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What causes Diabetes
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Complications of Diabetes
The most important aspect of treating diabetes is controlling blood sugar levels. Whether blood sugar levels are controlled through diet and exercise, insulin, other medications or any combination of these, it is an essential component to maintaining good health and avoiding both the potential short term and long term health complications associated with diabetes.
For more advanced, complicated cases of diabetes where kidney failure is present or an inability to respond to common treatments is present, organ transplantation may be the only option.
Treatment of Diabetes
1) Monitor Blood Sugar
Continual blood sugar monitoring is essential in the treatment of diabetes. This task can be quite easily learned, and becomes part of daily life once a patient is comfortable with the process. Your doctor will inform you of the safe range for your blood sugar level, depending on your age, the type of diabetes you have and any complications that may exist. The doctor will also inform you as to how often testing should be done. The frequency will largely depend on whether or not you use insulin.
Blood sugar ranges will vary between patients. Younger adults without complications usually target a range of 80-120 mg/dL before meals, and under 180 mg/dL after meals. Older adults with complications related to diabetes usually target 100-140 mg/dL before eating, and under 200 mg/dL after eating. It is important to note that low blood sugar in older adults presents more grave dangers than in younger adults.
An added benefit to patients who regularly monitor their own blood sugar is that over time they learn about what increases and decreases their blood sugar levels, enabling them to adjust their diet for targeted outcomes. Patients learn that many variables affect blood sugar levels.
Factors affecting blood sugar levels
Food raises your blood sugar and peaks 1 or 2 hours after food has been consumed. What you eat, how much you eat, when you eat - all of these variables will affect blood sugar.
Physical activity moves sugar into cells, where it can be used up as energy instead of being stored in blood. Generally speaking, the more physically active a person is, the lower their blood sugar will be. Any physical activity can help to lower blood sugar, particularly aerobic exercise, such as jogging, walking, biking and swimming.
Medications such as insulin and oral diabetes medications act by lowering blood sugar levels. Those patients taking medications for unrelated conditions can affect blood sugar levels. Steroids often raise blood sugar levels. High blood pressure medications (ex. thiazides) and high cholesterol medications (ex. niacin) can increase blood sugar levels. A doctor should be aware of every medication a patient takes, so as to modify diabetes medications or treatment.
The physical stress that an illness exerts on the body causes it to produce hormones that act to raise blood sugar levels in order to facilitate healing. Fevers increase a body's metabolism and will impact the rate at which blood sugar is used by the body. Always carefully monitor blood sugar levels when suffering from any illness.
Diabetics should consume only moderate amounts of alcohol and will sometimes be instructed to avoid alcohol altogether. Alcohol can either decrease or increase blood sugar levels, so it is important to monitor blood sugar levels before and after consuming alcohol to learn how alcohol affects your levels.
The fluctuations of hormones can affect blood sugar levels and the body's responsiveness to insulin. Estrogen usually causes cells to become more responsive to insulin, while progesterone causes cells to become less responsive. Although most people do not experience a change in blood sugar levels due to these hormones, those people who do experience such changes will likely see them in the 3rd week of the menstrual cycle when both these hormones are typically at their highest levels. Before reaching menopause, hormones can affect blood sugar levels. A corresponding decrease in these effects is seen post menopause.
2) Maintain a healthful diet
Adjusting your diet can be one of the simplest and most effective ways to control diabetes. A diet rich in vegetables, fruits and whole grains and low in fat, calories and animal products is essential. For those already eating a healthful diet, few dietary changes will be required as a good 'diabetes diet' reflects a diet that all people should be eating. Important for those with diabetes is understanding when and how much to eat. Often, patients with diabetes will visit a dietician to create a meal plan effective for them. The goal then is to consistently follow the meal plan to aid the body in keeping blood sugar levels consistent. Diet is vital in managing diabetes and will always have a profound impact on the degree to which diabetes affects your life and your health.
Consult with your doctor to ensure that you are following an exercise regime that works for your body and your diabetes. All and any activity is good, but it is vital that a diabetes patient get a sufficient amount of aerobic exercise. A good target for most people is 30 minutes a day of aerobic activity, such as walking, biking, swimming or jogging.
4) Maintaining a healthy weight
The number one risk factor in the development of Type 2 diabetes is being overweight, as fat causes the body's cells to be resistant to insulin. Loosing weight reverses this resistance. Any weight loss in an overweight person is good and will have a positive effect on blood sugar levels. Dieticians often assist those needing to lose weight with healthful diet plans effective for an individual's lifestyle and food preferences.
5) Diabetes medications
Diet and exercise are sometimes not effective enough in controlling diabetes. Insulin is one kind of medication used to treat diabetes. All those with Type 1 diabetes must take insulin daily. Some patients with Type 2 diabetes must take insulin every day. Insulin cannot effectively be taken orally and must be injected or pumped. Insulin can be injected using a syringe or an 'insulin pen injector'. An insulin pump that provides a continuous supply of insulin negates the need for injections. The pump is a small device that is worn outside the body with a catheter inserted into the abdomen connected to a supply of insulin. The pump can be adjusted to ensure the correct amount of insulin is pumped into body.
Medications used for Type 2 diabetes treatment
a) Sulfonylurea drugs
These medications act by stimulating the pancreas to both produce and release more insulin into the body. These medications are only effective if the pancreas is able to produce some insulin on its own. Low blood sugar is a common side effect of sulfonylurea drugs and these risks are heightened in patients with liver or kidney function impairment.
Meglitinides act similarly to sulfonylureas except that they act very quickly, and the effects fade very quickly, but patients are less likely to experience low blood sugar levels.
These medications work by inhibiting the production and release of glucose from the liver, causing less insulin to be required for moving blood sugar into the body's cells. Side effects of this group of medications can include loss of appetite, abdominal bloating, nausea and diarrhea. These side effects can be partly controlled by taking the medication with food. Lactic Acidosis is an uncommon, but very serious side effect. Lactic acid can build up in the body, leading to weakness, dizziness, muscle ache and fatigue.
d) Alpha-glucosidase inhibitors
This medication slows down the absorption of sugar into the bloodstream by blocking the action of enzymes that break down carbohydrates in the digestive tract. The outcome is a smaller increase in blood sugar after a meal. Side effects can include abdominal bloating and diarrhea. Taking too high doses of this medication can result in permanent liver damage.
These medications cause your body to become increasingly sensitive to insulin and stop the liver from producing an abundance of glucose. Side effects can include weight gain, fatigue and swelling. Liver damage can result from use of these medications. Anyone taking these medications must have their liver checked every month or two. Some doctors treating diabetes will rely on a combination of many medications to control blood sugar.
6) Organ transplant
a) Pancreas transplants
Usually, pancreas transplants are carried out at the same time or following a kidney transplant. Pancreas transplants are not always successful, but many patients whose pancreas transplants are successful no longer require insulin. Those patients who receive a new pancreas at the same time as a kidney transplant may experience greater success in kidney survival. Only those whose diabetes cannot be controlled or who experience severe complications associated with diabetes are considered candidates for pancreas transplant.
b) Islet cell transplantation
Over 70% of the approximately 1 million islet cells in the pancreas produce insulin. Beta cells reside in the islets. Transplanting these cells is an experimental procedure but may provide a less risky and less invasive procedure than pancreas transplants. This procedure involves transplanting fresh pancreas cells into the liver. These cells then spread throughout the liver and begin to produce insulin.
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