Diabetes Mellitus (cont.)
What can be done to slow diabetes complications?
Findings from the Diabetes Control and Complications
Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) have
clearly shown that aggressive and intensive control of elevated levels of blood sugar in patients
with type 1 and type 2 diabetes decreases the complications of nephropathy,
neuropathy, retinopathy, and may reduce the occurrence and severity of large
blood vessel diseases. Aggressive control with intensive therapy means achieving
fasting glucose levels between 70-120 mg/dl; glucose levels of less than 160
mg/dl after meals; and a near normal hemoglobin A1C levels (see below).
Studies in type 1 patients have shown that in intensively
treated patients, diabetic eye disease decreased by 76%, kidney disease
decreased by 54%, and nerve disease decreased by 60%. More recently the EDIC
trial has shown that type 1 diabetes is also associated with increased heart
disease, similar to type 2 diabetes. However, the price for aggressive blood
sugar control is a two to three fold increase in the incidence of abnormally low blood
sugar levels (caused by the diabetes medications). For this reason, tight
control of diabetes to achieve glucose levels between 70-120 mg/dl is not
recommended for children under 13 years of age, patients with severe recurrent
hypoglycemia, patients unaware of
their hypoglycemia, and patients with far advanced diabetes complications. To
achieve optimal glucose control without an undue risk of abnormally lowering
blood sugar levels, patients with type 1 diabetes must monitor their blood
glucose at least four times a day and administer insulin at least three times per day.
In patients with type 2 diabetes, aggressive blood sugar control has similar
beneficial effects on the eyes, kidneys, nerves and blood vessels.
- Diabetes is a chronic condition associated with abnormally high levels of
sugar (glucose) in the blood.
- Insulin produced by the pancreas lowers blood glucose.
- Absence or insufficient production of insulin causes diabetes.
- The two types of diabetes are referred to as type 1 (insulin dependent) and
type 2 (non-insulin dependent).
- Symptoms of diabetes include increased urine output, thirst and hunger as
well as fatigue.
- Diabetes is diagnosed by blood sugar (glucose) testing.
- The major complications of diabetes are both acute and chronic.
- Acutely: dangerously elevated blood sugar, abnormally low blood sugar due
to diabetes medications may occur.
- Chronically: disease of the blood vessels (both small and large) which can
damage the eye, kidneys, nerves, and heart may occur
- Diabetes treatment depends on the type and severity of the diabetes. Type 1
diabetes is treated with insulin, exercise, and a diabetic diet. Type 2 diabetes
is first treated with weight reduction, a diabetic diet, and exercise. When
these measures fail to control the elevated blood sugars, oral medications are
used. If oral medications are still insufficient, insulin medications are
considered.
Last Editorial Review: 7/22/2008
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