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Diabetes mellitus

A lot of people have diabetes and they live a long life with it. Diabetes can develop at any

age, but risk increases up to age 40. After age 30 it more commonly aects women than

men. Diabetes has been known for several thousand years. hen untreated, people with

diabetes could urinate fre!uently and copiously, therefore the "reeks named it siphon,

and later mellitus, meaning sweet. At that time, the diagnosis was made by tasting theurine, which was sweet. #he sweetness is caused by the presence of glucose in the urine.

$ts presence is useful in making the dierence between two forms of diabetes% mellitus

and insipidus. $nsulin is the lack hormone in diabetes, which in normal, is produced by

islets of &angerhans. 'ntil the (0thcentury, diabetes was a common cause of death. )ince

*+(*, new knowledge and techni!ues made it possible to do more for diabetics. Dr. lliot

-oslin of oston made a revolution in matter of diabetes. /e realied that the diabetes

patient needed to have understanding of his disease so that he could take care of himself.

#he patient and his family have to be well informed about the disease in order to make

day to day decisions about managing it.

1haracteristics. #he main problem in diabetes is the body2s inability of metabolie

glucose, which is a crucial process in ensuring the body2s cells with energy. "lucose is

stored under normal conditions in the form of glycogen and reconverted into glucose

when it is needed. #he insuciency of insulin leads to body2s inability to metabolie

glucose, which results in an abnormal accumulation of glucose in the bloodstream. #he

failure is similar to starvation. #he diabetic eats food but cannot use the energy,

therefore, in order to obtain energy, the people has to metabolie the stored fat. #his

results in loss of weight. A by product of fat metabolism is ketone bodies which may

produce diabetic acidosis.

cess urine production% as glucose accumulates above normal levels in the diabetic2sbloodstream, it is 5ltered by kidneys and remains in the urine. #he ecessive urine is

produced in order to eliminate the ecess of glucose in the blood.

$n diabetes, the glucose, protein, fat metabolism are aected, which produce changes in

the nerves, muscles, eyes, kidneys, blood vessels. #his disease may be mild, moderate

and severe, and nobody knows the eact causes. Diabetes worse in the presence of

illness, hyperfunctioning diseases, stress and during pregnancy.

#he diagnosis of diabetes is an easy one, especially in children, the symptoms are

evident% rapid weigh loss, etreme hunger, general weakness, fre!uent and copious

urination, ecessive thirst. 6inding glucose in the urine along with increased levels of

glucose in the blood generally con5rms the diagnosis. 7oreover, an adult of diabetes may

not have an evident set of symptoms for months, years. /e may 8ust have fatigue, or

skins infections. A woman may have a genital itch 9prurit:.

#he diet is a ma8or part of the treatment. #he patient should reduce the calories in the

food. Diet is the only treatment needed by many adult diabetics, especially those who are

obese ;obi


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containing concentrated sugar. )ome people may use diet guides, which indicate number

of calories and amount of protein, fat, carbohydrate.

'ntil recent years, insulin was prepared in the ') from beef or pork pancreas. =owadays,

the insulin drug is manufactured synthetically; sinthetikli< using a duplicate of human

genes. $nsulin has to be given my in8ection, usually subcutaneous in8ections, because the

insulin may be destroyed by gastric secretions, if taken orally. $nsulin infected once a dayshould mimic normal insulin action, which is the purpose of the intermediate and long>

action insulins. ?ther people re!uire two or more in8ections. #he usual time taking is

before breakfast and should be the same time every day. )econd in8ections is at supper

time. #he basic insulin dose is established according to the severity of the disease.. most

diabitics take *0>40units per day.

7ost diabetics self in8ect their insulin and the site of in8ection should be changed

everyday. Insulin shock.#he in8ected insulin much be matched

to the amount of blood sugar. $f there is too much insulin, too much eercise, or too little

ingested carbohydrate, the blood sugar level rapidly falls, a condition known

hypoglycemia; haipoglaisimi@< and the brain is deprived of energy. $t occurs at the time of

the insulin2s peak activity, resulting in insulin shock. #he 5rst sing is mild hunger, then

!uick sweating, palpitation, shallow breathing, mental confusion, loss of consciousness. $n

this case, the patient should be oered sugar, or intravenous glucose. Diabetes who use

insulin should always have a lump of sugar in order to avoid the insulin reaction.

epeated and prolonged episodes of insulin reaction may be damaging to the brain.

Development of a pump for infusion of insulin into the body2s bloodstream is a method of

treating diabetics with keto>acidosis. $n this method, a reduced amout of hypoglycemia

has been reported. $t includes a reservoir for insulin, a pump, and a Bpower pack2

containing batteries. #his method meets the physiological needs of the body. Oral

hypoglycemic drugs are useful in controlling mild diabetes that develops in people over

4C. $n order this method to work, some of the islets cells must be capable to produce

insulin, because the drugs stimulate their activity. #he dose varies from *> pills taken

before meals and throughout the day. Prolonged

hyperglycemia, caused by ecess of sugar, from insucient insulin activity, can cause

diabetic coma. $t involves the increased amount of ketone bodies as a by product of fat

metabolism> a chemical imbalance in the blood. $f we 5nd a diabetic in coma, and we

don2t know the cause, we should treat him with sugar and it will give an insulin reaction.

Diabetic acidosis occurs due to% the patient didn2t take the insulin for some days, take too

little, overeate or undereercise. #he treatment involves taking rapid>acting insulin every

3>4 hours.Diabetes re!uires a good control, which means feeling well with small amount of sugar, or

no sugar in the urine. #he patients should take personal glucose tests, to control their

urine daily, namely, in the beginning of the day. #he tests oer information about the

eciency of their diet and eercise and insulin activity. ?nce the patient

has made crucial ad8ustments, related to his diet, insulin intake, and planned his daily

activity, he is on his way to a normal life. /owever, there may be obstacles, like the

acceptance, initial depression, maintaining the schedule in parties and during traveling.

Also, the family2s lifestyle should be changed entirely. Juvenile[ djuvenail]

insulin dependent diabetes. oys and girls develop diabetes in e!ual numbers, the

onset is about years, or may be discovered in the 5rst hoursEdays of life. ut more oftenappears at puberty. $n this case, the insulin therapy is re!uired. #he children must avoid

icecream, concentrated carbohydrates, restricted animal fat. )hould prevail fruits,


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vegetables, eggs supply the growing organism with nutriets, peanut butter, whole grains

and honey instead of sugar.

Fregnancy is special for a diabetic woman and her unborn child. ut with good

management during diabetic2s pregnancy, the baby has an ecellent chance of being

normal and healthy. #herefore the diabetic mother need to be tested more often by the

obstetrician, controlling the urine glucose and blood glucose levels.

GGDiabetes is usually compared to aging, due to a loss of elasticity in the cells of theblood vessels, kidneys, eyes, nerve tissues. #he nerve>tissue changes may cause a

reduced sensation to touch and pain, loss of motor function. #he eye>ground changes can

cause loss of vision. #he changes of kidneys aect the 5ltration functions, loss of protein

from the blood into the urine, development of high pressure. 7edicine can reduce the

eects but cannot cure them. #he prevention is possible, and good diabetic control

contributes to a delay in development of the complications. #he vascular changes make

the feet vulnerable;valner@bl< to infections that can result in gangrene ;g@ngrin< and

amputation. Daily care is the best remedy. #oenails cut only by podiatrist;p@dai@trist

fourteen, with the peak incidence at the age of eight years. 1horea is rare after puberty

and never occurs after the age of twenty years. #he onset it gradual. #he mother mayobserve that the child becomes suddenly nervous, tends to drop things and stumbles.

?ften writing diculties are reported, the speech is aected and the purposeless

movements of legs and arms. #he emotional instability is the 5rst indication that chores is

developing, and more often, only one side of the body is involved. #he muscular

weakness is so marked that the child is unable to walk, talk or sit up, or the movements

may become violent. #he symptoms of chorea don2t occur at same time with arthritis.

Fatients with chore do not have fever, leukocytosis or rapid erythrocyte sedimentation

rate. #here are no changes in the spinal Huid. #he presence of fever and increased

sedimentation rate indicates cardiac involvement.

The medical interview


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#he medical interview is the most important tool of the physician. $t is done more often

than anything in the physician2s professional life. #he functions of the medical interview

are% to gather and to communicate information, to develop and maintain a therapeutic

relationship. ach function re!uires a speci5c behavior and a separate set of skills.

1ollecting information is the base function of the medical interview. hether this

information is physiological or biological, appropriate collection skills can increase the

eciency of the information that is collected. #he main steps of the conversationbetween patient and physician is to gather information and determine ;d@t@rmin< the

nature of the problem. #he re!uired skills are% open>ended !uestion 9tell me about..: ,

facilitation 9help the patient to continue, encourage:, direction9want to know more about

it:, , summariing and checking the worries.

A therapeutic relationship means a relationship that promotes care, cooperation, healing.

#he good interaction between patient and physician, gives the patient freedom to talk

openly and in more detail about hisEher feelings. #he interviewing techni!ues such as

reHection, legitimation, support, respect, partnership, empathy, positive regard,

avoidance of shame and humiliation and nonverbal skills contribute to intervieweciency. $n order to maintain a good relationship, the physician needs to handle the

patient2s emotions. #he physician should be attentive and aware of whether the emotions

become evident and when they have to be but they are not. Also the physician must

involve the patient in making decisions. #his fact would make the patient more

responsible for hisEher health and may improve the biological outcome. Fatients who are

understood by their physicians are satis5ed and feel better, and the physician is satis5ed

in turn. #he physician should establish baseline knowledge and attributions by asking the

patient to tell what heEshe knows about hisEher disease. Also he should avoid comple

medical terminology, and check the patient2s understanding and attention by asking him

to summarie the information. $n this way, the patients will better understand the natureof their illness, the diagnostic procedures, and the treatment. #he information provided

by physician should be brief and concrete. #he patient may be anious and therefore,

may not be able to understand the physician2s message. in this way, the physician must

follow some points 9to the structural elements of the interview:% optimiing the

environement, opening, preparing to listen, greeting, the introduction, identi5cation of

the barriers of communication, survey the problems, negotiate the problems, establish a

narrative thread, developing the life contet of the patient and illness.

*. ?ptimiing the environment by removing the environment2s barriers, eliminating the

distractions, ensuring privacy, making eye contact. Also, having nice telephone operators.

(. an open attitude, which means being ready to listen, to gather information, to beattentive and generate hypotheses ;haipothei

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