Diabetes mellitus Classification and external resources
United Nations blue circle symbol for diabetes. The United Nations ( UN) is an International organization whose stated aims are to facilitate cooperation in International law, International security [1]
ICD-10	E10.–E14.
ICD-9	250
MedlinePlus	001214
eMedicine	med/546  emerg/134
MeSH	C18.452.394.750

Diabetes mellitus (IPA: /ˌdaɪəˈbiːtiːz/ or /ˌdaɪəˈbiːtəs/, /məˈlaɪtəs/ or /ˈmɛlətəs/), often referred to simply as diabetes (Greek: διαβήτης), is a syndrome characterized by disordered metabolism and abnormally high blood sugar (hyperglycaemia) resulting from insufficient levels of the hormone insulin. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings E00-E35 - Endocrine diseases (E00-E07 Thyroid gland / Thyroid hormone ( Congenital iodine-deficiency syndrome ( E00-E35 - Endocrine diseases (E00-E07 Thyroid gland / Thyroid hormone ( Congenital iodine-deficiency syndrome ( The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Greek (el ελληνική γλώσσα or simply el ελληνικά — "Hellenic" is an Indo-European language, spoken today by 15-22 million people mainly In Medicine and Psychology, the term syndrome refers to the association of several clinically recognizable features signs (observed by a physician Metabolism is the set of Chemical reactions that occur in living Organisms in order to maintain Life. Blood sugar, used in a physiological context is a misnomer and misleading Hyperglycemia, hyperglycaemia, or high blood sugar is a condition in which an excessive amount of Glucose circulates in the Blood plasma Hormones (from Greek ὁρμή - "impetus" are chemicals released by cells that affect cells in other parts of the body Insulin is a Hormone with intensive effects on both metabolism and several other body systems (eg vascular compliance ^[2] The characteristic symptoms are excessive urine production (polyuria) due to high blood glucose levels, excessive thirst and increased fluid intake (polydipsia) attempting to compensate for increased urination, blurred vision due to high blood glucose effects on the eye's optics, unexplained weight loss, and lethargy. In Medicine, polyuria is a condition characterized by the passage of large volumes of urine (at least 2 Polydipsia is a medical symptom in which the patient drinks abnormally large amounts of Fluids The word derives from the Greek πολυδιψία, the These symptoms are likely to be less apparent if the blood sugar is only mildly elevated.

The World Health Organization recognizes three main forms of diabetes mellitus: type 1, type 2, and gestational diabetes (occurring during pregnancy),^[3] which have different causes and population distributions. 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 Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female While, ultimately, all forms are due to the beta cells of the pancreas being unable to produce sufficient insulin to prevent hyperglycemia, the causes are different. Beta cells ( beta-cells, β-cells) are a type of cell in the Pancreas in areas called the Islets of Langerhans. The pancreas is a Gland organ in the digestive and Endocrine system of Vertebrates. ^[4] Type 1 diabetes is usually due to autoimmune destruction of the pancreatic beta cells. Autoimmune diseases arise from an overactive Immune response of the body against substances and tissues normally present in the body Type 2 diabetes is characterized by insulin resistance in target tissues. Insulin resistance is the condition in which normal amounts of Insulin are inadequate to produce a normal Insulin response from Fat, Muscle This causes a need for abnormally high amounts of insulin and diabetes develops when the beta cells cannot meet this demand. Gestational diabetes is similar to type 2 diabetes in that it involves insulin resistance; the hormones of pregnancy can cause insulin resistance in women genetically predisposed to developing this condition. Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female

Gestational diabetes typically resolves with delivery of the child, however types 1 and 2 diabetes are chronic conditions. In Medicine, a chronic disease is a Disease that is long-lasting or recurrent ^[2] All types have been treatable since insulin became medically available in 1921. Insulin is a Hormone with intensive effects on both metabolism and several other body systems (eg vascular compliance Type 1 diabetes, in which insulin is not secreted by the pancreas, is directly treatable only with injected insulin, although dietary and other lifestyle adjustments are part of management. Type 2 may be managed with a combination of dietary treatment, tablets and injections and, frequently, insulin supplementation. This article is primarily about the human diet For a discussion of animal diets see List of feeding behaviours. Anti-diabetic drugs treat Diabetes mellitus by lowering Glucose levels in the blood While insulin was originally produced from natural sources such as porcine pancreas, most insulin used today is produced through genetic engineering, either as a direct copy of human insulin, or human insulin with modified molecules that provide different onset and duration of action. Insulin can also be delivered continuously by a specialized pump which subcutaneously provides insulin through a changeable catheter. An insulin pump is a medical device used for the administration of Insulin in the treatment of Diabetes mellitus, also known as continuous subcutaneous

Diabetes can cause many complications. Acute complications (hypoglycemia, ketoacidosis, or nonketotic hyperosmolar coma) may occur if the disease is not adequately controlled. In Medicine, an acute disease is a disease with either or both of a rapid onset a short course (as opposed to a chronic course Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of Glucose ( sugar) in the blood Ketoacidosis is a type of metabolic Acidosis which is caused by high concentrations of Ketone bodies, formed by the Deamination of Amino acids Nonketotic hyperosmolar coma (nonketotic Hyperglycaemia) is a type of Diabetic coma associated with a high mortality seen in Diabetes mellitus type 2. Serious long-term complications include cardiovascular disease (doubled risk), chronic renal failure, retinal damage (which can lead to blindness), nerve damage (of several kinds), and microvascular damage, which may cause impotence and poor healing. Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Chronic kidney disease (CKD also known as chronic renal disease, is a progressive loss of renal function over a period of months or years Diabetic retinopathy is Retinopathy (damage to the Retina) caused by complications of Diabetes mellitus, which can eventually lead to Blindness Blindness is the condition of lacking Visual perception due to Physiological or Neurological factors Diabetic neuropathies are neuropathic disorders that are associated with Diabetes mellitus. Poor healing of wounds, particularly of the feet, can lead to gangrene, which may require amputation. Please do not add warnings to this page about the pictures Wikipedia is not censored for taste and has a guideline preventing such warnings - WikipediaNo disclaimers in articles Amputation is the removal of a body extremity by trauma or Surgery. Adequate treatment of diabetes, as well as increased emphasis on blood pressure control and lifestyle factors (such as not smoking and keeping a healthy body weight), may improve the risk profile of most aforementioned complications. Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette. In the developed world, diabetes is the most significant cause of adult blindness in the non-elderly and the leading cause of non-traumatic amputation in adults, and diabetic nephropathy is the main illness requiring renal dialysis in the United States. Diabetic nephropathy ( nephropatia diabetica) also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive Kidney In Medicine, dialysis (from Greek "dialusis" meaning dissolution "dia" meaning through and "lusis" meaning loosening is primarily ^[5]

Classification

The term diabetes, without qualification, usually refers to diabetes mellitus, which is associated with excessive sweet urine (known as "glycosuria") but there are several rarer conditions also named diabetes. 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 Diabetes is a Chronic disease with no cure As of 2008. It is associated with an impaired Glucose cycle, altering Metabolism. 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 Glycosuria or glucosuria is an abnormal condition of Osmotic Diuresis due to excretion of Glucose by the kidneys The most common of these is diabetes insipidus in which the urine is not sweet (insipidus meaning "without taste" in Latin); it can be caused by either kidney (nephrogenic DI) or pituitary gland (central DI) damage. Diabetes insipidus ( DI) is a condition characterized by excretion of large amounts of severely diluted Urine, which cannot be reduced when fluid intake The kidneys are complicated organs that have numerous biological roles The pituitary gland, or hypophysis, is an Endocrine gland about the size of a Pea.

The principal two idiopathic forms of diabetes mellitus are known as types 1 and 2. The term "type 1 diabetes" has universally replaced several former terms, including childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes (IDDM). Likewise, the term "type 2 diabetes" has replaced several former terms, including adult-onset diabetes, obesity-related diabetes, and non-insulin-dependent diabetes (NIDDM). Beyond these two types, there is no agreed-upon standard nomenclature. Various sources have defined "type 3 diabetes" as, among others, gestational diabetes,^[6] insulin-resistant type 1 diabetes (or "double diabetes"), type 2 diabetes which has progressed to require injected insulin, and latent autoimmune diabetes of adults (or LADA or "type 1.5" diabetes. Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood Latent autoimmune diabetes in adults (LADA is a genetically-linked hereditary autoimmune disorder that results in the body mistaking the pancreas as foreign and responding Type 15 is one of several names now applied to those who are diagnosed with diabetes as adults but who do not immediately require insulin for treatment are often not overweight and have little ^[7]) There is also maturity onset diabetes of the young (MODY) which is a group of several single gene disorders with strong family histories that present as type 2 diabetes before 30 years of age. Maturity onset diabetes of the young ( MODY) refers to any of several hereditary forms of diabetes caused by mutations in an autosomal dominant gene

Type 1 diabetes mellitus

Main article: Diabetes mellitus type 1

Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas, leading to a deficiency of insulin. Diabetes mellitus type 1 (Type 1 diabetes Type I diabetes T1D T1DM IDDM juvenile diabetes is a form of Diabetes mellitus. Diabetes mellitus type 1 (Type 1 diabetes Type I diabetes T1D T1DM IDDM juvenile diabetes is a form of Diabetes mellitus. Beta cells ( beta-cells, β-cells) are a type of cell in the Pancreas in areas called the Islets of Langerhans. Islets of Langerhans is the area in which the Endocrine (ie hormone-producing cells of the Pancreas are grouped The main cause of this beta cell loss is a T-cell mediated autoimmune attack. T cells belong to a group of White blood cells known as Lymphocytes, and play a central role in Cell-mediated immunity. Autoimmunity is the failure of an organism to recognize its own constituent parts as self, which results in an immune response against its own cells and tissues ^[4] There is no known preventive measure which can be taken against type 1 diabetes; it is about 10% of diabetes mellitus cases in North America and Europe (though this varies by geographical location), and is a higher percentage in some other areas. 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. Type 1 diabetes can affect children or adults but was traditionally termed "juvenile diabetes" because it represents a majority of the diabetes cases in children.

The principal treatment of type 1 diabetes, even from its earliest stages, is replacement of insulin combined with careful monitoring of blood glucose levels using blood testing monitors. Without insulin, diabetic ketoacidosis often develops which may result in coma or death. Diabetic ketoacidosis (DKA is a life-threatening complication in patients with diabetes mellitus Treatment emphasis is now also placed on lifestyle adjustments (diet and exercise) though these cannot reverse the progress of the disease. Apart from the common subcutaneous injections, it is also possible to deliver insulin by a pump, which allows continuous infusion of insulin 24 hours a day at preset levels, and the ability to program doses (a bolus) of insulin as needed at meal times. The subcutaneous tissue or subcutis is the layer of Loose connective tissue directly underlying the Dermis. An insulin pump is a medical device used for the administration of Insulin in the treatment of Diabetes mellitus, also known as continuous subcutaneous In medicine a bolus (from Latin bolus, ball is the administration of a Medication, Drug or other compound that is given to raise An inhaled form of insulin, Exubera, was approved by the FDA in January 2006, although Pfizer discontinued the product for business reasons in October 2007. Inhalable insulin was available from September 2006 to October 2007 in the United States as a new method of delivering Insulin, a drug used in the treatment of diabetes ^[8]

Type 1 treatment must be continued indefinitely in essentially all cases. Treatment need not significantly impair normal activities, if sufficient patient training, awareness, appropriate care, discipline in testing and dosing of insulin is taken. However, treatment is burdensome for patients, insulin is replaced in a non-physiological manner, and this approach is therefore far from ideal. The average glucose level for the type 1 patient should be as close to normal (80–120 mg/dl, 4–6 mmol/l) as is safely possible. Some physicians suggest up to 140–150 mg/dl (7-7. 5 mmol/l) for those having trouble with lower values, such as frequent hypoglycemic events. Values above 200 mg/dl (10 mmol/l) is sometimes accompanied by discomfort and frequent urination leading to dehydration. Dehydration ( hypohydration) is the removal of Water ( hydro in ancient Greek) from an object Values above 300 mg/dl (15 mmol/l) usually require medical treatment and may lead to ketoacidosis, although they are not immediately life-threatening. Ketoacidosis is a type of metabolic Acidosis which is caused by high concentrations of Ketone bodies, formed by the Deamination of Amino acids However, low levels of blood glucose, called hypoglycemia, may lead to seizures or episodes of unconsciousness and absolutely must be treated immediately. Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of Glucose ( sugar) in the blood

Type 2 diabetes mellitus

Main article: Diabetes mellitus type 2

Type 2 diabetes mellitus is characterized differently due to insulin resistance or reduced insulin sensitivity, combined with reduced insulin secretion. Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non - Insulin -dependent Diabetes mellitus (NIDDM or adult-onset diabetes is a metabolic The defective responsiveness of body tissues to insulin almost certainly involves the insulin receptor in cell membranes. In Molecular biology, the insulin receptor is a transmembrane receptor that is activated by Insulin. In the early stage the predominant abnormality is reduced insulin sensitivity, characterized by elevated levels of insulin in the blood. At this stage hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver. Anti-diabetic drugs treat Diabetes mellitus by lowering Glucose levels in the blood The liver is a vital organ in the human body and is present in Vertebrates and some other animals As the disease progresses the impairment of insulin secretion worsens, and therapeutic replacement of insulin often becomes necessary.

There are numerous theories as to the exact cause and mechanism in type 2 diabetes. Central obesity (fat concentrated around the waist in relation to abdominal organs, but not subcutaneous fat) is known to predispose individuals for insulin resistance. Central obesity, the "apple-shaped" Obesity commonly referred to as belly fat, is the accumulation of Visceral fat ( fat deposited Abdominal fat is especially active hormonally, secreting a group of hormones called adipokines that may possibly impair glucose tolerance. The adipokines or adipocytokines are a group of Cytokines ( cell -to-cell signalling Proteins secreted by Adipose tissue. Obesity is found in approximately 55% of patients diagnosed with type 2 diabetes. ^[9] Other factors include aging (about 20% of elderly patients in North America have diabetes) and family history (type 2 is much more common in those with close relatives who have had it). In the last decade, type 2 diabetes has increasingly begun to affect children and adolescents, likely in connection with the increased prevalence of childhood obesity seen in recent decades in some places. ^[10]

Type 2 diabetes may go unnoticed for years because visible symptoms are typically mild, non-existent or sporadic, and usually there are no ketoacidotic episodes. Diabetic ketoacidosis (DKA is a life-threatening complication in patients with diabetes mellitus However, severe long-term complications can result from unnoticed type 2 diabetes, including renal failure due to diabetic nephropathy, vascular disease (including coronary artery disease), vision damage due to diabetic retinopathy, loss of sensation or pain due to diabetic neuropathy, and liver damage from non-alcoholic steatohepatitis. Renal failure or kidney Diabetic nephropathy ( nephropatia diabetica) also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive Kidney Coronary artery disease (CAD (or atherosclerotic Heart disease) is the end result of the accumulation of atheromatous plaques within the walls Diabetic retinopathy is Retinopathy (damage to the Retina) caused by complications of Diabetes mellitus, which can eventually lead to Blindness Diabetic neuropathies are neuropathic disorders that are associated with Diabetes mellitus. Non-alcoholic fatty liver disease ( NAFLD) is fatty inflammation of the Liver when this is not due to excessive alcohol use

Type 2 diabetes is usually first treated by increasing physical activity, decreasing carbohydrate intake, and losing weight. Carbohydrates (from ' Hydrates of Carbon ' or saccharides ( Greek σάκχαρον meaning " Sugar " are the most 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 These can restore insulin sensitivity even when the weight loss is modest, for example around 5 kg (10 to 15 lb), most especially when it is in abdominal fat deposits. It is sometimes possible to achieve long-term, satisfactory glucose control with these measures alone. However, the underlying tendency to insulin resistance is not lost, and so attention to diet, exercise, and weight loss must continue. The usual next step, if necessary, is treatment with oral antidiabetic drugs. Anti-diabetic drugs treat Diabetes mellitus by lowering Glucose levels in the blood Insulin production is initially only moderately impaired in type 2 diabetes, so oral medication (often used in various combinations) can be used to improve insulin production (e. g. , sulfonylureas), to regulate inappropriate release of glucose by the liver and attenuate insulin resistance to some extent (e. Sulfonylurea (UK Sulphonylurea derivatives are a class of Antidiabetic drugs that are used in the management of Diabetes mellitus type 2 ("adult-onset" g. , metformin), and to substantially attenuate insulin resistance (e. Metformin ( INN; trade names Glucophage, Riomet, Fortamet, Glumetza, Obimet, Dianben, Diabex, g. , thiazolidinediones). The Medication class of thiazolidinedione (also called glitazones) was introduced in the late 1990s as an adjunctive therapy for Diabetes mellitus (type According to one study, overweight patients treated with metformin compared with diet alone, had relative risk reductions of 32% for any diabetes endpoint, 42% for diabetes related death and 36% for all cause mortality and stroke. The relative risk reduction is a measure used in Epidemiology. ^[11] Oral medication may eventually fail due to further impairment of beta cell insulin secretion. At this point, insulin therapy is necessary to maintain normal or near normal glucose levels.

Gestational diabetes

Main article: Gestational diabetes

Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood It occurs in about 2%–5% of all pregnancies and may improve or disappear after delivery. Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female Gestational diabetes is fully treatable but requires careful medical supervision throughout the pregnancy. About 20%–50% of affected women develop type 2 diabetes later in life.

Even 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 cardiac and central nervous system anomalies, and skeletal muscle malformations. Large for gestational age (LGA babies are those whose Birth weight lies above the 90th percentile for that Gestational age. Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. Surfactants are wetting agents that lower the Surface tension of a liquid allowing easier spreading and lower the Interfacial tension between two liquids Infant respiratory distress syndrome ( IRDS) also called "Respiratory distress syndrome of newborn" previously called hyaline membrane disease) is a Hyperbilirubinemia may result from red blood cell destruction. Jaundice, also known as icterus (attributive adjective "icteric" is yellowish discoloration of the Skin, sclerae (whites of the eyes In severe cases, perinatal death may occur, most commonly as a result of poor placental profusion due to vascular impairment. Induction may be indicated with decreased placental function. Induction is a method of artificially or prematurely stimulating labour in a woman A cesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia. A Caesarean section (or Cesarean section in American English) also known as C-section, is a form of Childbirth in which a surgical Dystocia ( Antonym eutocia) is an abnormal or difficult Childbirth or labour

A 2008 study completed in the U. S. found that more American women are entering pregnancy with preexisting diabetes. In fact the rate of diabetes in expectant mothers has more than doubled in the past 6 years. ^[12] This is particularly problematic as diabetes raises the risk of complications during pregnancy, as well as increasing the potential that the children of diabetic mothers will also become diabetic in the future.

Other types

There are several rare causes of diabetes mellitus that do not fit into type 1, type 2, or gestational diabetes; attempts to classify them remain controversial. 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 type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. In Cell biology, a mitochondrion (plural mitochondria) is a membrane-enclosed Organelle found in most eukaryotic cells. 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). Chronic Pancreatitis is a long-standing Inflammation of the Pancreas that alters its normal structure and functions Cystic fibrosis (also known as CF, mucoviscoidosis, or mucoviscidosis) is a hereditary disease affecting the exocrine (mucus glands of the lungs 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. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases ^[3]

Signs and symptoms

The classical triad of diabetes symptoms is polyuria, polydipsia and polyphagia, which are, respectively, frequent urination; increased thirst and consequent increased fluid intake; and increased appetite. In Medicine, polyuria is a condition characterized by the passage of large volumes of urine (at least 2 Polydipsia is a medical symptom in which the patient drinks abnormally large amounts of Fluids The word derives from the Greek πολυδιψία, the Polyphagia is a compound word which literally means "eating too much Symptoms may develop quite rapidly (weeks or months) in type 1 diabetes, particularly in children. However, in type 2 diabetes the symptoms develop much more slowly and may be subtle or completely absent. Type 1 diabetes may also cause a rapid yet significant weight loss (despite normal or even increased eating) and irreducible fatigue. All of these symptoms except weight loss can also manifest in type 2 diabetes in patients whose diabetes is poorly controlled.

When the glucose concentration in the blood is raised beyond the renal threshold, reabsorption of glucose in the proximal renal tubuli is incomplete, and part of the glucose remains in the urine (glycosuria). In Physiology, the renal threshold is the concentration of a substance dissolved in the Blood above which the Kidneys begin to remove it into the Urine In Physiology, reabsorption or tubular reabsorption is the flow of Glomerular filtrate from the Proximal tubule of the Nephron The proximal tubule is the portion of the duct system of the Nephron leading from Bowman's capsule to the Loop of Henle. Urine is a liquid waste product of the body secreted by the Kidneys by a process of filtration from Blood and Excreted through the Urethra. Glycosuria or glucosuria is an abnormal condition of Osmotic Diuresis due to excretion of Glucose by the kidneys This increases the osmotic pressure of the urine and inhibits the reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Osmotic pressure is the hydrostatic pressure produced by a difference in concentration between solutions on the two sides of a surface such as a semipermeable membrane Lost blood volume will be replaced osmotically from water held in body cells, causing dehydration and increased thirst. Dehydration ( hypohydration) is the removal of Water ( hydro in ancient Greek) from an object

Prolonged high blood glucose causes glucose absorption, which leads to changes in the shape of the lenses of the eyes, resulting in vision changes. Blurred vision is a common complaint leading to a diabetes diagnosis; type 1 should always be suspected in cases of rapid vision change whereas type 2 is generally more gradual, but should still be suspected.

Patients (usually with type 1 diabetes) may also present with diabetic ketoacidosis (DKA), an extreme state of metabolic dysregulation characterized by the smell of acetone on the patient's breath; a rapid, deep breathing known as Kussmaul breathing; polyuria; nausea; vomiting and abdominal pain; and any of many altered states of consciousness or arousal (such as hostility and mania or, equally, confusion and lethargy). Acetone (also known as propanone, dimethyl ketone, 2-propanone, propan-2-one and β-ketopropane) is a colorless mobile flammable Kussmaul breathing is the very deep and labored Breathing with normal or reduced frequency found among people with severe Acidosis; it is a form of Hyperventilation Abdominal pain can be one of the Symptoms associated with transient disorders or serious disease In severe DKA, coma may follow, progressing to death. In Medicine, a coma (from the Greek koma, meaning deep sleep is a profound state of Unconsciousness. Diabetic ketoacidosis is a medical emergency and requires hospital admission.

A rarer but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 diabetes and is mainly the result of dehydration due to loss of body water. Nonketotic hyperosmolar coma (nonketotic Hyperglycaemia) is a type of Diabetic coma associated with a high mortality seen in Diabetes mellitus type 2. Often, the patient has been drinking extreme amounts of sugar-containing drinks, leading to a vicious circle in regard to the water loss. Positive feedback, sometimes referred to as "cumulative causation" is a Feedback loop system in which the system responds to perturbation in the same direction

Genetics

Both type 1 and type 2 diabetes are at least partly inherited. Type 1 diabetes appears to be triggered by some (mainly viral) infections, or in a less common group, by stress or environmental exposure (such as exposure to certain chemicals or drugs). There is a genetic element in individual susceptibility to some of these triggers which has been traced to particular HLA genotypes (i. The human leukocyte antigen system ( HLA) is the name of the Major histocompatibility complex (MHC in humans The genotype is the genetic constitution of a cell an organism or an individual (i e. , the genetic "self" identifiers relied upon by the immune system). However, even in those who have inherited the susceptibility, type 1 diabetes mellitus seems to require an environmental trigger. A small proportion of people with type 1 diabetes carry a mutated gene that causes maturity onset diabetes of the young (MODY). In biology mutations are changes to the Nucleotide sequence of the Genetic material of an organism Maturity onset diabetes of the young ( MODY) refers to any of several hereditary forms of diabetes caused by mutations in an autosomal dominant gene

There is a stronger inheritance pattern for type 2 diabetes. Those with first-degree relatives with type 2 have a much higher risk of developing type 2, increasing with the number of those relatives. Concordance among monozygotic twins is close to 100%, and about 25% of those with the disease have a family history of diabetes. For other uses see Concordance. Concordance as used in Genetics usually means the presence of the same trait in both Twins are Offspring resulting from the same Pregnancy, either of the same or opposite Sex. Candidate genes include KCNJ11 (potassium inwardly rectifying channel, subfamily J, member 11), which encodes the islet ATP-sensitive potassium channel Kir6. Inwardly rectifing potassium channels ( Kir, IRK) are a specific subset of potassium selective ion channels. 2, and TCF7L2 (transcription factor 7–like 2), which regulates proglucagon gene expression and thus the production of glucagon-like peptide-1. Proglucagon is a precursor of Glucagon, and several other components Glucagon-like peptide-1 (GLP-1 is derived from the transcription product of the Proglucagon gene ^[4] Moreover, obesity (which is an independent risk factor for type 2 diabetes) is strongly inherited. ^[13]

Various hereditary conditions may feature diabetes, for example myotonic dystrophy and Friedreich's ataxia. Myotonic dystrophy (DM is a chronic, slowly progressing highly variable inherited multisystemic Disease that can manifest at any age from birth to old age Friedreich's ataxia is an Inherited disease that causes progressive damage to the Nervous system resulting in symptoms ranging from Gait disturbance Wolfram's syndrome is an autosomal recessive neurodegenerative disorder that first becomes evident in childhood. Neurodegenerative Disease ( Greek νέυρο- néuro-, "nerval" and Latin dēgenerāre, "to decline" or "to It consists of diabetes insipidus, diabetes mellitus, optic atrophy, and deafness, hence the acronym DIDMOAD. ^[14]

Pathophysiology

Mechanism of insulin release in normal pancreatic beta cells. Insulin production is more or less constant within the beta cells, irrespective of blood glucose levels. It is stored within vacuoles pending release, via exocytosis, which is primarily triggered by food, chiefly food containing absorbable glucose. The chief trigger is a rise in blood glucose levels after eating

Insulin is the principal hormone that regulates uptake of glucose from the blood into most cells (primarily muscle and fat cells, but not central nervous system cells). Glucose (Glc a Monosaccharide (or simple Sugar) also known as grape sugar, is an important Carbohydrate in Biology. Therefore deficiency of insulin or the insensitivity of its receptors plays a central role in all forms of diabetes mellitus. In Biochemistry, a receptor is a Protein molecule embedded in either the Plasma membrane or Cytoplasm of a cell to which a mobile signaling

Much of the carbohydrate in food is converted within a few hours to the monosaccharide glucose, the principal carbohydrate found in blood and used by the body as fuel. Monosaccharides (from Greek monos: single sacchar: sugar are the most basic unit of Carbohydrates They consist of one sugar and Insulin is released into the blood by beta cells (β-cells), found in the Islets of Langerhans in the pancreas, in response to rising levels of blood glucose 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. Insulin is also the principal control signal for conversion of glucose to glycogen for internal storage in liver and muscle cells. Glycogen is a Polysaccharide of Glucose (Glc which functions as the secondary short term energy storage in Animal cells Lowered glucose levels result both in the reduced release of insulin from the beta cells and in the reverse conversion of glycogen to glucose when glucose levels fall. This is mainly controlled by the hormone glucagon which acts in an opposite manner to insulin. Glucagon is an important Hormone involved in Carbohydrate metabolism. Glucose thus recovered by the liver re-enters the bloodstream; muscle cells lack the necessary export mechanism.

Higher insulin levels increase some anabolic ("building up") processes such as cell growth and duplication, protein synthesis, and fat storage. Anabolism is the set of Metabolic pathways that construct molecules from smaller units Protein biosynthesis (synthesis is the process in which cells build Proteins The term is sometimes used to refer only to protein translation but more Lipids are broadly defined as any fat- Soluble ( lipophilic) naturally-occurring Molecule, such as fats oils waxes cholesterol sterols fat-soluble Insulin (or its lack) is the principal signal in converting many of the bidirectional processes of metabolism from a catabolic to an anabolic direction, and vice versa. For the related metabolic process see Anabolism. Catabolism is the set of Metabolic pathways which break down molecules into In particular, a low insulin level is the trigger for entering or leaving ketosis (the fat burning metabolic phase).

If the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin (insulin insensitivity or resistance), or if the insulin itself is defective, then glucose will not be absorbed properly by those body cells that require it nor will it be stored appropriately in the liver and muscles. Insulin resistance is the condition in which normal amounts of Insulin are inadequate to produce a normal Insulin response from Fat, Muscle The net effect is persistent high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis. Acidosis is an increased Acidity (ie an increased Hydrogen ion Concentration)

Diagnosis

The diagnosis of type 1 diabetes, and many cases of type 2, is usually prompted by recent-onset symptoms of excessive urination (polyuria) and excessive thirst (polydipsia), often accompanied by weight loss. These symptoms typically worsen over days to weeks; about a quarter of people with new type 1 diabetes have developed some degree of diabetic ketoacidosis by the time the diabetes is recognized. The diagnosis of other types of diabetes is usually made in other ways. These include ordinary health screening; detection of hyperglycemia during other medical investigations; and secondary symptoms such as vision changes or unexplainable fatigue. Diabetes is often detected when a person suffers a problem that is frequently caused by diabetes, such as a heart attack, stroke, neuropathy, poor wound healing or a foot ulcer, certain eye problems, certain fungal infections, or delivering a baby with macrosomia or hypoglycemia. Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain Neuropathy is a medical term usually short for Peripheral neuropathy. Mycosis (plural mycoses) is a condition in which Fungi pass the resistance barriers of the human or animal body and establish Infections Classification Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of Glucose ( sugar) in the blood

Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:^[3]

• fasting plasma glucose level at or above 126 mg/dL (7. 0 mmol/l).
• plasma glucose at or above 200 mg/dL (11. 1 mmol/l) two hours after a 75 g oral glucose load as in a glucose tolerance test. A glucose tolerance test in medical practice is the administration of Glucose to determine how quickly it is cleared from the blood
• random plasma glucose at or above 200 mg/dL (11. 1 mmol/l).

A positive result, in the absence of clinical symptoms of diabetes, should be confirmed by another of the above-listed methods on a different day. Most physicians prefer 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. According to the current definition, two fasting glucose measurements above 126 mg/dL (7. 0 mmol/l) is considered diagnostic for diabetes mellitus.

Patients with fasting glucose levels between 110 and 125 mg/dL (6. 1 and 7. 0 mmol/l) are considered to have impaired fasting glycemia. 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 Patients with plasma glucose at or above 140 mg/dL or 7. 8 mmol/l two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance. Impaired Glucose Tolerance (IGT is a pre- Diabetic state of dysglycemia that is associated with Insulin resistance and increased risk of cardiovascular pathology Of these two pre-diabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus as well as cardiovascular disease.

While not used for diagnosis, an elevated level of glucose irreversibly bound to hemoglobin (termed glycosylated hemoglobin or HbA1c) of 6. Hemoglobin ( also spelled haemoglobin and abbreviated Hb or Hgb) is the Iron -containing Oxygen -transport Metalloprotein Glycosylated (or glycated hemoglobin ( hemoglobin A1c Hb1c, or HbA1c) is a form of Hemoglobin used primarily to identify the average 0% or higher (the 2003 revised U. S. standard) is considered abnormal by most labs; HbA1c is primarily used as a treatment-tracking test reflecting average blood glucose levels over the preceding 90 days (approximately). However, some physicians may order this test at the time of diagnosis to track changes over time. The current recommended goal for HbA1c in patients with diabetes is <7. 0%, which is considered good glycemic control, although some guidelines are stricter (<6. Diabetes is a Chronic disease with no cure As of 2008. It is associated with an impaired Glucose cycle, altering Metabolism. 5%). People with diabetes who have HbA1c levels within this range have a significantly lower incidence of complications from diabetes, including retinopathy and diabetic nephropathy. Retinopathy is a general term that refers to some form of non-inflammatory damage to the Retina of the Eye. Diabetic nephropathy ( nephropatia diabetica) also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive Kidney ^[15][16]

Screening

Diabetes screening is recommended for many people at various stages of life, and for those with any of several risk factors. A Risk factor is a concept in Finance theory such as the CAPM, APT and other theories that use pricing kernels The screening test varies according to circumstances and local policy, and may be a random blood glucose test, a fasting blood glucose test, a blood glucose test two hours after 75 g of glucose, or an even more formal glucose tolerance test. A glucose tolerance test in medical practice is the administration of Glucose to determine how quickly it is cleared from the blood Many healthcare providers recommend universal screening for adults at age 40 or 50, and often periodically thereafter. Earlier screening is typically recommended for those with risk factors such as obesity, family history of diabetes, high-risk ethnicity (Hispanic, Native American, Afro-Caribbean, Pacific Island, and South Asian ancestry). In Medicine, a family history consists of information about disorders that a patient's direct blood relatives have suffered from Hispanic (hispano hispánico hispânico Hispānus adjective from ''Hispānia'', the Roman name for the Iberian Peninsula) is a term that historically For indigenous peoples in the United States other than Hawaii and Alaska see also Native Americans in the United States. The African diaspora was the movement of Africans and their descendants to places throughout the world - predominantly to the Americas, then later to Europe, the The Pacific Ocean contains an estimated 20000 to 30000 Islands (the exact number has yet to be precisely determined ^[17][18]

Many medical conditions are associated with diabetes and warrant screening. A partial list includes: high blood pressure, elevated cholesterol levels, coronary artery disease, past gestational diabetes, polycystic ovary syndrome, chronic pancreatitis, fatty liver, hemochromatosis, cystic fibrosis, several mitochondrial neuropathies and myopathies, myotonic dystrophy, Friedreich's ataxia, some of the inherited forms of neonatal hyperinsulinism. Dyslipidemia is a disruption in the amount of Lipids in the blood Polycystic ovary syndrome abbreviated PCOS or PCO (also known clinically as Stein-Leventhal syndrome, Sclerocystic ovary syndrome, Hyperthecosis Fatty liver, also known as fatty liver disease ( FLD) steatorrhoeic hepatosis, or steatosis hepatitis, is a reversible condition where Haemochromatosis, also spelled hemochromatosis (see spelling differences) also called siderophilia Cystic fibrosis (also known as CF, mucoviscoidosis, or mucoviscidosis) is a hereditary disease affecting the exocrine (mucus glands of the lungs Myotonic dystrophy (DM is a chronic, slowly progressing highly variable inherited multisystemic Disease that can manifest at any age from birth to old age Friedreich's ataxia is an Inherited disease that causes progressive damage to the Nervous system resulting in symptoms ranging from Gait disturbance The risk of diabetes is higher with chronic use of several medications, including high-dose glucocorticoids, some chemotherapy agents (especially L-asparaginase), as well as some of the antipsychotics and mood stabilizers (especially phenothiazines and some atypical antipsychotics). Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. Asparaginase ( is an Enzyme that catalyzes the Hydrolysis of Asparagine to Aspartic acid. Phenothiazine is the Organic compound with the formula S(C6H42NH The atypical antipsychotics (also known as second generation antipsychotics) are a group of Antipsychotic drugs used to treat psychiatric conditions

People with a confirmed diagnosis of diabetes are screened routinely for complications. This includes yearly urine testing for microalbuminuria and examination of the retina (retinal photography) for retinopathy. Microalbuminuria occurs when the kidney leaks small amounts of albumin into the urine The vertebrate retina is a light sensitive part inside the inner layer of the Eye. In the UK, screening for diabetic retinopathy has helped reduce the incidence of legal blindness since its implementation.

Prevention

Type 1 diabetes risk is known to depend upon a genetic predisposition based on HLA types (particularly types DR3 and DR4), an unknown environmental trigger (suspected to be an infection, although none has proven definitive in all cases), and an uncontrolled autoimmune response that attacks the insulin producing beta cells. The human leukocyte antigen system ( HLA) is the name of the Major histocompatibility complex (MHC in humans Autoimmunity is the failure of an organism to recognize its own constituent parts as self, which results in an immune response against its own cells and tissues Beta cells ( beta-cells, β-cells) are a type of cell in the Pancreas in areas called the Islets of Langerhans. ^[19] Some research has suggested that breastfeeding decreased the risk in later life; ^[20][21] various other nutritional risk factors are being studied, but no firm evidence has been found. Breastfeeding is the feeding of an Infant or young Child with Breast milk directly from human Breasts, not from a Baby bottle or other ^[22] Giving children 2000 IU of Vitamin D during their first year of life is associated with reduced risk of type 1 diabetes, though the causal relationship is obscure. ^[23]

Children with antibodies to beta cell proteins (ie, at early stages of an immune reaction to them) but no overt diabetes, and treated with vitamin B-3 (niacin), had less than half the diabetes onset incidence in a 7-year time span as did the general population, and an even lower incidence relative to those with antibodies as above, but who received no vitamin B3. Niacin, also known as vitamin B3, is a water-soluble vitamin which prevents the deficiency disease Pellagra. ^[24]

Type 2 diabetes risk can be reduced in many cases by making changes in diet and increasing physical activity. ^[25][26] The American Diabetes Association (ADA) recommends maintaining a healthy weight, getting at least 2½ hours of exercise per week (several brisk sustained walks appears sufficient), having a modest fat intake, and eating a good amount of fiber and whole grains. The American Diabetes Association, or the ADA is an American health organization providing Diabetes research information and advocacy The ADA does not recommend alcohol consumption as a preventive, but it is interesting to note that moderate alcohol intake may reduce the risk (though heavy consumption absolutely clearly increases damage to body systems significantly). Regularly having more than two drinks a day increases the risk of developing Alcoholism, Alcoholic liver disease, and some forms of Cancer. There is inadequate evidence that eating foods of low glycemic index is clinically helpful despite recommendations and suggested diets in favor. The Glycemic index (also glycaemic index) or GI is a measure of the effects of Carbohydrates on Blood glucose levels ^[27]

There are numerous studies which suggest connections with some aspect of Type II diabetes with ingestion of certain foods or with some drugs. Some studies have shown delayed progression to diabetes in predisposed patients through prophylactic use of metformin,^[26] rosiglitazone,^[28] or valsartan. Rosiglitazone is an Anti-diabetic drug in the Thiazolidinedione class of drugs Valsartan is an Angiotensin II receptor antagonist (more commonly called an "ARB" which stands for Angiotensin Receptor Blocker acting on the AT1 ^[29] In patients on hydroxychloroquine for rheumatoid arthritis, incidence of diabetes was reduced by 77% though causal mechanisms are unclear. Hydroxychloroquine is an Antimalarial drug sold under the trade name Plaquenil, also used to reduce inflammation in the treatment of Rheumatoid arthritis Rheumatoid arthritis ( RA) is a chronic systemic autoimmune disorder that causes the Immune system to attack the Joints, where ^[30] Breastfeeding may also be associated with the prevention of type 2 of the disease in mothers. ^[31]

Treatment and management

Main article: Diabetes management

Diabetes mellitus is currently a chronic disease, without a cure, and medical emphasis must necessarily be on managing/avoiding possible short-term as well as long-term diabetes-related problems. Diabetes is a Chronic disease with no cure As of 2008. It is associated with an impaired Glucose cycle, altering Metabolism. In Medicine, a chronic disease is a Disease that is long-lasting or recurrent There is an exceptionally important role for patient education, dietetic support, sensible exercise, self glucose monitoring, with the goal of keeping both short-term blood glucose levels, and long term levels as well, within acceptable bounds. Diabetes is a Chronic disease with no cure As of 2008. It is associated with an impaired Glucose cycle, altering Metabolism. Careful control is needed to reduce the risk of long term complications. This is theoretically achievable with combinations of diet, exercise and weight loss (type 2), various oral diabetic drugs (type 2 only), and insulin use (type 1 and increasingly for type 2 not responding to oral medications). In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications should be undertaken to control blood pressure^[32] and cholesterol by exercising more, smoking cessation, consuming an appropriate diet, wearing diabetic socks, and if necessary, taking any of several drugs to reduce pressure. 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 A diabetic sock is a Sock which is specially designed for those with Diabetes. Many Type 1 treatments include the combination use of regular or NPH insulin, and/or synthetic insulin analogs such as Humalog, Novolog or Apidra; the combination of Lantus/Levemir and Humalog, Novolog or Apidra. Another Type 1 treatment option is the use of the insulin pump with some of the most popular pump brands being: Cozmo, Animas, Medtronic Minimed, and Omnipod.

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. A general practitioner, or GP is a medical practitioner who provides Primary care and specializes in Family medicine. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located In other circumstances, general practitioners and specialists share care of a patient in a team approach. Optometrists, podiatrists/chiropodists, dietitians, physiotherapists, clinical nurse specialists (eg, Certified Diabetes Educators and DSNs (Diabetic Specialist Nurse)), or nurse practitioners may jointly provide multidisciplinary expertise. Optometry is a health care profession concerned with Eyes and related structures as well as vision, Visual systems and vision information Podiatry or podiatric medicine is a field of Healthcare devoted to the study and treatment of disorders of the Foot, Ankle, and the "anatomical A dietitian (also 'dietician' though 'dietitian' is used consistently by professionals is an expert in Food and Nutrition. A Certified diabetes educator (CDE is a health care professional who is specialized and certified to teach people with Diabetes how to manage their condition. A Nurse Practitioner (NP is a Registered nurse who has completed specific advanced Nursing education (generally a Master's degree) and training in the In countries where patients must provide their own health care (i. e. , the United States in the developed world), the impact of out-of-pocket costs of diabetic care can be high. In addition to the medications and supplies needed, patients are often advised to receive regular consultation from a physician (e. g. , at least every three to six months).

Cure

Cures for type 1 diabetes

Main article: Cure for diabetes mellitus type 1

There is no practical cure now for type 1 diabetes. Diabetes mellitus type 1 (Type 1 diabetes Type I diabetes T1D T1DM IDDM juvenile diabetes is a form of Diabetes mellitus. The fact that type 1 diabetes is due to the failure of one of the cell types of a single organ with a relatively simple function (i. e. the failure of the islets of Langerhans) has led to the study of several possible schemes to cure this form of diabetes mostly by replacing the pancreas or just the beta cells. ^[33] Only those type 1 diabetics who have received either a pancreas or a kidney-pancreas transplant (often when they have developed diabetic kidney disease (ie, nephropathy) and become insulin-independent may now be considered "cured" from their diabetes. A simultaneous pancreas-kidney transplant is a promising solution, showing similar or improved survival rates over a kidney transplant alone. ^[34] Still, they generally remain on long-term immunosuppressive drugs and there is a possibility that the immune system will mount a host versus graft response against the transplanted organ. For a list of immunosuppressive drugs see the Transplant rejection page. Transplant rejection occurs when a transplanted organ or tissue fails to be accepted by the body of the transplant recipient ^[33]

Transplants of exogenous beta cells have been performed experimentally in both mice and humans, but this measure is not yet practical in regular clinical practice partly due to the limited number of beta cell donors. Thus far, like any such transplant, it has provoked an immune reaction and long-term immunosuppressive drugs have been needed to protect the transplanted tissue. ^[35] An alternative technique has been proposed to place transplanted beta cells in a semi-permeable container, isolating and protecting them from the immune system. Stem cell research has also been suggested as a potential avenue for a cure since it may permit regrowth of Islet cells which are genetically part of the treated individual, thus perhaps eliminating the need for immuno-suppressants. Stem cells are cells found in most if not all multi-cellular Organisms. ^[33] This ha been done in mice, and a 2007 trial of 15 newly diagnosed patients with type 1 diabetes treated with stem cells raised from their own bone marrow after immune suppression showed that the majority did not require any insulin treatment for prolonged periods of time. Stem cells are cells found in most if not all multi-cellular Organisms. Bone marrow is the flexible tissue found in the hollow interior of Bones In adults marrow in large bones produces new Blood cells It constitutes 4% of Immunosuppression involves an act that reduces the activation or Efficacy of the Immune system. ^[36]

Microscopic or nanotechnological approaches are under investigation as well, in one proposed case with implanted stores of insulin metered out by a rapid response valve sensitive to blood glucose levels. At least two approaches have been demonstrated in vitro. These are, in some sense, closed-loop insulin pumps.

Cures for type 2 diabetes

Type 2 has had no cure. But, very recently, it has been shown that a type of gastric bypass surgery can normalize blood glucose levels in 80-100% of severely obese patients. Gastric bypass procedures (GBP are any of a group of similar operations used to treat Morbid obesity —the severe accumulation of excess weight as fatty tissue—and the health The effect is not due to weight loss because it usually occurs within days of surgery, which is before significant weight loss happens. The pattern of secretion of gastrointestinal hormones is changed by the bypass and removal of the duodenum and proximal jejunum, which together form the upper (proximal) part of the small intestine. In Anatomy of the Digestive system, the duodenum is a hollow jointed tube about 25-30 cm (10-12 in long connecting the Stomach to the Jejunum In Anatomy of the Digestive system, the jejunum is the central of the three divisions of the Small intestine and lies between the Duodenum and In Biology the small Intestine is the part of the Gastrointestinal tract (gut between the Stomach and the Large intestine, and comprises the precise clausal mechanisms are being intensively researched. this approach may become a standard treatment for some Type 2s in the relatively near future. ^[37] One hypothesis is that the proximal small intestine is dysfunctional in type 2 diabetes; its removal eliminates the source of an unknown hormone that contributes to insulin resistance. ^[38] This surgery has been widely performed on morbidly obese patients and has had the additional the benefit of reducing the death rate from all causes by up to 40%. ^[39] A small number of normal to moderately obese patients with type 2 diabetes have successfully undergone similar operations. ^[40][41]

Prognosis

Patient education, understanding, and participation is vital since the complications of diabetes are far less common and less severe in people who have well-controlled blood sugar levels. Diabetes is a Chronic disease with no cure As of 2008. It is associated with an impaired Glucose cycle, altering Metabolism. ^[42][43] Wider health problems accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise. Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette. Hypercholesterolemia (literally high blood cholesterol is the presence of high levels of Cholesterol in the blood. Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated According to a study, women with high blood pressure have a threefold risk of developing diabetes. Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories

Anecdotal evidence suggests that some of those with type 2 diabetes who exercise regularly, lose weight, and eat healthy diets may be able to keep some of the disease or some of the effects of the disease in 'remission. ' Certainly these tips can help prevent people predisposed to type 2 diabetes and those at pre-diabetic stages from actually developing the disorder as it helps restore insulin sensitivity. However patients should talk to their doctors about this for real expectations before undertaking it (esp. to avoid hypoglycemia or other complications); few people actually seem to go into total 'remission,' but some may find they need less of their insulin medications since the body tends to have lower insulin requirements during and shortly following exercise. Regardless of whether it works that way or not for an individual, there are certainly other benefits to this healthy lifestyle for both diabetics and nondiabetics.

The way diabetes is managed changes with age. Insulin production decreases because of age-related impairment of pancreatic beta cells. Additionally, insulin resistance increases because of the loss of lean tissue and the accumulation of fat, particularly intra-abdominal fat, and the decreased tissue sensitivity to insulin. Glucose tolerance progressively declines with age, leading to a high prevalence of type 2 diabetes and postchallenge hyperglycemia in the older population. ^[44] Age-related glucose intolerance in humans is often accompanied by insulin resistance, but circulating insulin levels are similar to those of younger people. ^[45] Treatment goals for older patients with diabetes vary with the individual, and take into account health status, as well as life expectancy, level of dependence, and willingness to adhere to a treatment regimen. ^[46]

Acute complications

Main articles: Diabetic ketoacidosis , nonketotic hyperosmolar coma , hypoglycemia , and diabetic coma

Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is an acute and dangerous complication that is always a medical emergency. 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. Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of Glucose ( sugar) in the blood Diabetic coma is a Medical emergency in which a person with Diabetes mellitus is Comatose (unconscious because of one of the acute complications Diabetic ketoacidosis (DKA is a life-threatening complication in patients with diabetes mellitus A medical emergency is an Injury or Illness that is acute and poses an immediate risk to a person's life or long term health Lack of insulin causes the liver to turn fat into ketone bodies for use as fuel. The liver is a vital organ in the human body and is present in Vertebrates and some other animals Ketone bodies are three water-soluble compounds that are produced as by-products when Fatty acids are broken down for energy in the Liver and This is normal when periodic, but can become a serious problem if sustained. Elevated levels of ketone bodies in the blood decrease the blood's pH, leading to DKA. pH is the measure of the acidity or alkalinity of a Solution. On presentation at hospital, the patient in DKA is typically dehydrated, and breathing rapidly and deeply. Abdominal pain is common and may be severe. The level of consciousness is typically normal until late in the process, when lethargy may progress to coma. Ketoacidosis can become severe enough to cause hypotension, shock, and death. In Physiology and Medicine, hypotension refers to an abnormally low Blood pressure. Urine analysis reveals significant levels of ketone bodies (which spill over from the blood when the kidneys filter blood) well before overt symptoms. Prompt, proper treatment usually results in full recovery, though death can result from inadequate or delayed treatment, or from complications. Nevertheless, DKA is always a medical emergency and requires medical attention. Ketoacidosis is much more common in type 1 diabetes than type 2.

Nonketotic hyperosmolar coma

Hyperosmolar nonketotic state (HNS) is an acute complication sharing many symptoms with DKA, but an entirely different cause and different treatment. Nonketotic hyperosmolar coma (nonketotic Hyperglycaemia) is a type of Diabetic coma associated with a high mortality seen in Diabetes mellitus type 2. In a person with very high blood glucose levels (usually considered to be above 300 mg/dl (16 mmol/l)), water is drawn out of cells into the blood by osmosis and the kidneys dump glucose into the urine. Osmosis is the Diffusion of a solvent (frequently water through a semi-permeable membrane, from a solution of low solute concentration (high water potential This results in loss of water and an increase in blood osmolarity. Osmolarity is a measure of the osmoles of solute per Liter of solution while the osmolality is a measure of the osmoles of Solute per Kilogram If fluid is not replaced (by mouth or intravenously), the osmotic effect of high glucose levels combined with the loss of water will eventually lead to dehydration. Dehydration ( hypohydration) is the removal of Water ( hydro in ancient Greek) from an object The body's cells become progressively dehydrated as water is taken from them and excreted. Electrolyte imbalances are also common and dangerous. As with DKA, urgent medical treatment is necessary, especially volume replacement. Lethargy may ultimately progress to a coma, which is more common in type 2 diabetes than type 1.

Hypoglycemia

Hypoglycemia, or abnormally low blood glucose, is an acute complication of several diabetes treatments. Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of Glucose ( sugar) in the blood The patient may become agitated, sweaty, and have many symptoms of sympathetic activation of the autonomic nervous system resulting in feelings similar to dread and immobilized panic. &trade The autonomic nervous system ( ANS) (or visceral nervous system) is the part of the Peripheral nervous system that acts as a Control Consciousness can be altered or even lost in extreme cases, leading to coma, seizures, or even brain damage and death. An epileptic seizure is caused by excessive and/or hypersynchronous electrical Neuronal activity and is usually self-limiting In patients with diabetes, this may be caused by several factors, such as too much or incorrectly timed insulin, too much or incorrectly timed exercise (exercise decreases insulin requirements) or not enough food (specifically glucose-producing carbohydrates), but this is an over-simplification.

It is more accurate to note that iatrogenic hypoglycemia is typically the result of the interplay of absolute (or relative) insulin excess and compromised glucose counterregulation in type 1 and advanced type 2 diabetes. The terms iatrogenesis and iatrogenic artifact refer to adverse effects or complications caused by or resulting from medical treatment or advice Decrements in insulin, increments in glucagon, and, absent the latter, increments in epinephrine are the primary glucose counterregulatory factors that normally prevent or rapidly correct hypoglycemia. In insulin-deficient diabetes (exogenous) insulin levels do not decrease as glucose levels fall, and the combination of deficient glucagon and epinephrine responses causes defective glucose counterregulation.

Furthermore, reduced sympathoadrenal responses can cause hypoglycemia unawareness. The concept of hypoglycemia-associated autonomic failure (HAAF) in diabetes posits that recent incidents of hypoglycemia causes both defective glucose counterregulation and hypoglycemia unawareness. By shifting glycemic thresholds for the sympathoadrenal (including epinephrine) and the resulting neurogenic responses to lower plasma glucose concentrations, antecedent hypoglycemia leads to a vicious cycle of recurrent hypoglycemia and further impairment of glucose counterregulation. In many cases (but not all), short-term avoidance of hypoglycemia reverses hypoglycemia unawareness in most affected patients, although this is easier in theory than it is in practice.

In most cases, hypoglycemia is treated with sugary drinks or food. In severe cases, an injection of glucagon (a hormone with the opposite effects of insulin) or an intravenous infusion of dextrose is used for treatment, but usually only if the person is unconscious. Glucagon is an important Hormone involved in Carbohydrate metabolism. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. In hospitals, intravenous dextrose is often used.

Chronic complications

Vascular disease

Chronic elevation of blood glucose level leads to damage of blood vessels (angiopathy). The blood vessels are part of the Circulatory system and function to transport Blood throughout the body Angiopathy is the generic term for a disease of the Blood vessels ( arteries, Veins and capillaries) The endothelial cells lining the blood vessels take in more glucose than normal, since they don't depend on insulin. The endothelium is the thin layer of cells that line the interior surface of Blood vessels forming an interface between circulating Blood in the They then form more surface glycoproteins than normal, and cause the basement membrane to grow thicker and weaker. Not to be confused with Peptidoglycan. Glycoproteins are proteins that contain Oligosaccharide chains ( Glycans) covalently attached The basement membrane is a structure that supports overlying Epithelial or Endothelial cells. In diabetes, the resulting problems are grouped under "microvascular disease" (due to damage to small blood vessels) and "macrovascular disease" (due to damage to the arteries). Macrovascular disease is a disease of any large ( macro) Blood vessels in the body Arteries are Blood vessels that carry blood away from the Heart.

Image of fundus showing scatter laser surgery for diabetic retinopathy

The damage to small blood vessels leads to a microangiopathy, which can cause one or more of the following:

• Diabetic retinopathy, growth of friable and poor-quality new blood vessels in the retina as well as macular edema (swelling of the macula), which can lead to severe vision loss or blindness. The fundus of the Eye is the interior surface of the eye opposite the lens, and includes the Retina, Optic disc, Macula and A laser scalpel is a Scalpel for Surgery, cutting or ablating living biological tissue by the energy of Laser light Diabetic retinopathy is Retinopathy (damage to the Retina) caused by complications of Diabetes mellitus, which can eventually lead to Blindness Diabetic retinopathy is Retinopathy (damage to the Retina) caused by complications of Diabetes mellitus, which can eventually lead to Blindness The vertebrate retina is a light sensitive part inside the inner layer of the Eye. Macular Edema occurs when fluid and Protein deposits collect on or under the Macula of the Eye, a yellow central area of the Retina The macula or macula lutea (from Latin macula, "spot" + lutea, "yellow" is an oval Yellow spot near the center Vision loss or visual loss is the absence of vision where it existed before which can happen either acutely (i Retinal damage (from microangiopathy) makes it the most common cause of blindness among non-elderly adults in the US.
• Diabetic neuropathy, abnormal and decreased sensation, usually in a 'glove and stocking' distribution starting with the feet but potentially in other nerves, later often fingers and hands. Diabetic neuropathies are neuropathic disorders that are associated with Diabetes mellitus. When combined with damaged blood vessels this can lead to diabetic foot (see below). Diabetic foot is an umbrella term for foot problems in patients with Diabetes mellitus. Other forms of diabetic neuropathy may present as mononeuritis or autonomic neuropathy. Autonomic Neuropathy (also called visceral neuropathy) is a disease of the non-voluntary non-sensory Nervous system (i Diabetic amyotrophy is muscle weakness due to neuropathy. Diabetic amyotrophy, a complication of Diabetes, is Diabetic neuropathy characterized by painful muscle wasting and weakness
• Diabetic nephropathy, damage to the kidney which can lead to chronic renal failure, eventually requiring dialysis. Diabetic nephropathy ( nephropatia diabetica) also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive Kidney The kidneys are complicated organs that have numerous biological roles In Medicine, dialysis (from Greek "dialusis" meaning dissolution "dia" meaning through and "lusis" meaning loosening is primarily Diabetes mellitus is the most common cause of adult kidney failure worldwide in the developed world.

Macrovascular disease leads to cardiovascular disease, to which accelerated atherosclerosis is a contributor:

• Coronary artery disease, leading to angina or myocardial infarction ("heart attack")
• Stroke (mainly the ischemic type)
• Peripheral vascular disease, which contributes to intermittent claudication (exertion-related leg and foot pain) as well as diabetic foot. Macrovascular disease is a disease of any large ( macro) Blood vessels in the body Atherosclerosis is a Disease affecting arterial Blood vessels It is a chronic inflammatory response in the walls of arteries in large part due to the accumulation Coronary artery disease (CAD (or atherosclerotic Heart disease) is the end result of the accumulation of atheromatous plaques within the walls Angina pectoris, commonly known as angina, is severe Chest pain due to Ischemia (a lack of blood and hence Oxygen supply of the heart Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain Peripheral vascular disease (PVD also known as peripheral artery disease (PAD or peripheral artery occlusive disease (PAOD is a collator for all Diseases Intermittent claudication (Latin claudicatio intermittens is a clinical diagnosis given for muscle pain (ache cramp numbness or sense of fatigue classically calf muscle which occurs
• Diabetic myonecrosis ('muscle wasting')

Diabetic foot, often due to a combination of neuropathy and arterial disease, may cause skin ulcer and infection and, in serious cases, necrosis and gangrene. Diabetic myonecrosis is a rare complication of Diabetes. It is caused by Infarcted Muscle tissue usually in the thigh Ulcers are healing wounds that develop on the skin mucous membranes or eye An infection is the detrimental Colonization of a host Organism by a foreign Species. Necrosis (in Greek Νεκρός = "dead" is the name given to unnatural Death of cells and living tissue. It is why diabetics are prone to leg and foot infections and why it takes longer for them to heal from leg and foot wounds. It is the most common cause of adult amputation, usually of toes and or feet, in the developed world.

Carotid artery stenosis does not occur more often in diabetes, and there appears to be a lower prevalence of abdominal aortic aneurysm. Carotid stenosis is a narrowing of the lumen of the Carotid artery, usually caused by Atherosclerosis. Abdominal aortic aneurysm, also written as AAA and often pronounced 'triple-A' is a localized dilatation of the Abdominal aorta, that exceeds the normal diameter However, diabetes does cause higher morbidity, mortality and operative risks with these conditions. ^[47]

Diabetic encephalopathy is the increased cognitive decline and risk of dementia observed in diabetes. Dementia (from Latin de- "apart away" + Mens ( genitive mentis) "mind" is the progressive decline Various mechanisms are proposed, including alterations to the vascular supply of the brain and the interaction of insulin with the brain itself. ^[48].

Epidemiology

In 2000, according to the World Health Organization, at least 171 million people worldwide suffer from diabetes. Its incidence is increasing rapidly, and it is estimated that by the year 2030, this number will double. Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in the more developed countries. The greatest increase in prevalence is, however, expected to occur in Asia and Africa, where most patients will likely be found by 2030. The increase in incidence of diabetes in developing countries follows the trend of urbanization and lifestyle changes, perhaps most importantly a "Western-style" diet. This has suggested an environmental (i. e. , dietary) effect, but there is little understanding of the mechanism(s) at present, though there is much speculation, some of it most compellingly presented.

Diabetes is in the top 10, and perhaps the top 5, of the most significant diseases in the developed world, and is gaining in significance there and elsewhere (see big killers). This list shows causes of Human Deaths worldwide for a single year 2002 arranged by the associated Mortality rate.

For at least 20 years, diabetes rates in North America have been increasing substantially. In 2005 there were about 20. 8 million people with diabetes in the United States alone. According to the American Diabetes Association, there are about 6. 2 million people undiagnosed and about 41 million people that would be considered prediabetic. ^[49] However, the criteria for diagnosing diabetes in the USA mean that it is more readily diagnosed than in some other countries. The Centers for Disease Control has termed the change an epidemic. The Centers for Disease Control and Prevention (or CDC) is an agency of the United States Department of Health and Human Services based in unincorporated In Epidemiology, an epidemic (from Greek epi- upon + demos people is a classification of a disease that appears as new cases in a The National Diabetes Information Clearinghouse estimates that diabetes costs $132 billion in the United States alone every year. The National Diabetes Information Clearinghouse (NDIC is an information dissemination service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK About 5%–10% of diabetes cases in North America are type 1, with the rest being type 2. The fraction of type 1 in other parts of the world differs; this is likely due to both differences in the rate of type 1 and differences in the rate of other types, most prominently type 2. Most of this difference is not currently understood. The American Diabetes Association point out the 2003 assessment of the National Center for Chronic Disease Prevention and Health Promotion (Centers for Disease Control and Prevention) that 1 in 3 Americans born after 2000 will develop diabetes in their lifetime. ^[50][49]

According to the American Diabetes Association, approximately 18. 3% (8. 6 million) of Americans age 60 and older have diabetes. ^[51] Diabetes mellitus prevalence increases with age, and the numbers of older persons with diabetes are expected to grow as the elderly population increases in number. The National Health and Nutrition Examination Survey (NHANES III) demonstrated that, in the population over 65 years old, 18% to 20% have diabetes, with 40% having either diabetes or its precursor form of impaired glucose tolerance. Impaired Glucose Tolerance (IGT is a pre- Diabetic state of dysglycemia that is associated with Insulin resistance and increased risk of cardiovascular pathology ^[44]

Indigenous populations in first world countries have a higher prevalence and increasing incidence of diabetes than their corresponding non-indigenous populations. In Australia the age-standardised prevalence of self-reported diabetes in Indigenous Australians is almost 4 times that of non-indigenous Australians. ^[52] Preventative community health programs such as Sugar Man (diabetes education) are showing some success in tackling this problem. The Sugar Man is an innovative interactive model for Diabetes education developed by registered nurse Michael Porter

History

The term diabetes (Greek: διαβήτης, diabētēs) was coined by Aretaeus of Cappadocia. Greek (el ελληνική γλώσσα or simply el ελληνικά — "Hellenic" is an Indo-European language, spoken today by 15-22 million people mainly Aretaeus ( is one of the most celebrated of the ancient Greek Physicians of whose life however few particulars are known It was derived from the Greek verb διαβαίνειν, diabaínein, itself formed from the prefix dia-, "across, apart," and the verb bainein, "to walk, stand. " The verb diabeinein meant "to stride, walk, or stand with legs asunder"; hence, its derivative diabētēs meant "one that straddles," or specifically "a compass, siphon. " The sense "siphon" gave rise to the use of diabētēs as the name for a disease involving the discharge of excessive amounts of urine. Diabetes is first recorded in English, in the form diabete, in a medical text written around 1425. In 1675, Thomas Willis added the word mellitus, from the Latin meaning "honey", a reference to the sweet taste of the urine. Thomas Willis ( 27 January 1621 &ndash 11 November 1675) was an English doctor who played an important part in the history of Latin ( lingua Latīna, laˈtiːna is an Italic language, historically spoken in Latium and Ancient Rome. This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians. In 1776, Matthew Dobson confirmed that the sweet taste was because of an excess of a kind of sugar in the urine and blood of people with diabetes. ^[53]

The ancient Indians tested for diabetes by observing whether ants were attracted to a person's urine, and called the ailment "sweet urine disease" (Madhumeha). India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country Ants are social Insects of the family Formicidae and along with the related families of Wasps and Bees belong to the order The Korean, Chinese, and Japanese words for diabetes are based on the same ideographs (糖尿病) which mean "sugar urine disease".

In medieval Persia, Avicenna (980-1037) provided a detailed account on diabetes mellitus in The Canon of Medicine, "describing the abnormal appetite and the collapse of sexual functions and he documented the sweet taste of diabetic urine. See Also Persian Empire History of Iran and Greater Iran (also referred to as the " Iranian Cultural Continent TemplateInfobox Muslim scholars --> ( Persian /ابو علی الحسین ابن عبدالله ابن سینا (born The Canon of Medicine ( Arabic: القانون في الطب Al-Qanun fi al-Tibb " The Law of Medicine " Persian " Like Aretaeus before him, Avicenna recognized a primary and secondary diabetes. He also described diabetic gangrene, and treated diabetes using a mixture of lupine, trigonella (fenugreek), and zedoary seed, which produces a considerable reduction in the excretion of sugar, a treatment which is still prescribed in modern times. Please do not add warnings to this page about the pictures Wikipedia is not censored for taste and has a guideline preventing such warnings - WikipediaNo disclaimers in articles Lupin, often spelled lupine in North America, is the common name for members of the Genus Lupinus in the legume family Trigonella is a large genus from the family Fabaceae, with about 130 species Fenugreek ( Trigonella foenum-graecum) is a plant in the family Fabaceae. Zedoary ( Curcuma zedoaria, known as kacōramu in Telugu) is the name for a perennial Herb and member of the genus Curcuma Linn Avicenna also "described diabetes insipidus very precisely for the first time", though it was later Johann Peter Frank (1745-1821) who first differentiated between diabetes mellitus and diabetes insipidus. Johann Peter Frank (1745 - 1821 was a German physician and Hygienist who was a native of Rodalben. ^[54]

Although diabetes has been recognized since antiquity, and treatments of various efficacy have been known in various regions since the Middle Ages, and in legend for much longer, pathogenesis of diabetes has only been understood experimentally since about 1900. "Ancient" redirects here For other uses see Ancient_(disambiguation. Snake oil is a Traditional Chinese medicine used to treat Joint pain ^[55] The discovery of a role for the pancreas in diabetes is generally ascribed to Joseph von Mering and Oskar Minkowski, who in 1889 found that dogs whose pancreas was removed developed all the signs and symptoms of diabetes and died shortly afterwards. Josef Baron von Mering (born February 28, 1849, in Cologne - died January 5, 1908, at Halle an der Saale, Germany Oskar Minkowski ( January 13 1858, Kaunas, Lithuania - July 18 1931, Sanatorium Fürstenburg an der Havel Mecklenburg-Strelitz ^[56] In 1910, Sir Edward Albert Sharpey-Schafer suggested that people with diabetes were deficient in a single chemical that was normally produced by the pancreas—he proposed calling this substance insulin, from the Latin insula, meaning island, in reference to the insulin-producing islets of Langerhans in the pancreas. Sir Edward Albert Sharpey-Schafer ( June 2 1850, Hornsey, Middlesex &ndash March 29 1935, North Berwick, Islets of Langerhans is the area in which the Endocrine (ie hormone-producing cells of the Pancreas are grouped ^[55]

The endocrine role of the pancreas in metabolism, and indeed the existence of insulin, was not further clarified until 1921, when Sir Frederick Grant Banting and Charles Herbert Best repeated the work of Von Mering and Minkowski, and went further to demonstrate they could reverse induced diabetes in dogs by giving them an extract from the pancreatic islets of Langerhans of healthy dogs. Frederick Grant Banting KBE MC FRSC ( November 14, 1891 &ndash February 21, 1941) was a Dr Charles Herbert Best, CC ( February 27, 1899 &ndash March 31, 1978) was a medical scientist ^[57] Banting, Best, and colleagues (especially the chemist Collip) went on to purify the hormone insulin from bovine pancreases at the University of Toronto. James Bertram Collip ( November 20, 1892 &ndash June 19, 1965) was part of the Toronto group which isolated Insulin. This article is about the University of Toronto's St George Campus This led to the availability of an effective treatment—insulin injections—and the first patient was treated in 1922. For this, Banting and laboratory director MacLeod received the Nobel Prize in Physiology or Medicine in 1923; both shared their Prize money with others in the team who were not recognized, in particular Best and Collip. The Nobel Prize in Physiology or Medicine (Nobelpriset i fysiologi eller medicin is awarded once a year by the Swedish Karolinska Institute. Banting and Best made the patent available without charge and did not attempt to control commercial production. Insulin production and therapy rapidly spread around the world, largely as a result of this decision. Insulin is a Hormone with intensive effects on both metabolism and several other body systems (eg vascular compliance

The distinction between what is now known as type 1 diabetes and type 2 diabetes was first clearly made by Sir Harold Percival (Harry) Himsworth, and published in January 1936. Sir Harold Percival (Harry Himsworth ( 19 May 1905 &ndash 1 November 1993) was a British scientist best known for his ^[58]

Despite the availability of treatment, diabetes has remained a major cause of death. For instance, statistics reveal that the cause-specific mortality rate during 1927 amounted to about 47. Statistics is a mathematical science pertaining to the collection analysis interpretation or explanation and presentation of Data. Mortality rate is a measure of the number of Deaths (in general or due to a specific cause in some population scaled to the size of that population per unit time 7 per 100,000 population in Malta. Malta, officially the Republic of Malta (Repubblika ta' Malta is a European Microstate, comprising an Archipelago of three islands ^[59]

Other landmark discoveries include:^[55]

• identification of the first of the sulfonylureas in 1942
• reintroduction of the use of biguanides for Type 2 diabetes in the late 1950s. Sulfonylurea (UK Sulphonylurea derivatives are a class of Antidiabetic drugs that are used in the management of Diabetes mellitus type 2 ("adult-onset" Biguanide can refer to a molecule or to a class of drugs based upon this molecule The initial phenformin was withdrawn worldwide (in the U. Phenformin is an Anti-diabetic drug from the Biguanide class It is no longer widely available because it is known to induce Lactic acidosis. S. in 1977) due to its potential for sometimes fatal lactic acidosis and metformin was first marketed in France in 1979, but not until 1994 in the US. Metformin ( INN; trade names Glucophage, Riomet, Fortamet, Glumetza, Obimet, Dianben, Diabex,
• the determination of the amino acid sequence of insulin (by Sir Frederick Sanger, for which he received a Nobel Prize)
• the radioimmunoassay for insulin, as discovered by Rosalyn Yalow and Solomon Berson (gaining Yalow the 1977 Nobel Prize in Physiology or Medicine)^[60]
• the three-dimensional structure of insulin (PDB 2INS)
• Dr Gerald Reaven's identification of the constellation of symptoms now called metabolic syndrome in 1988
• demonstration that intensive glycemic control in type 1 diabetes reduces chronic side effects more as glucose levels approach 'normal' in a large longitudinal study,^[61] and also in type 2 diabetics in other large studies
• identification of the first thiazolidinedione as an effective insulin sensitizer during the 1990s

In 1980, U. Peptide sequence or amino acid sequence is the order in which Amino acid residues connected by Peptide bonds lie in the chain in Peptides Frederick Sanger, OM, CH, CBE, FRS (born 13 August 1918) is an English biochemist and twice Radioimmunoassay (RIA is a Scientific method used to test Antigens (for example Hormone levels in the Blood) without the need to use a Rosalyn Sussman Yalow (born July 19, 1921) is an American medical physicist, and a co-winner of the 1977 Nobel Prize in Physiology Solomon Aaron Berson ( 22 April 1918 &ndash 11 April 1972) was an American Physician and Scientist whose discoveries The Protein Data Bank ( PDB) is a repository for 3-D structural data of Proteins and Nucleic acids These data typically obtained by X-ray crystallography Gerald M "Jerry" Reaven is an American endocrinologist and professor emeritus in medicine at the Stanford University School of Medicine in Metabolic syndrome is a combination of medical disorders that increase the risk of developing Cardiovascular disease and diabetes. Diabetes is a Chronic disease with no cure As of 2008. It is associated with an impaired Glucose cycle, altering Metabolism. The Medication class of thiazolidinedione (also called glitazones) was introduced in the late 1990s as an adjunctive therapy for Diabetes mellitus (type S. biotech company Genentech developed human insulin. The insulin is isolated from genetically-altered bacteria (the bacteria contain the human gene for synthesizing human insulin), which produce large quantities of insulin. Scientists then purify the insulin and distribute it to pharmacies for use by diabetes patients.

Social issues

The 1989 Declaration of St Vincent was the result of international efforts to improve the care accorded to those with diabetes. Doing so is important both in terms of quality of life and life expectancy but also economically - expenses to diabetes have been shown to be a major drain on health- and productivity-related resources for healthcare systems and governments.

Several countries established more and less successful national diabetes programmes to improve treatment of the disease. ^[62]

A study shows that diabetic patients with neuropathic symptoms such as numbness or tingling in feet or hands are twice more likely to be unemployed than those without the symptoms. Paresthesia (pron /ˌpɛɹɪsˈθiʒə/ paraesthesia in British English, pron Unemployment occurs when a person is available to work and currently seeking work but the person is without work. ^[63]

See also

• List of terms associated with diabetes

References

External links

• American Diabetes Association
• MedlinePlus Diabetes from the U.S. National Library of Medicine
• National Diabetes Education Program