DIABETIC ARTHROPATHY
Diabetes mellitus affects more than 120
m illion people worldwide. Type 2 dia-
betes is by far the more common form
of the disease. About 1 in 5 0 people in
the UK has this type. It is three to four
times more common in black people,
and
seven
times
more
common in
Asians. It also becomes more common
D
w ith increasing age.
SYMPTOMS
Lack of insulin causes high levels of
glucose to remain in the blood. This, in
turn, results in a high level of glucose
in the urine. This condition, termed
gly-
cosuria
,
causes
the
passage
of large
quantities of urine, excessive thirst, and
urinary tract infections
.
Lack of glucose in
the cells causes weight loss, hunger,
and
fatigue,
and
leads
to
chemical
imbalances. For further information on
the symptoms, see the illustrated box
on the previous page.
In Type 1 diabetes, symptoms such as
thirst, weight loss, and excessive urina-
tion usually develop rapidly over a few
weeks. If it is not promptly diagnosed
and treated at this stage, it may lead to
diabetic ketoacidosis
,
w hich is a poten-
tially fatal condition.
Type 2 diabetes may be present for
months or years w hile causing few
noticeable symptoms. It may only be
diagnosed when a complication (see
below), such as poor vision, is detect-
ed during a medical check-up.
COMPLICATIONS
Some complications of diabetes mellitus
result from damage to capillaries (tiny
blood vessels)
throughout
the
body.
These
conditions
include
retinopathy
(damage to the retina, w hich is the light-
sensitive part of the eye) and
diabetic
nephropathy
(kidney damage). Damage to
the blood vessels supplying nerves causes
diabetic neuropathy
(damage to nerve
fibres); this may first appear in the fin-
gers and toes, then spread up the limbs.
The loss of sensation, and poor circula-
tion, may result in
ulcers
on the feet and
legs. Other problems include dizziness
on standing and, in men,
impotence
.
People w ith diabetes have a greater
risk of developing
atherosclerosis
(accu-
mulation of fatty deposits on the lining
of
the
arteries),
hypertension
(high
blood
pressure),
other
cardiovascular
disorders
,
and
diabetic cataract
(opacity
in the lens of the eye).
DIAGNOSIS AND TREATMENT
If diabetes mellitus is suspected, a urine
sample w ill be taken and tested for the
presence of glucose. The diagnosis is
confirmed by a blood test to detect
abnormally high levels of glucose in
the blood. If the results of this test are
unclear, a glucose tolerance test may be
done. The person is asked to fast for
several hours, and then is given glu-
cose; the blood and the urine are tested
at 3 0-minute intervals to show how
efficiently the body is utilizing the glu-
cose. Tests may also be carried out to
detect and assess damage to
organs
such as the eyes, kidneys, and heart.
Treatment aims to keep blood glu-
cose
levels
as
normal
as
possible.
Dietary control is an essential element.
The ideal diet for a person w ith dia-
betes resembles
the
sort of healthy
eating plan recommended for everyone
(see
diabetic diet
) .
If the person is over-
weight, and particularly if he or she has
Type 2
diabetes, weight loss can be
achieved
by
a
reduced-calorie
diet.
Also, regular exercise and treatment
with
antidiabetic drugs
may be required.
In addition to general treatment, all
people with Type 1 diabetes need to have
regular injections of insulin. The injec-
tions are usually self-administered two,
three, or four times a day. The insulin
doses need to be matched to activity lev-
els and food intake. If the glucose/insulin
balance is not maintained,
hyperglycaemia
(too much glucose in the blood) or
hypo-
glycaemia
(too little glucose in the blood)
may
develop.
Careful
monitoring
of
blood glucose levels is also an essential
part
of self-treatment.
Pancreas trans-
plants have been tried as a possible cure
for the condition, but with little success.
Research is being done on a possible
treatment
involving
transplantation
of
clusters of insulin-producing cells.
Treatment of type 2 diabetes usually
consists of dietary measures, weight
reduction,
exercise,
and
antidiabetic
drugs, often
hypoglycaemic
drugs such
as sulphonylureas. Some people eventu-
ally need insulin injections.
In general, careful control of blood
glucose levels reduces the risk of com-
plications or, if such problems have
already developed, slow their progres-
sion. People with diabetes should have
regular medical check-ups so that any
complications can be detected as early
as possible. Additional tests, such as
measurement of
glycosylated haemoglo-
bin
(w hich shows blood glucose levels
over the previous three months) and
urine tests to detect
proteinuria
,
can
improve medical control and aid early
detection of problems.
OUTLOOK
W ith modern treatment and efficient
self-monitoring, people w ith diabetes
mellitus can usually live a normal life;
however, the disease is irreversible and
life expectancy is reduced.
diabetic arthropathy
Joint damage associated w ith
diabetes
mellitus
.
It results from the loss of pro-
tective pain sensation that can occur
when peripheral nerves are damaged
(see
diabetic neuropathy
) .
The condition
often affects the joints in the legs; the
ankle is particularly vulnerable.
Affected joints
(called neuropathic
joints or Charcot’s joints) tend to be
swollen and
deformed but painless.
Treatment includes fitting a special cast
to reduce swelling in the limb, and the
use of supportive footwear.
diabetic cataract
An opacity in the lens of the eye (see
cataract
)
due to
diabetes mellitus
.
The
slow-growing
opacities
that
often
appear in old age (senile cataracts) tend
to develop
10-15
years earlier than
usual in people who have diabetes.
Occasionally, young people with poorly
controlled
diabetes
develop
juvenile
cataracts, w hich are diffuse opacities
that develop rapidly. Treatment for dia-
betic cataract is the same as for other
forms of cataract.
diabetic coma
A
life-threatening
state
of
uncon-
sciousness and unresponsiveness, due
either to
diabetic ketoacidosis
or to
hypo-
glycaemia
.
The latter condition may be
induced either by excessive doses of
oral hypoglycaemic
drugs or by an inad-
equate intake of food.
diabetic diet
A nutritional regime designed to pre-
vent complications of
diabetes mellitus
by controlling the timing and amount
of
energy
intake, thereby m inim izing
the occurrence of
hyperglycaemia
(high
blood glucose levels) or
hypoglycaemia
(low blood glucose levels).
People with diabetes should follow
the same kind of healthy diet that is
recommended for people in general
(see
nutrition
) .
The diet should be rich
in
complex
carbohydrates
(such
as
bread and pasta) and contain less than
3 0 per cent fat. In addition, the energy
intake (see
calorie
) needs to be con-
trolled in order to maintain a healthy
228
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