DIABETES MELLITUS, INSULIN-DEPENDENT

General Information

DEFINITION--A chronic disease of metabolism characterized by the body's inability to produce enough insulin to process carbohydrates, fat and protein efficiently. Treatment requires injections of insulin. Insulin-dependent diabetes is often called ketosis-prone diabetes if it begins in adulthood and juvenile diabetes if it begins in childhood.

BODY PARTS INVOLVED

• Islet cells of the pancreas that produce insulin.
• All body cells that need insulin to convert food into chemicals the body can use.

SEX OR AGE MOST AFFECTED--Usually begins before age 30; may begin at any age.

SIGNS & SYMPTOMS

• Fatigue; excess thirst.
• Increased appetite and weight loss.
• Frequent urination.
• Itching around the genitals.
• Increased susceptibility to infections, especially urinary-tract infections and yeast infections of the skin, mouth or vagina.

CAUSES

• Too little insulin produced by the islet cells of the pancreas for unknown reasons.
• Interference with insulin use in the body cells for unknown reasons.
• Virus infection of the pancreas.

RISK INCREASES WITH

• Family history of diabetes mellitus. It often skips one generation.
• Pregnancy.

HOW TO PREVENT--Cannot be prevented.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory urine and blood studies to measure glucose, cholesterol and insulin.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Hospitalization for severe complications.
• Surgery for treatment of some complications, such as failing eyesight, gangrene or coronary-artery disease.
• Regular foot care by a podiatrist and regular eye examination by a specialist.

POSSIBLE COMPLICATIONS

• Cardiovascular disease, especially stroke, atherosclerosis and coronary-artery disease.
• Kidney failure.
• Blindness.
• Peripheral vascular disease, with gangrene in legs and feet and sexual impotence in men.
• Life-threatening hypoglycemia (low blood sugar) if too much insulin is used.
• Life-threatening ketoacidosis (very high blood sugar) with breakdown of body cells.

PROBABLE OUTCOME--This disease is presently considered incurable, but symptoms and progress of the disease can be controlled with rigid adherence to treatment. Life expect-ancy is somewhat reduced, but many persons with diabetes have a nearly normal life span.

How To Treat

GENERAL MEASURES--

• Learn all you can about controlling diabetes and recognizing signs and symptoms of ketoacidosis or hypoglycemia. Learn the techniques of home monitoring of blood sugar.
• Keep a vial of glucagon available at all times to use if hypoglycemia occurs.
• Learn to give yourself insulin injections. They will be necessary every day for life.
• Wear a Medic-Alert bracelet or pendant (See Glossary).
• Seek medical treatment for any infection.
• See Resources for Additional Information.

MEDICATION--Your doctor will prescribe insulin by injection. The dosage must be individualized and occasionally adjusted. Normal therapy is 2 or more injections per day under the skin (subcutaneous).

ACTIVITY--

• No restrictions. Exercise is an important part of controlling diabetes. Consult your doctor.
• Insulin dosage may need to be adjusted according to the planned physical activity. Consult your doctor.

DIET--A special diet will be prescribed. A dietitian or nutritionist should be consulted.

Call Your Doctor If

• You have symptoms of diabetes mellitus.
• The following occurs during treatment: Inability to think clearly; weakness; sweating; paleness; rapid heartbeat; seizures; or coma (may indicate hypoglycemia). Fruity odor on the breath; changes in breathing pattern; or stupor (may indicate ketoacidosis) Several days of illness or weakness. Numbness, tingling or pain in the feet or hands. Chest pain.