DIABETES
What is Diabetes?
Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Diabetes can be associated with serious complications such as organ damage to the heart, nerves, eyes, kidneys and other organs, and premature death, but persons with diabetes can take measures to reduce the likelihood of such occurrences.
Type 1 Diabetes was previously called Insulin-Dependent Diabetes Mellitus (IDDM) or juvenile-onset (early age of onset generally) Diabetes. Type 1 Diabetes accounts for only about 5% to 10% of all diagnosed cases of Diabetes. Risk factors are less well defined for type 1 Diabetes than for type 2 Diabetes, but autoimmune, genetic, and environmental factors or triggers are involved in the development of this type of Diabetes.
Type 2 Diabetes was previously called Non-Insulin Dependent Diabetes Mellitus (NIDDM) but now is generally referred to as Adult-Onset Diabetes. Type 2 Diabetes accounts for about 90% to 95% of all diagnosed cases of Diabetes. Risk factors for type 2 Diabetes include older age, obesity, family history of Diabetes, prior history of gestational Diabetes, impaired glucose tolerance, and physical inactivity (lack of exercise).
Gestational Diabetes develops in 2% to 5% of all pregnancies but generally disappears when a pregnancy is over. Obesity is also associated with higher risk. Women who have had Gestational Diabetes are at increased risk of later developing Type 2 Diabetes. In some studies, nearly 40% of women with a history of Gestational Diabetes go on to develop Type 2 Diabetes in the future. If you had Diabetes of Pregnancy it is therefore important to have at least annual follow-up and screening.
Complications of Diabetes:
Heart Disease: Heart disease is the major cause of Diabetes-related deaths. Adults with Diabetes have heart disease death rates about two to four times as high as that of adults without Diabetes.
Stroke: The risk of stroke is two to four times higher in people with Diabetes.
Hypertension: An estimated 60% to 65% of people with diabetes have Hypertension, which is high blood pressure as an illness.
Kidney Disease: Diabetes is the leading cause of end-stage kidney failure, accounting for about 40% of new cases.
Blindness: Diabetes is the leading cause of new cases of blindness in adults 20 to 70 years old. Diabetic retinopathy causes up to 24,000 new cases of blindness each year.
Nervous System Disease: About 60% to 70% of people with Diabetes have mild to severe forms of nervous system damage (which often includes impaired sensation or pain in the feet or hands, leading to foot ulcers and other complications, slowed digestion of food in the stomach, and other nerve problems). Severe forms of Diabetic nerve disease are a major contributing cause of lower extremity amputations due to its combined damage to the nerves and peripheral circulation. In the US for example, more than half of lower limb amputations in the United occur among people with Diabetes.
Dental Disease: Periodontal disease (a type of gum disease that can lead to tooth loss) occurs with greater frequency and severity among people with Diabetes.
Complications of Pregnancy: The rate of major congenital malformations in babies born to women with preexisting diabetes varies from 0% to 5% among women who receive preconception care to 10% among women who do not receive preconception care.
Other complications:
Diabetes can directly cause acute life-threatening events, such as states where the glucose and insulin become so unregulated that it can induce comas, life-threatening blood abnormalities. This happens when the Diabetes leads to consitions called Diabetic Ketoacidosis and Hyperosmolar Nonketotic Coma. Diabetic Ketoacidosis and Hyperosmolar Nonketotic Coma are medical conditions that can result from very high glucose levels, abnormalities in ou blood salts or electrolytes, and several other biochemical imbalances involved in uncontrolled Diabetes.
People with Diabetes are more susceptible to many other illnesses. For example, they are more likely to die of pneumonia, influenza, and other infections than people who do not have Diabetes.
Diagnosis of Diabetes:
There are now new diagnostic criteria for Diabetes. The routine diagnostic test for Diabetes is now a fasting plasma glucose (blood sugar) test. However, in certain clinical circumstances, physicians may choose to perform another test called an Oral Glucose Tolerance Test. This test is performed by administering 75 grams of glucose dissolved in water, then measuring the plasma glucose concentration at various times up to 3 hours later.
A confirmed fasting plasma glucose value of greater than or equal to 126 milligrams/deciliter (mg/dL) indicates a diagnosis of Diabetes. In the presence of symptoms of Diabetes, a confirmed nonfasting plasma glucose value of greater than or equal to 200 mg/dL indicates a diagnosis of Diabetes.
When a doctor chooses to perform an Oral Glucose Tolerance Test, a blood sugar level greater than or equal to 200 mg/dL after 2 hours indicates a diagnosis of Diabetes.
A fasting blood glucose level of >100 mg/ml, we now know, places an individual at risk and is considered "Pre-Diabetes". This individual should be followed more closely and important lifestyle changes made to delay or prevent the onset of actual Diabetes.
Treatment of Diabetes:
Treatment of Diabetes is aimed at keeping any Diabetic individual’s blood sugar near normal levels as much as possible and and all times. Training in self-management is integral to the treatment of Diabetes. Treatment must be individualized and must address medical, psychosocial, and lifestyle issues.
Treatment of Type 1 Diabetes: Type 1 Diabetes represents the complete or near-complete lack of insulin production by the pancreas and this aspect can make Type 1 Diabetes difficult to control. Treatment requires a regimen that includes a carefully calculated diet, planned physical activity, home blood glucose testing and multiple daily insulin injections.
Treatment of Type 2 Diabetes: Treatment includes exercise, diet control or Diabetic Diets, periodic home blood glucose testing, and most often various oral medications used alone or in combination. Sometimes individuals with Type 2 Diabetes can achieve better blood sugar control when some oral medications are combined with some forms of insulin. Approximately 40% of people with Type 2 Diabetes do require insulin injections.
Impaired fasting glucose or “Pre-Diabetes” is a new category in which persons have fasting plasma glucose values of 100-125 mg/dL. These glucose values are greater than the level considered normal but less than the level that is diagnostic of Diabetes. A siginificant number of such individuals with impaired fasting blood sugar will go on to develop Diabetes, although with proper lifestyle changes like diet and exercise, weight loss, the onest of Diabetes could be avoided or considerably dealyed.
What Is Insulin?
Within the organ called the pancreas, specialized cells called beta cells make the hormone insulin. With each meal, beta cells release insulin to help the body use or store the glucose it gets from the food we eat.
In people with Type 1 Diabetes, the beta cells have been destroyed and the pancreas no longer makes insulin. These patients almost always require insulin shots to manage glucose from meals. Insulin cannot be taken as a pill. It would be broken down during digestion just like the protein in food. Insulin must be injected into the fat under your skin for it to get into your blood
People with Type 2 Diabetes make insulin, but their bodies don't respond well to it. Some people with Type 2 Diabetes need to take oral medications for control of the Diabetes, or some times insulin shots to help increase their bodies use of glucose for energy.
There are many types of insulin products and regimens. These insulins differ in how they are made, how they work in the body, and in price. There are four major types of insulin and what determines their category is; how soon the insulin starts working (onset), when it works its greatest effect (peak time), and how long it lasts in your body (duration).
Oral Medications (pills) to treat type 2 diabetes; The first line treatment for Type 2 Diabetes is following a Diabetic Diet with good meal planning for blood glucose (sugar) control, achieving weight loss, and regular committed exercise programs. Often these measures are not enough to bring blood sugar down into the normal range. The next step is taking a medicine that lowers blood sugar levels. There are two kinds of medicines: oral medications (pills) and insulin shots
How do the Medications work?;
In people with Diabetes, blood sugar levels are too high. These high levels occur because glucose remains in the blood rather than entering cells, where it belongs. But for glucose to pass into a cell, insulin must be present, and the cell must be "hungry" for glucose.
Because people with Type 1 Diabetes no longer have beta cells, they cannot make make insulin. For these patients, insulin shots are the only way to keep blood sugar levels in control.
People with Type 2 Diabetes tend to have two problems. They don't make quite enough insulin, and the cells of their bodies don't seem to be sensitive to insulin and the cells therefore do not take in glucose as well as they should.
All Diabetes medications sold today are members of three classes of drugs. They work in different ways to lower blood sugar.
The first class of drugs stimulates the beta cells of the pancreas to release more insulin. These drugs are known as Sulfonylureas and another medication is Repaglinide as an example. You can ask you doctor for more detailed information on how these drugs work and are taken. These drugs can cause low blood sugare to occur (Hypoglycemia)
The second class of Diabetes drugs sensitizes the body to the insulin that is already present. Examples of this calss of medications are Glucophage (Metformin), which lowers blood sugar by helping insulin work better. It is usually taken two or three times a day. A side effect of metformin includes bloating which usually improves once you take the medication over time. Another set of medication in this class is called the Thiazolinedones--rosiglitazone, and pioglitazone. They help insulin work better in the muscle and fat. These medications however can lead to fluid retention, please consult your physician if you experience signs or symptoms of fluid retention.
The third class of oral drugs slows or blocks the breakdown of starches and certain sugars. Examples are Acarbose and Meglitol. They help the body lower blood sugar by blocking the breakdown of foods containing starches and therefore complex sugars, such as bread, potatoes, and pasta. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood sugar levels after a meal. They should be taken with the first bite of a meal. These drugs may have some side effects, including gas and diarrhea.
Written by Dr. Mark L. Siefring M.D.: Key Resourcing with some paraphrasing from UpToDate
What is Diabetes?
Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Diabetes can be associated with serious complications such as organ damage to the heart, nerves, eyes, kidneys and other organs, and premature death, but persons with diabetes can take measures to reduce the likelihood of such occurrences.
Type 1 Diabetes was previously called Insulin-Dependent Diabetes Mellitus (IDDM) or juvenile-onset (early age of onset generally) Diabetes. Type 1 Diabetes accounts for only about 5% to 10% of all diagnosed cases of Diabetes. Risk factors are less well defined for type 1 Diabetes than for type 2 Diabetes, but autoimmune, genetic, and environmental factors or triggers are involved in the development of this type of Diabetes.
Type 2 Diabetes was previously called Non-Insulin Dependent Diabetes Mellitus (NIDDM) but now is generally referred to as Adult-Onset Diabetes. Type 2 Diabetes accounts for about 90% to 95% of all diagnosed cases of Diabetes. Risk factors for type 2 Diabetes include older age, obesity, family history of Diabetes, prior history of gestational Diabetes, impaired glucose tolerance, and physical inactivity (lack of exercise).
Gestational Diabetes develops in 2% to 5% of all pregnancies but generally disappears when a pregnancy is over. Obesity is also associated with higher risk. Women who have had Gestational Diabetes are at increased risk of later developing Type 2 Diabetes. In some studies, nearly 40% of women with a history of Gestational Diabetes go on to develop Type 2 Diabetes in the future. If you had Diabetes of Pregnancy it is therefore important to have at least annual follow-up and screening.
Complications of Diabetes:
Heart Disease: Heart disease is the major cause of Diabetes-related deaths. Adults with Diabetes have heart disease death rates about two to four times as high as that of adults without Diabetes.
Stroke: The risk of stroke is two to four times higher in people with Diabetes.
Hypertension: An estimated 60% to 65% of people with diabetes have Hypertension, which is high blood pressure as an illness.
Kidney Disease: Diabetes is the leading cause of end-stage kidney failure, accounting for about 40% of new cases.
Blindness: Diabetes is the leading cause of new cases of blindness in adults 20 to 70 years old. Diabetic retinopathy causes up to 24,000 new cases of blindness each year.
Nervous System Disease: About 60% to 70% of people with Diabetes have mild to severe forms of nervous system damage (which often includes impaired sensation or pain in the feet or hands, leading to foot ulcers and other complications, slowed digestion of food in the stomach, and other nerve problems). Severe forms of Diabetic nerve disease are a major contributing cause of lower extremity amputations due to its combined damage to the nerves and peripheral circulation. In the US for example, more than half of lower limb amputations in the United occur among people with Diabetes.
Dental Disease: Periodontal disease (a type of gum disease that can lead to tooth loss) occurs with greater frequency and severity among people with Diabetes.
Complications of Pregnancy: The rate of major congenital malformations in babies born to women with preexisting diabetes varies from 0% to 5% among women who receive preconception care to 10% among women who do not receive preconception care.
Other complications:
Diabetes can directly cause acute life-threatening events, such as states where the glucose and insulin become so unregulated that it can induce comas, life-threatening blood abnormalities. This happens when the Diabetes leads to consitions called Diabetic Ketoacidosis and Hyperosmolar Nonketotic Coma. Diabetic Ketoacidosis and Hyperosmolar Nonketotic Coma are medical conditions that can result from very high glucose levels, abnormalities in ou blood salts or electrolytes, and several other biochemical imbalances involved in uncontrolled Diabetes.
People with Diabetes are more susceptible to many other illnesses. For example, they are more likely to die of pneumonia, influenza, and other infections than people who do not have Diabetes.
Diagnosis of Diabetes:
There are now new diagnostic criteria for Diabetes. The routine diagnostic test for Diabetes is now a fasting plasma glucose (blood sugar) test. However, in certain clinical circumstances, physicians may choose to perform another test called an Oral Glucose Tolerance Test. This test is performed by administering 75 grams of glucose dissolved in water, then measuring the plasma glucose concentration at various times up to 3 hours later.
A confirmed fasting plasma glucose value of greater than or equal to 126 milligrams/deciliter (mg/dL) indicates a diagnosis of Diabetes. In the presence of symptoms of Diabetes, a confirmed nonfasting plasma glucose value of greater than or equal to 200 mg/dL indicates a diagnosis of Diabetes.
When a doctor chooses to perform an Oral Glucose Tolerance Test, a blood sugar level greater than or equal to 200 mg/dL after 2 hours indicates a diagnosis of Diabetes.
A fasting blood glucose level of >100 mg/ml, we now know, places an individual at risk and is considered "Pre-Diabetes". This individual should be followed more closely and important lifestyle changes made to delay or prevent the onset of actual Diabetes.
Treatment of Diabetes:
Treatment of Diabetes is aimed at keeping any Diabetic individual’s blood sugar near normal levels as much as possible and and all times. Training in self-management is integral to the treatment of Diabetes. Treatment must be individualized and must address medical, psychosocial, and lifestyle issues.
Treatment of Type 1 Diabetes: Type 1 Diabetes represents the complete or near-complete lack of insulin production by the pancreas and this aspect can make Type 1 Diabetes difficult to control. Treatment requires a regimen that includes a carefully calculated diet, planned physical activity, home blood glucose testing and multiple daily insulin injections.
Treatment of Type 2 Diabetes: Treatment includes exercise, diet control or Diabetic Diets, periodic home blood glucose testing, and most often various oral medications used alone or in combination. Sometimes individuals with Type 2 Diabetes can achieve better blood sugar control when some oral medications are combined with some forms of insulin. Approximately 40% of people with Type 2 Diabetes do require insulin injections.
Impaired fasting glucose or “Pre-Diabetes” is a new category in which persons have fasting plasma glucose values of 100-125 mg/dL. These glucose values are greater than the level considered normal but less than the level that is diagnostic of Diabetes. A siginificant number of such individuals with impaired fasting blood sugar will go on to develop Diabetes, although with proper lifestyle changes like diet and exercise, weight loss, the onest of Diabetes could be avoided or considerably dealyed.
What Is Insulin?
Within the organ called the pancreas, specialized cells called beta cells make the hormone insulin. With each meal, beta cells release insulin to help the body use or store the glucose it gets from the food we eat.
In people with Type 1 Diabetes, the beta cells have been destroyed and the pancreas no longer makes insulin. These patients almost always require insulin shots to manage glucose from meals. Insulin cannot be taken as a pill. It would be broken down during digestion just like the protein in food. Insulin must be injected into the fat under your skin for it to get into your blood
People with Type 2 Diabetes make insulin, but their bodies don't respond well to it. Some people with Type 2 Diabetes need to take oral medications for control of the Diabetes, or some times insulin shots to help increase their bodies use of glucose for energy.
There are many types of insulin products and regimens. These insulins differ in how they are made, how they work in the body, and in price. There are four major types of insulin and what determines their category is; how soon the insulin starts working (onset), when it works its greatest effect (peak time), and how long it lasts in your body (duration).
Oral Medications (pills) to treat type 2 diabetes; The first line treatment for Type 2 Diabetes is following a Diabetic Diet with good meal planning for blood glucose (sugar) control, achieving weight loss, and regular committed exercise programs. Often these measures are not enough to bring blood sugar down into the normal range. The next step is taking a medicine that lowers blood sugar levels. There are two kinds of medicines: oral medications (pills) and insulin shots
How do the Medications work?;
In people with Diabetes, blood sugar levels are too high. These high levels occur because glucose remains in the blood rather than entering cells, where it belongs. But for glucose to pass into a cell, insulin must be present, and the cell must be "hungry" for glucose.
Because people with Type 1 Diabetes no longer have beta cells, they cannot make make insulin. For these patients, insulin shots are the only way to keep blood sugar levels in control.
People with Type 2 Diabetes tend to have two problems. They don't make quite enough insulin, and the cells of their bodies don't seem to be sensitive to insulin and the cells therefore do not take in glucose as well as they should.
All Diabetes medications sold today are members of three classes of drugs. They work in different ways to lower blood sugar.
The first class of drugs stimulates the beta cells of the pancreas to release more insulin. These drugs are known as Sulfonylureas and another medication is Repaglinide as an example. You can ask you doctor for more detailed information on how these drugs work and are taken. These drugs can cause low blood sugare to occur (Hypoglycemia)
The second class of Diabetes drugs sensitizes the body to the insulin that is already present. Examples of this calss of medications are Glucophage (Metformin), which lowers blood sugar by helping insulin work better. It is usually taken two or three times a day. A side effect of metformin includes bloating which usually improves once you take the medication over time. Another set of medication in this class is called the Thiazolinedones--rosiglitazone, and pioglitazone. They help insulin work better in the muscle and fat. These medications however can lead to fluid retention, please consult your physician if you experience signs or symptoms of fluid retention.
The third class of oral drugs slows or blocks the breakdown of starches and certain sugars. Examples are Acarbose and Meglitol. They help the body lower blood sugar by blocking the breakdown of foods containing starches and therefore complex sugars, such as bread, potatoes, and pasta. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood sugar levels after a meal. They should be taken with the first bite of a meal. These drugs may have some side effects, including gas and diarrhea.
Written by Dr. Mark L. Siefring M.D.: Key Resourcing with some paraphrasing from UpToDate