MY HANDI-CAPABLE REPORTER JULY 2003
Changing Pessimism to Optimism, VOL. 8 ISS. 7
by Ron Boehm, Publisher, MHCR
While in the hospital for an UTI( Urinary Tract Infection ) I had a Colonoscopy, and my blood was checked for DIABETES. I was diagnosed as having DIABETES and was put on a 1500 calorie diet. No way, I said, my sugar count in my blood rose to over 300, that's high I was told, it should be around 100 base. As a newly diagnosed diabetic patient, I put together some meaningful information that you should look into.
Almost every one of us knows someone who has diabetes. An estimated 16 million people in the United States have diabetes mellitus -- a serious, lifelong condition.
About half of these people do not know they have diabetes and are not under care for the disorder. Although diabetes occurs most often in older adults, it is one of the most common chronic disorders in children in the United States. About 123,000 children and teenagers age 19 and younger have diabetes.
What Is Diabetes?
Diabetes is a disorder of metabolism -- the way our bodies use digested food for growth and energy. Most of the food we eat is broken down by the digestive juices into a simple sugar called glucose. Glucose is the main source of fuel for the body.
After digestion, the glucose passes into our bloodstream where it is available for body cells to use for growth and energy. For the glucose to get into the cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.
When we eat, the pancreas is supposed to automatically produce the right amount of insulin to move the glucose from our blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the body cells do not respond to the insulin that is produced. As a result, glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.
How Is Diabetes Managed?
Before the discovery of insulin in 1921, all people with type 1 diabetes died within a few years after the appearance of the disease. Although insulin is not considered a cure for diabetes, its discovery was the first major breakthrough in diabetes treatment.
Today, daily injections of insulin are the basic therapy for type 1 diabetes. Insulin injections must be balanced with meals and daily activities, and glucose levels must be closely monitored through frequent blood sugar testing.
Diet, exercise, and blood testing for glucose are also the basis for management of type 2 diabetes. In addition, some people with type 2 diabetes take oral drugs or insulin to lower their blood glucose levels.
People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves trying to keep blood sugar levels from going too low or too high.
When blood sugar levels drop too low -- a condition known as hypoglycemia -- a person can become nervous, shaky, and confused. Judgment can be impaired. Eventually, the person could pass out. The treatment for low blood sugar is to eat or drink something with sugar in it.
On the other hand, a person can become very ill if blood sugar levels rise too high, a condition known as hyperglycemia. Hypoglycemia and hyperglycemia, which can occur in people with type 1 diabetes or type 2 diabetes, are both potentially life-threatening emergencies.
People with diabetes should be treated by a doctor who monitors their diabetes and checks for complications. Doctors who specialize in diabetes are called endocrinologists or diabetologists. In addition, people with diabetes often see ophthalmologists for eye examinations, podiatrists for routine foot care, dietitians for help in planning meals, and diabetes educators for instruction in day-to-day care.
The goal of diabetes management is to keep blood glucose levels as close to the normal (nondiabetic) range as safely possible. A recent Government study, sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), proved that keeping blood sugar levels as close to normal as safely possible reduces the risk of developing major complications of diabetes.
The 10-year study, called the Diabetes Control and Complications Trial (DCCT), was completed in 1993 and included 1,441 people with type 1 diabetes. The study compared the effect of two treatment approaches -- intensive management and standard management -- on the development and progression of eye, kidney, and nerve complications of diabetes. Researchers found that study participants who maintained lower levels of blood glucose through intensive management had significantly lower rates of these complications.
Researchers believe that DCCT findings have important implications for the treatment of type 2 diabetes, as well as type 1 diabetes.
What Is the Status of Diabetes Research?
NIDDK supports basic and clinical research in its own laboratories and in research centers and hospitals throughout the United States. It also gathers and analyzes statistics about diabetes. Other institutes at the National Institutes of Health also carry out research on diabetes-related eye diseases, heart and vascular complications, pregnancy, and dental problems.
Other Government agencies that sponsor diabetes programs are the Centers for Disease Control and Prevention, the Indian Health Service, the Health Resources and Services Administration, the Bureau of Veterans Affairs, and the Department of Defense.
Many organizations outside of the Government support diabetes research and education activities. These organizations include the American Diabetes Association, the Juvenile Diabetes Foundation International, and the American Association of Diabetes Educators.
In recent years, advances in diabetes research have led to better ways to manage diabetes and treat its complications. Major advances include:
(a).. New forms of purified insulin, such as human insulin produced through genetic
engineering
(b).. Better ways for doctors to monitor blood glucose levels and for people with
diabetes to test their own blood glucose levels at home
(c).. Development of external and implantable insulin pumps that deliver appropriate
amounts of insulin, replacing daily injections
(d).. Laser treatment for diabetic eye disease, reducing the risk of blindness
(e).. Successful transplantation of kidneys in people whose own kidneys fail because
of diabetes
(f).. Better ways of managing diabetic pregnancies, improving chances of successful
outcomes
(g).. New drugs to treat type 2 diabetes and better ways to manage this form of
diabetes through weight control
(h).. Evidence that intensive management of blood glucose reduces and may prevent
development of microvascular complications of diabetes
(i).. Demonstration that antihypertensive drugs called ACE-inhibitors prevent or delay
kidney failure in people with diabetes
What Will the Future Bring?
In the future, it may be possible to administer insulin through nasal sprays or in the form of a pill or patch. Devices that can "read" blood glucose levels without having to prick a finger to get a blood sample are also being developed.
Researchers continue to search for the cause or causes of diabetes and ways to prevent and cure the disorder. Scientists are looking for genes that may be involved in type 2 diabetes and type 1 diabetes. Some genetic markers for type 1 diabetes have been identified, and it is now possible to screen relatives of people with type 1 diabetes to see if they are at risk for diabetes.
The new Diabetes Prevention Trial -- type 1 diabetes, sponsored by NIDDK, identifies relatives at risk for developing type 1 diabetes and treats them with low doses of insulin or with oral insulin-like agents in the hope of preventing type 1 diabetes. Similar research is carried out at other medical centers throughout the world.
Transplantation of the pancreas or insulin-producing beta cells offers the best hope of cure for people with type 1 diabetes. Some pancreas transplants have been successful. However, people who have transplants must take powerful drugs to prevent rejection of the transplanted organ. These drugs are costly and may eventually cause serious health problems.
Scientists are working to develop less harmful drugs and better methods of transplanting pancreatic tissue to prevent rejection by the body. Using techniques of bioengineering, researchers are also trying to create artificial islet cells that secrete insulin in response to increased sugar levels in the blood.
For type 2 diabetes, the focus is on ways to prevent diabetes. Preventive approaches include identifying people at high risk for the disorder and encouraging them to lose weight, exercise more, and follow a healthy diet. The Diabetes Prevention Program, another new NIDDK project, will focus on preventing the disorder in high-risk populations.
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