongoing basis. We will continue gathering information at the court until the PHN position has been filled.
Congratulations to Hermia Parks (my supervisor) for her promotion, she is now the Assistant Director of Public Health Nursing. I wish her the best. Best Wishes Hermia! .
Editor: Kristen Thompson, PHN; Contributors: Hermia Parks, PHN, MA, Assistant Director of Public Health Nursing; and Judy Earp, MHA, Director of Public Health Nursing.
