Monday, July 18, 2005

diabetes?

What is diabetes?

Diabetes is a disorder of metabolism—the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body.

After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.

When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.

How do you get Diabetes?
There are two main types of diabetes mellitus. These are known as type 1 and type 2.
  1. Type 1 diabetes mellitus used to be called insulin-dependent diabetes mellitus, or juvenile-onset diabetes mellitus, because it usually begins in childhood or adolescence.
  2. In type 1 diabetes mellitus, the pancreas releases no insulin at all because the body has destroyed the cells that produce it (islet cells). The patient therefore relies on treatment with insulin.
  3. Type 2 diabetes mellitus is the most common form of diabetes. It used to be called non-insulin dependent diabetes mellitus, or adult onset diabetes because it usually begins in adulthood.
  4. In type 2 diabetes, patients can still produce insulin, but they do not produce enough and/or their bodies cannot use it properly.
    Another form of diabetes, known as gestational diabetes, occurs in some women during pregnancy. It is a temporary condition caused by pregnancy and usually occurs in the later stages, once the baby has formed but is still growing.

Diabetes is a permanent change in your internal chemistry that results in having too much sugar, or glucose in your blood. Without treatment, your blood sugar remains high and has the potential of affecting every organ and system in your body.


Symptoms of diabetes:

  • Thirst
  • Dehydration
  • Passing large amounts of urine
  • Urinary tract infection
  • Weight loss
  • Fatigue
  • Blurry vision

There are several causes of diabetes.

A person could be affected by one or more of them.

  • Heredity is an important factor in diabetes. It is difficult to predict who will inherit the condition. Families with a strong tendency towards diabetes should know the symptoms of diabetes and take precautions to lower the other risk factors.
  • Overweight
  • Unbalanced diet
  • Stress
  • Infections
    Diseases of the pancreasDiabetes is usually diagnosed from simple urine or blood test. With treatment, the insulin problem can be solved, and your blood sugar can be brought down or normalized so that the body is not damaged. A person with diabetes can remain healthy and look forward to a normal life span.

How long does Diabetes last?

Diabetes Mellitus is a life-long, chronic condition.

Type 1 diabetes usually begins in childhood or adolescence. The symptoms tend to occur suddenly after the onset of the disease and are usually more obvious than those of type 2.

Type 2 diabetes usually begins in adulthood (mainly after 40 years of age). It develops gradually in most cases and may be present for several years before it is detected.
Gestational diabetes is a temporary condition that may occur during pregnancy and usually goes away after the baby is born.

What are the tests for diagnosing diabetes?

The fasting plasma glucose test is the preferred test for diagnosing type 1 or type 2 diabetes. It is most reliable when done in the morning. However, a diagnosis of diabetes can be made after positive results on any one of three tests, with confirmation from a second positive test on a different day:
  • A random (taken any time of day) plasma glucose value of 200 mg/dL or more, along with the presence of diabetes symptoms.
  • A plasma glucose value of 126 mg/dL or more after a person has fasted for 8 hours.
  • An oral glucose tolerance test (OGTT) plasma glucose value of 200 mg/dL or more in a blood sample taken 2 hours after a person has consumed a drink containing 75 grams of glucose dissolved in water. This test, taken in a laboratory or the doctor's office, measures plasma glucose at timed intervals over a 3-hour period.


Gestational diabetes is diagnosed based on plasma glucose values measured during the OGTT. Glucose levels are normally lower during pregnancy, so the threshold values for diagnosis of diabetes in pregnancy are lower. If a woman has two plasma glucose values meeting or exceeding any of the following numbers, she has gestational diabetes: a fasting plasma glucose level of 95 mg/dL, a 1-hour level of 180 mg/dL, a 2-hour level of 155 mg/dL, or a 3-hour level of 140 mg/dL.

How is diabetes managed?

Before the discovery of insulin in 1921, everyone with type 1 diabetes died within a few years after diagnosis. Although insulin is not considered a cure, its discovery was the first major breakthrough in diabetes treatment.

Today, healthy eating, physical activity, and taking insulin via injection or an insulin pump are the basic therapies for type 1 diabetes. The amount of insulin must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose checking.

Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.

People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too low or too high. When blood glucose levels drop too low—a condition known as hypoglycemia—a person can become nervous, shaky, and confused. Judgment can be impaired, and if blood glucose falls too low, fainting can occur.
A person can also become ill if blood glucose levels rise too high, a condition known as hyperglycemia.

People with diabetes should see a health care provider who will help them learn to manage their diabetes and who will monitor their diabetes control. An endocrinologist is a doctor who often specializes in diabetes care. In addition, people with diabetes often see ophthalmologists for eye examinations, podiatrists for routine foot care, and dietitians and diabetes educators to learn the skills needed for day-to-day diabetes management.

The goal of diabetes management is to keep blood glucose levels as close to the normal range as safely possible. A major study, the Diabetes Control and Complications Trial (DCCT), sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), showed that keeping blood glucose levels close to normal reduces the risk of developing major complications of type 1 diabetes.

This 10-year study, completed in 1993, included 1,441 people with type 1 diabetes. The study compared the effect of two treatment approaches—intensive management and standard management—on the development and progression of eye, kidney, and nerve complications of diabetes. Intensive treatment aimed to keep hemoglobin A1C as close to normal (6 percent) as possible. Hemoglobin A1C reflects average blood glucose over a 2- to 3-month period. Researchers found that study participants who maintained lower levels of blood glucose through intensive management had significantly lower rates of these complications. More recently, a followup study of DCCT participants showed that the ability of intensive control to lower the complications of diabetes has persisted 8 years after the trial ended.

The United Kingdom Prospective Diabetes Study, a European study completed in 1998, showed that intensive control of blood glucose and blood pressure reduced the risk of blindness, kidney disease, stroke, and heart attack in people with type 2 diabetes.

How is Diabetes treated?

Treatment is aimed at controlling the elevated blood glucose without causing an abnormally low glucose level (hypoglycaemia). An important aspect of your treatment plan will involve eating a healthy diet (low fat, salt and sugar and high fibre). You should also monitor your blood glucose levels.

  • Type 1 diabetes mellitus is treated with insulin, exercise, and a healthy diet.
  • Type 2 diabetes mellitus is first treated with weight reduction, a healthy diet and regular exercise.
  • In type 2 diabetes, if the above measures fail to control the elevated blood glucose, oral (by mouth) medicines are used to try to boost insulin production, improve the body’s use of it, or reduce the speed at which glucose enters the blood. Treatment with insulin will be considered if these other medicines are insufficient.
  • Gestational diabetes is usually controlled by a healthy diet and regular exercise. Some women may require treatment with insulin.


Treating high blood pressure and controlling the levels of fats (lipids) in the blood are also very important in patients with diabetes as they are at greater risk than the normal population of developing serious cardiovascular diseases.

A group of medicines known as ACE (angiotensin converting enzyme) inhibitors are sometimes used to reduce the risk of developing cardiovascular complications in diabetes and can also reduce the risk or progression of kidney and eye diseases.
Although there is currently no cure for diabetes mellitus, it can be controlled successfully with an active treatment plan. The potential benefit of pancreas transplants and islet cell transplants in type 1 patients is being investigated