For 2,000 years diabetes has been recognized as a devastating and deadly disease. In the first century A.D. a Greek, Aretaeus, described the destructive nature of the affliction which he named "diabetes" from the Greek word for "siphon." Eugene J. Leopold in his text Aretaeus the Cappodacian describes Aretaeus' diagnosis: "...For fluids do not remain in the body, but use the body only as a channel through which they may flow out. Life lasts only for a time, but not very long. For they urinate with pain and painful is the emaciation. For no essential part of the drink is absorbed by the body while great masses of the flesh are liquefied into urine."Physicians in ancient times, like Aretaeus, recognized the symptoms of diabetes but were powerless to effectively treat it. Aretaeus recommended oil of roses, dates, raw quinces, and gruel. And as late as the 17th century, doctors prescribed "gelly of viper's flesh, broken red coral, sweet almonds, and fresh flowers of blind nettles."Diabetes mellitus (DM) or simply diabetes, is a chronic health condition in which the body either fails to produce sufficient amount of insulin or responds abnormally to insulin. Speaking about the classification of diabetes mellitus, it is of three types, namely, Type 1 diabetes, Type 2 diabetes and Gestational diabetes. The ultimate outcome for all three types of diabetes is high blood glucose level or hyperglycemia. The pathophysiology of diabetes mellitus is very complex, as the disease is characterized by different etiologies but share similar signs, symptoms and complications.
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In the 17th century a London physician, Dr. Thomas Willis, determined whether his patients had diabetes or not by sampling their urine.If it had a sweet taste he would diagnose them with diabetes mellitus- "honeyed" diabetes.The Chinese had a different method by seeing if ants were attracted to the urine because of the high sugar in the urine.If the ants were attracted to the urine, they were diagnosed with diabetes. This method of monitoring blood sugars went largely unchanged until the 20th century.Despite physicians' valiant efforts to combat diabetes, their patients remained little more than human guinea pigs. In the early 20th century, diabetologists such as Dr. Frederick Allen prescribed low calorie diets-as little as 450 calories per day for his patients. His diet prolonged the life of people with diabetes but kept them weak and suffering from near starvation. In effect, the most a person afflicted with diabetes could do was blindly offer himself to the medical establishment and pray for a cure. In his book, The Discovery of Insulin, Michael Bliss describes the painful wasting death of many people with diabetes before insulin: "Food and drink no longer mattered, often could not be taken. A restless drowsiness shaded into semi-consciousness. As the lungs heaved desperately to expel carbonic acid (as carbon dioxide), the dying diabetic took huge gasps of air to try to increase his capacity. 'Air hunger' the doctors called it, and the whole process was sometimes described as 'internal suffocation.' The gasping and sighing and sweet smell lingered on as the unconsciousness became a deep diabetic coma. At that point the family could make its arrangements with the undertaker, for within a few hours death would end the suffering."
Then in 1921 something truly miraculous occurred in Ontario, Canada. A young surgeon Frederick Banting, and his assistant Charles Best, kept a severely diabetic dog alive for 70 days by injecting it with a murky concoction of canine pancreas extract. With the help of Dr. Collip and Dr. Macleod, Banting and Best administered a more refined extract of insulin to Leonard Thompson, a young boy dying of diabetes. Within 24 hours, Leonard's dangerously high blood sugars had dropped to near normal levels. Until the discovery of insulin, most children diagnosed with diabetes were expected to live less than a year. In a matter of 24 hours the boy's life had been saved. News of the miracle extract, insulin, spread like wildfire across the world.Since insulin's discovery, medical breakthroughs continued to prolong and ease the lives of people with diabetes.
In 1935 Roger Hinsworth discovered there were two types of diabetes: "insulin sensitive" (type I) and "insulin insensitive" (type II). By differentiating between the two types of diabetes, Hinsworth helped open up new avenues of treatment.Starting in the late 1930s, new types of pork and beef insulin were created to better manage diabetes. PZI, a longer acting insulin, was created in 1936. In 1938 NPH insulin was marketed, and in 1952 Lente, containing high levels of zinc which promotes a longer duration of action was invented.In the 1950s, oral medications-sulfonylureas were developed for people with type II. These drugs stimulate the pancreas to produce more insulin, helping people with type II diabetes keep tighter control over their blood sugars.In the 1960s urine strips were developed. Dorothy Frank, who has had type I diabetes since 1929, remembers, "In order to test your blood sugars there were these do-it-yourself urine kits-blue meant there was no sugar present, and orange meant you were positive." With the invention of urine strips, it was no longer necessary to play chemist, with a collection of test tubes lined up on the bathroom sink, waiting for the results.Becton-Dickinson introduced the single use syringe in 1961. This greatly reduced the amount of pain from injections as well as the time-consuming ritual of boiling needles and glass syringes.
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The first portable glucose meter was created in 1969 by Ames Diagnostics.Since then, new technologies have brought us glucose meters the size of calculators that can be easily carried in a pocket or purse. Thankfully, the days of hefting around a three pound glucose meter are over.In the late '70s the insulin pump was designed to mimic the body's normal release of insulin. The pump dispenses a continuous insulin dosage through a cannula (plastic tube), using a small needle that is inserted into the skin. The first pumps, created in 1979, were large and bulky and had to be carried in a backpack.
In 1979 Derata released the first needle-free insulin delivery system-the Derma-Ject. It weighed 1-1/2 pounds and cost $925 dollars. The Derma-Ject carried the insulin on the side and had no pressure adjustment feature. The hemoglobin A1c test was devised in 1979 in order to create a more precise blood sugar measurement. With the A1c, hemoglobin, the oxygen-carrying pigment in red blood cells, is used to track glucose changes over a period of four months, the life span of the cell. Hemoglobin links with the glucose in blood; the more glucose present, the greater amount of hemoglobin linked with glucose.The A1c became a standard measurement for blood sugar control in the comprehensive ten-year study from 1983 to 1993-the Diabetes Control and Complications Trial (DCCT).
In May of 1995, Metformin, an oral medication for people with type II diabetes, was finally approved for use in the United States by the FDA. Unlike sulfonylurea drugs, which stimulate insulin release, Metformin does not increase insulin production. Instead, it heightens sensitivity to insulin and increases the muscles' ability to use the insulin. Since Metformin promotes weight loss, decreases hyperglycemia, and improves lipid levels, it has been shown to be an effective tool for people with type II diabetes when used in conjunction with sulfonylureas.Precose, an oral medication, was approved for use by people with type II diabetes in September 1995. Precose delays the digestion of carbohydrates, thereby reducing the sudden rise in blood glucose after eating a meal. Precose can be used in conjunction with diet to lower blood sugars in people with type II whose glucose levels cannot be regulated through diet alone.Lispro, a new fast-acting insulin, was released in August of 1996 by Eli Lilly under the brand name Humalog. Lispro is designed to simulate the body's natural insulin output. Because of lispro's fast-acting tendencies, patients can take this insulin 15 minutes or less before eating a meal, instead of waiting as they would with Regular insulin.
The pathophysiology of diabetes mellitus (all types) is related to the hormone insulin, which is secreted by the beta cells of the pancreas. This hormone is responsible for maintaining glucose level in the blood. It allows the body cells to use glucose as a main energy source. However, in a diabetic person, due to abnormal insulin metabolism, the body cells and tissues do not make use of glucose from the blood, resulting in an elevated level of blood glucose or hyperglycemia. Over a period of time, high glucose level in the bloodstream can lead to severe complications, such as eye disorders, cardiovascular diseases, kidney damage and nerve problems.
In Type 1 diabetes, the pancreas cannot synthesize enough amount of insulin hormone as required by the body. The pathophysiology of Type 1 diabetes mellitus suggests that it is an autoimmune disease, in which the body's own immune system generates secretion of substances that attack the beta cells of the pancreas. Consequently, the pancreas secretes little or no insulin. Type 1 diabetes is more common among children and young adults (around 20 years). Since it is common among young individuals and insulin hormone is used for treatment, Type 1 diabetes is also referred to as Insulin Dependent Dabetes Mellitus (IDDM) or Juvenile Diabetes.
In case of Type 2 diabetes mellitus, there is normal production of insulin hormone but the body cells are resistant to insulin. Since the body cells and tissues are non responsive to insulin, glucose remains in the bloodstream. It is commonly manifested by middle-aged adults (above 40 years). As insulin is not necessary for treatment of Type 2 diabetes, it is known as Non-insulin Dependent Diabetes Mellitus (NIIDM) or Adult Onset Diabetes.
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Gestational diabetes, on the other hand, occurs among pregnant women. It is caused due to fluctuations of the hormonal level during pregnancy. Usually, the blood glucose level returns to normal after the baby is born.
As already mentioned above, the symptoms and effects of all the three forms of diabetes are similar. The noticeable manifested symptoms include increased thirst (polydipsia), increased urination (polyuria), increased appetite (polyphagia), excessive fatigue, unexplained weight loss and body irritation. Regarding the definition of diabetes mellitus, it is often described as a fasting blood glucose level of 126 milligrams per deciliter (mg/dL) or more. As per statistics, Type 2 diabetes is the most commonly occurring type, in comparison to the other two forms of diabetes mellitus.Early and correct detection of the type of diabetes is necessary to prevent severe health effects. After diagnosis, a physician may prescribe appropriate medication for treatment of diabetes, which could include insulin injections or oral insulin medicines, depending upon the type of diabetes mellitus. In addition, healthy lifestyle modifications, especially diet and exercise are recommended for the effective management of symptoms and long-term effects. Since diabetes is a global health issue, studies regarding the pathophysiology of diabetes mellitus are currently in progress in order to minimize its associated health effects.In 2002 alone 150million people were diagnosed with diabetes mellitus
The causes of diabetes mellitus are unclear, however, there seem to be both hereditary and environmental factors involved. Research has shown that some people who develop diabetes have common genetic markers.
In Type 1 diabetes, the immune system, the body's defense system against infection, is believed to be triggered by a virus or another microorganism to destroy the cells in the pancreas that produce insulin.
In Type 2 diabetes, age, obesity, and family history of diabetes play a role.In Type 2 diabetes, the pancreas may produce enough insulin, however, cells have become resistant to the insulin produced and it may not work as effectively. Symptoms of Type 2 diabetes can begin so gradually that a person may not know that they have it. Early signs are tiredness, extreme thirst, and frequent urination. Other symptoms may include sudden weight loss, slow wound healing, urinary tract infections, gum disease, or blurred vision. It is not unusual for Type 2 diabetes to be detected while a patient is seeing a doctor about another health concern that is actually being caused by the yet undiagnosed diabetes.Individuals who are at high risk of developing Type 2 diabetes mellitus include people who:Are obese (more than 20% above their ideal body weight).Have a relative with diabetes mellitus.Belong to a high-risk ethnic population (African-American, Native American, Hispanic, or Native Hawaiian).Have been diagnosed with gestational diabetes or have delivered a baby weighing more than 9 lbs (4 kg).Have high blood pressure (140/90 mmHg or above).Have a high density lipoprotein cholesterol level less than or equal to 35 mg/dL and/or a triglyceride level greater than or equal to 250 mg/dL.Have had impaired glucose tolerance or impaired fasting glucose on previous testing.
Several common medications can impair the body's use of insulin, causing a condition known as secondary diabetes. These medications include treatments for high blood pressure (furosemide, clonidine, and thiazide diuretics), drugs with hormonal activity (oral contraceptives, thyroid hormone, progestins, and glucocorticorids), and the anti-inflammation drug indomethacin. Several drugs that are used to treat mood disorders (such as anxiety and depression) can also impair glucose absorption. These drugs include haloperidol, lithium carbonate, phenothiazines, tricyclic antidepressants, and adrenergic agonists. Other medications that can cause diabetes symptoms include isoniazid, nicotinic acid, cimetidine, and heparin.
Complications occur in diabetes because of the effects of higher than normal blood glucose levels on small blood vessels and nerves in the body and also because of the long term effects on large vessels. It is not fully understood how diabetes causes complications but it seems to relate to effects of glucose binding irreversibly to small vessels and nerves and affecting the way they work (a process called glycosylation).
Retinopathy-The retina is the thin layer of tissue at the back of the eye which contains small blood vessels and nerve endings for vision. Retinopathy refers to damage to the retina. Minor changes to the retina are very common after ten to 15 years of diabetes (nonââ‚¬"proliferative or background retinopathy)- but this does not impair vision. In a landmark study conducted in 1978 by Dr. P. McNair and titled Hypomagnesemia, a Risk Factor in Diabetic Retinopathy9, it was demonstrated that diabetics with the lowest magnesium levels had the most severe retinopathy, and that low magnesium levels were linked significantly to retinopathy more than any other factor. Of more concern is where there is progression to new blood vessel formation (called proliferative retinopathy). This can threaten vision. The progression of retinopathy is related to poor diabetes control and long duration of diabetes. It can be treated by laser treatment or may require surgery for complications.Temporary blurred vision associated with changes in blood glucose levels.Large changes in blood glucose levels can cause blurred vision and difficulty in focusing. This is common at the time of diagnosis when blood glucose levels which have been running high are brought under control or after a period of stabilisation where blood glucose levels are improved. The blurred vision does not last long and usually disappears after a few weeks. It does not cause any long term damage. Any change in glasses prescriptions should be delayed for a while after large changes in blood glucose levels.Cataracts are a clouding of the lens and are more likely to occur in people with diabetes but usually only in older people. These can be successfully treated by surgery.
Kidney problems (nephropathy)
The kidneys filter waste products from our bodies and pass them into the urine. Nephropathy refers to the kidney damage associated with diabetes which again is a greater risk for people with poorly controlled diabetes over long periods. Risks are greater in those with high blood pressure or who smoke. Advanced nephropathy can cause kidney failure requiring dialysis or kidney transplantation.Major advances in detecting nephropathy mean that it can be detected at an early stage and treated effectively. Screening is done by testing urine samples for leakage of microscopic amounts of protein (called microalbuminuria). If early kidney damage is detected the treatment is to improve diabetes control as much as possible and medications are given to slow or stop further kidney damage and to control blood pressure.
Nerve problems (neuropathy)
Neuropathy refers to nerve damage associated with diabetes. Symptoms can include numbness or pins and needles especially in the feet and lower legs. Neuropathy is uncommon in young people but sensitive tests can detect minor neuropathy in young people with only fairly short periods of poor control. In the early stages neuropathy can be reversed with improved diabetes control. Screening for neuropathy is part of most complications screening programs.
Older people with diabetes have an increased risk of heart attacks and strokes due to narrowing of or blockages in large blood vessels. Risks are greater in people with untreated high blood pressure- high blood cholesterol levels or who smoke. Large vessel narrowing can also occur in the penis causing impotence (problems getting an erection) and in the legs causing circulation problems.Adolescents with type 2 diabetes or combination type 1 and type 2 diabetes are at a greater risk of vascular disease at an earlier age.
Foot problems (due to decreased blood flow or nerve problems) do not occur in children and adolescents. However children with diabetes should protect their feet from injury because scarring and other damage could cause problems in later life.Foot injuries- plantar warts- calluses- corns and inââ‚¬"grown toenails may be more of a problem in children and adolescents with diabetes since infections are more likely in a high sugar environment and will be slower to heal. Proper care of the toenails is important and shoes should be worn for sports and outside play. Any scarring on the soles of the feet can increase the risk of longterm foot problems. Any foot injury needs to be cared for properly.It is important that problems with foot alignment (such as flat feet or high arches) are detected in children with diabetes- since these may lead to an increased risk of later foot problems and can be corrected if discovered early.
Peope with diabetes are at an increased risk of some other conditions- particularly thyroid gland problems- coeliac disease and- more rarely- other autoimmune disorders such as adrenal disease and rheumatoid arthritis. These are all conditions with a similar cause to diabetes- where the body forms antibodies against certain tissues and causes them not to work properly (called auto immune conditions).
The first treatment for type 2 diabetes is often meal planning for blood glucose (sugar) control, weight loss, and exercising. Sometimes these measures are not enough to bring blood glucose levels down near the normal range. The next step is taking a medicine that lowers blood glucose levels. There are two kinds of medicines: oral medications (pills) and insulin shots. Diabetes pills are not insulin.In people with diabetes, blood glucose levels are too high. These high levels occur because glucose remains in the blood rather than entering cells, where it belongs. But for glucose to pass into a cell, insulin must be present and the cell must be "hungry" for glucose.People with type 1 diabetes don't make insulin. For them, insulin shots are the only way to keep blood glucose levels down.People with type 2 diabetes tend to have two problems: they don't make quite enough insulin and the cells of their bodies don't seem to take in glucose as eagerly as they should.
All diabetes pills sold today in the United States are members of five classes of drugs: sulfonylureas, meglitinides, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors. These five classes of drugs work in different ways to lower blood glucose levels.
Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. Sulfonylurea drugs have been in use since the 1950s. Chlorpropamide (brand name Diabinese) is the only first-generation sulfonylurea still in use today. The second generation sulfonylureas are used in smaller doses than the first-generation drugs. There are three second-generation drugs: glipizide (brand names Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl). These drugs are generally taken one to two times a day, before meals. All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in side effects, how often they are taken, and interactions with other drugs.
Meglitinides are drugs that also stimulate the beta cells to release insulin. Repaglinide (brand name Prandin) and nateglinide (Starlix) are meglitinides. They are taken before each of three meals.Because sulfonylureas and meglitinides stimulate the release of insulin, it is possible to have hypoglycemia (low blood glucose levels).You should know that alcohol and some diabetes pills may not mix. Occasionally, chlorpropamide, and other sulfonylureas, can interact with alcohol to cause vomiting, flushing, or sickness. Ask your doctor if you are concerned about any of these side effects.
Metformin (brand name Glucophage) is a biguanide. Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by the liver. Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbed. It is usually taken two times a day. A side effect of metformin may be diarrhea, but this is improved when the drug is taken with food.
Rosiglitazone (Avandia), troglitazone (Rezulin), and pioglitazone (ACTOS) form a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and also reduce glucose production in the liver. Thiazolidinediones are taken once or twice a day with food. Although effective in lowering blood glucose levels, thiazolidinediones can have a rare but serious effect on the liver. For this reason, your doctor will perform blood tests regularly to monitor the health of your liver.
Acarbose (brand name Precose) and meglitol (Glyset) are alpha-glucosidase inhibitors. These drugs help the body to lower blood glucose levels by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood glucose levels after a meal. They should be taken with the first bite of a meal. These drugs may have side effects, including gas and diarrhea.
Oral combination therapy
Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together. For example, a biguanide and a sulfonylurea may be used together. Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood glucose control when taking only a single pill does not have the desired effects. Switching from one single pill to another is not as effective as adding another type of diabetes medicine.Injectable insulins come in four different types.The different classifications indicate both how quickly an insulin gets absorbed into the blood stream, and how long an insulin exerts a measurable effect in the body. The American Diabetes Association advises patients that they will probably have to use more than one type of injectable insulin to control their blood sugar. To meet this need for more than one type of insulin, some drug makers market premixed insulin products.
A non-diabetic produces the constantly varying amounts of insulin necessary for obtaining energy from glucose. A diabetic cannot achieve this balance. Beyond the basic requirements to provide adequate calories and necessary nutrients, there are marked differences in diet strategy for the two major groups of diabetic patients: Type 1 insulin-dependent non-obese patients and Type 2 obese patients who do not require insulin. Patients who are on insulin therapy must schedule their meals to provide regular caloric intake. In overweight patients, special attention must be given to total caloric consumption.
There is no need to disproportionately restrict the intake of carbohydrates in the diet of most diabetic patients. In fact, Dr. H.P. Himsworth demonstrated in 1930 that if carbohydrates were taken out of the diet and replaced by either protein or fats, a person would quickly develop insulin resistance and diabetes5. The key here is in the choice of high-fiber complex carbohydrates. One of the first dietary rules for all diabetics is to avoid all sugar and foods containing sugar, such as pastry, candy and soft drinks. While these refined sugars and other simple carbohydrates like white flour must be carefully watched, most diabetics are actually encouraged to eat more complex carbohydrates - the same bulky, fiber-rich unprocessed foods that are now recommended for everyone. Vegetables are ideal. For example, a diabetic can eat a large plate of spinach that contains as much carbohydrate as a tablespoonful of sugar, without suffering any ill effects. Spinach, asparagus, broccoli, cabbage, string beans and celery are among the so-called "Food Exchange Group A" vegetables that the American Diabetes Association (ADA) says can be generously included in the diabetic diet. What makes these complex carbohydrates special is their ability to slow down the body's absorption of carbohydrates by helping to delay the emptying of the stomach and thereby smoothing out the absorption of sugars into the blood. Whole grain cereals also have this ability. Fully one third of diabetic patients in clinical surveys have hyper-lipidemia, clearly indicating the need for dietary management. The most sensible approach is to limit the amount of fat in their diet and to substitute polyunsaturated fats for the saturated type when possible. Fish and poultry are especially recommended instead of fatty cuts of meat. Greasy, fried foods are strongly discouraged.
Obesity is much more likely in people who eat a high-fat diet, which is often a high calorie diet, since each gram of fat contains nine calories instead of the four calories in each gram of protein or carbohydrate. With obesity comes an increased risk of a variety of problems, not the least of which is adult-onset diabetes. Many diabetics have found it beneficial to eat smaller, more frequent meals, rather than the two or three big meals most people consume daily. Researchers have found that multiple frequent feedings tend to keep blood cholesterol levels lower, for the diabetic and non-diabetic alike. Vitamins and Minerals
Generally a well-balanced diet rich in vitamins and minerals is one of the most important factors in the control of diabetes and prevention of diabetic complications. One reason for stressing the need for proper levels of nutrients is the excessive urination experienced by the diabetic. Normally the body reabsorbs glucose and other watersoluble nutrients. When glucose rises to levels above 160- 170mg/dl, as it does quite frequently in even well controlled diabetic patients, it acts as an osmotic diuretic. This process overwhelms the kidney's ability to reabsorb glucose and other water-soluble nutrients, thus the increased urination, and substantial losses of nutrients such as vitamins B-1, B-6 and B-12 and the minerals magnesium, zinc and chromium pass out along with the urine. Consequently diabetes and its complications are as much a result of nutritional wasting as of elevated blood sugar. Weight reduction and control can bring this incurable disease closer to complete remission than any medication
Regular exercise can improve the functioning of the cardiovascular system, improve strength and flexibility, improve lipid levels, improve glycemic control, help decrease weight, and improve quality of life and self-esteem. Exercise increases the cellular glucose uptake by increasing the number of cell receptors. The following points should be considered in educating patients regarding beginning an exercise program. Exercise program must be individualized and built up slowly. Insulin is more rapidly absorbed when injected into a limb that is exercised, therefore can result in hypoglycemia.Patients need to be informed that exercise of a high intensity can also cause blood glucose levels to be higher after exercise than before, even though blood glucose levels are in the normal range before beginning exercise. This hyperglycemia can also extend into the post-exercise state and is mediated by the counter-regulatory hormones.
The exercise program should include a five to ten minute warm-up and cool-down session. The warm-up increases core body temperature and prevents muscle injury and the cool-down session prevents blood pooling in the extremities and facilitates removal of metabolic by-products. Research studies show there are similar cardiorespiratory benefits that occur when activity is done in shorter sessions, (approximately 10 minutes) accumulated throughout the day than in activity sessions of prolonged sessions (greater than 30 minutes).This is an important factor to emphasize with patients who donââ‚¬â„¢t think they have the time and energy for exercise.
Gather all the materials prior to starting any teaching, and be ready to explain the purpose and action of each.Start by explaining the sigs and symtoms of hyper glycemia and hypoglycemia.Then develop a diet plan specific to the patient.Eating at the same time each day and the same amount helps the glucose levels.Every day, choose foods from these food groups: starches, vegetables, fruit, meat and meat substitutes, and milk and yogurt. How much of each depends on how many calories you need a day.Limit the amounts of fats and sweets you eat each day.Exercise: even mild exercise can lower your blood glucose, BP and cholesterol. Also reduces your risk for heart disease, stroke, relieves stress, strengthens your heart, muscles, and bones.Insulin also works better when we exercise, your circulation improves, and it keeps your joints flexible. Exercise goes hand in hand w/nutrition to help with weight reduction too.Prevent complications by scheduling an annual physical and a routine eye exam.Constant monitoring of glucose levels.Paying attention to your feet.Taking an aspirin daily to prevent a heart attack or stroke.Getting vaccines and immunizations.Maintaining good dental hygene.Limiting intake of alcohol and quiting smoking.monitoring blood pressure and cholesterol.At last explain the syringe sizes and units. Explain how only insulin syringes should be used, as only they measure in units. Give a quick overview of various types of insulin (rapid,short, and long acting), but focus on the insulin the patient will be using. Give storage information and information on mixing the insulin by gently rolling it between the palms of your hands. Explain expiration times and warn against using insulin that has particles floating in it. Make sure the patient understands how and when to check glucose levels in relation to insulin dosing and, if on a sliding scale, how to read and adjust dosages appropriately.Demonstrate the proper way to draw up the insulin by first demonstrating proper hand washing skills. Have the patient perform an immediate return demonstration.Demonstrate proper injection, preferably when giving the next dose of insulin.Show the proper areas in which to inject and explain about site rotation.Injectable insulins come in four different types. The different classifications indicate both how quickly an insulin gets absorbed into the blood stream, and how long an insulin exerts a measurable effect in the body. The American Diabetes Association advises patients that they will probably have to use more than one type of injectable insulin to control their blood sugar. To meet this need for more than one type of insulin, some drug makers market premixed insulin products.
Three thousand years have passed since Aretaeus spoke of diabetes as "the mysterious sickness." It has been a long and arduous process of discovery, as generations of physicians and scientists have added their collective knowledge to finding a cure. It was from this wealth of knowledge that the discovery of insulin emerged in a small laboratory in Canada. Since insulin saved the life of young Leonard Thompson 75 years ago, medical innovations have continued to make life easier for people with diabetes.Perhaps, diabetes researchers should heed Hippocrate's humble warning to future physicians, written in his Corpus Hippocraticum in the first century B.C., as quoted in Hans Shadewaldt's The History of Diabetes Mellitus: "Life is short, art is long, the right moment soon speeds past, experience deceives, judgment is difficult!"