Diabetes

Diabetes mellitus is a group of diseases that affect a person’s ability to process blood glucose (sugar). Normally, a person’s pancreas produces insulin to help their body store and use the sugar from the food they eat, but when a person has diabetes, their pancreas releases little or no insulin, or their body does not react to the insulin being produced. This can result in a buildup of sugar in the blood and potentially dangerous complications like stroke or heart disease. In the United States, the estimated number of people with diabetes is 30.2 million, which represents about 30 percent of the population. The three main types are type 1 diabetes, type 2 diabetes, and gestational diabetes.

Types of Diabetes

Type 1 diabetes, also known as juvenile diabetes due to its onset during childhood, is an autoimmune condition in which the body attacks and damages its own pancreas, rendering it unable to produce insulin. People with type 1 diabetes must take artificial insulin to stay alive.

Doctors are uncertain as to the exact cause of type 1 diabetes, but there are some known risk factors including:

  • Family history — Those with a parent or sibling who has type 1 diabetes are more likely to develop it themselves
  • Genetics — Type 1 diabetes has been linked to the presence of certain genes
  • Geography — Further from the equator, instances of type 1 diabetes increase
  • Age — Type 1 diabetes generally appears either between the ages of 4 and 7, or between the ages of 10 and 14

Unlike type 1 diabetes, people with type 2 diabetes are able to produce insulin, but either the amount produced is not enough or their body does not respond to it. Type 2 diabetes is often caused by obesity and is the most common type of diabetes, accounting for over 95% of cases in adults.

Type 2 diabetes risk factors are much more defined than those for type 1 diabetes and include:

  • Higher body weight
  • Inactivity
  • Family history
  • Race — African Americans, Hispanics, American Indians and Asian-Americans are at higher risk of developing type 2 diabetes
  • Age — risk increases with age
  • Gestational diabetes
  • Polycystic ovary syndrome
  • High blood pressure
  • Abnormal cholesterol

Though they account for only 1%-5% of all cases, there are also a few rare kinds of diabetes that can be caused by diseases of the pancreas, certain surgeries, medications or infections.

Prediabetes is a condition in which a person has high blood sugar but does not yet have diabetes. Those with prediabetes may experience signs of high blood sugar, which are similar to early symptoms of diabetes. These include headache, fatigue, confusion or trouble concentrating, blurred vision, frequent urination, and increased thirst. Once the disease progresses, people experience more severe diabetes symptoms like weight loss, irritability, slow-healing sores and frequent infections. Type 2 diabetes symptoms can worsen over time, while type 1 diabetes symptoms can appear rapidly, often within a day or two.

Symptoms of diabetes in women are similar to those observed in men, but there are some that are unique to women, including vaginal and oral yeast infections, vaginal thrush, urinary infections and polycystic ovary syndrome. In addition to the more general diabetes symptoms, signs of diabetes in men include low testosterone, erectile dysfunction and decreased sex drive.

Diabetes Complications

Complications of diabetes become more prevalent and severe with time. If a person has diabetes and irregular or high blood sugar for a long period of time, eventually the complications may become disabling or possibly even life-threatening.

Some of these complications include:

  • Cardiovascular disease — Those with diabetes have a significantly higher risk of developing cardiovascular problems, including heart attacks, strokes and coronary artery disease with chest pain.
  • Nerve damage — High blood sugar can damage the walls of the capillaries that nourish the nerves. Diabetic neuropathy can cause tingling, numbness, burning or pain, usually beginning in the toes or fingers and gradually spreading.
  • Kidney damage — Diabetes can damage the blood vessel clusters that enable the kidney to filter waste from a person’s blood. Severe kidney damage can lead to kidney failure.
  • Diabetic ketoacidosis — This life-threatening complication of diabetes occurs when a person’s body starts breaking down fat too quickly, causing the blood to become acidic.
  • Eye damage — Diabetic retinopathy occurs when diabetes causes damage to the blood vessels of the retina, which can potentially cause blindness. Diabetes can also be linked to other eye conditions like cataracts and glaucoma.
  • Foot damage — In addition to diabetic neuropathy, which often occurs in the feet, cuts and blisters can develop into serious diabetic foot infections, which often heal poorly and can require amputation.
  • Alzheimer’s disease — Long-term irregularities in blood sugar have been linked to an increased risk of Alzheimer’s disease.
  • Skin conditions
  • Hearing impairment
  • Depression

Diabetic shock occurs when a person has severe hypoglycemia (or low blood sugar). It can have serious symptoms like loss of consciousness, trouble speaking, seizures and even diabetic coma, and requires immediate medical evaluation. Hypoglycemia can happen rapidly and may even occur despite a person’s compliance with their diabetes care plan.

What Is the Best Path to Recovery from Diabetes Complications?

Complications of diabetes can be painful and may severely impact a person’s daily life. When combined with another injury or illness, the disease can create a very complex medical picture. Kindred Hospitals have an interdisciplinary care approach that enables us to provide diabetes care in conjunction with care for conditions like kidney disease and heart disease.

While our collaborative team treats these conditions, they are also able to provide rehabilitation for:

  • Cardiovascular changes
  • Diabetic foot infection or ulcers
  • Diabetic retinopathy
  • Hypertension
  • Amputation
  • Diabetic nephropathy
  • Diabetic neuropathy

Our transitional care hospitals use the latest in glycemic management for all diabetic patients in our care, including basal bolus insulin therapy, which combines fast-acting insulin with longer-lasting insulin to maintain a steady balance of blood sugar levels. This approach prevents dramatic low and high blood sugar readings, minimizing the risk of hypoglycemia, hyperglycemia, and diabetic shock. Our care is adapted from the standards of the American Diabetes Association and the American Association of Clinical Endocrinologists.

We work with patients to improve glucose control with:

  • Nutrition therapy and education from a registered dietitian
  • Healthy lifestyle training for weight reduction and stress relief
  • Exercise supervised by physical therapists
  • Disease management education to minimize future risk of diabetes complications
  • Instruction in self-management strategies such as:
    • Blood sugar monitoring
    • Hypo- and hyperglycemia symptom recognition
    • Medication management
    • Insulin pump management
    • Consistent carbohydrate meal planning
  • Monitoring of insulin and other medication regimens by a clinical pharmacist, to prevent negative medication interactions

“When patients need medical care for a condition like kidney disease or heart disease, and they are also suffering from complications of diabetes, the treatment approach must reflect a deep understanding of all the ways diabetes affects the body,” says Dr. Sean Muldoon, the Chief Medical Officer of Kindred Healthcare's Hospital Division. “The collaborative care team at Kindred specializes in these types of medically complex scenarios, creating comprehensive treatment plans to manage diabetes and its complications while treating serious conditions that require long-term acute care.”


Success Spotlight: Arthur's Story

Arthur loves to ride his motorcycle, swim and fish, and spend time with his family. His friends and family lovingly call him King Arthur and he is also known as an avid sign collector and camper. Arthur was traveling when he was found unconscious in his car over 100 miles from his home after having run out of gas. The good Samaritan who discovered him immediately called for help and Arthur was rushed to a general hospital. Doctors diagnosed him with acute diabetes and high blood pressure and found that he also had an abscess in his back that had become infected. Arthur began to receive treatment to stabilize his condition and began to recover quickly. 

His rapid progress allowed him to be transferred to Kindred Hospital to receive rehabilitation therapy and wound care so he could return home. When he first arrived he needed moderate assistance for mobility and his daily needs from his caregivers and therapists as his balance had been affected and he had yet to regain his full strength after his episode. Arthur was eager to get better and he applied himself to all of his therapies with a positive attitude and looked forward to all his rehab gym sessions with his physical and occupational therapists. Working together with his team he exceeded all his goals and was able to be discharged from Kindred walking on his own and fully independent once again.

“I am thankful to the person who found me and sought out help,” Arthur expressed. “And I can’t thank my family enough for being here with me and for me. Kindred is wonderful, and they sure know how to treat a King! I just can’t say enough great things about everybody – if I could, I would take you all home with me because I’ve never felt so special.”

 


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