Diabetes

Diabetes Mellitus is when the body cannot properly produce enough insulin and thus regulate blood sugars. Abnormal blood sugars are the consequence; not the cause.

There are 2 main types of Diabetes: Type 1 and Type 2

Type 1: you don’t make insulin. The body’s immune system attacked and destroyed the cells in the pancreas which made insulin. This autoimmune disease is diagnosed mostly in children or adolescents. It requires insulin to manage. No insulin = death.

Type 2: you body makes insulin, but over many years the body becomes resistant to that insulin. The body makes more; which it in turn becomes resistant to and the cycle continues. This is what adults develop; particularly when overweight.

Think of insulin like money, and blood sugar we’ll call groceries. Now add inflation. Insulin bought groceries for a while; but as the groceries cost more you need more insulin to buy the same thing. This cycle continues until you start running out of money (insulin); now you can’t control your groceries (and blood sugars rise). Exercise causes your body to use blood sugar in a way that bypasses the need for insulin; in above scenario like getting free groceries. This is why exercise is so highly recommended for diabetics; getting something for free is far better than just keep paying more.

In the hospital we primarily use insulin. This gives us more control over sugars and avoid problems oral medications can cause like: interactions with other medications, interacting with dye in CT scans, taking medications and then not being allowed to eat before procedures. We hold the home diabetes pills and use insulin while here; at discharge we can either resume or change the pills or prescribe new insulin if needed.

The diabetic educator at Chippenham is a great resource, especially for new diabetics. If you want to learn more about diabetes or itss management request a consult from the diabetic educator.

The main issues with diabetes is the excess sugar over time damages tissues, particularly blood vessels and nerves. Starting small and getting larger.

Nerve damage: diabetic neuropathy. Numbness, tingling, burning, “funny bone” sensation. Often begins in the toes of both feet and works its way up the leg like a pair of socks. Can happen in fingers too. Many other nerves can be damaged as well.

Blood vessels: diabetes causes damage to blood vessels which narrows and eventually blocks them. If the blood vessels are in the legs you’ll have poor circulation (peripheral arterial disease); in your heart arteries causes heart attacks (coronary artery disease), in the brain causes strokes (cerebral vascular accidents); particularly a type called lacunar which are like trimming the tips of branches from brain’s blood vessel “tree.”

A blood test called A1c gives us a 3 month average of what the blood sugars have been. Even if high or low today, this provides insight to how the patient’s sugar have been controlled and informs the treatment plan. Non-diabetics are < 6. 6-10 can often be treated with oral medications. Once A1c > 10 most people need insulin.

Low blood sugars (hypoglycemia) occurs when sugars are < 70. People can feel confused, sweaty, jittery/shaking, generally bad. Eating something sweet will bring the sugar level back up.