Diabetes

Diabetes mellitus is a common disease in the United States. It is estimated that over 16 million Americans are already caught with diabetes, and 5.4 million diabetics are not aware of the existing disease. Diabetes prevalence has increased steadily in the last half of this century and will continue rising among U.S. population. It is believed to be one of the main criterions for deaths in United States, every year. This diabetes information hub projects on the necessary steps and precautions to control and eradicate diabetes, completely. Diabetes is a metabolic disorder where in human body does not produce or properly uses insulin, a hormone that is required to convert sugar, starches, and other food into energy. Diabetes mellitus is characterized by constant high levels of blood glucose (sugar). Human body has to maintain the blood glucose level at a very narrow range, which is done with insulin and glucagon. The function of glucagon is causing the liver to release glucose from its cells into the blood, for the production of energy.

There are three main types of diabetes:

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Type 1 diabetes Type 2 diabetes Gestational diabetes

Type 1 and Type 2 diabetes impede a persons carefree life. When breakdown of glucose is stopped completely, body uses fat and protein for producing the energy. Due to this mechanism symptoms like polydipsia, polyuria, polyphegia, and excessive weightloss can be observed in a diabetic. Desired blood sugar of human body should be between 70 mg/dl -110 mg/dl at fasting state. If blood sugar is less than 70 mg/dl, it is termed as hypoglycemia and if more than 110 mg /dl, its hyperglycemia. Diabetes is the primary reason for adult blindness, end-stage renal disease (ESRD), gangrene and amputations. Overweight, lack of exercise, family history and stress increase the likelihood of diabetes. When blood sugar level is constantly high it leads to kidney failure, cardiovascular problems and neuropathy. Patients with diabetes are 4 times more likely to have coronary heart disease and stroke. In addition, Gestational diabetes is more dangerous for pregnant women and their fetus. Though, Diabetes mellitus is not completely curable but, it is controllable to a great extent. So, you need to have thorough diabetes information to manage this it successfully. The control of diabetes mostly depends on the patient and it is his/her responsibility to take care of their diet, exercise and medication. Advances in diabetes research have led to better ways of controlling diabetes and treating its complications. Hence they include:-

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New improved Insulin and its therapy, (external and implantable insulin pumps) have advanced well to manage elevated blood sugars without any allergic reactions. Oral hypoglycemic drug, controls diabetes type 2. New improved blood glucose monitor (new device for self blood glucose monitoring), and hemoglobin A1c laboratory test to measure blood glucose control during previous 3 months. Effective availability of the treatments for affected body organs due to diabetes. Better ways to manage mother and its fetus health during the gestational diabetes phase.

Symptoms of Diabetes

In both types of diabetes, signs and symptoms are more likely to be similar as the blood sugar is high, either due to less or no production of insulin, or insulin resistance. In any case, if there is inadequate glucose in the cells, it is identifiable through certain signs and symptoms. These symptoms are quickly relieved once the Diabetes is treated and also reduce the chances of developing serious health problems. Diabetes Type 1: In type 1, the pancreas stop producing insulin due to autuimmune response or possibly viral attack on pancreas. In absence of insulin, body cells dont get the required glucose for producing ATP (Adenosin Triphosphate) units which results into primary symptom in the form of nausea and vomiting. In later stage, which leads to ketoacidosis, the body starts breaking down the muscle tissue and fat for producing energy hence, causing fast weight loss. Dehydration is also usually observed due to electrolyte disturbance. In advanced stages, coma and death is witnessed. Diabetes Type 2:

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Increased fatigue : Due to inefficiency of the cell to metabolize glucose, reserve fat of body is metabolized to gain energy. When fat is broken down in the body, it uses more energy as compared to glucose, hence body goes innegative calorie effect, which results in fatigue. Polydipsia : As the concentration of glucose increases in the blood, brain receives signal for diluting it and, in its counteraction we feel thirsty. Polyuria: Increase in urine production is due to excess glucose present in body. Body gets rid of the extra sugar in the blood by excreting it through urine. This leads to dehydration because along with the sugar, a large amount of water is excreted out of the body. Polyphegia : The hormone insulin is also responsible for stimulating hunger. In order to cope up with high sugar levels in blood, body produces insulinwhich leads to increased hunger. Weight flactuation : Factors like loss of water (polyuria), glucosuria , metabolism of body fat and protein may lead to weight loss. Few cases may show weight gain due to increased appetite. Blurry vision : Hyperosmolar hyperglycemia nonketotic syndrome is the condition when body fluid is pulled out of tissues including lenses of the eye, which affects its ability to focus, resulting blurry vision. Irritability : It is a sign of high blood sugar because of the inefficient glucose supply to the brain and other body organs, which makes us feel tired and uneasy. Infections : The body gives few signals whenever there is fluctuation in blood sugar (due to suppression of immune system) by frequent skin infections like fungal or bacterial or UTI (urinary tract infection). Poor wound healing : High blood sugar resists the flourishing of WBC, (white blood cell) which are responsible for body immune system. When these cells do not function accordingly, wound healing is not at good pace. Secondly, long standing diabetes leads to thickening of blood vessels which affect proper circulation of blood in different body parts.

of every 25 females have prediabetes aged from 12 to 19 years.

What Causes Diabetes

The precise Etiology of most cases of diabetes is uncertain, although certain contributing factors are as follows: Type 1 diabetes Type 1 Diabetes is autoimmune disease that affects 0.3% on average. It is result of destruction of beta cells due to aggressive nature of cells present in the body. Researchers believe that some of the Etiology and Risk factors which may trigger type 1 diabetes may be genetic, poor diet (malnutrition) and environment (virus affecting pancreas). Secondly, in most of the cases, diabetes occurs because there is abnormal secretion of some hormones in blood which act as antagonists to insulin. Example- Adrenocortical hormone, Adrenaline hormone and Thyroid hormone. Type 2 diabetes Type 2 Diabetes is also called non insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. It occurs when the body produces enough insulin but cannot utilize it effectively. This type of diabetes usually develops in middle age. A general observation says that about 90-95 % of people suffering with diabetes are type 2; about 80 percent are overweight. It is more common among people who are older; obese; have a family history of

diabetes; have had gestational diabetes. There are number of risk factors found to be responsible for type 2 diabetes like, the more the Etiology and Risk factors carried by an individual, the higher the risk for developing diabetes.

Following are the Causes of Diabetes

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Hereditary or Inherited Traits : It is strongly believed that due to some genes which passes from one generation to another, a person can inherit diabetes. It depends upon closeness of blood relationship as mother is diabetic, the risk is 2 to 3%, father is diabetic, the risk is more than the previous case and if both the parents are diabetic, the child has much greater risk for diabetes. Age : Increased age is a factor which gives more possibility than in younger age. This disease may occur at any age, but 80% of cases occur after 50 year, incidences increase with the age factor. Poor Diet (Malnutrition Related Diabetes) : Improper nutrition, low protein and fiber intake, high intake of refined products are the expected reasons for developing diabetes. Obesity and Fat Distribution : Being overweight means increased insulin resistance, that is if body fat is more than 30%, BMI 25+, waist grith 35 inches in women or 40 inches in males. Sedentary Lifestyle : People with sedentary lifestyle are more prone to diabetes, when compared to those who exercise thrice a week, are at low risk of falling prey to diabetes. Stress : Either physical injury or emotional disturbance is frequently blamed as the initial cause of the disease. Any disturbance in Cortiosteroid or ACTH therapy may lead to clinical signs of the disease. Drug Induced: Clozapine (Clozaril), olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel) and ziprasidone (Geodon) are known to induce this lethal disease. Infection : Some of the strephylococci is suppose to be responsible factor for infection in pancreas. Sex : Diabetes is commonly seen in elderly especially males but, strongly in women and those females with multiple pregnancy or suffering from (PCOS) Polycystic Ovarian Syndrome. Hypertension : It had been reported in many studies that there is direct relation between high systolic pressure and diabetes. Serum lipids and lipoproteins : High triglyceride and cholesterol level in the blood is related to high blood sugars, in some cases it has been studied that risk is involved even with low HDL levels in circulating blood.

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Gestational Diabetes

Gestational diabetes is a form of diabetes 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 affects about 4% of all pregnant women. It is estimated that about 135,000 cases of gestational diabetes 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. Glucose builds up in the blood to high level, it is called hyperglycemia. Gestational diabetes 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.

Why there is a need to take care of gestational diabetes

Gestational diabetes can harm you and your baby, so you need to consider about it seriously and start caring at once. The main aim of gestational diabetes treatment is to keep blood glucose levels equal to those of normal pregnant women. It needs a planned meal and scheduled physical activity, even blood glucose testing andinsulin injections if required. If gestational diabetes is taken care off properly, reduces the risk of a cesarean section birth that high weight babies may require.

Types of Gestational Diabetes

There are 2 types of gestational diabetes: Type A1: Only diet modification is sufficient to maintain normal glucose levels. Type A2: Insulin or other medications along with diet are required to maintain normal range of blood glucose. Gestational diabetes is also classified into different forms of diabetes which existed prior to pregnancy:

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Type B: onset at age 20 or older or with duration of less than 10 years. Type C: onset at age 10-19 or duration of 1-19 years. Type D: onset before age 10 or duration greater than 20 years. Type F: diabetic nephropathy. Type R: diabetic retinopathy. Type H: diabetes with ischemic heart disease. Type T: diabetes requiring kidney transplant.

Symptoms of Gestational Diabetes

Often women with gestational diabetes exhibit no symptoms. Screening glucose challenge test is a preliminary screening test performed between 26-28 weeks. However, symptoms of gestational diabetes are similar as Type II diabetes. It includes increased thirst, increased urination, fatigue, nausea and vomiting, bladder and yeast infection, and blurred vision. Gestational Diabetes Risk of diabetes in Future: Gestational diabetes is only a temporary phase, it disappears after pregnancy. But once you are diagnosed with gestational diabetes, your chances are 2 in 3 that it will return in future. It is hard to tell whether the particular woman has diabetes due to gestational diabetes or type 2 diabetes. There seems to be a link between the tendency to get gestational diabetes and type 2 diabetes. Gestational diabetes and type 2 diabetes both involve insulin resistance. Risk factors for gestational diabetes include:

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Strong family history of type 2 diabetes Mothers age - a woman is at higher risk if she is aged at the time of pregnancy Obesity Fallen prey to gestational diabetes in previous pregnancy A previous pregnancy that resulted in a child with a birth weight of 9 pounds or more If you are diagnosed with prediabetes, impaired glucose tolerance, or impaired fasting glucose

Gestational Diabetes Test

Depending on risk factors, the doctor will decide when you need to be checked fordiabetes. 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 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 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, 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:

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Fasting Blood Glucose Level95 mg/dl 1 Hour Blood Glucose Level180 mg/dl 2 Hour Blood Glucose Level155 mg/dl 3 Hour Blood Glucose Level140 mg/dl

Treatment for Gestational Diabetes

Women with gestational diabetes 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:

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Know your blood sugar and keep it under control Eat a healthy diet Get regular, moderate physical activity Keep a healthy weight

Women with gestational diabetes 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 will also need to take insulin, to help manage their diabetes if blood sugar is shooting up, in spite of all this. The extra insulin can help them lower their blood sugar level.

Diabetes Complications

Once we have crossed the reversible stage of prediabetes and enter diabetes stage, certain changes start developing in our body. These changes occur due to high blood sugar level with instability in the hormones as well as blood vessels and nerves. When these changes become permanent in the body it develops into serious Diabetes Complications and body indicates these changes by steady symptoms.

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Diabetic retinopathy shows symptoms of pain in the eyes and may even result in loss of vision. Renal (kidney) disease shows symptoms of swelling (edem a) in the feet and legs. It then passes over total body and as the disease progresses, blood pressure also increases. Tingling, burning, numbness, tightness, shooting or stabbing pain in the hands, feet or other parts of your body, especially at night. Digestive problems also occur if, the nerves controlling internal organs get damaged (autonomic neuropathy). You may have scanty or profuse sweating, difficulty of sensing when your bladder is full, when there is a low blood sugar, increased sexual problems, weakness, dizziness, and fainting. Chest pain (angina) or shortness of breath dizziness or light headache, shoulder or stomach pain, fast heartbeat. You might not show any symptoms until having a heart attack or stroke.

When alarming symptoms given by the body are ignored and the same status is maintained, it starts dam aging body organs, such as heart, kidney, eye, feet, and skin. The physiology for each and every affected organ is explained one by one.

Diabetic Retinopathy

Diabetic retinopathy is a type of micro vascular disease in which the micro vessel, supplying blood to the retina of our eye is affected. Retinopathy is related to high blood sugar level and obstructs the flow of oxygen to the cells of the retina. Retina is an ultra thin layer of blood vessel made up of rods and cones. As soon as the retinareceives signals of light, it is sent to the brain and a three dimensional figure is formed and identified, this is sent back to the eye by which we can recognize the things around us. The high blood glucose level hinders its working and leaves obstacles in passing light through the retina, thus, leading to improper vision. The early stage of this disease is called non proliferate diabetic retinopathy. The blurred and distorted vision is because of macular edema. Proliferative diabetic retinopathy is the advanced form of diabetic retinopathy; the new blood vessels break, as they are weak and leak blood into vitreous of the eye, which will lead to floating spots in the eye. The pace of damage is not similar in both the eyes but, both the eyes are affected by this disease. Some times one eye is affected more easily than the other. After some period, the swollen and scar nerve tissue of the retina is totally destroyed and pulls up the entire layer of retina and detaches it from the back of the eye. Retinal detachment is the cause behind blindness among diabetics in middle age. The other two types of eye problems usually seen earlier in the people suffering from diabetes are:

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Cataract :- A thin cloudy layer appears in front of your eye leading to unclear vision. In cataract surgery this thin layer is removed and setting of a plastic layer in front of the lens is done, thus gives you a clear vision again. Glaucoma :- Due to high pressure on the optic nerve, it gets damaged. The dam aged optic nerve creates disturbance in clear vision. Laser surgery or simple eye drops may help in regaining the normal vision.

A diabetic must go for the regular eye checkup so that the early stages of diabeticretinopathy can be detected and treated in initial stages itself, with less harm to the eyes. Blood sugar levels should also be monitored and maintained to prevent blood vessel damage.

Diabetic Neuropathy

Nerves depend on multiple tiny vessels which carry nutrients and oxygen to keep intact all the segments of these very long nerves. Damage to one small segment can result in loss of feeling, pain or burning sensations that bother the foot and leg. Feet:- Diabetes can decrease the blood supply to the foot and gradually damages the nerves which carry sensation. A second micro vascular disease is diabetic foot or diabetic peripheral neuropathy or distal symmetric neuropathy. Neuropathy is the common complication of diabetes, and due to high blood sugar, chemical changes occur in the nerves. It always starts in the feet as they are the longest nerves and fed with longest blood vessels of the body. Generally it is seen in the obese people with high blood sugar levels and age more than 40 years. Neuropathy can develop within a span of first few years and it affects approximately 60% of diabetics.

Signs and symptoms of Diabetic Neuropathy y y y y

Decrease or no sweating i.e. dry scaly skin with callus formation. Numbness, tingling, and some sort of burning sensation. Weakness and loss of reflexes. Decrease sensation to the slight change in temperature.

Diabetics need to take care of their feet especially the area between toes, and must not overlook if there is any kind of blisters, ulcer, redness or soreness or formation of callus etc. If any suspicion or doubt arises for the foot then it should be followed by immediate physical examination. The clinical examination will show the sensation in the feet and determine if it is normal or diminished. Blood flow may be improved with good sources of vitamin E intake along with blood pressure medicine (ACE inhibitors). Although amputations are common withdiabetes, about half can be prevented with simple steps that protect the feet.

Diabetes Skin Care

Diabetes affects different body parts of a person including skin. The skin disorders can be seen in normal individual too, but diabetics are more frequently prone to it. Fortunately, most of the skin infections can easily be controlled if detected in early stages. Infection can be bacterial, fungal or simple itching. Some of the specific skin infections frequently seen in the diabetic patients are Dermopathy, Necrobiosis lipoidica, Diabeticorum, Xanthomatosis and Blisters.

Diabetes Skin Infections:

Bacterial infections :- Bacterial infections are more commonly seen in people with diabetes than in normal individuals. Styes - Infection of glands and eyelids, Boils and hair follicles infections, skin and tissue are affected by carbuncles. These infections are spread by few bacterial germs but the most common is Staphylococcus bacteria. Fungal infections :- Candida-albicans is the yeast-like fungus, responsible for red sore skin with frequent sense of itching and developing into blisters and scales. These patchy infections usually appear at skin folding, where moisture is persisting for longer period, like armpits and groin, under the foreskin, under breast, finger and toesnail (onychomycosis), in the mouth (thrush), in the vagina etc. Some of the known fungal infections are athlete's foot, ring worms and jock itch. Itching :- Itching may result from poor blood circulation, dry skin, or any kind of bacterial and viral infection, mostly observed in lower extremities. Wiping your body till completely dry and using good moisturizing agent are the suggestive steps to manage simple itching. Diabetic Dermopathy :- Dermopathy shows skin changes occurring in diabetics due to affected blood vessels (i.e. oval to circular), slightly indented dry brown to purple and scaly patches. When zinc doses are administered for several weeks it appears to help the lesions resolve over several months, especially when combined with near normal blood sugars. Necrobiosis Lipoidica Diabeticorum :- Necrobiosis Lipodica Diabecicorum (NLD) seems similar to dermopathy, but it is more worst than the latter, as it penetrates deeply into the skin, making the spots red with a well defined purple line. See your doctor at right time or else it may crack or break. Xanthomatosis, Sclerosis and Diabetic blisters :- High blood sugar aggravates these conditions; xanthomatosis is slight yellowish pea like pigmentation in feet, arms, legs, hands, buttocks etc. In sclerosis, skin of toe, forehead, hands becomes thick and waxy, and stiffness in the joints is observed. Sometimes painless diabetic blisters erupt in the fingers, toes, hands, forehands and feet look like burned sores. These are commonly seen in overweight, type 1 diabetic, and revert back to normal as soon as blood sugar is controlled out. Disseminated Granuloma Annulare :- Sharp well define ring or arc shape raised area of skin is seen, then it is nothing but disseminated granuloma annulare. The common body parts where it can be seen are on the fingers or ears.

Acanthosis nigricans :- This is the condition, in which brown tanned patches appear in different parts of the body like neck, armpits and groin, hands, elbow and knees. This is usually seen in the people with overweight; especially women are more likely to be caught with this. Allergic Reactions :- Visible allergic reaction in the area of skin is examined when insulin is injected and, it may develop rashes.

Diabetic Nephropathy

Diabetic Nephropathy is a complication in which kidneys are damaged due to persistent high blood sugar level in the blood. Its one of the common causes of kidney failure world wide, especially in adults. Kidney functions as a filtering machine in a human body by throwing out the waste in the form of urine. It maintains electrolyte balance, blood pH level and regulates blood pressure, and also releases some of the hormones. When the kidneys start damaging, they fail to carry out these functions with proficiency. Protein molecules along with other bodies which are present in the blood, start appearing in the urine. In the initial phase of nephropathy where damage is not too severe, drugs and diet can control the condition. When protein starts leaking in the urine it is called asmicroalbuminuria, as the condition starts worsening, large amount of protein is thrown in the urine with heavy losses of protein from the body. Few easily noticed symptoms of kidney failure are fatigue, decreased appetite, nausea and vomiting. It has been observed that about 30 to 40 % of Type I diabetics and 20 to 30 % of Type 2 diabetics, develop moderate to severe kidney failure.
Diabetic Nephropathy can be screened in simple urine test at any diagnostic laboratory. Type 1 diabetic must

check nephropathy test in fourth year of diagnosis and Type 2 at the time of diagnosis. It is always better to go for routine tests in the further years. When it shows albuminiuria, modification of diet, regular exercise with some medication for blood pressure control (an ACE inhibitor or angiotension receptor blocker [ARB]) is generally recommended, even if blood pressure is normal. Patients with elevated blood pressures and albuminuria are treated with an ACE inhibitor or ARB. These medications can reduce the percent of protein extraction in the urine and help in slowing down the progression of diabetes, nephropathy and related kidney diseases. Diabetes myonecrosis may develop before or at the time of diagnosis of diabetes, generally it is a type of gangrene caused by Clostridium bacteria. This bacterium produces toxins, which leads to tissue diabetic mastopathy. It is a condition usually seen in pre-menopausal women suffering from Type 1 diabetes for many years with insulin therapy. Although very rare, it can be seen in men with diabetes as diabeticmastopathy, which is associated with micro-vascular complications such as damage to the eyes, kidneys and heart, or other disorders such as thyroid problem.

Suggestions for preventing Diabetic Nephropathy y y y y y y

Maintain blood sugar level within normal range. Control blood pressure with modifying diet, relaxation techniques, and medication. Decrease intake of salt, fast foods, preserved and baked items to maintain blood pressure. Decrease animal protein, simple sugars and animal fats in the diet. Check urine regularly for microalbumin. Take care of bladder or urinary tract infections and treat them early.

Heart Disease and Stroke

It has been observed that people suffering from diabetes tend to have 50% increased heart risks like getting heart diseases or strokes. If you are a diabetic - middle aged person, you may have heart attack earlier than those who are heart patients, more aged than you. Heart complications are "micro vascular disease and "macro vascular disease". The damage to small blood vessels leads to a microangiopathy. Coronary artery disease (CAD) is the most common form of heart disease in diabetes. In such a condition, the arteries that supply blood to the heart get narrowed or obstructed due to fatty clots. Plaque is formed out of

cholesterol, calcium, and other substances that float in blood and inside the walls of coronary arteries and other arteries. When these small vessels are blocked and start narrowing, it is named asatherosclerosis.

Arteries without Fat

Arteries with Fat

A heart attack results when blood flow is completely blocked, usually by a blood clot forming over a plaque that has busted and opened (ruptured). Heart attack (myocardial infection) causes complete death of the heart muscle cells. The pain of heart attack is usually combined with other signs such as

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Chest discomfort - it feels like heavy load on the heart, or crushing or squeezing Chest pain radiating to jaws, neck, shoulders, or arms Sweating Nausea and vomiting Shortness of breath Dizziness with mild to severe headache. Irregular and fast heartbeats Loss of consciousness

People with Type 2 diabetes often have low HDL cholesterol and raised triglyceride levels, which together increases the risk of atherosclerosis. High blood pressure, smoking, obesity and physical inactivity are also risk factors for CVD. High blood sugar causes changes in the hormones and the cells that can damage your blood vessels or nerves, or both. Damaged blood vessels are more likely to build up plaque, increasing the risk of coronary artery disease, heart attack and stroke. Damage to smaller blood vessels can lead to loss of vision, kidney disease, and nerve problems.

Causes for Heart Disease and Stroke

Heart or large blood vessel disease. These complications sometimes referred as macro vascular disease, which may cause peripheral arterial disease, stroke, or heart attack. PAD (peripheral arterial disease) is a condition which results due to narrowing of the arteries that supply blood to legs, abdomen, pelvis, arms, and neck. It builds upexcess cholesterol, calcium, and other substances (plaque) inside the arteries, particularly in the ones which supply oxygen rich blood to legs. General symptoms of PAD are

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Decreased leg strength, its reduced functioning and poor balance when standing. Cold and numb feet or toes. Sores that is slow to heal. Tight or squeezing pain in the calf, foot, thigh, or buttock

It is suggested to recognize the early stages of heart problems with routine check ups and go ahead with the treatment as early as possible. Medical treatment is needed to prevent further complications and eventually the death. The permanent damages occurring in the heart can be reduced to minimum, if treated early.

Diabetic Care

Diabetes can be a tough disease to handle. There are many reasons for it, firstly, causes of the disease are not clearly known, it is difficult to prevent. Secondly, once you get the disease, it is not possible to cure the same and you need to take care of your health for entire life. This task can be quite daunting; here are a few tips to help you. Diabetic Care Tips If you have diabetes, you need to take some precautions, in your day to day life as well and not only at those times, when you feel sick. Here are some precautions that you can take in your everyday life:

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You should monitor your blood glucose level regularly. Depending on the severity of your condition, your doctor would tell you about the intervals, in which you should take the test. You should take regular doses of medicine or insulin, as have been prescribed. Regular exercise proves to be useful in controlling glucose levels. However, you should avoid few exercises, that are known to cause further complications like cardiovascular diseases, hypoglycemia etc. In case your glucose level drops suddenly during or after exercise, you should consume a fruit juice or some similar drink that provides you with sugar. Weight reduction is a key of success in managing diabetes; hence take all the measures of carb control, what you can.

In case you are suffering from any ailment like flu, cold or any other disease or infection, some extra precautions need to be taken, to avoid further complications by diabetes:

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Check your blood sugar level more frequently, to ensure that no harm is being caused by diabetes. The illness may force some changes in your diet; consult your doctor/endocrinologist about the changes you need to make in your diabetes medicine accordingly. You should drink lots of water and other clear liquids. Remember not to cut yourself completely from food even if you are not experiencing hunger. Consult the doctor, if you feel abnormal in any manner. For example you may be feeling excessively sleepy, giddy, may have trouble with urination etc.

Even though diabetes is a chronic condition, the same does not mean, that you will have to avoid every activity you enjoy, once you contract it. You can have the same amount of fun, provided, that you take certain precautions. Remember, if you have diabetes, you cannot ignore the precautions, nor do you need to get bogged down completely by them.

All About Insulin

The failure to make insulin or insufficiency of insulin is termed as Diabetes mellitus. Insulin is a natural hormone which controls the level of the sugar glucose in the blood. Insulin allows cells to use glucose for energy. Cells cannot utilize glucose without insulin. Excess glucose builds up in the bloodstream, increasing the risk of diabetes. Glucose is the body's primary source of fuel. Insulin enables the body cells to take glucose from the bloodstream. The cells might use glucose for production of energy if required, or it is sent to the liver to preserve it, in the form of glycogen.

Functions of Insulin
In addition to its role of regulating glucose metabolism, insulin also

Stimulates lipogenesis

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Diminishes lipolysis Increases amino acid transport into cells Modulates transcription Altering the cell content of numerous mRNAs Stimulates growth DNA synthesis Cell replication

Structure of Insulin

Insulin is composed of 2 peptide chains i.e. A chain and B chain. Both the chains are linked together by two disulfide bonds, and one disulfide is formed within the A chain. In most species, the A chain consists of 21 amino acids and the B chain of 30 amino acids that means it is composed of 51 amino acids in two peptide chains (A and B). The three-dimensional structure of insulin molecule (insulin monomer) exists in two main conformations. These differ in the extent of helix in the B chain due to phenol or its derivatives. In acid solutions, the insulin monomer assembles as dimmers (diffuses in the blood) neutral pH and in the presence of zinc ions, as hexamers. The intermediate and long acting insulin has high proportion of hexamers, to delay its action. The sequence ofamino acid in insulin varies among species, certain segments are conserved, like positions of the three disulfide bonds, both ends of the A chain and the C-terminal residues of the B chain. These similarities in the amino acid sequence of insulin lead to a three dimensional conformation of insulin that is very similar among species, and insulin from one animal is very likely biologically active in other species. Indeed, piginsulin has been widely used for human.

The first of these molecules to be marketed - called insulin lispro - is engineered such that lysine and proline resting on the C-terminal end of the B chain are reversed; this modification does not alter receptor binding, but minimizes the tendency to form dimmers and hexamers.

Insulin Synthesis

Insulin is synthesized as a preprohormone in the beta cells of the islets of Langerhans. Its signal peptide is removed in the cisternae of the endoplasmic reticulum and then packaged into secretory vesicles in the Golgi. It is folded in its native structure and locked in this conformation by, the formation of 2 disulfide bonds. In normal individual, insulin is produced by the body in response to the rise in blood glucose level. Apart from it, spurts of insulin are produced throughout the day and night, to look after the body resting needs for insulin and ensure that cells can take up glucose. In other words, function of insulin is to counter the concerted action of the numerous hyperglycemia generating hormones and to sustain low blood glucose levels. There are numerous hyperglycemic hormones untreated disorders associated with insulin, generally leading to severe hyperglycemia and a shortened life span. In people with type 1 diabetes, the pancreas no longer release the insulin as the beta cells are destroyed and they need insulin shots to use glucose from meals. People with type 2 diabetes can produce insulin but, their body doesn't respond well to it. Some people with type 2 diabetes need diabetes pills or insulin dosages to utilize glucose for energy generation. Insulin cannot be taken as a pill as it will be break down during digestion just like

the protein in food. Insulin must be injected into the fat under your skin, to make it get into your blood. By reducing the concentration of glucose in the blood, insulin is thought to prevent or reduce the long-term complications of diabetes, including damage to the blood vessels, eyes, kidneys, and nerves.

Types of Insulin

Good control of blood glucose levels is important for your health, now and in the future. Understanding your insulin treatment will help you to control diabetes. It will also help you to fit the diabetes into your life, instead of trying to fit your life around the diabetes. There are more than 20 types of insulin products available in four basic forms, each with a different time of onset and duration of action. The decision as to which insulin to choose is based on an individual's lifestyle, blood sugar level and a physician's preference and experience. Criterions to be considered in choosing insulin are:

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Onset:- how soon it starts working. Peak time:- when it works the hardest. Duration:- how long it lasts in the body.

Obesity affects the work of insulin in the body. If body has extra fat tissue, then it will be more resistant to insulin. Treatment for Type 1 diabetes most likely includes insulin via injections, inhaled insulin or an insulin pump. Your physician will recommend the appropriate insulin treatment and its delivery mechanism, in respect to individual case. Insulin was prepared from bovine (beef) and porcine (pork) sources. Beef and pork insulin is no longer available in the United States. Instead, recombinant (human) insulin is used and marketed. Insulin cant be taken by mouth because it would be destroyed by digestion, so it is administered subcutaneous by syringe. Since 1982, most of the newly approved insulin preparations have been produced by inserting portions of DNA ("recombinant DNA") into special lab-cultivated bacteria or yeast. This process allows the bacteria or yeast cells to produce complete human insulin. Recombinant human insulin has, for the most part, replaced animal-derived insulin, such as pork and beef insulin. Regular insulin acts within 30 minutes and its effect lasts for 6 to 8 hours. The maximal effect occurs 1 to 3 hours following the injection. As compared to regular insulin, insulin lispro acts more rapidly, has an earlier maximal effect and a shorter duration action. Therefore, insulin lispro should be given within 15 minutes of a meal, compared to regular insulin, which is given 30-60 minutes before meals. Nowadays people with diabetes no longer need needles or shots to take insulin, as researchers have prepared new ways to get insulin into the bloodstream which can be just inhaled. In January 2006, the FDA approved inhaled insulin, started as a treatment option for Type 1 and Type 2 diabetes. This new type of insulin, available by the name Exubera, comes in powder form and is the first new insulin delivery option since the discovery of the hormone in the 1920s.

Insulin Regimens

Insulin regimen is the way that your insulin injections are organized throughout the day. Type1 diabetics need more than one injection per day and use more than one type of insulin. The combination of insulins and the number of times you take your injections, frame your insulin regimen. There are numerous types of insulin regimens. Ideally, you will develop an individualized regimen that fits in with your life style. Two standard types of insulin regimen are discussed here. 1. Twice-daily mixture of short acting and intermediate or long acting insulin It is a 'conventional' therapy in which a mixture of short and long acting insulin is given in the morning and then again before the evening meal. Insulin is either drawn up from different bottles into the same syringe or use the pre-mixed insulin (disposable pen injectors). One plus point of this regimen is that there is no need of insulin shot at lunch and dinner time, but it becomes very essential to maintain timings of each meal. And, delaying or skipping of any meal will be oblivious cause of hypoglycemia. Lack of flexibility is again a problem if, a premixed insulin is used as it is harder to vary the insulin dose according to the changes in your daily routine. The

doses of short and long acting insulin cannot be varied independently of one another. This regimen works as follow:

y y y y

the morning short acting insulin takes care of breakfast the morning long acting insulin takes care of lunch the evening short acting insulin takes care of the evening meal the evening long acting insulin takes care of overnight insulin needs

2. Multiple daily injections of short or fast acting insulin with one or two separate injections of intermediate or long acting insulin This type of regimen is termed as 'intensive' or 'flexible' insulin therapy. Short or fast acting insulin is given before meals and long acting insulin is given at bedtime. Although a lunchtime injection is usually required, the use of a pen injector can make it a quick and easy task. This insulin regimen is much more flexible especially for mealtimes. It can easily accustom according to the body's natural needs, by providing constant supply. This regimen work as follows:

y y

the short or fast acting insulin takes care of meals the long acting insulin takes care of background insulin needs

Diabetes Insulin Classification

Good control of blood glucose levels is always important for your health. Proper insulin supervision will help you to take control of your diabetes. It will also help you to fit thediabetes into your life rather than trying to fit your life around the diabetes. Insulin is classified according to how long it is effective in the body. There are five different types of insulins ranging from short to long acting. Some insulins are clear in appearance, while others are cloudy. Diabetics need varying amounts of both short and long acting insulin as everyone is different and will respond differently to the insulin they take. Lets see the classification of different types of insulin Rapid onset-fast acting insulin: It is fast acting so starts working within one to 20 minutes. It is clear in appearance and its peak time is about one hour later and lasts for three to five hours. When you inject rapid onset-fast acting type of insulin, you must eat immediately after you inject. The two rapid onset-fast acting insulin types currently available are:

y y

Novo Rapid (Insulin Aspart) Humalog (Lispro)

Short acting insulin: It looks clear and begins to lower blood glucose levels within 30 minutes, so you need to take your injection half an hour before eating. Short acting insulin has peak effect of four hours and works for about six hours. Short acting insulin types, currently available include:

y y y

Actrapid Humulin Hypurin Neutral (bovine - highly purified beef insulin)

Intermediate acting insulin:- Intermediate acting insulin looks cloudy. They have either protamine or zinc added to delay their action. This insulin starts to show its effect about 90 minutes after you inject, peak at 4 to 12 hours and lasts for 16 to 24hours. Intermediate acting insulins presently available with protamine:

y y y

Protaphane Humulin NPH Hypurin Isophane (bovine)

Mixed insulin: Mixed insulin is cloudy in appearance. It is a combination of either a rapid onset-fast acting or a short acting insulin and intermediate acting insulin. Advantage of it is that, two types of insulin can be given in one injection. When it shows 30/70 then it means 30% of short acting is mixed with 70%of intermediate acting insulin. Note: - Roll or shake well the vial of insulin in order to mixed them evenly. The mixed insulins currently available include:

y y y y

NovoMix30 Humalog Mix 25 Mixtard 30/70 Mixtard 20/80

Long acting insulin: There are two kinds of long acting insulin available in market, both with clear appearance.

y y

Lantus (Glargine) - It has no peak period as it works constantly when released into your bloodstream at a relatively constant rate. (full 24 hours) Levemir (Detemir) - It has a relatively flat action, can last up to 24 hours and may be given once or twice during the day.

Diabetes and Insulin Analogs

A short time ago insulin products called "insulin analogs" have been formed so that the structure differs slightly from human insulin, (with respect of amino acids) to change onset and peak of action. People with Type 1 diabetes usually need a combination of different types of insulin in order to control blood sugar with ease. The following table lists some of the more common insulin preparations available today. Onset, peak, and duration of action are approximate for each insulin product, as there may be variability depending on each individual, the injection site and the individual exercise program

Types of Insulin

Examples

Onset of Action

Peak of Action

Duration of Action

Humalog (lispro) 15 minutes Eli Lilly Rapid-acting NovoLog (aspart) Novo Nordisk 15 minutes

30-90 minutes

3-5 hours

40-50 minutes

3-5 hours

Short-acting (Regular)

Humulin R Eli Lilly Novolin R Novo Nordisk

30-60 minutes

50-120 minutes

5-8 hours

Humulin N Eli Lilly Novolin N Novo Nordisk Intermediateacting (NPH) Humulin L Eli Lilly Novolin L Novo Nordisk

1-3 hours

8 hours

20 hours

1-2.5 hours

7-15 hours

18-24 hours

Mixed acting

Humulin 50/50 Humulin 70/30 Humalog Mix 75/25 Humalog Mix 50/50

The onset, peak, and duration of action of these mixtures would reflect a composite of the intermediate and short- or rapid-acting components, with one peak of action.

Eli Lilly Novolin 70/30 Novolog Mix 70/30 Novo Nordisk

Ultralente Eli Lilly Long-acting Lantus (glargine) Aventis

4-8 hours

8-12 hours

36 hours

1 hour

None

24 hours

Insulin Injection Devices

There are many different devices available to inject insulin. It includes:

y y y

Insulin syringes Insulin delivery pens Insulin pumps

Insulin syringes:

y y y y

Insulin syringes are to be used with 10ml insulin vials Syringes are manufactured in 30 unit (0.3ml), 50 unit (0.5ml) and 100 unit (1.0ml) measures. Its size will depend on the insulin dose, for example, it is easier to measure a 10 unit dose in a 30 unit syringe, and 55 units in a 100 unit syringe Needles of the syringes are available in different lengths ranging from 8mm to 13mm. You will be informed by your doctor for its selection Use each syringe only once.

Insulin pen:

y y y

Pen is available in all shapes and sizes. An insulin cartridge (3ml, containing 300 units of insulin) fits into the device. When finished, a new cartridge is inserted. However, some pen devices are pre-filled with insulin and the whole device is disposable Durable pen available are NovoPen 3, NovoPen Demi, Innovo and HumaPen Pre-filled disposable devices include Innolet, FlexPen and Novolet

Insulin pumps:

y y

The insulin pump is a device that holds a reservoir of insulin. The pump is programmed to deliver insulin into the body through thin plastic tubing known as the infusion set The pump is worn outside the body, in a pouch or on your belt. The infusion set has a fine needle or flexible cannula that is inserted just below the skin (usually on the abdomen) where it stays in place for two to three days Only short or rapid acting insulin can be used in the pump. Whenever food is eaten, the pump is programmed to deliver a surge of insulin into the body similar to the way the pancreas does in people without diabetes. Between meals, a small and steady rate of insulin is released

Diabetes Treatment and Insulin Problems

There are many things which can affect how the insulin is absorbed from the injection site into the bloodstream. It includes:

y y y y y y y y y

Mode of administration Selecting the 'right' dose and timing Selecting a suitable insulin preparation (typically on 'speed of onset and duration of action' grounds) Adjusting dosage and timing to fit food intake timing, amounts, and types Adjusting dosage and timing in accordance with exercise undertaken Adjusting dosage, type and timing according to other conditions like stress, illness etc The dosage is non-physiological in that a subcutaneous bolus dose of insulin alone is administered instead of combination of insulin It is dangerous in case of mistake (Hypoglycemia or Hyperglycemia) Once open insulin may be preserved for 30 days at temperature less than 86 F.

Blood Sugar Levels

Diabetes is a disease characterized by abnormal metabolism of blood sugar and defective insulin production. Blood sugar levels are an important parameter for the diagnosis, treatment and prognosis of diabetes. Blood sugar level is the level of sugar circulating in blood at a given time. Blood glucose levels vary at different time on various part of the day. Some factors that affect blood sugar levels are body composition, age, physical activity and sex. Males and females may also have differing blood sugar level. Normal guidelines for blood sugar: Blood Sugar Range : Level of Blood sugar on waking up with an empty stomach should be normally between 80 to 120 mg/dl. Thereafter normal blood sugar should be between 120 to 160 mg/dl two hours after having food and during bedtime the blood sugar values should be between 100 to 140 mg/dl. Any variations from the above mentioned value range of blood sugar is suggestive of diabetes, if the value of an individuals blood sugar tends to be more than the upper limit. Repeated blood sugar test is necessary to confirm diabetes. Conditions wherein blood sugar level will be higher other than diabetes: There are certain conditions where blood sugar level of an individual will differ from the normal range and repeated medical tests are necessary to confirm it as diabetes. The various conditions are pregnancy and lactation, fasting, after severe binge eating, fever, severe injuries, after severe physical exertion, severe dehydration, for patients undergoing certain medical therapeutic procedures, etc. In such cases blood sugar level changes are normal and not linked to regular diabetes. Measures to control Blood sugar level: Diabetes can be controlled to a great extent by controlling blood sugar levels. For controlling blood sugar levels it is mandatory for an individual to undergo periodic monitoring of blood sugar levels under the guidelines of the physician. There are many methods to control blood sugar levels. They are-

y y y y y y

Have proper balanced diet Maintain an active lifestyle Do regular exercises Take proper medications Avoid smoking and intake of alcohol Do skipping meals or eat unhealthy food.

A properly controlled blood sugar level will keep the diabetes in check. Adverse effects of blood sugar levels on diabetes patients: While in most of the cases, blood sugar levels will be high in case of diabetes patients, its level can have adverse effect on the patient depending upon its severity and complications. A severely high level of blood sugar may

result in various symptoms like breathlessness. It may also lead to complications involving the circulatory system and the blood vessels. A severely low blood sugar level may lead to unconsciousness. So blood sugar level should be kept in proper control for control of diabetes. It is necessary to monitor blood sugar levels at regular intervals.

Diabetes Medications

When diet, exercise and ideal body weight arent enough to maintain normal blood sugar level, you may need to start medication. Medications used to treat diabetesinclude insulin too. Usually, people with Type 1 diabetes don't use oral medications. Diabetes Medications work best in people with Type 2 diabetes who are having high blood sugar for less than ten years with normal weight or obesity. Some people who begin treatment with oral medications eventually need to take insulin. Unfortunately, insulin cannot be taken in pills form because enzymes in your stomach alter it, which makes it ineffective. Hence, insulin is taken with insulin syringe or insulin pump. Insulin and oral diabetes medications deliberately work to lower your blood sugar. In certain cases medications taken for other conditions may affect glucose levels. Blood sugar levels may rise due to corticosteroids. Thiazides medications are used to control high blood pressure and niacin is used to lower high cholesterol. Your doctor has to change your diabetes treatment, if you need to take certain high blood pressure medications. Number of drug options exists in market for treating type 2 diabetes, including:

Sulfonylureas

Since 1994, sulfonylureas is the only drug used for diabetes in United States. It stimulates the pancreas for the production of more insulin to lower down the blood sugar. It can be effective when the pancreas can release some insulin by its own.Sulfonylureas such as glipizide (Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glynase PresTab, Micronase) and glimepiride (Amaryl) are prescribed more often. If your body is sensitive to sulfa drug then you must avoid sulfonylureas. Side Effects:

y y y y

Low blood sugar. Stomach upset. Skin rash and itching. Weight gain.

Biguanides

Metformin (Glucophage, Glucophage XR) is the generic name of this drug. It works by inhibiting the production and release of glucose from your liver. It also lowers down the insulin secretion. One good thing about biguanides drug is that it tends to low down weight gain than do others. It can also improve blood cholesterol level, which is generally high if you are type 2 diabetic. Side Effects:

If you already have a kidney problem, metformin may build up in your body. Inform your doctor when you are placed on this medication regarding your kidney problem.

y y y

If you are vomiting, have diarrhea, and can't drink enough fluids, you may need to stop taking this diabetes medication for a few days. You may feel metallic taste. If you are going for medical test using dye, or planning to opt for any surgery, then inform your doctor about your metformin intake. He will instruct you to stop taking metformin for some specific period.

Alpha-glucosidase Inhibitors

Alpha-glucosidase inhibitors are of two types, acarbose and miglitol. They block the enzymes of digestive system which are responsible for the break down of the starches you eat. The sugar produced is absorbed slowly and helps prevent the rise of blood sugar level throughout the day, but usually right after meals. Drugs under this class are Acarbose (Precose) and Miglitol (Glyset). Side Effects:

y y

Stomach problems such as gas, bloating and diarrhea etc.- temporary effects. High dosages may cause permanent changes in liver.

Thiazolidinediones

The generic names for these drugs are pioglitazone (Actos) and Troglitazone (Rezulin), Rosiglitazone (Avandia). Troglitzeone (Rezulin) was banned in March 2000 as it causes liver failure. Thiazolidinediones drug makes your body tissue more sensitive to insulin. The insulin can then move glucose from your blood into your cells for the production of energy. Side Effects:

y y y y y

It may affect your liver function and lead to nausea, vomiting, stomach pain, lack of appetite, tiredness, yellowing of the skin or whiteness in the eyes, or dark-colored urine. If you take birth control pills, this drug may decrease its effectiveness in preventing pregnancy. Unusual weight gain. Loss of appetite may develop risk of anemia which will make you feel tired. Swelling in the legs or ankles.

Meglitinides

Meglitinides is available with the generic name Repaglinide (Prandin). It helps the pancreas to produce more insulin right after meals which lowers blood sugar. Its effect is much similar to short acting sulfonylureas. Meglitinides works quickly, and the results fade rapidly, so your doctor might prescribe Repaglinide only or with Metformin. Side Effects:

y y

weight gain low blood sugar

Glycosuria

Clinical diagnosis of the diabetes require some of the laboratory tests, glycosuria (finding glucose in the urine) is one of the significant test for detecting frankdiabetes. Those who are non diabetic, for them glycosuria can occur for the short term due to emotional stress, pain, hyperthyroidism, alimentary hyperglycemia or meningitis. It can also occur when there is insufficiency of insulin and if a substantial amount of food with high sugar is consumed.
Glycosuria is a condition in which glucose or simple sugar is detected in the urine despite of normal blood sugar

level. The normally functioning kidneys absorb and reabsorb the extra blood sugar till renal threshold, with the help of millions of micro tubules Nephron (filtering unit of kidney). The renal threshold is a concentration level above which all simple sugar is not absorbed in the blood; hence extra glucoseis excreted by the kidneys in the urine. Renal threshold of normal kidney is around 10mmol/L. In few cases, when drugs are used for a longer span of time, it may alter the threshold level of kidney. The amount of glucose not reabsorbed by the kidneys is usually less than 0.1%. Adults excrete about 65 mg of glucose per day. The relationship between glycosuria and the renal threshold are explained in the diagram given below. In renal glycosuria glucose is abnormally eliminated in the urine due to improper action of the nephron. The renal glycosuria occurs only when there are abnormally functioning kidneys, due some dent in the kidneys or as an autosomal recessive trait.

Glycosuria Causes

The suspected causes of renal glycosuria can be that the level of blood glucose could get too high due to which the renal tubules cannot reabsorb it completely or, there might be failure of the tubules to reabsorb all the glucose. Thyrotoxicosis, Acromegaly, Cushing's syndrome, Rapid gastric emptying (dumping syndrome) and peptic ulcers, all these can raise blood glucose above the threshold. Stress hormones elevate blood glucose and in a severely ill patient they may even elevate glucose, beyond the renal threshold. Secondary causes elevating urine sugar level (temporarily) are as stated below-

y y y y y y y y

Pregnancy: During pregnancy there is increased renal blood flow, leading to lowered renal threshold Oculocerebrorenal Dystrophy (Lowe syndrome) Cystinosis Wilson's disease Interstitial nephrities Hereditary tyrosinaemia Heavy metal poisoning such as lead, mercury or with old tetracycline Intestinal glucose-galactose malabsorption

Glycosuria occurs without significant pathology and is mainly bifurcated into 3categories:-

y y y

Type A :- it is classical glycosuria, with decline in both, glucose threshold and maximal glucose reabsorption rate. Type B :- There is a decline in the glucose threshold and a normal rate of reabsorption. Type O :-There is failure of glucose reabsorption. Plasma glucose, glucose tolerance test, insulin levels and HbA1C, all are normal.

Mainly for the affected individuals, this condition causes no visible signs and symptoms or serious effects, but it is a marker for detecting the status of kidney and adiabetic.

Synonyms of glycosuria are listed below y y

Benign glycosuria Familial renal glycosuria

y y y y

Nondiabetic glycosuria Primary renal glycosuria Diabetes renalis Renal diabetes

History and Statistic

Diabetes is not a newly born disease, it has been with human race from long back but, we came to knew about it in 1552 B.C. Since this period, many of Greek as well French physicians had worked on it and made us aware of the nature of disease, organs responsible for it etc. In 1870s, a French physician had discovered a link between Diabetes and diet intake, and an idea to formulate individual diet plan came into picture. Diabetic diet was formulated with inclusion of milk, oats and other fiber containing foods in 1900-1915. Function of insulin, its nature, along with its use started from 1920 -1923, discovered by Dr. Banting, Prof. Macleod and Dr .Collip, who were awarded a Noble prize. In the decade of 1940, it has been discovered that different organs like kidney and skin are also affected if diabetes is creeping from a long term. A major turn in this research was in the year 1955, when the oral hypogycemic drugs had been manufactured.
Diabetes was recognized with complete details and its types (Type 1and Type 2 diabetes - that is insulin

dependent and non insulin dependent) in the year, 1959. As we know this is one of the old diseases, existing in many individuals and still on rising charts. Hence, scientists are continuously working to relieve us from it, by discovering the relevant drugs and making new researches. According to W.H.O estimates, by 2025 total 300 million of the worldwide population will be affected by diabetes. For every 21 seconds, someone is diagnosed with diabetes, an estimation given by American Diabetes Association. And, there are 20.8 million diabetics in US at present, which is roughly estimated as 7% of US population, out of this figure about 6.2 millions are unaware of the diabetes existence in there life.

Hypoglycemia

Glucose is an important fuel for the body to produce energy. The glucose used by the body as a fuel is released from the metabolism of carbohydrates. After a meal, glucose is produced and circulated to different body cells through the circulating blood. The cells require insulin to take up glucose inside the membrane and generate energy. When there is inadequate production of insulin, glucose metabolism is slowed down and less glucose is circulated in the blood. This condition is termed as Hypoglycemia. It happens to every diabetic patient from time to time and the severity differs in each case. Although you are taking good care of diabetes, hypoglycemia may result as it is mostly an insulin reaction which in turn depends on number of factors at a time. As blood sugar begins to fall, the counter regulatory hormone like glucagon, another hormone stimulates break down of glycogen and releases glucose, causing blood glucose level to rise. For diabetes, glucagon response to hypoglycemia is impaired, which makes it tough for the body to revert back the normal blood glucose level. Hypoglycemia can be diagonised in people with diabetes who take certain medications to keep their blood glucose levels in control. Hypoglycemia is mild and it can be easily treated by drinking or eating something with carbohydrate. But left untreated, hypoglycemia can lead to loss of consciousness. Although it can happen suddenly, hypoglycemia can usually be treated quickly, bringing your blood glucose level back to the normal.
Hypoglycemia is a problem for every diabetic so it is important to learn its causes, signs, symptoms, diagnosis

and prevention in order to cope up with it as early as possible.

All About Hypoglycemia

Hypoglycemia is also commonly known as low blood sugar level which occurs when the blood sugar level drops below the normal level. This is common among people with diabetes. Glucose is distributed to the blood stream and cells. Insulin produced by the pancreas helps glucose enter the cell membrane. The excess glucose is stored in liver in the form of glycogen to be used later. This is used when the glucose level falls low. In case of diabetes patients, the insulin secretion is less and therefore glucose that goes through the cells is also less. This results in low blood sugar or hypoglycemia. The symptoms of hypoglycemia are hunger, nervousness, drowsiness or sleepiness, loss of conscious, confusion, perspiration, dizziness, sweating, pale skin color, etc. This hypoglycemia may occur even at sleep with complications like nightmare, fatigue and delirium when waking up. Hypoglycemia in diabetic people : Hypoglycemia occurs in almost all diabetic people. This is mild and has little side effects, yet when treated leads to loss of consciousness. Hypoglycemia can be overcome immediately by bringing glucose to normal level and also taking in water and other carbohydrates foods, such as rice, potatoes, breads, milk, fruits, cereals, etc., Hypoglycemia occurs in people with diabetes since they undergo medication to reduce blood sugar levels. This may cause the blood sugar level to become too low. This has mild effect and when not treated leads to loss of consciousness. Hypoglycemia in people without diabetes: Hypoglycemia occurs in people without diabetes who consume too small or delayed snacks and meals. The blood sugar level is reduced due to increased activity such as exercise or other physical activities. Two types of hypoglycemia occurring in people without diabetes are reactive and fasting hypoglycemia. Reactive hypoglycemia: The symptoms of reactive hypoglycemia occur within 4 hours after the meal. The blood glucose level may fall less than 70mg/dL at the time of occurrence and may become normal after taking food. This type of hypoglycemia can be overcome by taking food and snacks at an interval of 3 hours and also by taking in high fiber food and regular exercise. The fasting hypoglycemia can be diagnosed only by undergoing tests of blood samples and the blood glucose level is less tan 50 mg/dL. This may be due to overnight fasting, more physical activities, etc., this can be overcome by taking food stuff regularly such as rice, grains, breads, cereals, etc., which are rich in carbohydrates.

Hypoglycemia Symptoms

y y y y y y y y y y y y y

Shakiness jerky movements Dizziness Seizure Sweating Hunger Headache Perspiration Difficulty speaking Difficulty paying attention Pale skin color Tingling sensations around the mouth Feeling anxious or weak

Certain times, due to insulin, diabetic oral drug, alcohol etc your blood sugar level might decrease, while you are sleeping. You can identify it by following symptoms.

y y y

Cry out or have nightmares Find that your pants or sheets are damp from perspiration Feel tired, irritable, or confused when you wake up

Causes of Hypoglycemia

Hypoglycemia results due to different factors in every individual but, certain abnormal conditions are repeatedly seen in hypoglycemic patients due to oral hypoglycemic drug or medication, insulin, alcohol, hormonal deficiency, critical illness, trauma etc. Oral hypoglycemic drug/ Medication: In people taking certain glucose medication Orinase, Tolinase, Diabinese and others drugs like salicylate, sulpha drug, pantamidine, quinine. In the diabetics experiencing hypoglycemia, it has been observed that there is lowing condition when:

y y y y

Meals or snacks are too small, delayed, or skipped Excessive doses of insulin or some diabetes medications, including sulfonylureas and meglitinides (Alpha-glucosidase inhibitors, biguanides, and thiazolidinediones when used with other diabetes medicines.) increased activity or exercise Drinking alcohol

Insulin: When the insulin shot and the food intake do not match there is much possibility that there may be an episode of hypoglycemia and hyperglycemia. Dosage is not the only important factor but, adjusting time according to meal intake on regular basis is also a crucial feature. Alcohol: Binge intake of alcohol, can cause hypoglycemia because your body's breakdown of alcohol interferes with your liver's efficiency to raise blood glucose. Alcohol intake also affects the pancreas production of insulin, ultimately increasing more chances of hypoglycemia, in the future. Hormonal Deficiencies: New born baby and children are more suspected for hypoglycemia due to some inborn error or developmental defects. Shortages of cortisol, growth hormone, glucagon, or epinephrine, lack of pituitary or adrenal hormones can lead to fasting hypoglycemia. Laboratory tests for hormone levels will determine a diagnosis and then treatment can be undertaken. Hormone replacement therapy (HRT) might be advised. Critical Illnesses: Critical illnesses, even for a moderate period affect the liver, heart, or kidneys and develop a case of hypoglycemia. Sepsis and starvation are other causes of hypoglycemia. Diet: Hypoglycemia is a result of hearty diet full of simple carbohydrates. It is also termed as reactive hypoglycemia. It may also develop, if a person with diabetes misses a snack, doesn't eat the whole meal, eats later than usual, doesn't eat when ill, or drinks alcohol without eating any food. Intense exercise may also trigger a hypoglycemic reaction. Medical Conditions: There are medical conditions that can also lead to low blood glucose levels, even the person who does not have diabetes may also develop hypoglycemia in certain conditions like, thyroid problems, certain other hormonal deficiencies or after having stomach surgery. Hypoglycemia can occur in people with certain tumors that produce insulin, liver disease or adrenal failure or if you have certain conditions like kidney problems.

Treating Hypoglycemia

Signs and symptoms of hypoglycemia changes from person to person. You should be aware of the symptoms and explain it to your family or peer groups, so that they can easily identify it. If you have experienced hypoglycemia repeatedly in short duration then you need to see your doctor to modify you plan of treatment. Once the test results confirm hypoglycemia, start its treatment. It is important to treat hypoglycemia

quickly because it can get worse and you could pass out. If so, you will need treatment, such as an injection of glucagon or an emergency treatment in a hospital. When you finish the treatment part, wait 15 or 20 minutes and check your blood sugar level again. If your blood glucose is still low and symptoms of hypoglycemia don't go away, repeat the treatment. After regaining the normal blood sugar you need to eat your regular meals and snacks as planned to keep the blood glucose level up. Ask your health care professional or dietitian to list foods that you can use to treat low blood glucose. If it is 70 mg/dl or below, you can take any one of the listed things:

y y y y y y

2 or 3 glucose tablets 1/2 cup (4 ounces) of any fruit juice 1/2 cup (4 ounces) of a regular (not diet) soft drink 1 cup (8 ounces) of milk 5 or 6 pieces of hard candy 1 or 2 teaspoons of sugar or honey

After 15 minutes, check your blood glucose again to know whether you are out of risk zone or not. If it is still too low, have another serving. Repeat these steps until your blood glucose is at least 70 mg/dl. If you pass out from hypoglycemia, and situation has worsened, then you need to take care of the following things:

y y y y y

Dont inject insulin. Dont take any food or fluids. Dont put your hands in your mouth. Inject glucagons Call for emergency help.