DIABETES

I. INTRODUCTION

Diabetes is a chronic long lasting health condition that affects how your body
turns food into energy. Most of the food we eat is broken down into sugar which
is also called glucose and released into our bloodstream. When our blood
sugar goes up it signals our pancreas to release insulin. Insulin acts like a key
to let the blood sugar into our body’s cells for use as energy. If you have
diabetes, your body either doesn’t make enough insulin or can’t use the insulin
it makes as well as it should. When there isn’t enough insulin or cells stop
responding to insulin, too much blood sugar stays in our bloodstream. Over
time that can lead to serious health problems such as amputation of body parts,
heart disease, vision loss, and kidney disease.

There is no cure yet for Diabetes but being a caregiver it is very important for us
to know on how we could properly handle our patients with diabetes and how
they could maintain their healthy lifestyle. As caregiver our role is to guide them
with proper diet, appropriate exercise, assist them in taking their medicines as
needed and to check their sugar counts daily or as prescribed by their
Physicians, getting Diabetes self-management education and support. As well
as keeping their health care appointments which could also reduce the impact
of diabetes on our patients lives.

We need to “walk the walk” meaning it is not only our patients who need to do
the dieting and exercising, we need to show them that they are not alone on
their battle against Diabetes.

II. ANATOMY / PHYSIOLOGY AND EFFECTS OF AGING

The endocrine system is a collection of glands. These glands secretes a variety

of Hormones, which travel to specific target organs via the bloodstream.
Hormones have specific functions such as regulating growth, metabolism,
temperature and reproductive development. Like the nervous system, the
endocrine system acts as a signalling pathway, although hormones are slower
acting than nerve impulses.

Endocrine signals can last from a few hours to a few weeks. The main control
center for the organs in the endocrine system is the hypothalamus in the brain.
 The field of medicine concerned with the endocrine system is known as
Endocrinology.

Endocrine glands tend to be vascular and do not have ducts. Ducts are instead
found in exocrine glands, which produce hormonal signals outside of the body.
The hormones of endocrine are stored in vacuoles of granules ready to be
released.

Endocrine glands are found throughout the body and have a variety of different
roles. The key endocrine glands and organs are listed below.

 Hypothalamus. The hypothalamus is located at the base of the brain, near the

optic chiasm where the optic nerves behind each eye cross and meet. The
hypothalamus secretes hormones that stimulate or suppress the release of
hormones in the pituitary gland, in addition to controlling water balance, sleep,
temperature, appetite, and blood pressure.
 Pineal body. The pineal body is located below the corpus callosum, in the
middle of the brain. It produces the hormone melatonin, which helps the body
know when it's time to sleep.
 Pituitary. The pituitary gland is located below the brain. Usually no larger than a
pea, the gland controls many functions of the other endocrine glands.
 Thyroid and parathyroid. The thyroid gland and parathyroid glands are
located in front of the neck, below the larynx (voice box). The thyroid plays an
important role in the body's metabolism. The parathyroid glands play an
important role in the regulation of the body's calcium balance.
 Thymus. The thymus is located in the upper part of the chest and produces
white blood cells that fight infections and destroy abnormal cells.
 Adrenal gland. An adrenal gland is located on top of each kidney. Like many
glands, the adrenal glands work hand-in-hand with the hypothalamus and
pituitary gland. The adrenal glands make and release corticosteroid hormones
and epinephrine that maintain blood pressure and regulate metabolism.
 Pancreas. The pancreas is located across the back of the abdomen, behind the
stomach. The pancreas plays a role in digestion, as well as hormone production.
Hormones produced by the pancreas include insulin and glucagon, which
regulate levels of blood sugar.
 Ovary. A woman's ovaries are located on both sides of the uterus, below the
opening of the fallopian tubes (tubes that extend from the uterus to the ovaries).
In addition to containing the egg cells necessary for reproduction, the ovaries
also produce estrogen and progesterone.
 Testis. A man's testes are located in a pouch that hangs suspended outside the
male body. The testes produce testosterone and sperm.
Hormones are the chemicals the endocrine system uses to send messages to
organs and tissue throughout the body. Once released into the bloodstream,
hormones travel to their target organ or tissue, which has receptors that
recognize and react to the hormone.

Below are some examples of hormones that are produced by the endocrine
system.

Secreting
Hormone Function
gland(s)

increases blood pressure, heart rate, and

adrenaline adrenal
metabolism in reaction to stress

aldosterone adrenal controls the body’s salt and water balance

cortisol adrenal plays a role in stress response

dehydroepiandrosterone aids in production of body odor and growth of

adrenal
sulfate (DHEA-S) body hair during puberty

works to regulate the menstrual cycle, maintain

estrogen ovary pregnancy, and develop female sex
characteristics; aids in sperm production

follicle-stimulating hormone
pituitary controls the production of eggs and sperm
(FSH)

helps increase levels of blood glucose (blood

glucagon pancreas
sugar)

insulin pancreas helps reduce your blood glucose levels

controls estrogen and testosterone production

luteinizing hormone (LH) pituitary
as well as ovulation

melatonin pineal controls sleep-wake cycles

 helps with lactation, childbirth, and mother-child
oxytocin pituitary
bonding

parathyroid hormone parathyroid controls calcium levels in bones and blood

helps prepare the body for pregnancy when an

progesterone ovary
egg is fertilized

prolactin pituitary promotes breast-milk production

contributes to sex drive and body density in

ovary, teste,
testosterone males and females as well as development of
adrenal
male sex characteristics

helps control several body functions, including

thyroid hormone thyroid
the rate of metabolism and energy levels

FUNCTIONS OF THE ENDOCRINE SYSTEM

EFFECTS OF AGING

As the body ages, changes occur that affect the endocrine system, sometimes
altering the production, secretion, and catabolism of hormones.

HYPOTHALAMUS -

PINEAL GLAND - The pineal gland shows clear age-related changes. Human pineal gland
calcification increases with age. Some studies have related calcification of the pineal gland to a
disturbed circadian rhythmicity in the sleep–wake cycle and a decline in melatonin production
with age.

PITUITARY GLAND -  the structure of the anterior pituitary gland changes as vascularization
decreases and the connective tissue content increases with increasing age. This restructuring
affects the gland’s hormone production. For example, the amount of human growth hormone
that is produced declines with age, resulting in the reduced muscle mass commonly observed in
the elderly.

THYROID - With aging, the thyroid may become lumpy (nodular). Metabolism slows over time,
beginning at around age 20. Because thyroid hormones are produced and broken down
(metabolized) at the same rate, thyroid function tests are most often still normal. In some people,
thyroid hormone levels may rise, leading to an increased risk of death from cardiovascular disease.

PARATHYROID - Parathyroid hormone affects calcium and phosphate levels, which affect bone
strength. Parathyroid hormone levels rise with age, which may contribute to osteoporosis. Notice
that osteoporosis is common in both elderly males and females.

THYMUS - aging correlates with a reduced ability of the immune system to

generate antigen specific responses to pathogens and vaccination. This
collectively results in a higher incidence of infection, neoplastic, and
autoimmune diseases which are preferentially observed in older
individuals

ADRENAL GLAND - The adrenal glands also undergo changes as the body ages; as fibrous
tissue increases, the production of cortisol and aldosterone decreases

PANCREAS - Pancreas undergoes various pathological changes with aging characterized by

increased fatty replacement, fibrosis, lymphoplasmacytic infiltration, amyloid deposition, a
decreased weight as well as development of intra-epithelial neoplastic changes. These age-
related alterations lead to diabetes mellitus and can predispose the individual to pancreatic
ductal adenocarcinoma

OVARY - A well-known example of the aging process affecting an endocrine gland is

menopause and the decline of ovarian function. With increasing age, the ovaries decrease in
both size and weight and become progressively less sensitive to gonadotropins. This gradually
causes a decrease in estrogen and progesterone levels, leading to menopause and the inability
to reproduce. Low levels of estrogens and progesterone are also associated with some disease
states, such as osteoporosis, atherosclerosis, and hyperlipidemia, or abnormal blood lipid
levels.

TESTIS - Testosterone levels also decline with age, a condition called andropause (or
viropause); however, this decline is much less dramatic than the decline of estrogens in women,
and much more gradual, rarely affecting sperm production until very old age. Although this
means that males maintain their ability to father children for decades longer than females, the
quantity, quality, and motility of their sperm is often reduced.

III. CONDITION

Diabetes is a chronic (long-lasting) health condition that affects how your
body turns food into energy. Most of the food you eat is broken down into
sugar (also called glucose) and released into your bloodstream. When your
blood sugar goes up, it signals your pancreas to release insulin.
THE TYPES OF DIABETES ARE:

 Type 1 diabetes: This type is an autoimmune disease, meaning your body

attacks itself. In this case, the insulin-producing cells in your pancreas are
destroyed. Up to 10% of people who have diabetes have Type 1. It’s usually
diagnosed in children and young adults (but can develop at any age). It was
once better known as “juvenile” diabetes. People with Type 1 diabetes need
to take insulin every day. This is why it is also called insulin-dependent
diabetes.
 Type 2 diabetes: With this type, your body either doesn’t make enough
insulin or your body’s cells don’t respond normally to the insulin. This is the
most common type of diabetes. Up to 95% of people with diabetes have
Type 2. It usually occurs in middle-aged and older people. Other common
names for Type 2 include adult-onset diabetes and insulin-resistant
diabetes. Your parents or grandparents may have called it “having a touch of
sugar.”
 Prediabetes: This type is the stage before Type 2 diabetes. Your blood
glucose levels are higher than normal but not high enough to be officially
diagnosed with Type 2 diabetes.

IV. CAUSE / ETIOLOGY OF THE CONDITION

Diabetes causes vary depending on your genetic makeup, family history,

ethnicity, health and environmental factors. There is no common diabetes cause
that fits every type of diabetes as the causes of diabetes vary depending on the
individual and the type. In fact, type 1 diabetes and type 2 diabetes causes are
very different. Type 1 diabetes is an autoimmune condition where the pancreas
cannot produce insulin, whereas type 2 diabetes is the body’s resistance to
insulin.
The cause of diabetes, regardless of the type, is having too much glucose
circulating in your bloodstream. However, the reason why your blood glucose
levels are high differs depending on the type of diabetes.

Causes of Type 1 diabetes: This is an immune system disease. Your body

attacks and destroys insulin-producing cells in your pancreas. Without insulin to
allow glucose to enter your cells, glucose builds up in your bloodstream. Genes
may also play a role in some patients. The following triggers may be involved:
 Viral or bacterial infection
 Chemical toxins within food
 Unidentified component causing autoimmune reaction
 Underlying genetic disposition may also be a type 1 diabetes cause.

Cause of Type 2 diabetes and prediabetes: Your body’s cells don't allow

insulin to work as it should to let glucose into its cells. Your body's cells have
become resistant to insulin. Your pancreas can’t keep up and make enough
insulin to overcome this resistance. Glucose levels rise in your bloodstream.
This is the most likely type 2 diabetes cause.
 Obesity
 Living a sedentary lifestyle
 Increasing age
 Bad diet

Other diabetes causes

There are a variety of other potential diabetes causes. These include the
following:

Pancreatitis or pancreatectomy as a cause of diabetes. Pancreatitis is known to

increase the risk of developing diabetes, as is a pancreatectomy.

Polycystic Ovary Syndrome (PCOS). One of the root causes of PCOS is

obesity-linked insulin resistance, which may also increase the risk of pre-
diabetes and type 2 diabetes.

Cushing’s syndrome. This syndrome increases production of the cortisol

hormone, which serves to increased blood glucose levels An over-abundance of
cortisol can cause diabetes.

Glucagonoma. Patients with glucagonoma may experience diabetes because of

a lack of equilibrium between levels of insulin production and glucagon
production.
 Steroid induced diabetes (steroid diabetes) is a rare form of diabetes that occurs
due to prolonged use of glucocorticoid therapy.

V. RISK FACTOR

Factors that increase your risk differ depending on the type of diabetes you
ultimately develop.
Risk factors for Type 1 diabetes include:
 Having a family history (parent or sibling) of Type 1 diabetes.
 Injury to the pancreas (such as by infection, tumor, surgery or accident).
 Presence of autoantibodies (antibodies that mistakenly attack your own
body’s tissues or organs).
 Physical stress (such as surgery or illness).
 Exposure to illnesses caused by viruses.
Risk factors for prediabetes and Type 2 diabetes include:
 Family history (parent or sibling) of prediabetes or Type 2 diabetes.
 Being overweight.
 Having high blood pressure.
 Having low HDL cholesterol (the “good” cholesterol) and high triglyceride
level.
 Being physically inactive.
 Being age 45 or older.
 Having gestational diabetes or giving birth to a baby weighing more than 9
pounds.
 Having polycystic ovary syndrome.
 Having a history of heart disease or stroke.
 Being a smoker.

VI. SYMPTOMS
Symptoms of diabetes include:
 EXCESSIVE THIRST AND FREQUENT URINATION - Your kidneys are
forced to work overtime to filter and absorb the excess glucose. When your
kidneys can't keep up, the excess glucose is excreted into your urine,
dragging along fluids from your tissues, which makes you dehydrated. This
will usually leave you feeling thirsty.
 BLURRED VISION - High blood sugar causes the lens of the eye to swell,
which changes your ability to see.
 NUMBNESS OR TINGLING IN THE HANDS OR FEET - High blood sugar
can cause diabetic neuropathy, which damages the nerves that send signals
from your hands and feet
 SLOW-HEALING SORES OR CUTS - wounds tend to heal more slowly and
progress more quickly. Although cuts, grazes, scratches, and blisters can
occur anywhere on the body, the feet are one of the most common places of
injury. A small wound on the foot can quickly develop into a foot ulcer. Foot
 ulcers can become serious if left untreated. If a foot ulcer develop it will end
up having a lower limb amputation.
 YEAST INFECTIONS. Both men and women with diabetes can get these.
Yeast feeds on glucose, so having plenty around makes it thrive. Infections
can grow in any warm, moist fold of skin, including:
o Between fingers and toes
o Under breasts
o In or around sex organs
 DRY MOUTH - medication side effects and high blood sugar levels.
 In men: Decreased sex drive, erectile dysfunction, decreased muscle
strength - They have low testosterone levels, causing low sex
drive and erectile
 UNPLANNED WEIGHT LOSS. If your body can't get energy from your food, it
will start burning muscle and fat for energy instead. You may lose weight even
though you haven't changed how you eat.
 NAUSEA AND VOMITING. When your body resorts to burning fat, it makes
ketones. These can build up in your blood to dangerous levels, a possibly life-
threatening condition called diabetic ketoacidosis. Ketones can make you feel
sick to your stomach.
 HUNGER AND FATIGUE- Your body converts the food you eat into glucose
that your cells use for energy. But your cells need insulin to take in glucose.
If your body doesn't make enough or any insulin, or if your cells resist the
insulin your body makes, the glucose can't get into them and you have no
energy. This can make you hungrier and more tired than usual.

Type 1 diabetes symptoms: Symptoms can develop quickly – over a few weeks

or months. Symptoms begin when you’re young – as a child, teen or young
adult. Additional symptoms include nausea, vomiting or stomach pains and
yeast infections or urinary tract infections.

Type 2 diabetes and prediabetes symptoms: You may not have any symptoms
at all or may not notice them since they develop slowly over several years.
Symptoms usually begin to develop when you’re an adult, but prediabetes and

VII. TREATMENT

Getting diagnosed so you can receive the right treatment begins with one of
three tests. In most cases, your doctor will want to repeat a test that is high in
order to confirm the diagnosis:
 A fasting glucose test is a test of your blood sugar levels taken in the
morning before you have eaten. A level of 126 mg/dL or higher may mean
that you have diabetes.
 An oral glucose tolerance test (OGTT) entails drinking a beverage
containing glucose and then having your blood glucose levels checked every
 30 to 60 minutes for up to 3 hours. If the glucose level is 200 mg/dL or
higher at 2 hours, then you might have diabetes.
 The HBA1c test   is a simple blood test that shows your average blood
sugar levels for the past 2-3 months. An HBA1c level of 6.5% or higher may
mean you have diabetes.

What Are the Treatments for Diabetes?

Diabetes is a serious disease that you cannot treat on your own. Doctors will
help you make a diabetes treatment plan that is right for your patient -- and
that you can understand. You may also need other health care professionals
on your diabetes treatment team, including a foot doctor, nutritionist, eye
doctor, and a diabetes specialist called an endocrinologist.
Treatment for diabetes requires keeping close watch over your blood sugar
levels (and keeping them at a goal set by a doctor) with a combination
of medications, exercise, and diet. By paying close attention to what and
when you eat, you can minimize or avoid the "seesaw effect" of rapidly
changing blood sugar levels, which can require quick changes in medication
dosages, especially insulin. 

Diabetes Medications
If you have type 1 diabetes, your pancreas no longer makes the insulin your
body needs to use blood sugar for energy. You will need insulin in the form of
injections or through use of a continuous pump.
Injectable insulin comes in five types:
 Rapid-acting (taking effect within a few minutes and lasting 2-4 hours)
 Regular or short-acting (taking effect within 30 minutes and lasting 3-6
hours)
 Intermediate-acting (taking effect in 1-2 hours and lasting up to 18 hours)
 Long-acting (taking effect in 1-2 hours and lasting beyond 24 hours)
 Ultra-long-acting (taking effect in 1-2 hours and lasting 42 hours)
Each treatment plan is tailored for the person and can be adjusted based on
what you eat and how much you exercise, as well as for times of stress and
illness.
People with diabetes check their blood sugar up to several times a day with an
instrument called a GLUCOMETER. The glucometer measures glucose levels
in a sample of your blood dabbed on a strip of treated paper.
For some people with type 2 diabetes, diet and exercise are enough to keep the
disease under control. Other people need medication, which may include insulin
and an oral drug.
Drugs for type 2 diabetes work in different ways to bring blood sugar levels back
to normal. They include:
 Drugs that increases insulin production by the pancreas,
including chlorpropamide (Diabinese), glimepiride,
(Amaryl), glipizide (Glucotrol), glyburide (DiaBeta, Glynase), nateglinide (
Starlix), and repaglinide (Prandin)
  Drugs that decrease sugar absorption by the intestines, such
as acarbose (Precose) and miglitol (Glyset)
 Drugs that improve how the body uses insulin, such
as pioglitazone (Actos) and rosiglitazone (Avandia)
 Drugs that decrease sugar production by the liver and improve insulin
resistance, like metformin (Glucophage). Metformin causes weight loss
and this is one of the ways it helps bring blood sugars back to normal.
 Drugs that increase insulin production by the pancreas or its blood levels
and/or reduce sugar production from the liver,
includingalogliptin (Nesina), dulaglutide (Trulicity), exenatide (Byetta, Byd
ureon), linagliptin (Tradjenta), liraglutide (Victoza), lixisenatide (Adlyxin), s
axagliptin (Onglyza), semaglutide (Ozempic), andsitagliptin (Januvia).
 Drugs that block the reabsorption of glucose by the kidney and increase
glucose excretions in urine, called sodium-glucose co-transporter 2
(SGLT2) inhibitors. They also trigger weight loss which helps bring blood
sugars back to normal. They
are canaglifozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardian
ce), and ertugliflozin (Steglatro). These drugs can also help reduce the
risk of hospitalization for heart failure and cardiovascular death in patients
with heart failure.
 Pramlinitide (Symlin) is an injectable synthetic hormone. It helps lower
blood sugar after meals in people with diabetes who use insulin.

VIII. CAREGIVER APPROACH

Dealing with Diabetic Patients needs to have patience, as Caregivers we should

be willing to “walk the walk” when it comes to living a healthier lifestyle. Diabetic
patients are encouraged to follow their new healthy diets and exercise routines
when they see their support doing the same. Let the patient see you eat
healthily and exercise with them for motivation. Always be calm and composed
it helps both the caregiver and the patient. Stress can increase blood glucose
levels. Your patient may feel stressed if they sense that you are impatient or
unhappy. 

As a caregiver we need to encourage Physical activities for our patients it

helps control blood sugar levels and lowers their risk of heart disease and nerve
damage. Physical Activity may include :

- brisk walking
- exercise (if possible Arm Jumping jack, Side body reaching one
arm up and down, Back Stroke, Step Touch side to side, Side push
Swing your leg forward, Curl your heel and leg lift)
- Yoga
- Slow Dancing
- Swimming
 People with diabetes experience disproportionately high rates of emotional
and mental health problems such as depression, anxiety and eating disorders.
As a caregiver we need to :

- Create a support system

- We need to keep in touch with their family or friends for support.
- We need to talk to them and assure them that we understand and
we are willing to help them.
- If possible we need let them do things they enjoy as long as
allowed for them to feel they still have worth and to gain
confidence.
- We should not let them worry or be stressed.
- We should encourage them to express how they feel.
- Be positive and cheerful

Having illness such as diabetes makes our patients social life became dull so as
a caregiver we need to boost their social well being :

- We should let the patient interact with other people

- If possible we can ask from our support team (family and friends) to
visit the patient often or to communicate with them
- We can also ask the relatives if our patient can attend groups that
has with their same condition.

IX. TRIVIA - MYTHS AND FACTS ABOUT DIABETES

1. Diabetes is Caused by Eating Too Much Sweet Food 

Not necessarily. Diabetes is a chronic disease that is marked by high blood
glucose levels, which result from the body’s inability to produce insulin or
respond to it efficiently.
Insulin is responsible for reducing blood glucose levels in the body when it is too
high. Although eating sweet food may not cause diabetes, a diet high in sugar
and fat can lead to obesity, increasing the risk of developing type 2 diabetes.
2. Diabetes Can be Cured 
Diabetes is a chronic disease with no cure. However, the condition can be
managed to prevent complications from arising.
3. Patients on Insulin Have More Serious Diabetes Than Those on Oral
Medications 
Patients with type 1 diabetes are not able to produce insulin due to an immune
disorder affecting the pancreas. Therefore, oral medications that stimulate the
production of insulin by the pancreas are not suitable. Such patients require
insulin injections to control their blood glucose level.
For patients with type 2 diabetes, initial treatment may involve only oral
medications or insulin injections. Some patients may require a combination of
both treatments to achieve optimal control of their blood glucose levels.

4. Amputation is Inevitable for Diabetics 

When poorly controlled, diabetes can lead to blood vessel damage in the long
run, which in turn leads to complications like foot ulcers and amputation, nerve
damage, blindness, kidney failure, heart disease, and even stroke.
However, such complications are avoidable if diabetes is properly managed.
For this reason, it is important for diabetic patients to go for regular screenings
of their feet, eyes and kidneys to monitor for the above-mentioned
complications.

5. People With Diabetes Should Avoid Carbohydrates 

Carbohydrates may raise blood glucose levels as they are broken down into
glucose to provide energy for the body.
However, carbohydrates are present in a variety of food (including fruit and
vegetables), which may also be important sources of other nutrients. Hence, it
may not be practical to totally avoid carbohydrates. Consult a dietician, who can
offer advice on a suitable diet for diabetic patients.

6. Diabetics Can Eat Snacks or Candies With No Added Sugar or That Are
Diabetic-friendly 
Snacks or candies that have no added sugar or that are made for diabetics are
preferred alternatives to regular snacks since they may contain less sugar; the
sugar in these products may have been replaced by artificial sweeteners.

However, snacks or candies tend to be of low nutritional value and can be high
in fat. Hence, it would be a good practice to take a look at the content of the
products before consumption and to take them in moderation.