We now turn to the common problems of metabolism that can often be treated, controlled, or prevented in a home setting. Knowledge of sugar diabetes is important, because of its high prevalence. This disease has been recognized from antiquity. Both Greek and Chinese writings have mentioned it; and in the sixteenth century Paracelsus initiated the study of the chemistry of diabetic urine. The word mellitus, introduced by Thomas Willis one hundred years later, describes the sweetness of the diabetic urine, “as if imbued with honey.” This rapidly led to a dietary approach to this disease, until finally Langerhans, a medical student, in 1869 described the islets in the pancreas where the basic production of insulin occurs. Two Canadians, Banting and Best, finally prepared the extract from dog pancreas that was capable of reducing the elevated blood glucose level. A fascinating long history of discoveries marks the approaches to understanding and treating this common disorder.
It is estimated that there are about 200 million diabetics in the world and approximately 4.2 million in the United States. This disease is more frequent in older people. Hence, as the population grows and becomes older, diabetes will continue to increase. With treatment, the life expectancy of the diabetic is increasing, and since inheritance is an important factor, the more diabetics that have children, the greater will be the prevalence of this disease, Obesity is also on the rise and appears to precipitate diabetes among those predisposed to it.
Next to obesity and thyroid disorders, diabetes is the third most common problem in metabolism. Interrelated are the metabolic or hormone, and vascular or long-termed components of this disease. The latter consist of an accelerated arteriosclerosis that leads to premature aging and particularly affects the eyes and the kidneys. Gangrene of the foot, arteriosclerotic heart disease, blindness, and kidney failure (uremia) are the most frequent manifestations of the vascular syndrome. Statistically, the diabetic is faced, not only with a decreased life expectancy, but also with the eventual possibility of disabling complications.
The early detection of diabetes first involves a high index of suspicion. This disease is two and half times more frequent in relatives of known diabetics. Furthermore, 85% of diabetic patients were or are overweight. Four out of five diabetics are over 45 years of age. Mothers who deliver large babies have a high potential for the development of diabetes.The simplest screening test for this disorder is a urinalysis for sugar.
Measurement of the blood sugar (glucose) level in the fasting patient should also be encouraged as a screening tool. The five-hour Glucose Tolerance Test is less commonly performed for diabetes, but is usually used to diagnose and evaluate hypoglycemia. Pathologic changes occur with the passage of time in diabetes, and seem accelerated by failure to control this disease. The
islets of Langerhans in the pancreas typically deteriorate, resulting in the lack of insulin production. Atherosclerosis occurs earlier in a diabetic patient, often leading to coronary artery disease and stroke as the most frequent cause of death. These also occur from the lack of insulin production. The eyes show changes after 10 to 1 5 years of diabetes. Small retinal hemorrhages, dilated sacs in the weakened blood vessel (aneurysms), and waxy patches (exudates) develop.
Later a dangerous type of new blood vessel forms, then further hemorrhages and gradual or sudden loss of vision. Although marvelous advances in the diagnosis and treatment of these visual complications have been made, diabetic eye disease remains the second most frequent cause of blindness in the United States. Increased tendencies toward cataract formation also occur. In the kidney, characteristic damage to the filtering unit (glomerulus) progresses to destroy renal function. Infections of the kidney and urinary tract are common, and many patients go on to develop high blood pressure, serious loss of protein, and later kidney failure.
The symptoms of diabetes, as mentioned above, are multiple. Increased fatigability and weakness is common. The diagnosis is frequently suggested by history of increased thirst (polydipsia), increased urination (polyuria), and excessive hunger (polyphagia) in association with weight loss. Long standing disease is reflected in the pathologic changes mentioned above.
Two typical types of diabetes mellitus are seen. The juvenile onset type is characterized by a rapid onset, with instable diabetes, associated with loss of weight and strength, irritability, and the three “polys” mentioned above.
Insulin therapy is mandatory in this type of patient and long-term medical counseling is needed. The second type of diabetes is termed maturity onset. Frequently symptoms are minimal or absent at first. Weight loss or weight gain may be present. These may be increased tendency to urinary infections or Vaginitis. Blurred or decreased vision, anemia, loss of sensation, or other neurologic problems may send the patient to the physician. Since many patients are obese, the reduction of weight associated with a careful diet can bring a return of health to most people who will cooperate with simple health principles.
The treatment of diabetes involves several basic principles. Doctors aim to correct the underlying metabolic abnormalities and thereby reduce diabetic symptoms.
It is estimated that there are about 200 million diabetics in the world and approximately 4.2 million in the United States. This disease is more frequent in older people. Hence, as the population grows and becomes older, diabetes will continue to increase. With treatment, the life expectancy of the diabetic is increasing, and since inheritance is an important factor, the more diabetics that have children, the greater will be the prevalence of this disease, Obesity is also on the rise and appears to precipitate diabetes among those predisposed to it.
Next to obesity and thyroid disorders, diabetes is the third most common problem in metabolism. Interrelated are the metabolic or hormone, and vascular or long-termed components of this disease. The latter consist of an accelerated arteriosclerosis that leads to premature aging and particularly affects the eyes and the kidneys. Gangrene of the foot, arteriosclerotic heart disease, blindness, and kidney failure (uremia) are the most frequent manifestations of the vascular syndrome. Statistically, the diabetic is faced, not only with a decreased life expectancy, but also with the eventual possibility of disabling complications.
The early detection of diabetes first involves a high index of suspicion. This disease is two and half times more frequent in relatives of known diabetics. Furthermore, 85% of diabetic patients were or are overweight. Four out of five diabetics are over 45 years of age. Mothers who deliver large babies have a high potential for the development of diabetes.The simplest screening test for this disorder is a urinalysis for sugar.
Measurement of the blood sugar (glucose) level in the fasting patient should also be encouraged as a screening tool. The five-hour Glucose Tolerance Test is less commonly performed for diabetes, but is usually used to diagnose and evaluate hypoglycemia. Pathologic changes occur with the passage of time in diabetes, and seem accelerated by failure to control this disease. The
islets of Langerhans in the pancreas typically deteriorate, resulting in the lack of insulin production. Atherosclerosis occurs earlier in a diabetic patient, often leading to coronary artery disease and stroke as the most frequent cause of death. These also occur from the lack of insulin production. The eyes show changes after 10 to 1 5 years of diabetes. Small retinal hemorrhages, dilated sacs in the weakened blood vessel (aneurysms), and waxy patches (exudates) develop.
Later a dangerous type of new blood vessel forms, then further hemorrhages and gradual or sudden loss of vision. Although marvelous advances in the diagnosis and treatment of these visual complications have been made, diabetic eye disease remains the second most frequent cause of blindness in the United States. Increased tendencies toward cataract formation also occur. In the kidney, characteristic damage to the filtering unit (glomerulus) progresses to destroy renal function. Infections of the kidney and urinary tract are common, and many patients go on to develop high blood pressure, serious loss of protein, and later kidney failure.
The symptoms of diabetes, as mentioned above, are multiple. Increased fatigability and weakness is common. The diagnosis is frequently suggested by history of increased thirst (polydipsia), increased urination (polyuria), and excessive hunger (polyphagia) in association with weight loss. Long standing disease is reflected in the pathologic changes mentioned above.
Two typical types of diabetes mellitus are seen. The juvenile onset type is characterized by a rapid onset, with instable diabetes, associated with loss of weight and strength, irritability, and the three “polys” mentioned above.
Insulin therapy is mandatory in this type of patient and long-term medical counseling is needed. The second type of diabetes is termed maturity onset. Frequently symptoms are minimal or absent at first. Weight loss or weight gain may be present. These may be increased tendency to urinary infections or Vaginitis. Blurred or decreased vision, anemia, loss of sensation, or other neurologic problems may send the patient to the physician. Since many patients are obese, the reduction of weight associated with a careful diet can bring a return of health to most people who will cooperate with simple health principles.
The treatment of diabetes involves several basic principles. Doctors aim to correct the underlying metabolic abnormalities and thereby reduce diabetic symptoms.
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