Sugar Bear (Investigating Type 2 Diabetes)

candy1

This week we endured our annual glucometer training. It, combined with demonstrated proficiency, is required by our health region so that we may keep using the glucometers they supply. Fair enough. Since it’s a tool we use or maintain on a regular basis it’s no surprise we all “passed”.

In the simplest terms glucometer use goes like this; we poke you with a sharp (sterile) object, you bleed, we suck up some blood with a little (sterile) strip, the machine beeps, we find out how much sugar (glucose) is floating around in your blood stream.

This is similar to the one we use…(yay for visuals!)

aviva2

Part of being a proficient glucometrist (made up word, seems legit) is knowing how to interpret the readings.

My first encounter with diabetes was when my great uncle was diagnosed with diabetes mellitus type 2 (formerly non-insulin dependent diabetes or adult onset diabetes). I felt sooo bad for him as a kid because he always had to prick his fingers to check his sugars. He would then write down the level in a little book to make sure they weren’t fluctuating too much. Later on he had to start giving himself subcutaneous insulin injections into his stomach. He also wasn’t allowed to have dessert anymore. What a way to have to live!

According to the Canadian Diabetes Association, “Type 2 diabetes is a disease in which your pancreas does not produce enough insulin, or your body does not properly use the insulin it makes. As a result, glucose (sugar) builds up in your blood instead of being used for energy. Your body gets glucose from foods like bread, potatoes, rice, pasta, milk and fruit. To use this glucose, your body needs insulin. Insulin is a hormone that helps your body to control the level of glucose in your blood.” 3

For all you other glucometrists out there, a normal glucose level is between 5-10mmol/L. <4mmol/L is considered hypoglycemia (blood sugar is too low). >11mmol/L is considered hyperglycemia (blood sugar is too high). 4

hypo5

Because of the acute effects of hypoglycemia (staggering, slurred speech, confusion, irritation) it has often been misinterpreted as drunkenness/intoxication. Thankfully most police in Canada are now provided with training to recognize the signs and symptoms to avoid putting hypoglycemics unattended in the drunk tank. They are instructed to call the ambulance for anyone displaying these symptoms. Yes, we tend to do a lot of drunk calls to check sugars. Sometimes it’s a bit of a pain but as my father always says- “When you assume, you make an *ss out of you and me.”

hyper6

Hyper and hypoglycemia can look very similar and both can be medical emergencies. Hypoglycemia is more dangerous because it develops rapidly. However, it can also be easily treated with simple sugar and if corrected early enough does not require a hospital visit. If you don’t have glucometer training (or a glucometer), it is safe to assume the diabetic displaying the signs/symptoms above is hypoglycemic- provide them with sugar (about 15 grams of carbohydrates). If their signs/symptoms do not improve then seek medical attention (because you might be wrong).

Some causes of blood sugar fluctuations are: food (too much, too little), alcohol, dehydration, other illness, exercise (over, under), stress, medication (too much, too little, other).

Type 2 diabetes is often a weight related disease. With an increase in childhood obesity it is occurring in much younger populations unfortunately. Other risk factors are family history, race, age, fat distribution (around the tummy), inactivity, prediabetes, and gestational diabetes.

Usually in the early stages of onset type 2 diabetes can be controlled through a regulated diet, exercise, and weight management. More severe forms may need to be controlled through oral or liquid medications such as Metformin (Glucophage), Glipizide (Glucotrol), Glimepiride (Amaryl), Acarbose (Precose). 7 Eventually, like my uncle, type 2 diabetics may require insulin via subcuntaneous injection or insulin pump. (I assume this is why we no longer refer to type 2 as NIDDM-non-insulin dependent diabetes mellitus. Yeesh.) Some common types of insulin are Novolin, Humolog, Lantus, Novolog. 8 They differ in how long they last or fast they act.

Signs/Symptoms of Developing Type 2 Diabetes:

  • “Increased thirst and frequent urination. Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink — and urinate — more than usual.
  • Increased hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger.
  • Weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine.
  • Fatigue. If your cells are deprived of sugar, you may become tired and irritable.
  • Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus clearly.
  • Slow-healing sores or frequent infections. Type 2 diabetes affects your ability to heal and resist infections.
  • Areas of darkened skin. Some people with type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies — usually in the armpits and neck. This condition, called acanthosis nigricans, may be a sign of insulin resistance.” 9

Complications of uncontrolled type 2 diabetes develop slowly but can be debilitating and even life threatening. Not managing your sugars properly can lead to; heart and blood vessel disease (increased risk of heart attack/stroke), nerve damage, kidney damage, eye damage, foot damage, skin and mouth damage, impaired ability to heal. 10

On another personal note, I had another uncle who did not manage his diabetes very well. He ended up with severe nerve damage in his feet. One night he put a heating pad on them because they felt cold (probably due to poor peripheral circulation). He fell asleep only to wake up with second degree burns in the morning.

Here are some gross pictures to really illustrate why you shouldn’t mess with diabetes…

diabetic-foot1-300x22511 (This is honestly what my first emergency call led me to. I immediately knew two things; 1. I had the stomach for the job. 2. The guy hadn’t looked at his feet in a while.)

?????????????????12

module_4_diabetic_retinopathy13

So with the holiday season upon us, please think twice before passing off Uncle Harry’s strange behavior as just too many pina coladas.

Next blog- Type 1 Diabetes!

Medic15

Sources:

Note- hyperlinks 7 and 8 lead to great chart resources!

1  http://blog.indiantrailslibrary.org/?p=1929

http://forum.smartcanucks.ca/142864-free-glucometer-your-choice-canada/

3 http://www.diabetes.ca/diabetes-and-you/living/just-diagnosed/type2/

4 http://www.diabetes.ca/documents/about-diabetes/Lows_and_Highs_final1.pdf

5 http://safetyca.info/diseases/reactive-hypoglycemia-what-is-it-dichcum

6 http://mixturesrx.com/blog/?tag=hyperglycemia

7 http://www.joslin.org/info/oral_diabetes_medications_summary_chart.html

8 http://diabetes.niddk.nih.gov/dm/pubs/medicines_ez/insert_C.aspx

9 http://www.mayoclinic.com/health/type-2-diabetes/DS00585/DSECTION=symptoms

10 http://www.mayoclinic.com/health/type-2-diabetes/DS00585/DSECTION=complications

11 http://www.rochdalevillagehealth.com/2013/03/27/diabetic-epidemic-in-jamaica-queens-new-york/

12 http://www.cags-accg.ca/index.php?page=252

13 http://www.freewebs.com/doctorkesari/diabetescomplications.htm

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One thought on “Sugar Bear (Investigating Type 2 Diabetes)

  1. Pingback: Similarities Between Type 1 And Type 2 Diabetes | I'm Type 1 Diabetic

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