Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
The pancreas is involved in secreting enzymes for digestion.
Various hormonal signals from the stomach and small intestine
cause the release of these enzymes. Getting the pancreas
angry, as in chronic alcoholism, gall bladder stones and
trauma can lead to leakage of these digestive enzymes, with
the disastrous results of auto digestion. But our subject
today is a hormone released by this organ called insulin.
Insulin is in charge of the uptake of sugars into the cells
of the body and into storage areas. Lack of insulin causes a
well-known disease called diabetes mellitus, and it comes in
two types. The first type is generally discovered in youth,
is generally hereditary, and needs injections of insulin. We
have discussed this disease in the past. The second type is
lower sensitivity to insulin or impaired release; this can be
treated by pills that stimulate more release of insulin. It
is generally found in older individuals who are overweight.
We will be discussing this disease today.
The American National Institute of Health is involved now in
a massive campaign to prevent this disease, which can often
be treated by losing weight alone. One of the reasons that
your mothers told you that eating too much sugar can cause
diabetes is not because of increasing the level of sugar in
your blood but because it can make you fat. Diabetics of this
type do have the same problems as diabetics of the first
type, but are less likely to have ketoncidosis, a treacherous
increase of acids in the blood. However, eyesight,
circulation to the limbs and infection-fighting ability are
all impaired, as well as having a higher risk of heart and
kidney disease.
It has been determined that if this disease does start, good
control of sugars through daily checking of blood sugars with
hand-held monitors, and periodical checking of hemoglobin 1-a-
c (a measure of blood sugars over the past three months) can
prevent problems.
Treatment is with the drugs mentioned above which release
insulin. An older drug has made a comeback, called metformin,
and it works slightly differently. It cannot be used in
patients at risk of kidney failure. It may actually prevent
this disease from occurring in high-risk patients. Acarbose
prevents the absorption of carbohydrates so as to prevent
high levels of sugar in the blood. Many times these drugs are
used in combinations.
Preventing this disease and its bad complications (leg
amputations and blindness are two of dreaded complications)
is basically through maintaining good weight control and
exercise. I believe these are not new messages from this
column. Write me in care of the Yated.
A message from Glaxo, sponsor of this column. Avandia
is the newest medication in the fight against diabetes and is
considered the next generation in controlling this disease.
It works totally differently than older drugs and results in
excellent control. From Glaxo.
