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Diabetes Mellitus

istock_000003325499xsmallDiabetes mellitus is a hereditary or developmental disease marked by a disorder of carbohydrate metabolism caused by abnormal insulin levels.

Insulin is an essential hormone secreted by the pancreas, which is critical for the metabolism of glucose. Insulin also functions to convert glucose to glycogen (for storage in the liver and skeletal muscle), and to efficiently transfer glucose from the blood to skeletal and cardiac muscle.

Clinically, diabetes mellitus is classified into two main types: insulin dependent diabetes mellitus (also known as Type I, or juvenile diabetes) and non-insulin dependent diabetes mellitus (also known as Type II, or adult-onset diabetes). Type I diabetes is usually regulated by the daily use of insulin. The onset of Type I diabetes is quite sudden, most commonly effecting individuals under the age of 30 years. Type II diabetes; on the other hand, is usually regulated by diet and exercise alone, or by the aid of oral hypoglycemics (which lower blood glucose levels). The onset of Type II diabetes is usually much slower than Type I. Type II diabetes is usually found in obese individuals over 40 years of age. The three factors that stabilize diabetes are diet, exercise, and hypoglycemic agents such as insulin or oral hypoglycemics. In the well-controlled diabetic these factors are all in equilibrium. Since athletics lowers blood sugar, however, any increase in exercise must be compensated for by increasing food intake or lowering the amount of hypoglycemic agent administered. If these adjustments are not made, hypoglycemia (abnormally low blood sugar caused by excessive insulin, too little food, or increase in activity), or hyperglycemia (abnormally high blood sugar caused by severe infections, dietary indiscretions, decreased activity, or failure to take insulin) will develop.

Symptoms

The symptoms of hypoglycemia (also referred to as insulin shock) are variable and nonspecific. They include: pail and moist skin, glossy eyes, irritibility, hunger, apprehension, confusion, nausea, “drunken” appearance, and numbness. The symptoms of hyperglycemia (also referred to as diabetic comma) may develop slowly over several days. The two most critical symptoms of hypoglycemia are ketoacidosis and polyuria. Ketoacidosis (excessive acidity of body fluids due to ketone build-up) is caused by the body metabolizing fats instead of glucose, due to the lack of insulin. The results of fat metabolism are ketone bodies that alter the body’s normal pH. The respiratory system tries to eliminate the excessive ketones, which gives the patients breath a characteristic fruity odor. Polyuria (excretion of excessive urine) tries to eliminate glucose build-up via frequent urination. When glucose is excreted, however, large amounts of water are also lost with it (making the patient very thirsty). The resulting dehydration coupled with ketoacidosis, depresses the nervous system, and causes confusion or lapse into a coma. A summary of the symptoms of hyperglycemia are: labored breathing, fruity smelling breath, nausea or vomiting, thirst, dry and red skin, positive urine test for sugar, dry mucous linings of the mouth, and mental confusion or unconsciousness followed by coma.

Management/Treatment

Proper management of diabetes mellitus consists of maintaining a steady balance between diet, exercise, and insulin. Blood glucose monitoring devices that analyze blood sugar levels from finger punctures should be used by every person to adjust insulin levels to address the glucose fluctuations resulting from exercise. The best form of treatment for hypoglycemia is prevention. To avoid this problem the diabetic athlete should have a pre-exercise snack consisting of complex carbohydrates and protein. Regular sugar intake should continue every 30 minutes during exercise. If symptoms of hypoglycemia appear, the person should be given sugar in the forms of: orange juice, candy bars, fruit, or commercial glucose tablets/gels. The person should also be treated for shock, but prompt recovery should follow sugar administration. Unconscious persons suspected of hypoglycemia should never be given anything orally, but transported immediately to a medical facility. Treatment of hyperglycemia consits of fluid replacement, treatment for shock, and the administration of insulin with physician advisement. If you are uncertin as to which condition a diabetic person may be suffering, all stuporous or lethargic people should be treated for hypoglycemia. The amount of sugar given could be lifesaving to the hypoglycemic person, while unlikely to cause additional harm to the hyperglycemic. Therefore, sugar should be given as an emergency measure to the diabetic person, followed by prompt transport to the hospital if recovery is not immediately apparent.

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