Type I and Type ll Diabetes

There are 2 types of diabetes:

Type l

This is also known as insulin dependent diabetes mellitus (IDDM). In Type l no insulin is made in the body. This can occur at any age but especially in the young. Treatment is in the form of dietary controls and insulin injections.

Type ll

This is also known as non-insulin dependent diabetes mellitus (NIDDM). This accounts for 90% of all cases. In Type ll, the pancreas produces insufficient insulin. It usually occurs in people over the age of 40 and about 85% of patients are obese at the time of diagnosis. Very often other membes of their family also have diabetes. Type II diabetes can be treated by dietary controls alone or dietary controls and anti-diabetes tablet. Some may also need insulin injections.

Extra demands on the pancreas can also cause some women to develop diabetes during pregnancy. This is referred to as gestational diabetes (GDM). About 20-50% of GDM patients will develop diabetes in later life.

What are the symptoms?

Symptoms are similar for both types of diabetes. The most common symptoms are: -

• excessive urination

• constant thirst

• tiredness

• frequent hunger, strong appetite

• weight loss despite a hearty appetite

• frequent fungal infections especially in the genital areas

• blurred vision

Preventers

Preventers are used to prevent attacks or daily symptoms. It should be used as directed by your doctor to help reduce the frequency and severity of attacks. However, it does not give rapid relief of the asthma symptoms and therefore cannot be used for acute attacks.

When used over a period of time (minimally two weeks) preventers reduce the inflammation of the airways and also the production of mucus. You must not stop using them without the advice of your doctor as they keep the condition at bay. They should be used even though you have not had an asthma attack for some weeks.

Examples of preventers are anti-inflammatory agents such as budesonide, beclomethasone or fluticasone.

Oral Corticosteroids

Sometimes a short cause of oral steroids (e.g. prednisone) is also needed, particularly if the asthma attack is bad. The purpose of this is to bring the asthma patient's condition back under control. The oral steroid is usually stopped after a short period of time.

Relievers

Relievers act quickly and are used to relieve the symptoms of an attack. These are given when the asthma patient begins to cough and wheeze. They act by relaxing the muscles in the airways, thereby, allowing the air to flow more normally into the lungs. Your doctor will advise you how often you need to use the reliever ( usually once every 3 to 4 hours).

In cases of more severe asthma, it may be used more frequently. You are advised to inform your doctor if you find that you are often needing extra doses. Relievers are also used before exercise or sport for children who get symptoms such as cough, wheezing or shortness of breath when they play. The medication is taken just before the activity begins, and during it if needed.

Examples of relievers (bronchodilators) are salbutamol, fenoterol, ipratropium bromide or terbutaline.

Delivery devices

There are a variety of devices available to ensure that patients are given an inhaler they can and will use. This is important as the right choice would mean the medication can get to work in the airways as soon and as effectively as possible. Each device has its own advantages and some suit some people more than others. Your doctor will help you choose the device most suitable for you or your child.

• Metered dose inhalers (MDIs) Of all the devices available MDIs are the most commonly prescribed by doctors. These inhalers use a small aerosol to deliver a measured amount of drug directly into the airways. The advantages of MDIs are that if used correctly they are effective, small and portable, and relatively cheap. However it requires good coordination between activating the device and inhalation. MDIs are therefore considered generally unsuitable for children below 6 years and for many elderly patients or those with problems such as arthritis

•  Spacer devices ( e.g. Aerochamber, Volumatic)
  
  If your child is below 6 years of age, a metered dose inhaler used with a spacer is probably the best method. Spacers are essentially holding chambers that are connected to the MDI.
  
  The medication is released from the MDI into the spacer .The spacer holds the medication until the patient is ready to breathe and allows the patient to breathe at a slower and more effective rate. Spacers are available with face masks, which makes them suitable to use with babies, younger children and older people.
  
  Anti-inflammotory agents such as inhaled steroids can occasionally lead to thrush in the mouth and throat. The use of spacers or holding chambers can help prevent this. Patients are also advised to rinse their mouths after using the inhaler.

• Breath actuated MDIs (e.g. Autohaler )
  
  This type of inhaler releases the medication when the patient breathes in through the mouth piece. This is much easier to use than the conventional MDIs and children will find this easy to handle. It is however much more expensive than a MDI.

• Dry powder inhalers (e.g. Diskhaler, Spinhaler, Turbohaler, Rotahaler )
  
  These inhaler devices rely on the inspiration of a dry powder. These are particularly suitable for children above 5 years of age as they are extremely easy to use.

• Nebulisers

Nebulisers devices have the advantage of delivering a much higher dose of medication than any of the other inhalation devices. What the nebuliser does is convert a solution containing medication into a fine mist which can be inhaled into the lungs . These are especially useful during a bad attack of asthama when the patient may be affected to such an extent that the usual inhaler is not able to deliver the medication as effectively. Nebilisers are not usually necesary and you should only buy on eon the advice of your doctor.

Diet 

Diet plays a very important part in the management of diabetes. As diabetes is a disorder of glucose utilisation, many people assume incorrectly that they need only avoid sweet  foods and drinks to manage the condition. There's more to managing diabetes than that.

• Diabetes should have 3 regular meals daily and they do not miss any meals.

• Starchy foods which are high in fiber, should form the basis of a diabetic's diet. Such foods include whole meal bread, noodles, oats, unsweetened crackers, chickpeas and lentils.

• Foods that are high is sugar (e.g. white refined sugar, chocolate and honey) and fats should be kept to a minimum. Fat increases their risk of getting heart disease. It is also recommended that the food be grilled instead of fried.

• Salty foods and salt intake must be reduced. Avoid foods such as crisps and peanuts.

• Diabetics should plan their meals in advance. A consistent balance of  meals makes certain that there's a consistent intake of calories. This in turn ensures there's a consistent glucose load which the body can handle itself or with the help of anti-diabetes medications or insulin injections.

• Adjustment of caloric intake is recommended to achieve and maintain a desirable body weight. This can be done with the help of the doctor.

• Alcohol consumption should be kept to a minimum as too much alcohol can upset the blood sugar level.

Eating  'diabetic'  foods is not necessary as that do not offer any special advantages for the diabetic patient. These products are not usually any lower in calories than their ordinary counterparts. There are also specialized nutrition formulas for diabetics who can't stick to a diabetic diet. Such formulas aim to provide the nutritional requirements of the diabetic. It is important to remember that healthy eating is the key to a diabetic's diet and they can eat the same type of diet that everyone should be eating.

Exercise 

Nearly half of patients with Type II diabetes are overweight. Their enlarged fat cells do not respond well to insulin and also require the body to produce more insulin. Besides dietary controls, exercise are a great help in reducing weight. The goal is to keep their weight as close to the ideal body weight. Regular exercise also helps the insulin to work better and keeps the patient healthier.

However, it is advisable for the patient to consult their doctor on a suitable exercise plan to avoid hypoglycaemia. This can happen if  the insulin does is not reduced before exercise or not enough food was consumed before exercise. Your doctor will be able to advice you on the choice of exercise, dietary and medication adjustments that may be required.
 

Insulin 

 Type I diabetic patient require insulin injections daily. Type II diabetic patients may or may not need them. The first insulin available for treatment was produced in 1921. During that time the insulin was extracted  from the  pancreas of cattle and pigs (bovine and porcine insulin's). With the improvements in technology, synthetic human insulin, which is identical to the insulin made in our body, can now be produced using yeast and bacteria.

Insulin has to be given by injection as it can be destroyed in the stomach if taken orally. The patient's doctor makes decisions on insulin treatment, as each patient's insulin treatment is individualized according to the needs.

There are many types of insulin available.

The different types of insulin which are available are distinguished by:

• the onset of action
  the speed at which the injected insulin is absorbed into the blood

• Peak  effect
  the time the insulin level reaches its peak

• Duration of action
  the time it takes for all the injected insulin to be absorbed. 

Anti-Diabetes Tablets

These tablets do not contain insulin. Instead they contain drugs which either  help the pancreas to produce more insulin or help the body to use sugar more effectively. They can sometimes produce side effects like low blood sugar attacks, sickness, diarrhea and rashes. Patients should notify  their doctor when  they experience unexpected problems after starting with these tablets.  

Symptoms 

Symptoms of  hypoglycaemia include:

• Lack of concentration

• Irritability

• Shaking and weakness

• Sweating

• Blurred vision

Treatment 

The treatment is to promptly take sugar by mouth ( in the form of glucose tablets, sugar lumps or glucose drink). Recovery is usually very quick.

Occasionally, unconsciousness can occur and hospital treatment is necessary.

Blood Glucose Monitoring 

Monitoring glucose level can be done through urine or blood testing. However, blood testing is more accurate. Home blood glucose meters are available and these are simple to use. Check with your doctor or pharmacist on which meter to choose  and the proper techniques of using them.

These tests are simple to do and can be done  anytime you need to get a reading. It is usually recommended that you carry out 2-3 readings in a day, 2-3 days in a week. Readings can be taken at times either before or after meals as it varies from person to person. These readings should be recorded in a record book or diary to be shown to the doctor during routine visits. Whener you  feel that the readings is 'too low' or much 'too high'. it is recommended that referral to your doctor is necessary. From these readings your doctor can help you to adjust  your diet or exercise, or even your medication, to keep your blood glucose levels within the targeted range.

Skin Care 

Diabetics are prone to skin infections because the high sugar levels in the body are conducive to bacterial and fungal growth. As such diabetics have to ensure that their skin care routine can minimize the occurrence of skin infections. Therefore, correct skin cleansing and the use of skin care preparations are important.

• Use cleansing agents which are acidic, with a pH of about 5.5. This ensures that the skin's natural protective function is maintained.

• Cleansers should be mild, as strong preparations can irritate the skin.

• Use lukewarm water to wash.

• Alkaline-based cleansing agents should be avoided especially if the skin is itchy or  inflamed.

• Refrain from scratching if skin is itchy. A break in the skin can encourage infection. Apply a lotion or cream with anti-itch properties.

• When washing do not forget areas such as armpits, genital and parietal areas, skin folds on the areas between the toes.

• After washing, apply a moisturizing lotion to keep the skin moist and supple.

• Take special care to avoid any injuries or scratches.

Foot Care

Foot care is especially important to the diabetic patient. In addition to skin infections, the feet are also prone to ulceration. This is due to the reduced blood supply and oxygen  to the legs.

• Diabetics should wash their feet daily  and dry them thoroughly. Remember to ensure that the spaces between the toes are kept dry too.

• If you have dry skin, massage a little moisturizing cream onto it, but not between the toes.

• Socks are to be changed daily.

• Toenails should be kept trimmed. When trimming toenails do it straight across and avoid trimming too close to the skin to avoid unnecessary injuries.

• Shoes should be  comfortable and not too tight a fit. Always feel inside shoes before  putting them on as the reduced sensitivity in the feet prevents you from feeling sharp objects or pieces of grit under the feet.

• The feet must be examined daily to look out for scratches, blisters, ulcers or any other wounds.

• Diabetes should not go around barefoot.

• It is important to remember not to apply any chemical agents to the feets such as corn or callous removers including corn plasters. These contain acids, which can be very dangerous to the diabetic patient. 

Eye Care 

Diabetics  are also prone to certain eye diseases such as cataracts, glaucoma and even blindness (due to retinopathy). The incidence of cataracts is higher in diabetes  and also  it progresses at a faster rate in diabetics.

Glaucoma is also more common in diabetics. Early  diagnosis and proper management is essential to prevent optic nerve damage and loss of vision as a consequence of the damage.

Diabetic retinopathy is one of the leading causes of blindness. The longer the person suffers from diabetes, the greater the risk of developing diabetic retinopathy which can lead to blindness.

Diabetic must:

• go for annual eye check-ups.

• carry out blood pressure checks routinely.

• refer to an ophthalmologist promptly if there are visual problems.

Tooth Care  

Care on the teeth is also important. Diabetics should be careful of any lesions in the mouth or gums. These can easily become infected and cause a myriad of problems.

Diabetics should pay a 6 monthly visit to their dentist to ensure that all is well with their gums and teeth.