Diabetes Mellitus

Diabetes Mellitus 

Definition
Diabetes is a disease in which the pancreas no longer produces enough insulin or cells stop responding to insulin, and blood glucose can not be absorbed into the body's cells. Symptoms include frequent urination, drowsiness, thirst and hunger. Treatment includes changes in eating habits, drugs administered orally and, in some cases, daily injections of insulin.

Description
Diabetes is a chronic disease that causes serious health complications, including renal (kidney), heart disease, stroke and blindness. Approximately 17 million Americans suffer from diabetes. Unfortunately, nearly half do not know they have it.

Background
To play a role in every cell of the human body needs energy. The main source of energy in the body is glucose, a monosaccharide containing carbohydrates digested food (sugars and starches). Circulating in blood glucose from food digestion, cells need energy source ready. Insulin is a hormone, or by cells of the pancreas, the organ that is located behind the stomach produces chemicals. Bonds insulin out of the cell and acts as a key to open a door, through which you can enter the glucose to enter the cell receptor site. Some of glucose may become a concentrated energy source, such as glycogen or fatty acid, and saved for later use. When not produce enough insulin or the door is no longer able to recognize key insulin, glucose remains in the blood cells.
The agency will try to dilute the high blood levels of sugar in the blood, a condition called hyperglycemia, efforts in the cells and the blood sugar water diluted and excreted in the urine. This is unusual people diagnosed with diabetes to be constantly thirsty, drink plenty of water, frequent urination, and your body is trying to get rid of excess glucose. This high concentration of glucose in urine.
At the same time, the body is trying to get rid of glucose from the blood cells to glucose starvation and send signals to the body to eat more food, so that patients with extreme hunger. Starvation of the cells to provide energy for the body to attempt to convert the glucose into fat and protein. Cause collapse of the energy of fat and protein acidic compound is known as the formation of ketone bodies in blood. The ketone is also excreted in the urine. Ketones in the blood, a condition called ketoacidosis. This can be life threatening if not treated in time, lead to coma and death.

The type of diabetes
Type I diabetes, sometimes called juvenile diabetes, the most common in childhood or adolescence. In this form of diabetes, the body produces little or no insulin. It is characterized by sudden onset were more frequent in the population decline of southern European countries, the Middle East or Asia, the Nordic countries (Finland, Scotland, Scandinavia). In the United States, there are about three people in 1000 for the development of type I diabetes This form is also known as insulin-dependent diabetes because people who develop this type need daily insulin injections.
In patients with labile diabetes is Type I package, frequent and rapid fluctuations in blood glucose levels between hyperglycemia (a state in which patients with excessive glucose or sugar) and low blood sugar ( abnormally low glucose conditions Next, or blood sugar). These patients may require different types of insulin throughout the day injection several glucose levels are maintained in a fairly normal range.
The most common form of diabetes, Type II, occurs in approximately 3-5% of Americans age 50-years old, and an increase of 10-15% over 50 years of age. Over 90% of people with diabetes in the United States for patients with type II diabetes. Sometimes referred to as the age of onset or adult-onset diabetes, this form of diabetes usually occurs in people who are overweight and do not exercise. These indigenous peoples of the Americas, is also more common in Hispanic and African American descent. Have migrated to Western culture from East India, Japan, Australian Aboriginal culture suffering easiest type II diabetes than those who remain in their home countries.
Type II is considered a milder form, it is the slow onset (sometimes a few years, the development process), as can usually be controlled with diet and oral diabetes medications. Out of control and consequences of the treatment of type II diabetes, the form, however, is also known as diabetes mellitus non-insulin dependent, a term is a bit misleading, as serious writing. However, with diet and oral medication, insulin injections, sometimes with diet and oral medication is necessary, if you do not work, many people with type II diabetes can control the disease.
Another form of diabetes, known as gestational diabetes in pregnancy and after the baby is delivered, you can usually resolve. In the second or third trimester of pregnancy, approximately 2% of gestational diabetes, the disease progresses. In 2004, according to reports, the incidence of gestational diabetes in 10 years 35%. Children of women with gestational diabetes are more likely to be premature children, hypoglycemia, or have severe jaundice at birth. , But the condition is usually through diet therapy, insulin injections may be needed. These women who have diabetes during pregnancy are at increased risk of developing type II diabetes within 5-10 years.
You can also develop in patients with diabetes due to pancreatic disease, alcoholism, malnutrition and other serious diseases, with emphasis on the body.

Causes and symptoms

Reason
Cause of diabetes is not clear, however, seems to be inherited (genetic factors by family), and environmental factors. Studies have shown that some people with diabetes who have a common genetic markers. In type I diabetes, the immune system, anti-infection, the body's defense system is considered by viruses or other microorganisms, destroying insulin-producing cells generate the pancreas is triggered. Type II diabetes, age, obesity, family history of diabetes play a role.
In type II diabetes, the pancreas to produce enough insulin, but the cells produce insulin resistance, may not work effectively. Type II diabetes symptoms began, a person may not know he or she has. The first signs of lethargy, extreme thirst, frequent urination. Other symptoms include sudden weight loss, slow wound healing, urinary tract infections, gum disease, or blurred vision. This is an unusual type II diabetes is detected, and the patient to see a doctor, and other health problems, in fact, has not been diagnosed with diabetes caused.
An individual who is in the development of type II diabetes in high risk individuals, including that:
Obesity (over 20% of their ideal body weight)
Having a family member with diabetes
The minority group at high risk (African Americans, Native Americans, Hispanics, Native Hawaiians)
Have you been diagnosed with gestational diabetes or have delivered baby weighing more than 9 pounds (4 kilograms)
High blood pressure (140/90 mm Hg or greater)
There are levels of high density lipoprotein cholesterol of less than or equal to 35 mg / dl and / or greater than or equal to 250 triglycerides mg / dl
Impaired glucose tolerance or impaired glucose fasting the previous test
Several common medications can impair the body's insulin-induced side called diabetes conditions. These drugs include the treatment of high blood pressure (furosemide, clonidine, thiazide diuretics), drugs with hormonal activity (oral contraceptives, thyroid hormone, progesterone, glucocorticorids) and anti-inflammatory drug indomethacin. Some drugs used to treat mood disorders (such as anxiety and depression) can also affect the absorption of glucose. These drugs include haloperidol, lithium carbonate, phenothiazines, tricyclic antidepressants, adrenergic agonists. The symptoms of diabetes can lead to other drugs, including isoniazid acid, nicotinic, cimetidine (d) and heparin. A 2004 study found low levels of essential mineral chromium may increase the risk of insulin resistance-related diseases.

Symptom
Symptoms of diabetes may suddenly in previously healthy children and adolescents (a few days or weeks), or progressive development (several years), overweight adults, 40 years of age. Typical symptoms are tiredness, loss ill, frequent urination, thirst, excessive hunger, and weight.
In type I diabetic ketoacidosis, status from starvation or uncontrolled diabetes, is common. Keto compounds decompose the fat and protein in blood as the body. Symptoms include abdominal pain, vomiting, difficulty breathing, extreme lethargy, drowsiness. Ketoacidosis patients also have a sweet breath odor. In this case, if untreated, can lead to coma and death.
With Type II diabetes, the disease may become evident until the patient some other medical conditions. The patient may have heart disease, chronic gum and urinary tract infections, blurred vision, numbness of the feet and legs, or slow healing wounds. Women may experience genital itching.

Diagnosis
It is suspected based on the symptoms of diabetes. Urine analysis and blood tests can be used to confirm the diagnosis based on the amount of glucose found in diabetes. Urine may also ketones and protein in the urine, and can help diagnose diabetes and renal function assessment. These tests can also be used to monitor the disease, once the patient is a standardized diet, oral medication or insulin.

Urinalysis
, Sugar in urine and Diastix is ​​a piece of paper, color change test strips when dipped in urine. The test strip, compared with a graph, the amount of glucose in the urine based on the change of display color. At levels of glucose in the urine in blood glucose level of hysteresis. Blood tests, urine test stick, a piece of paper, or change the color of the Tablet PC, the presence of sugar, not exact, but it can provide a quick and easy read.
Ketones in the urine can be detected using the test rod of a similar type (Acetest or Ketostix). Ketoacidosis in type I diabetes patients with life-threatening situations, as a quick and simple test to detect ketones can assist in establishing the diagnosis earlier.
Another test rod can determine the presence of protein in urine or albumin. Protein in the urine can be shown that the problem of renal function, and can be used to track the development of renal failure. Urinary protein test more sensitive detection of microalbuminuria using radiolabeled chemistry, a small amount of protein in the urine can not appear in the paper detection.

Blood tests
Fasting plasma glucose test. When blood from the patient's arm vein, the patient has not eaten after a certain period of time, for at least 8 hours, normally in the morning before breakfast. The red blood cells are separated from the sample, measure the amount of glucose remaining in the plasma. 7.8 mmol / l (200 mg / l) or greater plasma levels may indicate diabetes. In another day of fasting blood glucose test, usually need to be repeated to confirm the results.
Test postprandial blood glucose. The blood is to patients immediately after eating a meal.
Test of oral glucose tolerance. From venous blood samples before and after the patient drink a thick, sweet syrup glucose and other sugars. In the non-diabetes, the blood glucose levels rise immediately after the beverage, and then gradually decreases, as insulin is utilized by the body metabolism or absorption, sugar. In patients with diabetes, the blood glucose rises and remains high after sweet beverage liquid. Plasma glucose level of 11.1 mmol / l (200 mg / dl) or later after two hours, the beverage syrup and other points during the two hour test to confirm the diagnosis of diabetes.
If symptoms of diabetes, and the plasma glucose level of at least 11.1 mmol / L, at least 7 mmol / L level of fasting blood glucose, or a plasma level of two hours glucose of at least 11.1 A diagnosis of diabetes is recognized mmol / L, in the event of oral glucose tolerance.
Home blood glucose monitoring equipment allows patients with diabetes to control their own level. The spines of a small needle or lancet finger and a drop of blood obtained by the monitoring and analysis equipment. Some patients may have to test their blood glucose levels several times a day, and use this information to adjust the insulin dose.

Treatment
There is no cure for diabetes. The conditions, however, can be managed so that patients can live a relatively normal life. Treating diabetes focuses on two goals: to maintain glucose within a normal range, and to prevent the development of long-term complications. Careful monitoring, diet, exercise, blood glucose levels is important, because the use of insulin or oral drugs in the prevention of diabetes complications. In 2003, the American Diabetes Association, the latest standard of diabetes care management. These standards will help manage the latest recommendations of health professionals on the diagnosis and treatment of this disease.

Changes in eating habits
Diet and exercise is the first application moderate treatment of diabetes. For many patients with type II diabetes, weight loss can be an important goal, to help control your diabetes. A good balanced, nutritious diet provides approximately 50% -60% of calories from carbohydrates, approximately 10-20% of calories from protein, less than 30 percent of calories from fat. The amount of heat required for an individual depends on the age, weight and activity level. Caloric intake is also need to be distributed throughout the course of the day, so that glucose in the blood system of the overvoltage to be kept at a minimum.
The number of calories provided by different tracking food can become complicated, so patients usually should consult a nutritionist or dietitian. A personalized, easy to manage diet plan can be adjusted for each patient. The American Diabetes Association and the American Dietetic Association recommends a diet based on food use changing table. Each food exchange contains a known amount of calories, protein, fat, carbohydrates shaped. The plan of the patient's diet should include a certain number of exchanges from each food category (meat or protein, fruits, bread, starch, vegetables and fats) to be eaten at meal time and snacks. Patients to choose the food we eat, as long as you stick with the flexibility to change the provisions of the quantity.
For many patients with type II diabetes, weight loss is an important factor in controlling the disease. Food exchange system and the program of moderate intensity exercise, can help you lose excess weight and improve your overall health.

Oral medications
Oral medications to lower blood glucose in patients with type II diabetes. In 1990, 23.4 outpatient prescriptions for oral hypoglycemic agents assigned. In 2001, this figure had increased to 91.8 million prescriptions. Oral hypoglycemic account for billions of dollars more for $ 5 each year in the fastest growing segment in the early years of the 21st century global sales at retail of diabetes medications. Provisions for type II diabetes drugs are a class of compounds called sulfonylureas include tolbutamide, tolazamide, vinegar and bleach. In the same class, and now the new drugs, including glyburide and glipizide glimeperide. How these drugs work is not clear, but it seems to stimulate cells of the pancreas to produce more insulin. New drugs can be used to treat diabetes include metformin, acarbose, troglitizone. The choice of drug depends on the individual patient's file. All drugs have side effects, and can allow specific patients. Example, may stimulate weight gain or cause stomach irritation, so that their people who are overweight or who have stomach ulcers may not be the best method of treatment. Others, such as metformin, has been shown to have a positive effect, such as reduction of cardiovascular disease mortality, but the increased risk in the other cases. Although these drugs are an important aspect of the treatment of type II diabetes, are no substitute for a well-planned diet and moderate exercise. Oral medication was not effective in patients with type I diabetes produce little or no insulin.
Are progressing in developing new oral drug diabetes. In 2003, glipizide and metformin in combination tablet approved drugs called Metaglip Dingle. With diet and exercise, and initial treatment of type 2 diabetes drugs. Another combination of drugs approved by the Food and Drug Administration of USA (FDA), metformin, rosiglitazone (Avandia) drugs to increase the sensitivity of muscle cells to insulin. It is marketed under the name AVANDAMET. Therefore, many new drugs are in development, it is best to keep in touch with your doctor, the doctor can find the best medications, diet and exercise plan to meet the needs of each patient.

Insulin
Patients with Type I diabetes need daily injections of insulin to help the body use glucose. The amount and type of insulin required depends on the height, weight, age, food intake, and diabetes activities individually. Type II diabetic patients, if they are unable to control diabetes with diet, exercise and oral medications may be necessary to use insulin injections. Subcutaneous injections, just below the skin with a needle and syringe small. The injection site can be anywhere in the body, there is a loose skin, including the top of the upper arm, abdomen or thigh.
Purified human insulin is most commonly used, but the source of insulin from beef and pork are also available. It can give to a type of insulin, a once daily injection of a single dose of insulin. It can be mixed with different types of insulin, and gives a dose or divided into two or more doses in a day. Require multiple injections per day in patients which can be used in the process, the management of insulin pump, a small dose of insulin requirements. Worn outside the body, a small battery operated pump and connected to the abdomen of the needle inserted. The pump can be programmed to inject small doses of insulin, at different times during the day, or the patient may be able to adjust the insulin dose, diet and exercise.
Conventional insulin are fast acting and start working within 15-30 minutes, the peak hypoglycemic effect about two hours after injection. Its impact lasted for about four to six hours. NPH (Neutral Protamine Hagedorn) insulin action and prolonged, in effect, within one to three hours to work, and as 18-26 hours. The ultra-long lasting insulin is a long-term work within four to eight hours, and continued for 28-36 hours.
Hypoglycemia, or low blood sugar, can be caused by too much insulin, too little food (or eating too late for the action of insulin), alcohol consumption, or increased exercise. A patient's symptoms of hypoglycemia may be hungry, irritable, confused and tired. The patient may become sweaty and agitated. If left untreated, the patient may lose consciousness or seizures. This condition is sometimes called insulin reaction must be considered by patients as sweets, sugar, fruit juice or other sugar snacks to eat or drink sweet things.

Surgery
The healthy pancreas is transplanted into diabetic patients successful treatment, however, this transplant is usually only when kidney transplants performed at the same time. Although pancreas transplantation is feasible, it is unclear whether the potential benefits outweigh the risks of surgery and drug therapy.
Replacement therapy
Diabetes patients with life-threatening if not properly managed, should not attempt to treat this disease without medical medical supervision. A variety of alternative therapies can help patients manage symptoms and disease diabetes support. Acupuncture can help relieve the pain caused by diabetic neuropathy stimulus cetain point. Consult a qualified physician. Herbs can help control diabetes. Although there is no herbal substitute for insulin, some herbs can help regulate sugar levels in the blood or manage other diabetic symptoms. Some of the options are:
Fenugreek (fenugreek) has been shown in some studies, but also for reducing cholesterol, reducing blood insulin and glucose levels
Bilberry (Vaccinium) can reduce blood sugar levels in the blood and help maintain healthy blood vessels
Garlic (Allium sativum), lowering blood sugar and cholesterol levels
Onions (onions) can help reduce the levels of blood glucose by releasing insulin to metabolize them,
Pepper (capsicum) can help relieve the pain of peripheral nerves (a type of diabetic neuropathy)
Ginkgo (Ginkgo biloba) can maintain blood flow to the retina, help prevent diabetic retinopathy
Any treatment, and the lower pressure level, and can also be very useful in helping to reduce the need of insulin treatment for diabetes. In replacement therapy, the purpose of the hypnotherapy, biofeedback and meditation to reduce stress.

Prognosis
Uncontrolled diabetes leading to end-stage renal disease, blindness and amputations. It also doubled the risk of heart disease and increase the risk of stroke. Eye problems, including cataracts, glaucoma, diabetic retinopathy is more common in patients with diabetes.
Diabetic peripheral neuropathy is a nerve endings, especially in the legs and feet, become less sensitive. Diabetic foot ulcers are a particular problem since the patient does not feel the pain of blisters, calluses or minor injuries. Poor blood circulation in the legs and feet, and promote wound healing delay. You can not feel pain, delayed wound healing complications can lead to infection and difficult to treat minor injuries, blisters or cocoon. In case of severe infection, the infected tissue begins to decay, rot. The most serious consequence of this is the need for amputation of toes, feet or legs due to severe infection.
Heart disease and kidney disease is a common complication of diabetes. Long-term complications may include kidney dialysis or a kidney transplant, the need for renal failure.
Babies born to diabetic mothers are at increased risk of birth defects and distress at birth.

Prevention
Research continues, the prevention of diabetes and to improve the detection of the risk of diabetes. Although the risk of type I diabetes is unpredictable, maintaining ideal body weight and regular exercise, can reduce the development of type II diabetes. Surgery of the disease, physical and mental stress, pregnancy, alcohol increases the risk of diabetes, therefore, maintain a healthy lifestyle is crucial to prevent the incidence of type II diabetes, and prevent further complications disease.
Main features of the
Cataract - clouding of the eye.
Sensitive nerve of diabetic peripheral neuropathy - dull pain, temperature and pressure conditions, especially in the legs and feet.
Diabetic retinopathy - the conditions of the small blood vessels of the retina, the light feeling in the back of the eye, the tissue is damaged, leading to blurred vision, sudden blindness, or black spots, lines, or flashing lights in the field of view.
Glaucoma - intraocular pressure damage to the optic nerve sends visual images to the brain.
Blood sugar - conditions too much glucose or sugar in the blood.
Hypoglycemia - very little of glucose or sugar in the blood condition.
- Insulin, a hormone produced by the pancreas or chemical human insulin cells to use glucose (sugar), the main source of energy in the body.
Ketoacidosis - due to starvation or uncontrolled Type I diabetes. Keto compounds decompose the fat and protein in blood as the body. Symptoms include abdominal pain, vomiting, shortness of breath, extreme fatigue, lethargy.
Kidney dialysis - a process by dialysis machines, blood is filtered to remove debris normally eliminated by the kidneys. Then, after filtration, the circulation of the blood back to the patient's body. This process is also known as renal dialysis.
Pancreas - a gland located behind the stomach, produces insulin.