Category Archives: Diabetes

Despite being just a freshman, Kalamazoo United's Brandon Murray has carved out a contributingrole for the team. What's even more impressive is his doing so despite a type 1 diabetes diagnosis.

According to the American Diabetes Association type 1 diabetes, formerly known asjuvenile diabetes,is when the body does not produce insulin.

"The body breaks down the sugars and starches you eat into a simple sugar called glucose, which it uses for energy," the website reads. "Insulin is a hormone that the body needs to get glucose from the bloodstream into the cells of the body. With the help of insulin therapy and other treatments, even young children can learn to manage their condition and live long, healthy lives."

Dealing with diabetes is something Murray has had to adjust to over the last couple of years, after getting diagnosed as a 10-year-old.

In fifth grade, when I was 10-years-old, around halfway through the season I started not feeling well," Murray said "I couldn't skate a full shift, I was always thirsty and had to use the bathroom while I was on the ice. It was becoming a problem in school and in hockey and I wasn't feeling like me.

"We went to my cousin's house to visit and my aunt who is a nurse suggested to my mom that I get a check up. The lady in the walk-in clinic said we should go to the emergency room and within a few hours they tested my blood sugar and urine and a couple of weeks after that I knew what it was."

Adjusting to every day life after his diagnosis was a challenge, but as time wore on Murray became more and more comfortable with his condition.

"It was embarrassing to check my blood sugar in the locker room or give myself insulin with my pen," Murray said. "It felt like I was the different kid, but it made me stronger and I could communicate with my teammates better. As I got more questions, I became more familiar with how to answer and I wasn't the weird one anymore.

I just had to accept the fact that it's not going to go away anytime soon and embrace it, so that I can better educate people on how it affects your every day life."

That ADA notes that "sometimes people experience a drop in blood glucose during or after exercise, so it is very important to monitor your blood glucose, take proper precautions, and be prepared to treat hypoglycemia," the website read.

To learn how different types of activity affect you the ADA suggests that you should frequently check your blood glucose before, during, and after an exercise session.

Through trial and error, Murray had to learn what kept his levels balanced so that he could stay healthy in his athletic endeavors. Now that he has adjusted, Murray feels better than ever on the ice.

"I learned to play hockey with diabetes, it was a struggle but I feel its made me a better hockey player," Murray said. "I always have to check my blood sugar better on game day, if I was too high or too low it would affect my performance. Ive learned a balanced amount of eating and snacking to avoid lows or highs."

United coach Tyler Kindle spoke very highly of Murray. Kindle has been impressed with his young guy's ability to compete with older athletes.

That can be a difficult situation and he handles it really well, it hasn't been a distraction at all," Kindle said. "He has to be very disciplined to take care of that while competing and he does very well.

Hes a strong kid, which is huge for a freshman to have the strength to step in and compete against older kids. Hes going to be a big part of the the team going forward as he improves, he has the potential to be a top defensemen at the high school level.

Murray has played in 18 of United's 20 games this season, becoming more comfortable with his role and the team every day.

"He's having a really solid season for a freshman, hes been able to step in and chew up some time on the back end and hes been a great addition to our defense," Kindle said. He gets a pretty regular shifts on the back end and hes done a good job playing against kids three or four years older than him.

Hes been a great kid to have around, hes always got something pretty witty to say. He was really quiet at first, but hes fit in really well.

Murray doesn't think of his diabetes as a weakness, it has become a hidden strength something that he can take pride in.

Im very proud of it, I participate in walks, it feels good that Im not the only person with the disease and I can talk to other people with it and they understand, Murray said "Before my diagnosis, I wasn't at my full potential. Something was holding me back and I feel like this was it; I don't know how, but it's allowed me to grow into a stronger hockey player.

Link:
Type 1 diabetes not a problem for Kalamazoo United freshman Brandon Murray - MLive.com

Jan. 31, 2017 -- Diabetes could be an early sign of pancreatic cancer, new research suggests.

A presentation to the European Cancer Congress in Amsterdam reports that 50% of people in two sample groups who had been diagnosed with pancreatic cancer had been diagnosed with type 2 diabetes in the previous year and been given their first medication to control it.

Fewer than 5 out of 100 people can expect to be alive 5 years after being diagnosed with pancreatic cancer. Survival rates are poor because the cancer doesn't usually cause any symptoms until late in the disease.

The American Cancer Society estimates more than 53,000 people will be diagnosed with pancreatic cancer in 2017.

"Although it has been known for some time that there is an association between type 2 diabetes and pancreatic cancer, the relationship between the two conditions is complex," Alice Koechlin, from the International Prevention Research Institute in Lyon, France, told the conference.

The pancreas contains cells that make insulin. Type 2 diabetes happens when these cells are unable to make enough insulin or the insulin doesn't work properly.

The study involved 368,377 people with type 2 diabetes in Belgium and 456,311 in Italy.

Among these patients over a 5-year period, there were 885 and 1,872 cases of pancreatic cancer diagnosed respectively.

The researchers found that patients had a 3.5 times higher risk of being diagnosed with pancreatic cancer compared to those on other non-insulin, non-incretin diabetes treatments in the first 3 months after their first prescription for a class of diabetes medications known as incretins. The risks decreased with time. These are hormones that stimulate the pancreas to produce more insulin.

Among patients who already had type 2 diabetes, the need to switch to injecting insulin because their condition got worse was associated with a seven-times-higher risk of being diagnosed with pancreatic cancer.

"Doctors and their diabetic patients should be aware that the onset of diabetes or rapidly deteriorating diabetes could be the first sign of hidden pancreatic cancer, and steps should be taken to investigate it," Koechlin said.

"The association between pancreatic cancer and type 2 diabetes has been an area of interest to researchers for several years, so its great to see studies generating new and potentially very valuable information which could alert clinicians to the need for further investigation in certain patients, said Maggie Blanks, chief executive of the Pancreatic Cancer Research Fund, in a statement.

"We now need the work developing early diagnostic tests to catch up so that we can make use of this information as soon as possible. There are global efforts investigating biomarkers for pancreatic cancer in blood or saliva that may have diagnostic potential and the early research that PCRF has funded which identified biomarkers in urine is progressing towards a clinical trial.

"We may well be on the cusp of a significant improvement in both identifying those at higher risk and being able to diagnose quickly, so that appropriate treatment can start as soon as possible."

These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

SOURCES:

2017 European Cancer Congress: "Early detection of pancreatic cancer among diabetic patients: results from prescription database analyses."

European Cancer Organisation.

Pancreatic Cancer Research Fund.

American Cancer Society.

Continued here:
Diabetes May Be Warning Sign of Pancreatic Cancer - WebMD

Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period.[2] Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can cause many complications.[3]Acute complications can include diabetic ketoacidosis, nonketotic hyperosmolar coma, or death.[4] Serious long-term complications include heart disease, stroke, chronic kidney failure, foot ulcers, and damage to the eyes.[3]

Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced.[5] There are three main types of diabetes mellitus:

Prevention and treatment involve maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco. Control of blood pressure and maintaining proper foot care are important for people with the disease. Type 1 DM must be managed with insulin injections.[3] Type 2 DM may be treated with medications with or without insulin.[7] Insulin and some oral medications can cause low blood sugar.[8]Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 DM.[9] Gestational diabetes usually resolves after the birth of the baby.[10]

As of 2015[update], an estimated 415 million people had diabetes worldwide,[11] with type 2 DM making up about 90% of the cases.[12][13] This represents 8.3% of the adult population,[13] with equal rates in both women and men.[14] As of 2014[update], trends suggested the rate would continue to rise.[15] Diabetes at least doubles a person's risk of early death.[3] From 2012 to 2015, approximately 1.5 to 5.0 million deaths each year resulted from diabetes.[7][11] The global economic cost of diabetes in 2014 was estimated to be US$612 billion.[16] In the United States, diabetes cost $245 billion in 2012.[17]

The classic symptoms of untreated diabetes are weight loss, polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger).[18] Symptoms may develop rapidly (weeks or months) in type1 DM, while they usually develop much more slowly and may be subtle or absent in type2 DM.

Several other signs and symptoms can mark the onset of diabetes although they are not specific to the disease. In addition to the known ones above, they include blurry vision, headache, fatigue, slow healing of cuts, and itchy skin. 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. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.

Low blood sugar is common in persons with type 1 and type 2 DM. Most cases are mild and are not considered medical emergencies. Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild cases to more serious issues such as confusion, changes in behavior such as aggressiveness, seizures, unconsciousness, and (rarely) permanent brain damage or death in severe cases.[19][20] Moderate hypoglycemia may easily be mistaken for drunkenness;[21] rapid breathing and sweating, cold, pale skin are characteristic of hypoglycemia but not definitive.[22] Mild to moderate cases are self-treated by eating or drinking something high in sugar. Severe cases can lead to unconsciousness and must be treated with intravenous glucose or injections with glucagon.

People (usually with type1 DM) may also experience episodes of diabetic ketoacidosis, a metabolic disturbance characterized by nausea, vomiting and abdominal pain, the smell of acetone on the breath, deep breathing known as Kussmaul breathing, and in severe cases a decreased level of consciousness.[23]

A rare but equally severe possibility is hyperosmolar nonketotic state, which is more common in type2 DM and is mainly the result of dehydration.[23]

All forms of diabetes increase the risk of long-term complications. These typically develop after many years (1020), 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[24] and about 75% of deaths in diabetics are due to coronary artery disease.[25] Other "macrovascular" diseases are stroke, and peripheral vascular disease.

The primary complications of diabetes due to damage in small blood vessels include damage to the eyes, kidneys, and nerves.[26] Damage to the eyes, known as diabetic retinopathy, is caused by damage to the blood vessels in the retina of the eye, and can result in gradual vision loss and blindness.[26] Damage to the kidneys, known as diabetic nephropathy, can lead to tissue scarring, urine protein loss, and eventually chronic kidney disease, sometimes requiring dialysis or kidney transplant.[26] Damage to the nerves of the body, known as diabetic neuropathy, is the most common complication of diabetes.[26] The symptoms can include numbness, tingling, pain, and altered pain sensation, which can lead to damage to the skin. Diabetes-related foot problems (such as diabetic foot ulcers) may occur, and can be difficult to treat, occasionally requiring amputation. Additionally, proximal diabetic neuropathy causes painful muscle wasting and weakness.

There is a link between cognitive deficit and diabetes. Compared to those without diabetes, those with the disease have a 1.2 to 1.5-fold greater rate of decline in cognitive function.[27]

Diabetes mellitus is classified into four broad categories: type1, type2, gestational diabetes, and "other specific types".[5] The "other specific types" are a collection of a few dozen individual causes.[5] Diabetes is a more variable disease than once thought and people may have combinations of forms.[29] The term "diabetes", without qualification, usually refers to diabetes mellitus.

Type1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas, leading to insulin deficiency. This type can be further classified as immune-mediated or idiopathic. The majority of type1 diabetes is of the immune-mediated nature, in which a T-cell-mediated autoimmune attack leads to the loss of beta cells and thus insulin.[30] It causes approximately 10% of diabetes mellitus cases in North America and Europe. Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type1 diabetes can affect children or adults, but was traditionally termed "juvenile diabetes" because a majority of these diabetes cases were in children.

"Brittle" diabetes, also known as unstable diabetes or labile diabetes, is a term that was traditionally used to describe the dramatic and recurrent swings in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. This term, however, has no biologic basis and should not be used.[31] Still, type1 diabetes can be accompanied by irregular and unpredictable high blood sugar levels, frequently with ketosis, and sometimes with serious low blood sugar levels. Other complications include an impaired counterregulatory response to low blood sugar, infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison's disease).[31] These phenomena are believed to occur no more frequently than in 1% to 2% of persons with type1 diabetes.[32]

Type1 diabetes is partly inherited, with multiple genes, including certain HLA genotypes, known to influence the risk of diabetes. The increase of incidence of type 1 diabetes reflects the modern lifestyle.[33] In genetically susceptible people, the onset of diabetes can be triggered by one or more environmental factors,[34] such as a viral infection or diet. Several viruses have been implicated, but to date there is no stringent evidence to support this hypothesis in humans.[34][35] Among dietary factors, data suggest that gliadin (a protein present in gluten) may play a role in the development of type 1 diabetes, but the mechanism is not fully understood.[36][37]

Type2 DM is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion.[5] The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus cases due to a known defect are classified separately. Type2 DM is the most common type of diabetes mellitus.

In the early stage of type2, the predominant abnormality is reduced insulin sensitivity. At this stage, high blood sugar can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce the liver's glucose production.

Type2 DM is due primarily to lifestyle factors and genetics.[38] A number of lifestyle factors are known to be important to the development of type2 DM, including obesity (defined by a body mass index of greater than 30), lack of physical activity, poor diet, stress, and urbanization.[12] Excess body fat is associated with 30% of cases in those of Chinese and Japanese descent, 6080% of cases in those of European and African descent, and 100% of Pima Indians and Pacific Islanders.[5] Even those who are not obese often have a high waisthip ratio.[5]

Dietary factors also influence the risk of developing type2 DM. Consumption of sugar-sweetened drinks in excess is associated with an increased risk.[39][40] 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.[38] Eating lots of white rice also may increase the risk of diabetes.[41] A lack of exercise is believed to cause 7% of cases.[42]

Gestational diabetes mellitus (GDM) resembles type2 DM in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 210% of all pregnancies and may improve or disappear after delivery.[43] However, after pregnancy approximately 510% of women with gestational diabetes are found to have diabetes mellitus, most commonly type 2.[43] Gestational diabetes is fully treatable, but requires careful medical supervision throughout the pregnancy. Management may include dietary changes, blood glucose monitoring, and in some cases, insulin may be required.

Though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital heart and central nervous system abnormalities, and skeletal muscle malformations. Increased levels of insulin in a fetus's blood may inhibit fetal surfactant production and cause respiratory distress syndrome. A high blood bilirubin level may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A Caesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.[citation needed]

Prediabetes indicates a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type2 DM. Many people destined to develop type2 DM spend many years in a state of prediabetes.

Latent autoimmune diabetes of adults (LADA) is a condition in which type1 DM develops in adults. Adults with LADA are frequently initially misdiagnosed as having type2 DM, based on age rather than etiology.

Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization when the current taxonomy was introduced in 1999.[44]

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.

"Type 3 diabetes" has been suggested as a term for Alzheimer's disease as the underlying processes may involve insulin resistance by the brain.[45]

The following is a comprehensive list of other causes of diabetes:[46]

Insulin is the principal hormone that regulates the uptake of glucose from the blood into most cells of the body, especially liver, muscle, and adipose tissue. Therefore, deficiency of insulin or the insensitivity of its receptors plays a central role in all forms of diabetes mellitus.[48]

The body obtains glucose from three main places: the intestinal absorption of food, the breakdown of glycogen, the storage form of glucose found in the liver, and gluconeogenesis, the generation of glucose from non-carbohydrate substrates in the body.[49] Insulin plays a critical role in balancing glucose levels in the body. Insulin can inhibit the breakdown of glycogen or the process of gluconeogenesis, it can stimulate the transport of glucose into fat and muscle cells, and it can stimulate the storage of glucose in the form of glycogen.[49]

Insulin is released into the blood by beta cells (-cells), found in the islets of Langerhans in the pancreas, in response to rising levels of blood glucose, typically after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage. Lower glucose levels result in decreased insulin release from the beta cells and in the breakdown of glycogen to glucose. This process is mainly controlled by the hormone glucagon, which acts in the opposite manner to insulin.[50]

If the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin (insulin insensitivity or insulin resistance), or if the insulin itself is defective, then glucose will not be absorbed properly by the body cells that require it, and it will not be stored appropriately in the liver and muscles. The net effect is persistently high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis.[49]

When the glucose concentration in the blood remains high over time, the kidneys will reach a threshold of reabsorption, and glucose will be excreted in the urine (glycosuria).[51] This increases the osmotic pressure of the urine and inhibits reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume will be replaced osmotically from water held in body cells and other body compartments, causing dehydration and increased thirst (polydipsia).[49]

Diabetes mellitus is characterized by recurrent or persistent high blood sugar, and is diagnosed by demonstrating any one of the following:[44]

A positive result, in the absence of unequivocal high blood sugar, should be confirmed by a repeat of any of the above methods on a different day. It is preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test.[55] According to the current definition, two fasting glucose measurements above 126mg/dl (7.0mmol/l) is considered diagnostic for diabetes mellitus.

Per the World Health Organization people with fasting glucose levels from 6.1 to 6.9mmol/l (110 to 125mg/dl) are considered to have impaired fasting glucose.[56] people with plasma glucose at or above 7.8mmol/l (140mg/dl), but not over 11.1mmol/l (200mg/dl), two hours after a 75g oral glucose load are considered to have impaired glucose tolerance. Of these two prediabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus, as well as cardiovascular disease.[57] The American Diabetes Association since 2003 uses a slightly different range for impaired fasting glucose of 5.6 to 6.9mmol/l (100 to 125mg/dl).[58]

Glycated hemoglobin is better than fasting glucose for determining risks of cardiovascular disease and death from any cause.[59]

The rare disease diabetes insipidus has similar symptoms to diabetes mellitus, but without disturbances in the sugar metabolism (insipidus means "without taste" in Latin) and does not involve the same disease mechanisms. Diabetes is a part of the wider condition known as metabolic syndrome.

There is no known preventive measure for type1 diabetes.[3] Type2 diabetes which accounts for 85-90% of all cases can often be prevented or delayed by maintaining a normal body weight, engaging in physical exercise, and consuming a healthful diet.[3] Higher levels of physical activity reduce the risk of diabetes by 28%.[60] Dietary changes known to be effective in helping to prevent diabetes include maintaining a diet rich in whole grains and fiber, and choosing good fats, such as the polyunsaturated fats found in nuts, vegetable oils, and fish.[61] Limiting sugary beverages and eating less red meat and other sources of saturated fat can also help prevent diabetes.[61] Tobacco smoking is also associated with an increased risk of diabetes and its complications, so smoking cessation can be an important preventive measure as well.[62]

The relationship between type 2 diabetes and the main modifiable risk factors (excess weight, unhealthy diet, physical inactivity and tobacco use) is similar in all regions of the world. There is growing evidence that the underlying determinants of diabetes are a reflection of the major forces driving social, economic and cultural change: globalization, urbanization, population ageing, and the general health policy environment.[63]

Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific situations.[64] Management concentrates on keeping blood sugar levels as close to normal, without causing low blood sugar. This can usually be accomplished with a healthy diet, exercise, weight loss, and use of appropriate medications (insulin in the case of type1 diabetes; oral medications, as well as possibly insulin, in type2 diabetes).

Learning about the disease and actively participating in the treatment is important, since complications are far less common and less severe in people who have well-managed blood sugar levels.[65][66] The goal of treatment is an HbA1C level of 6.5%, but should not be lower than that, and may be set higher.[67] Attention is also paid to other health problems that may accelerate the negative effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise.[67]Specialized footwear is widely used to reduce the risk of ulceration, or re-ulceration, in at-risk diabetic feet. Evidence for the efficacy of this remains equivocal, however.[68]

People with diabetes can benefit from education about the disease and treatment, good nutrition to achieve a normal body weight, and exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.[69]

Medications used to treat diabetes do so by lowering blood sugar levels. There are a number of different classes of anti-diabetic medications. Some are available by mouth, such as metformin, while others are only available by injection such as GLP-1 agonists. Type1 diabetes can only be treated with insulin, typically with a combination of regular and NPH insulin, or synthetic insulin analogs.[citation needed]

Metformin is generally recommended as a first line treatment for type2 diabetes, as there is good evidence that it decreases mortality.[70] It works by decreasing the liver's production of glucose.[71] Several other groups of drugs, mostly given by mouth, may also decrease blood sugar in type II DM. These include agents that increase insulin release, agents that decrease absorption of sugar from the intestines, and agents that make the body more sensitive to insulin.[71] When insulin is used in type2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications.[70] Doses of insulin are then increased to effect.[70][72]

Since cardiovascular disease is a serious complication associated with diabetes, some have recommended blood pressure levels below 130/80mmHg.[73] However, evidence supports less than or equal to somewhere between 140/90mmHg to 160/100mmHg; the only additional benefit found for blood pressure targets beneath this range was an isolated decrease in stroke risk, and this was accompanied by an increased risk of other serious adverse events.[74][75] A 2016 review found potential harm to treating lower than 140 mmHg.[76] Among medications that lower blood pressure, angiotensin converting enzyme inhibitors (ACEIs) improve outcomes in those with DM while the similar medications angiotensin receptor blockers (ARBs) do not.[77]Aspirin is also recommended for people with cardiovascular problems, however routine use of aspirin has not been found to improve outcomes in uncomplicated diabetes.[78]

A pancreas transplant is occasionally considered for people with type1 diabetes who have severe complications of their disease, including end stage kidney disease requiring kidney transplantation.[79]

Weight loss surgery in those with obesity and type two diabetes is often an effective measure.[80] Many are able to maintain normal blood sugar levels with little or no medications following surgery[81] and long-term mortality is decreased.[82] There however is some short-term mortality risk of less than 1% from the surgery.[83] The body mass index cutoffs for when surgery is appropriate are not yet clear.[82] It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control.[84]

In countries using a general practitioner system, such as the United Kingdom, care may take place mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or research projects. In other circumstances, general practitioners and specialists share care in a team approach. Home telehealth support can be an effective management technique.[85]

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22.530

3037.5

37.545

4552.5

52.560

6067.5

67.575

7582.5

82.5

28-91

92-114

115-141

142-163

164-184

185-209

210-247

248-309

310-404

405-1879

As of 2016, 422 million people have diabetes worldwide,[86] up from an estimated 382 million people in 2013[13] and from 108 million in 1980.[86] Accounting for the shifting age structure of the global population, the prevalence of diabetes is 8.5% among adults, nearly double the rate of 4.7% in 1980.[86] Type2 makes up about 90% of the cases.[12][14] Some data indicate rates are roughly equal in women and men,[14] but male excess in diabetes has been found in many populations with higher type 2 incidence, possibly due to sex-related differences in insulin sensitivity, consequences of obesity and regional body fat deposition, and other contributing factors such as high blood pressure, tobacco smoking and alcohol intake.[87][88]

The World Health Organization (WHO) estimates that diabetes mellitus resulted in 1.5 million deaths in 2012, making it the 8th leading cause of death.[7][86] However another 2.2 million deaths worldwide were attributable to high blood glucose and the increased risks of cardiovascular disease and other associated complications (e.g. kidney failure), which often lead to premature death and are often listed as the underlying cause on death certificates rather than diabetes.[86][89] For example, in 2014, the International Diabetes Federation (IDF) estimated that diabetes resulted in 4.9 million deaths worldwide,[15] using modelling to estimate the total amount of deaths that could be directly or indirectly attributed to diabetes.[16]

Diabetes mellitus occurs throughout the world but is more common (especially type 2) in more developed countries. The greatest increase in rates has however been seen in low- and middle-income countries,[86] where more than 80% of diabetic deaths occur.[90] The fastest prevalence increase is expected to occur in Asia and Africa, where most people with diabetes will probably live in 2030.[91] The increase in rates in developing countries follows the trend of urbanization and lifestyle changes, including increasingly sedentary lifestyles, less physically demanding work and the global nutrition transition, marked by increased intake of foods that are high energy-dense but nutrient-poor (often high in sugar and saturated fats, sometimes referred to as the "Western-style" diet).[86][91]

Diabetes was one of the first diseases described,[92] with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine".[93] The first described cases are believed to be of type1 diabetes.[93] Indian physicians around the same time identified the disease and classified it as madhumeha or "honey urine", noting the urine would attract ants.[93] The term "diabetes" or "to pass through" was first used in 230BCE by the Greek Apollonius of Memphis.[93] The disease was considered rare during the time of the Roman empire, with Galen commenting he had only seen two cases during his career.[93] This is possibly due to the diet and lifestyle of the ancients, or because the clinical symptoms were observed during the advanced stage of the disease. Galen named the disease "diarrhea of the urine" (diarrhea urinosa). The earliest surviving work with a detailed reference to diabetes is that of Aretaeus of Cappadocia (2nd or early 3rd century CE). He described the symptoms and the course of the disease, which he attributed to the moisture and coldness, reflecting the beliefs of the "Pneumatic School". He hypothesized a correlation of diabetes with other diseases and he discussed differential diagnosis from the snakebite which also provokes excessive thirst. His work remained unknown in the West until 1552, when the first Latin edition was published in Venice.[94]

Type1 and type2 diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400-500CE with type1 associated with youth and type2 with being overweight.[93] The term "mellitus" or "from honey" was added by the Briton John Rolle in the late 1700s to separate the condition from diabetes insipidus, which is also associated with frequent urination.[93] Effective treatment was not developed until the early part of the 20th century, when Canadians Frederick Banting and Charles Herbert Best isolated and purified insulin in 1921 and 1922.[93] This was followed by the development of the long-acting insulin NPH in the 1940s.[93]

The word diabetes ( or ) comes from Latin diabts, which in turn comes from Ancient Greek (diabts) which literally means "a passer through; a siphon."[95]Ancient Greek physician Aretaeus of Cappadocia (fl. 1st century CE) used that word, with the intended meaning "excessive discharge of urine", as the name for the disease.[96][97] Ultimately, the word comes from Greek (diabainein), meaning "to pass through,"[95] which is composed of - (dia-), meaning "through" and (bainein), meaning "to go".[96] The word "diabetes" is first recorded in English, in the form diabete, in a medical text written around 1425.

The word mellitus ( or ) comes from the classical Latin word melltus, meaning "mellite"[98] (i.e. sweetened with honey;[98] honey-sweet[99]). The Latin word comes from mell-, which comes from mel, meaning "honey";[98][99] sweetness;[99] pleasant thing,[99] and the suffix -tus,[98] whose meaning is the same as that of the English suffix "-ite".[100] It was Thomas Willis who in 1675 added "mellitus" to the word "diabetes" as a designation for the disease, when he noticed the urine of a diabetic had a sweet taste (glycosuria). This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians.

The 1989 "St. Vincent Declaration"[101][102] was the result of international efforts to improve the care accorded to those with diabetes. Doing so is important not only in terms of quality of life and life expectancy but also economicallyexpenses due to diabetes have been shown to be a major drain on healthand productivity-related resources for healthcare systems and governments.

Several countries established more and less successful national diabetes programmes to improve treatment of the disease.[103]

People with diabetes who have neuropathic symptoms such as numbness or tingling in feet or hands are twice as likely to be unemployed as those without the symptoms.[104]

In 2010, diabetes-related emergency room (ER) visit rates in the United States were higher among people from the lowest income communities (526 per 10,000 population) than from the highest income communities (236 per 10,000 population). Approximately 9.4% of diabetes-related ER visits were for the uninsured.[105]

The term "type1 diabetes" has replaced several former terms, including childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes mellitus (IDDM). Likewise, the term "type2 diabetes" has replaced several former terms, including adult-onset diabetes, obesity-related diabetes, and noninsulin-dependent diabetes mellitus (NIDDM). Beyond these two types, there is no agreed-upon standard nomenclature.

Diabetes mellitus is also occasionally known as "sugar diabetes" to differentiate it from diabetes insipidus.[106]

In animals, diabetes is most commonly encountered in dogs and cats. Middle-aged animals are most commonly affected. Female dogs are twice as likely to be affected as males, while according to some sources, male cats are also more prone than females. In both species, all breeds may be affected, but some small dog breeds are particularly likely to develop diabetes, such as Miniature Poodles.[107] The symptoms may relate to fluid loss and polyuria, but the course may also be insidious. Diabetic animals are more prone to infections. The long-term complications recognised in humans are much rarer in animals. The principles of treatment (weight loss, oral antidiabetics, subcutaneous insulin) and management of emergencies (e.g. ketoacidosis) are similar to those in humans.[107]

Inhalable insulin has been developed.[108] The original products were withdrawn due to side effects.[108] Afrezza, under development by pharmaceuticals company MannKind Corporation, was approved by the FDA for general sale in June 2014.[109] An advantage to inhaled insulin is that it may be more convenient and easy to use.[110]

Transdermal insulin in the form of a cream has been developed and trials are being conducted on people with type 2 diabetes.[111][112]

More:
Diabetes mellitus - Wikipedia

Learn about Diabetes

You can learn how to take care of your diabetes and prevent some of the serious problems diabetes can cause. The more you know, the better you can manage your diabetes.

Share this booklet with your family and friends so they will understand more about diabetes. Also make sure to ask your health care team any questions you might have.

You can learn how to take care of your diabetes.

Diabetes is when your blood glucose, also called blood sugar, is too high. Blood glucose is the main type of sugar found in your blood and your main source of energy. Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries glucose to all of your bodys cells to use for energy.

Your pancreasan organ, located between your stomach and spine, that helps with digestionreleases a hormone it makes, called insulin, into your blood. Insulin helps your blood carry glucose to all your bodys cells. Sometimes your body doesnt make enough insulin or the insulin doesnt work the way it should. Glucose then stays in your blood and doesnt reach your cells. Your blood glucose levels get too high and can cause diabetes or prediabetes.

Over time, having too much glucose in your blood can cause health problems.

Prediabetes is when the amount of glucose in your blood is above normal yet not high enough to be called diabetes. With prediabetes, your chances of getting type 2 diabetes, heart disease, and stroke are higher. With some weight loss and moderate physical activity, you can delay or prevent type 2 diabetes. You can even return to normal glucose levels, possibly without taking any medicines.

The signs and symptoms of diabetes are

Some people with diabetes dont have any of these signs or symptoms. The only way to know if you have diabetes is to have your doctor do a blood test.

The three main types of diabetes are type 1, type 2, and gestational diabetes. People can develop diabetes at any age. Both women and men can develop diabetes.

Type 1 diabetes, which used to be called juvenile diabetes, develops most often in young people; however, type 1 diabetes can also develop in adults. In type 1 diabetes, your body no longer makes insulin or enough insulin because the bodys immune system, which normally protects you from infection by getting rid of bacteria, viruses, and other harmful substances, has attacked and destroyed the cells that make insulin.

Treatment for type 1 diabetes includes

Type 2 diabetes, which used to be called adult-onset diabetes, can affect people at any age, even children. However, type 2 diabetes develops most often in middle-aged and older people. People who are overweight and inactive are also more likely to develop type 2 diabetes.

Type 2 diabetes usually begins with insulin resistancea condition that occurs when fat, muscle, and liver cells do not use insulin to carry glucose into the bodys cells to use for energy. As a result, the body needs more insulin to help glucose enter cells. At first, the pancreas keeps up with the added demand by making more insulin. Over time, the pancreas doesnt make enough insulin when blood sugar levels increase, such as after meals. If your pancreas can no longer make enough insulin, you will need to treat your type 2 diabetes.

Treatment for type 2 diabetes includes

Gestational diabetes can develop when a woman is pregnant. Pregnant women make hormones that can lead to insulin resistance. All women have insulin resistance late in their pregnancy. If the pancreas doesnt make enough insulin during pregnancy, a woman develops gestational diabetes.

Overweight or obese women have a higher chance of gestational diabetes. Also, gaining too much weight during pregnancy may increase your likelihood of developing gestational diabetes.

Gestational diabetes most often goes away after the baby is born. However, a woman who has had gestational diabetes is more likely to develop type 2 diabetes later in life. Babies born to mothers who had gestational diabetes are also more likely to develop obesity and type 2 diabetes.

More information about diabetes and pregnancy is provided in the NIDDK health topic, What I need to know about Gestational Diabetes.

Over time, diabetes can lead to serious problems with your blood vessels, heart, nerves, kidneys, mouth, eyes, and feet. These problems can lead to an amputation, which is surgery to remove a damaged toe, foot, or leg, for example.

The most serious problem caused by diabetes is heart disease. When you have diabetes, you are more than twice as likely as people without diabetes to have heart disease or a stroke. With diabetes, you may not have the usual signs or symptoms of a heart attack. The best way to take care of your health is to work with your health care team to keep your blood glucose, blood pressure, and cholesterol levels in your target range. Targets are numbers you aim for.

Most people with diabetes get care from primary care providers, such as internists, family physicians, or pediatricians. A team of health care providers can also improve your diabetes care.

In addition to a primary care provider, your health care team may include

If diabetes makes you feel sad or angry, or if you have other problems that worry you, you should talk with a counselor or mental health professional. Your doctor or certified diabetes educator can help you find a counselor.

Talk with your doctor about what vaccines and immunizations, or shots, you should get to keep from getting sick. Preventing illness is an important part of taking care of your diabetes.

When you see members of your health care team, ask lots of questions. Prepare a list of questions before your visit. Be sure you understand everything you need to know about taking care of your diabetes.

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Types of Diabetes | NIDDK

The following symptoms of diabetes are typical. However, some people with type 2 diabetes have symptoms so mild that they go unnoticed.

Common symptoms of diabetes:

Early detection and treatment of diabetes can decrease the risk of developing the complications of diabetes.

Women with gestational diabetes often have no symptoms, which is why it's important for at-risk women to be tested at the proper time during pregnancy.

Learn more about gestational diabetes.

Have you already been diagnosed with diabetes but are concerned about symptoms that may be the result of complications related to diabetes?

Visit the Complications section.

You may also be interested in our book, Uncomplicated Guide To Diabetes' Complications, 3rd Edition

Do you have questions or concerns about diabetes symptoms? Want to connect with others? Visit the American Diabetes Association Community to find support now!

If you've recently been diagnosed with type 2 diabetes, enroll in the FREE Living With Type 2 Diabetes program to get more information and support.

Read more here:
Diabetes Symptoms: American Diabetes Association

Diabetes is a chronic condition in which the levels of glucose (sugar) in the blood are too high. Blood glucose levels are normally regulated by the hormone insulin, which is made by the pancreas. Diabetes occurs when there is a problem with this hormone and how it works in the body.

Around 5.1 per cent of Australians aged 18 years or older have diabetes. The risk of diabetes increases with age, from 2.8 per cent in people aged 35 to 44, to 15.0 per cent in those aged 65 to 74. Aboriginal people have one of the highest rates of type 2 diabetes in the world.

The glucose in the bloodstream needs to move into body tissues so that cells can use it for energy. Excess glucose is also stored in the liver, or converted to fat and stored in other body tissues.

Insulin is a hormone made by the pancreas, which is a gland located just below the stomach. Insulin opens the doors (the glucose channels) that let glucose move from the blood into the body cells. It also allows glucose to be stored in muscle, the liver and other tissues. This is part of a process known as glucose metabolism.

In diabetes, either the pancreas cant make insulin (type 1 diabetes), or the cells dont respond to the insulin properly (insulin resistance) and the pancreas produces inadequate insulin for the bodys increased needs (type 2 diabetes).

If the insulin cannot do its job, the glucose channels cannot open properly. Glucose builds up in the blood instead of getting into cells for energy. High blood glucose levels cause the health problems linked to diabetes, often referred to as complications.

The symptoms of ketoacidosis are:

If a person with type 1 diabetes skips a meal, exercises heavily or takes too much insulin, their blood sugar levels will fall. This can lead to hypoglycaemica. The symptoms include tremor, sweating, dizziness, hunger, headache and change in mood. This can be remedied with a quick boost of sugar (such as jellybeans or glucose tablets), then something more substantial such as fruit. A person with type 1 diabetes should have lollies on hand at all times, just in case.

Type 2 diabetes, the most common form of diabetes, affects 85 to 90 per cent of all people with diabetes. While it usually affects mature adults (over 40), younger people are also now being diagnosed in greater numbers as rates of overweight and obesity increase. Type 2 diabetes used to be called non-insulin dependent diabetes or mature onset diabetes.

Research shows that type 2 diabetes can be prevented or delayed with lifestyle changes. However, there is no cure.

Certain women are at increased risk of developing gestational diabetes. High risk groups include:

Gestational diabetes can be monitored and treated and, if well controlled, these risks are greatly reduced. The baby will not be born with diabetes.

In severe cases, a person may pass up to 30 litres of urine per day. Without treatment, diabetes insipidus can cause dehydration and, eventually, coma due to concentration of salts in the blood, particularly sodium.

The name of this condition is a bit misleading, since diabetes insipidus has nothing to do with diabetes caused by high blood sugar levels, apart from the symptoms of thirst and passing large volumes of urine. Depending on the cause, diabetes insipidus can be treated with medications, vasopressin replacement and a low-salt diet.

Management depends on the type of diabetes, but can include:

Original post:
Diabetes - Better Health Channel

What is diabetes?

Diabetes is a disease in which the body is unable to properly use and store glucose (a form of sugar). Glucose backs up in the bloodstream causing ones blood glucose (sometimes referred to as blood sugar) to rise too high.

There are two major types of diabetes. In type 1 (fomerly called juvenile-onset or insulin-dependent) diabetes, the body completely stops producing any insulin, a hormone that enables the body to use glucose found in foods for energy. People with type 1 diabetes must take daily insulin injections to survive.This form of diabetes usually develops in children or young adults, but can occur at any age. Type 2 (formerly called adult-onset or non insulin-dependent) diabetes results when the body doesnt produce enough insulin and/or is unable to use insulin properly (insulin resistance).This form of diabetes usually occurs in people who are over 40, overweight, and have a family history of diabetes, although today it is increasingly occurring in younger people, particularly adolescents.

People with diabetes frequently experience certain symptoms. These include:

In some cases, there are no symptoms this happens at times with type 2 diabetes. In this case, people can live for months, even years without knowing they have the disease. This form of diabetes comes on so gradually that symptoms may not even be recognized.

Diabetes can occur in anyone. However, people who have close relatives with the disease are somewhat more likely to develop it. Other risk factors include obesity, high cholesterol, high blood pressure, and physical inactivity. The risk of developing diabetes also increases as people grow older. People who are over 40 and overweight are more likely to develop diabetes, although the incidence of type 2 diabetes in adolescents is growing. Diabetes is more common among Native Americans, African Americans, Hispanic Americans and Asian Americans/Pacific Islanders. Also, people who develop diabetes while pregnant (a condition called gestational diabetes) are more likely to develop full-blown diabetes later in life.

There are certain things that everyone who has diabetes, whether type 1 or type 2, needs to do to be healthy. They need to have a meal (eating) plan. They need to pay attention to how much physical activity they engage in, because physical activity can help the body use insulin better so it can convert glucose into energy for cells.Everyone with type 1 diabetes, and some people with type 2 diabetes, also need to take insulin injections. Some people with type 2 diabetes take pills called "oral agents" which help their bodies produce more insulin and/or use the insulin it is producing better.Some people with type 2 diabetes can manage their disease without medication by appropriate meal planning and adequate physical activity.

Everyone who has diabetes should be seen at least once every six months by a diabetes specialist (an endocrinologist or a diabetologist). He or she should also be seen periodically by other members of a diabetes treatment team, including a diabetes nurse educator, and a dietitian who will help develop a meal plan for the individual. Ideally, one should also see an exercise physiologist for help in developing a physical activity plan, and, perhaps, a social worker, psychologist or other mental health professional for help with the stresses and challenges of living with a chronic disease. Everyone who has diabetes should have regular eye exams (once a year) by an eye doctor expert in diabetes eye care to make sure that any eye problems associated with diabetes are caught early and treated before they become serious.

Also, people with diabetes need to learn how to monitor their blood glucose. Daily testing will help determine how well their meal plan, activity plan, and medication are working to keep blood glucose levels in a normal range.

Your healthcare team will encourage you to follow your meal plan and exercise program, use your medications and monitor your blood glucose regularly to keep your blood glucose in as normal a range as possible as much of the time as possible. Why is this so important? Because poorly managed diabetes can lead to a host of long-term complications among these are heart attacks, strokes, blindness, kidney failure, and blood vessel disease that may require an amputation, nerve damage, and impotence in men.

But happily, a nationwide study completed over a 10-year period showed that if people keep their blood glucose as close to normal as possible, they can reduce their risk of developing some of these complications by 50 percent or more.

Maybe someday. Type 2 diabetes is the most common type of diabetes, yet we still do not understand it completely. Recent research does suggest, however, that there are some things one can do to prevent this form of diabetes.Studies show that lifestyle changes can prevent or delay the onset of type 2 diabetes in those adults who are at high risk of getting the disease. Modest weight loss (5-10% of body weight) and modest physical activity (30 minutes a day) are recommended goals.

Find more information about diabetes in What You Need to Know about Diabetes A Short Guide available from the Joslin Online Store.

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Diabetes Facts & Information | Joslin Diabetes Center

Diabetes mellitus type2, (also known as type 2 diabetes; ), is a long term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin.[3] Common symptoms include increased thirst, frequent urination, and unexplained weight loss. Symptoms may also include increased hunger, feeling tired, and sores that do not heal.[4] Often symptoms come on slowly.[3] Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations.[1] The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.[5][6]

Type2 diabetes primarily occurs as a result of obesity and not enough exercise.[1] Some people are more genetically at risk than others.[3] Type 2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes.[1] In diabetes mellitus type1 there is an absolute lack of insulin due to breakdown of islet cells in the pancreas.[7] Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or A1C.[4]

Type2 diabetes is partly preventable by staying a normal weight, exercising regularly, and eating properly. Treatment involves exercise and dietary changes.[1] If blood sugar levels are not adequately lowered, the medication metformin is typically recommended.[8][9] Many people may eventually also require insulin injections.[10] In those on insulin, routinely check blood sugar levels is advised, however this may not be needed in those taking pills.[11]Bariatric surgery often improves diabetes in those who are obese.[12][13]

Rates of type2 diabetes have increased markedly since 1960 in parallel with obesity.[14] As of 2013 there were approximately 368million people diagnosed with the disease compared to around 30million in 1985.[15][16] Typically it begins in middle or older age,[3] although rates of type 2 diabetes are increasing in young people.[17][18] Type 2 diabetes is associated with a ten-year-shorter life expectancy.[19] Diabetes was one of the first diseases described.[20] The importance of insulin in the disease was determined in the 1920s.[21]

The classic symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss.[22] Other symptoms that are commonly present at diagnosis include a history of blurred vision, itchiness, peripheral neuropathy, recurrent vaginal infections, and fatigue.[7] Many people, however, have no symptoms during the first few years and are diagnosed on routine testing.[7] People with type2 diabetes mellitus may rarely present with hyperosmolar hyperglycemic state (a condition of very high blood sugar associated with a decreased level of consciousness and low blood pressure).[7]

Type 2 diabetes is typically a chronic disease associated with a ten-year-shorter life expectancy.[19] This is partly due to a number of complications with which it is associated, including: two to four times the risk of cardiovascular disease, including ischemic heart disease and stroke; a 20-fold increase in lower limb amputations, and increased rates of hospitalizations.[19] In the developed world, and increasingly elsewhere, type2diabetes is the largest cause of nontraumatic blindness and kidney failure.[23] It has also been associated with an increased risk of cognitive dysfunction and dementia through disease processes such as Alzheimer's disease and vascular dementia.[24] Other complications include acanthosis nigricans, sexual dysfunction, and frequent infections.[22]

The development of type2 diabetes is caused by a combination of lifestyle and genetic factors.[23][25] While some of these factors are under personal control, such as diet and obesity, other factors are not, such as increasing age, female gender, and genetics.[19] A lack of sleep has been linked to type2 diabetes.[26] This is believed to act through its effect on metabolism.[26] The nutritional status of a mother during fetal development may also play a role, with one proposed mechanism being that of altered DNA methylation.[27] The intestinal bacteri Prevotella copri and Bacteroides vulgatus have been connected with type2 diabetes.[28]

A number of lifestyle factors are known to be important to the development of type2 diabetes, including obesity and being overweight (defined by a body mass index of greater than 25), lack of physical activity, poor diet, stress, and urbanization.[19][29] Excess body fat is associated with 30% of cases in those of Chinese and Japanese descent, 6080% of cases in those of European and African descent, and 100% of cases in Pima Indians and Pacific Islanders.[7] Those who are not obese often have a high waisthip ratio.[7] Smoking also appears to increase the risk of type 2 diabetes mellitus.[30]

Dietary factors also influence the risk of developing type2 diabetes. Consumption of sugar-sweetened drinks in excess is associated with an increased risk.[31][32] The type of fats in the diet are also important, with saturated fats and trans fatty acids increasing the risk, and polyunsaturated and monounsaturated fat decreasing the risk.[25] Eating lots of white rice appears to also play a role in increasing risk.[33] A lack of exercise is believed to cause 7% of cases.[34]Persistent organic pollutants may also play a role.[35]

Most cases of diabetes involve many genes, with each being a small contributor to an increased probability of becoming a type2 diabetic.[19] If one identical twin has diabetes, the chance of the other developing diabetes within his lifetime is greater than 90%, while the rate for nonidentical siblings is 2550%.[7] As of 2011, more than 36genes had been found that contribute to the risk of type2 diabetes.[36] All of these genes together still only account for 10% of the total heritable component of the disease.[36] The TCF7L2 allele, for example, increases the risk of developing diabetes by 1.5times and is the greatest risk of the common genetic variants.[7] Most of the genes linked to diabetes are involved in beta cell functions.[7]

There are a number of rare cases of diabetes that arise due to an abnormality in a single gene (known as monogenic forms of diabetes or "other specific types of diabetes").[7][19] These include maturity onset diabetes of the young (MODY), Donohue syndrome, and Rabson-Mendenhall syndrome, among others.[19] Maturity onset diabetes of the young constitute 15% of all cases of diabetes in young people.[37]

There are a number of medications and other health problems that can predispose to diabetes.[38] Some of the medications include: glucocorticoids, thiazides, beta blockers, atypical antipsychotics,[39] and statins.[40] Those who have previously had gestational diabetes are at a higher risk of developing type2 diabetes.[22] Other health problems that are associated include: acromegaly, Cushing's syndrome, hyperthyroidism, pheochromocytoma, and certain cancers such as glucagonomas.[38]Testosterone deficiency is also associated with type2 diabetes.[41][42]

Type2 diabetes is due to insufficient insulin production from beta cells in the setting of insulin resistance.[7] Insulin resistance, which is the inability of cells to respond adequately to normal levels of insulin, occurs primarily within the muscles, liver, and fat tissue.[43] In the liver, insulin normally suppresses glucose release. However, in the setting of insulin resistance, the liver inappropriately releases glucose into the blood.[19] The proportion of insulin resistance versus beta cell dysfunction differs among individuals, with some having primarily insulin resistance and only a minor defect in insulin secretion and others with slight insulin resistance and primarily a lack of insulin secretion.[7]

Other potentially important mechanisms associated with type2 diabetes and insulin resistance include: increased breakdown of lipids within fat cells, resistance to and lack of incretin, high glucagon levels in the blood, increased retention of salt and water by the kidneys, and inappropriate regulation of metabolism by the central nervous system.[19] However, not all people with insulin resistance develop diabetes, since an impairment of insulin secretion by pancreatic beta cells is also required.[7]

The World Health Organization definition of diabetes (both type1 and type2) is for a single raised glucose reading with symptoms, otherwise raised values on two occasions, of either:[46]

A random blood sugar of greater than 11.1mmol/l (200mg/dL) in association with typical symptoms[22] or a glycated hemoglobin (HbA1c) of 48mmol/mol (6.5 DCCT%) is another method of diagnosing diabetes.[19] In 2009 an International Expert Committee that included representatives of the American Diabetes Association (ADA), the International Diabetes Federation (IDF), and the European Association for the Study of Diabetes (EASD) recommended that a threshold of 48mmol/mol (6.5 DCCT%) should be used to diagnose diabetes.[47] This recommendation was adopted by the American Diabetes Association in 2010.[48] Positive tests should be repeated unless the person presents with typical symptoms and blood sugars >11.1mmol/l (>200mg/dl).[47]

Threshold for diagnosis of diabetes is based on the relationship between results of glucose tolerance tests, fasting glucose or HbA1c and complications such as retinal problems.[19] A fasting or random blood sugar is preferred over the glucose tolerance test, as they are more convenient for people.[19] HbA1c has the advantages that fasting is not required and results are more stable but has the disadvantage that the test is more costly than measurement of blood glucose.[49] It is estimated that 20% of people with diabetes in the United States do not realize that they have the disease.[19]

Diabetes mellitus type2 is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency.[50] This is in contrast to diabetes mellitus type 1 in which there is an absolute insulin deficiency due to destruction of islet cells in the pancreas and gestational diabetes mellitus that is a new onset of high blood sugars associated with pregnancy.[7] Type1 and type2 diabetes can typically be distinguished based on the presenting circumstances.[47] If the diagnosis is in doubt antibody testing may be useful to confirm type1 diabetes and C-peptide levels may be useful to confirm type2 diabetes,[51] with C-peptide levels normal or high in type2 diabetes, but low in type1 diabetes.[52]

No major organization recommends universal screening for diabetes as there is no evidence that such a program improve outcomes.[53][54] Screening is recommended by the United States Preventive Services Task Force (USPSTF) in adults without symptoms whose blood pressure is greater than 135/80mmHg.[55] For those whose blood pressure is less, the evidence is insufficient to recommend for or against screening.[55] There is no evidence that it changes the risk of death in this group of people.[56] They also recommend screening among those who are overweight and between the ages of 40 and 70.[57]

The World Health Organization recommends testing those groups at high risk[53] and in 2014 the USPSTF is considering a similar recommendation.[58] High-risk groups in the United States include: those over 45 years old; those with a first degree relative with diabetes; some ethnic groups, including Hispanics, African-Americans, and Native-Americans; a history of gestational diabetes; polycystic ovary syndrome; excess weight; and conditions associated with metabolic syndrome.[22] The American Diabetes Association recommends screening those who have a BMI over 25 (in people of Asian descent screening is recommending for a BMI over 23.[59]

Onset of type2 diabetes can be delayed or prevented through proper nutrition and regular exercise.[60][61] Intensive lifestyle measures may reduce the risk by over half.[23][62] The benefit of exercise occurs regardless of the person's initial weight or subsequent weight loss.[63] High levels of physical activity reduce the risk of diabetes by about 28%.[64] Evidence for the benefit of dietary changes alone, however, is limited,[65] with some evidence for a diet high in green leafy vegetables[66] and some for limiting the intake of sugary drinks.[31] In those with impaired glucose tolerance, diet and exercise either alone or in combination with metformin or acarbose may decrease the risk of developing diabetes.[23][67] Lifestyle interventions are more effective than metformin.[23] While low vitamin D levels are associated with an increased risk of diabetes, correcting the levels by supplementing vitamin D3 does not improve that risk.[68]

Management of type2 diabetes focuses on lifestyle interventions, lowering other cardiovascular risk factors, and maintaining blood glucose levels in the normal range.[23] Self-monitoring of blood glucose for people with newly diagnosed type2 diabetes may be used in combination with education,[69] however the benefit of self monitoring in those not using multi-dose insulin is questionable.[23][70] In those who do not want to measure blood levels, measuring urine levels may be done.[69] Managing other cardiovascular risk factors, such as hypertension, high cholesterol, and microalbuminuria, improves a person's life expectancy.[23] Decreasing the systolic blood pressure to less than 140mmHg is associated with a lower risk of death and better outcomes.[71] Intensive blood pressure management (less than 130/80mmHg) as opposed to standard blood pressure management (less than 140/85100mmHg) results in a slight decrease in stroke risk but no effect on overall risk of death.[72]

Intensive blood sugar lowering (HbA1c<6%) as opposed to standard blood sugar lowering (HbA1c of 77.9%) does not appear to change mortality.[73][74] The goal of treatment is typically an HbA1c of around 7% or a fasting glucose of less than 7.2mmol/L (130mg/dL); however these goals may be changed after professional clinical consultation, taking into account particular risks of hypoglycemia and life expectancy.[75][59] It is recommended that all people with type2 diabetes get regular ophthalmology examination.[7] Treating gum disease in those with diabetes may result in a small improvement in blood sugar levels.[76]

A proper diet and exercise are the foundations of diabetic care,[22] with a greater amount of exercise yielding better results.[77]Aerobic exercise leads to a decrease in HbA1c and improved insulin sensitivity.[77]Resistance training is also useful and the combination of both types of exercise may be most effective.[77] A diabetic diet that promotes weight loss is important.[78] While the best diet type to achieve this is controversial,[78] a low glycemic index diet or low carbohydrate diet has been found to improve blood sugar control.[79][80] Culturally appropriate education may help people with type2 diabetes control their blood sugar levels, for up to six months at least.[81][needs update] If changes in lifestyle in those with mild diabetes has not resulted in improved blood sugars within six weeks, medications should then be considered.[22] There is not enough evidence to determine if lifestyle interventions affect mortality in those who already have DM2.[62]

There are several classes of anti-diabetic medications available. Metformin is generally recommended as a first line treatment as there is some evidence that it decreases mortality;[9][23][82] however, this conclusion is questioned.[83] Metformin should not be used in those with severe kidney or liver problems.[22]

A second oral agent of another class or insulin may be added if metformin is not sufficient after three months.[75] Other classes of medications include: sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, SGLT2 inhibitors, and glucagon-like peptide-1 analog.[75] There is no significant difference between these agents.[75]Rosiglitazone, a thiazolidinedione, has not been found to improve long-term outcomes even though it improves blood sugar levels.[84] Additionally it is associated with increased rates of heart disease and death.[85]Angiotensin-converting enzyme inhibitors (ACEIs) prevent kidney disease and improve outcomes in those with diabetes.[86][87] The similar medications angiotensin receptor blockers (ARBs) do not.[87] A 2016 review recommended treating to a systolic blood pressure of 140 to 150 mmHg.[88]

Injections of insulin may either be added to oral medication or used alone.[23] Most people do not initially need insulin.[7] When it is used, a long-acting formulation is typically added at night, with oral medications being continued.[22][23] Doses are then increased to effect (blood sugar levels being well controlled).[23] When nightly insulin is insufficient, twice daily insulin may achieve better control.[22] The long acting insulins glargine and detemir are equally safe and effective,[89] and do not appear much better than neutral protamine Hagedorn (NPH) insulin, but as they are significantly more expensive, they are not cost effective as of 2010.[90] In those who are pregnant insulin is generally the treatment of choice.[22]

Weight loss surgery in those who are obese is an effective measure to treat diabetes.[91] Many are able to maintain normal blood sugar levels with little or no medications following surgery[92] and long-term mortality is decreased.[93] There however is some short-term mortality risk of less than 1% from the surgery.[94] The body mass index cutoffs for when surgery is appropriate are not yet clear.[93] It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control.[95][96]

no data

7.5

7.515

1522.5

22.530

3037.5

37.545

4552.5

52.560

6067.5

67.575

7582.5

82.5

Globally as of 2010 it was estimated that there were 285million people with type2 diabetes making up about 90% of diabetes cases.[19] This is equivalent to about 6% of the world's adult population.[97] Diabetes is common both in the developed and the developing world.[19] It remains uncommon, however, in the underdeveloped world.[7]

Women seem to be at a greater risk as do certain ethnic groups,[19][98] such as South Asians, Pacific Islanders, Latinos, and Native Americans.[22] This may be due to enhanced sensitivity to a Western lifestyle in certain ethnic groups.[99] Traditionally considered a disease of adults, type2 diabetes is increasingly diagnosed in children in parallel with rising obesity rates.[19] Type2 diabetes is now diagnosed as frequently as type1 diabetes in teenagers in the United States.[7]

Rates of diabetes in 1985 were estimated at 30million, increasing to 135million in 1995 and 217million in 2005.[15] This increase is believed to be primarily due to the global population aging, a decrease in exercise, and increasing rates of obesity.[15] The five countries with the greatest number of people with diabetes as of 2000 are India having 31.7million, China 20.8million, the United States 17.7million, Indonesia 8.4million, and Japan 6.8million.[100] It is recognized as a global epidemic by the World Health Organization.[101]

Diabetes is one of the first diseases described[20] with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine."[102] The first described cases are believed to be of type1 diabetes.[102] Indian physicians around the same time identified the disease and classified it as madhumeha or honey urine noting that the urine would attract ants.[102] The term "diabetes" or "to pass through" was first used in 230BCE by the Greek Apollonius Of Memphis.[102] The disease was rare during the time of the Roman empire with Galen commenting that he had only seen two cases during his career.[102]

Type1 and type2 diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400500AD with type1 associated with youth and type2 with being overweight.[102] The term "mellitus" or "from honey" was added by the Briton John Rolle in the late 1700s to separate the condition from diabetes insipidus which is also associated with frequent urination.[102] Effective treatment was not developed until the early part of the 20th century when the Canadians Frederick Banting and Charles Best discovered insulin in 1921 and 1922.[102] This was followed by the development of the long acting NPH insulin in the 1940s.[102]

View post:
Diabetes mellitus type 2 - Wikipedia, the free encyclopedia

New PBS listing will improve quality of life for people with type 2 diabetes 15 August 2016

Diabetes Australia welcomed the Minister for Health Sussan Leys announcement of the Federal Governments decision to list diabetes drug Bydureon on the Pharmaceutical Benefits Scheme (PBS) and said the move would improve quality of life for many people with type 2 diabetes.

Aged 18 - 35 and living with type 1 diabetes? You can help with a survey into Online Youth Empowerment and Support.The survey aims to find out the usefulness and effectiveness of an online diabetes service on diabetes self-management during life transitions in young adults with type 1 diabetes.

Albert Abdul- Rahman has had a lifetime of adapting to change which stands him in good stead to face one of the biggest challenges in his life: learning to walk again after his left foot was amputated just three weeks ago.

Aged 19, Albert left Papua New Guinea for Queensland where he joined the Australian army: "There was no way I was prepared for the culture shock, I thought I knew about life in Australia, but everything was different to what I was used to." Albert embraced life with the army and spent six years as an engineer, learning a great deal about his new country and remaining an important part of the Papua New Guinea community living in Townsville.

Diabetes Australia and OPSM have partnered to raise awareness of diabetes and eye health in Australia. Each day 280 Australians develop diabetes thats one every five minutes.

From Kim Kardashian to Russell Crowe, masseur to the stars Philip Rule was comfortable dealing with the biggest names in sport and entertainment.

He was on top of the world work-wise and feeling healthy so a diagnosis of type 2 diabetes came out of the blue for 5th generation coalminer who, as well as being a massage whiz, has 30 years experience underground.

I was diagnosed with type 2 diabetes in 2005. I wasnt particularly overweight and I didnt think I was unhealthy so it was a bit of a surprise, Philip said.

Truck driver Jake Williams from Flemington in Melbourne was diagnosed with Type 1 diabetes at 11 years old. Once he and his family got over the initial shock of diagnosis, Jake got into a routine of dealing with his diabetes and throughout his teens gave as little thought as possible to managing his health.

Busy with work and the responsibilities of being a new dad, diabetes was definitely on the back burner during his twenties; I really didnt let my diabetes have much effect on my life. When you have a young family and youre busy with work, its easy to miss appointments and ignore any little warning signs

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Diabetes Australia

Diabetes is an important health concern particularly if you are a person with diabetes or at high risk for developing it; have loved one with diabetes; or are a health care provider or public health practitioner. Diabetes is serious, common and costly, yet it is controllable. The New Jersey Diabetes Prevention and Control Program seeks to reduce the health impacts of diabetes by:

Diabetes Disaster Guidelines [pdf 211kb]

Grant Programs

Commission for the Blind & Visually Impaired/Diabetic Eye Disease Detection Program

NJ 2-1-1 Diabetes Education and Prevention Program Services The NJ Department of Health has partnered with NJ 2-1-1, to provide the most up-to-date information on diabetes prevention and education to New Jersey residents.

NJ 2-1-1 is a statewide non-emergency, information call center and website. NJ 2-1-1 call specialists will provide callers with information on local Diabetes Prevention Programs and Diabetes Self-Management Education programs. Please feel free to visit the website, http://nj211.org/diabetes-management-and-prevention, to learn more about this partnership.

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Diabetes Prevention and Control - New Jersey