body weight. People who take insulin
need to coordinate their meals with the
times for their insulin injections.
diabetic ketoacidosis
A severe, acute complication of Type 1
diabetes mellitus
a condition in w hich
produces too little
If levels of insulin are too low, the
generates more glucose, but the tissues
are unable to take up the glucose prop-
erly and have to break down fats to
obtain energy, causing the production
of acidic chemicals called ketone bod-
ies. Diabetic ketoacidosis may be the
first sign that a person has insulin-
dependent diabetes, or it may develop
in a person known to have the condi-
tion who has taken insufficient insulin.
The features of diabetic ketoacidosis
include nausea; vomiting; deep, rapid
breathing; breath that smells of acetone
(like nail polish remover); and confu-
sion. The condition can progress to
of diabetic ketoacidosis
involves giving insulin to correct the
deficiency and fluids containing salts to
relieve dehydration.
diabetic maculopathy
maculopathy, diabetic
diabetic nephropathy
Kidney damage resulting from long-
standing or poorly controlled
The disorder includes damage
to capillaries (tiny blood vessels) in the
kidneys and hardening of the tissues. As
a result, the kidneys become less able to
filter the blood efficiently. Protein may
escape into the urine, depleting the
nephrotic syn-
) .
In severe cases, chronic
may develop. Many affected peo-
pressure), w hich may also cause dam-
age to the blood vessels.
People with
should have
regular check-ups so any kidney prob-
lems can be treated as soon as possible.
Checks may include urine tests for pro-
tein, as well as
kidney function tests
diabetic neuropathy
Any of various types of
ease of or damage to the nerves) that
diabetes mellitus
The most common type of diabetic
neuropathy is called peripheral sensory
neuropathy. In the early stages of this
disorder, intermittent pain and tingling
are felt in the extremities, particularly
in the feet. The pain gradually worsens
until, finally, pain sensation is lost to an
area. People with sensory neuropathy
in the feet can develop cuts, scrapes, or
blisters that they may not notice. If left
untreated, serious complications may
result from such injuries. Daily obser-
vation of the feet is critical.
Another form of diabetic neuropathy
is damage to motor nerves (w hich in i-
tiate movements). This problem causes
weakened muscles. The foot is particu-
larly susceptible, and may undergo a
change of appearance as a result. A fur-
ther form, diabetic amyotrophy, causes
painful wasting of the thigh muscles.
Autonomic neuropathies affect the
nerves that regulate involuntary vital
functions. Symptoms and signs include
(low blood pres-
sure on standing); diarrhoea at night;
inability to empty the bladder com-
pletely, w hich may lead to urinary tract
infection; and
Cranial neuro-
pathies affect nerves that supply the
head and face; damage to nerves sup-
plying the eye muscles causes impaired
vision and eye pain.
diabetic pregnancy
Pregnancy associated with
diabetes mel-
The term
“ diabetic pregnancy”
may refer to a pregnancy in a woman
w ith pre-existing diabetes, or to dia-
betes that develops during pregnancy;
the latter
condition is
known as gestational diabetes.
Women with established diabetes can
have a normal pregnancy provided that
the diabetes is well controlled. Careful
control of blood glucose levels must
begin well before conception. Poor con-
trol may affect the baby’s growth, and
increase the risk of fetal malformations
and complications during pregnancy.
In gestational diabetes, the mother
does not produce enough insulin to
keep blood glucose levels normal. The
condition is usually detected in the sec-
ond half of pregnancy, when urine tests
reveal the presence of glucose. Treat-
ment is the same as for women who
A doctor may go through several steps
to ascertain the cause of a person’s
problem. The medical history, physical
examination, and tests may prove vital
clues. A doctor usually makes at least
a provisional diagnosis before
beginning any treatment because
treatment can mask symptoms, making
the doctor’s task of establishing an
exact diagnosis more difficult.
Taking the medical history
Perhaps the most important part of the
diagnostic procedure is the patient’s own
account of his or her illness - the medical
history. “Listen to the patients, they are telling
you their diagnosis” is the traditional teaching
given to medical students. Many doctors believe
that the medical history provides the strongest
basis for ascertaining a diagnosis. The added
information derived from the physical
examination may be small, but, attimes, critical.
Conducting a physical examination
After the medical history has been obtained,
the doctor has in mind a short list of probable
diagnoses. A physical examination helps
shorten the list. The doctor is then left with a
differential diagnosis. A differential diagnosis
is a group of possible diseases that could
account for patterns of symptoms and signs
(i.e., physical findings, such as enlargements
of lymph nodes or tenderness in a specific
region ofthe abdomen).
Ordering special tests
Next, based on his or her provisional diagnosis,
the doctor may order a series of laboratory tests
on the blood (and sometimes the urine) and may
also arrange for diagnostic imaging of suspect
organs by techniques such as ultrasound
scanning, X-rays, CT scanning, MRI, or
radionuclide scanning. The results ofthese tests
either confirm the doctor’sprovisional diagnosis
or narrow the possibilities so the doctor may be
confident in making the correct diagnosis.
Using a computer
Doctors today also use computer systems and
algorithms to help reach a diagnosis. Both
approaches rely on analysis of large numbers
of patient records to quantity probabilities and
to devise an orderly series of questions - a
decision tree. The main purposes of computer
assistance is to remind the doctor ofthe full
range of possible diagnoses for a particular
set of symptoms, thereby making it less likely
that any possibility will be overlooked. It
remains the task ofthe doctor to integrate the
facts and decide upon a diagnosis.
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