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YOUR BODY makes glucose, a kind of sugar, from the foods you eat. This glucose travels through the bloodstream for immediate use as “fuel”, or is stored in the liver for future use. When there is a build-up of glucose in the blood, the pancreas sends out a hormone, insulin. It is the action of insulin that enables glucose to move from the bloodstream into the body’s cells, which then use the glucose as a source of energy. Diabetes results when, for one reason or another, there is a breakdown in this process and glucose accumulates in the blood. In other words, diabetes signifies the body’s inability to use glucose (sugar) as fuel in the normal way. When diabetes sets in before age 30, it is generally because the pancreas is producing a deficient amount of insulin — or none at all —Because me body mistakenly destroys the cells in the pancreas that secrete insulin. There are no oral drugs for this type of diabetes which usually starts abruptly. It always needs to be treated by supplying the missing hormone through injections of insulin. Even one day without insulin can bring on the risk of diabetic coma and death. This type of diabetes is known as Insulin-Dependent Diabetes (IDD), or juvenile-onset diabetes, or Type I diabetes.When diabetes occurs in adults over age 40, it is often because they are genetically pre-disposed to develop it (A family-history search could uncover close relatives who have or had it). Peoplewith adult-onset diabetes typically produce sufficient amounts of insulin in the pancreas. Bat the hormone has lost its ability to effectively move glucose out of the blood and into the cells, resulting in a condition known as insulin resistance. In effect, the cells resist the action of insulin, causing sugar levels to accumulate in the blood.This results in what is known as adult-onset diabetes or Non-Insulin-Dependent Diabetes (NIDD) — so called because, except in a small proportion of diabetics and in certain emergency situations, it does not need to be treated with insulin. 90 per cent of diabetics have the Type II form of the disease.*61\332\2*

Because pills have to be absorbed from the gut before they can work, anything that upsets absorption may interfere with their action. This may include a stomach or bowel operation years ago. Diarrhea and vomiting are obvious problems but taking them after a big meal may delay absorption. Some foods may slow their absorption more than others. Taking them on an empty stomach can irritate the stomach in some people. You must never take them and then not eat. Instructions for taking sulphonylureas vary depending on which book one reads. Most suggest with the meal – I interpret this as swallowing them when you have eaten some, but not all of your food – for example, between the cereal and the toast, or, at dinner time, between the soup and the main course. Wash your pills down with a drink of water or other non-alcoholic beverage.
If your pills are prescribed twice a day, then take them twice a day. With oral hypoglycemic pills this usually means with breakfast and with your evening meal – but if you are taking tolbutamide or glipizide it may mean with breakfast and lunch – so ask your doctor. It is rare to need more pills with the evening meal than with the morning meal. Too much sulphonylurea at night increases the risk of nocturnal hypoglycemia. But I do see one man who eats very little in the day and a great deal in the evening who needs 80 mg gliclazide with breakfast and 160 mg gliclazide with his evening meal. This sort of adjustment is only possible in someone who is monitoring their blood glucose carefully. If you take your pills at the wrong time, or take them all at once when you have been advised to divide them you run the considerable risk of hypoglycemia.

Getting the best out of your treatment
•       Diet is the basis of all treatment for diabetes.
•       If you are on additional treatment learn everything you can about it.
•       If you are taking insulin:
1.       Learn how fast and for how long each of your insulins acts – both theoretically and in your own case.
2.       Gain confidence in adjusting your own insulin dose.
3.       Consider advances in insulin injection techniques.
4.       Consider whether you have injection site problems.
•       If you are taking oral hypoglycemic pills:
1.       Learn how fast and for how long your pills act.
2.      Learn the maximum safe dose of your pills and consider making adjustments within this maximum.
•       Do not be upset if you cannot control your diabetes on pills and diet. The need for insulin treatment is not a disaster and you will learn how to cope with it very quickly.

*22/102/5*

TYPE I DIABETES: COMPLICATIONS OF DIABETESBaseball fans all around the world know that Jackie Robinson, the first African-American player to break into the Major Leagues, was one of baseball’s greatest superstars. But few realize he had diabetes.At first Jackie and his doctors were able to keep his disease under good control, and it hardly bothered him at all. But problems developed. First he developed an infection in a knee that he had once injured sliding into second base. The infection spread through his body, and Jackie almost died before antibiotics finally brought it under control.In later years diabetes affected Jackie’s nerves and blood pressure, causing burning pains in his legs that eventually made him give up playing golf. Tiny blood vessels in his eyes began to bleed. Though doctors fought the damage with the newest techniques of laser surgery, Jackie lost the sight of one eye, then of the other. Then three heart attacks struck within four years; the last one killed him at the age of fifty-three.Today very few people die of diabetic coma, but the disease can cause a number of serious complications that can limit and shorten life. People with diabetes are more likely than the average person to develop ailments of the heart and blood vessels, kidney problems, nerve damage, and eye problems, for example. (Diabetes is currently the leading cause of blindness in the United States.)Fortunately, there are a number of ways of diagnosing diabetes early, as well as treatments that can help to prevent its disabling and life-threatening effects in many patients. In 1993 diabetes specialists and their patients were excited by the report on a large-scale, federally sponsored study. The results of this ten-year study showed that keeping the blood sugar level under careful, tight control could prevent most of the damaging complications of the disease.*16\268\2*