Diabetes

Eplain the different types of insulin, charatertics, strength, addtives and animal insulin

Types of Insulin Rapid-acting insulin, such as insulin lispro (Eli Lilly), insulin aspart (Novo Nordisk), or insulin glulisine (sanofi-aventis), begin to work about 5 minutes after injection, peak in about 1 hour, and continue to work for 2 to 4 hours. Regular or Short-acting insulin (human) usually reaches the bloodstream within 30 minutes after injection, peaks anywhere from 2 to 3 hours after injection, and is effective for approximately 3 to 6 hours. Intermediate-acting insulin (human) generally reaches the bloodstream about 2 to 4 hours after injection, peaks 4 to 12 hours later and is effective for about 12 to 18 hours. Long-acting insulin (ultralente) reaches the bloodstream 6 to 10 hours after injection and is usually effective for 20 to 24 hours. There are also two long-acting insulin analogues, glargine and detemir. They both tend to lower glucose levels fairly evenly over a 24-hour period with less of a peak of action than ultralente. Premixed insulin can be helpful for people who have trouble drawing up insulin out of two bottles and reading the correct directions and dosages. It is also useful for those who have poor eyesight or dexterity and is a convenience for people whose diabetes has been stabilized on this combination. Characteristics of Insulin The three characteristics of the four types of insulin are onset, peaktime, and duration. Onset is the length of time before insulin reaches the bloodstream and begins lowering blood glucose. Peaktime is the time during which insulin is at maximum strength in terms of lowering blood glucose. Duration is how insulin continues to lower blood glucose. Insulin Strength All insulins come dissolved or suspended in liquids. However, the solutions have different strengths. The most commonly used strength in the United States today is U-100. That means it has 100 units of insulin per milliliter of fluid. U40, which has 40 units of insulin per milliliter of fluid, is not used in the U.S., but is still used in Europe and in Latin America. If you're traveling outside of the U.S., be certain to match your insulin strength with the correct size syringe. Insulin Additives All insulins have added ingredients. These prevent bacteria from growing and help maintain a neutral balance between acids and bases. In addition, intermediate and long-acting insulins also contain ingredients that prolong their actions. In some rare cases, the additives can bring on an allergic reaction. Animal Insulins For many years, the insulin used by people with diabetes was produced from the pancreases of pigs and cows. Synthetic human insulin derived from genetically engineered bacteria first became available in the 1980s, and now all insulin available in the United States is manufactured in a laboratory. Although the development of synthetic human insulin was a boon for most people, especially those who were allergic to the animal insulins, a few people find that they can manage their diabetes better using animal insulins. Although animal insulins are no longer produced in the United States, the FDA allows individuals to import animal insulins for their own personal use. Source: American Diabetes Association

OBSERVATIONS DURING INITIAL INTERVIEW

Does the person exhibit problems with ambulating? Does the person seem in obvious pain; complain of pain in extremities (especially legs and feet)? Is the individual overweight? Does the person seem to be alert? Does the individual give logical oral responses? What is the person's energy level?

What are some complications of having diabetes?

Complications of Diabetes Heart disease and stroke In 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65 years or older. In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. The risk for stroke is 2 to 4 times higher among people with diabetes. High blood pressure In 2003-2004, 75% of adults with self-reported diabetes had blood pressure greater than or equal to 130/80 millimeters of mercury (mm Hg), or used prescription medications for hypertension. Blindness Diabetes is the leading cause of new cases of blindness among adults aged 20-74 years. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year. Kidney disease Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2005. In 2005, 46,739 people with diabetes began treatment for end-stage kidney disease in the United States and Puerto Rico. In 2005, a total of 178,689 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States and Puerto Rico. Nervous system disease About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, erectile dysfunction, or other nerve problems. Almost 30% of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling). Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations. Amputations More than 60% of nontraumatic lower-limb amputations occur in people with diabetes. In 2004, about 71,000 nontraumatic lower-limb amputations were performed in people with diabetes. Dental disease Periodontal (gum) disease is more common in people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes. Persons with poorly controlled diabetes (A1c > 9%) were nearly 3 times more likely to have severe periodontitis than those without diabetes. Almost one-third of people with diabetes have severe periodontal disease with loss of attachment of the gums to the teeth measuring 5 millimeters or more. Complications of pregnancy Poorly controlled diabetes before conception and during the first trimester of pregnancy among women with type 1 diabetes can cause major birth defects in 5% to 10% of pregnancies and spontaneous abortions in 15% to 20% of pregnancies. Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to both mother and child. Other complications Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma. People with diabetes are more susceptible to many other illnesses. Once they acquire these illnesses, they often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes. Persons with diabetes aged 60 years or older are 2-3 times more likely to report an inability to walk one-quarter of a mile, climb stairs, do housework, or use a mobility aid compared with persons without diabetes in the same age group. Preventing diabetes complications Diabetes can affect many parts of the body and can lead to serious complications such as blindness, kidney damage, and lower-limb amputations. Working together, people with diabetes, their support network, and their health care providers can reduce the occurrence of these and other diabetes complications by controlling the levels of blood glucose, blood pressure, and blood lipids, and by receiving other preventive care practices in a timely manner. Glucose control Studies in the United States and abroad have found that improved glycemic control benefits people with either type 1 or type 2 diabetes. In general, every percentage point drop in A1cblood test results (e.g., from 8.0% to 7.0%) can reduce the risk of microvascular complications (eye, kidney, and nerve diseases) by 40%. In patients with type 1 diabetes, intensive insulin therapy has long-term beneficial effects on the risk of cardiovascular disease. Blood pressure control Blood pressure control reduces the risk of cardiovascular disease (heart disease or stroke) among persons with diabetes by 33% to 50%, and the risk of microvascular complications (eye, kidney, and nerve diseases) by approximately 33%. In general, for every 10 mm Hg reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12%. Control of blood lipids Improved control of LDL cholesterol can reduce cardiovascular complications by 20% to 50%. Preventive care practices for eyes, feet, and kidneys Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50% to 60%. Comprehensive foot care programs can reduce amputation rates by 45% to 85%. Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30% to 70%. Treatment with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are more effective in reducing the decline in kidney function than other blood pressure lowering drugs. In addition to lowering blood pressure, ARBs reduce proteinuria, a risk factor for developing kidney disease, by 35%, similar to the reduction achieved by ACE inhibitors.

VOCATIONAL IMPEDIMENTS. WHAT HAPPENS IF THE CLIENT IS NOT SURE ON ALOT FO THE QUESTIONS?

Do the specific functional limitations prevent the person from performing the jobs performed in the past? Do the specific functional limitations restrict the type of jobs the person might qualify for in the future? Will a need for rest during the workday, level amounts of physical exertion, and regular meal times affect the person's chances for employment? Consider the client's degree of control of the diabetic condition, including eyes, and circulatory system. Ultimate control/adjustment to this disease involves: Proper knowledge of diet and self-care (care of feet, syringe use, hygiene). Understanding and adherence to proper diet and exercise. Proper usage of medications. Management of complications. The diabetic client who does not have good knowledge of the above factors, and does not illustrate established control would be an extremely poor candidate for successful rehabilitation. Vocational goals or occupations requiring irregular work hours or long work periods without rest should be avoided.

ORAL AGENTS WORK (facts,guidelines for taking the drug, and side-effects)

HOW ORAL AGENTS WORK If diet and exercise do not work in lowering the blood glucose level in people with Type II diabetes, pills are sometimes prescribed. These pills are not insulin, they belong to a class of drugs called sulfonylureas. They work by increasing both the release of insulin from the pancreas and the number of insulin receptors. People with Type II diabetes often have reduced levels of insulin and reduced numbers of insulin receptors. IMPORTANT FACTS TO KNOW You may not need to take diabetes pills for the rest of your life. Some people who lose weight begin to use their own insulin better and are able to stop taking diabetes pills. Even though this doesn't always happen, it is one of the reasons weight loss is recommended for overweight people with type II diabetes. These pills may not work for everyone, an estimated 20?30% of patients fail to respond and will require insulin injections. Guidelines for taking oral diabetes medication Take your diabetes pills the same time each day unless your physician has told you differently Eat regular meals, Skipping a meal can cause low blood sugar Tell your doctor about all other medications you are taking Wear medical identification which states that you have diabetes Side Effects: Sometimes side effects occur with these medications, however they are quite rare. These usually occur within the first two months. If you experience any of these side effects listed below, report them to your physician. Hypoglycemia (low blood glucose) Skin Rash Sensitivity to light Nausea and vomiting Headache Fast heart beat It is important to know the name, dosage and duration of action (how long the pill works) of the oral agent you are taking. You should not increase, skip, or change your dose unless you are told to do so by your physician. Women who take oral hypoglycemic agents and are planning to become pregnant, should contact their physician. Oral hypoglycemic agents when taken with some medications can cause either hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose). Be sure to tell all your doctors that you have diabetes. Below are a few examples: Drugs that may cause: HYPOGLYCEMIA Cimetidine (Tagamet) Aspirin (large doses) Allopurinol Alcohol Insulin Phenytoin (dilantin) HYPERGLYCEMIA Steroids (Prednisone, Hydrocortisone) Estrogen Furosemide (lasix) Nicotine Caffeine (large doses) Thiazide diuretics Over?the?counter cough medicines (sugar containing) Nicotinic acid (Niacin) There are many over?the?counter medications that you can purchase to treat your cough, cold and flu symptoms. Carefully read the directions on the label, the list of ingredients, and discuss these products with your pharmacist. Remember to test your blood glucose levels more frequently whenever you are ill so you can make adjustments in your treatment program to keep your blood sugar levels near normal. (See "Sick Day Guidelines")

IPE CONSIDERATIONS

Maintain medical control through diet, medications, etc. Maintain weight control. Avoid jobs with irregular hours, long hours of work without breaks, and irregular physical exertion. In discussions of job goals, give some consideration to potential long term complications, e.g. visual problems, amputations, kidney problems.

What are some risk factors for non-insultion dependant diabetics? How about for those that are dependant ?

Non-insulin-dependent diabetes Family history. Family history of diabetes is one of the strongest risk factors for NIDDM. People with diabetic family members have a strikingly increased risk compared with people with no family history of diabetes. The highest familial risk is for individuals whose identical twin has been diagnosed with NIDDM. This high risk indicates that there is a genetic predisposition to developing NIDDM; however, a specific diabetogenic gene(s) has not yet been discovered. Racial and ethnic group. As described in the previous section, there is wide variability in NIDDM risk among different racial and ethnic groups. This variation may be due to differences in the number of risk factors in these populations, to differences in genetic makeup that determine susceptibility to diabetes, or to both. Some studies have found that whereas ethnic populations at high risk of diabetes (such as blacks, Mexican Americans, and Pima Indians) tend to have higher prevalence of such known risk factors as obesity, this alone cannot account for the increased prevalence of diabetes. Genetic makeup is a probable contributor to their risk. For example, a study of NIDDM in Mexican Americans indicated that prevalence is associated with the proportion of Native American genes in the population. NIDDM prevalence in the subgroup with the lowest percentage of Native American genes was 5 percent - similar to that of the general U.S. population?whereas in the group with the highest proportion of Native American genes the prevalence was 14.5 percent. A similar relationship was observed in Nauruans and other Pacific Island populations, in whom the prevalence of NIDDM declines with increasing proportion of foreign genetic characteristics. Obesity. Obesity (body weight greater than 20 percent above ideal) is a strong risk factor for NIDDM. One study found a dramatic increase in diabetes with increasing relative weight. The prevalence of diabetes is about three times as high in people in the heaviest weight category (those more than 40 percent above the desirable weight for their sex and height) as in those at or below desirable weight. Family history and obesity appear to interact to increase the probability of developing NIDDM. In the adult U.S. population, an individual who is either obese or has a diabetic parent is twice as likely to have diabetes as someone with neither risk factor. Obese people with at least one parent with diabetes are four times as likely to have diabetes as nonobese individuals without a diabetic parent. Other metabolic factors. Elevated blood glucose may increase the risk of developing NIDDM. About 1 to 5 percent of individuals with impaired glucose tolerance develop diabetes each year, making IGT an important risk factor. The associations between NIDDM risk and such factors as insulin concentration, blood lipids, and blood pressure are unclear. Environment factors. Certain environmental or lifestyle factors may increase the risk of developing NIDDM in susceptible population groups. A higher diabetes prevalence is observed in populations that have migrated to more urbanized locations, compared with people of the same group who remained in their traditional home. Urbanization is usually related to major changes in diet, physical activity, and socioeconomic status, as well as increased obesity, which may in turn increase the risk of glucose intolerance and diabetes. Adoption of a "Western" lifestyle (which may include a diet high in fat and a sedentary way of life) is associated with a dramatically increased rate of NIDDM in the Pima Indians of Arizona, the Nauruans of the South Pacific, and a number of other developing populations in whom diabetes was nearly unknown before they adopted new habits. Other risk factors. Diabetes prevalence and incidence are higher in Americans who are physically inactive. Increased levels of physical activity appeared to be protective for NIDDM in several studies. The benefit of increased activity was highest in people at higher risk of developing NIDDM, i.e., more obese, hypertensive, or with a family history of diabetes. In addition, people whose diets are high in fat and low in carbohydrates may have an increased risk of NIDDM. Income and educational level are also associated with NIDDM risk. In the United States, people in the lowest income brackets have higher risk of diabetes: however, the reverse appears to be true in some developing societies. Level of educational attainment also appears to be inversely related to diabetes risk in the United States. Insulin-dependent diabetes Family history. IDDM tends to cluster in families, although less than NIDDM. The identical twin of a child with IDDM has at least 50 times the risk of developing IDDM as a child in an unaffected family, whose risk for developing diabetes by age 20 is only 0.5 percent. Siblings of children with IDDM have about a 10 percent chance, or a 20?fold increased risk, of developing the disease by age 50. Genetic factors. As in NIDDM, genetic background may be related to IDDM risk. The incidence of IDDM in black Americans appears to be intermediate between the rate in U.S. whites and the rate in African blacks. Genetic comparisons of these three populations support the hypothesis that the genetic contribution from the white population is responsible for the increased incidence of IDDM in black Americans compared with Africans. Studies have revealed strong associations between IDDM and certain genetic markers. However, although people with certain genetic characteristics have a greatly increased risk of developing IDDM, the vast majority of "genetically susceptible" individuals do not develop diabetes. Hence, other factors not yet identified must be responsible

what are some of the common functional limations?

Physical stamina/endurance Standing Walking Motor coordination Heavy exertion Tactile discrimination Finger dexterity Handling Grasping Manual dexterity Tolerance to extremes in temperature Tolerance to long hours without rest/food intake Tolerance to occupations that pose unusual injury hazards (cuts, burns, skin injuries) Concentration Visual acuity

INITIAL INTERVIEW QUESTIONS

Please describe the onset and history of the problem. Please explain/describe the following: a. b. c. d. Method of control (pills, injections, diet) Amount of medication (insulin units) When taken Problems with control (Give recent example, dates, and HbA1c results.) Do you have difficulty with any of the following? If so, describe: a. Vision (Does the client wear glasses or contact lenses?) b. Urination (bladder and/or kidney infections) c. Hypertension d. Circulation (leg pains or numbness? If so, see cardiovascular section). e. Tingling or loss of sensation in extremities f. Abnormal vomiting or diarrhea g. Dizziness or fainting spells h. Becoming easily fatigued i. Concentration j. Healing of cuts or skin conditions Do you follow an established routine of diet, exercise, rest, and sleep? Describe. Please discuss any activities and/or environmental conditions that cause fatigue or complications

Pre-diabetes? Prevelence rate? Prevention?

Prediabetes is a condition in which individuals have blood glucose levels higher than normal but not high enough to be classified as diabetes. People with prediabetes have an increased risk of developing type 2 diabetes, heart disease, and stroke. People with prediabetes have impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Some people have both IFG and IGT. IFG is a condition in which the fasting blood sugar level is 100 to 125 milligrams per deciliter (mg/dL) after an overnight fast. This level is higher than normal but not high enough to be classified as diabetes. IGT is a condition in which the blood sugar level is 140 to 199 mg/dL after a 2-hour oral glucose tolerance test. This level is higher than normal but not high enough to be classified as diabetes. In 1988-1994, among U.S. adults aged 40-74 years, 33.8% had IFG, 15.4% had IGT, and 40.1% had prediabetes (IGT or IFG or both). More recent data for IFG, but not IGT, are available and are presented below. Prevalence of impaired fasting glucose in people younger than 20 years of age, United States In 1999-2000, 7.0% of U.S. adolescents aged 12-19 years had IFG. Prevalence of impaired fasting glucose in people aged 20 years or older, United States, 2007 In 2003-2006, 25.9% of U.S. adults aged 20 years or older had IFG (35.4% of adults aged 60 years or older). Applying this percentage to the entire U.S. population in 2007 yields an estimated 57 million American adults aged 20 years or older with IFG, suggesting that at least 57 million American adults had prediabetes in 2007. After adjusting for population age and sex differences, IFG prevalence among U.S. adults aged 20 years or older in 2003-2006 was 21.1% for non-Hispanic blacks, 25.1% for non-Hispanic whites, and 26.1% for Mexican Americans. Prevention or delay of diabetes Progression to diabetes among those with prediabetes is not inevitable. Studies have shown that people with prediabetes who lose weight and increase their physical activity can prevent or delay diabetes and return their blood glucose levels to normal. The Diabetes Prevention Program, a large prevention study of people at high risk for diabetes, showed that lifestyle intervention reduced developing diabetes by 58% during a 3-year period. The reduction was even greater, 71%, among adults aged 60 years or older. Interventions to prevent or delay type 2 diabetes in individuals with prediabetes

What are the three main types of diabetes? What are the other types of diabetes?

Type 1 Diabetes : was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. In adults, type 1 diabetes accounts for 5% to 10% of all diagnosed cases of diabetes. Risk factors for type 1 Diabetes may be autoimmune, genetic, or environmental. There is no known way to prevent type 1 diabetes. Several clinical trials for preventing type 1 Diabetes are currently in progress or are being planned. Type 2 diabetes: was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult onset diabetes. In adults, type 2 diabetes accounts for about 90% to 95% of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it. Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or Other Pacific Islanders are at particularly high risk for type 2 diabetes and its complications. Type 2 diabetes in children and adolescents, although still rare, is being diagnosed more frequently among American Indians, African Americans, Hispanic/Latino Americans, and Asians/Pacific Islanders. Gestational diabetes: is a form of glucose intolerance diagnosed during pregnancy. Gestational diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians. It is also more common among obese women and women with a family history of diabetes. During pregnancy, gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant. Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually type 2. Women who have had gestational diabetes have a 40% to 60% chance of developing diabetes in the next 5-10 years. Other types : of diabetes result from specific genetic conditions (such as maturity-onset diabetes of youth), surgery, medications, infections, pancreatic disease, and other illnesses. Such types of diabetes account for 1% to 5% of all diagnosed cases. BRITTLE DIABETES A term used to describe diabetes where the person's glucose level swings quickly from one extreme to the other. It is a sign of poor diabetic control and is a serious complication. This type of diabetes is also called "labile" or "unstable diabetes." IMPAIRED GLUCOSE TOLERANCE Occurs when an individual's glucose levels are higher than normal, but below the level of someone with diabetes. This used to be called "borderline," "subclinical," or "latent" diabetes. This disability is not functionally limiting. DIABETES INSIPIDUS A disease of the pituitary gland and is not diabetes mellitus. Diabetes insipidus is often called "water diabetes" to set it apart from "sugar diabetes." The causes and treatments are not the same for the two diseases, although many people who have diabetes insipidus show many of the same signs as do people with diabetes mellitus—they have to urinate often, and tend to feel weak, thirsty, and hungry. These people are not to be considered under the Diabetes Mellitus disability.

What are some things to keep in mind when working with someone who is diabetic?

The most important consideration in working with persons with diabetes is the level of diabetic control that the individual is able to maintain rather than the type of diabetes that he or she has. Poor diabetic control produces the uncomfortable symptoms and serious complications of diabetes. This control is dependent on many different factors such as the severity of the disease, self-care, stress, and other health problems. A blood test called the HbA1c is a very good measure of the average level of diabetic control over the last several months. Test results below 7 show good diabetic control, but results with higher numbers indicate less and less control. An HbA1c of 11 or 13 is quite serious. The management of diabetes requires complex and difficult self-care on a daily basis. The person is trying to keep the very complicated and delicate processes of cell metabolism going and many things can and do go wrong. Consequently, frustration and depression are very common among persons with diabetes mellitus.

Treating diabetes

Treating diabetes Diabetes can lead to serious complications, such as blindness, kidney damage, cardiovascular disease, and lower-limb amputations, but people with diabetes can lower the occurrence of these and other diabetes complications by controlling blood glucose, blood pressure, and blood lipids. Many people with type 2 diabetes can control their blood glucose by following a healthy meal plan and exercise program, losing excess weight, and taking oral medication. Some people with type 2 diabetes may also need insulin to control their blood glucose. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. Among adults with diagnosed diabetes (type 1 or type 2), 14% take insulin only, 13% take both insulin and oral medication, 57% take oral medication only, and 16% do not take either insulin or oral medication. Medications for each individual with diabetes will often change during the course of the disease. Many people with diabetes also need to take medications to control their cholesterol and blood pressure. Self-management education or training is a key step in improving health outcomes and quality of life. It focuses on self-care behaviors, such as healthy eating, being active, and monitoring blood sugar. It is a collaborative process in which diabetes educators help people with or at risk for diabetes gain the knowledge and problem-solving and coping skills needed to successfully self-manage the disease and its related conditions.

What is Diabetes Mellitus ? Explain why this can happen in the body? Signs? What happens if its left untreated? what are some ways to control it?

chronic and incurable disease in which the process of moving glucose from the blood into the cell is not functioning correctly.The body changes food into glucose (a form of sugar) that is then carried by the blood to all of the cells in the body. issue or process in boy: The hormone insulin moves the glucose from the blood into the cell. Each cell uses glucose as its energy source and without glucose the cell begins to starve. Diabetes occurs when the body does not make enough insulin or when the cells cannot use the insulin that is made. When glucose cannot enter the cell, it begins to accumulate in the blood. The symptoms of diabetes are the result of the body attempting to deal with both starving cells and an abnormal buildup of sugar in the blood. Signs: signs of diabetes include fatigue, frequent urination, weight loss, extreme thirst, and hunger. If left untreated: If diabetes is not treated, the starving cells will turn to the body's supply of fat and protein from the muscles as an emergency energy source. This creates another problem because the wastes from fats and proteins are acids (ketones) and these begin to build up in the blood. This can result is diabetic ketoacidosis (DKA), which is a medical emergency that may put a person into a coma if not treated immediately. Ways to control it: Although diabetes is incurable, it is controllable. Some diabetics achieve control by the use of diet and exercise, some require oral medications to stimulate the production of insulin, and some require the injection of insulin. Many diabetics use a glucose-monitoring device to get the information to help them control their disease. Because this disease affects the metabolism of every cell of the body, the treatment involves the artificial maintenance of this complex process. Maintaining good diabetic control is frequently difficult and frustrating.