Diabetes Mellitus

Diabetes Mellitus Overview

noreply@blogger.com (sheril) — Thu, 17 May 2012 05:00:00 +0000

Diabetes Mellitus and Heart Disease

noreply@blogger.com (sheril) — Wed, 16 May 2012 12:48:00 +0000

Diabetes mellitus is hard enough to deal with in everyday life. Unfortunately, this disease leads to many other serious conditions, one of which is heart disease, which leads to a heart attack. This discusses the link between diabetes mellitus and heart disease.

What is the connection between diabetes mellitus, heart disease, and stroke?

If you have diabetes mellitus, you are at least twice as likely as someone who does not have diabetes mellitus to have heart disease or a stroke. People with diabetes mellitus also tend to develop heart attack or have strokes at an earlier age than other people. If you are middle-aged and have type 2 diabetes mellitus, some studies suggest that your chance of having a heart attack is as high as someone without diabetes mellitus who has already had one heart attack. Women who have not gone through menopause usually have less risk of heart disease than men of the same age. But women of all ages with diabetes mellitus have an increased risk of heart disease because diabetes mellitus cancels out the protective effects of being a woman in her child-bearing years.People with diabetes mellitus who have already had one heart attack run an even greater risk of having a second one. In addition,
heart attacks in people with diabetes mellitus are more serious and more likely to result in death. High blood glucose levels over time can lead to increased deposits of fatty materials on the insides of the blood vessel walls. These deposits may affect blood flow, increasing the chance of clogging and hardening of blood vessels (atherosclerosis).

Facts about diabetes mellitus

Cardiovascular disease is the major cause of death in diabetes mellitus, accounting for some 50% of all diabetes mellitus fatalities, and much disability.
On average, people with type 2 diabetes mellitus will die 5-10 years before people without diabetes mellitus and most of this excess mortality is due to cardiovascular disease.
People with type 2 diabetes mellitus are over twice as likely to have a heart attack or stroke as people who do not have diabetes mellitus. Indeed, people with type 2 diabetes mellitus are as likely to suffer a heart attack as people without diabetes mellitus who have already had a heart attack.
Strokes occur twice as often in people with diabetes mellitus and hypertension as in those with hypertension alone.
People with diabetes mellitus are 15-40 times more likely to have a lower limb amputation compared to the general population.
People with diabetes mellitus have two to four times the risk of developing atherosclerosis compared to people without diabetes mellitus.
The treatment of cardiovascular disease accounts for a large part of the huge healthcare costs attributable to type 2 diabetes mellitus, that have been estimated to account for 10-12% of European health care expenditure.
Part of the cardiovascular risk associated with IGT and diabetes mellitus is undoubtedly due to their association with other cardiovascular risk factors such as hypertension, high LDL-cholesterol and low HDL-cholesterol and smoking.
Lifestyle changes that improve blood glucose control e.g. weight loss, dietary changes and increased physical activity are also likely to improve these other cardiovascular risk factors.

What are the risk factors for heart disease and stroke in people with diabetes mellitus?

Diabetes mellitus itself is a risk factor for heart disease and stroke. Also, many people with diabetes mellitus have other conditions that increase their chance of developing heart disease and stroke. These conditions are called risk factors. One risk factor for heart disease and stroke is having a family history of heart disease. If one or more members of your family had a heart attack at an early age (before age 55 for men or 65 for women), you may be at increased risk.
You can't change whether heart disease runs in your family, but you can take steps to control the other risk factors for heart

disease listed here:

Having central obesity.

Central obesity means carrying extra weight around the waist, as opposed to the hips. A waist measurement of more than 40 inches for men and more than 35 inches for women means you have central obesity. Your risk of heart disease is higher because abdominal fat can increase the production of LDL (bad) cholesterol, the type of blood fat that can be deposited on the inside of blood vessel walls.

Having abnormal blood fat (cholesterol) levels.

LDL cholesterol can build up inside your blood vessels, leading to narrowing and hardening of your arteries-the blood vessels that carry blood from the heart to the rest of the body. Arteries can then become blocked. Therefore, high levels of LDL cholesterol raise your risk of getting heart disease.
Triglycerides are another type of blood fat that can raise your risk of heart disease when the levels are high.
HDL (good) cholesterol removes deposits from inside your blood vessels and takes them to the liver for removal. Low levels of HDL cholesterol increase your risk for heart disease.

Having high blood pressure.

If you have high blood pressure, also called hypertension, your heart must work harder to pump blood. High blood pressure can strain the heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems.

Smoking.

Smoking doubles your risk of getting heart disease. Stopping smoking is especially important for people with diabetes mellitus because both smoking and diabetes mellitus narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in your legs and increase the risk of amputation.

How to minimise the Risk of Heart Disease

People who have diabetes mellitus that goes undetected and untreated face an increased risk for heart disease because atherosclerosis may occur at earlier-than-expected ages and more sever in diabetics. People who have diabetes mellitus-related atherosclerosis in their coronary arteries sometimes suffer what is called “silent ischemia” or silent heart attack. Silent, in this case, means without typical pain because neuropathy, or nerve damage, is a result of uncontrolled diabetes mellitus. These people will not feel many sensations of touch, vibration, heat, cold or pain, and this may also include the expected pain of a heart attack. The resulting vague -- instead of acute -- symptoms may be ignored, or passed off as indigestion or stomach upset. When there is damage to the autonomic nervous system, signals that should be sent to the brain to regulate heart rate and blood pressure are blocked.

Early diagnosis and learning how to monitor and control the disease are key to avoiding complications down the road. Some experts suggest that the course of this disease can be changed when patients:

Adopt a good attitude
Are committed to doing what is necessary to learn about their condition and its treatment, and
Make a conscious decision to control the disease instead of allowing the disease to control them.

Diabetics respond to almost the same health regimen that helps heart patients recover. A closely monitored and controlled diet that involves reducing the intake of sugar and fats, and increasing the amounts of complex carbohydrates and fiber; weight control and smoking cessation; and a regularly performed aerobic exercise routine can be critical to both groups.

A specially tailored exercise regimen can lower triglycerides and blood glucose, heighten sensitivity to insulin and lower blood pressure. When a person begins aerobic exercise, muscle glycogen is the primary fuel. After five to 10 minutes, glucose uptake from blood is seven to 20 times the resting rate, depending upon how strenuous the exercise is and diabetics can benefit from this uptake.

If you are over 40 and notice any vague symptoms -- fatigue, constant thirst, excessive urination, transient blurred vision, or even that minor skin injuries take a long time to heal -- make an appointment with you physician. If there are other diabetics in your immediate family or if you are more than 20 percent over your ideal body weight, schedule a physical examination as soon as possible.

There is no cure for diabetes mellitus, but with careful monitoring and commitment, diabetics can avoid complications and enjoy a long, productive life. Making an equally important commitment to reduce the risks of cardiovascular disease can help make this possible.

Diabetic Nephropathy

noreply@blogger.com (sheril) — Sat, 12 May 2012 08:03:00 +0000

Nephropathy means kidney disease or damage. Diabetic nephropathy is damage to your kidneys caused by diabetes mellitus. In severe cases it can lead to kidney failure. But not everyone with diabetes mellitus has kidney damage.

Diabetic nephropathy (DN) is typically defined by macroalbuminuria—that is, a urinary albumin excretion of more than 300 mg in a 24-hour collection—or macroalbuminuria and abnormal renal function as represented by an abnormality in serum creatinine, calculated creatinine clearance, or glomerular filtration rate (GFR). Clinically, diabetic nephropathy is characterized by a progressive increase in proteinuria and decline in GFR, hypertension, and a high risk of cardiovascular morbidity and mortality.

How does Diabetes Mellitus cause Nephropathy

When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood.

Diabetes mellitus can damage this system. High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak and useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria.

When diabetic nephropathy is diagnosed early, (during microalbuminuria), several treatments may keep diabetic nephropathy from getting worse. Having larger amounts of protein in the urine is called macroalbuminuria. When diabetic nephropathy is caught later (during macroalbuminuria), end-stage renal disease, or ESRD, usually follows.

In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. This failure, ESRD, is very serious. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis).

who gets diabetic nephropathy?

There are several factors that can increase your risk of developing diabetic nephropathy. These include:

Having chronically elevated blood sugar levels
Being overweight or obese
Smoking
Having a diabetes mellitus-related vision problem (diabetic retinopathy) or nerve damage (diabetic neuropathy)
Having a family history of diabetic nephropathy or belonging to certain ethnic groups (African American, Mexican, Pima Indian) can also increase your risk of diabetic nephropathy.

But the factors listed above are the ones you can do something about.

Signs and symptoms of Diabetic Nephropathy

Early signs and symptoms of diabetic nephropathy in patients with diabetes mellitus are typically unusual. However, a vast array of signs and symptoms listed below may manifest when diabetic nephropathy has progressed:

Albumin or protein in the urine
High blood pressure
Ankle and leg swelling, leg cramps
Going to the bathroom more often at night
High levels of blood urea nitrogen (BUN) and serum creatinine
Less need for insulin or antidiabetic medications
Morning sickness, nausea, and vomiting
Weakness, paleness, and anemia
Itching

The differential diagnosis of diabetic nephropathy is vast, but includes the following in a patient with known diabetes mellitus:

Primary or secondary glomerular disease
Nephrosclerosis
Renovascular hypertension
Renal artery stenosis
Renal vein thrombosis
Multiple myeloma
Cholesterol embolization
Chronic obstruction
Interstitial nephritis
Amyloidosis

How is diabetic nephropathy diagnosed?

The problem is diagnosed using simple tests that check for a protein called albumin in the urine. Urine does not usually contain protein. But in the early stages of kidney damage-before you have any symptoms-some protein may be found in your urine, because your kidneys aren't able to filter it out the way they should.

Finding kidney damage early can keep it from getting worse. So it’s important for people with diabetes mellitus to have regular testing.

If you have type 1 diabetes mellitus, get a urine test every year after you have had diabetes mellitus for 5 years.

If your child has diabetes mellitus, yearly testing should begin when your child is 10 years old and has had diabetes mellitus for 5 years.

If you have type 2 diabetes mellitus, start yearly testing at the time you are diagnosed with diabetes mellitus.

Can I prevent Diabetic Nephropathy?

Diabetic nephropathy can be prevented by keeping blood sugar in your target range. Research has shown that tight blood sugar control reduces the risk of microalbuminuria by one third. In people who already had microalbuminuria, the risk of progressing to macroalbuminuria was cut in half. Other studies have suggested that tight control can reverse microalbuminuria.

How can i treat Diabetic Nephropathy?

People with diabetes mellitus often focus on keeping their blood sugar levels in the right ranges. And while it is important to control blood sugar, it turns out that controlling blood pressure is at least as important. That's because high blood sugar and high blood pressure work in concert to damage the blood vessels and organ systems. (See "Treatment of diabetic nephropathy".)

For these reasons, the most important things you can do to stall diabetic nephropathy and protect against other diabetes mellitus complications are to:

Make healthy lifestyle choices
Keep your blood sugar as close to normal as possible (see 'Manage blood sugar levels' below).
Keep your blood pressure below 130/80, if possible (see 'Manage high blood pressure' below).
Lifestyle changes — Changing your lifestyle can have a big impact on the health of your kidneys. The following measures are recommended for everyone, but are especially important if you have diabetic nephropathy:
Limit the amount of salt you eat (see "Patient information: Low sodium diet (Beyond the Basics)")
If you smoke, quit smoking (see "Patient information: Quitting smoking (Beyond the Basics)")
Lose weight if you are overweight (see "Patient information: Diet and health (Beyond the Basics)" and "Patient information: Exercise (Beyond the Basics)" and "Patient information: Weight loss treatments (Beyond the Basics)")

Manage blood sugar levels — Keeping blood sugars close to normal can help prevent the long-term complications of diabetes mellitus. For most people, a target for fasting blood glucose and for blood glucose levels before each meal is 80 to 120 mg/dL (4.4 to 6.6 mmol/L); however, these targets may need to be individualized. (See "Patient information: Self-blood glucose monitoring in diabetes mellitus (Beyond the Basics)".)

A blood test called A1C is also used to monitor blood sugar levels; the result provides an average of blood sugar levels over the last one to three months. An A1C of 7 percent or less is usually recommended; this corresponds to an average blood glucose of 150 mg/dL (8.3 mmol/L) (table 1). Even small decreases in the A1C lower the risk of diabetes mellitus-related complications to some degree.

Manage high blood pressure — Many people with diabetes mellitus have hypertension (high blood pressure). Although high blood pressure causes few symptoms, it has two negative effects: it stresses the cardiovascular system and speeds the development of diabetic complications of the kidney and eye. A healthcare provider can diagnose high blood pressure by measuring blood pressure on a regular basis. (See "Patient information: High blood pressure in adults (Beyond the Basics)".)

The treatment of high blood pressure varies. If you have mild hypertension, your healthcare provider may recommend weight loss, exercise, decreasing the amount of salt in the diet, quitting smoking, and decreasing alcohol intake. These measures can sometimes reduce blood pressure to normal. (See "Patient information: High blood pressure, diet, and weight (Beyond the Basics)".)

If these measures are not effective or your blood pressure needs to be lowered quickly, your provider will likely recommend one of several high blood pressure medications. Your provider can discuss the pros and cons of each medication and the goals of treatment. (See "Patient information: High blood pressure treatment in adults (Beyond the Basics)".)

A blood pressure reading below 130/80 is the recommended goal for most people with diabetic nephropathy.

Blood pressure medications — Most people with diabetic nephropathy need at least one medication to lower their blood pressure. Several medications can be used for this purpose, but a medication known as an angiotensin converting enzyme inhibitor (abbreviated ACE inhibitor) or a related drug known as an angiotensin receptor blocker (ARB) are used most commonly. ACE inhibitors are generally used first because they have been available longer than ARBs.

ACE inhibitors and ARBs are particularly useful for people with diabetic nephropathy because they decrease the amount of protein in the urine and can prevent or slow the progression of diabetes mellitus-related nephropathy. In fact, the kidney benefits of ACE inhibitors and ARBs are so robust that healthcare providers sometimes prescribe them for people with diabetic nephropathy who have normal blood pressure.

Still, despite their kidney-protecting abilities, ACE inhibitors and ARBs do have their downsides. For instance, ACE inhibitors cause a persistent dry cough in 5 to 20 percent of the people who take them. Some people get used to the cough; others find it so disruptive that they cannot continue taking an ACE inhibitor. For them, ARBs are often a good alternative, because ARBs are less likely to cause a cough.

In rare cases, you can have more serious side effects with ACE inhibitors and ARBs. These include a decrease in kidney function or a condition called hyperkalemia, in which too much potassium accumulates in the blood. To monitor for these and other side effects, healthcare providers sometimes run blood tests soon after starting these drugs. In some people, the medications will need to be stopped.

More information on the risks and side effects of ACE inhibitors and ARBs is available (see "Major side effects of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers").

Monitor for signs of change — After beginning treatment and lifestyle changes to stall diabetic nephropathy, you will need to have repeat urine and blood tests to determine if urine protein levels have improved. If the urine protein levels have not improved or your kidney function has worsened, your healthcare provider may need to adjust your medications or recommend other strategies to protect your kidneys.

Kidney Failure

Once kidneys fail, dialysis is necessary. The person must choose whether to continue with dialysis or to get a kidney transplant. This choice should be made as a team effort. The team should include the doctor and diabetes mellitus educator, a nephrologist (kidney doctor), a kidney transplant surgeon, a social worker, and a psychologist.

Pregnancy and Diabetic Nephropathy

If you have diabetes mellitus and are interested in getting pregnant, it is important to talk with your healthcare provider well in advance, especially if you have diabetic nephropathy. Diabetes mellitus and its attendant problems can increase the risk of complications in pregnancy, especially in women with decreased kidney function. However, many women with mild diabetic nephropathy have normal pregnancies and healthy babies.

To ensure the best outcome with a pregnancy, the most important thing you can do is to keep your blood sugar and blood pressure under tight control. However, women who are pregnant or attempting to get pregnant should not take ACE inhibitors or ARBs, as these drugs can cause birth defects. Instead, other medications (such as calcium channel blockers) are used during pregnancy to keep the blood pressure in check.

Diabetes Mellitus

noreply@blogger.com (sheril) — Fri, 11 May 2012 09:42:00 +0000

Diabetes mellitus ; Why to read this article ?

Before reading this diabetes mellitus article, you should know why to read this article. this article is written to make you aware of deadly disease called diabetes mellitus and warn you to take care this.
Diabetes mellitus is a serious syndrome ( group of disease ) that kills many people than other deadly disease like AIDS cancer. About 2.8 % (171 million) of worlds population is affected by diabetes mellitus in 2000 and expected to be about 4.4 % ( 366 million ) in 2030. diabetes mellitus is a common disease in US. Over 16 million Americans already caught diabetes mellitus. About 5.4 million people people who caught diabetes mellitus are still not aware of their existing disease. Diabetes mellitus is one of the main criteria of death in US. Also Diabetes mellitus is the primary reason for adult blindness and Major renal disease, gangrene and amputation. The patient with diabetes mellitus are four times more likely to have coronary heart disease and stroke.
This diabetes mellitus article deals with understanding of diabetes mellitus. Understanding is the major step for the treatment and prevention of diabetes mellitus. This diabetes mellitus article also deals with precaution to control and exaduate the diabetes mellitus completely.

Diabetes Mellitus

Diabetes mellitus not a disease, It is a syndrome which means group of disease. understanding of diabetes mellitus is necessary before treating and start taking medicines.
Diabetes mellitus simply referred to as diabetes is a metabolic syndrome charecterised by high blood sugar (glucose) level. Metabolism referred to the way our body use digested food for the production of energy. The food we eat is digested to carbohydrate, protein, fat etc. The food that affect blood sugar (glucose) level is carbohydrates. eg: bread, rice, potato, corn, milk products etc. Generally those carbohydrates are then digested (broken down) into glucose (blood sugar). Glucose then enter the blood circulation. Blood doesn't need the glucose. Our body (cells) needs the glucose for the production of energy. Insulin is necessary for the transport of glucose from the blood into cells. Insulin is a hormone produced by beta cells of islets of Langerhans ( group of endocrine cells ) of pancreas. After eating the food, pancreas automatically release an adequate amount of insulin to move the glucose present in our blood to the cell. So a healthy pancreas adjust the amount of insulin based on the level of glucose in the blood, hence lower the blood glucose level and thereby cells get the glucose they wanted for the production of energy
Insulin is the only hormone which helps in the transport of glucose into the cell. That is insulin helps in the uptake of glucose by the cell for the production of energy they needed. Think of what happens when pancreas stops the production of insulin, what happens when pancreas does not produce enough insulin that is needed or what happens when the insulin produced does not respond (cells become resistant to insulin). No doubt, the result is too much glucose in the blood (hyperglycemia). Even though the blood has plenty of glucose the cells are not getting it for their essential energy and growth requirement. This condition is called as Diabetes Mellitus. Now do you understand how serious the disease is ?
The high glucose level produce classic symptoms of polyuria (frequent urination), polydipsia ( increased thirst ) and polyphagia (increased hunger). We deal with it later
In the ancient world, diabetes mellitus is first identified as a disease associated with sweet urine and excessive muscle loss. Diabetes mellitus is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime.

Types of Diabetes Mellitus

Symptoms of Diabetes Mellitus

Symptoms of diabetes mellitus is caused by high blood glucose level in blood (hyperglycemia). The signs and symptoms of diabetes mellitus is more likely the same for both type 1 and type 2 diabetes mellitus because the cause of symptoms of diabetes mellitus is high blood glucose level either due to no production of insulin or insulin resistance. The occurance of diabetes mellitus can be identified through certain signs and symptoms. These symptoms are quickly relieved once the diabetes mellitus treated and also can reduce the risk of developing various health problems. Hence you should start treatment for diabetes mellitus once the symptoms has been seen and diagnosed diabetes mellitus to avoid the its complications.
Type 1 diabetes mellitus is caused by the destruction of beta cells (cells which produce insulin) of islet of Langerhans (group of endocrine cells) of pancreas which may due to auto immune disorder (immune system attacking the host cell) or due to any viral infection of the cell. Whatever the cause is, no insulin or no enough insulin. So glucose from the blood could not enter the cell for their energy production. This cause primary symptoms of nausea and vomiting. In the later stage it leads to diabetic ketoacidosis. Since the cells are not getting any glucose for their energy, they start breaking down fat and muscle tissue for their energy causing fast weight loss. Due to electrolyte imbalance, dehydration is observed. If left untreated, in advanced stage coma and death is witnessed.
Type 2 diabetes mellitus is caused by insulin resistance (body cells do not respond to insulin). The result is hyperglycemia. Major symptoms are..

Increased fatigue: In diabetes mellitus, glucose could not enter the cell. hence blood has too much glucose and body cells lack glucose. glucose is the main source of energy to cell. this means that cells lack energy or they are in a starving stage. since we have no produced energy to do work, we feel tired (fatigue) while doing work

Polyuria: Do you know what is the function of kidney ? it is not only excretion but also reabsorption. Kidney excrete substance like urea and reabsorb substance like glucose that reaches the kidney through blood. So what happens when glucose level in blood is too high above the maximum level that kidney can reabsorb (renal threshold). Of course the glucose is lost through urine. To excrete glucose, more water is used. So along with glucose more water is lost trough urine and frequent urination is seen.

Polydipsia(increased thirst): As explained above when large amount of water is lost through urine, our body loss large amount of fluid and high amount of glucose in blood increases the osmolarity. In order to maintain osmolarity, brain stimulates and we feel thirst

Polyphagia(increased hunger): In diabetes mellitus, cells are not getting any glucose. So they lack energy and brain get stimulated and we feel hunger

Blurry vision: When blood glucose level is increased too high, osmolarity of blood is also increased which results in the suction of water from the body including the lens to dilute the blood (maintain normal osmolarity). It affects the shape of lens and leads to blurry vision. If left untreated, it may lead to double vision, cloudy vision, retinal detatchment and even cause blindness.

Slow healing of wounds: Wound of a person with diabetes mellitus heals slowly. here are the reasons
poor circulation : If you have diabetes mellitus for a long time, your arteries will be more probably deposited with fat which slows down blood flow causing poor circulation. For healing of a wound, oxygen and healing nutrients are essential whose supply is limited by poor circulation.
Immune system issues: To heal a wound, dead and damaged tissue has to clear away and have to build new skin cells. This is done by immune system. The immune system does not work effectively in a person with diabetes mellitus.

Infections: When there is diabetes mellitus, our body gives few signs by frequent skin infection like fungal, bacterial, and urinary tract infection. Women with diabetes mellitus find it especially difficult to recover from bladder or vaginal infection. This infections are caused due to depression of the immune system

Irritability: Irritability is a common sigh of diabetes mellitus because of the inefficient glucose supply to brain and other organ which makes us feel tired and uneasy

Dry skin: Diabetes mellitus cause dry and itchy skin which may result from peripheral diabetic neuropathy which affects circulation and proper functioning of sweat glands.

Tingling hands and feet: Diabetes mellitus damages blood vessels and nerves which leads to loss of sensation in the hands and feet

Headache

If above symptoms are identified, then you should consult a doctor and start treatment as early as possible. the doctor will advice you to follow an active life style that includes exercise on a daily basis as well as healthy eating plan and if needed prescribes you diabetes mellitus medicines.

Causes of Diabetes Mellitus

The real cause of diabetes mellitus is uncertain, although certain contributing factors are as follows.

Cause of type 1 Diabetes Mellitus

Type 1 diabetes mellitus is caused by the destruction of cells in pancreas that produce insulin results in the severe lack of insulin. It is an autoimmune disease. researchers believe that some of the etiology and risk factors which trigger type 1 diabetes mellitus are

Infection with a specific virus or bacteria
Exposure to chemical toxins in food
Exposure as a young infant to cow's milk where an unidentified component stimulates autoimmune reaction in the body

In most of the cases diabetes mellitus occurs because there is abnormal secretion of some hormones in the blood which acts antagonistic to insulin. eg: adrenocortical hormone, adrenaline hormone, thyroid hormone etc

Cause of type 2 Diabetes mellitus

Type 2 diabetes mellitus develops usually in middle age. 90 - 95 % people people suffering from diabetes mellitus are type 2 diabetes mellitus and about 80 % people with diabetes mellitus are overweight. Type 2 diabetes mellitus is believed to develop when receptors of the cells which helps in the transport of glucose from blood to cell fails to respond to insulin (insulin resistance). So more insulin is produced and this overproduction exhaust the insulin producing beta cells in pancreas.

Type 2 diabetes mellitus is most common in people who are

Older
Obese
Having a family history of diabetes mellitus
Have had gestational diabetes mellitus

Following are the causes of diabetes mellitus...

Hereditary:

It is believed that some genes (responsible for diabetes mellitus) may transfer from one generation to another and may inherit diabetes mellitus. It depends upon the closeness of blood relationship. That is if you have a parent, brother or sister with diabetes mellitus, there is a chance for developing diabetes mellitus to you too.

Age:

Person with increased age are more prone to develop diabetes mellitus than young. Diabetes mellitus can develop at any age, but 80 % of diabetes mellitus occur after 50 yrs. Incidence of diabetes mellitus increase with age factor.

Poor diet:

Improper nutrition, higher use of refined products and low intake of proteins and fibers are expected reason for developing diabetes mellitus.

Obesity and Fat deposition:

The person with obesity are prone to develop diabetes mellitus. About 80 % of people with diabetes mellitus are overweight. Being overweight means increased insulin resistance. A person with body fat more than 30 % of BMI, waist grith 35 inches in women or 40 inches in male are prone to diabetes mellitus.

Sedentary life style:

People with a sedentary life style are at a risk of developing diabetes mellitus when compared to those people who exercise thrice a week.

Stress:
Either a physical injury or an emotional disturbance may be an initial cause of diabetes mellitus. This is explained as any disturbance in corticosteroid hormone or ACTH therapy may lead to clinical signs of diabetes mellitus.

Drug induced:

Drugs such as clozapine (clozaril), olanzapine (zyprexa), risperidone (risperdal), induce diabetes mellitus. Drugs such as steroids, dilantin and other may elevate blood sugar level through some mechanism and induce diabetes mellitus. Drugs such as alloxan, thiazide diuretics, streptozocin are toxin to beta cells of pancreas and induce diabetes mellitus.

Associated with other disease:

Certain syndromes like prader-willi, down, progeria and turners syndrome may result in hyperglycemia and if this state prolonged may result in diabetes mellitus.

Infection:

Certain infections to pancreas can induce diabetes mellitus.

Sex:

Diabetes mellitus is commonly seen in elderly males than in females, but diabetes mellitus is more stronger in females than in males especially those females with poly cystic ovarian syndrome (PCOS) or multiple pregnancy.

Hypertension:

Many studies proved that people with high systolic pressure are prone to diabetes mellitus.

Serum lipids and lipoproteins:

Person with high triglyceride and cholesterol level in blood are more likely to develop diabetes mellitus. In some cases it has been studied that risk is involved even with low HDL level in circulating blood.

This doesn't means that you will develop diabetes mellitus if you have these factors. These are the factors that cause diabetes mellitus. The more risk factors you have, the more likely you develop diabetes mellitus

Complications of Diabetes Mellitus

When we crossed the reversible stage of diabetes mellitus (prediabetes) and enters the diabetes stage, there develops certain changes in the body. These changes occur due to untreated diabetes mellitus and improper hormone balance. When these changes kept untreated, it become permanent and leads to certain diabetes mellitus complications. Diabetes mellitus complications begins because of blood vessel and nerve damage caused due to high blood sugar, prolonged diabetes mellitus high cholesterol level and high blood pressure. Nerve damage of the respective organ is the root cause of complications of diabetes mellitus.
The complications are

Diabetic retinopathy is caused due to blood vessel damage in the retina causing poor circulation and lack of oxygen to nourish the retina and also in extreme cases leakage of blood in to retina can cause loss of vision. pain in eye is the man symptom shown by diabetic retinopathy in the initial stage.
Uncontrolled diabetes mellitus can damage the nerves in your body causing diabetic neuropathy. Diabetic neuropathy cause tingling, numbness, tightness, burning,shooting or stabbing pain in feet, hand or other body parts especially at night
Diabetic nephropathy (diabetic kidney disease) is caused by damage of small vessels to kidney due to untreated diabetes mellitus. Diabetic nephropathy shows symptoms edema (swelling) in feet and legs. It then passes over the total body and as the disease progress, blood pressure is also increased.
Heart disease, stroke, and heart attack are caused by blockage of blood vessels to heart. The blockage results in lack of oxygen to heart tissue. Symptoms like chest pain (angina) , shortness of breath, dizziness or light headache, stomach or shoulder pain, fast heart beat are seen in diabetes heart disease. You might not show any symptoms until having a stroke or heart attack.
Diabetic gastroparesis is a disorder in which stomach takes too much time to empty its contents. It is caused due to damage of nerves supplying the stomach.
Erectile dysfunction is also seen in association with diabetes mellitus caused due to damage of nerves to penis.
Urinary tract infection is caused in diabetes mellitus due to nerve damage, but the main cause is due to gastroparesis where there is a delay in emptying the stomach content which in turn increases bacterial growth and cause infection. Due to high blood glucose, immune system does not work well and it is not able to fight the infection.

Diabetic retinopathy Diabetic neuropathy

Diabetic nephropathy

care of Diabetes mellitus

Diabetes mellitus is a tough disease to handle. the reason is

Cause of diabetes mellitus is not well known
Diabetes mellitus is difficult to prevent
Once you got diabetes mellitus, it is not possible to cure it completely and you need to take care of your health for the entire life

Diabetes mellitus care is a lifelong responsibility.

Diabetes mellitus care tips

If you are a person with diabetes mellitus, you need some precaution in your day to day life

Monitor your blood glucose level regularly. Depending on the severity of your diabetes mellitus, your doctor will tell you the time interval
Should take regular doses of medicines or insulin as prescribed.
Regular exercise has been proven in controlling blood glucose level. But certain exercise are known to cause to some diabetes mellitus complications like hypoglycemia, cardiovascular disease
In case you feel hypoglycemia (blood glucose level drops) after exercise, you should consume some drinks which supply sugar like a fruit juice.
Weight reduction is the most important step in managing diabetes mellitus. Obesity is directly related to insulin resistance. So take all steps to reduce your weight.
Don't smoke: smoking and using other type of tobacco increase your risk to various diabetes mellitus complications including heart attack, stroke, nerve damage and kidney disease. In fact smokers with diabetes mellitus are three times likely to die due to cardiovascular disease than non smokers who have diabetes mellitus
Keep your cholesterol and blood pressure under control. Like diabetes mellitus high blood pressure can damage your blood vessels. High cholesterol is a concern too. When you have diabetes mellitus along with blood pressure, the damage will be more severe, rapid and leads to heart attack, stroke or other life threatening conditions. Having a regular exercise and a healthy eating habit can go a long way towards controlling high cholesterol level and blood pressure. sometimes medicines are needed.
If you are suffering from diseases like flu, cold or any other infection, some extra care is needed to be taken to avoid further complications of diabetes mellitus
The diseases or infection may force some changes in your diet. Consult a doctor for assistance
Keep your vaccine up to date: Diabetes mellitus can suppress the immune system of our body which makes routine vaccine more important.
Drink lots of water and other other clear liquids.
Even if you are not feeling hungry, don't cut your food.
Take care of your teeth: Diabetes mellitus make you prone to gum infection. Brush your teeth atleast twice a day and a dental check up atleast twice a year. Consult your dentist right away if your gum looks red or swollen or bleeds.
Pay attention to your feet: Prolonged diabetes mellitus can cause damage the nerves in your feet and reduce blood flow to your feet. If left untreated can cause cuts and blusters that can lead to serious infections (diabetic foot)
Consider a aspirin daily: Aspirin reduce the bloods ability to clot. Taking a daily aspirin can reduce the complications of diabetes mellitus related to heart. Ask your doctor about it including the strength of aspirin if needed.
Consult your doctor if you are feeling abnormal in many manner. If you are feeling excessive sleepy, trouble with urination, giddiness etc

Even though diabetes mellitus is a chronic disease, it doesn't means that you have to avoid every acts you enjoyed once you are caught with diabetes mellitus. You can have all the fun provided you should take some precautions. Diabetes care is within your control. If you are willing to do your part, diabetes mellitus wont stand in your way of active, healthy life.

Can Diabetes mellitus be cured ?

You might heard in many books and sites that " Diabetes mellitus cannot be cured". If i repeat the same here, it will be lie. Yes, diabetes mellitus can be cured. Before dealing with it, listen why to cure diabetes mellitus.
Diabetes mellitus is very serious disease. If you ignore it, it leads to many complications and may end in death too. About 70 - 75 % death in patients with diabetes mellitus is due to cardiovascular diseases which is the main complication of diabetes mellitus and acute myocardial infarction is responsible for 30 % of above cases. Diabetes mellitus doubles the heart attack chance in males and even triple in women. Prolonged diabetes mellitus and diabetes mellitus in elderly person are more like to develop silent myocardial infarction (painless heart attack) with increased chance of death. It has been estimated by diabetic specialist that chronic diabetes mellitus shortens a persons lifespan by an average of 13.5 years.
Now you know why to cure diabetes mellitus. lets talk about how to cure it. In case of type 1 diabetes mellitus, doctors prescribe you insulin to decrease your blood glucose level. Let me tell you one thing. These medications cant cure your diabetes mellitus. It can only decrease your blood glucose level and thereby preventing complications of diabetes mellitus. To cure your type 1 diabetes mellitus, your body should produce insulin. Pancreas transplantation is a permanent treatment for type 1 diabetes mellitus and it is successful in many cases. About 400 - 500 pancreas transplants are performed in US per year.
In case of type 2 diabetes mellitus, medications cant cure your diabetes mellitus. It is possible to cure type 2 diabetes mellitus too. It will be discussed later in the treatment of diabetes mellitus.

Prevention of Diabetes Mellitus

Prevention is proven to be the most effective and powerful method to fight against diabetes mellitus. More than 50 % of diabetes is caused by inappropriate lifestyle. Changing your lifestyle could be a big step towards the prevention of diabetes mellitus.
In type 2 diabetes mellitus, prevention is a big deal. It is important to prevent type 2 diabetes mellitus if you are at increased risk of diabetes mellitus. eg: if you are overweight and a family history of diabetes mellitus.
Prevention of diabetes mellitus is very simple by eating more healthfully, becoming more physically active, losing a few extra pounds, making a few simple steps in your lifestyle may prevent complications of diabetes mellitus such as heart disease, nerve, eye disease and kidney damage.

Tips to prevent Diabetes Mellitus

Get more physical activity: there are many benefits if you do daily exercise like loss weight, lower your blood sugar and boost your sensitivity to insulin. Losing 10 % of initial body weight and regular exercise can immensely reduce the risk of diabetes mellitus.

Get plenty of fibers: fibers helps to

Improve your blood sugar control and reduce your risk to diabetes mellitus
Lower your risk of cardiovascular disease.
Lose weight by helping you feel full

foods high in fibers includes vegetables, fruits, seeds, whole grans etc.

Go to whole grains: whole grains reduce you risk of diabetes mellitus and help to maintain blood sugar level. Try to make atleast half your grains to whole grains.

Lose extra weight: If you are obese, it means you are in high risk of diabetes mellitus. that is overweight is directly related to obesity. Hence diabetes prevention hinge on weight loss. Studies revealed that overweight adult reduce their diabetes risk by 16 % for every kilo gram (2.2 pounds) of weight loss.

Management of Diabetes mellitus

The theme of management of diabetes mellitus is to control blood sugar level. Keeping your blood sugar level with a target range can help not only to prevent complications of diabetes mellitus but also to live a long and healthy life. If you are obese, you need to reduce your body weight so that insulin works better. Do you know what makes your blood sugar level rise and fall. They are

Food

Healthy eating is the main step towards the management of diabetes mellitus. The blood sugar level is affected by not only what you eat but also when you eat and how much you eat.
Tips to Manage Diabetes Mellitus through Food

Eat several meals a day or eat healthy snacks at regular times every day
Makes every meal well balanced. That is every meal must have the right mix of starches, fruits, vegetables, proteins and fats
Coordinate your meals and medications: Too much food in comparison with your diabetes mellitus medicines especially insulin may cause your blood sugar level climb too high (hyperglycemia) and too little food in comparison with insulin may result in dangerously low blood sugar ( hypoglycemia). Ask your diabetes health care specialist about the best coordinated meal and medication schedule.

Exercise

Physical activity is the second most important step towards the management of diabetes mellitus. When you exercise your muscle use glucose (blood sugar) for energy. Regular physical activity not only reduce the blood glucose level but also reduces the insulin resistance. Physical activities increases the body's response to insulin. More strenuous you work, longer the effects last. Even light activities such as gardening, house works can also manage your diabetes mellitus by lowering blood glucose level.

Medications

When diet, exercise alone are not sufficient for managing diabetes mellitus, insulin and other medications are used. These medications helps to lower the blood glucose level by different mechanism and helps to manage diabetes mellitus. The effectiveness of these medicines depends on the timing and dose

Medicines of Diabetes Mellitus

When diet, exercise and ideal body weight are not enough to manage diabetes mellitus, we may need to start medicines. The kind of medicines we take depends upon the type of diabetes mellitus, your schedule and other health conditions. If you have type 1 diabetes mellitus you will need to take insulin. Usually people with type 1 diabetes mellitus do not use oral medications. In people with type 2 diabetes mellitus their body cant keep up with insulin. So they may need to take pills. Some people take both insulin and pills along with meal planning and exercise. Diabetes pills helps patients with type 2 diabetes mellitus and gestational diabetes mellitus to keep their blood glucose level on target.

Medicines for type 1 Diabetes Mellitus

Type 1 diabetes mellitus once called as juvenile diabetes mellitus and insulin dependent diabetes mellitus usually found in children, teenagers and young adults. If you have type 1 diabetes mellitus you may need to take insulin because your body can no longer produce insulin. you also might need to take other type of diabetes that work with insulin. unfortunately insulin cannot be taken as pills because enzymes in your stomach alter it. Hence insulin is taken with insulin syringe or insulin pump.

Medicines for type 2 Diabetes Mellitus

Type 2 diabetes mellitus once called as adult onset diabetes mellitus and non insulin dependent diabetes mellitus is most common type of diabetes mellitus. It causes when body's cells become resistant to insulin. If body cant keep up with the need of insulin, you may need diabetes medicines. ADA recommends that most people starts with metformin, a kind of diabetes pill. But before starting any diabetes medication you should consult your doctor and ask his guidance.

Medicines for Gestational Diabetes Mellitus

Gestational diabetes mellitus is the diabetes mellitus that occur for the first time during pregnancy. The hormone of pregnancy or a shortage of insulin can cause gestational diabetes mellitus. Most women with gestational diabetes mellitus control it with diet planning and exercise. But some women needs insulin for their management of gestational diabetes mellitus.

Drugs used to treat type 2 diabetes mellitus are

sulfonylureas
biguanides
alpha glucosidase inhibitors
thiazolidinediones
meglitinides

Diabetes Mellitus treatment

Can diabetes mellitus be cured ? The answer to your question is yes. The main goal of diabetes mellitus treatment is to control your blood glucose level with in a target permanently. Lets discuss it in detail

Treatment of type 1 Diabetes mellitus

In our body there are many hormone which can increase the blood glucose level like thyroid hormone, glucagone, corticosteroid etc. but the only hormone which reduces the blood glucose level is insulin. Type 1 diabetes mellitus is caused due to autoimmune disorder which destroys the insulin producing cells in pancreas. Hence insulin is not present in the body. Inorder to treat type 1 diabetes mellitus you should supply insulin. The insulin we inject can reduce the blood glucose level, but it is temporary only. For treating type 2 diabetes mellitus permanently we have to supply the insulin producing cells. The islet cell transplantation and pancreas transplantation are permanent treatment for type 1 diabetes mellitus. About 400 to 500 pancreas transplantation are taking place in US every year. But the problem with this method is, there is a chance for rejecting the pancreas we transplanted. so we have to take some immunosuppessive drugs to avoid the attacking of our immune system on the transplanted pancreas. Now researches have proved that liver cells can be altered and can be used to produce insulin. The experiment was successful in mice and researches are going on.

Treatment of type 2 Diabetes mellitus

In type 2 diabetes mellitus, it is not the problem with insulin but it is the problem with the body's cells. Type 2 diabetes mellitus is caused by insulin resistance. That is our body does not respond to insulin. For treating type 2 diabetes mellitus, we have to treat our body cells to increase their response towards insulin. Many of the people are using medicines for treating type 2 diabetes mellitus. It is not the right way for treating type 2 diabetes mellitus permanently. Of course medicines are essential only in some cases. Consider this. If you are using drug to treat diabetes mellitus means you are using it to control your blood glucose level. After some day your doctor may increase the dose of your medicine. That means your cells are not responding well to the initial dose. that is you cells become resistant to that drug with that dose. is it good ? think of it. This method of treatment is only temporary.

The permanent method of treating type 2 diabetes mellitus are changing your lifestyle, diet control and regular exercise. It depends on severity of diabetes mellitus. Diet and exercise are also medicines. If you exercise daily your cells will be more active and responds good to insulin. Diet also helps to maintain blood glucose level. It will take an average of 6 months to treat diabetes mellitus with this method and depends on severity of diabetes mellitus, your diet and exercise plan. If your diabetes mellitus is so severe, you may need to take some medicines in order to control your blood glucose level. Try to avoid medicines and take a good control of your diabetes mellitus with diet and exercise.

Diet for Diabetes mellitus

Diabetes mellitus diet has a significant role in managing diabetes mellitus. Diabetes mellitus diet may be used alone or in combination with insulin or along with other diabetic pills. The main objective of diabetes mellitus diet is to maintain ideal body weight by providing adequate nutrition and maintaining normal blood glucose
Diet plan for a person with diabetes mellitus is based on height, weight, sex, age, physical activity and nature of diabetes mellitus. While planning diabetes mellitus diet the dietitian has to consider complications such as high cholesterol level, high blood pressure and also should focus on certain important factors such as

Fibers should be atleast 1.4 oz/day
Instead of 3 heavy meal go for 4-5 small meals with regular interval
Replace bakery products and fast foods by simple whole cooked cereals
Don't eat carbohydrate 2 hours before bed time
Consume fresh fruit and vegetables atleast 5 times/day
You need to select foods that are higher in nutrition and low in calorie

Diabetes Mellitus Nutrition

Diabetes mellitus patients must be always cautious about the source of their calorie intake. Recent researches carried out by health experts conclude that herbal supplements such as cactus, bitter melon, goat rue, nopal, bilberry, gumar, onion and garlic are effective in lowering the blood glucose level thereby helping diabetes mellitus patients to undergo less treatment distress. It had been proved that a balanced diabetes mellitus diet contains some important nutrients and useful supplements to help control the dancing blood sugar.

Look at the diabetic nutritional supplements we receive from our food and their action in controlling diabetes mellitus

Biotin - helps in metabolism of carbohydrate, fat and protein
Chromium - helps in metabolism of glucose
Vit C - prevent sugar from getting attached to protein
Vit E - improve insulin sensitivity
Vit B6 - helps to prevent diabetic neuropathy
Magnesium - helps to lower blood pressure and reduce the risk of heart attack by relaxing the muscle tissue
Vit D - helps in reducing insulin resistance
Zinc - helps in improving action of insulin

Diabetes mellitus patients have greater need of nutrient supplement for fulfilling the metabolic and anti oxidant requirement of body. Design your diet as per above necessities and living your diabetic lifestyle will be much easier road to travel upon.

Diabetic Neuropathy

noreply@blogger.com (sheril) — Thu, 10 May 2012 17:52:00 +0000

Diabetic neuropathy is a neuropathic disorders that are associated with diabetes mellitus. These conditions are thought to result from diabetic microvascular injury involving small blood vessels that supply nerves (vasa nervorum) in addition to macrovascular conditions that can culminate in diabetic neuropathy.

Nerve damage caused by diabetes mellitus can also lead to future problems with internal organs such as the digestive tract, heart, and sexual organs causing indigestion, diarrhea or constipation, dizziness, bladder infections, and impotence. In some cases, diabetic neuropathy can flare up suddenly, causing weakness and weight loss. Depression may follow.

Signs and symptoms of Diabetic Neuropathy

This unreferenced section requires citations to ensure verifiability.
Diabetic neuropathy affects all peripheral nerves including pain fibers, motor neurons and the autonomic nervous system. It therefore can affect all organs and systems, as all are innervated. There are several distinct syndromes based upon the organ systems and members affected, but these are by no means exclusive. A patient can have sensorimotor and autonomic neuropathy or any other combination. Symptoms vary depending on the nerve(s) affected and may include symptoms other than those listed. Symptoms usually develop gradually over years.

Symptoms may include:

Numbness and tingling of extremities
Dysesthesia (abnormal sensation to a body part)
Diarrhea
Erectile dysfunction
Urinary incontinence (loss of bladder control)
Facial, mouth and eyelid drooping
Vision changes
Dizziness
Muscle weakness
Difficulty swallowing
Speech impairment
Fasciculation (muscle contractions)
Anorgasmia
Burning or electric pain

Causes of Diabetic Neuropathy

Unfortunately, researchers and doctors do not really know what causes diabetic neuropathy, but several factors are likely to contribute to the disorder. High blood glucose, a condition associated with diabetes mellitus, causes chemical changes in nerves. These changes impair nerves abilities to transmit signals. High blood glucose also damages blood vessels that carry oxygen and nutrients to the nerves. In addition, inherited factors probably unrelated to diabetes mellitus may make some people more susceptible to nerve disease than others.

How high blood glucose leads to nerve damage is a subject of intense research. The precise mechanism is not known. Researchers have discovered high glucose levels affect many metabolic pathways in the nerves, leading to an accumulation of a sugar called sorbitol and depletion of a substance called myoinositol. However, studies in humans have not shown convincingly these changes are the mechanism that causes nerve damage.

More recently, researchers have focused on the effects of excessive glucose metabolism on the amount of nitric oxide in nerves. Nitric oxide dilates blood vessels. In a person with diabetes mellitus, low levels of nitric oxide may lead to constriction of blood vessels supplying the nerve, contributing to nerve damage.

Another promising area of research centers on the effect of high glucose attaching to proteins, altering the structure and function of the proteins and affecting vascular function. Researchers are studying how these changes occur, how they are connected, how they cause nerve damage, and how to prevent and treat damage.

People with diabetes mellitus can develop nerve problems at any time. Significant clinical diabetic neuropathy can develop within the first 10 years after diagnosis of diabetes mellitus and the risk of developing diabetic neuropathy increases the longer a person has diabetes mellitus. Some recent studies have reported that 60 percent of patients with diabetes mellitus have some form of neuropathy, but in most cases (30 to 40 percent) there are no symptoms. Approx' 30 to 40 percent of patients with diabetes mellitus have symptoms suggesting neuropathy, compared with only 10 percent of people without diabetes mellitus. Diabetic neuropathy appears to be more common in smokers, people over age 40, and those who have had problems controlling their blood glucose levels.

Major Types Of Diabetic Neuropathy

Diffuse Neuropathy

Diffuse neuropathy is a kind of nerve problem that affects many parts of the body. There are two types of diffuse neuropathy. Peripheral neuropathy affects the feet and hands and autonomic neuropathy affects the internal organs. Autonomic neuropathy can affect a lot of body processes and systems, everything from sexual response in both women and men, digestive problems that cause weight loss, even regulation of body temperature and sweat.

Focal Neuropathy

This kind of diabetic neuropathy appears suddenly and affects specific nerves, most often in the torso, leg or head. Symptoms can include severe pain in an area of the body, eye and hearing problems or even paralysis on one side of the face called Bell's palsy. Carpel tunnel syndrome is a common symptom of focal neuropathy. This type of diabetic neuropathy is unpredictable and most often occurs in older people who have mild diabetes mellitus. Although it's painful, it tends to improve by itself without causing long-term damage.

Diffuse Neuropathy

The two categories of diffuse neuropathy are peripheral neuropathy affecting the feet and hands and autonomic neuropathy affecting the internal organs.

Peripheral Neuropathy The most common type of peripheral neuropathy damages the nerves of the limbs, especially the feet. Nerves on both sides of the body are affected.

Common symptoms of peripheral neuropathy are:

Numbness or insensitivity to pain or temperature
Tingling, burning, or prickling
Sharp pains or cramps
Extreme sensitivity to touch, even light touch
Loss of balance and coordination.

These symptoms are often worse at night.
The damage to nerves often results in loss of reflexes and muscle weakness.

The foot often becomes wider and shorter, the gait changes, and foot ulcers appear as pressure is put on parts of the foot that are less protected. Because of the loss of sensation, injuries may go unnoticed and often become infected. If ulcers or foot injuries are not treated in time, the infection may involve the bone and require amputation. However, problems caused by minor injuries can usually be controlled if they are caught in time. Avoiding foot injury by wearing well-fitted shoes and examining the feet daily can help prevent amputations.

Autonomic Neuropathy (also called visceral neuropathy) Autonomic neuropathy is another form of diffuse neuropathy. It affects the nerves that serve the heart and internal organs and produces changes in many processes and systems. Urination and sexual response

Autonomic neuropathy most often affects the organs that control urination and sexual function. Nerve damage can prevent the bladder from emptying completely, so bacteria grow more easily in the urinary tract (bladder and kidneys).

When the nerves of the bladder are damaged, a person may have difficulty knowing when the bladder is full or controlling it, resulting in urinary incontinence.

The nerve damage and circulatory problems of diabetes mellitus can also lead to a gradual loss of sexual response in both men and women, although sex drive is unchanged.

Digestion

Autonomic neuropathy can affect digestion. Nerve damage can cause the stomach to empty too slowly, a disorder called gastric stasis. When the condition is severe (gastroparesis), a person can have persistent nausea and vomiting, bloating, and loss of appetite. Blood glucose levels tend to fluctuate greatly with this condition. If nerves in the esophagus are involved, swallowing may be difficult. Nerve damage to the bowels can cause constipation or frequent diarrhea, especially at night. Problems with the digestive system often lead to weight loss.

Cardiovascular system

Autonomic neuropathy can affect the cardiovascular system, which controls the circulation of blood throughout the body. Damage to this system interferes with the nerve impulses from various parts of the body that signal the need for blood and regulate blood pressure and heart rate. As a result, blood pressure may drop sharply after sitting or standing, causing a person to feel dizzy or light-headed, or even to faint (orthostatic hypotension).

Neuropathy that affects the cardiovascular system may also affect the perception of pain from heart disease. People may not experience angina as a warning sign of heart disease or may suffer painless heart attacks. It may also raise the risk of a heart attack during general anesthesia.

Hypoglycemia

Autonomic neuropathy can hinder the body's normal response to low blood sugar or hypoglycemia, which makes it difficult to recognize and treat an insulin reaction. Sweating

Autonomic neuropathy can affect the nerves that control sweating. Sometimes, nerve damage interferes with the activity of the sweat glands, making it difficult for the body to regulate its temperature. Other times, the result can be profuse sweating at night or while eating (gustatory sweating).

Focal Neuropathy

Occasionally, diabetic neuropathy appears suddenly and affects specific nerves, most often in the torso, leg, or head. Focal neuropathy may cause:

Pain in the front of a thigh
Severe pain in the lower back or pelvis
Pain in the chest, stomach, or flank
Chest or abdominal pain sometimes mistaken for angina, heart attack, or appendicitis
Aching behind an eye
Inability to focus the eye
Double vision
Paralysis on one side of the face (Bell's palsy)
Problems with hearing

This kind of diabetic neuropathy is unpredictable and occurs most often in older people who have mild diabetes mellitus. Although focal neuropathy can be painful, it tends to improve by itself after a period of weeks or months without causing long-term damage.

People with diabetes mellitus are also prone to developing compression neuropathies. The most common form of compression neuropathy is carpal tunnel syndrome. Asymptomatic carpal tunnel syndrome occurs in 20 to 30 percent of people with diabetes mellitus, and symptomatic carpal tunnel syndrome occurs in 6 to 11 percent. Numbness and tingling of the hand are the most common symptoms. Muscle weakness may also develop.

Diagnosis of Diabetic Neuropathy

A doctor diagnoses diabetic neuropathy based on symptoms and a physical exam. During the exam, the doctor may check muscle strength, reflexes, and sensitivity to position, vibration, temperature, and light touch. Sometimes special tests are also used to help determine the cause of symptoms and to suggest treatment.

A simple screening test to check point sensation in the feet can be done in the doctor's office. The test uses a nylon filament mounted on a small wand. The filament delivers a standardized 10-gram force when touched to areas of the foot. Patients who cannot sense pressure from the filament have lost protective sensation and are at risk for developing neuropathic foot ulcers.

Nerve conduction studies check the flow of electrical current through a nerve. With this test, an image of the nerve impulse is projected on a screen as it transmits an electrical signal. Impulses that seem slower or weaker than usual indicate possible damage to the nerve. This test allows the doctor to assess the condition of all the nerves in the arms and legs.

Electromyography (EMG) is used to see how well muscles respond to electrical impulses transmitted by nearby nerves. The electrical activity of the muscle is displayed on a screen. A response that is slower or weaker than usual suggests damage to the nerve or muscle. This test is often done at the same time as nerve conduction studies.

Ultrasound employs sound waves. The sound waves are too high to hear, but they produce an image showing how well the bladder and other parts of the urinary tract are functioning.

Nerve biopsy involves removing a sample of nerve tissue for examination. This test is most often used in research settings.

If your doctor suspects autonomic neuropathy, you may also be referred to a physician who specializes in digestive disorders (gastroenterologist) for additional tests.

Treatment of Diabetic Neuropathy

Despite advances in the understanding of the metabolic causes of diabetic neuropathy, treatments aimed at interrupting these pathological processes have been limited. Thus, with the exception of tight glucose control, treatments are for reducing pain and other symptoms.
Options for pain control include tricyclic antidepressants (TCAs), serotonin reuptake inhibitors (SSRIs) and antiepileptic drugs (AEDs). A systematic review concluded that "tricyclic antidepressants and traditional anticonvulsants are better for short term pain relief than newer generation anticonvulsants." A combination of these medication (gabapentin + nortriptyline) may also be superior to a single agent.
The only two drugs approved by the FDA for diabetic peripheral diabetic neuropathy are the antidepressant duloxetine and the anticonvulsant pregabalin. Before trying a systemic medication, some doctors recommend treating localized diabetic periperal diabetic neuropathy with lidocaine patches.

Tricyclic antidepressants

TCAs include imipramine, amitriptyline, desipramine and nortriptyline. These drugs are effective at decreasing painful symptoms but suffer from multiple side effects that are dosage dependent. One notable side effect is cardiac toxicity, which can lead to fatal arrhythmias. At low dosages used for diabetic neuropathy, toxicity is rare, but if symptoms warrant higher doses, complications are more common. Among the TCAs, amitriptyline is most widely used for this condition, but desipramine and nortriptyline have fewer side effects.

Serotonin-norepinephrine reuptake inhibitors

The SSNRI duloxetine (Cymbalta) is approved for diabetic neuropathy, while venlafaxine is also commonly used. By targeting both serotonin and norepinephrine, these drugs target the painful symptoms of diabetic neuropathy, and also treat depression if it exists. On the other hand, selective serotonin reuptake inhibitors are not useful.

Selective Serotonin reuptake inhibitor

SSRIs include fluoxetine, paroxetine, sertraline and citalopram and are not recommended to treat painful diabetic neuropathy because they have been found to be no more efficacious than placebo in several controlled trials. Side effects are rarely serious, and do not cause any permanent disabilities. They cause sedation and weight gain, which can worsen a diabetic's glycemic control. They can be used at dosages that also relieve the symptoms of depression, a common comorbidity of diabetic neuropathy.

Antiepileptic drugs

AEDs, especially gabapentin and the related pregabalin, are emerging as first line treatment for painful diabetic neuropathy. Gabapentin compares favorably with amitriptyline in terms of efficacy, and is clearly safer. Its main side effect is sedation, which does not diminish over time and may in fact worsen. It needs to be taken three times a day, and it sometimes causes weight gain, which can worsen glycemic control in diabetics. Carbamazepine (Tegretol) is effective but not necessarily safe for diabetic neuropathy. Its first metabolite, oxcarbazepine, is both safe and effective in other neuropathic disorders, but has not been studied in diabetic neuropathy. Topiramate has not been studied in diabetic neuropathy, but has the beneficial side effect of causing mild anorexia and weight loss, and is anecdotally beneficial. Clinical studies have differed regarding its effectiveness; improved diabetic control may improve this.

Classic analgesics

The above three categories of drugs fall under the heading of "atypical, adjuvant and potentiators" and are often combined with opioids and/or NSAIDs, usually having effects greater than the sum of their parts.
Duloxetine + extended release morphine ± naproxen ± hydroxyzine (esp. with oxycodone) ± morphine or hydromorphone immediate release for breakthrough pain is a common recipe in cases where diabetic neuropathy is a complicating factor in a debilitating chronic pain condition — amitryptiline may be more effective than Duloxetine in some. Opioids requiring Cytochrome P-450 activation (e.g. codeine, dihydrocodeine) should perhaps be used with an agent not chemically related to the SSRIs; conversely, they may impact parts of the Liberation, Absorption, Distribution, Metabolism & Elimination profile for morphine, hydromorphone, oxymorphone &c the other way.

Physical therapy

Physical therapy can be an effective and alternative treatment option for patients with diabetes mellitus. This may help reduce dependency on pain relieving drug therapies. Certain physiotherapy techniques can help alleviate symptoms brought on from diabetic neuropathy such as deep pain in the feet and legs, tingling or burning sensation in extremities, muscle cramps, muscle weakness, sexual dysfunction, and diabetic foot.
Transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) use a painless electric current and the physiological effects from low frequency electrical stimulation to relieve stiffness, improve mobility, relieve neuropathic pain, reduce oedema, and heal resistant foot ulcers.
Gait training, posture training, and teaching these patients the basic principles of off-loading can help prevent and/or stabilize foot complications such as foot ulcers. Off-loading techniques can include the use of mobility aids (e.g. crutches) or foot splints. Gait re-training would also be beneficial for individuals who have lost limbs, due to diabetic neuropathy, and now wear a prosthesis.
Exercise programs, along with manual therapy, will help to prevent muscle contratures, spasms and atrophy. These programs may include general muscle stretching to maintain muscle length and a person’s range of motion.General muscle strengthening exercises will help to maintain muscle strength and reduce muscle wasting. Aerobic exercise such as swimming and using a stationary bicycle can help peripheral diabetic neuropathy, but activities that place excessive pressure on the feet (e.g. walking long distances, running) may be contraindicated.
Heat, therapeutic ultrasound, hot wax and short wave diathermy are also useful for treating diabetic neuropathy. Pelvic floor muscle exercises can improve sexual dysfunction caused by diabetic neuropathy.

Diabetic Retinopathy

noreply@blogger.com (sheril) — Thu, 10 May 2012 17:22:00 +0000

Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which can eventually lead to blindness. It is an ocular manifestation of systemic disease which affects up to 80% of all patients who have had diabetes mellitus for 10 years or more. Despite these intimidating statistics, research indicates that at least 90% of these new cases could be reduced if there was proper and vigilant treatment and monitoring of the eyes. The longer a person has diabetes mellitus, the higher his or her chances of developing diabetic retinopathy.

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.

If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.

Stages of diabetic retinopathy

Diabetic retinopathy has four stages:

Mild Nonproliferative Retinopathy. At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels.

Moderate Nonproliferative Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.

Severe Nonproliferative Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.

Proliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.

Symptoms of diabetic retinopathy

Seeing spots or floaters in your field of vision
Blurred vision
Having a dark or empty spot in the center of your vision
Difficulty seeing well at night

In patients with diabetes mellitus, prolonged periods of high blood sugar can lead to the accumulation of fluid in the lens inside the eye that controls eye focusing. This changes the curvature of the lens and results in the development of symptoms of blurred vision. The blurring of distance vision as a result of lens swelling will subside once the blood sugar levels are brought under control. Better control of blood sugar levels in patients with diabetes mellitus also slows the onset and progression of diabetic retinopathy.

Often there are no visual symptoms in the early stages of diabetic retinopathy. That is why the American Optometric Association recommends that everyone with diabetes mellitus have a comprehensive dilated eye examination once a year. Early detection and treatment can limit the potential for significant vision loss from diabetic retinopathy.

Causes of Diabetic Retinopathy

Diabetes mellitus causes abnormal changes in the blood sugar (glucose) that your body ordinarily converts into energy to fuel different bodily functions.

Uncontrolled diabetes mellitus allows unusually high levels of blood sugar (hyperglycemia) to accumulate in blood vessels, causing damage that hampers or alters blood flow to your body's organs — including your eyes.

Diabetes mellitus generally is classified as two types:

Type 1 diabetes mellitus. Insulin is a natural hormone that helps regulate the levels of blood sugar needed to help "feed" your body. When you are diagnosed with type 1 diabetes mellitus, you are considered insulin-dependent because you will need injections or other medications to supply the insulin your body is unable to produce on its own. When you don't produce enough of your own insulin, your blood sugar is unregulated and levels are too high.

Type 2 diabetes mellitus. When you are diagnosed with type 2 diabetes mellitus, you generally are considered non-insulin-dependent or insulin-resistant. With this type of diabetes mellitus, you produce enough insulin but your body is unable to make proper use of it. Your body then compensates by producing even more insulin, which can cause an accompanying abnormal increase in blood sugar levels.
With both types of diabetes mellitus, abnormal spikes in blood sugar increase your risk of diabetic retinopathy.

Eye damage occurs when chronically high amounts of blood sugar begin to clog or damage blood vessels within the eye's retina, which contains light-sensitive cells (photoreceptors) necessary for good vision.

Risk factors of diabetic retinopathy

All people with diabetes mellitus are at risk – those with Type 1diabetes mellitus(juvenile onset) and those with Type 2 diabetes mellitus (adult onset). The longer a person has diabetes mellitus, the higher the risk of developing some ocular problem. Between 40 to 45 percent of Americans diagnosed with diabetes mellitus have some stage of diabetic retinopathy. After 20 years of diabetes mellitus, nearly all patients with Type I diabetes mellitus and >60% of patients with Type II diabetes mellitus have some degree of retinopathy; however, these statistics were published in 2002
Prior studies had also assumed a clear glycemic threshold between people at high and low risk of diabetic retinopathy. However, it has been shown that the widely accepted WHO and American Diabetes Association diagnostic cutoff for diabetes mellitus of a fasting plasma glucose = 7.0 mmol/l (126 mg/dl) does not accurately identify diabetic retinopathy among patients. The cohort study included a multi-ethnic, cross-sectional adult population sample in the US, as well as two cross-sectional adult populations in Australia. For the US-based component of the study, the sensitivity was 34.7% and specificity was 86.6%. For patients at similar risk to those in this study (15.8% had diabetic retinopathy), this leads to a positive predictive value of 32.7% and negative predictive value of 87.6%.
Published rates vary between trials, the proposed explanation being differences in study methods and reporting of prevalence rather than incidence values.
During pregnancy, diabetic retinopathy may also be a problem for women with diabetes mellitus. It is recommended that all pregnant women with diabetes mellitus have dilated eye examinations each trimester to protect their vision.
People with Down's syndrome, who have three copies of chromosome 21, almost never acquire diabetic retinopathy. This protection appears to be due to the elevated levels of endostatin,[12] an anti-angiogenic protein, derived from collagen XVIII. The collagen XVIII gene is located on chromosome 21.

Diagnosis of diabetic retinopathy

Diabetic retinopathy and macular edema are detected during a comprehensive eye exam that includes:

Visual acuity test. This eye chart test measures how well you see at various distances.

Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. This allows the eye care professional to see more of the inside of your eyes to check for signs of the disease. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.

Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

Your eye care professional checks your retina for early signs of the disease, including:

Leaking blood vessels.
Retinal swelling (macular edema).
Pale, fatty deposits on the retina--signs of leaking blood vessels.
Damaged nerve tissue.
Any changes to the blood vessels.

If your eye care professional believes you need treatment for macular edema, he or she may suggest a fluorescein angiogram. In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The test allows your eye care professional to identify any leaking blood vessels and recommend treatment.

Management of Diabetic Retinopathy

There are three major treatments for diabetic retinopathy, which are very effective[citation in reducing vision loss from this disease. In fact, even people with advanced retinopathy have a 90 percent chance of keeping their vision when they get treatment before the retina is severely damaged. These three treatments are laser surgery, injection of corticosteroids or Anti-VEGF into the eye, and vitrectomy.
Although these treatments are very successful (in slowing or stopping further vision loss), they do not cure diabetic retinopathy. Caution should be exercised in treatment with laser surgery since it causes a loss of retinal tissue. It is often more prudent to inject triamcinolone or Anti-VEGF. In some patients it results in a marked increase of vision, especially if there is an edema of the macula.
Avoiding tobacco use and correction of associated hypertension are important therapeutic measures in the management of diabetic retinopathy.
The best way of addressing diabetic retinopathy is to monitor it vigilantly and achieve euglycemia.

Treatment for Diabetic Retinopathy

During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes mellitus should control their levels of blood sugar, blood pressure, and blood cholesterol.

Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision.

Scatter laser treatment works better before the fragile, new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatment may still be possible, depending on the amount of bleeding.

If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye.

Treatment of macular edema

Macular edema is treated with laser surgery. This procedure is called focal laser treatment. Your doctor places up to several hundred small laser burns in the areas of retinal leakage surrounding the macula. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session. Further treatment may be needed.

A patient may need focal laser surgery more than once to control the leaking fluid. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart.

Focal laser treatment stabilizes vision. In fact, focal laser treatment reduces the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it can be improved. Contact your eye care professional if you have vision loss.

What happens during laser treatment?

Both focal and scatter laser treatment are performed in your doctor's office or eye clinic. Before the surgery, your doctor will dilate your pupil and apply drops to numb the eye. The area behind your eye also may be numbed to prevent discomfort.

The lights in the office will be dim. As you sit facing the laser machine, your doctor will hold a special lens to your eye. During the procedure, you may see flashes of light. These flashes eventually may create a stinging sensation that can be uncomfortable. You will need someone to drive you home after surgery. Because your pupil will remain dilated for a few hours, you should bring a pair of sunglasses.

For the rest of the day, your vision will probably be a little blurry. If your eye hurts, your doctor can suggest treatment.

Laser surgery and appropriate follow-up care can reduce the risk of blindness by 90 percent. However, laser surgery often cannot restore vision that has already been lost. That is why finding diabetic retinopathy early is the best way to prevent vision loss.

What is a vitrectomy?

If you have a lot of blood in the center of the eye (vitreous gel), you may need a vitrectomy to restore your sight. If you need vitrectomies in both eyes, they are usually done several weeks apart.

A vitrectomy is performed under either local or general anesthesia. Your doctor makes a tiny incision in your eye. Next, a small instrument is used to remove the vitreous gel that is clouded with blood. The vitreous gel is replaced with a salt solution. Because the vitreous gel is mostly water, you will notice no change between the salt solution and the original vitreous gel.

You will probably be able to return home after the vitrectomy. Some people stay in the hospital overnight. Your eye will be red and sensitive. You will need to wear an eye patch for a few days or weeks to protect your eye. You also will need to use medicated eyedrops to protect against infection.

Are scatter laser treatment and vitrectomy effective in treating proliferative retinopathy?
Yes. Both treatments are very effective in reducing vision loss. People with proliferative retinopathy have less than a five percent chance of becoming blind within five years when they get timely and appropriate treatment. Although both treatments have high success rates, they do not cure diabetic retinopathy.

Once you have proliferative retinopathy, you always will be at risk for new bleeding. You may need treatment more than once to protect your sight.

What can I do if I already have lost some vision from diabetic retinopathy?
If you have lost some sight from diabetic retinopathy, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry may provide low vision services.

Preventing Diabetic Retinopathy

If you want to avoid diabetic retinopathy or control its progress, try these tips:

Keep blood sugar within normal limits.
Monitor blood pressure and keep it under good control.
Maintain a healthy diet.
Exercise regularly.
Don't smoke.
Follow your doctor's instructions to the letter.
Above all, make sure you have regular eye exams!

Non-proliferative diabetic retinopathy (NPDR). This early stage of DR — identified by deposits forming in the retina — can occur at any time after the onset of diabetes mellitus.

Often no visual symptoms are present, but examination of the retina can reveal tiny dot and blot hemorrhages known as microaneurysms, which are a type of out-pouching of tiny blood vessels.

In type 1 diabetes mellitus, these early symptoms rarely are present earlier than three to four years after diagnosis. In type 2 diabetes mellitus, NPDR can be present even upon diagnosis.

Proliferative diabetic retinopathy (PDR). Of the diabetic eye diseases, proliferative diabetic retinopathy has the greatest risk of visual loss.

The condition is characterized by these signs:

Development of abnormal blood vessels (neovascularization) on or adjacent to the optic nerve and vitreous.
Pre-retinal hemorrhage, which occurs in the vitreous humor or front of the retina.
Ischemia from decreased or blocked blood flow, with accompanying lack of oxygen needed for a healthy retina.

These abnormal blood vessels formed from neovascularization tend to break and bleed into the vitreous humor of the eye. Besides sudden vision loss, more permanent complications can include tractional retinal detachment and neovascular glaucoma.

Macular edema may occur separately from or in addition to NPDR or PDR.

You should be monitored regularly, but you typically don't require laser treatment for diabetic eye disease until the condition is advanced.

How does having gestational diabetes mellitus affect my pregnancy and my baby?

noreply@blogger.com (sheril) — Thu, 10 May 2012 15:02:00 +0000

Most women who develops diabetes mellitus during pregnancy go on to have healthy babies. Dietary changes and exercise may be enough to keep your blood glucose levels under control, though sometimes medication is needed too.
It's important to keep your blood glucose levels in check because poorly controlled diabetes mellitus can have serious short- and long-term complications for you and your baby.
If your blood glucose level is too high, too much glucose will end up in your baby's blood. When it happens, your baby's pancreas needs to produce more insulin to process extra glucose. All these excess glucose and insulin can cause your baby to put on extra weight, particularly in the upper body.
This can lead to what's called macrosomia. A macrosomic baby may be too large to enter the birth canal Or the baby's head may enter the canal but then his shoulders may get stuck. In this situation, called shoulder dystocia, your practitioner will have to use special maneuvers to deliver your baby. Delivery can sometimes result in fractured bone or nerve damage, both of which heal without permanent problems in about 99 percent of babies. (In very rare cases, the baby may suffer brain damage with lack of oxygen during this process.) What's more, the maneuvers needed to deliver a broad-shouldered baby can lead to injuries to the vaginal area or require a large episiotomy for you. Because of these risks, if your practitioner suspects that your baby may be overly large, she may recommend that you give birth by cesarean section. Fortunately, only a minority of women with well-controlled gestational diabetes mellitus ends up with overly large babies.
In addition, babies who have excessive fat stores as a result of high maternal glucose levels during pregnancy often continue to be overweight in childhood and adulthood.
Shortly after birth, your baby may have low blood glucose (hypoglycemia) because his body will still be producing extra insulin in response to your excess glucose. This is much more likely if your blood glucose levels were high during pregnancy and especially during labor.
Your delivery team will test your baby's blood glucose at birth and continue to check it as needed by taking a drop of blood from his heel. Feeding your baby as soon as possible after birth, preferably by breastfeeding can help prevent or treat hypoglycemia.
In severe cases of hypoglycemia, though, he'll be given intravenous glucose solution. Testing your baby's blood glucose level and providing an intravenous glucose if necessary can prevent serious problems such as seizures, coma, and brain damage that might result if the condition were to go unnoticed.
Your baby may also be at higher risk for breathing problems at birth, particularly if your blood glucose levels aren't well controlled or you deliver early (the lungs of babies whose mothers have diabetes mellitus tend to mature a bit later). The risk of newborn jaundice is increased, too.
If your blood glucose control is especially poor, your baby is at risk for polycythemia (an increase in the number of red blood cells) and hypocalcemia (low calcium in the blood), and your baby's heart function could be affected as well.
Some studies have found a link between severe gestational diabetes mellitus and an increased risk of stillbirth in the last two months of pregnancy. And, finally, women with gestational diabetes mellitus are at increased risk for developing preeclampsia, particularly those who are obese before pregnancy or whose blood glucose levels are not well controlled.
What will I need to do if I have gestational diabetes mellitus?
You'll need to keep diligent track of your glucose levels, using a home glucose meter or strips. To keep those levels where they should be, you'll want to:
Eat a well-planned diet. The ADA recommends getting nutritional counseling from a registered dietitian who'll help you develop specific meal and snack plans based on your height, weight, and activity level.
Your diet must have the correct balance of protein, fats, and carbohydrates, while providing the proper vitamins, minerals, and calories. To keep your glucose levels stable, it's particularly important that you don't skip meals, especially breakfast, and that you avoid sugary items like candy, cookies, cakes, and soda.
This may sound daunting, but it's not so hard once you get the hang of it. And don't think of yourself as being on a special or restrictive diet. The principles of the diabetic diet are good ones for everyone to follow. Think of this as an opportunity to create healthier eating habits for yourself and your whole family. If everyone in the house is eating the same foods, you won't feel as deprived.
Exercise. Studies show that moderate exercise also helps improve your body's ability to process glucose, keeping blood glucose levels in check. Many women with gestational diabetes mellitus benefit from 30 minutes of aerobic activity, such as walking or swimming, each day. Ask your practitioner what level of physical activity would be beneficial for you.
Take insulin if necessary. If you're not able to control your blood glucose well enough with diet and exercise alone, your provider will prescribe insulin shots for you to give yourself as well. About 15 percent of women with gestational diabetes mellitus need insulin. Recently, some practitioners have been prescribing oral medications instead of injections for some cases of gestational diabetes mellitus.

Does having gestational diabetes put me at higher risk for diabetes mellitus in the future?

noreply@blogger.com (sheril) — Thu, 10 May 2012 13:18:00 +0000

Yes. About one third to one half of women who had gestational diabetes mellitus will develop it again in later pregnancy. And up to 50 percent of women with gestational diabetes mellitus will develop diabetes mellitus at some point in future.

Risk Factors

You're obese. (Your risk is about 50 to 75 percent if you're obese and less than 25 percent if you are at normal weight.)
You had very high blood glucose levels during pregnancy (especially if you needed medication).
Your diabetes mellitus was diagnosed early in the pregnancy.
The results of your postpartum glucose test were borderline (relatively high, but not high enough to classify it as a diabetes mellitus)

What can I do to minimize my risk of developing diabetes in the future?

Keeping your body weight down, taking healthy food choices, and exercising regularly can help you ward off the disease.

In addition, breastfeeding your baby may provide you with some protection.

There's research suggesting an association between breastfeeding and increased postpartum weight loss, as well as a decreased risk of developing type 2 diabetes mellitus and cardiovascular disease.

What can I do to minimize related risks for my child through infancy and beyond?

Do your best to keep your blood sugar levels in check during pregnancy. After birth, nurse your baby. There is evidence that breastfeeding has positive effect on glucose metabolism and may help prevent childhood obesity and decrease your child's risk of diabetes mellitus, among other things.
And because your child is at higher risk for childhood and adult obesity – as well as an increased risk of cardiovascular disease and diabetes mellitus – it's particularly important that you help him to eat a healthy diet, maintain a normal body weight, and stay physically active.
Finally, be sure that your child's healthcare practitioner knows that you had diabetes mellitus during pregnancy.

Gestational Diabetes Mellitus

noreply@blogger.com (sheril) — Wed, 09 May 2012 16:22:00 +0000

Gestational diabetes mellitus is a form of diabetes mellitus which affects pregnant women. It is believed that the hormones produced during pregnancy reduce a woman's receptivity to insulin, leading to high blood sugar levels. Gestational diabetes mellitus affects about 4% of all pregnant women. It is estimated that about 135,000 cases of gestational diabetes mellitus arise in the United States each year.

Hormones involved in development of placenta, which helps the baby to develop also blocks, the action of the mother's insulin in her body. This problem is called insulin resistance. During pregnancy a mother may need up to three times more insulin for glucose to leave the blood and transform to energy. When body is not able to use insulin due to insulin resistance it develops into Gestational Diabetes mellitus. Glucose builds up in the blood to high level, it is called hyperglycemia.

Gestational diabetes mellitus affects the mother in late pregnancy and the baby too. Insulin does not cross the placenta, as glucose and other nutrients do. Extra blood glucose passes through the placenta that gives the baby a high blood glucose level. It results the baby's pancreas to make extra insulin to get rid of the blood glucose. Since the baby is getting more energy than it needs to develop and grow, the extra energy is stored as fat. It can lead to Macrosomia i.e. “Fat” baby. At birth this fat baby develops problem in breathing or may develop hypoglycemia due to over production of insulin.

Types of Gestational Diabetes Mellitus

The two subtypes of gestational diabetes mellitus (diabetes mellitus which began during pregnancy) are:

Type A1gestational diabetes mellitus

Abnormal oral glucose tolerance test (OGTT), but normal blood glucose levels during fasting and two hours after meals; diet modification is sufficient to control glucose levels

Type A2 gestational diabetes mellitus

Abnormal OGTT compounded by abnormal glucose levels during fasting and/or after meals; additional therapy with insulin or other medications is required

The second group of diabetes mellitus which existed prior to pregnancy is also split up into several subtypes.

Type B gestational diabetes mellitus: onset at age 20 or older or duration of less than 10 years.

Type C gestational diabetes mellitus: onset at age 10-19 or duration of 10–19 years.

Type D gestational diabetes mellitus: onset before age 10 or duration greater than 20 years.

Type E gestational diabetes mellitus: overt diabetes mellitus with calcified pelvic vessels.

Type F gestational diabetes mellitus: diabetic nephropathy.

Type R gestational diabetes mellitus: proliferative retinopathy.

Type RF gestational diabetes mellitus: retinopathy and nephropathy.

Type H gestational diabetes mellitus: ischemic heart disease.

Type T gestational diabetes mellitus: prior kidney transplant.

An early age of onset or long-standing disease comes with greater risks, hence the first three subtypes.

Symptoms of Gestational Diabetes Mellitus

Usually there are no symptoms, or the symptoms are mild and not life threatening to the pregnant woman. The blood sugar (glucose) level usually returns to normal after delivery.

Symptoms may include:

Blurred vision
Fatigue
Frequent infections, including those of the bladder, vagina, and skin
Increased thirst
Increased urination
Nausea and vomiting
Weight loss despite increased appetite

Risk Factors for Gestational Diabetes Mellitus

Classical risk factors for developing gestational diabetes mellitus are

previous diagnosis of gestational diabetes mellitus or prediabetes
Gave birth to a baby that weighed more than 9 pounds or had a birth defect
Have high blood pressure
Have too much amniotic fluid
impaired glucose tolerance, or impaired fasting glycaemia
Family history revealing a first-degree relative with type 2 diabetes mellitus
Maternal age - a woman's risk factor increases as she gets older (especially women over 35 years of age).
Ethnic background (those with higher risk factors include African-Americans, Afro-Caribbeans, Hispanics, Native Americans, Pacific Islanders, and people originating from South Asia)
Overweight, obese or severely obese increases the risk by a factor 2.1, 3.6 and 8.6, respectively.
Previous poor obstetric history

In addition to this, statistics shows a double risk of gestational diabetes mellitus in smokers. Polycystic ovarian syndrome is also a risk factor, although relevant evidence remains controversial. Some studies have looked at more controversial potential risk factors, such as short stature.

About 40-60% of women with gestational diabetes mellitus have no demonstrable risk factor; for this reason many advocate to screen all women. Typically, women with gestational diabetes mellitus exhibit no symptoms (another reason for universal screening), but some women may demonstrate increased thirst, increased urination, fatigue, nausea and vomiting, bladder infection, yeast infections and blurred vision.

Gestational Diabetes Mellitus Test

Depending on risk factors, the doctor will decide when you need to be checked for diabetes mellitus. If you are at higher risk, the blood glucose level may be checked at your first prenatal visit. If your test results are normal, you will be checked again sometime between weeks 24 and 28 of your pregnancy.

Depending on the risk and your test results, you may have one or more of the following tests:

Fasting blood glucose or random blood glucose test: When plasma glucose level is >126 mg/dl or when random plasma glucose >200 mg/dl is confirmed on a subsequent day then the woman is at risk to develop GDM. Hence, you will be suggested by your doctor to go for some confirmatory tests.

Screening glucose challenge test: It is a preliminary screening test, which is performed between 26-28 weeks. This test will diagnose whether diabetes mellitus exists or not by indicating whether or not the body is using glucose. The Glucose Challenge Screening is now considered to be a standard test performed during the second trimester of pregnancy.

Oral glucose tolerance test (OGTT): Women who are considered at risk for gestational diabetes mellitus are being asked to go for this test. The glucose challenge is performed by giving 1.76 oz of glucose drink and then drawing a blood sample an hour later and measuring the level of blood glucose present. Women with a blood sugar level greater than 140 mg/dl may have gestational diabetes mellitus, and require a follow up test called a 3-hour oral glucose tolerance test (OGTT).

According to ADA following values are considered to be abnormal for the OGTT:

Fasting Blood Glucose Level=95 mg/dl
1 Hour Blood Glucose Level=180 mg/dl
2 Hour Blood Glucose Level=155 mg/dl
3 Hour Blood Glucose Level=140 mg/dl

Treatment for Gestational Diabetes Mellitus

Women with gestational diabetes mellitus have healthy pregnancies and healthy babies if, they follow a treatment plan from their health care provider. It is required to keep your blood glucose levels in a target range. Each woman should have a specific plan designed just for her needs, so one can follow these general tips to stay healthy with gestational diabetes mellitus:

Watching Your Baby

Your health care provider should closely check both you and your baby throughout the pregnancy. Fetal monitoring to check the size and health of the fetus often includes ultrasound and nonstress tests.

A nonstress test is a very simple, painless test for you and your baby. A machine that hears and displays your baby's heartbeat (electronic fetal monitor) is placed on your abdomen. When the baby moves, the baby's heart rate normally increases 15 - 20 beats above its regular rate.

Your health care provider can compare the pattern of your baby's heartbeat to movements and find out whether the baby is doing well. The health care provider will look for increases in the baby's normal heart rate occurring within a certain period of time.

Diet and Exercise
The best way to improve your diet is by eating a variety of healthy foods. You should learn how to read food labels, and check them when making food decisions. Talk to your doctor or dietitian if you are a vegetarian or on some other special diet.

In general, your diet should be moderate in fat and protein and provide controlled levels of carbohydrates through foods that include fruits, vegetables, and complex carbohydrates (such as bread, cereal, pasta, and rice). You will also be asked to cut back on foods that contain a lot of sugar, such as soft drinks, fruit juices, and pastries.

You will be asked to eat three small- to moderate-sized meals and one or more snacks each day. Do not skip meals and snacks. Keep the amount and types of food (carbohydrates, fats, and proteins) the same from day to day.

Your doctor or nurse will prescribe a daily prenatal vitamin. They may suggest that you take extra iron or calcium. Talk to your doctor or nurse if you're a vegetarian or are on some other special diet.

Remember that "eating for two" does not mean you need to eat twice as many calories. You usually need just 300 extra calories a day (such as a glass of milk, a banana, and 10 crackers).

If managing your diet does not control blood sugar (glucose) levels, you may be prescribed diabetes mellitus medicine by mouth or insulin therapy. You will need to monitor your blood sugar (glucose) levels during treatment.

Most women who develop gestational diabetes mellitus will not need diabetes mellitus medicines or insulin, but some will.

Women with gestational diabetes mellitus should note down their blood sugar level, physical activity and everything she eats and drinks, in a daily record book. This can help track how well the treatment is working and what is to be done further to maintain the normal blood sugar level. Some women with gestational diabetes mellitus will also need to take insulin, to help manage their diabetes mellitus if blood sugar is shooting up, in spite of all this. The extra insulin can help them lower their blood sugar level.

Related article

Does having gestational diabetes put me at higher risk for diabetes mellitus in the future?
How does having gestational diabetes mellitus affect my pregnancy and my baby?

Prediabetes

noreply@blogger.com (sheril) — Wed, 09 May 2012 16:19:00 +0000

Prediabetes is the state in which some but not all of the diagnostic criteria for diabetes mellitus are met. Prediabetes is described as the “gray area” between normal blood sugar and diabetic levels.

Prediabetes is a stage between normal and diabetes mellitus stage. It is an alarming sign for upcoming diabetes mellitus or a chance to change your future. Universally, numerous terms are given like, Borderline Diabetes, Chemical Diabetes, Touch of Diabetes etc. According to the ADA statistics 17 million US citizens have diabetes mellitus and 16 millions have prediabetes. ADA defines it as a stage before the development of diabetes mellitus, with normal glucose tolerance, but with an increased risk of developing diabetes mellitus in near future.

Prediabetes is a condition when your blood sugar level triggers higher than normal, but not so high that we can justify it as type 2 diabetes mellitus. According to the Centers for Disease Control and Prevention, 41 million U.S. adults aged 40 to 74 have prediabetes. And the same reports from, The American Academy of Pediatrics show that, one of every 10 males and one of every 25 females have prediabetes aged from 12 to 19 years.

Signs and Symptoms of Prediabetes

Prediabetes can take a long time to transform finally as diabetes mellitus. It has been generally observed that prediabetes will eventually convert to diabetes mellitus but, at the same time, there are greater possibilities to revert back to normal if taken care seriously. People suffering from prediabetes may show same symptoms as in diabetes mellitus but, they will be erupting occasionally like:

Excessive thirst
Unexplained weight loss
Tingling sensations in feet and fingers
Excess Hunger
Flu-like symptoms, including weakness and fatigue
Frequent Urination
Irritability
Frequent infections
Blurred vision
Skin itching

Causes of Prediabetes

The exact cause of prediabetes is unknown, although researchers have discovered some genes that are related to insulin resistance. Excess fat — especially abdominal fat — and inactivity also seem to be important factors in the development of prediabetes.

What is clear is that people who have prediabetes aren't quite processing sugar (glucose) properly anymore. This causes sugar to build up in the bloodstream instead of doing its normal job of fueling the cells that make up muscles and other tissues. Most of the glucose in your body comes from the foods you eat, specifically foods that contain carbohydrates. Any food that contains carbohydrates can affect your blood sugar levels, not just sweet foods. During digestion, sugar enters your bloodstream and with the help of insulin is then absorbed into the body's cells to give them energy.

Insulin is a hormone that comes from the pancreas, a gland located just behind the stomach. When you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a key that unlocks microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.

When you have prediabetes, this process begins to work improperly. Instead of fueling your cells, sugar builds up in your bloodstream. This occurs when your pancreas doesn't make enough insulin or your cells become resistant to the action of insulin or both.

Diagnosis of Prediabetes

People with prediabetes will never know by their own about their high blood sugar. If they are suffering from the mentioned factors which indicates risk zone, they should periodically go for routine check up and should be cautious enough about the given signs and symptoms. Once they crossed the age of 45, they must routinely visit a doctor and ask for its diagnosis.

There are two types of blood tests to determine whether you are suffering from prediabetes or not, they are as follows:

Fasting blood glucose test : A fasting blood sugar level under 100 milligrams of glucose per deciliter of blood (mg/dl) is considered normal. If your blood sugar level is 100 to 125mg/dL, you have prediabetes - also called impaired fasting glucose (IFG). If you are suffering from prediabetes then the fasting blood sugar as well as post postprandial blood sugar will fluctuate easily.

Oral Glucose Tolerance Test (OGTT) : After fasting for at least eight hours, FBS (fasting blood sugar) is checked and then an oral dose of 8 ounce sugary syrup is administered. The blood glucose level is checked after an hour and if it reaches 144-199 mg/dl after two hours, you have impaired glucose tolerance.

Pathophysiology of prediabetes

Diabetes mellitus is a group of metabolic diseases that are characterized by hyperglycemia and defects in insulin production in the pancreas and/or impaired tolerance to insulin effects. Diabetes Mellitus is a leading cause of morbidity and mortality. Because the disease can be insidious, the diagnosis is often delayed. Effects of the disease can be macrovascular, as seen in the cardiovascular system/arthrosclerosis, or microvascular, as seen with diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy.
Normal glucose homeostasis is controlled by three interrelated processes. There is gluconeogenesis (glucose production that occurs in the liver), uptake and utilization of glucose by the peripheral tissues of the body, and insulin secretion by the pancreatic islet cells. What triggers the production and release of insulin from the pancreas is the presence of glucose in the body. The main function of insulin is to increase the rate of transport of glucose into certain cells of the body, such as striated muscles, fibroblasts, and fat cells. It is also necessary for transport of amino acids, glycogen formation in the liver and skeletal muscles, triglyceride formation from glucose, nucleic acid synthesis, and protein synthesis.
Insulin enters cells by first binding to target insulin receptors. Diabetes mellitus and some of those with prediabetes have impaired glucose tolerance—in these individuals, blood glucose rises to abnormally high levels. This may be from a lack of pancreatic hormone release or failure of target tissues to respond to the insulin present or both.

Risk factors of Prediabetes

The same factors that increase the risk of developing type 2 diabetes mellitus increase the risk of developing prediabetes, including:

Extra weight. Being overweight is a primary risk factor for prediabetes. The more fatty tissue you have — especially inside and between the muscle and skin around your abdomen — the more resistant your cells become to insulin.
Inactivity. The less active you are, the greater your risk of prediabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
Advancing age. The risk of prediabetes increases as you get older, especially after age 45. This may be because people tend to exercise less, lose muscle mass and gain weight as they age. However, older people aren't the only ones at risk of prediabetes and type 2 diabetes mellitus. The incidence of these disorders is also rising in younger age groups.
Family history. The risk of prediabetes increases if a parent or sibling has type 2 diabetes mellitus.
Race. Although it's unclear why, people of certain races — including African-Americans, Hispanics, American Indians, Asian-Americans and Pacific Islanders — are more likely to develop prediabetes.
Gestational diabetes mellitus. If you developed gestational diabetes mellitus when you were pregnant, your risk of later developing diabetes mellitus increases. If you gave birth to a baby who weighed more than 9 pounds (4.1 kilograms), you're also at increased risk of diabetes mellitus.
Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes mellitus.
Sleep. Several recent studies have linked a lack of sleep or too much sleep to an increased risk of insulin resistance. Research suggests that regularly sleeping fewer than six hours or more than nine hours a night might up your risk of prediabetes or type 2 diabetes mellitus.

Complications of Prediabetes

Progression into type 2 diabetes mellitus is the most serious consequence of untreated prediabetes.

Type 2 diabetes mellitus complications include:

High blood pressure
High cholesterol
Heart disease
Stroke
Kidney disease
Blindness
Amputations

Management of Prediabetes

Intensive weight loss and lifestyle intervention, if sustained, can substantially improve glucose tolerance and prevent progression from IGT to type 2 diabetes mellitus. The Diabetes Prevention Program (DPP) study found a 16% reduction in diabetes mellitus risk for every kilogram of weight loss. Reducing weight by 7% through a low-fat diet and performing 150 minutes of exercise a week is the goal. The ADA guidelines recommend modest weight loss (5-10% body weight), moderate-intensity exercise (30 minutes daily), and smoking cessation.
For patients with severe risk factors, prescription medication may be appropriate. This can be considered in patients for whom lifestyle therapy has failed or is not sustainable and who are at high-risk for developing type 2 diabetes mellitus. Metformin and acarbose help prevent the development of frank diabetes mellitus, and also have a good safety profile. Evidence also supports thiazolidinediones but there are safety concerns, and data on newer agents such as GLP-1 receptor agonists, DPP4 inhibitors or meglitinides are lacking.

Treatments and drugs for Prediabetes

If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back to normal or at least keep it from rising toward the levels seen in type 2 diabetes mellitus. Guidelines from the American College of Endocrinology suggest the following to treat prediabetes:

Eat healthy foods. Choose foods low in fat and calories and high in fiber. Focus on fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without compromising taste or nutrition.

Get more physical activity. Aim for 30 to 60 minutes of moderate physical activity at least five days a week. Take a brisk daily walk. Ride your bike. Swim laps. If you can't fit in a long workout, break it up into smaller sessions spread throughout the day.

Lose excess weight. If you're overweight, losing just 5 to 10 percent of your body weight — only 10 to 20 pounds (4.5 to 9 kilograms) if you weigh 200 pounds (91 kilograms) — can reduce the risk of developing type 2 diabetes mellitus. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

Take medications as needed. Sometimes medications — such as the oral diabetes mellitus drugs metformin (Glucophage) and acarbose (Precose) — also are an option if you're at high risk of diabetes mellitus. This includes if your prediabetes is worsening or you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome. Some studies have indicated that pioglitazone (Actos) and similar drugs, which improve insulin sensitivity, might help reduce the risk of converting from prediabetes to diabetes mellitus, but were associated with weight gain and water retention (edema).
In other cases, medications to control cholesterol — statins, in particular — and medications to control high blood pressure are needed. Healthy lifestyle choices remain essential, however.

Because the findings from several recent studies suggest that regularly getting a good night of sleep may reduce insulin resistance, try to get at least six hours or more of sleep each night.

Prevention of Prediabetes

Unlike diabetes mellitus, prediabetes is a reversible condition with the administration of proper medication and life style modification. Thus prediabetes can be prevented with right diet and exercise.

Healthy Choices Of Food : The selection of right type of food is extremely important at this stage. One should restrict to food with low fat and low calories, and on the other side, fresh fruits and vegetables with lots of antioxidant should be the preferred choice.

Life-style modification : The person with less physical activity and sedentary life are at the risk of falling prey to prediabetes. The best way to keep ourselves active is by, walking, using stairs as far as possible, and spending daily 30 mins for some specific exercise like yoga.

Maintain ideal body weight : The persons who are overweight may develop more complications in the maintenance of normal blood sugar level, thus it is advised to maintain ideal body weight. To reduce excess of weight they should see a registered dietitian, and by working with your doctor, follow your treatment plan. It can help you to keep your prediabetes from worsening and developing into type 2 diabetes mellitus.

Type 2 Diabetes Mellitus

noreply@blogger.com (sheril) — Tue, 08 May 2012 16:12:00 +0000

Type 2 diabetes mellitus (also called type 2 diabetes, adult-onset diabetes mellitus, non-insulin-dependent diabetes mellitus or just diabetes) is a lifelong (chronic) disease in which there are high levels of sugar (glucose) in the blood. Type 2 diabetes mellitus is the most common form of diabetes mellitus.

Type 2 diabetes mellitus affects the way the body processes and uses carbohydrates, fats and proteins. During digestion, food is broken down into its basic components. The liver processes these nutrients into one type of sugar -- glucose. Glucose is the most basic fuel for the body. Glucose enters your body's cells with the help of insulin. Insulin is a hormone produced by the pancreas. Without insulin, glucose cannot pass through the cell wall.
Type 2 diabetes mellitus occurs when your body's cells do not react efficiently to insulin. This condition is called insulin resistance.

In people with insulin resistance, the pancreas first makes extra insulin to maintain a normal blood sugar. Over time, the body's insulin resistance gets worse. The pancreas cannot keep up with the demand for more and more insulin. As a result, blood glucose levels rise. Untreated, type 2 diabetes mellitus can be life-threatening.

Type 2 diabetes mellitus runs in families. It most often affects people who are older than 40. But type 2 diabetes mellitus is now being seen in more and more young people. Obesity greatly increases the risk of type 1 diabetes mellitus.

There's no cure for type 2 diabetes mellitus, but you can manage — or even prevent — the condition. Start by eating well, exercising and maintaining a healthy weight. If diet and exercise aren't enough to control your type 2 diabetes mellitus, you may need diabetes medications or insulin therapy to manage your blood sugar.

Symptoms of Diabetes Mellitus.

The classic symptoms of diabetes mellitus are

polyuria (frequent urination),
polydipsia (increased thirst),
polyphagia (increased hunger), and
weight loss.

Other symptoms that are commonly present at diagnosis include:

history of blurred vision, itchiness,
peripheral neuropathy,
recurrent vaginal infections, and
fatigue.

Many people however have no symptoms during the first few years and are diagnosed on routine testing. People with type 2 diabetes mellitus may rarely present with nonketotic hyperosmolar coma (a condition of very high blood sugar associated with a decreased level of consciousness and low blood pressure).

Causes of type 2 Diabetes Mellitus

When sugar cannot enter cells, high levels of sugar build up in the blood. This is called hyperglycemia.

Type 2 diabetes mellitus usually occurs slowly over time. Most people with the disease are overweight when they are diagnosed. Increased fat makes it harder for your body to use insulin the correct way. Type 2 diabetes mellitus can also develop in people who are thin. This is more common in the elderly. Family history and genes play a large role in type 2 diabetes mellitus. Low activity level, poor diet, and excess body weight around the waist increase your risk

Type 2 diabetes mellitus develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin. When you have type 2 diabetes mellitus, your fat, liver, and muscle cells do not respond correctly to insulin. This is called insulin resistance. As a result, blood sugar does not get into these cells to be stored for energy. Exactly why this happens is unknown, although excess weight and inactivity seem to be contributing factors.

Insulin is a hormone that comes from the pancreas, a gland situated just behind and below the stomach. When you eat, the pancreas secretes insulin into the bloodstream. Insulin is needed to move blood sugar (glucose) into cells, where it is stored and later used for energy. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.

The liver acts as a glucose storage and manufacturing center. When your insulin levels are low — when you haven't eaten in a while, for example — the liver metabolizes stored glycogen into glucose to keep your glucose level within a normal range. In type 2 diabetes mellitus, this process works improperly. Instead of moving into your cells, sugar builds up in your bloodstream. This occurs when your pancreas doesn't make enough insulin or your cells become resistant to the action of insulin.

Risk Factors of Type 2 Diabetes Mellitus

Researchers don't fully understand why some people develop type 2 diabetes mellitus and others don't. It's clear that certain factors increase the risk, however, including:

Weight. Being overweight is a primary risk factor for type 2 diabetes mellitus . The more fatty tissue you have, the more resistant your cells become to insulin.
Fat distribution. If your body stores fat primarily in your abdomen, your risk of type 2 diabetes mellitus is greater than if your body stores fat elsewhere, such as your hips and thighs.
Inactivity. The less active you are, the greater your risk of type 2 diabetes mellitus . Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
Family history. The risk of type 2 diabetes mellitus increases if your parent or sibling has type 2 diabetes mellitus.
Race. Although it's unclear why, people of certain races — including blacks, Hispanics, American Indians and Asian-Americans — are more likely to develop type 2 diabetes mellitus than whites are.
Age. The risk of type 2 diabetes mellitus increases as you get older, especially after age 45. That's probably because people tend to exercise less, lose muscle mass and gain weight as they age. But type 2 diabetes mellitus is also increasing dramatically among children, adolescents and younger adults.
Prediabetes. Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as type 2 diabetes mellitus. Left untreated, prediabetes often progresses to type 2 diabetes mellitus.
Gestational diabetes mellitus. If you developed gestational diabetes mellitus when you were pregnant, your risk of developing type 2 diabetes mellitus later increases. If you gave birth to a baby weighing more than 9 pounds (4.1 kilograms), you're also at risk of type 2 diabetes mellitus

Diagnosis of Type 2 Diabetes mellitus

Fasting blood glucose level -- diabetes mellitus is diagnosed if it is higher than 126 mg/dL two times
Hemoglobin A1c test --

Normal: Less than 5.7%
Pre-diabetes: 5.7% - 6.4%
Diabetes mellitus: 6.5% or higher

Oral glucose tolerance test -- diabetes mellitus is diagnosed if glucose level is higher than 200 mg/dL after 2 hours

Complications of Type 2 Diabetes mellitus

Type 2 diabetes mellitus can be easy to ignore, especially in the early stages when you're feeling fine. But type 2 diabetes mellitus affects many major organs, including your heart, blood vessels, nerves, eyes and kidneys. Controlling your blood sugar levels can help prevent these complications.

Although long-term complications of diabetes mellitus develop gradually, they can eventually be disabling or even life-threatening. Some of the potential complications of diabetes mellitus include:

Heart and blood vessel disease. Diabetes mellitus dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of arteries (atherosclerosis) and high blood pressure. The risk of stroke is two to four times higher for people with diabetes mellitus, and the death rate from heart disease is two to four times higher for people with diabetes mellitus than for people without the disease, according to the American Heart Association.

Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood sugar can eventually cause you to lose all sense of feeling in the affected limbs. Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.

Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Diabetes mellitus can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant.

Eye damage. Diabetes mellitus can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes mellitus also increases the risk of other serious vision conditions, such as cataracts and glaucoma.

Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections. Severe damage might require toe, foot or even leg amputation.

Skin and mouth conditions. Diabetes mellitus may leave you more susceptible to skin problems, including bacterial and fungal infections. Gum infections also may be a concern, especially if you have a history of poor dental hygiene.

Osteoporosis. Diabetes mellitus may lead to lower than normal bone mineral density, increasing your risk of osteoporosis.

Alzheimer's disease. Type 2 diabetes mellitus may increase the risk of Alzheimer's disease and vascular dementia. The poorer your blood sugar control, the greater the risk appears to be. So what connects the two conditions? One theory is that cardiovascular problems caused by diabetes mellitus could contribute to dementia by blocking blood flow to the brain or causing strokes. Other possibilities are that too much insulin in the blood leads to brain-damaging inflammation, or lack of insulin in the brain deprives brain cells of glucose.

Hearing problems. Diabetes mellitus can also lead to hearing impairment.

Prevention of Type 2 Diabetes Mellitus

Healthy lifestyle choices can help you prevent type 2 diabetes mellitus. Even if type 2 diabetes mellitus runs in your family, diet and exercise can help you prevent the disease. If you've already been diagnosed with type 2 diabetes mellitus, the same healthy lifestyle choices can help you prevent potentially serious complications. And if you have prediabetes, lifestyle changes can slow or halt the progression from prediabetes to diabetes mellitus.

Eat healthy foods. Choose foods low in fat and calories. Focus on fruits, vegetables and whole grains. For every 1,000 calories you consume, try to have at least 14 grams of fiber, because fiber helps control blood sugar levels.

Get physical activities. Aim for 30 minutes of moderate physical activity a day. Take a brisk daily walk. Ride a bike. Swim laps. If you can't fit in a long workout, spread 10-minute or longer sessions throughout the day.

Lose excess pounds. If you're overweight, losing 5 to 10 percent of your body weight can reduce the risk of diabetes mellitus. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

There's some evidence that coffee and, possibly, tea drinking may decrease your risk of developing type 2 diabetes mellitus, but more research is needed.

Sometimes medication is an option as well. Metformin (Glucophage), an oral diabetes medication, may reduce the risk of type 2 diabetes mellitus— but healthy lifestyle choices remain essential.

Management of Type 2 Diabetes Mellitus

Management of type 2 diabetes mellitus focuses on lifestyle interventions, lowering other cardiovascular risk factors, and maintaining blood glucose levels in the normal range. Self-monitoring of blood glucose for people with newly diagnosed type 2 diabetes mellitus was recommended by the National Health Services in 2008, however the benefit of self monitoring in those not using multi-dose insulin is questionable. Managing other cardiovascular risk factors including: hypertension, high cholesterol, and microalbuminuria, improves a person's life expectancy. Intensive blood sugar lowering (HbA1C<6%) as opposed to standard blood sugar lowering (HbA1C of 7-7.9%) does not appear to change mortality. The goal of treatment is typically an HbA1C of less than 7% or a fasting glucose of less than 6.7 mmol/L (120 mg/dL) however these goals may be changed after professional clinical consultation, taking into account particular risks of hypoglycemia and life expectancy. It is recommended that all people with type 2 diabetes mellitus get regular ophthalmology examination.

Lifestyle

A proper diet and exercise are the foundations of diabetic care with a greater amount of exercise yielding better results. Aerobic exercise leads to a decrease in HbA1C and improved insulin sensitivity. Resistance training is also useful and the combination of both types of exercise may be most effective. A diabetic diet that promotes weight loss is important. While the best diet type to achieve this is controversial a low glycemic index diet has been found to improve blood sugar control. Culturally appropriate education may help people with Type 2 diabetes mellitus control their blood sugar levels, for up to six months at least. If changes in lifestyle, in those with mild diabetes mellitus, has not resulted in improved blood sugars within six weeks medications should then be considered.

Diet and Weight Control

Work closely with your doctor, nurse, and dietitian to learn how much fat, protein, and carbohydrates you need in your diet. Your meal plans should fit your daily lifestyle and habits, and should try to include foods that you like.

Managing your weight and eating a well-balanced diet are important. Some people with type 2 diabetes mellitus can stop taking medications after losing weight (although they still have diabetes mellitus).

Medications for Type 2 Diabetes Mellitus

Metformin 500mg tablets

There are several classes of anti-diabetic medications available. Metformin is generally recommended as a first line treatment as there is some evidence that it decreases mortality. A second oral agent of another class may be used if metformin is not sufficient. Other classes of medications include: sulfonylureas, nonsulfonylurea secretagogues, alpha glucosidase inhibitors, thiazolidinediones, glucagon-like peptide-1 analog, and dipeptidyl peptidase-4 inhibitors. Metformin should not be used in those with severe kidney or liver problems. Injections of insulin may either be added to oral medication or used alone.

Most people do not initially need insulin. When it is used, a long-acting formulation is typically added at night, with oral medications being continued. Doses are then increased to effect (blood sugar levels being well controlled). When nightly insulin is insufficient twice daily insulin may achieve better control. The long acting insulins, glargine and detemir, do not appear much better than neutral protamine Hagedorn (NPH) insulin but have a significantly greater cost making them, as of 2010, not cost effective. In those who are pregnant insulin is generally the treatment of choice.

Surgery for Type 2 Diabetes Mellitus

Weight loss surgery in those who are obese appears to be an effective measure to treat diabetes mellitus. Many are able to maintain normal blood sugar levels with little or no medications following surgery and long term mortality is decreased. There however is some short term mortality risk of less than 1% from the surgery. The body mass index cutoffs for when surgery is appropriate are not yet clear.

Prognosis

Your treatment plan is likely to require adjustment over time. Insulin resistance increases with age. And the insulin-producing cells in the pancreas may wear out as the pancreas tries to keep up with the body's extra insulin needs.

After the first few years, the majority of people with type 2 diabetes mellitus require more than one medicine to keep their blood sugar controlled. About one out of three people with type 2 diabetes mellitus requires insulin.

The prognosis in people with type 2 diabetes mellitus varies. It depends on how well an individual modifies their risk of complications. Heart attack, stroke and kidney disease can result in premature death. Disability due to blindness, amputation, heart disease, stroke and nerve damage may occur. Some people with type 2 diabetes mellitus become dependent on dialysis treatments because of kidney failure.

There is a tremendous amount you can do to decrease your risk of complications:

Eat a healthy diet
Get regular exercise
Pay careful attention to your blood sugar levels
Reduce your other risks of heart disease

Type 1 Diabetes Mellitus

noreply@blogger.com (sheril) — Tue, 08 May 2012 14:46:00 +0000

Type 1 diabetes mellitus (Type 1 diabetes, insulin dependent diabetes mellitus, juvenile diabetes) is a form of diabetes mellitus. Type 1 diabetes mellitus is an autoimmune disease that results in destruction of insulin-producing beta cells of the pancreas. Lack of insulin causes an increase in fasting blood glucose level (around 70-120 mg/dL in nondiabetic people) that begins to appear in the urine above the renal threshold (about 190-200 mg/dl in most people) which results in the classical symptoms are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss.

Type 1 diabetes mellitus (formerly known as "childhood" diabetes mellitus) is not exclusively a childhood problem; the adult incidence of type 1 diabetes mellitus is noteworthy—in fact, many adults who contract type 1 diabetes mellitus are misdiagnosed with type 2 diabetes mellitus due to confusion at this point.

Incidence of diabetes mellitus varies from eight to 17 per 100,000 in Northern Europe and the U.S., with a high of about 35 per 100,000 in Scandinavia, to a low of one per 100,000 in Japan and China.

Type 1 diabetes mellitus is fatal unless treated with insulin.Insulin replace the missing hormone formerly produced by the now non-functional beta cells in the pancreas. In recent years, pancreas transplants have also been used to treat type 1 diabetes mellitus. Islet cell transplant is also being investigated and has been achieved in mice, and in experimental trials in humans as well. Use of stem cells to produce a new population of functioning beta cells seems to be a future possibility.

symptoms of Type 1 Diabetes Mellitus

The classical symptoms of type 1 diabetes mellitus includes

polyuria (frequent urination)
polydipsia (increased thirst)
polyphagia (increased hunger)
fatigue and
weight loss.

Insulin-dependent diabetes mellitus characterized by dramatic and recurrent swings in blood glucose levels, often occurring for no apparent reason, is sometimes known as brittle diabetes mellitus, unstable diabetes mellitus or labile diabetes mellitus. The results of such swings can be irregular and unpredictable hyperglycemias, frequently involving ketosis, and sometimes serious hypoglycemias. Brittle diabetes mellitus occurs no more frequently than in 1% to 2% of diabetics

Other Symptoms that may arise are

nausea
vomiting
abdominal pain
fatigue
absence of menstruation

Diagnosis of diabetes mellitus

Urinalysis shows glucose and ketone bodies in the urine, but a blood test is required for diagnosis
Fasting blood glucose is 126 mg/dL or higher
Random (nonfasting) blood glucose exceeds 200 mg/dL (this must be confimed with a fasting test)
Insulin test (low or undetectable level of insulin)
C-peptide test (low or undetectable level of the protein C-peptide, a by-product of insulin production)

Type 1 Diabetes Mellitus Pathophysiology

The cause of type 1 diabetes mellitus is still not fully understood. Some theories suggest that type 1 diabetes mellitus is generally a virally triggered autoimmune response in which the immune system attack on virus infected cells is also directed against the insulin producing beta cells in the pancreas. The autoimmune attack may be triggered by reaction to an infection, for example by one of the viruses of the Coxsackie virus family or German measles, although the evidence is inconclusive. In type 1 diabetes mellitus, pancreatic beta cells in the Islets of Langerhans are destroyed or damaged sufficiently to effectively abolish endogenous insulin production. This etiology distinguishes type 1 diabetes mellitus origin from type 2 diabetes mellitus. It should also be noted that the use of insulin in treating a patient does not mean that patient has type 1 diabetes mellitus; the type of diabetes mellitus a patient has is determined only by the cause—fundamentally by whether the patient is insulin resistant (type 2 diabetes mellitus) or insulin deficient without insulin resistance (type 1 diabetes mellitus).

This vulnerability is not shared by everyone, for not everyone infected by the suspected organisms develops type 1 diabetes mellitus. This has suggested presence of a genetic vulnerability and there is indeed an observed inherited tendency to develop type 1 diabetes mellitus. It has been traced to particular HLA genotypes, though the connection between them and the triggering of an auto-immune reaction is still poorly understood.

Some researchers believe that the autoimmune response is influenced by antibodies against cow's milk proteins. A large retrospective controlled study published in 2006 strongly suggests that infants who were never breastfed had a risk for developing type 1 diabetes mellitus twice that of infants who were breastfed for at least three months. The mechanism is not fully understood. No connection has been established between autoantibodies, antibodies to cow's milk proteins, and type 1 diabetes mellitus. A sub type of type 1 diabetes mellitus (identifiable by the presence of antibodies against beta cells) typically develops slowly and so is often confused with type 2 diabetes mellitus. In addition, a small proportion of type 2 diabetes mellitus cases manifest a genetic form of the disease called maturity onset diabetes of the young (MODY).

Vitamin D in doses of 2000 IU per day given during the first year of a child's life has been connected in one study in Northern Finland (where intrinsic production of Vitamin D is low due to low natural light levels) with an 80% reduction in the risk of getting type 1 diabetes mellitus later in life. The causal connection, if any, is obscure.

Type 1 diabetes mellitus was previously known as juvenile diabetes mellitus because it is one of the most frequent chronic diseases mellitus in children; however, the majority of new-onset type 1 diabetes mellitus is seen in adults. Scientific studies that use antibody testing ( islet cell antibodies (ICA), glutamic acid decarboxylase antibodies (GADA) and insulinoma-associated (IA-2) autoantibodies) to distinguish between type 1 and type 2 diabetes mellitus demonstrate that most new-onset type 1 diabetes mellitus is seen in adults.

Some suggest that deficiency of Vitamin D3 (one of several related chemicals with Vitamin D activity) may be an important pathogenic factor in type 1 diabetes mellitus independent of geographical latitude, and so of available sun intensity.

Some chemicals and drugs preferentially destroy pancreatic cells. Pyrinuron (Vacor, N-3-pyridylmethyl-N'-p-nitrophenyl urea), a rodenticide introduced in the United States in 1976, selectively destroys pancreatic beta cells, resulting in type 1 diabetes mellitus after accidental or intentional ingestion. Vacor was withdrawn from the U.S. market in 1979, but is still used in some countries. Zanosar is the trade name for streptozotocin, an antibiotic and antineoplastic agent used in chemotherapy for pancreatic cancer; it also kills beta cells, resulting in loss of insulin production. Other pancreatic problems, including trauma, pancreatitis or tumors (either malignant or benign), can also lead to loss of insulin production leading to type 1 diabetes mellitus

Complications of Type 1 Diabetes Mellitus

Emergency Complications

Diabetic ketoacidosis

In a person with type 1 diabetes mellitus, the body will use fat as a fuel if insulin is not present. The by-products of fat metabolism are ketones. Ketones build up in the blood and "spill" over into the urine. A condition called ketoacidosis develops when the blood is made acidic by the ketones.

Hypoglycemia

Hypoglycemia (low blood glucose) occurs when the balance between insulin, food intake, and exercise is disturbed. Symptoms of mild hypoglycemia include hunger, nervousness, and fast heart rate. More serious hypoglycemia can lead to confusion and even loss of consciousness. Loss of consciousness due to low blood sugar is called hypoglycemic coma.

Long term complications

People who have had Type 1 diabetes mellitus for several years are likely to develop long-term complications, which can be minimized but not entirely eliminated by proper diabetic management:

Vascular disease

By age 55, about 35% of men and women with type 1 diabetes mellitus have died from a heart attack compared to 8% of nondiabetic men and 4% of nondiabetic women.
People with type 1 diabetes mellitus are also at higher risk to develop blockages in the major arteries of the legs than non diabetics. Lower the risk of vascular disease by aggressively treating cholesterol and blood pressure, exercising regularly, and avoiding or quitting tobacco products.

Microvascular Disease

Microvascular (small vessel) changes occur in capillaries of every organ of the body. There is a thickening of the wall of the small blood vessels. These changes are responsible for many of the diabetes mellitus complications.

Eye Complications

Changes in the small blood vessels of the retina (also known as diabetic retinopathy) predispose the diabetic to several eye disorders. After 15 years of diabetes mellitus, 80% of diabetics will have some diabetic retinopathy.
If bleeding and scarring has developed, a retinal detachment may occur, causing blindness. Vascular changes in the iris may cause obstruction of the flow of ocular fluid and cause glaucoma. Diabetics are also more likely than non diabetics to develop cataracts.

Diabetic Nephropathy (kidney disease)

Kidney abnormalities may be noted early in diabetes mellitus disease. Poorly controlled diabetes mellitus may accelerate the development of kidney failure. Urinary tract infections in diabetics tend to be more severe and may result in kidney damage.
Diabetics are more vulnerable to kidney damage from high blood pressure than non diabetics.

Diabetic Neuropathy (nerve damage)

People with diabetes mellitus may develop temporary or permanent damage to nerve tissue. Diabetic neuropathy is more likely to develop if blood glucose is poorly controlled. Some diabetics will not develop neuropathy, while others may develop this condition relatively early.
On average, symptoms such as numbness and tingling occur 10 to 20 years after diabetes mellitus has been diagnosed.

Diabetic Foot Problems

The feet of people with diabetes mellitus are very susceptible to infection and injury. Many diabetes mellitus-related hospital admissions are for foot problems, and a significant number of non-accident-related leg amputations are performed on diabetics.
Several foot problems are common in people with diabetes mellitus, including skin changes (loss of hair; loss of ability to sweat; and dry, cracked skin), arterial insufficiency (impaired blood supply to feet), neuropathy, and specific foot deformities (hallux valgus, bunion, hammertoe, and calluses).

Skin and mucous membrane problems

People with diabetes mellitus are more likely than non diabetics to develop infections. Hyperglycemia (high blood sugar) predisposes diabetics to fungal infections of the skin, nails, and female genital tract and to urinary tract infection.

Management of Type 1 Diabetes Mellitus

These goals are accomplished through education, insulin use, meal planning and weight control, exercise, foot care, and careful self-testing of blood glucose levels.

Insulin therapy

Type 1 diabetes mellitus is treated with insulin replacement therapy—either via subcutaneous injection or insulin pump, along with attention to dietary management, typically including carbohydrate tracking, and careful monitoring of blood glucose levels using glucose meters. Today, the most common insulins are biosynthetic products produced using genetic recombination techniques; formerly, cattle or pig insulins were used, and even sometimes insulin from fish.[31] Major global suppliers include Eli Lilly and Company, Novo Nordisk, and Sanofi-Aventis. A more recent trend, from several suppliers, is insulin analogs which are slightly modified insulins with different onset or duration of action times.

Untreated type 1 diabetes mellitus commonly leads to coma, often from diabetic ketoacidosis, which is fatal if untreated. Continuous glucose monitors have been developed and marketed which can alert patients to the presence of dangerously high or low blood sugar levels, but technical limitations have limited the impact these devices have had on clinical practice so far.

Treatment of diabetes mellitus focuses on lowering blood sugar or glucose (BG) to the near normal range, approximately 80–140 mg/dl (4.4–7.8 mmol/L).[32] The ultimate goal of normalizing BG is to avoid long-term complications that affect the nervous system (e.g. peripheral neuropathy leading to pain and/or loss of feeling in the extremities), and the cardiovascular system (e.g. heart attacks, vision loss). People with type 1 diabetes mellitus always need to use insulin, but treatment can lead to low BG (hypoglycemia), i.e. BG less than 70 mg/dl (3.9 mmol/l). Hypoglycemia is a very common occurrence in people with diabetes mellitus, usually the result of a mismatch in the balance among insulin, food and physical activity, although the nonphysiological method of delivery also plays a role.

Diabetes mellitus Diet management

The patient should be instructed on an ADA diet, with caloric intake of 25-35 kcal/kg body weight, but no greater than 2400 kcal or less than 1800 kcal. Actual weight gain with confirmation of actual caloric intake will further aid in adjusting the patient's caloric needs to allow appropriate weight gain. Women who are under their ideal weight have additional weight to gain in addition to the recommended 11-kg weight gain (a minimum of 7 kg for obese patients). The diet should be 40-50% carbohydrate, 30% fat, and 20-30% protein. Women with renal disease should have protein limited to 90 g of protein to minimize the impact of pregnancy on their disease. The calories are divided into 3 meals and 3 snacks, with the evening snack recommended to be a half-sandwich. The protein in meat provides calories in the early morning hours, when intermediate insulin is peaking and fetal glucose utilization is maximized due to increased movements during sleep.

The snack for hypoglycemia should be milk or peanut butter with crackers. Orange juice should be discouraged unless it is the only food available, because it causes an abrupt rise in glucose that is not sustained. Glucagon emergency kits should be given to all type 1 diabetes mellitus patients and their spouses taught how to use it if the patient is found unresponsive.

Soluble fiber assists in satiating hunger, but more importantly, it helps reduce glycemic swings. The patient should note exactly what she ate, the amount, and the mode of preparation when she has a postprandial glucose level over 130 mg/dL. Attention should be directed to the bedtime snack when there is elevation or lowering of the fasting glucose.

The dietitian is a crucial team member in the care of a type 1 diabetic pregnant patient. Visits should occur as often as needed to obtain proper compliance. The dietitian should make a concerted effort to individualize the diet, respecting different lifestyles and ethnicity. A minimum of two visits is always necessary, and family involvement is encouraged to improve compliance.

Physical Activity

Regular exercise is especially important for the person with diabetes mellitus, as it helps control the amount of sugar in the blood and helps burn excess calories and fat to achieve optimal weight.

Before people with diabetes mellitus begin any exercise program, they should obtain medical approval. Type 1 diabetics must take special precautions before, during and after participation in intense physical activity or exercise.

Self-Testing

Blood glucose monitoring is done by checking the glucose content of a small drop of blood. The testing is done on a regular basis and will inform the person with diabetes mellitus how well diet, medication, and exercise are working together to control diabetes mellitus.

The results can be used to adjust meals, activity, or medications to keep blood-sugar levels within an appropriate range. It will provide valuable information for the health care provider to suggest changes to improve care and treatment. Testing will identify high and low blood-sugar levels before serious problems develop.

Foot Care

People with diabetes mellitus are prone to foot problems because of complications related to the illness. Diabetes mellitus causes damage to the blood vessels and nerves, which can result in a decreased ability to sense trauma or pressure on the foot. A foot injury could go unnoticed until severe infection develops.

Additionally, diabetes mellitus alters the bodies immune system, decreasing the body's ability to fight infection. Small infections can rapidly progress to death of the skin and other tissues, necessitating amputation of the affected limb.
To prevent injury to the feet, diabetics should adopt a daily foot care routine.

Treating Low Blood Sugar

Low blood sugar, known as hypoglycemia, can occur in diabetics when they use too much insulin, exercise too much, or have not eaten enough food. Hypoglycemia can develop quickly in people with diabetes mellitus. Symptoms of low blood sugar typically appear when the sugar level falls below 70. Watch for weakness, shaking, sweating, headache, nervousness, and hunger.

If these symptoms occur and you have a blood sugar test kit available, do a blood sugar check. If the level is low, the person with diabetes mellitus should eat something with sugar: fruit juice, several teaspoons of sugar, a cup of skim milk, or regular soda. If you don't have a test kit handy, sugar should be eaten anyway - it can't hurt. Symptoms should subside within 15 minutes. If the symptoms don't subside, more sugar should be eaten and the sugar level tested again.

After the symptoms subside, more substantial food can be eaten. Eat simple sugar First to get the situation under control. Even if you or your child is hungry, "real" food should not be eaten until the sugar level comes up - real food won't produce enough sugar and takes too long to digest.

If you are a parent, relative, or friend of someone experiencing these symptoms, monitor the person closely. If symptoms become worse -- confusion, seizures, or unconsciousness -- give the person a shot of glucagon. You should have some glucagon stored for emergencies. Make sure everyone in your home, as well as babysitters and caregivers, knows how to use it. Periodically remind everyone how to use it, and check the expiration date. Don't panic. Glucagon works very fast -- usually within 15 minutes. While you are waiting for the person to revive, keep him on his side to prevent choking.

Treating High Ketones

When there is not enough insulin to move glucose into cells, glucose can build up in the blood. The body then looks for other forms of energy and uses fat as a fuel source. As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous to body tissue. This condition is known as ketoacidosis.

You can check for ketones using a simple urine test available at pharmacies. This test should be performed every 4-6 hours anytime a person with diabetes mellitus is registering blood sugar above 240; sick; unusually thirsty or has a dry mouth; urinating frequently; or vomited

The warning signs that ketoacidosis is getting serious might include flushed face, dry skin and mouth, nausea or vomiting, stomach pain, deep, rapid breathing, or fruity breath odor. If these symptoms occur, call the doctor or go to the emergency room right away. If left untreated, this condition will lead to coma and even death.

Monitoring

Visit your physician and/or diabetes mellitus educator at least 4 times a year.
Have your glycosylated hemoglobin (HbA1c) measured 2-4 times a year to evaluate your overall glucose control. (Ask your doctor how often you should be tested.)
Have your cholesterol and triglyceride levels and kidney function evaluated yearly.
Visit your ophthalmologist (preferably one that specializes in diabetic retinopathy) at least once a year, more frequently if signs of diabetic retinopathy develop. Every 6 months have a thorough dental cleaning and examination. Inform your dentist and hygienist that you have diabetes mellitus. Monitor your feet every day for early signs of injury or infection. Make sure your health care provider inspects your feet at each visit.
Stay up-to-date with all of your vaccinations (including pneumococcal), and get a flu shot every year in the fall.

Education

You are the most important person in managing your diabetes mellitus. Diabetes mellitus education is a crucial part of the treatment plan. Diabetes mellitus education basically involves learning how to live with your diabetes mellitus.

Knowledge of disease management is imperative to avoid developing short-term complications such as hypoglycemia and hyperglycemia and to delay or slow the onset of long-term complications of the disease such as diabetic retinopathy (eye disease) or diabetic nephropathy (kidney disease).

Type 1 Diabetes mellitus Treatment

Type 1 diabetes mellitus is treated with insulin replacement therapy—usually by insulin injection or insulin pump, along with attention to dietary management, typically including carbohydrate tracking, and careful monitoring of blood glucose levels using glucose meters. Today the most common insulins are biosynthetic products produced using genetic recombination techniques; formerly, cattle or pig insulins were used, and even sometimes insulin from fish. Major global suppliers include Eli Lilly and Company, Novo Nordisk, and Sanofi-Aventis. A more recent trend, from several suppliers, is insulin analogs which are slightly modified insulins which have different onset of action times or duration of action times.

Untreated type 1 diabetes mellitus commonly leads to coma, often from diabetic ketoacidosis, which is fatal if untreated. Continuous glucose monitors have been developed and marketed which can alert patients to the presence of dangerously high or low blood sugar levels, but technical limitations have limited the impact these devices have had on clinical practice so far.

In more extreme cases, a pancreas transplant can restore proper glucose regulation. However, the surgery and accompanying immunosuppression required is considered by many physicians to be more dangerous than continued insulin replacement therapy, and is therefore often used only as a last resort (such as when a kidney must also be transplanted, or in cases where the patient's blood glucose levels are extremely volatile). Experimental replacement of beta cells (by transplant or from stem cells) is being investigated in several research programs. Thus far, beta cell replacement has only been performed on patients over age 18, and with tantalizing successes amidst nearly universal failure.

Pancreas transplantation

In more extreme cases, a pancreas transplant can restore proper glucose regulation. However, the surgery and accompanying immunosuppression required is considered by many physicians to be more dangerous than continued insulin replacement therapy, so is generally only used with or some time after a kidney transplant. One reason for this is that introducing a new kidney requires taking immunosuppressive drugs such as cyclosporine. Nevertheless this allows the introduction of a new, functioning pancreas to a patient with diabetes mellitus without any additional immunosuppressive therapy. However, pancreas transplants alone can be wise in patients with extremely labile type 1 diabetes mellitus.

Islet cell transplantation

Experimental replacement of beta cells (by transplant or from stem cells) is being investigated in several research programs. Islet cell transplantation is less invasive than a pancreas transplant, which is currently the most commonly used approach in humans.
In one variant of this procedure, islet cells are injected into the patient's liver, where they take up residence and begin to produce insulin. The liver is expected to be the most reasonable choice because it is more accessible than the pancreas, and islet cells seem to produce insulin well in that environment. The patient's body, however, will treat the new cells just as it would any other introduction of foreign tissue, unless a method is developed to produce them from the patient's own stem cells or an identical twin is available who can donate stem cells. The immune system will attack the cells as it would a bacterial infection or a skin graft. Thus, patients now also need to undergo treatment involving immunosuppressants, which reduce immune system activity.
Recent studies have shown islet cell transplants have progressed to the point where 58% of the patients in one study were insulin-independent one year after transplantation. Scientists in New Zealand with Living Cell Technologies are currently in human trials with Diabecell, placing pig islets within a protective capsule derived of seaweed which enables insulin to flow out and nutrients to flow in, while protecting the islets from immune system attack via white blood cells.

Diabetes Mellitus Type 1 Inheritance

Type 1 diabetes mellitus is a polygenic disease, meaning many different genes contribute to its expression. Depending on locus or combination of loci, it can be dominant, recessive, or somewhere in between. The strongest gene, IDDM1, is located in the MHC Class II region on chromosome 6, at staining region 6p21. This is believed to be responsible for the histocompatibility disorder characteristic of type 1 diabetes mellitus: Insulin-producing pancreas cells (beta cells) display improper antigens to T cells. This eventually leads to the production of antibodies that attack these beta cells. Weaker genes are also located on chromosomes 11 and 18.

Prognosis

Prognosis is primarily dependent on the level of glucose control. Good control requires a motivated patient, an active management approach (education, diet, insulin, and exercise) with trained health care providers, and frequent patient-provider interactions. Another factor influencing prognosis is the amount of degenerative changes. With diligent antenatal care, the patient can anticipate a normal labor and delivery experience. Severe hypoglycemia and diabetic ketoacidosis can result in maternal compromise and even death. The fetus, if spared from congenital malformation or death in utero, may suffer significant impairment in the hostile uterine environment, with poor glucose control affecting brain development as well as that of other organs.