Citizendia

This article is about the management of diabetes mellitus. For more on the disease itself see diabetes mellitus. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc

Diabetes is a chronic disease with no cure as of 2008. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc In Medicine, a chronic disease is a Disease that is long-lasting or recurrent 2008 ( MMVIII) is the current year in accordance with the Gregorian calendar, a Leap year that started on Tuesday of the Common It is associated with an impaired glucose cycle, altering metabolism. The glucose cycle (also known as the hepatic futile cycle occurs primarily in the Liver and is the dynamic equilibrium between Glucose and Glucose 6-phosphate Metabolism is the set of Chemical reactions that occur in living Organisms in order to maintain Life. Management of this disease may include lifestyle modifications such as achieving and maintaining proper weight, diet, exercise and foot care.

Diabetes mellitus
Types of Diabetes
Diabetes mellitus type 1
Diabetes mellitus type 2
Gestational diabetes

Pre-diabetes:
Impaired fasting glycaemia
Impaired glucose tolerance
Disease Management
Diabetes management:
•Diabetic diet
•Anti-diabetic drugs
•Conventional insulinotherapy
•Intensive insulinotherapy
Other Concerns
Cardiovascular disease

Diabetic comas:
•Diabetic hypoglycemia
•Diabetic ketoacidosis
•Nonketotic hyperosmolar

Diabetic myonecrosis
Diabetic nephropathy
Diabetic neuropathy
Diabetic retinopathy

Diabetes and pregnancy
Blood tests
Blood sugar
Fructosamine
Glucose tolerance test
Glycosylated hemoglobin

Contents

Overview of management

Issues requiring management


The primary issue requiring management is the glucose cycle, whereby glucose in the bloodstream is made available to cells in the body, a process dependent upon the twin cycles of glucose entering the bloodstream, and insulin allowing appropriate uptake into the cells of the body. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Diabetes mellitus type 1 (Type 1 diabetes Type I diabetes T1D T1DM IDDM juvenile diabetes is a form of Diabetes mellitus. Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non - Insulin -dependent Diabetes mellitus (NIDDM or adult-onset diabetes is a metabolic Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood Impaired fasting glycaemia (IFG is a pre-diabetic state of dysglycemia associated with insulin resistance and increased risk of cardiovascular pathology although of lesser risk than Impaired Glucose Tolerance (IGT is a pre- Diabetic state of dysglycemia that is associated with Insulin resistance and increased risk of cardiovascular pathology The diet most often recommended for people who suffer from Diabetes mellitus is high in Dietary fiber, especially soluble fiber but low in fat (especially Saturated fat Anti-diabetic drugs treat Diabetes mellitus by lowering Glucose levels in the blood Conventional insulinotherapy is a therapeutic regimen for treatment of Diabetes mellitus which contrasts with the newer Intensive insulinotherapy. Intensive insulinotherapy is a therapeutic regimen for Diabetes mellitus treatment Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Diabetic coma is a Medical emergency in which a person with Diabetes mellitus is Comatose (unconscious because of one of the acute complications Diabetic hypoglycemia describes a low blood glucose level occurring in a person with Diabetes mellitus. Diabetic ketoacidosis (DKA is a life-threatening complication in patients with diabetes mellitus Nonketotic hyperosmolar coma (nonketotic Hyperglycaemia) is a type of Diabetic coma associated with a high mortality seen in Diabetes mellitus type 2. Diabetic myonecrosis is a rare complication of Diabetes. It is caused by Infarcted Muscle tissue usually in the thigh Diabetic nephropathy ( nephropatia diabetica) also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive Kidney Diabetic neuropathies are neuropathic disorders that are associated with Diabetes mellitus. Diabetic retinopathy is Retinopathy (damage to the Retina) caused by complications of Diabetes mellitus, which can eventually lead to Blindness For women with Diabetes mellitus, Pregnancy can present some particular challenges for both mother and child Blood sugar, used in a physiological context is a misnomer and misleading Fructosamine is a compound that can be considered the result of a reaction between Fructose and Ammonia or an Amine (with a molecule of water being released A glucose tolerance test in medical practice is the administration of Glucose to determine how quickly it is cleared from the blood Glycosylated (or glycated hemoglobin ( hemoglobin A1c Hb1c, or HbA1c) is a form of Hemoglobin used primarily to identify the average Both aspects can require management.

Complexities relating to management

The main complexities stem from the nature of the feedback loop itself, which is sought to be regulated:

As diabetes is a prime risk factor for cardiovascular disease, controlling other risk factors which may give rise to secondary conditions, as well as the diabetes itself, is one of the facets of diabetes management. Feedback is a circular causal Process whereby some proportion of a system's output is returned (fed back to the Input. Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Checking cholesterol, LDL, HDL and triglyceride levels may indicate hyperlipoproteinemia, which may warrant treatment with hypolipidemic drugs. Cholesterol is a Lipid found in the Cell membranes and transported in the Blood plasma of all Animals It is an essential component of mammalian Low-density lipoprotein ( LDL) is a type of Lipoprotein that transports Cholesterol and Triglycerides from the Liver to peripheral High-density lipoproteins ( HDL) is one of the 5 major groups of Lipoproteins ( Chylomicrons, VLDL, IDL, LDL, HDL (more properly known as, TAG or triacylglyceride) is Glyceride in which the Glycerol is Esterified with three Fatty acids It is the Hyperlipidemia, hyperlipoproteinemia or dyslipidemia is the presence of raised or abnormal levels of Lipids and/or Lipoproteins in the Checking the blood pressure and keeping it within strict limits (using diet and antihypertensive treatment) protects against the retinal, renal and cardiovascular complications of diabetes. Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories Antihypertensives are a class of drugs that are used in Medicine and Pharmacology to treat Hypertension (high blood pressure Regular follow-up by a podiatrist or other foot health specialists is encouraged to prevent the development of diabetic foot. Podiatry or podiatric medicine is a field of Healthcare devoted to the study and treatment of disorders of the Foot, Ankle, and the "anatomical Diabetic foot is an umbrella term for foot problems in patients with Diabetes mellitus. Annual eye exams are suggested to monitor for progression of diabetic retinopathy.

The expense, inconvenience and discomfort of frequent blood glucose measurements has been a significant challenge until recently. Recently newer devices which monitor glucose levels on an ongoing basis have been developed, as detailed below.

Early advancements

Late in the nineteenth century, sugar in the urine (glycosuria) was associated with diabetes. Various doctors studied the connection. Frederick Madison Allen studied diabetes in 1909-12, then published a large volume, Studies Concerning Glycosuria and Diabetes, (Boston, 1913). Frederick Madison Allen (1879&ndash1964 was a doctor who is perhaps best remembered today for his work on a diet for sufferers of Diabetes mellitus. Year 1909 ( MCMIX) was a Common year starting on Friday (link will display full calendar of the Gregorian calendar (or a Common year starting Year 1912 ( MCMXII) was a Leap year starting on Monday (link will display the full calendar of the Gregorian calendar (or a Leap year starting He invented a fasting treatment for diabetes called the Allen treatment for diabetes. Fasting is primarily the act of willingly abstaining from some or all Food, Drink, or both for a period of time His diet was an early attempt at managing diabetes.

Modern approaches


Modern approaches to diabetes primarily rely upon dietary and lifestyle management, often combined with regular ongoing blood glucose level monitoring.

Diet management allows control and awareness of the types of nutrients entering the digestive system, and hence allows indirectly, significant control over changes in blood glucose levels. Blood glucose monitoring allows verification of these, and closer control, especially important since some symptoms of diabetes are not easy for the patient to notice without actual measurement.

Other approaches include exercise control, and other lifestyle changes which impact the glucose cycle.

Blood sugar level

Blood sugar level is measured by means of a glucose meter, with the result either in mg/dL (milligrams per deciliter in the USA) or mmol/L (millimoles per litre in Canada and Europe) of blood. A glucose meter (or glucometer) is a Medical device for determining the approximate concentration of Glucose in the Blood. The average normal person should have a glucose level of around 4. 5 to 7. 0 mmol/L (80 to 125 mg/dL). In the diabetic patient a before-meal level of <6. 1 mmol/L (<110 mg/dL) and a level two hours after the start of a meal of <7. 8 mmol/L (<140 mg/dL) is acceptable.

Optimal management of diabetes involves patients measuring and recording their own blood glucose levels. Blood sugar, used in a physiological context is a misnomer and misleading By keeping a diary of their own blood glucose measurements and noting the effect of food and exercise, patients can modify their lifestyle to better control their diabetes. For patients on insulin, patient involvement is important in achieving effective dosing and timing.

Hypo and hyperglycemia

Levels which are significantly above or below this range are problematic and can in some cases be dangerous. A level of <3. 8 mmol/L (<70 mg/dL) is usually described as a hypoglycemic attack (low blood sugar). Most diabetics know when they're going to "go hypo" and usually are able to eat some food or drink something sweet to raise levels. A patient who is hyperglycemic (high glucose) can also become temporarily hypoglycemic, under certain conditions (e. g. not eating regularly, or after strenuous exercise, followed by fatigue).

Levels greater than 13-15 mmol/L (230-270 mg/dL) are considered high, and should be monitored closely to ensure that they reduce rather than continue to remain high. The patient is advised to seek urgent medical attention as soon as possible if blood sugar levels continue to rise after 2-3 tests. High blood sugar levels are known as hyperglycemia, which is not as easy to detect as hypoglycemia and usually happens over a period of days rather than hours or minutes. If left untreated, this can result in diabetic coma and death. Diabetic coma is a Medical emergency in which a person with Diabetes mellitus is Comatose (unconscious because of one of the acute complications

A blood glucose test strip for an older style (ie, optical color sensing) monitoring system
A blood glucose test strip for an older style (ie, optical color sensing) monitoring system

Prolonged and elevated levels of glucose in the blood, which is left unchecked and untreated, will, over time, result in serious diabetic complications and sometimes even death. It is therefore highly important that a diabetic patient checks their blood levels either daily or every few days to see what levels they are achieving over a given period of time. There is also computer software for the PC which is available from blood testing manufacturers which can display results and trends over time. Type 1 patients will have to check on a more regular daily basis due to insulin therapy, which is a fine art to master.

A history of blood sugar level results is especially useful for the diabetic to present to their doctor or physician in the monitoring and control of the disease. Failure to maintain a strict regimen of testing can accelerate symptoms of the condition, and it is therefore imperative that any diabetic patient strictly monitor their glucose levels regularly.

Glycemic control

Glycemic control is a medical term referring to the typical levels of blood sugar (glucose) in a person with diabetes mellitus. Glucose (Glc a Monosaccharide (or simple Sugar) also known as grape sugar, is an important Carbohydrate in Biology. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Much evidence suggests that many of the long-term complications of diabetes, especially the microvascular complications, result from many years of hyperglycemia (elevated levels of glucose in the blood). Hyperglycemia, hyperglycaemia, or high blood sugar is a condition in which an excessive amount of Glucose circulates in the Blood plasma Good glycemic control, in the sense of a "target" for treatment, has become an important goal of diabetes care.

Because blood sugar levels fluctuate throughout the day and glucose records are imperfect indicators of these changes, the percentage of hemoglobin which is glycosylated is used as a proxy measure of long-term glycemic control in research trials and clinical care of people with diabetes. Hemoglobin ( also spelled haemoglobin and abbreviated Hb or Hgb) is the Iron -containing Oxygen -transport Metalloprotein Glycosylation is the enzymatic process that links Saccharides to produce glycans, either free or attached to Proteins and Lipids This enzymatic This test, the hemoglobin A1c or glycosylated hemoglobin reflects average glucoses over the preceding 2-3 months. Glycosylated (or glycated hemoglobin ( hemoglobin A1c Hb1c, or HbA1c) is a form of Hemoglobin used primarily to identify the average Glycosylated (or glycated hemoglobin ( hemoglobin A1c Hb1c, or HbA1c) is a form of Hemoglobin used primarily to identify the average In nondiabetic persons with normal glucose metabolism the glycosylated hemoglobin is usually 4-6% by the most common methods (normal ranges may vary by method).

"Perfect glycemic control" would mean that glucose levels were always normal (70-130 mg/dl, or 3. 9-7. 2 mmol/L) and indistinguishable from a person without diabetes. In reality, because of the imperfections of treatment measures, even "good glycemic control" describes blood glucose levels that average somewhat higher than normal much of the time.

Accepted "target levels" of glucose and glycosylated hemoglobin that are considered good control have been lowered over the last 25 years, because of improvements in the tools of diabetes care, because of increasing evidence of the value of glycemic control in avoiding complications, and by the expectations of both patients and physicians. What is considered "good control" also varies by age and susceptibility of the patient to hypoglycemia. Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of Glucose ( sugar) in the blood

In the 1990s the American Diabetes Association conducted a publicity campaign to persuade patients and physicians to strive for average glucose and hemoglobin A1c values below 200 mg/dl (11 mmol/l) and 8%. The American Diabetes Association, or the ADA is an American health organization providing Diabetes research information and advocacy Currently many patients and physicians attempt to do better than that.

Poor glycemic control refers to persistently elevated blood glucose and glycosylated hemoglobin levels, which may range from 200-500 mg/dl (11-28 mmol/L) and 9-15% or higher over months and years before severe complications occur.

Monitoring

An older style portable blood glucose meter. A blood sample is applied to an inserted strip (see image above) and color changes caused by reaction with blood glucose are measured by the meter.
An older style portable blood glucose meter. A blood sample is applied to an inserted strip (see image above) and color changes caused by reaction with blood glucose are measured by the meter.

Relying on their own perceptions of symptoms of hyperglycemia or hypoglycemia is usually unsatisfactory as mild to moderate hyperglycemia causes no obvious symptoms in nearly all patients. Other considerations include the fact that, while food takes several hours to be digested and absorbed, insulin administration can have glucose lowering effects for as little as 2 hours or 24 hours or more (depending on the nature of the insulin preparation used and individual patient reaction). In addition, the onset and duration of the effects of oral hypoglycemic agents vary from type to type and from patient to patient.

Personal (home) glucose monitoring

Control and outcomes of both types 1 and 2 diabetes may be improved by patients using home glucose meters to regularly measure their glucose levels. A glucose meter (or glucometer) is a Medical device for determining the approximate concentration of Glucose in the Blood. Glucose (Glc a Monosaccharide (or simple Sugar) also known as grape sugar, is an important Carbohydrate in Biology. [1] Glucose monitoring is both expensive (largely due to the cost of the consumable test strips) and requires significant commitment on the part of the patient. The effort and expense may be worthwhile for patients when they use the values to sensibly adjust food, exercise, and oral medications or insulin. These adjustments are generally made by the patients themselves following training by a clinician.

Regular blood testing, especially in type 1 diabetics, is essential to keep adequate control of glucose levels and to reduce the chance of long term side effects of the disease. Side Effect were an influential Disco band that recorded between 1972 and 1995 There are many (at least 20+) different types of blood monitoring devices available on the market today; not every meter suits all patients and it is a specific matter of choice for the patient, in consultation with a physician or other experienced professional, to find a meter that they personally find comfortable to use. A glucose meter (or glucometer) is a Medical device for determining the approximate concentration of Glucose in the Blood. The principle of the devices is virtually the same: a small blood sample is collected and measured. In one type of meter, the electrochemical, a small blood sample is produced by the patient using a lancet (a sterile pointed needle). The blood droplet is usually collected at the bottom of a test strip, while the other end is inserted in the glucose meter. This test strip contains various chemicals so that when the blood is applied, a small electrical charge is created between two contacts. This charge will vary depending on the glucose levels within the blood. In older glucose meters, the drop of blood is placed on top of a strip. A chemical reaction occurs and the strip changes color. The meter then measures the color of the strip optically.

Self-testing is clearly important in type I diabetes where the use of insulin therapy risks episodes of hypoglycaemia and home-testing allows for adjustment of dosage on each administration. [2] However its benefit in type 2 diabetes is more controversial as there is much more variation in severity of type 2 cases. [3] It has been suggested that some type 2 patients might do as well with home urine-testing alone. [4] The best use of home blood-sugar monitoring is being researched. [5]

Benefits of control and reduced hospital admission have been reported. [6] However, patients on oral medication who do not self-adjust their drug dosage will miss many of the benefits of self-testing, and so it is questionable in this group. This is particularly so for patients taking monotherapy with metformin who are not at risk of hypoglycaemia. Regular 6 monthly laboratory testing of HbAc1 (glycated haemoglobin) provides some assurance of longterm effective control and allows the adjustment of the patient's routine medication dosages in such cases. High frequency of self-testing in type 2 diabetes has not been shown to be associated with improved control. [7] The argument is made, though, that type 2 patients with poor long term control despite home blood glucose monitoring, either have not had this integrated into their overall management, or are long overdue for tighter control by a switch from oral medication to injected insulin. [8]

HbA1c test

A useful test that has usually been done in a laboratory is the measurement of blood HbA1c levels. Glycosylated (or glycated hemoglobin ( hemoglobin A1c Hb1c, or HbA1c) is a form of Hemoglobin used primarily to identify the average This is the ratio of glycosylated hemoglobin in relation to the total hemoglobin. Hemoglobin ( also spelled haemoglobin and abbreviated Hb or Hgb) is the Iron -containing Oxygen -transport Metalloprotein Persistent raised plasma glucose levels cause the proportion of these cells to go up. This is a test that measures the average amount of diabetic control over a period originally thought to be about 3 months (the average red blood cell lifetime), but more recently thought to be more strongly weighted to the most recent 2 to 4 weeks. In the non-diabetic, the HbA1C level ranges from 4. 0-6. 0%; patients with diabetes mellitus who manage to keep their HbA1C level below 6. 5% are considered to have good glycemic control. The HbA1c test is not appropriate if there has been changes to diet or treatment within shorter time periods than 6 weeks or there is disturbance of red cell aging (e. g. recent bleeding or hemolytic anemia) or a hemoglobinopathy (e. Hemolytic anemia is Anemia due to Hemolysis, the abnormal breakdown of Red blood cells (RBCs either in the Blood vessels (intravascular hemolysis Hemoglobinopathy is a kind of Genetic defect that results in abnormal structure of one of the Globin chains of the Hemoglobin molecule g. sickle cell disease). Sickle-cell disease or sickle-cell anaemia (or anemia) is a Blood disorder characterized by Red blood cells that assume an abnormal rigid In such cases the alternative Fructosamine test is used to indicate average control in the preceding 2 to 3 weeks. Fructosamine is a compound that can be considered the result of a reaction between Fructose and Ammonia or an Amine (with a molecule of water being released

Ongoing monitoring

Main article: Blood glucose monitoring

Recently, devices have been manufactured which provide ongoing monitoring of glucose levels on an automated basis during the day, for example:

  1. The Paradigm REAL-Time by Minimed, is a blood glucose monitoring device that provides blood glucose measurements to be made every five minutes. Blood glucose monitoring is a way of testing the concentration of Glucose in the blood ( Glycemia) The patient can thus adjust an insulin infusion pump immediately and mimic the "feed-back" mechanism of a pancreas. Significant reductions in complications of therapy have been demonstrated and reductions in long-term complications from diabetes mellitus are projected.
  2. The US Food and Drug Administration has also approved a non-invasive blood glucose monitoring device, the GlucoWatch G2 Biographer. This allows checking blood glucose levels, while puncturing the skin as little as twice a day. Once calibrated with a blood sample, it pulls body fluids from the skin using small electrical currents, taking six readings an hour for as long as thirteen hours. It has not proven to be reliable enough, or convenient enough to be used in lieu of conventional blood monitoring. Other non-invasive methods like radio waves, ultrasound and energy waves are also being tested.

Approaches to management

Insulin and other drug based approaches

Main article: Anti-diabetic drug

Currently, one goal for diabetics is to avoid or minimize chronic diabetic complications, as well as to avoid acute problems of hyperglycemia or hypoglycemia. Anti-diabetic drugs treat Diabetes mellitus by lowering Glucose levels in the blood Hyperglycemia, hyperglycaemia, or high blood sugar is a condition in which an excessive amount of Glucose circulates in the Blood plasma Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of Glucose ( sugar) in the blood Adequate control of diabetes leads to lower risk of complications associated with unmonitored diabetes including kidney failure (requiring dialysis or transplant), blindness, heart disease and limb amputation. Renal failure or kidney In Medicine, dialysis (from Greek "dialusis" meaning dissolution "dia" meaning through and "lusis" meaning loosening is primarily Heart disease is an Umbrella term for a variety for different diseases affecting the Heart. Amputation is the removal of a body extremity by trauma or Surgery. The most prevalent form of medication is hypoglycemic treatment through either oral hypoglycemics and/or insulin therapy. Anti-diabetic drugs treat Diabetes mellitus by lowering Glucose levels in the blood Insulin is a Hormone with intensive effects on both metabolism and several other body systems (eg vascular compliance There is emerging evidence that full-blown diabetes mellitus type 2 can be evaded in those with only mildly impaired glucose tolerance. [9]

Patients with type 1 diabetes mellitus require direct injection of insulin as their bodies cannot produce enough (or even any) insulin. As of 2005, there is no other clinically available form of insulin administration other than injection for patients with type 1: injection can be done by insulin pump, by jet injector, or any of several forms of hypodermic needle. An insulin pump is a medical device used for the administration of Insulin in the treatment of Diabetes mellitus, also known as continuous subcutaneous jet injector is a type of medical injecting Syringe that uses a high- Pressure narrow jet of the injection liquid instead of a Hypodermic needle A hypodermic needle is a hollow needle commonly used with a Syringe to inject substances into the body There are several insulin application mechanisms under experimental development as of 2004. There have also been proposed vaccines for type I using glutamic acid decarboxylase (GAD), but these are currently not being tested by the pharmaceutical companies that have sublicensed the patents to them. Glutamate decarboxylase (GAD is an Enzyme that catalyzes the decarboxylation of Glutamate to GABA and CO2

For type 2 diabetics, diabetic management consists of a combination of diet, exercise, and weight loss, in any achievable combination depending on the patient. This article is primarily about the human diet For a discussion of animal diets see List of feeding behaviours. Weight loss, in the context of Medicine or Health or Physical fitness, is a reduction of the total Body weight, due to a mean loss of fluid Obesity is very common in type 2 diabetes and contributes greatly to insulin resistance. Weight reduction and exercise improve tissue sensitivity to insulin and allow its proper use by target tissues. [10] Patients who have poor diabetic control after lifestyle modifications are typically placed on oral hypoglycemics. Some Type 2 diabetics eventually fail to respond to these and must proceed to insulin therapy.

Patient education and compliance with treatment is very important in managing the disease. Improper use of medications and insulin can be very dangerous causing hypo- or hyper-glycemic episodes.

Insulin therapy requires close monitoring and a great deal of patient education, as improper administration is quite dangerous. Intensive insulinotherapy is a therapeutic regimen for Diabetes mellitus treatment For example, when food intake is reduced, less insulin is required. A previously satisfactory dosing may be too much if less food is consumed causing a hypoglycemic reaction if not intelligently adjusted. Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of Glucose ( sugar) in the blood In addition, exercise decreases insulin requirements as exercise increases glucose uptake by body cells whose glucose uptake is controlled by insulin, and vice versa. In addition, there are available several types of insulin with varying times of onset and duration of action.

Insulin therapy creates risk because of the inability to continuously know a person's blood glucose level and adjust insulin infusion appropriately. New advances in technology have overcome much of this problem. Small, portable insulin infusion pumps are available from several manufacturers. They allow a continuous infusion of small amounts of insulin to be delivered through the skin around the clock, plus the ability to give bolus doses when a person eats or has elevated blood glucose levels. This is very similar to how the pancreas works, but these pumps lack a continuous "feed-back" mechanism. Thus, the user is still at risk of giving too much or too little insulin unless blood glucose measurements are made.

The FDA has approved a treatment called Exenatide, based on the saliva of a Gila monster, to control blood sugar in patients with type 2 diabetes. Exenatide ( INN, marketed as Byetta) is one of a new class of medications ( Incretin mimetics approved for the treatment of Diabetes mellitus type 2 For the band see Saliva (band; for the village in Azerbaijan see Səliva. The Gila monster (ˈhiːlə HEE-la Heloderma suspectum, is a species of venomous Lizard native to the Southwestern United States and northern

Diet and supplements

Main article: Diabetic diet

For most Type 1 diabetics there will always be a need for insulin injections throughout their life. The diet most often recommended for people who suffer from Diabetes mellitus is high in Dietary fiber, especially soluble fiber but low in fat (especially Saturated fat However, both Type 1 and Type 2 diabetics can see dramatic normalization of their blood sugars through controlling their diet, and some Type 2 diabetics can fully control the disease by dietary modification. As diabetes can lead to many other complications it is critical to maintain blood sugars as close to normal as possible and diet is the leading factor in this level of control.

The American Diabetes Association in 1994 recommended that 60-70% of caloric intake should be in the form of carbohydrates. The American Diabetes Association, or the ADA is an American health organization providing Diabetes research information and advocacy Carbohydrates (from ' Hydrates of Carbon ' or saccharides ( Greek σάκχαρον meaning " Sugar " are the most This is somewhat controversial, with some researchers claiming that 40% is better,[11] while others claim benefits for a high-fiber, 75% carbohydrate diet. [12].

An article summarizing the view of the American Diabetes Association[13] gives many recommendations and references to the research. The American Diabetes Association, or the ADA is an American health organization providing Diabetes research information and advocacy One of the conclusions is that caloric intake must be limited to that which is necessary for maintaining a healthy weight.

Specific diets

Glycemic index - lowering the glycemic index of one's diet can improve the control of diabetes. The Glycemic index (also glycaemic index) or GI is a measure of the effects of Carbohydrates on Blood glucose levels [14][15] This includes avoidance of such foods as potatoes,and white bread, and favoring legumes and whole grains.

Low Carb Diet - It has been suggested that the gradual removal of carbohydrates from the diet and replacement with fatty foods such as nuts, seeds, meats, fish, oils, eggs, avocados, olives, and vegetables may help reverse diabetes. Fats would become the primary calorie source for the body, and complications due to insulin resistance would be minimized. [16]

High fiber diet - It has been shown that a high fiber diet works better than the diet recommended by the American Diabetes Association in controlling diabetes, and may control blood sugar levels with the same efficacy as oral diabetes drugs. Dietary fibers are the indigestible portion of plant foods that move food through the Digestive system, absorbing water and easing Defecation. The American Diabetes Association, or the ADA is an American health organization providing Diabetes research information and advocacy [17][18][19]

Chromium and vanadium

Chromium - Cholesterol and triglycerides are risk factors in heart disease and diabetes, and studies show that chromium lowers levels of total cholesterol, LDL cholesterol, and triglycerides. Chromium (ˈkroʊmiəm is a Chemical element which has the symbol Cr and Atomic number 24 Cholesterol is a Lipid found in the Cell membranes and transported in the Blood plasma of all Animals It is an essential component of mammalian Low-density lipoprotein ( LDL) is a type of Lipoprotein that transports Cholesterol and Triglycerides from the Liver to peripheral (more properly known as, TAG or triacylglyceride) is Glyceride in which the Glycerol is Esterified with three Fatty acids It is the [20][21][22][23] Chromium supplements such as chromium picolinate have been shown to improve glucose tolerance in people with type 2 diabetes,[24][25][26] although other studies have not replicated this result. Chromium (ˈkroʊmiəm is a Chemical element which has the symbol Cr and Atomic number 24 Chromium(III picolinate is the Chemical compound that is sold as a nutritional supplement to prevent or treat Chromium deficiency. [27] A meta analysis of these trials concluded that chromium supplements had no beneficial effect on healthy people, but that there might be an improvement in glucose metabolism in diabetics, although the authors stated that the evidence for this effect remains weak. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses [28]

Vanadium - A form of vanadium, vanadyl sulfate, seems to improve glucose control in people with type 2 diabetes. Vanadium (vəˈneɪdiəm is a Chemical element that has the symbol V and Atomic number 23 [29][30][31][32][33]

A pilot study has also found evidence that Tai Chi and Qigong reduce the severity of type 2 diabetes. Tai chi chuan (is an internal Chinese martial art often practiced for Health reasons Qigong (or ch'i kung) refers to a wide variety of traditional cultivation practices that involve methods of accumulating circulating and working with Qi or energy [34] For a helpful presentation that highlights the importance of exercise in the prevention of diabetes, click here: [1]

References

  1. ^ Gray A, Raikou M, McGuire A, Fenn P, Stevens R, Cull C, Stratton I, Adler A, Holman R, Turner R (2000). "Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomized controlled trial (UKPDS 41). United Kingdom Prospective Diabetes Study Group". BMJ 320 (7246): 1373–8. doi:10.1136/bmj.320.7246.1373. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 10818026.  
  2. ^ Evans JM, Newton RW, Ruta DA, MacDonald TM, Stevenson RJ, Morris AD (1999). "Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database". BMJ 319 (7202): 83–6. PMID 10398627.  
  3. ^ Gallichan M (1997). "Self monitoring of glucose by people with diabetes: evidence based practice". BMJ 314 (7085): 964–7. PMID 9099125.  
  4. ^ Chantelau E, Nowicki S (1997). "Self monitoring of glucose by people with diabetes. Patients with non-insulin dependent diabetes should monitor urine rather than blood glucose". BMJ 315 (7101): 185. PMID 9251556.  
  5. ^ Farmer A, Wade A, French DP, Goyder E, Kinmonth AL, Neil A (2005). "The DiGEM trial protocol—a randomized controlled trial to determine the effect on glycaemic control of different strategies of blood glucose self-monitoring in people with type 2 diabetes [ISRCTN47464659]". BMC Fam Pract 6: 25. PMID 15960852.  
  6. ^ Kibriya MG, Ali L, Banik NG, Khan AK (1999). "Home monitoring of blood glucose (HMBG) in Type-2 diabetes mellitus in a developing country". Diabetes Res Clin Pract 46 (3): 253–7. doi:10.1016/S0168-8227(99)00093-5. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 10624792.  
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