Help me understand diabetes

Daytonite, BSN, RN · Nov 18, 2005

Do you have a pathophysiology textbook? You need to begin by reviewing what the pancreas does and how insulin works in the body. Then ask "what happens when the insulin isn't produced?" "What happens when insulin is over-produced, but isn't having much of an affect on the serum blood sugar?" The answers to those two questions will set you on a path toward understanding the difference between Type I and Type II Diabetes.

Always ask yourself "why?" Under what circumstances does a diabetic taking insulin get hypoglycemic? Under what circumstances does a diabetic get hyperglycemia?

Diabetes is a kind of complicated subject, but you need to have a thorough understanding of it because you will have a great many patients that will be diabetic and it affects their illnesses. Try looking up the answers to the questions I posed, then if you have more questions list them here. I am a diabetic and I could easily give you these answers, but I want you to take the time to find them on your own. I have a copy of Diabetes for Dummies around my house for reference. It explains so much about this disease is nice, easy language. I have a cat with diabetes also who is on insulin. She's really good at giving herself her shots. :chuckle She even steals my glucometer to check her blood sugar, the little scamp!

RNin2007 · Nov 18, 2005

Really, wow...how does your cat fare having diabetes? Do you have to check her blood sugar and administer insulin as often as you would for yourself? I have never known anyone with a diabetic pet. Just curious!

~J

Daytonite, BSN, RN · Nov 18, 2005

The cat was drinking water by the gallons, peeing up a storm and went from a butterball down to a still fat, but skinnier version of herself. I didn't notice it all at first because I have two other cats. The vet did a general chem panel on her when I took her in for her yearly shots and her blood sugar was 600! She is currently on 2 units of NPH insulin twice a day. It's very easy to inject. I just pull up a hunk of skin and hair behind her front elbows, spread the hair aside and inject just like in a human. I rotate sites and try to inject in places closer to her stomach for better absorption. She doesn't even flinch anymore and accepts this. I check her blood sugar by pricking her ear and getting a drop of blood just like you would for a human. It doesn't even seem to hurt her. I have to get a written prescription for syringes and insulin from the vet each time I need a refill and I get a kick out of watching the pharmacist's faces when they ask me her date of birth (who knows? she came to me as a hobo cat) or question me about her name. She's doing very well. I have a bottle of clear Karo syrup on hand in case of a hypoglycemic emergency, but that hasn't happened. She eats pretty good. I keep kibble available at all times that is a special formulation for diabetic cats from Purina and feed her Fancy Feast twice a day. At first I was giving her meat (high protein, no carb) because I was so concerned about carbohydrate content of her food, but the vet told me that while that would keep her blood sugar down, it lacked the vitamins and minerals she needed that is contained in canned and dry food. Cats, apparently, do not get the same complications that humans with diabetes do. They do get some changes in the lens of their eye, not the retina, a bit of neuropathy in their extremities (although it's really hard to tell), and heart disease over time. They can also get kidney disease. However, they don't get the compromised circulation in their extremities, stasis ulcers, or gangene. I've wondered if that is because of their relatively short life span because the lifespan of cats is about 15 plus or minus years or so and so many of the diabetic complications often take years and years to develop. It's very interesting and I try to find information on this. Purina's web site has a whole group of web pages on feline diabetes if you're interested.

This reminds me of a link to a very entertaining poem about a diabetic dog you might like. It spotlights one of the symptoms of diabetes, frequent urination. Turn your speakers on to hear the music.

http://www.user.shentel.net/nbaker/Laffs/limerick.htm

FirstYear2005 · Nov 18, 2005

Thanks for the advice. I am doing some searches and helping myself undestand.

let me ask this : WHY are carbs such a big part of the diet when carbs are basically sugar, and the person already has high blood sugar ????

Sorry about your cat LOL I have eight myself.

FirstYear2005 · Nov 18, 2005

Thanks for the advice. I am doing some searches and helping myself undestand.

let me ask this : WHY are carbs such a big part of the diet when carbs are basically sugar, and the person already has high blood sugar ????

Sorry about your cat LOL I have eight myself.

Daytonite, BSN, RN · Nov 18, 2005

Eight cats! Wow! My three take up the whole bed (they all stretch out full length and there's no room for me unless I turn into a pretzel!)

Anyway, carbs can be measured by their glycemic index. This has to do with how readily and how fast they release their sugar content when they enter the GI system. You've heard of "free" vegetables, haven't you? Very popular on diet programs. These are veggies like lettuce, broccoli, cabbage, cucumbers and there is a slew of others. When they get into the system they give very little carbohydrate so dieters and diabetics can eat pretty much as much as them as they want because they have practically no usable calories. Their blood sugar will stay down at normal levels. Other high carbs like corn, pinto beans, pasta and breads made with processed flours, and those all time favorites like candy, cake, cookies and ice cream drop their load of sugar on the person's system very fast causing a noticeable rise in blood sugar. A person with a normally functioning pancreas will merely cope with it by releasing more insulin and processing the glucose. However, a diabetic, depending on how compromised their pancreas and insulin producing ability is, will not. To give you an idea of how this works, when I eat low carb fresh veggies and fruits and NO processed foods my blood sugar will stay in nice control around 90 to 120 and never get any higher and I am on glucophage, an oral medication. However, if I get into cookies or candy my blood sugar shoots up and stays up there for awhile. I've experimented with this a little and found my blood sugar stayed at 160 for almost 5 hours after eating a dish of ice cream once. That's way too long and reveals the crappy quality of insulin my pancreas produces.

You have to have carbs to live. The brain requires a certain amount of carbohydrate to function and it has carbohydrate priority over all the other organs of the body. You can live on a very low carbohydrate diet, but you need other nutrients too. If you go on a high protein diet, which would be the ideal for a diabetic, you run the risk of putting your kidneys into failure. Go high fat and you run the risk of clogging up your arteries. If you don't give your body enough calories to function you will self-digest (your body will rob your organ tissues for the necessary fat and protein. Guess what the brain is mostly made of.) Look at anorexics on their last legs of life for examples of what happens when you don't put enough nutrition into the body.

So, what to do? Most of the experts say maintain a balance of all three. I've read a lot on diabetes to help me understand this whole thing because it is very, very complex. The research is pointing to a low carbohydrate diet with NO processed foods. Processed foods are thought to be the problem. The way my doctor explains it to me, anything from nature that has been tampered with by a machine or gadget is a processed food. So, that includes pretty much everything except fresh fruit and vegetables and fresh meats and fish--natural, untampered with foods. Sausage, lunchmeat and cheese, for example are considered processed food. Get this. . .so is canned food! So is pasta, white rice, white bread, potato chips, etc. I've noticed that Weight Watchers new Core program has gone to this approach. I'm not surprised since their diet has always been based on the traditional 1200 calorie ADA (American Diabetic Association) diet. I found a lot of information I could understand about this low glycemic index stuff on the Zone Perfect web site, the official web site of the Zone diet. In fact, my doctor told me to print out the Zone Food Blocks Lists of favorable carbohydrates, proteins and fat and stick with those foods only. Here is the link to that information in case you are interested. http://www.zoneperfect.com/site/content/miniblocks.asp

Hope this hasn't confused you more. I find it is an absolutely fascinating subject.

TheCommuter, BSN, RN · Nov 18, 2005

We are studying diabetes now. I guess I don't understand where the HYPOGLYCEMIA comes in , if diabetes is mostly hyperglycemia ?? Why are there such extremes in blood sugar ?
Any help would be appreciated ! Thanks !

I guess I have the misfortune of knowing about this disease; after all, I have plenty of diabetics in the family, including my mom, dad, all 4 grandparents, several aunts, and a few cousins.

If diabetes is mostly about hyperglycemia, then how would a diabetic occasionally become hypoglycemic? Think about all of the actions that may cause the blood glucose to drop below acceptable levels. These include vigorous exercise without replenishing the carbs, administering too much insulin or oral antidiabetic pills, skipping breakfast, eating too infrequently, and drinking alcohol-containing beverages.

Even though the typical diabetic has 'too much glucose' without enough of it entering the cells, always remember that glucose is the body's main source of energy. The brain cannot function without glucose, so much of the signs and symptoms of profound hypoglycemia are related to the lack of glucose being metabolized by the brain since the blood glucose is too low.