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I created this blog as an instrument of what I have encountered in the world of veterinary medicine as a proud vet student. Comments and suggestions are welcome here at;

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Aina Meducci 2012

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The following blog posts is not genuinely from my research but through readings and citation from trusted website. I do not own any of the copyright and therefore you may use it at your own risk

SINCE I AM NOT A VETERINARIAN YET, THEREFORE I CAN'T CONSULT ANY MEDICAL ADVICE TO YOU AND YOUR PETS! EXTREMELY IMPORTANT!.

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Diabetes


In surgery class, we often talk about causes of gangrene which are common to diabetic people. So here's the interesting part: untreated or superinfection wounds maybe lead to lower extremities amputation!


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A diabetic cat suffer from feline diabetes
(is this pic true?)


Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar (hyperglycemia), either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).

Diabetes insipidus is a condition in which the kidneys are unable to conserve water. It is characterized by excessive thirst and excretion of large amounts of severely diluted urine, with reduction of fluid intake having no effect on the concentration of the urine. There are several different types of DI, each with a different cause. The most common type in humans is central DI, caused by a deficiency of arginine vasopressin (AVP), also known as antidiuretic hormone(ADH). The second common type of DI is nephrogenic diabetes insipidus, which is caused by an insensitivity of the kidneys to ADH. It can also be an iatrogenic artifact of drug use.


Although they have a common name, diabetes mellitus and diabetes insipidus are two entirely separate conditions with unrelated mechanisms. Both cause large amounts of urine to be produced (polyuria), and the term diabetes is derived from the Greek name for this symptom. However, diabetes insipidus is either a problem with the production of antidiuretic hormone (cranial diabetes insipidus) or kidney's response to antidiuretic hormone (nephrogenic diabetes insipidus), whereas diabetes mellitus causes polyuria via a process called osmotic diuresis, due to the high blood sugar leaking into the urine and taking excess water along with it.


I will only discuss on Diabetes mellitus**


There are three main types of diabetes:


Type 1 diabetes

Results from the body's failure to produce insulin, and presently requires the person/animal to inject insulin. (Also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes.) Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas leading to insulin deficiency. This type of diabetes can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, where beta cell loss is a T-cell mediated autoimmuneattack.It can occur at any age, but it is most often diagnosed in children, teens, or young adults. In this disease, the body makes little or no insulin. Daily injections of insulin are needed.

Type 2 diabetes

Results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. (Formerly referred to as non-insulin-dependent diabetes mellitus, NIDDM for short, and adult-onset diabetes.)

The pancreas secretes insulin, but the body is partially or completely unable to use the insulin. This is sometimes referred to as insulin resistance. The body tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they do not continue to secrete enough insulin to cope with the higher demands.

Type 2 diabetes is typically recognized in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non-insulin-dependent diabetes mellitus. These names are no longer used because type 2 diabetes does occur in younger people, and some people with type 2 diabetes need to use insulin.It is usually controlled with diet, weight loss, exercise, and oral medications. Some of the causes include; high blood pressure, high blood fat level and overweight.

Gestational diabetes

Is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM.


Pathophysiology of Diabetes Mellitus




Sign and Symptoms

In susceptible animal such as cats and dogs, polyurination are common cause. The cat may also drink excessive of water. Feline patients are urinating vast amounts, because the water gets literally pulled out of the organism through the osmotic effect of the large sugar molecules. So they need to replace this water by drinking a lot.

Weight loss is another specific sign. Fact is, that a diabetic cat eats more than a healthy animal. The high blood sugar level in the blood stream initiates the brain to signal the body to eat even more to be able to get the blood sugar into the body tissues.If this cat illness is present for a longer time, a cat becomes eventually lethargic and very sick.

Diabetic Cat Walking on Hock

A fairly common problem in diabetic cats is a hindlimb weakness that may be caused by the increased blood sugar level.Constantly high glucose in the bloodstream causes conductivity problems in peripheral nerve axons, especially in the tibial nerve of one or both sides.

Typical signs are walking on the hocks or a 'plantigrade stance' and a weakness in the hindlimbs of variable severity.

And these are human symptoms;





Diabetes complications

Both forms of diabetes ultimately lead to high blood sugar levels, a condition called hyperglycemia. Over a long period of time, hyperglycemia damages the retina of the eye, the kidneys, the nerves, and the blood vessels.Damage to the retina from diabetes (diabetic retinopathy) is a leading cause of blindness.

  • Damage to the kidneys from diabetes (diabetic nephropathy) is a leading cause of kidney failure.

  • Damage to the nerves from diabetes (diabetic neuropathy) is a leading cause of foot wounds and ulcers, which frequently lead to foot and leg amputations.

  • Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach (gastroparesis), chronic diarrhea, and an inability to control heart rate and blood pressure during postural changes.

  • Diabetes accelerates atherosclerosis, (the formation of fatty plaques inside the arteries), which can lead to blockages or a clot (thrombus). Such changes can then lead to heart attack, stroke, and decreased circulation in the arms and legs (peripheral vascular disease).

  • Diabetes predisposes people to high blood pressure and high cholesterol and triglyceride levels. These conditions independently and together with hyperglycemia increase the risk of heart disease, kidney disease, and other blood vessel complications.

In the short run, diabetes can contribute to a number of acute (short-lived) medical problems.

Many infections are associated with diabetes, and infections are frequently more dangerous in someone with diabetes because the body's normal ability to fight infections is impaired. To compound the problem, infections may worsen glucose control, which further delays recovery from infection.

Hypoglycemia, or low blood sugar, occurs from time to time in most people with diabetes. It results from taking too much diabetes medication or insulin (sometimes called an insulin reaction), missing a meal, doing more exercise than usual, drinking too much alcohol, or taking certain medications for other conditions. It is very important to recognize hypoglycemia and be prepared to treat it at all times. Headache, feeling dizzy, poor concentration, tremors of hands, and sweating are common symptoms of hypoglycemia. You can faint or have a seizure if blood sugar level gets too low.

Diabetic ketoacidosis is a serious condition in which uncontrolled hyperglycemia (usually due to complete lack of insulin or a relative deficiency of insulin) over time creates a buildup in the blood of acidic waste products called ketones. High levels of ketones can be very harmful. This typically happens to people with type 1 diabetes who do not have good blood glucose control. Diabetic ketoacidosis can be precipitated by infection, stress, trauma, missing medications like insulin, or medical emergencies like stroke and heart attack.

Hyperosmolar hyperglycemic nonketotic syndrome is a serious condition in which the blood sugar level gets very high. The body tries to get rid of the excess blood sugar by eliminating it in the urine. This increases the amount of urine significantly and often leads to dehydration so severe that it can cause seizures, coma, and even death. This syndrome typically occurs in people with type 2 diabetes who are not controlling their blood sugar levels, who have become dehydrated, or who have stress, injury, stroke, or are taking certain medications, like steroids.


Diabetic foot ulcer (my favorite part!!)

Diabetic foot ulcers (an open wound or sore that develops on the skin) are one of the major causes of gangrene and amputation in people/animal with diabetes. Gangrene is results by
  • reduced sensation
  • reduced blood supply
These are described in more detail below.

Reduced sensation

The high blood sugar that is associated with diabetes can cause damage to the nerves (peripheral neuropathy), particularly in feet. Once damaged, the nerves are unable to transmit sensations of pain to your brain.Therefore it is easy to damage or injure your foot by treading on something sharp, or to develop a blister due to ill-fitting shoes without actually realising it.

As a result of the lack of pain, animal may continue walking without protecting the wound. This can make the wound worse and it may develop into an ulcer.

Reduced blood supply

High blood sugar can damage your blood vessels, causing the blood supply to feet to become restricted. If the skin on feet receives less blood, it will also receives a lower number of infection-fighting cells, which means that wounds will take longer to heal.Therefore, the reduced sensation means that animals are more likely to develop an ulcer, and the reduced blood supply means that the ulcer is more likely to become infected. The infection is likely to restrict the blood supply further, leading to gangrene. Worse gangrene may lead to amputation to prevent spreading of bacteria from the rest of the body.

**If person/animal have type 1, or type 2, diabetes, it is essential that to take extra care of feet.


Gangrene


Prevention and treatment

Self-treatment
  • Keep an ideal weight
  • Healthy lifestyle
  • Exercise
So here's the cycle

Medical treatment

Type 1 DM

  • Insulin via injection. Orally taken may destroy the insulin in the stomach
  • Eating healthy diet

Type 2 DM

  • Sulfonylurea or biguanide [metformin Glucophage)], to help control blood sugar level.
  • Insulin injection-control sugar level
  • It is becoming more common for people with type 2 diabetes to take a combination of oral medication and insulin injections to control blood sugar levels.

Medications

Sulfonylureas: These drugs stimulate the pancreas to make more insulin.

Biguanides: These agents decrease the amount of glucose produced by the liver.

Alpha-glucosidase inhibitors: These agents slow absorption of the starches one eats. This slows down glucose production.

Thiazolidinediones: These agents increase sensitivity to insulin.

Meglitinides: These agents stimulate the pancreas to make more insulin.

D-phenylalanine derivatives: These agents stimulate the pancreas to produce more insulin more quickly.

Amylin synthetic derivatives: Amylin is a naturally occurring hormone secreted by the pancreas along with insulin. An amylin derivative, such as pramlintide (Symlin), is indicated when blood sugar control is not achieved despite optimal insulin therapy. Pramlintide is administered as a subcutaneous injection along with insulin and helps achieve lower blood sugar levels after meals, helps reduce fluctuation of blood sugar levels throughout the day, and improves hemoglobin A1C levels.

Incretin mimetics: Incretin mimetics promote insulin secretion by the pancreas and mimic other blood sugar level lowering actions that naturally occur in the body.


Sources: Wikipedia, Gangrene www.nhs.uk, Diabetic in cats www.pet-health-pro.com, Diabetes, pubmed health, Diabetes emedicinehealth.com










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1 comments:

Ronald Chong Kian Nyap said...

Rawatan diabetis boleh dilakukan tanpa potong bahagian yg teruk. Dengan rawatan melalui sel terapi boleh mengantikan sel lama yg rosak menjadi sel baru. Pls call/sms/whatsapp 014-6228620. Bnyk testimoni sudah.

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