Mechanics:
Insulin dependent diabetes mellitus is a problem affecting the circulation of energy through the body. Ideally, a regular amount of insulin will help a good amount of sugar to go from the blood stream into cells, where it can be used. If there is too little insulin, not enough sugar will go from the blood stream into cells, cells will not get the sugar they need, and there will be lots of sugar sitting in the blood. If there is too much insulin, too much sugar will leave the blood stream too fast, and cells which need sugar will not get it. Type I diabetes mellitus almost only occurs in people with malfunctioning or destroyed pancreatic beta cells, and only affects approximately 5 to 10 percent of the number of people with diabetes mellitus.
When a cell does not get the sugar it needs, it can either die or use an alternate energy source. Usually, they start to use something else, namely fats. When a cell uses fat molecules for energy, it breaks it apart to form simple sugars and ketones. The cell uses the sugars and tosses the ketones into the blood stream. Ketones are acids. If the pH of blood changes, one can get sick, get into a coma, or die. Naturally, a body works to keep excess ketones out of itself, so kidneys are built to haul the stuff out of the blood and put it into what will become urine. Adding ketones to blood means extra wear and tear on the kidneys. Nervous system cells also wear down as a result of poor sugar circulation, because they have the highest sugar requirements of all the types of cells in the human body.
Normal care:
In order to keep diabetes from gravely injuring a person, doctors encourage taking insulin by some form of injection, eating moderately, and exercising in order to help keep the balance and flow of sugar through the body working properly. Because maintaining such a balance requires an ability to measure the balance, health care providers also encourage frequent blood glucose tests, which provide measurements of blood glucose levels in milligrams per deciliter. The people who work, live, and/or play around people with diabetes should also know at least the basics of dealing with emergency situations involving diabetes. Also, to help maintain a proper balance, test, insulin, and food logs will assist in learning to control diabetes. If blood glucose levels are too high, doctors suggest increasing insulin intake and/or exercising more. If blood glucose levels are too low, doctors suggest eating or drinking something with carbohydrates in it, usually of fruit origin.
When sick:
The patient should get more blood sugar tests. Also, the patient should still recieve insulin in partially reduced amounts, even if he or she is not eating or drinking carbohydrates at the time. The patient should drink more water. Blood sugars tend to rise in sick people with diabetes, and allowing them to go high is not good for the health of a patient. If there is doubt as to whether or not to call a doctor when a person with diabetes is sick, call one.
Things to keep in mind:
In order to keep the balance, diabetics and those who wish to help in their care should remember a few things.
- Insulin tends to lower blood sugar, and different kinds work at different speeds (thus, a diabetic should not recieve insulin that is not suited to the situation, as insulin with shorter durations of effect affect blood sugar more intensely.
- Exercise increases the effectiveness of insulin.
- Foods increase blood sugar, in different ways using different timings.
Exercise only increases the effectiveness of insulin. If there is no insulin to increase the effectiveness of, exercise only serves to increase the body's demand for energy, which can hurt the body, when it has no ability to circulate the energy properly. Exercising when ketones are present is actually harmful to the body. To measure for ketones, urine ketone tests are available at many drug stores. Most often, ketones will be present when blood sugars run too high, especially for long periods of time. Sometimes ketones will be present when blood sugars run too low for long periods of time. Also, different foods affect blood sugar in different ways. The more carbohydrates in the food, the more the food will increase blood sugar. If the food is full of complex carbohydrates, it will increase blood sugar over a longer period of time. If the food is taken with a protein source, it will more slowly and diffusely increase blood sugar. If the food has simple sugars, it will tend to increase blood sugar quickly and then stop affecting blood sugar quickly. If the food has processed sugars (most "sugar added" things apply here,) it will increase blood sugar quickly at first, drop off, and then later increase the blood sugar again, and then finally, slowly drop off. The goal for good diabetes care is always to have blood sugars in a good range and to eat when hungry. Exercise is key to this, because insulin becomes very ineffective in a very non-active lifestyle.
Possible complications and increased risks:
Over time, things like blood vessel disease, diabetic retinopathy, digital sclerosis, eruptive xanthomotosis, gum disease, heart disease, kidney disease, and neuropathy can result from long periods of poor diabetes care. However, even with good diabetes care, these things may happen, along with:
- Skin Conditions:
- Eye Conditions:
- Nerve Conditions:
Also, the circulatory system can lose some of its functionality. When enough sugar is present in the blood stream, hemoglobin starts to get encrusted in sugar. Labs can commonly measure the ratio of glycated hemoglobin to regular hemoglobin in percentages. In healthy, well maintained individuals, this is about 5 to 6 percent. Above 8 percent, most doctors begin to get concerned.
In the short term, poor diabetes care can induce:
Hypoglycemia (low blood sugar), with these results:
- Slight changes in internal sensations
- Increased hunger
- Emotional status changes (tending to feel empty, unloved, victimized)
- Shakiness
- Greater changes in internal sensations
- Extra thirst (requires about half a day of relatively mild hypoglycemia)
- Extra urination (requires about half a day of relatively mild hypoglycemia)
- Changes in external sensations
- Dizziness
- Apathy
- Dazed State
- State of no awareness but appearing conscious (usually marked by obvious differences in behavior)
- Unconsciousness
- Coma
- Death
Hyperglycemia (high blood sugar), with these results:
- Emotional status changes (tending to feel angry, sad, guilty)
- Slight feeling of increased internal acidity
- Slight feeling of copperiness, especially around mouth
- Extra thirst
- Extra urination
- Increased emotional status changes
- Increased changes in internal sensations
- Sickness
- Coma
- Death
In a case of poor diabetes care, the symptoms stack, and the longer no care is provided, the more likely an escalation of blood sugar imbalance, the more likely the symptoms will get worse. In cases of immediate symptoms in a person already diagnosed with diabetes, the most likely cause is hypoglycemia. If no blood sugar testing machines are available, assume blood sugar is low, but call a doctor or hospital, nonetheless. If a blood sugar testing machine is available, the patient should get a blood test, even if he or she appears to think that they should not get one (occasionally the emotional changes caused by blood sugar imbalances will make someone not want a blood test, even though it will help to stay healthy.)
With good care:
A diabetic tends to feel much better emotionally, have more energy, feel sick less often, and maintain a more healthy weight.
Sources used to relay this information:
- The American Diabetes Association at http://www.diabetes.org
- Eighteen years of personal experience, including interactions with endocrinologists whose names I cannot find
- Family members