There are two forms of diabetes, Type 1 and Type 2. Type 1 is often called insulin-deficient diabetes and is seen in a younger-age population. This form of diabetes is the result of the pancreas not making any insulin, which is an essential hormone that helps us metabolize sugars.
Type 2 diabetes, sometimes called adult-onset diabetes, is seen in an older-age population and is thought to result from lower insulin production from the pancreas as well as the body’s resistance to whatever insulin is made.
Regardless of which diabetes a patient has, there can be serious health complications if the diabetes isn’t managed well.
The cause of type 1 diabetes is not known, but it is suggested that it is the result of genetic factors and possible viral infection of the pancreas that damages the pancreas. This form can have severe consequences if not diagnosed and treated early.
Treatment for Type 1 diabetes is diet, close glucose control and insulin. Diet is important to limit how much and when sugars or carbohydrates are consumed. The goal of close glucose control, by which the amount of glucose in the blood is monitored to keep it in a narrow range, is to keep the amount of glucose to an accepted range to prevent long-term health effects of elevated blood sugar.
High blood glucose over a long period can have significant health consequences such as damage to the small blood vessels in the body leading to renal disease, loss of limbs, blindness and other complications.
It is the damage of the small blood vessels that leads to loss of sensation in diabetic foot disorder. As the diabetic loses sensation, the foot becomes prone to injuries. These injuries plus the lack of good blood flow leads to ulcers and infection in the foot/leg, which can lead to amputation if not treated.
Insulin is given in Type 1 diabetes since the pancreas does not produce insulin, anymore. The insulin can be given regularly by an injection or, more recently, by an implantable insulin pump.
A recent development is pancreas transplantation in which a new pancreas is given to a patient with type 1 diabetes. If this is successful, the patient no longer will need insulin injections on a regular basis.
By contrast, in Type 2 diabetes, the pancreas still produces insulin but not enough, or the insulin is not enough to overcome the resistance to it. Type 2 diabetes is seen in adults.
There has being a tremendous increase in Type 2 diabetes in recent years. It is believed that our sugar- and carbohydrate-rich diet, when combined with a more sedentary lifestyle, is responsible for weight gain and the increase in Type 2 diabetes.
As such as someone gains weight, the pancreas is working harder to produce more insulin to manage the increased amount of sugar consumed. As patients gain weight, they become more insulin-resistant so more and more insulin has to be produced by the pancreas to overcome the body’s’ resistance to insulin.Over time, the pancreas simply burns out and stops producing insulin or does not produces enough insulin.
A person’s risk and management of Type 2 diabetes is gauged by their level of hemoglobin A1C, or A1C for short. A1C reflects the percent amount of hemoglobin in the blood that glucose has attached to. A level less than 5.7 is considered normal; a level of 5.7 to 6.4 is considered pre-diabetic; and levels over 6.4 is consider diabetes.
The treatment for Type 2 diabetes involves diet control, weight loss, medications and insulin. In some patients diet and exercise are all that is needed keep blood glucose in a normal range. If these measures fail, then medication, oral hypo-glycemics, are useful to help lower blood glucose. Insulin is often added if these earlier measures fail.
Type 2 diabetics are at risk for diabetic complications especially if they have other medical problems such as high blood pressure and heart disease. These complications can include kidney disease, eye disease, stroke, blood vessel disease and worsening heart disease.
With modern treatment, diabetes is less the scare that it used to be, especially if diagnosed early and effectively treated. Many patients with diabetes can lead healthy and productive lives and can avoid some of known long-term complications if the proper steps are taken.
Dr. Dwight S. Tyndall, FAAOS, is spine surgeon practicing in the Region. His column covers a wide range of health and medical issues.
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