Diabetes mellitus

“ Diabetes mellitus affects the lives of 10 million Americans. Each year, 35,000 Americans die from this disease, and many times that number fall victim to heart attack, stroke, kidney failure, blood vessel disease and blindness related to diabetes. Diabetes now costs the country more than $6 billion annually in health care expenses, disability payments and lost wages. ”

“ In diabetes insipidus there is constant thirst and an excessive flow of urine, which, however, is not found to contain any abnormal constituent. Its effects upon the system are often similar to those of diabetes mellitus, except that they are much less marked, the disease being in general very slow in its progress. In some cases the health appears to suffer very slightly. It is rarely a direct cause of death, but from its debilitating effects may predispose to serious and fatal complications. It is best treated by tonics and generous diet. ”

“ Each year, an estimated 500,000 more Americans are told by their physicians that they have diabetes. This chronic disease interferes with the body's ability to derive energy from glucose, a type of sugar and an important product of digested food. When diabetes strikes children, it is in a form that can soon be fatal without daily injections of the life-saving hormone insulin. Most people with diabetes have another form of the disease that begins in adulthood and that, over the years, can insidiously and progressively damage the heart, eyes, kidneys, and nervous system. ”

“ Diabetes can lead to severe complications, including heart disease, blindness, kidney failure, and lower-extremity amputations. Up to 1 million Americans have type 1 diabetes, an autoimmune disorder that destroys insulin-producing cells in the pancreas, while an estimated 16 million Americans have type 2 diabetes, in which the body does not sufficiently produce or process enough insulin. Type 2 diabetes is often related to obesity, and it is rising rapidly among men and women of all ages. Type 2 diabetes is also on the rise among children, for whom it was once extremely rare. ”

“ Almost 17 million Americans have diabetes, a disease that prevents the body from using its own insulin to break down sugars. It is the sixth leading cause of death in the United States. During National Diabetes Month, we recognize advancements in preventing, treating, and detecting this disease, and we renew our commitment to helping Americans with diabetes live longer, healthier lives. ”

“ We are also working to raise awareness of the risk factors associated with diabetes. According to clinical research, people at risk for type 2 diabetes can reduce their risk by approximately 58 percent if they lose a modest amount of weight and stay physically active. ”

“ Diabetes is a chronic illness affecting nearly 21 million Americans of all ages and backgrounds. It can cause blindness, nontraumatic amputations, kidney disease, and increased risk of heart disease and stroke. Though diabetes affects Americans of all racial and ethnic backgrounds, certain groups are at higher risk, including Hispanic, Asian/Pacific, African, and Native Americans. A small percentage of people with the disease suffer from Type 1 diabetes, once known as juvenile diabetes. These individuals are usually children or young adults whose bodies are unable to make insulin. ”

“ As we have seen, thin people are not immune if the heredity tendency in them is strong; and they develop the severest form of diabetes at a relatively tender age, and yet [Pg 40] it is possible that even the number of these may be reduced in time. A leading authority once published the family trees of a number of diabetic families and these family trees suggest that the tendency to diabetes becomes stronger with each succeeding generation. In the grandparents the disease was mild and came on late in life—not until they had overeaten, presumably, for many years and were fat. ”

“ The added danger of diabetes may be avoided if the patient is in good condition before he goes to operation, and if acidosis is promptly combated with insulin. It is wise for the diabetic patient to employ only a very skillful surgeon, and to make certain either that he is familiar with the treatment of diabetes, or that he has associated with him some physician who has had a considerable experience with diabetes. ”

“ The disease is comparatively rare in the colored race; women more than men in the negro,- nine to six. In a considerable proportion of the cases of diabetes the patients have been very fat at the beginning of or prior to the onset of the disease. It is more common in cities than in country districts. The combination of intense application to business, over-indulgence in food and drink, with a sedentary life, seem particularly prone to induce the disease. Injury to or disease of the spinal cord or brain has been followed by diabetes. ”

“ An authority on the disease declared not long since that there are over half a million people in this country now who either have or will have diabetes as the result of the breaking down of their sugar metabolism. It is not surprising that the disease should be on the increase, for the consumption of sugar has multiplied to a very serious degree during the last few generations. ”

“ Type 2 diabetes, which is also known as "adult onset diabetes," is a metabolic disorder that is linked to a combination of genetics, excess weight, and lack of exercise. The most common form of diabetes is type 2, which comprises 95 percent of the diabetes cases in our Nation. It usually occurs in adults but now also affects a growing number of children who do not get enough exercise. At least 16 million Americans are currently at high risk of developing type 2 diabetes. ”

“ More troubling are statistics indicating that more than 5 million Americans are unaware of their diabetic condition, seriously jeopardizing their long-term health and well-being. An additional 10 million citizens are at high-risk of developing type 2 diabetes due largely to physical inactivity, obesity, and poor diet. ”

“ Diabetic men often were dominated by their mothers while being excessively dependent on them. Adult onset diabetes is usually controlled without insulin injections, particularly during the early stages of the disease. Treatment in about one-third of noninsulin-dependent diabetics is possible by diet alone; in others, it is necessary to take oral hypoglycemic drugs that stimulate the release of insulin.
The emotional symptoms of both forms of diabetes may include apathy, depression, personality disorders, or even psychosis as a result of undersecretion of insulin. ”

“ When a diabetic, old or young, goes into coma, he rarely comes out of it, no matter what the treatment is.
Case 10. H. S., male, 6 years, entered April 29, 1915. Duration of his diabetes uncertain; not discovered until day of entrance. An emaciated, frail looking boy. He would eat very little at first, and on ward diet, containing 31 grams of protein, 73 grams of carbohydrate, and 20 grams of fat, he excreted 5.7% of sugar, with a moderate amount of acetone, and a very slight trace of diacetic acid. ”

“ No one surely would deny the diagnostic value of glycosuria for diabetes, because in conditions of inanition, for instance, the sugar of a diabetic may completely vanish, although the disease continues. ”

“ The effort to gain an understanding and a sure method of controlling diabetes has taken years, and while the scientist delved in his laboratory, the seemingly unconquerable disease continued to take an ever-increasing toll of young and aged victims. ”

“ This condition is typically alleviated by yet another hit of sugar which builds an addiction not only to sugar, but to food in general. If the hypoglycemic then keeps on eating sugar to relieve the symptoms of sugar ingestion, eventually the pancreas becomes exhausted, producing an insulin deficiency, called diabetes. Medical doctors treat diabetes with insulin supplements either oral or intramuscular plus a careful diet with very low and measured amounts of sugar and starch for the remainder of the persons inevitably shortened and far less pleasant life. ”

“ The excessive use of sugar as a food is usually considered one cause of the disease, and obesity is supposed to favour its occurrence, but many observers consider that the obesity so often met with among diabetics is due to the same cause as the disease itself. No age is exempt, but it occurs most commonly in the fifth decade of life. It attacks males twice as frequently as females, and fair more frequently than dark people.
The symptoms are usually gradual in their onset, and the patient may suffer for a length of time before he thinks it necessary to apply for medical aid. ”

“ Actually a large part of the pancreas may be destroyed before diabetes results. In dogs, little more than one-tenth of the gland remaining intact is sufficient to prevent the excretion of sugar. Men are more susceptible to diabetes than dogs, but even in men the pancreas may be seriously affected by inflammation or cancer before its insulin capacity is reduced to the point where actual insulin shortage is manifest. ”

“ If the diabetic tendency of an individual is marked, diabetes may develop, in very early life. The pancreas here is too weak to withstand the normal functional strain of growth. When this is the case, the disease is of extreme severity. If the diabetic tendency is slight, it may not show itself except as the result of long continued overeating. If the pancreatic islands are functionally strong, they withstand infections and injury from disease or poor blood supply; if weak, they fail and diabetes results. ”

“ If there were no other reason but the greater frequency of diabetes among the obese, this of itself would be sufficient to act as a strong deterrent motive. It may well be used as such, especially in families where a tendency to diabetes has been manifest. Diabetes figures as a cause of death in life insurance statistics five times more frequently among those who are over-weight than in the general population. ”

“ Favorable Suggestion.—Just as soon as these patients realize that people have often had considerable quantities of sugar—two per cent. or more—in their urine for years without serious consequences and that most diabetics die, not from the affection itself, but from intercurrent disease, the reassurance of mind which ensues makes their nervous system cease to be a factor in the further disturbance of metabolism and they are able to consume more starch and sugar without increasing the amount of sugar in their urine. This is not true, of course, for the severe diabetes that attacks young people. ”

“ The hospital management of a case of diabetes is not complete until the patient can live a healthy life in spite of his disease. He may arrive at the hospital in a state of coma and be dragged from the very jaws of death with insulin, but afterwards, when he goes home, unless he has learned how to continue the use of insulin and combine with it an accurate diet, he will slip again into the same dangerous predicament. ”

“ In the parents the disease was more severe and appeared earlier in life, the result, presumably, of less overeating. In the third generation, the disease occurred in the children with still less provocation from overeating. Perhaps we can save our grandchildren, therefore, by keeping ourselves fit, and thus stamp out the diabetes of childhood which is always severe and, therefore, the most dreaded. ”

“ Keeping the urine sugar-free is the first requisite. Gangrenous ulcers of the feet can be made to heal by vigorous treatment with insulin, and diet. It is of great importance to encourage the circulation in the feet by massage and proper exercises. Finally, care in avoiding bruises and cuts of the skin of the feet will prevent much trouble. Every old diabetic patient should wash his feet daily, wear clean stockings, and very comfortable shoes. Watch and guard the feet. Achilles, the Greek hero, must have been a diabetic. ”

“ Diabetes is an affection of metabolism definitely recognized as due to serious organic changes, though existing in several forms. We are not as yet absolutely sure whether there may not be quite different organic diseases in the various forms. Of one thing clinical experience has given us assurance, that the condition of the patient's nervous system is extremely important. While certain forms of diabetes are due to pancreatic changes and others perhaps to changes in the liver or other abdominal organs, the nervous system itself can affect the consumption and excretion of sugar within the body. ”

“ THE TREATMENT OF FEVERS OCCURRING IN DIABETIC PATIENTS
Fevers increase the need for insulin.—Today, with insulin, a properly dieted patient is as robust and capable as his normal neighbor. His handicap is the continued necessity for keeping his enemy under control, but if this control is watchfully maintained, he should live as long and as useful a life as do his fellows. However, throughout his life he is exposed, as are his fellows, to diseases other than diabetes. ”

“ They are far beyond the early hopes of scientific investigators of the disease. In that terminal stage of diabetes known as coma, when the patient sinks into unconsciousness, insulin seems actually to restore life. Of far greater importance, it offers for the vast majority of diabetics comfort and extended existence. Its administration is closely bound with a knowledge of the food taken into the body, for it is known that a certain amount of insulin will aid the body in handling a certain amount of sugar. ”