Diabetes Mellitus

• Diabetes mellitus is a group of serious and chronic disorders affecting the metabolism of carbohydrates.
• These disorders are characterized by hyperglycemia, the abnormally large amounts of glucose in the blood.
• Diabetes mellitus was first named by a Greek physician, meaning "to flow through," due to the large amounts of urine generated by victims.
• The term "mellitus" was added to diabetes mellitus later, referring to the amount of glucose in the urine.
• Diabetes insipidus is a different disorder that also generates large amounts of urine, but it is "insipid," not sweet, and is caused by a damaged pituitary gland.
• The body needs a constant supply of energy, and glucose is its primary source.
• Carbohydrates provide most of the glucose, but about 10% of fats and up to nearly 60% of proteins can be converted to glucose if necessary.
• The distribution of glucose must be carefully managed for the maintenance of good health.
• Glucose is transported by the blood, and its entry into the cells is controlled by hormones.
• Insulin is the primary hormone that controls the entry of glucose into the cells.
• Insulin is secreted by the beta cells of the islets of Langerhans in the pancreas.
• When there is inadequate production of insulin or the body is unable to use the insulin it produces, glucose cannot enter the cells and it accumulates in the blood, creating hyperglycemia.
• Hyperglycemia can cause serious complications.
• Glucagon, secreted by the alpha cells of the islets of Langerhans, helps release energy when needed by converting glycogen to glucose.
• Somatostatin, a hormone produced by the delta cells of the islets of Langerhans and the hypothalamus, inhibits the release of insulin and glucagons.
• The amount of glucose in the blood normally rises after a meal.
• The pancreas reacts by providing insulin.
• As the insulin circulates in the blood, it binds to special insulin receptors on cell surfaces, causing the cells to accept the glucose.
• The resulting reduced amount of glucose in the blood in turn signals the pancreas to stop sending insulin.
• The etiology of diabetes is not confirmed, but it appears that diabetes may be genetic, with environmental factors contributing to its occurrence.
• Diabetes mellitus causes the body to break down its own tissue for protein and fat, resulting in polyphagia, loss of weight, weakness, and fatigue.
• The body’s use of protein from its own tissue causes it to excrete nitrogen.
• Because the untreated diabetic client cannot use carbohydrates for energy, excessive amounts of fats are broken down, and consequently the liver produces ketones from the fatty acids.
• Human insulin is the most common insulin given to clients.
• It is advisable for the diabetic client to carry identification explaining the condition so that people do not think he or she is drunk when, in reality, the person is experiencing an insulin reaction.
• Insulin reaction is dangerous because if frequent or prolonged, brain damage can occur.
• Various types of insulin are available, differing in the length of time required before they are effective and in the length of time they continue to act.
• Insulin pumps deliver insulin two ways: the basal rate and a premeal bolus.
• In healthy people, ketones are ketonuria.
• These insulins are rarely used because they contain antibodies that make them less pure than human insulin.
• Symptoms of an insulin reaction include headache, blurred vision, tremors, confusion, poor coordination, and even unconsciousness.
• Exercise helps the body use glucose by increasing insulin receptor sites and stimulating the creation of glucagon.
• Insulin is often given in two or more injections daily and may contain more than one type of insulin.
• Insulin pumps are not for everyone, and an endocrinologist and diabetes educator can determine the best candidates for pump therapy.
• Human insulin is preferred because it is very similar to insulin made by the pancreas.
• Exercise must be carefully discussed with the client’s physician.
• If the client is unconscious, intravenous treatment of dextrose and water is given.
• For clients with type 2 diabetes, exercise helps improve weight control, glucose levels, and the cardiovascular system.
• Exercise lowers cholesterol and blood pressure and reduces stress and body fat as it tones the muscles.
• Exercise should be on a regular basis, and it must be considered carefully as the meal plans are developed so that sufficient calories and insulin are prescribed.