Endocrinology

Grave’s Disease

What is Grave’s Disease?

Grave’s disease is an autoimmune disease. It most commonly affects the thyroid gland which is a small gland, shaped like a butterfly, located in front of the neck below the larynx (the voice box). The gland is responsible for producing and secreting the thyroid hormones, T3 and T4. In addition, it also controls the use of energy by the body.

The thyroid hormone levels are monitored by the pituitary gland located in the brain. The pituitary produces the thyroid stimulating hormone, TSH, which stimulates the thyroid gland to make its hormones. When a patient suffers from Grave’s disease, his or her immune system produce antibodies which mimic the function of TSH. This results in the over-production of the thyroid hormones than what is required by the body. Thus, this state is termed as hyperthyroidism or overactive thyroid. As a result of hyperthyroidism, the main functions of the body like the heart rate and metabolism rate are all speeded up. Grave’s disease is an example of hyperthyroidism which is quite similar to Hashimoto’s disease (another autoimmune disease that affect the thyroid glands).

  • Symptoms of Grave’s Disease
  • Incidence of Graves’s Disease
  • Causes of Grave’s Disease
  •  Diagnosing Grave’s Disease
  •  Treatment for Grave’s Disease 
  •  Thyroid Disease and Pregnancy
  • Conclusion

Symptoms of Grave’s Disease

Many sufferers of Grave’s disease show symptoms related to hyperthyroidism, like:

  • Enlarged thyroid or Goitre
  • Sleeping problems
  • Irritability or uneasiness
  •  Increased sensitivity to heat
  • An increase in perspiration
  • Hand tremors
  • Increased heart rate
  • Thinning of hair and skin
  • Frequent bowel movements or diarrhoea
  • Weight loss
  • Fatigue
  • Changes in the menstrual cycle.
  • Pregnancy problems

 

Grave’s Disease can also affect other parts of the body. A feature that is not likely to happen in other  hyperthyroidism conditions. Grave’s Disease can affect:

  • EYES- some sufferers of Grave’s disease have had inflamed tissue behind the eyes which cause swelling. This generally results in ‘bulging’ in one or both the eyes which have the tendency to affect one’s vision too. The eye symptoms can occur before or along with or after the occurrence of Grave’s disease. This state hardly ever occurs with thyroid glands which have normal function. The exact reason for the eye conditions are yet not known. It seems to show up and are more common in smokers where smoking can make the condition worse. In addition, the eye problems have the tendency to get better without treatment. 
  • THICK, RED SKIN usually on the shins or top of the feet- this skin condition is rare and not severe. It is said to be painless and that most sufferers with the skin condition also have the eye condition associated with Grave’s disease.

The progression of the symptoms of Grave’s disease can occur gradually or immediately. The symptoms are often confused with other health conditions as a number of other medical conditions can cause the signs and symptoms which are associated with Grave’s disease. Importantly, some sufferers show no symptoms at all.

USG1001-Graves-T1

Incidence of Graves’s Disease

Although, men and women have chances of acquiring the disease, women are said to be 10 times more affected by Grave’s disease than men. The disease can occur in anyone regardless of one’s age,  but it is shown that the condition starts most often in people in their 20s and 30s. Patients who have been diagnosed with Grave’s disease often have family members suffering from  other autoimmune or thyroid conditions. Some patients have also shown to have other autoimmune diseases like: Vitiligo, Rheumatoid arthritis, Addison’s disease, Type 1 diabetes, Pernicious, Lupus, etc.

Causes of Grave’s Disease

Scientists have found many factors that could contribute to Grave’s disease, some of them being:

  • Genetics- plays an important role as some people are more prone to the disease than others. Research is currently being undertaken to find out the exact gene/genes which play a role.
  • Gender- sex hormones are said to be involved as statistics show that women are more affected than men.
  • Stress- Severe anxiety or emotions stress can launch the disease in people who are vulnerable.
  • Pregnancy-the thyroid glands are said to be affected during pregnancy.
  • Infection- even though no studies have shown any direct link between infection and Grave’s disease, infection is thought to play a part.

 Diagnosing Grave’s Disease

A medical doctor will assess your symptoms. He or she will require a physical exam and one or a number of tests to find out if you have Grave’s disease. Some of these tests are as follows:

  • Thyroid Function Test- A blood sample is withdrawn and sent to the diagnostic laboratory to check for normal levels of thyroid hormone (T4) and TSH. Hyperthyroidism will be depicted by low levels of TSH and high levels of T4 in the blood. Occasionally, routine screening for thyroid defects may show mild hyperthyroidism or an overactive thyroid without any symptoms that relate to Grave’s disease. In this case, medical doctors may put forward a treatment plan to follow or ‘watchful waiting’ to see if the levels go back to normal. 
  • Radioactive Iodine Uptake (RAIU)- this test will inform the doctor how much iodine the thyroid gland takes in. The iodine is used in the production of the thyroid hormone. An uptake which is higher than normal will indicate Grave’s disease. Thus, this test helps to differentiate Grave’s disease from other overactive thyroid conditions.
  • Antibody Tests- A blood sample is obtained to check for certain antibodies that relate to Grave’s disease.

Diagnosing Grave’s disease in a pregnant woman is quite complex. This is because most of the symptoms associated with Grave’s disease show up in a normal pregnancy too. For example, heat sensitivity and fatigue are symptoms that arise both in Grave’s disease and pregnancy. Furthermore, health care professionals make the use of the RAIU test to eliminate other causes during pregnancy.

 Treatment for Grave’s Disease 

Three main types of treatments are available for Grave’s Disease, they are:

  • Drugs

Antithyroid medicine- in the United States two types are used.
Methimazole or MMI
Propylthiouracil or PTU

The drugs inhibit the over production of the thyroid hormone in the thyroid glands. MMIs are usually prescribed and preferred for non-pregnant people. In addition, they are not used for more than 1- 2 years. In some patients, the thyroid gland starts functioning normally, producing normal levels of thyroid hormone, after the drugs are stopped. But in most cases, this is not so.

  • Radioactive Iodine (RAI)- As previously mentioned, the thyroid gland required iodine to make the thyroid hormone. The RAI treatment involves orally taking a pill that contains radioactive iodine (RAI) which will work towards damaging the thyroid gland through radiation. Therefore, when thyroid cells are damaged or destroyed, less hormones will be produced, curing the condition. Having said that, the patient might require to take thyroid hormone to compensate for the necessary hormones the body requires, which it no longer can produce. Most importantly, RAIs have been used for a long time where side effects like infertility or birth defects does not occur.
  • Surgery- this results in the removal of the thyroid. This procedure too cures the overactive thyroid and requires one to take the hormone to compensate for the ones your body cannot produce.

In addition to these three types of treatments, there is another type of drug called the beta blocker. This do not affect the production of the thyroid hormone. They function to block or inhibit the thyroid hormone action on the body. As a result, the heart rate, tremor and anxiety are all reduced. Beta blockers act quickly once in the body and can make one feel better until the main treatment is received.

The best available treatment for a patient is dependant on many factors. Generally,  antithyroid drugs and RAI, or a combination of both, are the  preferred treatments. Monitoring the hormone levels during and after treatment is crucial. Thus, your doctor will monitor them vigilantly and will ask you to come for follow-up visits.

Complications that arise if not treated

When Grave’s disease go untreated there is a chance that it could result in heart problems, fragile bones and even death. Thyroid Storm is a very rare and life threatening condition that arise when overactive thyroid is left untreated. Acute stress (trauma, surgery, or infection) triggers the condition. In a pregnant woman,who hasn’t received the appropriate treatment for Grave’s disease, the disease can endanger the life of the mother and the baby.

 

Video of Grave´s disease


 

 Thyroid Disease and Pregnancy

During pregnancy, the normal hormonal changes that occur alters the levels of thyroid hormones. The thyroid hormone level increases and the gland may enlarge a little in healthy pregnant women. On an important note, these alterations does not affect the baby or the pregnancy in general. But, an overactive thyroid that is left untreated can complicate the pregnancy. Fatigue and feeling hot are normal symptoms of pregnancy which arise in hyperthyroidism too, making it difficult to differentiate the two. Thus, it is crucial for a pregnant woman to report to her doctor when she notices symptoms related to an overactive thyroid or goitre.

Specialists in the related field have still not come to an agreement if a screening test for thyroid problems during pregnancy is required. Grave’s disease does not start during pregnancy, even if it does it is very rare. Pregnant women who were diagnosed with Grave’s disease generally had symptoms related to the disease even before getting pregnant.

Guidelines for those who have Grave’s disease and want to become pregnant

Women who are suffering from Grave’s disease can get pregnant, given that they have been treated for the disease. Importantly, the pregnancy should be pre planned and the disease controlled well before getting pregnant as untreated or inadequately treated Grave’s disease can lead to complications for the mother, like:

  • Preeclampsia
  • Premature or Preterm birth
  • Miscarriage
  • Heart failures
  • Placental abruption

The health related problems that may arise in the baby  due to untreated or inadequately treated Grave’s disease include:

  • Preterm birth
  • Thyroid problems
  • Low birth weight
  • Stillbirth

Thus, those who have been diagnosed with Grave’s disease should talk to a doctor and learn how to go about the pregnancy and the one’s who do not want to get pregnant should talk to a doctor about birth control. If antithyroid drugs have been prescribed for you, you should consult your doctor about RAI if you want to get pregnant. Statistics have shown that women who underwent RAI (around 6 months before pregnancy)  did not require antithyroid drugs. The doctor will monitor you and the baby for thyroid problems that may arise later on in the pregnancy.

 Management of Grave’s Disease during Pregnancy

During pregnancy, it will be crucial for you to consult your OB/GYN and an endocrinologist who will monitor your hormone problems. You will have to inform the doctor if you underwent RAI or surgery to treat Grave’s disease prior to the pregnancy. In addition  the baby will be watched and monitored for thyroid problems that can arise in the late stages of pregnancy. Thus, the pregnancy should be planned in order to properly treat Grave’s disease before conceiving.

As mentioned before, pregnancy can cause changes in the hormones which in turn will bring about problems in the thyroid glands.  The problems of the thyroid can cause an impact on the growing foetus. Sometimes, the symptoms of Grave’s disease in pregnant women worsen in the first trimester and may get better later on in the pregnancy. After delivery, the symptoms may worsen. Due to this fluctuations and variations, the treatment plan given to the pregnant women with Grave’s disease often differ. Hence, a medical doctor will ascribe a treatment plan during pregnancy and after pregnancy.

Regular check up of thyroid hormones are required during pregnancy. If the pregnant woman is prescribed antithyroid medications, then PTU will be prescribed for the first trimester and MMI afterwards until delivery. Thyroid surgery during pregnancy is rarely an option and pregnant women cannot be given RAI. Beta-blockers may be prescribed and is often for a short term (first few weeks of pregnancy) to manage symptoms.

Breastfeeding while on antithyroid drugs is common and many women choose to do so as only very small amounts of the drug get into breast milk. Your doctor will talk you through the benefits and the possible risks of breastfeeding; therefore you will be to decide for yourself what is the best course of action for you and  for your baby.

Conclusion

Grave’s disease is an autoimmune disease that affects thyroid glands resulting in hyperthyroidism. Many factors are related to the cause of the disease some of them being: genetics, gender, stress, pregnancy as well as infections. Common symptoms of Grave’s disease include goitre, weight loss, increased heart rate, changes in menstrual cycle, eye changes, etc. Women are more affected by the disease than men. Thyroid function tests and RAIU are common tests used to diagnose the disease. Treatment may include antithyroid drugs, beta blockers and in some surgery may be performed. When left untreated the disease may cause fragile bones, heart problems and even death. Pre planned pregnancy is very important in the case of women  who are sufferers Grave’s disease as pregnancy in women who have this condition can bring about adverse effects to both the mother and the baby.

 

 

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

 

 

Click here for PDF

 

 

We welcome your comments at the end of the article.

 

 

The Team Manager Web Diseases

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VN:F [1.9.22_1171]
Rating: 7.0/10 (1 vote cast)
VN:F [1.9.22_1171]
Rating: 0 (from 0 votes)

Be the first to comment - What do you think?  Posted by Masna M - May 9, 2013 at 10:46

Categories: Endocrinology   Tags: , , , , , ,

Type 1 Diabetes Mellitus

Diabetes (“passing through”) mellitus (“sweet”) or DM is a group of metabolic disease characterized by increase in serum blood glucose (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both. Our body needs a constant supply of certain amount of glucose needed for energy utilization. Insulin is needed for the glucose to enter the cells. Without enough supply of insulin, glucose will remain within the bloodstream and depriving the cells of the nutrients.

  • What is Type 1 diabetes mellitus?
  • What are the causes of Type 1 diabetes mellitus?
  • What are the Risk Factors?
  • What are the Symptoms of Type 1 diabetes mellitus?
  • How is Type 1 DM diagnosed?
  • What are the Complications of Type 1 Diabetes Mellitus?
  • Conclusion

diabetes mellitus type 1

The major classifications of diabetes mellitus are:

  • Type 1 diabetes mellitus
  • Type 2 diabetes mellitus
  • Gestational diabetes mellitus
  • Diabetes mellitus assoicated with other medical conditions or syndrome

What is Type 1 diabetes mellitus?

Type 1 diabetes mellitus, previously known as juvenile-onset diabetes mellitus and insulin dependent diabetes mellitus (IDDM), results when the beta cells in the Islets of Langerhans of the pancreas is destroyed due to some autoimmune response. Normally, beta cells works by producing the hormone insulin which is needed by the body for energy. In the case of Type 1 diabetes mellitus, there is a deficient supply of insulin thereby the person needs constant injection of the said substance for life.

What are the causes of Type 1 diabetes mellitus?

The exact cause of Type 1 diabetes mellitus is unknown. Despite this ambiguity of knowledge, research have postulated three possible reasons on how the disease came to be: autoimmune response, genetics, and viral infection.

AUTOIMMUNE RESPONSE. An autoimmune response is when the body’s own immune system starts to fight off and eventually destroy the beta cells. This particular scenario is likened to a soldier with a blindfold. The immune system cannot detect who’s the enemy to destroy and the normal cells to keep. In this battle of fighting off the supposed to be invading pathogens or antigens, the normal beta cells are being eliminated as well. In the end, there will be no more supply of insulin to help the body cells fuel up for energy.

GENETICS. One reason that links family heredity or genetics to Type 1 diabetes mellitus is the discovery of at least 18 gene locations – labeled as IDDM1 to IDDM18. According to this rsearch, IDDM1 region contains the HLA genes that is responsible for the autoimmune response.  However, this is still not considered the main reason for the development of Type 1 diabetes mellitus. In one study, it was cited that there is only a 10% chance to have diabetes mellitus if a first-degree relative has diabetes.

VIRAL INFECTION. There are several viruses implicated in the development of Type 1 diabetes mellitus. The family of coxsackie viruses are highly regarded in this study.  Coxsackie virus, as well as mumps and congenital rubella, are believed to have caused the destruction of the beta cells leading to the development of Type 1 diabetes mellitus.

What are the Risk Factors?

It was mentioned that the former name of Type 1 diabetes mellitus is juvenile onset diabetes mellitus. That’s because it is most typical in children and adolescents. It usually appears between infancy and the late 30s. Studies have suggested that the following are risk factors for the occurrence of Type 1 diabetes mellitus:

  • When there is history of being ill in early infancy
  • If a parent has Type 1 diabetes mellitus (children are more likely to get the disease if the father is the one affected than from a mother who has the condition)
  • With medical history or present autoimmune disorders like Addison’s disease, Hashimoto’s thyroiditis, Grave’s disease, pernicious anemia, or multiple sclerosis.
  • Maternal factors like late pregnancy of the mother and history of preeclampsia during pregnancy

Video of Type 1 Diabetes mellitus

What are the symptoms of Type 1 diabetes mellitus?

Most medical professionals associate the 4 cardinal signs when discussing the symptoms of diabetes mellitus. These symptoms are true to all types of diabetes:

  • Polyuria (excessive urination)
  • Polydipsia (excessive thirst)
  • Polyphagia (excessive hunger)
  • Weight loss

Because glucose is unable to enter the cells, the cells starve, causing hunger. The large amount of glucose in the blood causes an increase in serum concentration, or osmolality. The renal tubules are unable to reabsorb all the excess glucose that is filtered by the glomeruli, and glycosuria results. Large amounts of body water are required to excrete this glucose, causing polyuria, nocturia, and dehydration. The increased osmolality and dehydration cause polydipsia.

Detecting polyuria in children can also include the recurrence bed-wetting even if the child has been toilet trained already. Just because they are children, do not neglect the sudden craving for sweets and cold drinks as this may signal that their sugar levels are already skyrocketing.  High blood glucose may also cause the following symptoms:

  • fatigue
  • blurred vision or other changes in eyesight
  • irritability
  • headache
  • nausea and vomiting

A child who goes to school may have trouble functioning, is seen apathetic or restless. An undetected Type 1 diabetes mellitus can lead to a diabetic coma of diabetic ketoacidosis wherein ketones may have already build up in the blood and urine. This is a very serious complication of Type 1 diabetes mellitus that needs to be corrected immediately.

How is Type 1 DM diagnosed?

Type 1 diabetes mellitus can be diagnosed through several blood tests, particulalry the blood glucose tests. The results of the tests plus the person’s accompanying complaints can help the doctors arrive at a final diagnosis of Type 1 diabetes mellitus.

The following tests are being used by doctors today to help them arrive to the final diagnosis of Type 1 diabetes mellitus.

FASTING BLOOD SUGAR (FBS). This test measures the amount of sugar (glucose) in the body after the person have not eaten for at least 8 hours, thus the word fasting. Part of the instruction prior to blood extraction is to adhere on the order of NPO or nothing per orem which means that the person should not to eat for at least 8 hours including drinking of water. That is why it is usually done in early morning before eating. the normal range for FBS is 70 to 99 milligrams per deciliter, written as mg/dL. If the FBS is more than 126 mg/dL diabetes is diagnosed. A second test may be required if the first test is not clearly diagnostic. If the fasting plasma glucose is between 100 and 125 mg/dL, the patient has impaired fasting glucose (IFG).

GLYCOSYLATED HEMOGLOBIN (HbA1c). This test is also known as glycohemoglobin test. As glucose tends to attached itself to hemoglobin, this test reveals average blood sugar levels for the past 2-3 months. Doctors use this test to assess the person’s adherence and compliance to the diabetes regimen, i.e., performing exercise, adequate nutrition, and taking of medications. The normal range of HbA1c is between 4% and 5.6%.

  • 5.7% – 6.4% – Increased risk of diabetes
  • 6.5% or higher – Indicates diabetes

It is highly recommended that for people with diabetes, they should maintain a hemoglobin A1c less than 7%. The higher the levels, the higher the risks of developing complications related to diabetes.

OTHER TESTS. Since diabetes affects so many body systems, additional tests recommended for baseline data include:

  • lipid profile
  • serum creatinine
  • urine microalbumin levels to monitor kidney function
  • urinalysis
  • electrocardiogram

What are the complications of Type 1 diabetes mellitus?

Overtime, a person can develop complications from Type 1 diabetes mellitus. The risk of having complications is also high among persons who do not manage their blood glucose to the desired level. This can be seen on those who do not follow strict dietary changes, stick to an exercise regimen, take their medications diligently, and visit their doctors for a follow-up check-up.

ACUTE COMPLICATIONS. Since utilization of blood glucose directly influences one’s physical activity, acute complications of diabetes mellitus occasionally happens in relation to the increase or decrease of blood glucose. If not corrected immediately, it can lead to life-threatening conditions and can result to one’s demise. But the good news is, it can often be prevented with appropriate care. Another point to consider is that these complications are considered symptoms, not diseases.

Hyperglycemia. An increase in the blood glucose is called hyperglycemia. There are several causes for hyperglycemia:

  • Eating more than the meal plan prescribes. More caloric intake (carbohydrates) with having less available insulin in the body can develop an imbalance in the system thus creating an increase in blood glucose.
  • Stress. The release of counter-regulatory hormones, including epinephrine, cortisol, growth hormone, and glucagon. These hormones all increase the blood glucose level.
  • Low immunity profile. Persons with diabetes are advised to stay healthy as possible in order to prevent themselves from getting sick. An infection or illness can tilt the body’s homeostasis and that can increase the levels of blood glucose.
  • Decreased activity or engaging in strenuous activity. That’s right. Either way, the utilization of blood glucose and insulin availability is altered if the person tends to be lazy or exercising less than usual or very active in all activities

A person with hyperglycemia may present the following complaints:

  • Headaches
  • Increased thirst (polydipsia)
  • Difficulty concentrating
  • Blurred vision
  • Frequent urination (polyuria)
  • Fatigue (weak, tired feeling)
  • Weight loss
  • Blood sugar more than 180 mg/dL

Hypoglycemia. Another sudden complication of diabetes mellitus is hypoglycemia or  low blood glucose levels. It occurs when there is not enough glucose available in relation to circulating insulin. This is sometimes referred to as an insulin reaction.  Causes of hypoglycemia may include:

  • skipping a meal
  • exercising more than usual
  • accidentally administering too much insulin
  • neglecting to eat or exercising more after taking medications

A person with hypoglycemia may present the following complaints:

  • Hunger
  • Sweating
  • Tremor
  • Blurred vision
  • Headache
  • Irritability

As the brain is continuously deprived of glucose, neurological symptoms may occur and can lead t0 confusion, seizures, and coma.

LONG-TERM COMPLICATIONS. Since Type 1 diabetes mellitus is a life-time medical condition, chronic elevation of blood glucose eventually leads to these kinds of complications:

Macroangiopathy (macrovascular) complications. This involves the large blood vessels of the body thereby compromising blood supply to the major organs like the brain, heart and even the peripheral circulation to the feet and legs is affected. Because of diabetes, these persons are more likely to have hypertension, elevated low-density lipoprotein (LDL) cholesterol and triglycerides, and increasing platelet functions, leading to increased tendencies of clotting.  As such, incidence of strokes, heart attacks and feet problems related to poor circulation are most likely to occur in the advancing condition of diabetes mellitus.

Microangiopathy (microvascular) complications. Blood circulation in the tiny vessels are also compromised in long-term diabetes. The organs affected are the eyes and kidneys. In the eyes, retinopathy occurs. This involves damage to the tiny blood vessels that supply the eye. Small hemorrhages occur, which can cause blindness if not corrected. Diabetes can also lead to cataract formations. It is advised that patients should undergo a yearly eye examination to monitor these medical conditions. Complication of diabetes involving the kidneys is called nephropathy. It is caused by damage to the tiny blood vessels thereby compromising blood circulation to the area. If nephropathy occurs, the kidneys are unable to remove waste products and excess fluid from the blood. End-Stage Renal Disease (ESRD) is the general outcome for this problem. Patients who develop ESRD secondary to diabetic nephropathy are managed through hemodialysis or peritoneal diaylsis.

OTHER COMPLICATIONS

Nerve Function. Neuropathy, which is damage to nerves as a result of chronic hyperglycemia. It can cause:

  • numbness and pain in the extremities
  • erectile dysfunction (impotence) in males
  • sexual dysfunction in women
  • gastroparesis (delayed stomach emptying)

Foot Problems. Impaired blood circulation to the lower extremities plus neuropathy can predispose the person with diabetes to develop foot complications. The decreased sensation felt in the feet pose a high risk of not knowing there are foreign objects that the person has already stepped into. Since there is the existing problem of poor blood circulation, healing process maybe delayed and we are now looking into the risk of infection. Diabetic patients are often admitted in the hospital because of unhealed wound in the foot. in some severe cases, this could lead to necrosis and gangrene formation which can result to amputation of the affected extremity.

How is Type 1 diabetes mellitus managed?

INSULIN SHOTS. For Type 1 diabetes mellitus, the management protocol centers on insulin injection (remember, the cause of this type of diabetes is lacking or absent insulin production). The dosage of insulin is determined by the healthcare provider with emphasis on teaching the client how to adjust the dosage or amount of insulin depending on the result of the blood glucose monitoring, the client’s lifestyle and willingness to spend time on injections. Persons with Type 1 diabetes mellitus will require multiple shots per day. With this, the client is taught how to inject the medication all by himself.

Insulin is generally given subcutaneously, although fast-acting insulin may be ordered via the intramuscular or intravenous route in urgent situations, or sometimes inhaled. There are several types of insulin and schedules by which it may be given. For persons who are always on the go and prefers a tighter control of blood glucose levels, the use of insulin pumps are recommended. This is a small device that delivers subcutaneous insulin continuously in small (basal) amounts. The patient can then add a bolus of insulin with the push of a button before meals or snacks. This provides insulin levels that are more normal, like a person without diabetes.

Some Important Details about Insulin Administration:

STORAGE: Insulin in use should be stored at room temperature, away from direct sunlight, and should be replaced after 4 weeks; administration of cold insulin causes subcutaneous  atrophy (lipoatrophy) or hypertrophy (lipodystrophy), which alters insulin absorption; extra vials of insulin not in use should be stored in refrigerator.

PREPARATION: Note date of expiration; discard vial and use a new one if regular insulin appears cloudy; do not shake to avoid inactivation and/or formation of bubbles that lead to storage errors; roll non-regular insulin gently between the palms of the hands to evenly disperse suspended particles’ draw regular (clear content) insulin first when mixing it with other types of insulin; only mix insulins of the same concentration and from the same source.

INJECTION: In order to prevent lipoatrophy and lipodystrophy, rotation of injection sites should be practiced. Do not inject insulin in an area that will be involved in strenuous activity/exercise, as it will increase the rate of absorption, onset and peak action of insulin.

ALCOHOL INTAKE: Avoid alcohol intake while taking insulin because it lowers blood glucose levels and can cause hypoglycemia.

EXERCISE. Exercise plan is indicated for every diabetic patients. Daily cardiovascular exercise decreases the risk for insulin resistance, reduces risk of complications, and improves glucose management. Persons with Type 1 diabetes mellitus are advised to check blood glucose before undergoing exercise or any other strenuous activity. Some patients are knowledgeable in checking their urine for any presence of ketones. Ketones are spilled into the blood if the blood glucose is very high (at 250 mg/dL). If ketones are present, call the practioner and avoid exercise. Monitor for signs of hypoglycemia for up to 24 hours after extensive exercise.

NUTRITION. There is a misconception among persons diagnosed with Type 1 diabetes mellitus that they can no longer eat the foods they want. As a matter of fact, food intake is only modified according to what is recommended in the My Pyramid food guidance system that is individualized for each person. Caloric intake is based on individual needs, including possible weight loss needs. Diet should consist of complex carbohydrate (CHO) in amounts tailored to individual  need, avoiding simple sugars; protein at 10 to 20% of caloric intake; saturated fat less than 10% of calories with cholesterol intake equal to or less than 300 mg/day; sodium intake 2,400 to 3,000 mg.day (same as for general population); dietary fiber 20 to 35 mg/day. Cultural preferences are also taken into consideration in order to increase adherence to the treatment plan.

MORE HEALTH CARE TIPS FOR DIABETES MELLITUS!!!

Self-awareness about the condition is essential in order to make steps or ways in managing it. Health teachings are provided to every person with diabetes mellitus so that they are knowledgeable in handling their well being. This will include:

  • Information about type of diabetes mellitus
  • Symptoms to report
  • Self-administration of medication
  • Fingerstick glucose monitoring
  • Plan for regular exam by physician
  • Need to wear Medic-Alert bracelet indicating diabetes mellitus and medication preparation
  • Need for lifelong medication management and lifestyle adjustments

Foot care is also important to prevent foot complications in the future.

  • Keep feet clean and dry.
  • Inspect feet daily using mirror to see soles.
  • Protect feet by wearing shoes (allow ½ to 3/4 –inch toe room) or slippers at all times.
  • Avoid snug-fitting socks and stockings.
  • Use cotton socks because they wick perspiration away from the skin

CONCLUSION

Type 1 diabetes mellitus is a lifelong condition. Individuals who are diagnosed with the disease gets to change a lot in terms of lifestyle, health behaviors, and outlook in life. A healthy diet that is supervised by the physician, medication adherence, and exercise regimen are all essential components of the treatment plan for Type 1 diabetes mellitus.

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

Click here for PDF

We welcome your comments at the end of the article.
The Team Manager Web Diseases

VN:F [1.9.22_1171]
Rating: 0.0/10 (0 votes cast)
VN:F [1.9.22_1171]
Rating: 0 (from 0 votes)

Be the first to comment - What do you think?  Posted by Katherine B. - April 11, 2013 at 10:12

Categories: Endocrinology   Tags: ,