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Patient Basics: Type 1 Diabetes Mellitus Originally published by Harvard Health. What Is It? Type 1 diabetes is a disease in which the body does not make enough insulin to control blood sugar levels. Type 1 diabetes was previously called insulin-dependent diabetes or juvenile diabetes. During digestion, food is broken down into basic components. Carbohydrates are broken down into simple sugars, primarily glucose. Glucose is a critically important source of energy for the body’s cells. To provide energy to the cells, glucose needs to leave the blood and get inside the cells. Insulin traveling in the blood signals the cells to take up glucose. Insulin is a hormone produced by the pancreas. When levels of glucose in the blood rise, like following a meal, the pancreas normally produces more insulin. Type 1 diabetes occurs when some or all of the insulin-producing cells in the pancreas are destroyed. This leaves the patient with little or no insulin. Without insulin, sugar accumulates in the bloodstream rather than entering the cells. As a result, the body cannot use this glucose for energy. Type 1 diabetes is an autoimmune disease. This means it begins when the body’s immune system attacks cells in the body. In type 1 diabetes, the immune system destroys insulin-producing cells (beta cells) in the pancreas. Why the immune system attacks the beta cells remains a mystery. Experts suspect that some people are genetically predisposed to the disease. And an environmental factor may act as a trigger. Viral infections and diet are two possible triggers. Type 1 diabetes is not caused by the amount of sugar in a person’s diet before the disease develops. Type 1 diabetes is a chronic disease. It is diagnosed most commonly between ages 10 and 16. Type 1 diabetes equally affects males and females. Symptoms Initial Symptoms Symptoms usually come on suddenly and strongly. Typically the most prominent symptoms are excessive urination and extreme thirst. This is because the increased glucose in the blood causes the kidneys to create more urine than usual. Losing more fluid in the urine makes a person dehydrated. And dehydration leads to great thirst. Children may start to wet the bed again. Weight loss, with no loss of appetite, also is common. The weight loss is due in part to dehydration. Water has weight. Imagine holding a gallon jug of water: it weighs about eight pounds. People with new, uncontrolled type 1 diabetes can lose a gallon of water from dehydration. Other common symptoms are weakness, fatigue, confusion, nausea and vomiting. Dehydration can cause weakness, fatigue and confusion. Another cause of these symptoms, along with nausea and vomiting, is a condition called ketoacidosis. Ketoacidosis occurs because cells can’t the glucose they need for energy. So the cells have to use something else. As an alternative fuel, the liver produces substances called ketones. Ketones are a kind of acid. When they build up in the blood, it’s called ketoacidosis. Ketoacidosis can cause heart problems and affect the nervous system. Within hours, it may put a person at risk of coma or death. Chronic Symptoms Even after it is diagnosed and treatment is begun, type 1 diabetes can affect all body systems. It is less likely to damage the body, and cause symptoms, if the blood sugar levels are well controlled by treatment. The serious and potentially life-threatening complications that can occur with type 1 diabetes include: - Eye damage (retinopathy) — Tiny blood vessels at the back of the eye are damaged by high blood sugar. Caught early, retinopathy can be stopped by tightly controlling blood sugar and laser therapy. If blood sugar remains high, retinopathy eventually causes blindness. - Nerve damage (neuropathy) — High blood sugar can damage nerves, leading to pain or numbness of the affected body part. Damage to nerves in the feet, legs and hands (peripheral neuropathy) is most common. Nerves that control body functions, such as digestion and urination, also can be damaged. - Foot problems — Sores and blisters commonly occur on the feet of people with diabetes. If peripheral neuropathy causes numbness, a sore may not be noticed. It can become infected. Blood circulation can be poor, leading to slow healing. Left untreated, a simple sore can lead to gangrene. Amputation may be necessary. - Kidney disease (nephropathy) — High blood sugar can damage the kidneys. If blood sugar remains high, it can lead to kidney failure. - Heart and artery disease — People with type 1 diabetes are more likely to have heart disease, strokes and problems related to poor circulation. - Diabetic ketoacidosis — This occurs when ketones are made by the body as a substitute for glucose. Symptoms include: - Nausea and vomiting - Abdominal pain - Fatigue - Lethargy - Coma and death (if ketoacidosis is left untreated) - Hypoglycemia — Low blood sugar (hypoglycemia) can result from insulin treatment (see Treatment section, below). Hypoglycemia may occur if too much insulin is taken or meals are skipped. Symptoms include: - Weakness - Dizziness - Trembling - Sudden sweating - Headache - Confusion - Irritability - Blurry or double vision Hypoglycemia can lead to coma if it is not corrected by eating or drinking carbohydrates. Glucagon is a substance that makes the liver release glucose into the bloodstream. An injection of glucagon can also correct hypoglycemia. Diagnosis Type 1 diabetes is diagnosed by a combination of symptoms, a person’s age and blood tests. The blood tests include tests for sugar levels and for other substances. Fasting plasma glucose (FPG) test. Blood is taken in the morning after fasting overnight. Normally, blood sugar levels remain between 70 and 100 milligrams per deciliter (mg/dL). Diabetes is diagnosed if a fasting blood sugar level is 126 mg/dL or higher. Oral glucose tolerance test (OGTT). Blood sugar is measured two hours after drinking 75 grams of glucose. Diabetes is diagnosed if the 2-hour blood sugar level is 200 mg/dL or higher. Random blood glucose test. A blood sugar of 200 mg/dL or greater at any time of day combined with symptoms of diabetes is sufficient to make the diagnosis. Hemoglobin A1C (glycohemoglobin). This test measures the average glucose level over the prior two to three months. Diabetes is diagnosed if the hemoglobin A1C level is 6.5% percent or higher. Expected Duration Type 1 diabetes is a lifelong disease. People with type 1 diabetes need regular checkups. They must carefully monitor their blood sugar levels every day. They must receive insulin treatment throughout life. A small number of people can become exceptions to this rule. Some people with diabetes eventually require kidney transplants. A transplant of the pancreas, or of the insulin-producing cells from the pancreas (called “islets”), sometimes is performed at the same time. Since the new pancreas can make insulin, this can cure the diabetes. On unusual occasions, when someone’s type 1 diabetes is very hard to control with available treatments, pancreas or islet transplantation may be performed even when kidney transplantation is not necessary. However, this approach is still experimental, and is not generally recommended. Prevention There is no proven way to prevent type 1 diabetes. Vitamin D deficiency, which is very common, may increase the risk of diabetes. However, correcting the deficiency has not been yet shown to prevent diabetes. Likewise, avoiding cow’s milk during infancy may possibly prevent type 1 diabetes in genetically susceptible infants. But there is no definite proof that this prevents the disease. Treatment Treatment of type 1 diabetes requires daily insulin injections. The injected insulin makes up for the insulin that is not produced by the body. Most people with type 1 diabetes need two to four injections per day. Some people use a syringe for injections. Other patients use semiautomatic injector pens that help to measure precise amounts of insulin. An increasing number of patients use insulin pumps. Insulin pumps deliver a regulated dose of insulin through a needle implanted under the skin. The insulin pump is worn in a pack on the body. People with type 1 diabetes must properly regulate insulin intake. Enough insulin must be taken to keep blood sugar levels from getting or staying too high. But low blood sugar can also be dangerous. Low blood sugar may occur if too much insulin is taken or if not enough carbohydrates are ingested in to balance the insulin. In order to properly regulate their insulin intake, people with type 1 diabetes need to monitor their blood sugar levels several times per day. They do this by testing a sample of blood. They must prick their finger and place a small drop of blood on a test strip. The test strip is inserted into a device called a glucose monitor. An accurate reading of blood sugar levels is returned within seconds. Newer glucose monitors have test strips that take the blood directly from the spot that was pricked. This process requires less blood. Other monitors allow blood to be taken from the forearm, thigh or the fleshy part of the hand. This can be less painful. People with diabetes need to watch their diets. A healthy diet for someone with type 1 diabetes keeps the amount of glucose in the blood relatively constant. This makes blood glucose levels easier to control with insulin. A person with type 1 diabetes typically is advised to eat, exercise and take insulin at about the same times every day. Regular habits help to keep glucose levels within the normal range. Fast-acting insulin may be taken as needed, depending on the amount of carbohydrates ingested. Your doctor or dietitian will help you determine the best insulin and diet schedule for you or your child. People with type 1 diabetes should get regular exercise. Exercise helps to keep the heart and blood vessels healthy. It also helps to control blood sugar by causing muscles to use glucose and by keeping body weight down. Ask your doctor how much and when to exercise to best control your diabetes. When To Call a Professional Call your health care professional if you experience a sudden increase in thirst and urination. Unexplained weight loss always should be reported to a physician. If you or your child has type 1 diabetes, see your doctor regularly to make sure that you are keeping good control of your blood sugar. You should also be checked regularly for early signs of complications such as heart disease, eye problems and skin infections. Your doctor most likely will suggest that you also visit other specialists regularly. These may include a podiatrist to check your feet and an ophthalmologist to check your eyes for signs of diabetes complications. Prognosis People with type 1 diabetes generally adjust quickly to the time and attention that is needed to monitor blood sugar, treat the disease and maintain a normal lifestyle. As time goes on, the risk of complications is substantial. But it can be reduced greatly if you strictly monitor and control your blood glucose levels. Additional Info American Diabetes Association ATTN: National Call Center 1701 N. Beauregard St. Alexandria, VA 22311 http://www.diabetes.org/ American Dietetic Association 120 South Riverside Plaza Suite 2000 http://www.eatright.org/ National Diabetes Information Clearinghouse 1 Information Way http://diabetes.niddk.nih.gov/ National Institute of Diabetes & Digestive & Kidney Disorders Office of Communications and Public Liaison Building 31, Room 9A04 31 Center Drive, MSC 2560 http://www.niddk.nih.gov/ Weight-Control Information Network 1 Win Way http://www.niddk.nih.gov/health/nutrit/win.htm
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Zdravi Recepti Kašica od keksa i čaja Varivo od lignji Varivo od čičoke Zdravo varivo od mahuna Krem juha od kikirikija Popularno Vrste glavobolja u trudnoći U prvom tromjesečju kada hormoni još divljaju glavobolje bi mogle biti češće, no kasnije, kada... Dijabetes u trudnoći Objavljeno: 16.11.2012 | Autor: trudnoca.hr Što je dijabetes? Dijabetes je kronična bolest koja dovodi do povišene razine šećera u krvi. Postoje dijabetes tipa 1 i dijabetes tipa 2 te se razlikuju po tome što kod tipa 1 gušterača uopće ne proizvodi inzulin koji je zadužen za korištenje glukoze za rast i stvaranje energije. Kod dijabetesa tipa 2 se javlja problem unatoč tome što gušterača proizvodi inzulin, no tijelo nije u mogućnosti apsorbirati ga. Teški oblici dijabetesa mogu dovesti do zatajenja bubrega, srčanih tegoba, sljepoće, osteoporoze, a u najtežim oblicima i do smrti. Dijabetes tipa 1 Dijabetes tipa 1 češći je kod djece, no moguće je da se pojavi i kod odraslih, no to se događa veoma rijetko. Od svih kroničnih bolesti kod djece dijabetes tipa 1 je najzastupljeniji. Kod dijabetesa tipa 1 dolazi do propadanja beta stanica u gušterači te proizvodnja inzulina u potpunosti prestaje. Sam proces propadanja beta stanica može trajati godinama, no nakon što proizvodnja inzulina u potpunosti prestane naglo će se javiti simptomi poput naglog gubitka tjelesne težine, česta i snažna žeđ, učestalo mokrenje, zamagljen vid i povećan apetit. Iako se smatra da ne postoji utjecaj genetike na razvoj dijabetesa tipa 1, česte su sumnje kako je okidač za razvoj ovog tipa dijabetesa vanjski utjecaj. Kako često djeca neznaju precizno objasniti kako se osjećaju, veoma je bitno redovito i temeljito pratiti razvoj bolesti. Djeca sa dijabetesom zahtjevaju cjelodnevnu njegu kako bi se pozorno pratila razina glukoze u krvi. Dijete će svakodnevno morati primati dozu inzulina, tako da je mnogo jednostavnije da vam liječnik pokaže i objasni kako se to radi kako nebi morali svakodnevno odlaziti kod liječnika na primanje inzulina. Vrlo je bitna i pravilna prehrana, tako da je preporučljivo savjetovati se sa vašim liječnikom i nutricionistom što je najbolje za vaše dijete, u kojim količinama i koliko često tokom dana dijete treba uzimati obroke jer su često potrebni i međuobroci, a razmak između obroka mora biti uvijek jednak. Kod djece može doći do hipoglikemije i tokom spavanja što je veoma opasno te se stoga ponekad preporučuju lagani obroci netom prije spavanja koji to u određenoj mjeri mogu spriječiti. Uzimanje inzulina može dovesti do izrazito niske razine glukoze kada nastupa hipoglikemija. Ukoliko je razina glukoze malo ispod prosječne javit će se simptomi poput znojenja, drhtavice i ubrzani otkucaji srca, dok ako razina glukoze padne znatno niže od prosječne posljedice bi mogle biti teže. U tom slučaju se javlja slabost, potpuna dezorijentiranost, agresivnost, a u najtežim oblicima i koma i smrt. Upravo kako bi se hipoglikemija izbjegla treba uvijek imati uz sebe prirodni zaslađeni sok, vrećice šećera ili tvrde bombone kako bi se odmah podigla razina glukoze u krvi. Ako se kroz 10-ak minuta stanje ne počne popravljati potrebno je dati glukagon. Upravo iz tog razloga je potrebno naučiti članove obitelji kako dati injekciju glukagona. Veoma je bitno i dati dovoljne količine tekućine djetetu. Kod djece može doći do hipoglikemije i tokom spavanja što je veoma opasno te se stoga ponekad preporučuju lagani obroci netom prije spavanja koji to u određenoj mjeri mogu spriječiti. Dijabetes tipa 2 Za razliku od dijabetesa tipa 1 koji se najčešće javlja kod djece, dijabetes tipa 2 pretežito se pojavljuje kod odraslih osoba, najčešće onih starijih od 40 godina starosti. Kod razvoja ovog tipa dijabetesa ključnu ulogu ima genetika. Dodatnu opasnost od pojave dijabetesa tipa 2 ljudi mogu smanjiti odgovornim ponašanjem jer se pojavljuje zbog prekomjerne tjelesne težine i kao posljedica preslabe fizičke aktivnosti. Kod dijabetesa tipa 2 gušterača redovito izlučuje inzulin, no problem se javlja kada tijelo nije u mogućnosti apsorbirati taj inzulin i pretvoriti ga u prijeko nam potrebnu energiju. U novije doba se dijabetes tipa 2 počinje pojavljivati i kod djece, a sumnja se da je uzrok tome sve veći broj pretile djece koja se nedovoljno kreću. Do dijabetesa ponekad mogu dovesti i bolesti ili operacije gušterače koje narušavaju njezino pravilno funkcioniranje te je učestalija pojava dijabetesa tipa 2 kod pušača. Uzimanje inzulina može dovesti do izrazito niske razine glukoze kada nastupa hipoglikemija. Ukoliko je razina glukoze malo ispod prosječne javiti će se simptomi poput znojenja, drhtavice i ubrzani otkucaji srca, dok ako razina glukoze padne znatno niže od prosječne posljedice bi mogle biti teže. U tom slučaju se javlja slabost, potpuna dezorijentiranost, agresivnost, a u najtežim oblicima i koma i smrt. Upravo kako bi se hipoglikemija izbjegla treba uvijek imati uz sebe prirodni zaslađeni sok, vrećice šećera ili tvrde bombone kako bi se odmah podigla razina glukoze u krvi. Ako se kroz desetak minuta stanje ne počne popravljati potrebno je dati glukagon. Upravo iz tog razloga je potrebno naučiti članove obitelji kako dati injekciju glukagona. Kako zatrudnjeti sa dijabetesom? Žene koje boluju od dijabetesa ne bi trebale trudnoću olako shvaćati jer dijabetes može izazvati mnogobrojne komplikacije za vas i vaše dijete. Mnogo češće dolazi do pobačaja ili mrtvorođenja upravo kod žena koje boluju od dijabetesa. Djeca koja se rode najčešće tokom života razvijaju dijabetes. Najveća opasnost za dijete je tokom prva 2 mjeseca trudnoće kada može doći do razvoja srčanih mana, zatajenja bubrega i oštećenja mozga kod djeteta. Ukoliko se trudnoći sa dijabetesom posveti dovoljna pažnja, naravno, velike su šanse da će vaše dijete biti zdravo i da neće biti većih teškoća za vrijeme trudnoće za vas ni vaše dijete. Vrlo je bitno često kontrolirati razinu glukoze kako bi odmah mogli reagirati ukoliko vam je razina glukoze jako povišena, pa je potrebno uzreti inzulin ili ako je razina glukoze izrazito niska pa je potrebno nadomjestiti šećer uzimanjem bombona ili sokova ili u krajnjoj liniji primiti injekciju glukagona koji bi razinu glukoze trebao dovesti u normalu. Kod žena sa dijabetesom liječnici najčešće preporučuju nešto veće doze folne kiseline, stoga se posavjetujte sa vašim liječnikom kada se odlučite na trudnoću. Ukoliko imate prekomjernu tjelesnu težinu prije trudnoće je potrebno smršaviti kako bi smanjili opasnosti za vas i dijete na najmanju moguću razinu. Svakako je potrebno izbaciti cigarete te uzimanje alkohola koji uzrokuje vrtoglavo brz rast i pad razine šećera u krvi. Kako smo već naveli, zdrava i pravilna prehrana u vidu više manjih obroka, zdravih namirnica i redovitog uzimanja obroka u jednakim vremenskim intervalima te redovita tjelovježba također djeluju pozitivno na uklanjanje mogućih komplikacija u trudnoći. Kao što se svim ženama savjetuje prije i za vrijeme trudnoće potrebno je uzimati dodatke prehrani koji sadrže folnu kiselinu koja pomaže pri pravilnom razvoju ploda već od samog začeća. Kod žena sa dijabetesom liječnici najčešće preporučuju nešto veće doze folne kiseline, tako da se posavjetujte sa vašim liječnikom kada se odlučite na dijete. Neki lijekovi za regulaciju glukoze u krvi se nesmiju uzimati tokom trudnoće te se na vrijeme konzultirajte sa vašim liječnikom kako bi prije začeća utvrdili koji su mogući načini regulacije šećera koji vama i vašem organizmu odgovaraju. Vezani članci Riješite se žgaravice u trudnoći na prirodan način Vrlo je malo sretnica koje uspiju izbjeći neugodnu žgaravicu u trudnoći. Poslušajte naše savjete i spriječite žgaravicu! Kretanjem protiv gestacijskog dijabetes mellitusa Trudni ste, imate između 20 i 35 godina, živite na širem području Zagreba i dobili ste dijagnozu gestacijskog dijabetesa, a nemate... Hipoglikemija Preporučuje se što češće dojiti kako zbog prevelikog vremenskog razmaka između dva dojenja ne bi došlo pada razine šećera u krvi, a ujedno...