Management of Diabetes in neurosurgical patients.
By Lesley-Anne Savage and Emma Jackson
What is diabetes?
Diabetes comprises of a group of disorders, all of which are characterised by a raised blood glucose level. This is the result of the lack of, or a resistance to the hormone insulin. Insulin is produced by the pancreas and acts on the glucose obtained from food.
There are two main types of diabetes mellitus:-
Type 1 Insulin dependent diabetes
- Without insulin glucose cannot move from the bloodstream to the cells, glucose builds up in the blood and is passed out of the body in the urine
- Most frequently develops in children, young people and young adults
Symptoms
The following can develop very rapidly:
- Increased thirst & urine production
- Weight loss (despite increased appetite)
- Tiredness
- Blurred vision
- High blood glucose
Treatment
- Daily insulin injections to maintain blood glucose within certain limits
- Adjustment to diet and lifestyle
NB-
Failure to take insulin = ketoacidosis
Unbalanced diet, daily activity and insulin =hypoglycaemia - Both conditions can lead to coma and death if not detected and appropriate action taken
Type 2 Non Insulin dependent diabetes
- Most commonly diagnosed in adults over the age of 40yrs Obesity can cause insulin resistance
- May be prevented or onset delayed
Symptoms
Appear more gradually and can take years to diagnose:
- Tiredness
- Frequent micturition
- Increased thirst
- Blurred vision
- Weight loss
- Frequent infections
Treatment
- Diet modification
- Oral tablets
- Exercise
- Insulin injections
Complications
Prolonged exposure to raised blood glucose levels can damage tissue and small blood vessels within the body, causing:
- Visual impairment (Diabetic retinopathy)
- Kidney damage (diabetic nephropathy)
- Nerve damage- foot ulcers, postural hypotension, gastrointestinal problems, bladder emptying & impotence (diabetic neuropathy)
- Type 2 increases the risk of coronary heart disease, peripheral vascular disease , stroke & TIA's
- Cataracts
- Urinary tract and skin infections
- Soft tissue conditions e.g. frozen shoulder
- Mental health problems e.g. depression, eating disorders