Type 1 diabetes
Diabetic treatment at the time of diagnosis is somewhat different than ongoing treatment. Type 1 diabetics are sometimes diagnosed when symptoms are acute, with very high blood glucose levels, electrolytes out of balance, and in a state of diabetic ketoacidosis with some degree of renal failure. In a worst case scenario, they may have become unconscious and comatose. This is a life-threatening condition requiring immediate hospitalization and expert care to get the body back to its normal balance.
Ongoing treatment of type 1 diabetes revolves around daily glucose monitoring and control, eating a healthy planned diet, and exercising regularly. Regular exercise lowers blood glucose, increases the body's sensitivity to insulin, and increases circulation. It is important to work closely with the doctor and a diabetes educator, to have regular check-ups (several times a year) that include monitoring tests such as microalbumin and A1c, and to get immediate attention for complications. These may include:
- Wound infections, especially on the feet; they can be slow to heal and, if not addressed promptly, may eventually lead to an amputation. Aggressive and specialized measures are often necessary, and the affected person may need to consult with a diabetic wound specialist, a doctor trained in working with the altered healing of diabetics.
- Diabetic retinopathy, which can lead to eye damage, a detached retina, and blindness; laser surgery can often be used to reattach the retina.
- Urinary tract infections, which can be frequent and resistant to antibiotic treatment; delayed or inadequate treatment can lead to or exacerbate kidney damage.
Type 1 diabetics must self-check their glucose levels and inject themselves with insulin several times a day. As an alternative, a number of type 1 diabetics have turned to wearing insulin pumps, programmable devices that are carried at the waist and provide small amounts of insulin (through a needle under the skin) throughout the day to more closely match normal insulin secretion The amount and type of insulin administered must be adjusted to take into account what the patient is eating, the size of their meals, and the amount of activity they are getting. There are several types of insulin available; some are fast-acting and short-lived while others take longer to act but have a longer duration.
Most type 1 diabetics use a combination of insulins to meet their needs, and maintaining control can sometimes be a challenge. Stress, illnesses, and infections can alter the amount of insulin necessary, and some type 1 diabetics have "brittle" control - their glucose levels make rapid swings during the day. As another complicating factor, type 1 diabetics may develop antibodies to insulin over time; their body begins to identify the injections as an "intruder" and works to destroy the insulin, resulting in the necessity of higher doses of insulin or of switching to a different kind.
Type 1 diabetics may also "overshoot," running into trouble with low glucose levels if they inject too much insulin, go extended periods of time without eating, or if their needs change unexpectedly. They must carry glucose with them, in the form of tablets or candy, and be ready to take some at the first signs of low blood sugar (hypoglycemia). Carrying glucagon injections (which stimulate the liver to release glucose) is also recommended for times when a person's hypoglycemia is not responding to oral glucose or for someone else to give them if the person has become unconscious. Acute conditions, such as diabetic ketoacidosis or kidney failure, may require hospitalization to resolve.
Type 2 diabetes
While there is no way to prevent type 1 diabetes, the risk of having type 2 diabetes can be greatly decreased by losing excess weight, exercising, and eating a healthy diet with limited fat intake. By identifying pre-diabetic conditions and making the necessary lifestyle changes to lower glucose levels to normal levels, it may be possible to prevent type 2 diabetes or delay its onset by several years. Normalizing blood glucose can also minimize or prevent vascular and kidney damage.
Type 2 diabetics usually self-check their glucose one or more times a day. Type 2 diabetics are on a continuum, ranging from those who can control their glucose levels with diet and exercise, to those who can take oral medications, to those who need to take daily insulin injections. Many will move along the continuum as their disease progresses. The oral medications available fall into three classes: those that stimulate the pancreas to produce more insulin, those that help make the body more sensitive to the insulin it is producing, and those that slow the absorption of carbohydrates in the stomach (slowing down the post-meal increase in blood glucose). Type 2 diabetics often take two or more of these medications and/or insulin injections - whatever it takes to achieve glucose control.
Type 2 diabetics may occasionally encounter serious complications if they have ignored initial symptoms, if they have neglected their ongoing treatment, or if they have a serious stress to their system such as a heart attack or stroke or a severe infection. Very high blood glucose levels and dehydration reinforce each other, leading to weakness, confusion, and in some cases to convulsions and coma. This is also a serious condition requiring immediate hospitalization.
With gestational diabetes, the mother-to-be will need to eat a modified diet, get regular exercise, and monitor glucose levels as often as her doctor suggests. If more control is needed, she will be given insulin injections (at this time, oral medications are not used). Usually, the diabetic state subsides after birth, although the woman remains at a higher risk of becoming a type 2 diabetic and she should be carefully monitored with any subsequent pregnancies. Right after birth, her baby will be monitored for signs of hypoglycemia and for any respiratory distress.