Health Guide

Nice Guidelines for Diabetes

Other names :
Diabetes mellitus, sugar diabetes.


Introduction :
An inability of the body to process sugar effectively.


Discovery :
The effects of insulin were discovered in 1921 by Canadian Dr. Frederick Banting and his medical student assistant Charles Best, after experimenting on dogs.


Types :
There are two totally different types of sugar diabetes - juvenile (type one) and mature (type two). Most people who develop juvenile diabetes which requires daily insulin injections, do so as a child or in early adult life. They must use the injections for the rest of their lives, as we do not have a cure for diabetes, only an effective form of control. Older people who develop maturity onset diabetes can often have the disease controlled by diet and tablets (see Medication Table). This is because there is not a lack of insulin, but a lack of response by the cells to the insulin. The tablets make the cell membrane respond to insulin again.


Cause :
Glucose, a type of sugar, is essential for the efficient working of every cell in the body. It is burned chemically to produce the energy for the cell to operate, and is found in most fruit and vegetables. When glucose is eaten, it is absorbed into the bloodstream from the small intestine. It then travels to all the body's microscopic cells through the arteries and capillaries. Once glucose reaches a cell, it must enter across the fine membrane that forms its outer skin. This skin is normally impermeable to all substances, but insulin has the ability to combine with glucose and transport it from the bloodstream, through the cell membrane and into the interior of the cell where it can be used as an energy source for that cell. Insulin is a chemical of very great complexity. It is made in the pancreas, which sits in the abdomen below the stomach. The insulin it produces enters the bloodstream, and is attracted to those cells that are running short of energy and require more glucose. If there is no glucose available because you have not been eating, or because the glucose cannot enter the cell, the cell weakens and eventually stops working altogether. People who lack the insulin necessary to take the glucose into the cells have type one (juvenile) diabetes, and if the insulin is not supplied, they become steadily weaker because their muscles and other organs cannot work properly. There may be very high levels of glucose in their blood stream, but because it cannot enter the cells, it cannot help them. These diabetics therefore require regular supplements of insulin to keep them well. Insulin from pigs and cattle has been available for many decades, and in the last few years, human insulin has been produced by genetic engineering techniques to enable diabetics to lead relatively normal lives. The only problem with insulin is that it cannot be taken by mouth as it is destroyed by acid in the stomach. It must be given by injection two or more times a day. This way insulin enters the blood stream directly and can start transporting the necessary glucose into the cells immediately.


Incidence :
90% of diabetics have the maturity onset (type two) form of the disease. There is an hereditary tendency to developing this type of diabetes, but there is no inheritance in type one diabetes.


Preventio Guideline :
If there is a family history of type two diabetes, patients should ensure that they remain within normal weight limits, and so delay or prevent the onset of the disease.


Investigations :
If you suspect that you may have diabetes, your doctor can perform a simple test on your blood or urine to determine the diagnosis within minutes. More sophisticated blood tests can be undertaken to measure the severity of diabetes, its type and even give a three month average for the blood sugar levels.


Screening :
Urine tests can be simply and cheaply undertaken to detect most cases of diabetes, but wide scale screening is not routine in the community.


Course :
The early symptoms of diabetes are excessive tiredness, thirst, excess passing of urine, weight loss, itchy rashes, pins and needles and blurred vision.


Treatment :
Juvenile diabetes is controlled by regular injections of insulin. Different types of insulin with varying periods of effect are available. Maturity onset diabetics must follow a strict diet and sometimes take medication (see Medication Table) on regular basis every day to control their blood sugar levels. The earlier diabetes is controlled, the better the outcome for the patient, as side effects and body damage are less likely.


Diet :
Diet is essential for all diabetics, because the amount of glucose you eat is not normally constant, and diabetics lack the means of adjusting the amount of glucose in their blood with insulin. As the insulin injections remain at a constant strength, the glucose intake must also remain constant. A diabetic diet has minimal sugar, and is low in fat and cholesterol. Regular, equal sized meals are better than occasional meals off varying size. Fat cells can react abnormally to insulin very easily, and so overweight diabetics must lose weight and remain within certain strict limits. Dietitians can assist diabetics with guidelines on an appropriate diet.


Complications :
Poorly controlled diabetes can cause eye cataracts and visual damage, glaucoma, kidney disease and failure, poor circulation to the feet with ulceration and gangrene, damage to nerves, impotence and an increased risk of all types of infection.


Outcome :
Prior to the isolation of insulin, diabetics died within a few months or years of diagnosis, but today, provided a diabetic is careful in managing their disease, patients can lead a normal length and healthy life.


Further information:
Diabetes Australia is a major charity that is represented in all major towns and cities. It offers education, supplies, support and services for diabetics.


Medical curiosity :
Diabetes has been recognised as a disease for over three thousand years. In ancient Egypt, and up to relatively recent times, diabetes was diagnosed by the physician sipping the patient’s urine and noting its sweet taste. Fortunately for doctors as well as patients, more sophisticated diagnostic tests are now available

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