ALL YOU NEED TO KNOW ABOUT DIABETES...
| Diabetes can be dangerous
and can cause death if you do not control your blood sugar in the
blood. Over time, elevated levels of blood sugar can damage the eyes,
blood vessels, nerves and kidneys. Here are some of the problems (also
called complications) that diabetes can cause.Blindness
and vision loss (called diabetic retinopathy): Diabetes can damage
small blood vessels in the retina can cause vision loss and even
blindness. For more information read our booklet Diabetes: Caring for
the eyes. Heart disease: People with diabetes are twice as likely to have heart disease and lesions in blood vessels of the heart. This increases your risk of heart attack and stroke. For more information read our booklet Diabetes and heart disease. Damage to nerves and blood vessels (called diabetic neuropathy): Damage to blood vessels of the legs can limit the supply of blood to the nerves in the legs and feet. This can cause burning, tingling and numbness in the affected areas that usually begins in the toes and then spreads to the entire foot. This also makes it difficult to feel injuries, such as foot ulcers. Damage to blood vessels can also put you at risk for infections and nonhealing ulcers. | |
| In severe cases, may have to be amputated (removed) parts of the foot or lower leg area. For more information read our brochure diabetic neuropathy. Kidney disease (called diabetic nephropathy): Diabetes can damage small blood vessels of the kidneys, which lose their ability to filter waste from the body for disposal. In some people, the kidneys stop working completely. These people require dialysis or a kidney transplant. Dialysis is a treatment that eliminates wastes in the blood. For more information, please read our brochure diabetic nephropathy. The good news is that complications of diabetes can often be prevented by taking care of himself, following the orders that your doctor gives you and controlling your blood sugar in the blood. For more information on how to prevent these problems, please read our brochure Preventing complications of diabetes. |
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Diabetes Mellitus. General Information. What is Diabetes Mellitus? Diabetes mellitus (DM) is a chronic (lifelong) that occurs when the pancreas, an organ in the abdomen behind the stomach, does not produce any insulin or produces little or it is defective (can not be used properly). The word diabetes comes from the Greek words meaning "crossing" or "run through" while mellitus is Latin and means "sweet as honey". But this we shall see later. A bit of history. Diabetes is a disease known since ancient times. The first historical reference we have a clinical picture much like the current diabetes found in an Egyptian papyrus discovered in a tomb at Thebes in 1862 by Ebers, papyrus was written in about 1500 BC JC, does nothing less than 3,500 years. It seems that the Egyptians ate well and with plenty, and among them was common obesity. Moreover, the Indian physicians, described in books dating from 600 BC JC the existence of patients suffering from thirst, rapid weight loss, lose strength and emit urine attracts the ants for its sweet taste. These references show that symptoms of the disease have been known for many years. However, the term diabetes, was not coined until the first century by a Turkish doctor, Aretaeus of Cappadocia.
Galen in the second century, interpreted the diabetes was caused by the inability of the kidney to retain water, and this idea, wrong somehow persisted for 15 centuries. Already in the seventeenth century, Thomas Willis dared to test the urine of a diabetic rediscovering, 2,200 years after the Hindus, that the urine tasted sweet. It was not until 1775 that Matthew Dobson discovered that the sweet taste of urine was due to the presence of sugar. Dobson concluded that "the loss of weight and strength of diabetics was due to the loss of nutritive material in the urine, much like the conclusion reached Cappadocia Aretaeus 1600 years before. The story does not say whether Dobson develop flushed after its conclusion. Until the late nineteenth century, the pancreas was still a great unknown from the point of view function. Around 1700 have already been performed excision of this organ in dogs, but the technique was flawed and had come to the erroneous conclusion that the pancreas was not necessary for life. In 1869, Paul Langerhans, who was then 22 years, he published his doctoral thesis on histology of the pancreas. In their studies, some groups described Langerhans cells as small islands, separate from the rest of the structure of the gland and the nature and function (in his words) "I can not explain."
In 1889, two surgeons, von Mering and Minkowski observed that after the removal of the pancreas in animals, they became diabetic. These experiments pointed to the pancreas undoubtedly be primarily responsible for diabetes, but still had to know how. Minkowski himself helped to resolve ongoing pancreatic autotransplantation. Transplants shows that, when they were large enough, did not show symptoms of diabetes in animals. Everything seemed to assume that the pancreas produced a substance (unknown then) that was poured into the blood and whose absence was responsible for diabetes. The search for this substance in 1921 led to Banting and Best discover insulin. A few months later, in January 1922 was successfully used for the first time in a child of 12 years (Leonard Thompson). Insulin was born, changing dramatically the prognosis of diabetes and allowing a comfortable life for millions of people around the world.
What is insulin? Insulin is a substance produced in the pancreas whose function is to regulate the amount of sugar (glucose) found in the blood, but how does this? Think of our body consists of cells and that they need energy (fuel) to operate. The foods we eat contain what we call immediate early (carbohydrates, proteins and fats) that have to be unfolded or break into smaller substances for absorption and subsequent use; one of these substances is glucose.
Glucose is used by all our cells as fuel for proper operation. To fulfill this mission, it must penetrate the glucose into cells of various organs, but it needs a key to open the doors of the cells. This key is insulin. We have said previously that insulin is secreted by the pancreas. Inside it are small groups of cells called islets of Langerhans ", formed by the beta cells that are responsible for producing insulin. When a healthy person takes food, begins a process of digestion and absorption of sugar from the blood. At that time the beta cells, "measuring" blood sugar levels constantly, produce and deliver the right amount of insulin for glucose to enter cells. This system works with a perfect balance so that, firstly all our cells are well fed, and on the other maintain high blood glucose levels within normal limits.
Excess glucose is stored as fat tissue (the large bank of energy the body) or in the liver as glycogen (the principal storage form of glucose) to that in the time periods that do not eat or consume much energy, go slowly from the blood and can go on being used by our bodies. hen there is little or no insulin or when the insulin that is not working properly, glucose can not enter cells and therefore accumulates in the blood. This increase in blood glucose is what is known as hyperglycemia.
What are the symptoms? People with diabetes may have different symptoms. The most common and directly related to hyperglycemia are more than usual urination (polyuria), have great thirst (polydipsia), being always hungry (polyphagia), tiredness and weight loss is striking. Other common symptoms include: itchy skin and especially on the genitals, slow wound healing, blurred vision, numbness in the feet, etc.. However, people with diabetes may have all, some or none of these symptoms. Let's see what happens every one of them. This requires knowing what is the renal threshold. Consider that the kidneys are a filter used to remove substances that are toxic to our body. When glucose is in the blood reaches the kidney, it filters it and returns it back to the blood, as they will not lose interest because it is the fuel for cells. However, this ability of the kidney is limited and so when the amount of blood glucose exceeds 180 mg / dl, the kidneys can no longer hold such quantities and from that moment begins to eliminate the urine (as a dam which overflows when there is too much tail l). This elimination of glucose in urine is what is known as glucosuria.
When a person has diabetes and takes a meal glucose will accumulate in the blood. When you get this blood to the kidney, the amount of glucose in excess (as we have seen was above 180 mg / dl) will start to be eliminated in the urine, dragging water and, therefore, begin to urinate a lot. This is called polyuria is usually the first symptom of uncontrolled diabetes. Water loss through urine stimulates the brain to send a message of "sed", so you start drinking heavily. This is called polydipsia. When no insulin for glucose to enter cells they can not get fuel and do not feed. This stimulates the brain to send a message of "hunger" by increasing the appetite. This is called polyphagia. Because the glucose that should be feeding the cells are being eliminated in the urine, the cells can not produce energy and this can cause tiredness and fatigue. In addition, weight loss from being unable to feed the cells. At the time a person with diabetes are given proper treatment, the glucose will penetrate into the interior of all cells and reducing blood glucose levels below 180, so as not remove the urine and disappear polyuria and polydipsia. The agency will have the feeling of being well fed, and not feel polyphagia, or lose weight and good blood glucose to enter muscle cells, they either will contract with disappearance of fatigue. That is, with proper treatment and sugar well controlled to eliminate the symptoms of diabetes.
How is it diagnosed? To know when a person has diabetes or not you have to know which are the figures of glucose in the blood (glycemia), considered as normal fasting glucose values between 60 and 110 mg / dl. Diabetes Mellitus is diagnosed by three different ways: fasting glucose less than 126 mg / dl determined, at least two separate occasions. Random glucose (performed at any time of day, even after eating), less than 200 mg / dl, provided it is accompanied by the typical symptoms of the disease (urinate a lot, have great thirst, weight loss, etc.) . Glucose 2 hours after oral glucose (SOG) equal to or greater than 200 mg / dl. (See below). Beware: it is always necessary to confirm the results if alteration occurs only in a single analytical. What happens then to people who have fasting glucose at or above 110 mg / dl but less than 126 mg / dl? In these situations it is indicated when performing a blood glucose curve or SOG (oral glucose). The completion of this test involves the administration, while fasting beforehand, a certain amount of glucose (75 grams) by mouth and are obtained for blood glucose at fasting and 2 hours after you have eaten. Depending on the amount of glucose obtained at 2 hours, we can find three situations: If glucose is below 140 mg / dl, the curve is normal and the person has diabetes. If at that time, glucose is less than 200 mg / dL, have diabetes. If glucose is between 140 mg / dl and 199 mg / dl, then you have an impaired glucose tolerance (we might say it is a stage prior to diabetes).
What kinds of diabetes exist? There are basically two types of diabetes: type 1 and type 2 diabetes. Diabetes mellitus type 1 (DM1) occurs when the pancreas stops producing insulin, a substance that is essential to live, so these people should administer insulin throughout their lives to survive. It usually presents in children and youth generally, its onset is usually sudden and is of 5 to 10% of all diabetes cases. Diabetes mellitus type 2 (DM2) occurs when the pancreas does not produce enough insulin or it can not properly exercise its action to bring glucose into cells. It is by far the most common, accounting for 90-95% of all diabetes cases. It is usually diagnosed after 40 years, symptoms are usually not very pronounced. It is usually controlled with diet, regular exercise and pills, but sometimes insulin is needed to achieve good control.
Another major type of diabetes is gestational diabetes, which is the elevation of glucose that was first discovered during pregnancy. Appears in the 2-6% of all pregnancies of healthy women. This type of diabetes can easily be controlled with diet alone, although a percentage of them are going to need insulin treatment. NOT be used during pregnancy, oral agents, as through the placenta to the fetus and may hurt. Gestational Diabetes Diagnosis is made after a SOG with 100 grams of glucose and taking out blood samples before glucose ingestion and every hour for 3 hours. Two or more values must be equal or exceed the following:
Uncontrolled diabetes during pregnancy poses a particular risk to the fetus, with the possibility, among other problems, excess weight at birth which can hinder the delivery or excessive fall in blood glucose after birth (neonatal hypoglycemia) . In most women with gestational diabetes, glucose is normalized to give birth. However, over time, have a higher risk of developing type 2 diabetes. Other types of diabetes are far less frequent than the previous are: MODY type diabetes (type 2 diabetes is but appears on young people). Diabetes secondary to pancreatic diseases (pancreatitis, pancreatic cancer ,...), endocrine diseases (acromegaly, Cushing's disease ,...), the ingestion of certain drugs (steroids, diuretics associated ,...), genetic diseases (Down syndrome ,...), etc..
1.5. How do you get? Why Diabetes occurs? Two factors are especially important in the development of diabetes: heredity and environmental factors. Type 1 diabetes, is caused by self-destruction of beta cells and therefore unable to produce insulin. But why these cells are destroyed? The body of a healthy person has defense mechanisms that make when a foreign agent, virus, bacteria, etc.. Falls within the body, identified as foreign and destroy it. In all these defense systems is called the immune system. There are people who, having contact with a virus or other substances, they attack the beta cells, not destroyed, but altered slightly, so that they are not recognized by the immune system, which recognizes them as foreign and the attacks with substances called ICA (antibodies against islet cells).
It was unclear why the same virus can, in some people, to attack the beta cells and make them unknown to their defense system and other not alter these cells. It is said that some people are genetically predisposed and therefore in contact with the virus, altering the beta cells that are attacked by its defense system and trigger diabetes. What is the risk for developing type 1 diabetes? The risk in the general population is approximately 0.3%. This risk increases if the parents are type 1 diabetics. If the parent is affected the risk is 2.5-6.1%, if only the mother: 0.5-2.9% and if they are both the risk increases to 10-25%. With regard to Type 2 diabetes is a large heritable component (complex and not well known until now) and a large environmental component. So, are more likely to develop individuals who meet one of the following characteristics:
Obesity. 80% of people with type 2 diabetes have some degree of obesity at the time of diagnosis. By losing weight, in most cases, control glucose levels without taking any medication. Being diabetic first-degree relatives: grandparents, parents, siblings ... Having had gestational diabetes or fetal pregnancies with large (over 4 Kg). The older more likely to have diabetes. Have Hypertension and alterations in cholesterol and / or triglycerides. Gestational Diabetes has also been seen that there are certain factors that predispose their occurrence: age over 35 years. Family history of diabetes. Obesity. Gestational diabetes in previous pregnancies. Previous pregnancies large (more than 4 KG).
Can it be prevented? When it comes to prevention we must differentiate between Type 1 diabetes and type 2, since, as we have seen previously, the causes that trigger their appearance are different in kind and another. When diagnosed type 1 diabetes is estimated that 90% of the beta cells are destroyed. But before this phase is a period shorter or longer in which there is only genetic predisposition, and only progresses to diabetes if you injure the beta cell. Well, at this stage is when a series of markers (ICA, IAA, GAD, etc.) That can determine with a blood test and, if positive, indicates that this person very likely to develop diabetes the coming years.
Whom they must perform these tests? Essentially performed among relatives of newly diagnosed patients, since these will be those with the risk of developing it. For example, if a child has diabetes and his brother has positive ICA likely to develop diabetes over the next ten years will be up to 75%. The basis for this type of prevention is therefore to stop the destruction of the beta cell. Different drugs have been tried: a block immune system and are called (cyclosporine A, azathioprine), others are called immunoregulatory (nicotinamide). Another way of trying to preserve beta cell (by resting) is with the administration of low doses of insulin during this phase, and so on.
These measures are attempts to delay the full onset of the disease in people known to have an elevated risk of developing it. While all these measures, so far, only performed in specialized centers and in the context of clinical trials. What can we do about type 2 diabetes? Leading a healthy life. The first thing is to avoid gaining weight, since it is known that obesity is one of the key factors that make the insulin it can not penetrate into the cells as well, losing those extra kilos, insulin may re-enter easily into the cell and exert their action properly. Therefore, we must all follow a healthy diet and do some form of daily physical activity (for details see the relevant chapters).
Furthermore, it is necessary to keep control over risk factors such as raised blood pressure and increased fats in the blood. Finally, it is crucial to perform an early diagnosis, especially in those with high risk. Therefore, blood sugar checks should be carried out at specific intervals, for in the case of any alteration appears to act fast.
Is there a cure? Diabetes, today, is a chronic disease. This means that from the moment we are diagnosed, will accompany us throughout life. However, although it has no cure can be controlled. Controlling diabetes is trying to get the blood glucose levels are at all times, as close to normal as possible. This prevents the annoying symptoms and significantly reduce the negative consequences in the short or long term can cause diabetes. Remember that treatment, easy to follow and often only going to be to follow a diet and exercise regularly, you will allow to be free of symptoms and therefore well being. However, should not abandon them under any circumstances because, although you will not notice anything, does not cease to have diabetes.
What's on? Above all always remember that diabetes care is a team effort that includes, of course, you, your doctor and all professional health care provider. Stay always in touch with them. Learn about diabetes. The more you know, the easier it is to follow the prescribed treatment or understand, for example, the constant fluctuations of glucose will be maintained throughout evolution. The information provided in this manual is furnished for information purposes only and should not be used as medical advice or instruction. Before making any decision based on what you read here or on any media, consult your doctor or health care professional who treats you. The diabetes treatment changes from person to person. Remember that you can have more than one "right way" to address a specific issue in relation to diabetes management.
Newly Diagnosed. Emotional Impact When a person is diagnosed with diabetes, sometimes the first reaction you have is to not believe it. Other times, are known to have diabetes but do not take care: why? These are forms of denial. It may take a while to accept this new situation, but the sooner you accept the diagnosis and start learning about their diabetes, the sooner you understand and accept the plan of care of diabetes, being a person completely independent and self-sufficient in the care and management of their disease.
Most of the people to be diagnosed, will experience some degree of anger. It is perfectly normal to feel that way sometimes, but you will not be able to help yourself when kept all the time angry and hostile. Try talking to family members, friends or other people with diabetes in order to externalize those feelings and vent. Also, consider the idea of channeling the energy that used to be mad to do something positive, such as volunteering in associations devoted to diabetes, etc..
It may be that you have feelings of guilt and look at the past events that make you think they are the cause of his diabetes. Sure it's candy, I have always loved so much!, Or is it the bread?, Etc.. Well, no, none of these things cause diabetes. When you think you have diabetes because of something they did review the causes and always remember that diabetes can have it any person. Many people with diabetes go through a period of mourning. It's normal to suffer from the loss of health when you have just given diagnosis and will "overwhelm" with all the things you should and should not do. But, over time, and with the help of family, friends and the whole healthcare team looking after you, sure you can quickly overcome this stage and live fully with his new traveling companion: diabetes.
Health Education. A person with diabetes can lead a normal life and life expectancy equal to that of another person without diabetes. But this, first we must accept unreservedly the new situation. Please note that the disease will be your companion for the rest of your life and do not get along with it the pain will be continuous. Knowing take care of yourself, know what to do in daily life situations and special situations, it causes the person a security can hardly be achieved without understanding the reasons why we are asked to do a few things that time we have left and that sometimes we may be uncomfortable, heavy, and so on. How to achieve this? Of course, trying to learn everything you can about diabetes, the more knowledge you gain more easy and comfortable it will be your disease.
Professional Support. The first step after diagnosis of diabetes is seeking help from different health professionals who serve you. Aid that, undoubtedly, is going to be offered without asking. Both his family doctor, specialist doctors, nurses, educators, dietitians, podiatrists, etc. are all going to give him their support and knowledge necessary for you to be someone completely independent and self with their illness. But he certainly would, sometimes, for lack of time, existing overcrowding in health care or other reasons, we do not have enough information or we are becoming more curious or just need to know more. In this situation we must not hesitate to ask and / or seek additional levels of information, such as books, magazines, websites, etc. in order to achieve higher and more complete knowledge and thus power and knowledge to lead a life as healthy as possible.
Diet. Diabetes mellitus is a disease in which diet is the foundation on which rests any other treatment, and often the only treatment to follow. Objectives of the Diet The ideal diet for people with diabetes is a balanced diet that meets their needs, tastes, physical activity level and lifestyle. The team of professional health care providers will guide you in developing a personalized meal plan to help you achieve specific objectives. The objectives to achieve are: Maintaining blood glucose levels as close to normal as possible through distribution of food of adequate quantity and time, and depending on the characteristics of the treatment used and physical activity performed. Eating adequate calories to achieve and maintain a reasonable weight in the adult, to achieve normal growth and development in children and to provide the energy needed during pregnancy and lactation.
Attenuate cardiovascular risk. Seeking to achieve levels of blood fats (cholesterol and triglycerides) adequate, and to maintain blood pressure at bay. Preventing and treating the consequences of poorly controlled diabetes, such as hypoglycemia and hyperglycemia, adaptation of food in special situations (diarrhea, fever, etc), and in case of associated diseases (hypertension, renal disease, increased cholesterol , etc). Improving all aspects of health with good food, of course, be adapted to personal tastes. To maximize the benefits to follow a correct diet in diabetes should have basic knowledge about nutrition. The better you understand your diet and the principles underlying it, the greater the flexibility you can enjoy. Once you understand their nutritional needs, you yourself will be able to design their own menus and modify your favorite recipes to adapt to your eating plan.
Basic Principles of Nutrition. NUTRIENTS. Foods are made of a series of components that are called nutrients which are required for life.
The nutrients that provide energy are called macronutrients and are made of: carbohydrates, proteins and fats. Each food has a different ratio composition of each. Vitamins and minerals (micronutrients) has no energy function but are essential to life by intervening in the vast majority of cellular processes. Carbohydrates or carbs. They provide energy as its main function being the easiest to use. They are found in bread, rice, pasta, fruits, vegetables, sweets, sugar, etc.. One gram (g) of carbohydrates gives us 4 kilocalories (kcal). Proteins. They are our structure and are therefore critical for growth and immune processes and repair the body. It is found in meat, fish, eggs, milk, vegetables, etc.. Each gram of protein also provides us with 4 Kcal.
Fat. They are the quintessential energy nutrient, each gram of fat provides 9 Kcal ingested. Fat is deposited in fat cells or used later, if necessary, to produce energy. In addition, they provide essential fatty acids (those nutrients the body can not synthesize and therefore must necessarily be ingested in food) and provide the body with fat soluble vitamins A, D, E and K. Its intake is essential, although in excess, is harmful to health. They are found in animal fats, oils, butter, nuts, etc.. CALORIES. A calorie is a unit of heat, and is used to express the ability to produce energy has a food. Your doctor or dietitian calculated how many calories you need per day and what food groups should be obtained. This is done taking into account their age, weight, height, physical activity level, metabolism and lifestyle in general. For example, a young person with a normal weight and moderate physical activity requires more energy than an older, inactive or have excess weight.
What is diabetes?
What health problems can diabetes cause?
What is the treatment for diabetes?
How can I check my blood sugar in the blood?
How often should I check my blood sugar in the blood?
What should my blood sugar in the blood?
How does food affect my blood sugar in the blood?
What about alcohol and cigarettes?
Will exercising help my blood sugar level in blood?
What is the glycosylated hemoglobin test?
Easy Exercises for Beginners. Exercises that promote bending and stretching are good for beginners because they are easy and are less likely to cause injury than other types of exercise. Although progress in the type and difficulty of the exercise is always a good idea to prepare for each session with a few minutes of bending and stretching. In addition to these exercises, there are other easy exercises that a beginner can do about the bed or on a mat on the floor or sitting in a chair. Crouching and up: Standing with legs apart, bend forward, backward and to each side. The following exercises can make them while lying in bed or on a mattress on the floor exercises for the feet: Move the toes in a circle. Then, move both feet in circular motions, first to one side, then another.
Elevation of the knees: Lying on your back, raise one knee as close as you can Roll: Start on your back, raise your arms above your head. Stretch, then roll from side to side slowly. Legs: Lying on side, raise one leg and move in a circular. Turn around to the other side and repeat with other leg. Exercises you can do while sitting in a chair with arms Circles: Raise both arms in front of you, make a circular motion first with one arm and then another. Then extend your arms sideways and move your arms in a circle in one direction and then the other. Repeat from the beginning.
Arms: While sitting, place your hands on the arms of the chair and try to lift his body from the chair using only the force of his arms. Exercises for People with Type 1 diabetes. The sports teams are are fun, and there is no reason not to participate. However, there are highly recommended risky or intense sports such as boxing, climbing, solo sailing, diving, weightlifting, etc.. Professional sport is not contraindicated at all and the performance of a well-balanced person with diabetes is the same as any other athlete. Recommendations: Try to increase the amount of food you eat when you plan to do extra exercise. You should also eat extra every hour while you exercise to make the calories you are using.
You should always have some source of sugar with it quickly to address any hypoglycemia. You can have a hypo hours after completion of the exercise, because intense and prolonged exercise (more than 1 hour) which uses sugar that comes from the liver and muscles. Your body replenishes these deposits in the following 12-24 hours. Perform glucose monitoring before, during and after exercise. Reduce your insulin dose when you are exercising (always check with your doctor or diabetes educator). However, decrease insulin only when absolutely certain that the activity to be undertaken will not be postponed for any reason.
Do not inject insulin into the site to be used during exercise (eg, inject in the arms or abdomen if you are running, if you inject paint into the abdomen or thighs, for those sports that use all muscles (swimming, etc. ..) the safest place is in the abdomen). Try to schedule exercise performance by avoiding the hours that coincide with the maximum effect of insulin.
Food Exchanges for the year. Any Risk Is the Exercise?. The exercise also has its risks, but these will be minimal if we know them and meet them. These are: The decline of sugar is the most important risk and more common in people who have diabetes and are taking insulin or pills, especially those who are well controlled. May occur during, after or even 5 or 6 hours after exercise. It often occurs when we do more exercise than we do every day, when you start exercise if we did not before, or if we increase the amount of exercise you were doing at once. Heart problems if you start to exercise without first consulting your doctor.
It can worsen your eyesight, if any damage (proliferative retinopathy) If you play sports violent, intense, or that imply that you keep your head down (eg, boxing, weightlifting, swimming, etc.).. They can damage your feet if you do not feel well or have bad circulation, if not careful in what shoes used, the type of exercise and the terrain through which it (ie run by a very uneven terrain, etc.)..
BEFORE MAKING ANY FINANCIAL ALWAYS CHECK WITH YOUR DOCTOR FOR ADVICE YOU ABOUT THE SUITABILITY OF ITS PERFORMANCE OR NOT.
Always carry some form of identification MEDICAL: pendants, bracelets, "ID DIABETIC", ETC.
Exercise when he has NEVER SUGAR HIGH, PLUS ACETONE IN URINE. In those cases, exercise can trigger significant and serious decompensation of their diabetes.
Insulin Basics. Insulin (see Chapter 1) is the pancreatic hormone whose absence or defect of action causes diabetes. It is a relatively large protein, making it (to date) can be used only injected, ingested because it is destroyed in the digestive tract before being absorbed like other dietary proteins.
Indications for insulin treatment. People with type 1 diabetes almost always be treated with insulin (except in very rare cases). Remember that insulin is essential to life, children and youth with diabetes. In all forms of hyperglycemic coma (ketoacidosis or hyperosmolar coma) or severe decompensation but do not get to eat. Transiently in special situations: surgery, trauma, infection, ..., though he was previously treated with diet alone or with diet and pills and well controlled. When you do not get control of type 2 diabetes despite following the diet correctly and have reached the maximum dose of pills.
In cases of disturbance at the level of liver or kidney, where the tablets are contraindicated. In gestational diabetes not controlled with diet alone. Insulin treatment does not mean "worse off" or that his diabetes is "more serious", but the treatment is either essential (type 1 diabetes) or other circumstance has been presented that the decompensation, or the pancreas itself can not continue to respond to the pills. Insulin therapy aims to achieve control of blood glucose as close as possible to that of people without diabetes, with a constant amount of insulin throughout the day and some "spikes" of higher concentration coinciding with the time where nutrients are absorbed from the diet, without causing too much insulin outside those periods, causing a drop in blood sugar. Insulin does not cause blindness, does not cause the movement or anything. These things will happen if your diabetes is poorly controlled, ie if you have long provided high blood sugar.
Having to increase the dose of insulin does not mean that diabetes is more serious. Most diabetics treated with insulin was injected twice daily, some once and others are injected three or four times a day. Types of Insulin. Insulin is used may be of animal origin (porcine, bovine or porcine / bovine) or human. Human insulins have moved to the animal and currently, a preparation not only human remains in the Spanish market: MC Lente insulin (porcine / bovine). Human insulins are produced using genetic engineering techniques from a bacterium (Escherichia coli) or yeast (Saccharomyces). According to the onset and duration of action, there are essentially three types of insulin: A. Rapid-acting insulins. They begin their action quickly and are short lived once you have injected. It is used before meals to control high blood sugar that occurs after food intake and also to quickly lower the blood glucose level necessitating rapid correction of it. Intermediate-acting insulins. This type of insulin is a substance added to them retardant (protamine or zinc), which gives them a start and longer duration of action. They are used to provide a number "basal" insulin and is usually injected twice a day.
Slow-acting insulins. They are less used. These insulins are more zinc added to slow the duration of the action. It uses an injection a day usually combined with regular insulin injections before meals. In the market there are preset mixtures of regular insulin and intermediate. When using these types of insulin must always bear in mind what proportion of each type of insulin: 10:90 10% of the amount of insulin injected is fast, while 90% is intermediate-acting. 20:80 20% of the amount of insulin injected is fast, while 80% is intermediate-acting. 30:70 30% of the amount of insulin injected is fast, while 70% is intermediate-acting. 40:60 40% of the amount of insulin injected is fast, while 60% is intermediate-acting 50:50 50% of the amount of insulin injected is fast and the other 50% is action intermediate.
Tables are reflected in the types of insulins marketed in Spain, with the start, peak and duration of action of each, as well as the presentation. Insulin lispro is a synthetic analogue of insulin, which is obtained by a modification of amino acids in the chain of insulin, reversing the amino acids lysine and proline at positions 28 and 29 of chain B. Has a peak faster and shorter action than regular insulin, so that action speaks ultrafast (beginning at 15 minutes of action with a period of 2 to 5 hours). Like regular insulin is aimed primarily at correcting the glucose spikes that occur after meals.
Technical administration of insulin. Whenever possible, insulin should give yourself. The injection is made into the subcutaneous tissue, which is the tissue between the skin and muscles, with an angle of 90 º, but in very thin people or children may be necessary to pinch the skin or injected with a 45 degree angle to avoid intramuscular administration. Steps to prepare insulin: If you use insulin vials steps to take to prepare your syringe will vary, depending on who uses only one type of insulin or has to prepare a mixture of insulins. Removing a single type of insulin. Check the expiry date of the vial of insulin, remember that regular insulin and insulin lispro are transparent and all other insulins are cloudy. Mix the insulin by rotating it slowly in his hands, but do NOT shake the vial. Clean the rubber stopper of the insulin vial with alcohol swab. Remove the syringe plunger slowly to have much air in the same equal to the dose of insulin you need to manage. Click with the stylus on the cap and inject, pushing the plunger, the entire air into the insulin bottle. Without removing the syringe from the bottle, invert, so that it is the cap down and carefully pull back the plunger until the syringe is filled with a little more insulin you need. Slowly push the plunger up to the line that marks the dose.
Observe whether they have been air bubbles in the syringe. If so, delete them by hitting the syringe with your finger on the part where they are. When the bubble has reached the end of the syringe, push the plunger until the correct dose. Remove the syringe from the vial and leave it on a flat surface until ready to inject. Be careful not to damage or contaminate the needle. How to prepare a mixture with two different types of insulin in a syringe: Without removing the needle from the bottle, turn over and slowly withdraw the plunger to fill the syringe with insulin in an amount greater than your regular insulin dose. Look carefully if they are out air bubbles. If so, tap with your fingers to allow the bubbles float to the top. Push the plunger to return to the vial of insulin and with it the air bubbles. Now pull the plunger until the desired dose again. No bubbles should appear again, but if they arose, repeat until no bubbles get a dose.
Insulin injection technique. Where and How to Inject Except in special situations (which usually occur in hospitals), insulin is injected subcutaneously always beneath the skin, called subcutaneous tissue. In very thin people and children, you may want to take a pinch of the skin to avoid injecting into muscle, where insulin is absorbed faster. Always use the same injection technique, to avoid having unnecessary differences in the rate of absorption and action of insulin. If due to an excessive length of the needle, from poor injection technique or by being a very thin person, insulin is deposited deeper in the muscle tissue, the absorption would be significantly faster, an undesirable effect, especially for the acting insulins. The opposite phenomenon, ie that insulin is deposited too superficially to have excess fat is not possible because the fat is deposited in the subcutaneous cellular tissue itself and not above it. Thus, the distance between the surface of the skin and the place to settle injected insulin, does not change in obese people.
Area or place of injection: Depending on the area you choose for injecting insulin, it will absorb more or less quickly. The abdomen is the area where absorption is faster, followed by the arms, buttocks and thighs. These variations have a significant effect on blood glucose enough to take them into account and, therefore, is recommended to use one area for each injection, with rotation in the same or between those areas where the absorption is more like (abdomen, arm or buttock-thigh) Physical exercise: Increases absorption when exercising the limb where the insulin injection. This effect is of little relevance when the exercise is performed after 30-45 minutes after injection of regular insulin and 2-2.5 hours after the injection of intermediate. When exercise takes place within these periods it is advisable to inject insulin in areas that will not be exercised.
Massage and subcutaneous blood flow increased (hot bath, sauna): Also increases absorption. Depth of injection: Intramuscular absorption occurs more rapidly than subcutaneous and, within it, if very superficial is absorbed more quickly than if it is deep. Insulin dose: The administration of a high amount of insulin but lengthens the duration of effect produces greater variability in their peak of action and increases the risk of hypoglycemia. Mixtures of insulin: When a rapid insulin preparation is mixed with another of NPH, the effect is similar to injection separately, but when mixed with regular insulin preparations are long-term reduction occurs the peak of action Conservation of rapid insulin Insulin.
Vials of insulin not in use must be kept refrigerated between 2 and 8 º C, store them in the bottom of the fridge. Avoid extreme temperatures (<2 ° C> 30 º C) and agitation to prevent excessive power loss, aggregation, freezing or precipitation, so, do not let the sun in a window on the dashboard of car or in the freezer. The vial or vials in use can be stored at room temperature, where less than 24 degrees Celsius. Once started the road is not advisable to use more than a month. The pre-filled syringes or pens may also be at room temperature and remain stable for 4 weeks. In case of displacement, it is advisable to use a thermos or other container that protects the insulin from rapid temperature changes.
Until very recently were the most common management system. The currently used are plastic and have very fine needles and short (8-12,7 mm) so they are virtually painless, and the injection is made perpendicular to the skin. Always use a syringe which is graduated identically to the insulin concentration used. In Spain, the insulin market, with the exception of insulin cartridges for pumps and injection pens and prefilled syringes, which are in the form of 40 IU / mL so that the syringes have a capacity of 1 mL and are graded from 0 to 40 *. The manufacturers recommend that syringes are used only once, and that barrenness is not safe to reuse. However, to reduce cost, many people with diabetes reused syringes. The syringe to be reused can be stored at room temperature. Benefits have not been demonstrated with chilling of the syringes, or with cleaning the needle with alcohol, it can be counterproductive and that alcohol can remove the silicone coating placed to puncture less painful.
They are pen-shaped devices for insulin administration, which integrate into a single unit: insulin, the needle and a dispenser mechanism. The insulin reservoir, designed specifically for each device are a prefilled insulin cartridges fast, intermediate or different mixtures fixed to a concentration of 100 IU / mL. The cartridge (cartridge) of insulin is changed when it runs out of insulin, but the boom lasts forever.
The needles, have similar characteristics to those of the syringes and recommendations regarding its use are the same. The mechanism to manage insulin dosage of 1 by 1 unit or 2 by 2 units up to a limit of units varies among different devices. This device uses sophisticated computer chips, a rapid insulin reservoir and batteries to provide power for the continuous infusion of insulin in the body automatically. The syringe is filled with a rapid-acting insulin and is connected to a plastic pipe of various sizes called "infusion system. At the end of the infusion system, there is a needle or a small catheter (tube about 2 cm long with a needle inserted, the needle is removed after insertion, leaving the catheter in the desired location for the infusion). The needle is inserted under the skin, usually in the abdomen. The infusion set is changed regularly every three days.
The pumps are designed to be used continuously and deliver insulin 24 hours a day, according to a scheduled plan, tailored to the needs of each person. The objective of the insulin pump is to mimic the action of beta cells. The pump can deliver a basal rate and bolus dose. The basal dose refers to the constant infusion of insulin whose function is to keep blood glucose levels between meals and overnight. Bolus doses are higher doses that are scheduled before meals. Insulin doses are calculated according to blood glucose values, but the pump is not automatic, so that the person using the glucose should be measured 4 to 8 times a day. You have to know how to interpret the values obtained, taking into account all the factors that influence blood sugar, and then decide what dose is appropriate. This is a great responsibility. People who use insulin pump must be highly motivated, they must know perfectly the functioning of the device, need to be willing to measure blood glucose frequently, and must learn to recognize when a problem occurs. Furthermore, it is essential that access to medical personnel who have experience in using these devices.
Oral Antidiabetic. Oral medications are useful only medicines to treat type 2 diabetes.
Anyway, the best treatment for this type of diabetes is to follow the dietary recommendations and exercise regularly. Only when these two measures are not sufficient to achieve adequate levels of blood glucose will want to take pills. If diet, exercise and pills are not enough to control your diabetes, then you may need treatment with insulin. Some people do not respond to input these tablets, ie fail to lower their blood glucose levels. Others, which go well with sulfonylureas (SU) for a long time, over the years may stop responding by depletion of their pancreatic beta cells or the presence of other processes (infection, stress ,...). In these cases you will need to switch medications and sometimes insulin will be needed to achieve levels of blood glucose appropriate. All sulfonylureas should be taken with food to avoid hypoglycemia 1 or 2 hours after drug intake (typically recommend taking it before meals). Your doctor will prescribe the best dose for you and when to take it. Remember that taking other drugs may modify the action of the SU. Note Always tell your doctor of any other drugs you are taking, even if it takes years.
Meglitinides. The only commercial drug belonging to this group is Repaglinide. It works by stimulating insulin secretion also at the level of the pancreatic beta cell. It has a faster acting and shorter than the SU, so it is useful when you want to correct the glycemic elevations that occur after meals. It also is taken before meals and seems to produce less hypoglycemia than SU. Your doctor will prescribe the most appropriate pattern to follow. Like all drugs, it also interacts with other treatments you may be taking. Tell your doctor if any medications you are taking.
Biguanides. They get lower the blood glucose via actions that occur outside the pancreas (extrapancreatic), mainly by decreasing hepatic glucose release, together with other not yet fully understood (decrease appetite, decrease intestinal absorption of glucose, increase the number of insulin receptors, enhance the action of insulin, ...). The magnitude of the decline in blood glucose is similar to sulfonylureas. They also have favorable effects on lipids (reduction in triglycerides, LDL and total cholesterol) and do not cause weight gain (even can produce weight loss). Only act if the sugar is elevated, lowering it more if it is not normal (hence do not produce hypoglycemia).
Glitazones (Thiazolidinediones) The thiazolidinediones act on a number of locations to lower blood glucose. On the one hand, reduce the overproduction of liver glucose level but also allow the insulin work better at the level of muscle and adipose tissue. So far, three drugs are known belonging to this group: Inhibitors of alpha-glucosidase acts by interfering with the absorption of sugar in the intestine after meals. They achieve this by inhibiting intestinal called alpha-glucosidase, which are enzymes that breaks down complex carbohydrates into monosaccharides (glucose, fructose). The result is a delay in digestion and absorption of carbohydrates with reduced glycemic spikes that occur after food intake.
They do not produce hypoglycemia. However, since they can often be associated with other drugs that do cause such as SU or insulin, you need to know that the conduct to be followed before hypoglycaemia in these cases is different from the usual. If hypoglycemia should not try to solve it with sugar (sucrose), milk (lactose) or a piece of bread (starch), since the effectiveness of these foods to overcome the fall in blood glucose can be much than predicted, precisely because the inhibitory effect of these drugs on the glycosidases that convert sugar, lactose and starch into glucose. Therefore, it is necessary to replace glucose and fructose (always carry glucose tablets or fruit), which do not require the action of glycosidases to be absorbed. It is likely that taking these pills may also notice some gastrointestinal distress (gas, intestinal pain, diarrhea, etc. ..), side effects usually disappear or decrease with time. Do not stop taking them. Always consult your doctor before making any changes in your treatment.
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