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The Truth About Diabetes

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The Truth About Diabetes

Diabetes is a killer; in fact, it is among the top ten killers of adults in the United States. "It can lead to, or contribute to, a number of other serious diseases" (Sizer and Whitney 112). Diabetes means "syphon" or "to run through" (Sizer and Whitney 112) therefore denoting the increase in urinary volume excreted by people suffering from this disease. Mellitus means "sweet". Diabetes mellitus means increased excretion of sugars being released with the urine, creating a sweet smell at the time of elimination. The patient with this type of disease has a problem with his insulin production or usage. Insulin is a hormone produced in the pituitary gland, that helps to digest the sugars and use them for energy, and must be given through an injection into the arms or legs; if this is not done the gastointestinal enzymes in a person's stomach will digest the hormone. A diabetic does not produce adequate insulin or cannot use his own. Diabetes mellitus is not a single disease. This is a heterogeneous syndrome for which several theories of etiology (explanation of the cause of the disease) have been proposed (WebMd Health). Diabetes is a life-threatening disease, but it is not a death sentence. With proper maintenance of insulin, exercise, and diet, diabetes can be controlled. Advances in medicine will create a larger variety of treatment options and help remove the stigma, as well as fears, associated with diabetes.

The signs and symptoms of diabetes are divided into early, secondary, and late signs. Some of the early signs include polyuria (excessive urination) and thirst; another sign can also be a sweet smell from urine. This odor is due to the loss of water through promoting cellular dehydration. Polyuria is the result of large amounts of glucose, ketone bodies, and protein being excreted by the kidney; an osmotic effect of sugar attracts water and promotes diuresis. The secondary signs include nausea and vomiting, dry mucous membranes with cracked lips, hot flushed skin, abdominal pain and or rigidity, acetone odor of the breath, soft eyeballs because of dehydration, and kidney disease. Other signs include impaired vision or blindness resulting from cataracts and damaged retinas, nerve damage, skin damage, and strokes and heart attacks. The root cause of all of these symptoms is probably the same (Sizer and Whitney 113). Late symptoms include hypotension, oliguria (secretion of a diminished amount of urine in relation to fluids intake) or anuria (the complete suppression of urinary secretion by the kidneys) (American Diabetes Association). Later, decreased circulating fluid volume lessens blood flow to the kidney, thus resulting in renal shutdown with oliguria or anuria. The late are more severe and present more of a problem. Coma and stupor are the final and most extreme symptoms. Electrolyte imbalances, profound shock, and rapidly lowering pH all contribute to the loss of consciousness (Luckmann and Soerensen 1544).

Diabetics can develop a myriad of chronic complications. The health problems relating to diabetes are in the eyes, skin, urinary system, and heart. Glaucoma occurs when pressure builds up in the eye. In most cases this pressure causes drainage of the aqueous humor to slow down to the point that it builds up in the anterior chamber. This pressure pinches the blood vessels that carry blood to the retina and optic nerve, causing less oxygen and nutrients to be delivered to the needed areas in the eye. Vision is gradually lost because the retina and nerve are damaged (American Diabetes Association). "Treatment is usually medications. People with diabetes are sixty percent more likely to develop cataracts, defined as the clear lens of the eye clouding, and blocking light" (American Diabetes Association). A person may need to wear sunglasses more than usual, and use glare control lenses in his glasses. Retinopathy and glaucoma may also develop in people with diabetes. Retinopathy is the general term used for all of the retinal disorders caused by diabetes. In ketoacidosis a condition called metabolic acidosis arises in untreated diabetes and in the patient whose condition remains uncontrolled by insulin. This is one of the most severe acute complications of diabetes (Luckmann and Sorensen 1567).

Skin changes and infections can occur in a diabetic patient. The different types of skin changes that occur are known as diabetic dermopathy and necrobiosis lipoidica diabeticorum, both attributed to microangiopathy (a disease of the small blood vessels), in which a membrane of capillaries thickens (diabetic microangiopathy), or in which clots form in the arterioles and the capillaries. Shin spots are brown spots located on the anterior surfaces of the lower extremities. These are painless and harmless, and initially measure less than one centimeter in diameter. Necrobiosis lipoidica diabeticorum is believed to be the result of trauma and consists of lesions that are similar to those that occur in diabetic dermopathy, but is more likely to be associated with ulcerations and necrosis. These lesions are reddish yellow and atrophic. Skin grafts (skin planting or placement of skin from another part of the body onto the damaged skin) are possible solutions to alter the damage caused by this problem. Necrobiosis lipoisica diabetic orum, a degenerative disease of the dermal connective tissue characterized by the development of erythematous papules or nodules in the pretibial are, is present most often in insulin-dependent women, which may later precede the onset of overt diabetes (American Diabetes Association). Infections like these mentioned do occur more in patients with diabetes than in other clients. The mechanisms of the onset of more frequent infections include a defect in the mobilization of inflammatory cells and impairment in the white blood cells. Recurring infections, such as boils and furuncles, in the undiagnosed client often lead the health care provider to suspect diabetes. The loss of sensation or nerve damage may delay the detection of infection. The persistence of glycosuria (sugars in the urine) may encourage bladder infections especially in a neurogenic bladder (a bladder that can not be controlled by the patient) (Brunner). Patients with diabetes are usually more susceptible to some microorganisms and fungi, in part because of the high sugar content in their blood and urine. Two out of three people with diabetes die from heart disease and stroke associated with blood vessel disease (Luckmann and Sorensen 1565-1569). Chronic hyperlipemia is excessive fats in the blood. Vascular degeneration may, in turn, affect the kidneys causing diabetic nephropathy, and the eyes causing diabetic retinopathy and eventually blindness. In addition to this, diabetes can eventually cause



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