Sunday, January 15, 2006

diabetes mellitus

Diabetes mellitus is the inability of the body to oxidize, or break down, carbohydrates because of faulty pancreatic activity and disturbance of the normal insulin mechanism.
The symptoms of diabetes include polyuria (frequent urination), polydipsia (excessive thirst), polyphagia (excessive eating), fatigue, blurred vision, poor wound healing, and frequent infections. Diabetes is common in old age. Generally, diabetes that has an onset in old age is mild and frequently without symptoms.
Diabetes mellitus affects the entire body; therefore, a diabetic needs to be monitored closely. By classifying the diabetes' severity, the treatment may be determined. If the diabetes is mild, it may be controlled by a diet and exercise program. More severe cases need oral or parenteral medication.
Type II diabetes is adult-onset diabetes controlled with oral hypoglycemic medications. Type I is juvenile-onset diabetes, which is usually controlled with insulin. Type II diabetes is a disease that affects older people who frequently have other chronic diseases, physical limitations, and psychosocial and economic problems that complicate management and limit the ability for self-care. A major problem for most people with diabetes mellitus is obesity.
Several principles of management are important for Type II diabetes. The first is to provide the diabetic with initial education and therapy. One needs to allow at least three months for a trial of exercise and diet before beginning more therapy. If drug therapy is instituted at the beginning, an attempt should be made to reduce the medication once control is established. After the trial period, the physician will select a method of drug therapy-sulfonylurea or insulin. The choice between sulfonylurea (oral hypoglycemic agent) and insulin depends on the patient's as well as the physician's preference. The choice also depends on the patient's physical condition as well as other factors. If a patient is obese, the physician should try to avoid insulin because peripheral insulin resistance may occur. When the patient has advanced neuropathy or retinopathy, insulin therapy is preferred over sulfonylurea. Elderly diabetics are at a great
risk of stroke, myocardial infarction, or aspiration
during hypoglycemia.
After the method of drug therapy has been chosen, the physician will develop the method and program for the patient's home glucose surveillance. The doctor will decide the technique, frequency of testing, and the manner or reporting. Other diabetes mellitus patients are less likely to have wide swings in blood sugar; therefore frequent measurement of urine sugars is not as important as it is with Type I diabetes mellitus patients. Diabetes is a very serious disease, which, if allowed to go uncontrolled, could result in severe complications of the eye, kidney, and nervous system.
For additional information write or call:
American Diabetes Association
1660 Duke Street
P.O. Box 257757
Alexandria, VA 22314
1-800-232-3472

See also DIABETIC RETINOPATHY; FOOT CARE; SEXUALITY.
Davidson, M. B. Diabetes Mellitus Diagnosis and Treatment. New York: Wiley Medical Publication, 1981.
Rogers, C. S., and McCue, J. D. Managing Chronic Disease-I987. Oradell, N.J.: Medical Economics Co. Inc., 1987.

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