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          ARRoGANT                CoURiERS      WiTH     ESSaYS

Grade Level:       Type of Work           Subject/Topic is on:
 [ ]6-8                 [ ]Class Notes    [Information about Insuln]
 [ ]9-10                [ ]Cliff Notes    [-dependent Diabetes     ]
 [ ]11-12               [ ]Essay/Report   [                        ]
 [x]College             [x]Misc           [                        ]

 Date: 06/94  # of Words:1791  School: Database       State: ?
ФФФФФФФФФ>ФФФФФФФФФ>ФФФФФФФФФ>Chop Here>ФФФФФФФФФ>ФФФФФФФФФ>ФФФФФФФФФ>ФФФФФФФФФ
******REMINDER******
The  information  contained  in  the  Rare  Disease  Database  is provided
for educational purposes only.  It should not  be  used for  diagnostic  or
treatment purposes.  If you wish  to  obtain more  information  about  this
disorder,  please  contact  your personal physician and/or the agencies
listed  in the "Resources" section of this report.

Insulin-dependent  Diabetes is a disorder in which the body  does not
produce enough insulin and is, therefore, unable to  convert nutrients
into   the energy necessary for daily  activity.   The disorder  affects
females  and   males  approximately   equally. Although the causes of
insulin-dependent  diabetes are not known, genetic factors seem to play a
role.


Symptomatology
--------------------------------

    Normally, sugars and starches (carbohydrates) in the foods we eat are
processed  by  digestive  juices  into  glucose.    Glucose circulates  in
the  blood  as a major  energy  source  for  body functions.  Its use is
regulated primarily  by insulin, a hormone produced by the pancreas gland
(located behind the  stomach).  In the  person  with  diabetes,  there  is
a  malfunction  in   the production  of  insulin.  There are two main types
of  diabetes: Type I or  Insulin-Dependent and Type II or
Noninsulin-Dependent.

    The insulin-dependent type of diabetes generally has onset during
childhood  or  adolescence,  though  it can  occur  at  any  age. Because
the   pancreas  supplies little or no  insulin  in  this disease,  daily
injections of  the hormone and a controlled  diet are  necessary  to
regulate blood  sugar   levels.   Insulin  is generally  effective in
preventing glucose buildup, but  it is  a treatment and not a cure for
diabetes.

    The  onset  of Insulin-Dependent Diabetes  begins  with  frequent
urination,   extreme  thirst, constant  hunger,  and  unexplained weight
loss.   Because   people  with  Type  I  Diabetes   lack sufficient
insulin, glucose accumulates in  the blood to  levels too high for the
kidneys to excrete.  In an effort to  remove the excess sugar, the kidneys
excrete large amounts of water as  well as  essential  body  elements
resulting  in  frequent  urination, thirst,  and   weakness.  Hunger and
fatigue are  caused  by  the body's  inability to utilize  foods properly
for nourishment  and energy.  To find alternate sources of  energy, the
body turns  to its  stores  of  fat and protein, causing weight  loss   and
the accumulation  of  fat  breakdown products  (acetone  and  related
acids)  in the blood.  These metabolites of fat produce increased acidity
of  the   blood,  and  a  potentially  fatal   condition (ketoacidosis) can
result if  treatment is not prompt.

    A  child with Type I Diabetes may also fail to grow  and  develop
normally.   Diabetics of all ages may experience itching  of  the skin,
changes in vision, and slow healing of cuts  and  bruises. Medical
attention  should  be sought if any  of  these  symptoms occur.

    The   diabetic   condition  can  result  in   certain   long-term
complications   which may involve many organs of the  body.   The blood
vessels, nervous  system, kidneys and eyes are particularly affected.
While successful  control of blood glucose levels  may reduce the risk of
complications, the  exact relationship between these  factors  is  not
fully  understood.   Studies   are  being conducted to determine whether
strict blood glucose control plays a  significant  role  in  preventing or
delaying  the  onset  of complications  resulting from diabetes.

1.  Cardiovascular Complications.
    Heart  and blood vessel diseases such as heart attack,  hardening of
the  arteries (arteriosclerosis), and stroke are the  leading causes  of
illness,   disability  and  death  among   diabetics. Persons  with
diabetes  are  twice as   likely  to  suffer  from coronary  heart disease
and stroke and five times as   likely  to suffer  from arterial disease of
the limbs than the  non-diabetic population.   Exactly  how diabetes
damages  the  cardiovascular system is not  yet clear.

2.  Diabetic Nephropathy (Kidney Disease).
    Kidney (renal) disease, or diabetic nephropathy, can be a serious
complication   of  diabetes.   Normally,  the   kidneys   cleanse
impurities from the  blood, but diabetes can cause damage to  the blood
vessels  in  the kidney and   interfere  with  this  vital process.  A
procedure called hemodialysis is  frequently used  to remove  waste
products from the blood when the kidneys  can   no longer perform this
function adequately.  Diabetics with  serious renal  disease may also be
candidates for a kidney transplant  if a suitable donor  organ is
available.

3.  Diabetic Neuropathy (damage to the nerves).
    Diabetes can also cause a complication called Diabetic Neuropathy which
is  damage to the peripheral nerves.   These  nerves  run throughout the
body, connecting the spinal cord to muscles, skin, blood  vessels,  and all
other organs.   Most  importantly,  they serve as the primary link between
the  central nervous system and the  entire  body.   Diabetes is a common
cause  of   peripheral neuropathy; however, this condition can also result
from  injury, alcoholism,  or other factors.  Almost all people  with
diabetes eventually   develop some peripheral nerve involvement,  but  for
many,  it is slight and  produces no symptoms.  For the 10 to  25 percent
who  suffer  from serious  neuropathy,  it  can  produce problems  such as
tingling and numbness in the  feet,  dizziness, impotence, leg pain and
double vision.

4.  Diabetic Retinopathy (damaged retina).
    Diabetes  is the leading cause of partial loss of vision and  new
blindness  in  the  United  States  today.   Generally,  diabetes affects
the  retina of the eye and produces a variety of  changes referred to as
diabetic  retinopathy.  Less frequent, but no less serious,  are  several
other eye  problems  caused  by  diabetes including  cataracts, glaucoma,
and optic nerve  disease.   While many  persons with diabetes undergo some
changes in the   retina, only  about  3 percent are seriously threatened
with  blindness. Today,  there  are  approximately 150,000  Americans  who
suffer significant  visual impairment due to diabetic retinopathy.  (For
more information on  this disorder, choose "Diabetic Retinopathy" as your
search term in the Rare  Disease Database.)

    Although  the  way in which diabetes damages eye  tissue  is  not
known,  two  important treatments have been developed  in  recent years.
The first, laser photocoagulation, uses  finely  focused beams  of  laser
light to seal off and destroy  abnormal  retinal vessels  and  diseased
tissues.  While this  treatment  does  not prevent  diabetic  changes  from
taking  place,  it  has  proven beneficial  in  reducing the risk of severe
vision loss  in  many cases.

    The  second technique, vitrectomy, involves surgical  removal  of
cloudy   eye  fluids that result from  blood  vessel  hemorrhage. This
procedure  offers  hope to people  with  severely  impaired vision
resulting  from  this  form  of   diabetic   retinopathy. Scientists
continue to explore better use of these  techniques as well as the basic
causes of eye damage resulting from  diabetes.

5.  Complications of Pregnancy.
    Diabetic  women  run  a greater risk of  having  babies  who  are
stillborn,   die in infancy, and suffer from  congenital  defects than  do
non-diabetics.    It is not  uncommon  for  infants  of diabetic  mothers
to be larger than normal  at birth if  maternal blood  glucose level is
elevated.  In fact, this is  sometimes  a warning  sign  of  diabetes  in a
woman  who  has  not  yet  been diagnosed  with  the disorder.  Strict
attention  to  control  of diabetes  is  essential during pregnancy to help
reduce risks  to both mother and baby.

    Diabetic  emergencies  which  require  prompt  medical  attention
include hypoglycemia and ketoacidosis.  Hypoglycemia, also called "insulin
reaction"  or "insulin shock" can occur if  the  blood sugar  level  of the
person with diabetes falls too  low.   This results from too much insulin
in  the system caused by too  large a dose of insulin, overly strenuous
exercise,  or failure to  eat shortly after insulin is taken.  Although
each person may   react differently,   common  symptoms  of  insulin
reaction   include trembling,  sweating and nervousness.  Some persons with
diabetes may experience hunger,  headache, nausea, drowsiness, or symptoms
similar  to inebriation.  In severe  cases of insulin shock,  the person
with  diabetes may even become  unconscious.   A  careful blend  of
correct  amounts of insulin, exercise  and   food  can usually prevent
insulin reaction.  When hypoglycemia does  occur, however,  most people
with diabetes sense early  warning  signals and eat or  drink something
sweet to raise the amount of sugar in the blood.  If a  person is
unconscious, an injection of  glucose solution   or  the  hormone
glucagon  (which   stimulates   the production of glucose), should be
administered.

Ketoacidosis,  or Diabetic Coma, results from too little  insulin
in the  system.

    When the body is unable to use glucose for fuel, it draws on  its own
stores  of protein and fat for energy.  Acids,  or  ketones, produced  by
the excessive breakdown of fat then  accumulate  in the  blood  stream
quicker  than the kidneys  can  excrete  them. Unlike hypoglycemia, the
symptoms of  ketoacidosis develop slowly over  a period of days.  The
person with diabetes  may  begin  to experience abdominal pain, nausea,
vomiting, rapid breathing  and drowsiness.  If left untreated, ketoacidosis
can progress to coma and  death.

    Ketoacidosis  can  be prevented by careful  daily  evaluation  of
insulin   needs.   Particularly  stressful  situations  such   as illness
or  surgery may  require increased amounts  of  insulin. Most  importantly,
a person with  diabetes should never  skip  or delay  an insulin injection
and should pay  careful attention  to his/her diet.

    A survey by the U.S. Department of Health, Education and  Welfare
during  1960 to 1962 on forty-four million adults showed that men and
women  with   diabetes ran a higher  than  average  risk  of periodontal
disease.


Related Disorders
--------------------------------

    Type II Diabetes (Non-Insulin Dependent Diabetes Mellitus) is the more
common  form of the disorder.  Also known as  Adult  Onset Diabetes,  it
usually  occurs after the age of 40  years.   This type  of  diabetes  is
not  secondary  to   other  diseases   or conditions.   In  many  cases,
the  disorder  can  be  controlled through   diet,  regular  exercise,  and
sometimes,  with   oral medications (e.g., chlorpropamide, glypizide, or
glyburide).


Therapies:  Standard
--------------------------------

    A  daily routine of insulin-injection, controlled diet,  exercise to
burn off glucose, and testing for blood sugar level is  vital in achieving
and maintaining good blood sugar control in patients with
Insulin-Dependent  Diabetes.   Urine  testing  for  glucose spillage  had
been a standard recommendation in past  years,  but has  now  been replaced
with self blood  glucose  testing.   Self monitoring  of blood glucose
levels uses a single drop  of  blood which is obtained with a finger stick,
and placed on a chemically treated  pad  on  a  plastic  strip;  the  color
change  of  the chemically treated  pad is compared to a color chart or
"read" by a battery operated portable  meter.

    Insulin  must  be given by injection, usually two or  more  times each
day.  Recently portable "insulin pumps" have been developed, which  permit
continuous administration of insulin, as  well  as additional amounts of
insulin when needed to control the changes in blood sugar level that occurs
after meals.

Etiology
--------------------------------

    The  exact  causes of Insulin-Dependent Diabetes  are  not  known
although  most  types of diabetes are known  to  have  hereditary factors.
Scientists believe that both heredity and  environment may play important
roles in the  development of diabetes.

 
    Research  suggests  that  certain viruses,  in  combination  with
genetic  susceptibility and other unknown environmental  factors, may
trigger  the  onset of some types of  this  disorder.   High levels of
growth hormone in  adolescents and adults under  stress may also stimulate
the production of  glucose by the liver.
