Diabetics

Definition:
Diabetes mellitus, or simply diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced.[2] This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst), and polyphagia (increased hunger).

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There are three main types of diabetes mellitus (DM).

*Type 1 DM results from the body’s failure to produce insulin, and currently requires the person to inject insulin or wear an insulin pump. This form was previously referred to as “insulin-dependent diabetes mellitus” (IDDM) or “juvenile diabetes”.

*Type 2 DM results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. This form was previously referred to as non insulin-dependent diabetes mellitus (NIDDM) or “adult-onset diabetes”.

*The third main form, gestational diabetes, occurs when pregnant women without a previous diagnosis of diabetes develop a high blood glucose level. It may precede development of type 2 DM.

Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes.
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Diabetes has no age bar. It can appear in a newborn, children, young adults, during pregnancy or in older people. If there are suspicious symptoms, tests should be done.

Some families have a tendency to develop diabetes, with many members being affected. This is because it is a genetic disease that an be inherited from both parents. Type 1 and 2 diabetes are inherited from multiple genes. In type 2 diabetes particularly, the environment and family’s dietary and exercise habits also influence these genes. Families that eat “well” and are sedentary with snacking and excessive TV viewing are more likely to develop type 2 diabetes. Sometimes type 1 diabetes can develop in persons without a family history or genetic predisposition. It may follow viral infections, especially with the mumps and coxsackie group of viruses. The virus attacks and destroys the cells in the pancreas responsible for manufacturing insulin.

There is now a third type of diabetes, where the mutation occurs in a single gene. This gene is dominant, so that if either parent carries it, then half the children (male and female) will be affected. It was called MODY (maturity onset diabetes of youth). The diabetes affecting newborn children is of this type.

Initially, MODY was called type 1.5 diabetes and it was presumed that it was caused by only one type of genetic defect. Recent research has shown that there are 13 defects that lead to MODY.

*It is likely to be present in people who have been diagnosed with diabetes before the age of 30.

*It is present in every generation of the family.

*It can be managed with diet, exercise and tablets. Insulin is usually not required (even in children).

*MODY (depending on the type) can result in the affected woman having small or large babies.

* There may be cysts in the kidney.

* Malabsorption can occur.

* Patients may be infertile.

The incidence of MODY is higher in areas where there is a great deal of consanguinity (marrying a close relative) and when people marry generation after generation from the same community.

It is now possible to test for MODY genes in many centres and identify high-risk individuals and families.

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Symptoms:
The classic symptoms of untreated diabetes are loss of weight, polyuria (frequent urination), polydipsia (increased thirst), and polyphagia (increased hunger). Symptoms may develop rapidly (weeks or months) in type 1 diabetes, while they usually develop much more slowly and may be subtle or absent in type 2 diabetes.

Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. Blurred vision is a common complaint leading to a diabetes diagnosis. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.

Causes:
The cause of diabetes depends on the type.

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Type 1

Type 1 diabetes is partly inherited, and then triggered by certain infections, with some evidence pointing at Coxsackie B4 virus. A genetic element in individual susceptibility to some of these triggers has been traced to particular HLA genotypes (i.e., the genetic “self” identifiers relied upon by the immune system). However, even in those who have inherited the susceptibility, type 1 DM seems to require an environmental trigger. The onset of type 1 diabetes is unrelated to lifestyle.

Type 2

Type 2 diabetes is due primarily to lifestyle factors and genetics.[16] A number of lifestyle factors are known to be important to the development of type 2 diabetes, including obesity (defined by a body mass index of greater than thirty), lack of physical activity, poor diet, stress, and urbanization.[4] Excess body fat is associated with 30% of cases in those of Chinese and Japanese descent, 60-80% of cases in those of European and African descent, and 100% of Pima Indians and Pacific Islanders. Those who are not obese often have a high waist–hip ratio.

Dietary factors also influence the risk of developing type 2 diabetes. Consumption of sugar-sweetened drinks in excess is associated with an increased risk.  The type of fats in the diet is also important, with saturated fats and trans fatty acids increasing the risk and polyunsaturated and monounsaturated fat decreasing the risk.  Eating lots of white rice appears to also play a role in increasing risk.  A lack of exercise is believed to cause 7% of cases.

The following is a comprehensive list of other causes of diabetes:

*Genetic defects of ?-cell function
*Maturity onset diabetes of the young
*Mitochondrial DNA mutations

*Genetic defects in insulin processing or insulin action
*Defects in proinsulin conversion
*Insulin gene mutations
*Insulin receptor mutations

*Exocrine pancreatic defects
*Chronic pancreatitis
*Pancreatectomy
*Pancreatic neoplasia
*Cystic fibrosis
*Hemochromatosis
*Fibrocalculous pancreatopathy

Diabetes has no age bar. It can appear in a newborn, children, young adults, during pregnancy or in older people. If there are suspicious symptoms, tests should be done.

Some families have a tendency to develop diabetes, with many members being affected. This is because it is a genetic disease that an be inherited from both parents. Type 1 and 2 diabetes are inherited from multiple genes. In type 2 diabetes particularly, the environment and family’s dietary and exercise habits also influence these genes. Families that eat “well” and are sedentary with snacking and excessive TV viewing are more likely to develop type 2 diabetes. Sometimes type 1 diabetes can develop in persons without a family history or genetic predisposition. It may follow viral infections, especially with the mumps and coxsackie group of viruses. The virus attacks and destroys the cells in the pancreas responsible for manufacturing insulin.

Diagnosis:
Diabetes is diagnosed with blood tests. Blood sugar count after a 12 hour fast should be less than 100mg/dl and two hours after a full meal less than 140 mg/. Glycosolated haemoglobin (HbA1 c) should be 5.6.

A GTT (glucose tolerance test) can be done in suspect cases. In this the fasting blood glucose level is checked and 75gm glucose given. The blood is checked every 30 to 60 minutes after that. One hour later the blood glucose level should be lower than 180 mg/dL, two hours later less than 155 mg/dL, and three hours later lower than 140 mg/dL.

Complications:
Uncontrolled, untreated, neglected diabetes of all types causes complications with the nervous system, heart, kidneys, eyes and muscles affected.

All forms of diabetes increase the risk of long-term complications. These typically develop after many years (10–20), but may be the first symptom in those who have otherwise not received a diagnosis before that time. The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease. The main “macrovascular” diseases (related to atherosclerosis of larger arteries) are ischemic heart disease (angina and myocardial infarction), stroke, and peripheral vascular disease.

Diabetes also damages the capillaries (causes microangiopathy). Diabetic retinopathy, which affects blood vessel formation in the retina of the eye, can lead to visual symptoms including reduced vision and potentially blindness. Diabetic nephropathy, the impact of diabetes on the kidneys, can lead to scarring changes in the kidney tissue, loss of small or progressively larger amounts of protein in the urine, and eventually chronic kidney disease requiring dialysis.

Another risk is diabetic neuropathy, the impact of diabetes on the nervous system — most commonly causing numbness, tingling, and pain in the feet, and also increasing the risk of skin damage due to altered sensation. Together with vascular disease in the legs, neuropathy contributes to the risk of diabetes-related foot problems (such as diabetic foot ulcers) that can be difficult to treat and occasionally require amputation. Additionally, proximal diabetic neuropathy causes painful muscle wasting and weakness.

Several studies suggest a link between cognitive deficit and diabetes. Compared to those without diabetes, the research showed that those with the disease have a 1.2 to 1.5-fold greater rate of decline in cognitive function, and are at greater risk.

Treatment:
The major goal in treating diabetes is to minimize any elevation of blood sugar (glucose) without causing abnormally low levels of blood sugar. Type 1 diabetes is treated with insulin, exercise, and a diabetic diet. Type 2 diabetes is treated first with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugars, oral medications are used. If oral medications are still insufficient, treatment with insulin is considered.

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A change in lifestyle goes a long way in preventing the onset of diabetes and controlling it after it sets in. These guidelines are particularly important if you have MODY or feel that you or your family members are in danger of developing it.

Prevention:
To prevent development of the disease as an adult, it is our children who need to be targeted for intervention. Lifestyle changes — a healthy diet and regular exercise — should be implemented at the school level.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Diabetes_mellitus
http://www.medicinenet.com/diabetes_treatment/article.htm
http://www.telegraphindia.com/1131118/jsp/knowhow/story_17579340.jsp#.UolfgL4o52Y

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