Diabetes can be Reversed

Reverse Diabetes Now

Reverse Your Diabetes Today by Matt Traverso gives you instant, online access to a simple, step-by-step system in which Matt teaches you his powerful secrets, techniques, and unique treatment approach for quickly and easily eliminating pre-diabetes and Type 2 diabetes in as little as 21 days. You will learn the ways and signals that show the level of your current condition. Secondly, the author exposes the truth about human inner health and what really causes diabetes.The author states that many of us still believe in myths and that is totally not good. Best of all, the step-by-step, done-for-you system inside Matt Traverso's Reverse Your Diabetes Today guide works without harmful drugs, needles, expensive treatments, or awful side effects. This exact same process can also greatly reduce your need for insulin if you have Type 1 diabetes. Continue reading...

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Type 1 IDDM Insulindependent diabetes mellitus

This type starts most commonly in younger people who have to have regular injections of insulin to remain well. As the person is not producing any insulin, the symptoms can come on very rapidly as blood glucose control is lost. Insulin has a very important role in maintaining stability in the body by preventing breakdown of proteins (found in muscle) and fats. When insulin fails, the by-products of the breakdown of fat and muscle build up in the blood and lead to the production of substances called ketones. If nothing is done to stop this, the level will rise until eventually it causes the person to go into what's known as a ketoacidotic coma. This is much less common these days as diabetes is usually diagnosed long before coma develops. However, when it occurs patients need urgent hospital treatment with insulin and fluids into a vein. This is not the same thing as a coma induced by low blood sugar (or hypoglycaemia) - see page 12.

Type 2 Niddm Noninsulindependent diabetes mellitus

Type 2 diabetes, also sometimes known as age-related or maturity onset diabetes, is more common in middle or later life and can be controlled by tablets or just by dietary modification. As the supply of insulin is reduced or is not quite as effective as normal, the blood glucose level rises more slowly. There is less protein and fat breakdown so ketones are produced in much smaller quantities and the risk of a ketoacidotic coma is low. oJJ Main symptoms of diabetes.

Blood Glucose and Related Blood Sugar Tests

Glucose, a simple sugar, is the main blood carbohydrate and a major source of energy for all cells. The fasting blood sugar (FBS), postprandial blood sugar (PPBS), and the glucose tolerance test (GTT), or standard oral glucose tolerance test (SOGTT), are three of the most frequently performed blood sugar tests and are used to determine the level of glucose in the blood. Variations in blood glucose levels are broadly categorized as hyperglycemia, or increased blood sugar levels, and hypoglycemia, or decreased blood sugar levels. Related blood sugar tests measure the body's ability to produce insulin and glucose. Insulin and glucose production can be monitored by measuring blood levels of C-peptide, the residue of insulin formation glucagon, a hormone that stimulates the production of glucose and insulin, the hormone responsible for glucose metabolism. Table 2-2 identifies each blood glucose test and related diagnostic applications. Table 2-2. Blood Glucose and Related Blood Sugar Tests...

Glucose Intolerance and Insulin Resistance

People with diabetes (both non-insulin-dependent and insulin-dependent) or with impaired glucose tolerance have a higher risk of CHD than people with normal glucose tolerance.34 Some of this association is due to the coexistence of glucose intolerance with low HDL cholesterol, high blood Vegetarian diets do not have a well-defined effect on glucose tolerance. Western vegetarian diets generally include more low glycemic index foods, such as legumes and fruit, than non-vegetarian Western diets and might therefore reduce the incidence of glucose intolerance. Snowdon and Phillips43 found that self-reported diabetes was less prevalent among vegetarian than among non-vegetarian Seventh-Day Adven-tists, and that diabetes was only half as common as a cause of death among Seventh-Day Adventists, as compared with the American population as a whole. However, Asian vegetarians from the Indian subcontinent suffer a high incidence of diabetes, despite eating relatively large amounts of legumes. It...

The Natural History Of Type 2 Diabetes

Although both insulin resistance and impaired insulin secretion precede the development of postprandial hyperglycemia and the subsequent type 2 diabetic phenotype, insulin resistance is more prominent in the prediabetic state and plays an important role in the pathogenesis of macrovascular disease. Insulin resistance is commonly the earliest manifestation in the development of type 2 diabetes, typically originating 5-10 years before postprandial glucose levels in the diabetic range (200 mg dL). As long as the P cell is able to compensate by increased insulin production, normal glucose tolerance is maintained. Thus, not all patients with insulin resistance will develop diabetes (8). Insulin resistance can be worsened by genetic factors, elevated free fatty acids, hyperglycemia, pregnancy, obesity, sedentary lifestyle, aging, and various medications (i.e., steroids, cw-retinoic acid, estrogens, nicotinic acid, oral contraceptives, phenothiazines, and antipsychotic agents). Insulin...

Diet and medical problems Diabetes

Case A.P. is a 47-year-old woman diagnosed with diabetes five years ago. She recently started on metformin and is tolerating it well. The need to start medication has motivated her to work on losing weight and controlling her disease. She wants to know what she should eat and not eat. The recommended diet for people with diabetes follows all the same guidelines of a normal healthy diet.14 The diet should contain carbohydrate, protein, and fat in reasonable proportions. Calories should be at a level that promotes a healthy weight, and the diet should be based on the intake of a variety of foods. The major nutrient that affects blood sugar levels is carbohydrate in the form of sugar and starch, as found in grains, fruits, vegetables, sweets, and milk. The total amount of carbohydrate consumed is more important than the source or type (evidence level A). Sucrose, or table sugar, does not increase blood sugar any more than the same amount of starch, so sucrose can be substituted for other...

Type 1 Diabetes Insulindependent Diabetes

This autoimmune disease is the result of genetic environmental triggers. These patients demonstrate CD8-cell infiltration of the islet cells that likely are involved with subsequent P-cell destruction. A long prodrome is usually present from genetic predisposition to onset of disease. These patients may demonstrate various antibodies to islet antigens including insulin, glutamic acid decarboxylase, and tyrosine phosphotase 1A-2. Thus, a combination of markers rather than a single test should be used for predictive and diagnostic testing to enhance sensitivity without losing specificity. A curious form of autoimmune diabetes is found in Autoimmune Polyglandular Syndrome Type I. This syndrome results from a mutation of the autoimmune regulator gene, resulting in a wide array of endocrine disturbances. The environmental trigger in development of type 1 diabetes in genetically susceptible individuals is believed to be the Coxsackie virus. This may be because of the anti- From Type 2...

How is diabetes diagnosed

My uncle had diabetes and he died when he was 40 ' Ending out I had diabetes was a complete shock. There were times in the beginning when I panicked and thought I would never be able to cope Diabetes may or may not be accompanied by obvious symptoms. In some cases, a number of symptoms become apparent very rapidly and are impossible to ignore. For example, when a person complains of going to the loo excessively, a continuous thirst and sudden weight loss, the doctor should immediately suspect diabetes. This, however, is not always the case. Some people who have diabetes do not even suspect it, because they haven't experienced any of the 'obvious' symptoms. In such cases, diabetes is discovered 'by accident' during a routine examination. The only certain way to determine that a person has diabetes is to have the doctor measure that person's blood sugar levels. This can be done through one of several different blood tests. Some tests require that nothing should be...

Diabetes Associated With Other Factors

Type 2 diabetes can also be associated with the following other clinical states, drugs, and chemicals US regulators have determined that six antipsychotic medications can increase the risk of impaired glucose tolerance and diabetes. These medications are Recent studies involving almost 20,000 schizophrenic patients across the United States showed that patients taking Risperdal had an increase in diabetes of 49 a 27 increase for Zyprexa, and patients taking Seroquel had 3.34 times as many cases of diabetes as those on older antipsychotic medications. It is important to consider that schizophrenic patients have a greater tendency to be overweight, and weight gain can increase the risk for type 2 diabetes (9). In a recent study in the Journal of Clinical Pharmacology, diabetic patients with psychoses had a 3 higher risk of developing diabetes within 1 month of first taking olanzapine and a 42.6 increase risk within 12 months of treatment, compared with controls. Thus, management of...

What blood tests are used to diagnose diabetes

Diagnostic tests are used to confirm a diagnosis of diabetes if there are symptoms or other indicators ofthe disease. For diagnostic tests, the doctor draws one or more samples of blood and sends them to a laboratory for analysis. Diagnostic tests vary according to cost, accuracy, and ease of administration. There are a number of different types of blood tests that can be used to diagnose diabetes. The random plasma glucose test -for which the patient does not have to fast - measures blood glucose levels at any given time. This is the simplest test for diabetes because it can be administered whether or not the person has had anything to eat or drink. The oral glucose tolerance test (OGTT) - which requires fasting and is administered after the patient has ingested a special glucose-containing solution-measures blood glucose levels five times over a period of 3 hours. First, an initial blood sugar is drawn to measure fasting plasma glucose levels, and the person being tested is then...

Physiological actions of insulin

FIGURE 1.1 Actions of insulin and glucagon on hepatic glucose output. FIGURE 1.1 Actions of insulin and glucagon on hepatic glucose output. Insulin Action on Protein Metabolism Average protein turnover in a well-fed man is estimated to be 250 to 300 g daily much greater than the average intake of protein of 75 to 100 g so turnover of endogenous proteins accounts for the majority of daily protein turnover. Overall insulin has an anabolic action on protein turnover. In vivo studies suggest that the main effect of insulin appears to be a reduction in protein breakdown (proteolysis) in muscle and liver rather than a stimulation of protein synthesis.34 In the insulin deficiency of diabetes, lack of insulin action on protein degradation contributes to weight loss by catabolism of lean tissue.

Molecular mechanisms of insulin action

Insulin exerts its effects on target organs (liver, muscle, fat) by binding to a cell surface receptor and activating a number of intracellular signaling cascades.7,8 This is an area of intense scientific scrutiny because it is hoped that understanding the mechanism of action of insulin will reveal new drug targets that may be amenable to manipulation by small, nonpeptide agonists. The intracellular signaling cascades activated are, to some extent, tissue specific one mechanism whereby insulin can have different effects on different organs. Even though a tissue may not possess many insulin receptors, it must also be remembered that insulin can exert an indirect effect by altering the flux of metabolites (e.g., fatty acids) delivered to or extracted from that tissue.9,10 Insulin binds reversibly to cell surface transmembrane receptors that are found in highest concentrations in insulin-sensitive tissues (Figure 1.2). The intracellular region of the insulin receptor possesses tyrosine...

Diabetes Prevention Study

The Diabetes Prevention Study involved 3234 patients with IGT and BMI greater than 24 kg m2. There were three groups for assignment placebo, metformin (850 mg twice daily), or intensive lifestyle changes. The lifestyle modifications included dietary instruction, 150 minutes of exercise weekly, and a calorie-restricted, low-fat diet. These patients were followed for an average of 2.8 years. The study demonstrated a 58 relative risk reduction in progression to diabetes with diet and exercise compared with a 31 relative risk reduction with metformin. The number of patients needed to treat was seven for 3 years for lifestyle modification and 14 for metformin. The metformin seemed to be more effective in the younger patients with higher BMI and higher fasting-glucose levels than in patients more than 60 years of age, who showed the least benefit with the drug (14).

Classification of diabetes

Diabetes mellitus is not a single disorder, but a collection of conditions with a common end result of raised blood glucose. Two main types of diabetes account for more than 95 of all cases of diabetes a minority of cases are due to various specific metabolic or genetic causes. Type 1 diabetes is a condition due to absolute insulin deficiency secondary to autoimmune destruction of the insulin-containing P-cells of the pancreas gland. Type 2 diabetes is a condition due to relative insulin deficiency and or impaired biological response to insulin (insulin resistance).15 Type 1 diabetes probably represents 5 to 10 of all cases of diabetes, and type 2 diabetes accounts for 85 of all cases. Other forms of diabetes may be secondary to other metabolic disorders, such as the endocrine disorder acromegaly in which excessive production of growth hormone inhibits the action of insulin or due to pancreatic problems (e.g., after surgical removal of pancreas) (Table 1.1). Individuals are usually...

Finnish Diabetes Prevention Study

In the Finnish Diabetes Prevention Study (15), 522 patients with IGT and a mean BMI of 31 kg m2 were evaluated. A control group was compared with a lifestyle-changes group with the same exercise as the Diabetes Prevention Study and similar fat- and calorie-restricted diets, with a fiber intake of at least 15 g 1000 cal. Once again, a 58 relative risk reduction was seen. The number of patients needed to treat to prevent diabetes was 22 for 1 year and five for 5 years with this study.

Classification of Diabetes Mellitus

Type 1 diabetes mellitus Type 2 diabetes mellitus Gestational diabetes Other forms Conditions with specific genetic causes e.g., maturity-onset diabetes of the young pancreas of subjects with type 1 diabetes shows infiltration of the islets of Langerhans with inflammatory white blood cells. Blood from subjects with type 1 diabetes has been found to contain a number of autoantibodies to components of the pancreas, including islet cell antibodies (ICA), insulin autoantibodies (IAA), and antibodies against glutamic acid decarboxylase (GAD) and insulinoma-associated autoantigen-2 (IA-2) (proteins found in pancreatic P-cells).16 Family studies have shown that these antibodies may be found in a proportion of first-degree relatives of patients with type 1 diabetes, some of whom later develop diabetes. Genetics. A number of lines of evidence suggest a genetic predisposition to developing type 1 diabetes. The lifetime risk of type 1 diabetes is 0.4 in white populations and rises to 5 to 6 if a...

The Troglitazone in the Prevention of Diabetes Study

The Troglitazone in the Prevention of Diabetes (TRIPOD) study evaluated 236 Hispanic women with gestational diabetes and a mean BMI of 30 kg m2. This trial used 400 mg day of troglitazone, and demonstrated a 55 relative risk reduction of diabetes with a number needed to treat of 15 patients for 2.5 years. The 121 women on placebo developed diabetes at a rate of 12 yearly, compared with 5 among the 114 that received troglitazone. Additionally, lowered plasma insulin levels were found in 89 of individuals on troglitazone. The decreased secretory demands on the P-cells caused by the reduction in insulin resistance not only delayed the development of diabetes, but preserved P-cell function (14). In an analysis of the 84 women who were still nondiabetic 8 months after the study medications had to be stopped, the rate of progression to type 2 diabetes was 21 in the placebo group and 3 in the troglitazone group, for a 92 risk reduction. This would not have been seen if the glitazone was...

Malnutritionassociated Diabetes

Diabetes associated with malnutrition usually presents in young individuals between the ages of 10 and 40. These patients do not get diabetic ketoacidosis but require insulin for glycemic control. Three different approaches can be used for glucose testing in order to diagnose diabetes The fasting plasma glucose test is the most popular choice and is currently used to diagnose approximately 90 of all individuals with type 2 diabetes. However, it is important to understand that postprandial hyperglycemia will precede fasting hypergly-cemia and should be strongly considered to screen patients, particularly those at risk. An oral glucose tolerance test can serve this purpose by giving excellent postprandial data and can also be used to concomitantly measure insulin levels to ascertain the patient's insulin sensitivity. It is recommended that, regardless of the type of test used, laboratory values that are abnormal should be documented at least twice to avoid missed diagnoses by laboratory...

Clinical presentation of diabetes

Type 1 Diabetes Type 1 diabetes usually presents in children or young adults with acute symptoms of diabetes (thirst, increased urination, tiredness, blurred vision) associated with weight loss. Peak incidence is between 11 and 13 years, although it may present at any age. The incidence of type 1 diabetes appears to be increasing, especially in the under age 5 age group.43 Sex distribution is roughly equal.44 Biochemical investigation of patients with type 1 diabetes shows that they have absolute insulin deficiency. Hyperglycemia occurs due to a lack of the effect of insulin to inhibit production of glucose by the liver, which continues unopposed. In the absence of insulin, fat stores are broken down (lipolysis) and increased amounts of free fatty acids reach the liver. Once at the liver, the fatty acids are further metabolized into ketone bodies that circulate in the bloodstream and, once present in excess, produce an acidosis of the bloodstream. Weight loss occurs in type 1 diabetes...

Physiological Effects of Insulin

There is a second point that can be taken from this review of daily partitioning of ingested fat between oxidation and storage because of the quite small fractional turnover of the pool of stored fat, there is implicitly a strong metabolic primacy for tightly regulating fractional release of stored FFA. Insulin is crucial in regulating this process, normally having potent effects to govern rates of lipolysis. In normal-weight individuals, it is estimated that a circulating insulin concentration of 15 U mL, or only twice normal fasting levels of insulin, is sufficient to achieve 50 suppression of fasting rates of lipolysis. This is of higher sensitivity than the effect of insulin to control hepatic production of glucose and far more sensitive than the levels of insulin that are needed to achieve robust stimulation of glucose uptake into skeletal muscle. Therefore, one summation of normal insulin action is that this promotes glucose oxidation rather than that of fat, along with...

Longterm complications of diabetes

Diabetes mellitus is a long-term disorder associated with a number of clinical problems causing ill health and death. Disease affecting the small blood vessels in the retina, kidney, and peripheral nerves appears to be most directly related to the duration and severity of the raised blood glucose (hyperglycemia). These complications are termed microvascular and may result in blindness, chronic renal failure requiring dialysis, and nerve damage to the feet contributing to the formation of foot deformity and ulceration. Large blood vessels are also affected (macrovascular disease) in the heart, brain, and peripheral circulation. People with diabetes have higher rates of coronary heart disease,4849 stroke,50 and peripheral vascular disease51 compared to similar subjects of the same age and sex. This contributes significantly to the higher rates of ill health and early death in people with diabetes.

Global burden of diabetes and ethnicity

Diabetes mellitus is a worldwide disorder, but the incidence (number of new cases per year per unit of population) and prevalence (number of known cases per unit of population) vary significantly with geographical location. Type 1 diabetes has high prevalence in Scandinavian countries and Malta and low prevalence in Japan (Figure 1.4a). Type 2 diabetes has very high prevalence in Pima Indians (who originate from Arizona in the U.S.) and Pacific Islanders (e.g., Nauru) and high prevalence in South Asians, Hispanics, and Africans (Figure 1.4b). Relative risk of developing diabetes is approximately fourfold in South Asians from the Indian subcontinent and twofold in African-Caribbean people compared to white Caucasians from the same geographical area. Migration studies in a number of different populations have shown that the prevalence of type 2 diabetes increases with increasing Westernization of migrant populations. This is probably due to a mix of factors, such as reduction in...

Insulin Resistance and Metabolic Syndrome

The incidence of PAD is greater in patients with diabetes or impaired glucose tolerance and insulin resistance 8 . The metabolic syndrome is also associated with a higher risk of vascular events 8 . The prevalence of the metabolic syndrome in a secondary prevention population has been reported as 58 in PAD patients, 41 in CHD patients, 43 in CVD patients and 47 in abdominal aortic aneurysm patients. With the increasing prevalence of the metabolic syndrome we expect to see more PAD associated with insulin resistance.

How does diabetes affect your nerves

Diabetes can affect your nerves in two ways as with the eyes and kidneys, the blood supply may be affected, or there can be direct damage to the nerves as a result of high blood glucose. Any kind of nerve damage is known medically as neuropathy. The consequences will depend on which of the three types of nerve is affected.

How does diabetes affect sexual function

A man's ability to have a normal erection depends upon a good supply of blood via the arteries to the penis, and on an intact nerve supply to constrict the veins leading from it. Blood enters the penis through the arteries, but cannot leave because the veins are constricted, thus producing an erection. Diabetes can affect both the blood supply and the nervous control needed to maintain an erection. It is important to remember, however, that sexual dysfunction can have psychological as well as physical causes, whether you have diabetes or not, so it is very important to discuss any sexual problems openly and frankly with your diabetes care team. There are treatments available for all forms of sexual dysfunction in men.

How does diabetes affect your skin

Your skin is your body's first line of defence against invasion by germs and the development of infections. Unfortunately, people with diabetes are at increased risk A small minority of people with diabetes may have skin problems caused by damage to the small blood vessels. When this occurs, it results in reddening and thinning of the skin over the lower shinbones - a condition known as necrobiosis lipoidica. Unfortunately, there is no effective treatment. Other skin-related problems that are statistically more likely to occur in people with diabetes include fungal infections, a depigmentation of the skin called vitiligo, and loss of hair on the head, known scientifically as alopecia.

How does diabetes affect your feet

You need to be aware ofchanges to your feet that can arise because ofyour diabetes and of what you can do to minimise the risk of damage. Most people with diabetes do not get serious foot problems, but even those who do can prevent the problem worsening by caring for their feet properly. Healthy circulation to your feet will help to keep the tissues strong, and you can encourage this by eating the right kinds of foods, keeping good control of your diabetes and by not smoking. Ensure that your shoes fit well with enough room for your toes, and with a fastening to keep them in place without rubbing. In addition, there are specific things you can do to look after your feet. These are designed to guard against four changes, which can be caused by diabetes. Dryness Loss of elasticity or dryness in the skin of your feet can be associated with neuropathy and a poor blood supply, but it can develop even when you have good circulation and a normal amount of feeling. You may notice your skin...

How does diabetes affect your heart

People with diabetes are two to four times more likely to develop cardiovascular disease than people who do not have diabetes, and are five times more likely to have a stroke. Statistics show that more than half the deaths in older people with diabetes are due to cardiovascular disease. Most of the complications occur when blood vessels become too narrow or are clogged, or the blood itself becomes too thick. This reduces or even blocks blood flow to the heart, brain and other important parts of the body. When blood flow to the heart is slowed for a period of time, one result is a kind of chest pain called angina, and this is a warning signal that something is reducing the flow of blood to the heart. Two types of cardiovascular complications that can result from diabetes are hypertension (high blood pressure) and atherosclerosis (hardening ofthe arteries).

Diabetes treatment options

Diabetes physicians have traditionally focused on treatments to reduce hyperglycemia. Good evidence from randomized, controlled trials now indicates that reducing hyperglycemia reduces the risk of microvascular complications of diabetes.4655 Subjects with diabetes also carry at least a doubling of risk of cardiovascular disease.56 Whether lowering glucose improves cardiovascular risk is currently uncertain, but the effect, if present, is likely to be modest.4656-59 Potential treatments for lowering glucose in diabetes mellitus will be considered here in a rather theoretical way because this may illuminate the mechanisms by which some of the evaluated plant treatments have an effect (Table 1.3).

General Mechanisms for Potential Diabetes Treatments

Increase pancreatic insulin secretion Insulin replacement Insulinomimetic agents Increase insulin sensitivity Sulfonylureas, glitinides, GLP-1, liraglutide, exendin-4 Insulin injection, pancreas transplant Metformin, insulin, glucagon antagonists Metformin, thiazolidinediones Reducing gastric motility will result in a slower delivery of carbohydrate-containing foods to the small intestine and may also increase gastric distension, resulting in a smaller volume of food being consumed. It has been suggested that part of the efficacy of the gut peptide glucagon-like peptide 1 (GLP-1) in type 2 diabetes is by decreasing gastric motility.60 Cholecystokinin (CCK) has also been investigated as a peptide agent to reduce gastric emptying.61 Reduction in food intake due to gastric distension does not necessarily reduce total calorie intake because the time gap between meals may be reduced in compensation. Any treatments that act primarily by slowing gastric motility are likely to have nausea and...

The Insulin Receptor A Tyrosine Kinase

Insulin binding activates the tyrosine kinase activity associated with the cytoplasmic domain of its receptor as shown in Figure 1-9-4. There is no trimeric G protein, enzyme, or second messenger required to activate this protein tyrosine kinase activity Once au phosphorylation begins, a complex of other events ensues. An insulin receptor substrate (IRS-1) binds the receptor and is phosphorylated on tyrosine residues, allowing proteins with SH2 (src homology) domains to bind to the phosphotyrosine residues on IRS-) and become active. In this way, the receptor activates several enzyme cascades, which involve Activation of protein phosphatases. Paradoxically, insulin stimulation via its tyrosine kinase receptor ultimately may lead to dephosphorylating enzymes J Insulin Binding r J Activates Tyrosine U_sJ Kinase Activity J Insulin Binding r J Activates Tyrosine U_sJ Kinase Activity Figure 1-9-4. Insulin Receptor Insulin receptor substrate Figure 1-9-4. Insulin Receptor

Diabetes And Carbohydrates

Carbohydrates in the diet include monosaccharides and disaccharides, the starches and the indigestible carbohydrates, such as cellulose, pectins, gums, and psyllium. The American Diabetes Association (ADA) recommends the following terms sugars, starch, and fiber, whereas terms such as simple sugars, complex carbohydrates, and fast-acting carbohydrates should be avoided because they are not well-defined. Various factors can effect glycemic excursions with food intake, including the type of sugar (lactose, fructose, sucrose, or glucose), the type of cooking and food processing, the type of starch (amylose or amylopectin), the food components (lectins, tannins, or phytates), the levels of preprandial and postprandial glucoses, and the degree of insulin resistance (see Table 1). Studies lasting 2-12 weeks comparing high-glycemic and low-glycemic diets showed no consistent improvements in A1-C, fructosamine, or insulin levels with mixed, inconsistent effects on lipids. This is somewhat...

How do you feel about having diabetes

Your emotions can be like a roller coaster, and ups and downs are very common. Your emotional reactions to diabetes may start even before treatment begins. Of course, how you react will depend partly on how suddenly your condition develops, but there are many other factors that influence your reactions to diagnosis and living with diabetes, which makes it very difficult to predict just how a person will react at any given time. How did you handle problems before your diabetes was diagnosed What was your general coping style Were you calm or nervous Were you persistent or did you give up easily The way you have handled life's problems in general will suggest how well you will cope with diabetes and its treatment. Your age will also have a bearing on how you respond emotionally. Your general physical health prior to the onset of diabetes will also play a role in determining your coping ability, as will your relationships with your family and friends. Immediately after diagnosis, people...

Diabetes And Protein

Protein intake accounts for 15-20 of average daily caloric intake this does not appear to vary in patients with diabetes. The effects of protein on appetite suppression, long-term weight loss, and regulation of energy intake has not been widely studied. Essential amino acids should be supplied in the diet to allow for protein synthesis. The proteins with the most essential amino acids are found in eggs, fish, poultry, lean meats, and dairy products. In general, protein will stimulate insulin to the same degree as carbohydrate. When diabetes is controlled, ingested protein will not increase plasma glucose because this ingested protein will not appear in the general circulation. Curiously, a recent review done at the Veterans Affairs Medical Center at the University of Minnesota in Minneapolis (5) evaluated the change in blood glucose over 8 hours in men consuming 50 g of beef or water. During the 8 hours after the beef was ingested, the blood glucose increased by an average of 3 mg dL...

Diabetes And Minerals Vitamins And Dietary Supplements

It is important for patients with diabetes to be counseled about the importance of consuming adequate amounts of minerals and vitamins from natural food sources and to be aware of the potential toxic effects of megadoses of vitamin and mineral supplements. Interest in antioxidant vitamins in people with diabetes has increased with the knowledge that diabetes may be a state of increased oxidative stress. At present, megadoses of dietary antioxidants, such as selenium, P-carotene, vitamin E, and vitamin C, have not demonstrated cardioprotection in diabetic patients in some clinical trials, such as the Heart Outcomes Prevention Evaluation (HOPE) trial, they have actually been shown to be inferior to certain medications, particularly angiotensin-converting enzyme (ACE) inhibitors (16). Family members of individuals with type 2 diabetes should be encouraged to engage in regular physical activity and dietary management to decrease their risk of developing the disease. Hyperhomocysteinemia...

Tissue Repair in Models of Diabetes Mellitus

Diabetes mellitus is a major cause of impaired tissue repair. Patients with this disease not only have a propensity to develop wounds, but when they do, they tend to have difficulty healing those wounds. Simple wounds often become chronic and infectious wound complications are not uncommon. Unfortunately, the amputation rate for diabetics is much higher than for the nondiabetic population. Because healing problems are so common and devastating, several models of tissue repair have been developed in animals that are made diabetic or have a genetic predisposition for diabetes mellitus. The goal of this chapter is to review these models and to try to relate their similarities to human diabetes mellitus. It must be remembered, however, that diabetes mellitus is a very complex spectrum of diseases and that no animal model completely represents all human forms. It is important to choose a model that answers the question that the investigator is asking. By understanding how the various...

Surgically Induced Diabetes Mellitus

The great benefit of the use of animals in biomedical research can be exemplified by the early studies on the effects of insulin on diabetes mellitus (5). Insulin's function was discovered in dogs that had their pancreas removed surgically. Investigators were able to reverse the animals' severe diabetes by treating them with insulin isolated from pancreatic extracts, eventually revolutionizing the treatment of diabetes. These techniques of surgically removing the pancreas can be performed in larger animals to produce insulin-dependent diabetes. It is conceivable that wound-healing studies could be performed after these procedures, but surgical excision of the pancreas is rarely, if ever, used for tissue repair studies, because much simpler animal models of diabetes mellitus are available. It is obvious that a pancreatic excision is a major stress on an animal that not only causes brittle diabetes, but also pancreatic exocrine dysfunction. These complicating factors make the use of...

Chemically Induced Diabetes Mellitus

Two agents, alloxan and streptozotocin, selectively attack the P-cells of the islets of Langerhans and induce insulin-dependent diabetes mellitus (IDDM) (6-8). Chemically induced diabetes mellitus has been induced in mice, rats, guinea pigs, hamsters, dogs, and monkeys. While the agents are specific for P-cells, not all animals develop the same degree of diabetes. Investigators usually test the animals for hyperglycemia prior to including each animal in a study. The animals may also develop mild damage to other organs, such as the kidneys, liver, and exocrine pancreas. Investigators have also found that there is some damage to a-cells (producing glucagon) and potentially other endocrine cells in the pancreas (6-8). In my experience, the animals often lose weight while developing diabetes. This weight loss could influence wound healing, since short-term weight loss may have significant effects on healing. The methodologies for chemically induced diabetes mellitus are simple. Three...

Socioeconomic Disparities In Obesity And Diabetes

So far, we have discussed overall trends. At every point in time, obesity and diabetes rates are higher in some populations than in others. Populations with higher rates generally include groups with less education, lower household income, blacks, and Native Americans, but there are some noticeable variations and interactions depending on whether we distinguish between moderate and severe obesity. For example, obesity as defined by a BMI of over 30 has been higher among men than women (although that gap has narrowed noticeably). However, severe obesity (BMI > 40) has been much higher among women for some time, and women also make up the vast majority (close to 85 ) of bariatric surgery patients (15). Table 1 shows descriptive prevalence statistics for obesity, severe obesity, and diagnosed diabetes for men and women and by socioeconomic characteristics. Individuals without health insurance are, on average, 10 yr younger than those with health insurance (partly an effect of...

The Insulin Glucagon System Pancreas

A) insulin, produced by the beta or B cells (make up 60-75 of islets) The two first, insulin and glucagon, are essential in the normal regulation of blood glucose, which is maintained at a level of 80 mg 100 mL (or 80 V ). The third one could have an influence in the case of diseased pancreatic cells, such as tumors leading to hyperglycemia. The fourth sometimes called the hunger hormone because it might stimulate the hunger center in the hypothalamus suppresses SS secretions from gut and pancreas and pancreatic enzyme output, too. However, its function is not known yet. All four are dumped into the portal blood and pass through the liver before getting into the general circulation. The curves shown in the central part of Figure 2.69 represent blood glucose (vertical axis) with insulin and glucagon concentrations, respectively, also in blood (horizontal axis). An increase in blood insulin produces a decrease in the concentration of blood glucose (curve In) while the opposite occurs...

How does stress affect your diabetes

Stress is particularly dangerous for people with diabetes. The hormones that the body releases as part of the fight or flight response are meant to prepare the body for quick action. These hormones break down stored glycogen into blood glucose, which the body should be able to use for energy. But people with diabetes cannot effectively use this extra glucose for energy, so the result is a rapid rise in blood sugar. During times of stress, your self-care skills may also slip a little bit. When you're under pressure, for example if you have to meet a tight deadline, you may not take time to eat. Even if you do eat, the chances are that you won't spend too much time choosing foods that fit into your diet plan. Alternatively, maybe you'll decide to forgo exercise, because there are just too many other important things on your 'to do' list, or you may decide, like a number of people, to have a few 'drinks' or smoke a bit more to help you to relax when you're feeling stressed. Any of these...

Species of Plants Reported to Be Used Traditionally to Treat Diabetes

Steroidal glycosides decrease blood glucose and stimulate glycogen synthase. Promotes peripheral sensitivity to insulin rather than altering secretion of insulin (Choi and Park, 2002) Extracts lower blood glucose and increase sensitivity to insulin (Miura and Kato, 1995) Variety natalensis protects pancreatic islet -cells from toxins by acting as a radical scavenger (Beppu et al., 2003) antihyperglycemic in STZ-treated mice (Beppu et al., 1993) Maintains glucose homeostasis in vivo (Rajasekaran et al., 2004) Contains polyhydroxyalkaloids that have antidiabetic properties (Yamashita et al., 2002) Hypoglycemic activity in rats (Dhar et al., 1968) Reported to have antihyperglycemic activity (Li et al., 2004) Reported to have antihyperglycemic activity (Li et al., 2004) Reported to have antihyperglycemic activity (Li et al., 2004) Used to treat diabetes (Marles and Farnsworth, 1995) Used to treat diabetes (Marles and Farnsworth, 1995) Extracts from whole plant have antidiabetic activity...

What causes stress in diabetes

Diabetes can cause stress in a number of different ways. You may feel under a great deal of pressure to maintain 'perfect' control of your diabetes. You may feel stressed because the side-effects of diabetes are interfering with your sex life and relationships. Problems with your treatment or adjustments to dietary and lifestyle changes can cause stress. Fears of short- or long-term complications are also common stressors for people with diabetes, and indeed worries about being able to fulfil responsibilities may also provoke a stress response.

Type 2 Diabetes Mellitus

Retrospective studies looking at diabetes prevalence over time have generally noted an increased prevalence with age in women with PCOS. Studies from Scandinavia have shown increased rates of type 2 diabetes and hypertension compared with controls (53). This study used a combination of ovarian morphology and clinical criteria to identify women with PCOS and found that 15 had developed diabetes, compared with 2.3 of the controls (53). A case-control study of PCOS in the United States has shown persistent Fig. 1. Glucose (top panel) and insulin (bottom panel) concentrations obtained during a 75-g oral glucose tolerance test (OGTT) in 408 premenopausal women with PCOS ( positive family history) and without (O negative family history) a family history of type 2 diabetes. Adapted from ref. 60. Fig. 1. Glucose (top panel) and insulin (bottom panel) concentrations obtained during a 75-g oral glucose tolerance test (OGTT) in 408 premenopausal women with PCOS ( positive family history) and...

What about living with someone who has diabetes

A chronic medical condition like diabetes does not just affect the sufferer it also affects everyone close to that person. In fact, those who are closest are likely to be the most profoundly affected, but they are also in the best position to help. Illness can create a number of changes in any relationship, and not always for the better. If you live with someone who has diabetes, you may now see that person, and even yourself, differently. Maybe you see the person with diabetes as being more fragile. You may even feel guilty about that person's condition, or about your feelings regarding his or her condition. Maybe you were quite dependent on that person and now you have to shoulder more responsibility. Ifyou are close to someone with diabetes, you can help enormously by learning as much as you can about the condition and its treatment. This will enable you to provide support and true understanding. Knowing the facts may also help you to conquer your fears of the unknown and eliminate...

What about children with diabetes

I was absolutely devastated when my son was diagnosed with diabetes, I thought 'Oh no, why couldn't it have been me not him ', the feelings of guilt, anger, and grief even, were overwhelming, it was as though I had lost my 'healthy' child and he had been replaced with this other one. Children and young people with diabetes are subject to all the normal pressures and pleasures of physical, emotional and social development. Their needs as individuals within a family or family system, and the role oftheir parents or carers and siblings When a child is diagnosed with diabetes, the critical tasks of decision making concerning the child's daily survival and treatment are transferred from healthcare professionals to the family. Immediately following diagnosis, the family is responsible for carefully balancing multiple daily insulin injections and food intake with physical activity in order to prevent large fluctuations in blood glucose levels, which can interfere with the child's normal...

Human Insulin Preparations

Although undergoing some major improvements over the past several years, human insulin still has some limitations. The human insulins have variable and inconsistent absorption rates that cause erratic and unpredictable blood-glucose-lowering effects, resulting from the varying onset of actions, peak, and duration of action of these products. This is because when regular insulin is administered subcutaneously, its absorption into the circulation is slow, with a subsequent slow onset of action. Therefore, regular insulin should be administered 30-40 minutes before a meal to avoid a potential physiological mismatch, with subsequent hypoglycemia. This advance administration can become inconvenient or somewhat hazardous at times, particularly if the patient is unable to eat and has taken insulin (e.g., if the meal becomes surprisingly delayed or is not palatable to the patient). Additionally, when larger doses of regular insulin are given subcutaneously, the duration of action is...

Abnormal Glucose Metabolism and Type 2 Diabetes

Excess weight is the most important modifiable risk factor for the development of type 2 diabetes. The incidence of diabetes rises as obesity prevalence increases (15). The prevalence of reported diabetes is 2.9 times higher in overweight than in nonoverweight persons in the NHANES data (16). Obesity is associated with type 2 diabetes mellitus in both women (17) and men (18). Also, the longer that people are obese, the higher becomes their risk of developing diabetes (19). From 1990 to 1998, the prevalence of type 2 diabetes increased by 33 . More than 85 of type 2 diabetic patients are overweight or obese (20). Type 2 diabetes accounts for 90 to 95 of the 20.8 million cases of diabetes mellitus in the United States today (21). Fat distribution is also very important in diabetes risk (22-25). Central or upper body fat deposition is independently associated with insulin resistance (23), diabetes (24,25), and cardiovascular disease (26). Intra-abdominal or visceral obesity is strongly...

Shortacting Insulins And Their Analogs

The first genetically altered rapid-acting analog insulin, lispro (Humalog), was formed by switching lysine and proline at the 28 and 29 position of the P-chain in the insulin molecule. This insulin was approved in 1996. The insulin aspart (NovoLog), formed by substituting aspartic acid for proline at the 28 position of the P-chain, was introduced in 2000. Both lispro and aspart analogs have similar rapid onsets of action of 5-15 minutes, which allows doses at, or even just after, a meal with peak effects occurring approximately 1 hour after injection. These analog insulins have a more rapid onset and shorter duration of action (4-5 hours) than human regular insulin (6-10 hours) when given subcutaneously, causing less hypoglycemia and better postprandial glucose control with lower postprandial glycemic excursions. These analog insulins are ideal add-ons for regimens that include long-acting and intermediate-acting insulins or for patients maximized on oral therapy who need coverage...

The Diabetes Prevention Program

The Diabetes Prevention Program (DPP) asked whether lifestyle intervention or treatment with metformin can prevent or delay the progression from IGT to diabetes, and whether their effectiveness differs according to age, sex, race, or ethnic group (50). This randomized trial engaged 27 centers in the United States and included 3234 individuals (50). Subjects were selected who had impaired fasting glucose of 95 to 125 and or postprandial glucose of 140 to 200. The mean BMI of this group was 34 kg m2. These persons were therefore at high risk of developing diabetes. Individuals were randomized to an intensive lifestyle arm, a metformin arm (850 mg bid), a troglitazone arm, and a placebo usual care arm. The troglitazone arm was stopped after about a year because of hepatic toxicity. The lifestyle intervention goals were as follows (50) the weight loss goal was 7 from baseline and the physical activity goal was at least 150 min week. The study was terminated early by the Data Safety...

What types of insulin are there

The basic difference is in how quickly they take effect, so they can be divided into short-, medium- or long-acting varieties. The short-acting insulin is always clear or colourless, whereas the other two are cloudy because they contain additives to slow down the absorption of insulin from under the skin. It is possible to mix short- and medium-acting insulin in the same syringe, but care must be taken not to contaminate the clear insulin with any cloudy insulin. For this reason the clear insulin is always drawn up first. If you find it difficult to mix the insulin yourself, you may be able to use one of the ready-mixed kinds which contain short- and medium-acting insulin in different proportions. All three types ofinsulin may be produced from animal sources - pig or beef - or from genetically engineered human hormone. Some so-called human insulin is in fact derived originally from pigs but altered so that it is indistinguishable from the human version. The human type is the most...

Why do I have to inject insulin several times a day

The object of insulin therapy is to imitate the body's natural supply of insulin as closely as possible. In a person who does not have diabetes, insulin is released by the pancreas in response to food. As the blood glucose level falls between meals, so the insulin level drops back towards zero. It never quite gets there, however, and there is no time in the 24 hours when there is no detectable insulin in the bloodstream. What you are trying to do when you give yourself insulin injections is to reproduce the normal pattern ofinsulin production from the pancreas. There are several ways of doing this using different types ofinsulin and numbers of injections per day. For example, many people follow a system which comprises three injections of short-acting insulin before the three main meals ofthe day, plus a night-time injection of a medium- or long-acting insulin to control blood glucose while they are asleep. Another popular and equally successful system involves two injections a day of...

Continuous Subcutaneous Insulin Infusion Pumps

Continuous subcutaneous insulin infusion via the external insulin infusion pump is an alternative to multiple daily injections for patients with labile glucose levels and frequent episodes of hypoglycemia. These pumps attach to the body through flexible plastic tubing with a needle inserted subcutaneously in the abdominal area. Weighing 4-6 oz, and measuring 2-3 in wide by approximately 4 in long, these pumps can be easily worn on a belt or slipped into a pocket. The patient needs to clean the needle and tubing apparatus every 2 days with refillable cartridges holding enough insulin for approximately 48 hours. These pumps provide greater flexibility in lifestyle, meal schedules, and travel. Blood glucose should be determined frequently to ascertain the correct insulin dose being delivered. The patient sets the pump to deliver a basal level of insulin during a period in the day. This can be varied for different times, depending on insulin use, by setting the pump at different rates....

Prevention of diabetes

In April 2002, the ADA published a position statement on the prevention or delay of type 2 diabetes.9 This statement reviews the evidence for the benefits of prevention, which people to screen, and how to implement prevention programs. Screening should occur during the regular office visit with either FPG or two-hour OGTT. If impaired glucose tolerance (IGT, defined as glucose > l40 mg dl but < 200mg dL on OGTT) or impaired fasting glucose (IFG, defined as FPG level of > ll0 mg dl but < l26 mg dl) is found, then intervention should proceed, including counseling for weight loss and increase in physical activity. Follow-up counseling is vital, with rescreening for diabetes every one to two years. Additional interventions to reduce other cardiovascular risk factors are appropriate, but drug therapy for glycemic control is not routinely recommended to treat IGT or IFG until more conclusive evidence is available. In addition, individuals at high risk for diabetes need to become...

Diabetes prevention program

Type 2 diabetes is a preventable disease for both men and women if obesity and physical inactivity can be modified with lifestyle changes. The Diabetes Prevention Program (DPP) research group conducted a large, randomized, controlled trial to compare directly the effects of lifestyle modification and medical therapy with metformin in the prevention of diabetes.12 In this study, more than 3200 US adults at high risk for the development of type 2 diabetes were randomized to standard lifestyle recommendations plus placebo, standard lifestyle recommendations plus metformin, a biguanide antihyper-glycemic agent, or an intensive lifestyle-modification program with goals of at least 7 weight loss and 150 minutes of physical activity per week. The participants had a mean age of 51 years, had a mean BMI of 34.0 kg m2, were 68 women, and were 45 racial minorities. Over the 2.8-year follow-up period, the intensive lifestyle-modification group had a 58 reduction in the incidence of diabetes,...

Why is exercise important for people with diabetes

For people with diabetes, exercise offers even greater benefits. Most importantly, regular exercise can help to improve blood glucose control. Daily physical activity reduces the body's resistance to insulin and increases the body cells' sensitivity to insulin. Therefore, people with type 1 diabetes can keep tight control over their blood sugar levels with smaller amounts ofinsulin. The same applies to individuals with type 2 diabetes who need to take insulin or oral diabetes medications. Another benefit of exercise is that it can help to reduce blood fat levels, decreasing the risk of heart attack or stroke. During moderate exercise, glucose stored in muscles is used up first. The muscles then begin using blood glucose, thus gradually lowering the blood glucose level. Even after exercising, the blood glucose continues to fall as the muscles replenish their glucose stores. It is also believed that some body cells respond better to insulin for up to several days after exercising. Since...

Type 1 diabetes and menopause

The relationship between type 1 diabetes and menopause is even more complex, as menopause in patients with type 1 diabetes may occur at a younger age.24' Genetic factors, including haplotypes found in association with the DR4 haplotype (more common in type 1 diabetes), may increase the risk of early menopause two-fold. The long-term effects of premature menopause, in addition to a shorter time for childbearing, include a higher risk of cardiovascular disease, abnormal lipid profile, and increased risk of osteoporosis. Earlymenopause may occur in women with type 1 diabetes from autoimmune premature ovarian failure (similar to the autoimmune thyroiditis seen more commonly in patients with type 1 diabetes), from peripheral hyperinsuline-mia and hyperandrogenemia seen in polycystic ovary syndrome, and from hypothalamic dysfunction from poorly controlled diabetes. A good menstrual history will help with the early detection of premature menopause in these women.

Diabetes complications

The complications of diabetes develop over manyyears and include microvas-cular disease (neuropathy, retinopathy, nephropathy) and macrovascular disease (myocardial infarction, stroke, peripheral vascular disease). Given the chronicity of diabetes, the increasing evidence that improving glycemic control in type 1 diabetes31 and type 2 diabetes32 can decrease microvascular complications and ameliorate macrovascular complications has been encouraging. Prevention and management of diabetes complications are now part of the standard of care in the management of all patients with diabetes. Cardiovascular disease remains the major cause of morbidity and mortality for all patients with diabetes. Women with diabetes are five times more likely to develop coronary artery disease than women without diabetes.33 The protective effect of female gender against cardiovascular disease before menopause is not true for any woman with diabetes. Presentation of heart disease may be atypical in the woman...

Efficacy Of Lowcarbohydrate Diets On Insulin Sensitivity And Glycemic Control

A limited number of studies have compared the effects of low- and high-carbohydrate diets on insulin sensitivity. Differences in methodology preclude a pooled analysis of measures of glucose and insulin (32) however, there is some evidence to suggest that low-carbohydrate diets are effective in improving insulin sensitivity and glycemic control (10,11,48). Samaha et al. (10) measured fasting glucose and mean glycosylated hemoglobin levels in nondiabetic and diabetic participants and insulin sensitivity (measured by the quantitative insulin sensitivity check QUICK ) in nondiabetic participants. Compared with the low-fat group, greater decreases in fasting glucose were observed in the low-carbohydrate group and a trend toward greater decreases in mean glycosylated hemoglobin levels was observed in diabetic participants consuming a low-carbohydrate diet after 6 mo. After adjustment for the amount of weight lost at 6 mo, the low-carbohydrate diet was no longer a significant predictor of...

MI Studies Addressing Dyslipidemia and Diabetes Dietary Intervention Study in Children

Other Studies Targeting Diabetes In a pilot study, Channon et al. tested the impact of MI on 22 adolescents, aged 14 to 18 yr, with diabetes (47). Participating youth received between one and nine MI sessions each, with an average of 4.7 sessions over 6 mo. The focus of the MI sessions consisted of awareness building (analyzing pros and cons), finding alternatives, problem solving, goal setting, and minimizing confrontation. Between 8 wk and 6 mo after the end of the intervention phase, patients who had received MI showed a significant reduction in HbA1c, from an average baseline measure of 10.8 to approx 10.0 . Knight and et al. (48) administered an MI-based group intervention in six weekly, 1-h sessions to six youths, ages 13 to 16, with poorly controlled Type 1 diabetes. The intervention included externalizing conversations as well as MI. Participation in the MI-based group was compared with a usual care control group (n 14). At the 6-mo follow-up assessment, adolescents who had...

Diabetes and other illnesses

Everybody gets colds and 'flu from time to time, and these, like other illnesses, can affect the control of your diabetes. The most likely result is that your blood glucose level will rise, so you need to make frequent checks to test whether this is happening, especially if you are on insulin. Because any illness can be potentially dangerous for people with diabetes, it is essential that you speak with your doctor and get specific instructions about self-care during sick days. You will need to know how often you should monitor your blood glucose when you are sick, when you will need to take more or less of your insulin or diabetes medication, and which over-the-counter medications are safe for you to use. By getting all the important information before you get sick, you will be prepared to take good care of yourself when, and if, it happens.

Insulin And Insulin Receptor

There are two insulin genes in rodents. In adult mice, insulin is expressed from the insulin 2 gene. However, ablation of either gene in mice is without consequences. In contrast, when both genes are knocked out, the mice develop diabetic ketoacidosis and die within days of birth (38). Inactivation of the two insulin genes impairs embryonic growth slightly, with a 10-20 decrease in body wt (38). Mice nullizygous at the insulin receptor (IR) locus have normal features at birth, and their intrauterine growth and development appear to be normal (39,40). However, upon careful measurements of embryonic weights, a small reduction ( 10 ) Lack of IR results in severe metabolic derangement. Within a few days of birth, mutant mice die of diabetic ketoacidosis. This demonstrates that the IR is required to mediate the metabolic actions of insulin in postnatal life. Whether insulin exerts other, nonmetabolic effects, and whether these effects are also mediated by IR, cannot be addressed by this...

Types Of Diabetes Mellitus

There are two basic types of diabetes mellitus juvenile-onset and maturity-onset. Both these types of diabetes are thought to occur in persons who have inherited a predisposition to the condition. It is thought, also, that juvenile-onset diabetes is initiated by viral infections of a certain kind (like German measles and mumps). Remember, the type of diabetes does not depend on the age of the patient. a. Type I Diabetes Mellitus (Juvenile-Onset Diabetes) (Acute-Onset Diabetes). Juvenile-onset diabetes results from an insufficient secretion of insulin from the pancreas. This type of diabetes begins suddenly (i.e., acute onset). Furthermore, the symptoms associated with diabetes mellitus appear quite suddenly in juvenile-onset diabetes. Persons who have juvenile-onset diabetes mellitus must use insulin injections to control the diabetes. b. Type II Diabetes Mellitus (Maturity-Onset Diabetes). Maturity-onset diabetes mellitus results from an individual's reduced sensitivity to the...

Use Of Insulin Preparations

Most insulin preparations are suspensions. Therefore, the patient must ensure that the insulin is thoroughly mixed before the syringe and needle is used to remove it from the bottle. THE INSULIN BOTTLE MUST NOT BE SHAKEN BEFORE THE DOSE IS EXTRACTED. If the bottle is shaken, air bubbles may be introduced into the product and the measured dose may be inaccurate (i.e., air bubbles are measured instead of insulin). To properly mix the insulin, the patient should roll the bottle slowly between the palms of the hands. Insulin bottles should be discarded when they contain lumps or visible grains of insulin or if the contents of the vial are discolored.

Irregularities Of Insulin Therapy

Theoretically, a person who has been prescribed insulin should have few problems with diabetes mellitus if food intake is controlled and if insulin administration is properly maintained. However, such control is easier said than done. Periods of stress (physical or mental in nature) can interfere with the delicate balance a diabetic has to maintain in order to function properly. If the diabetic ingests too much food (e.g., eats several pieces of candy at a holiday celebration), this delicate balance can be upset. Diabetics and their friends must be aware of potential difficulties associated with diabetes mellitus. Hypoglycemia and hyperglycemia are two of these potential difficulties. a. Hypoglycemia (Low Blood Sugar). Hypoglycemia (also known as low blood sugar or insulin reaction) results from an overdose of insulin or an oral hypoglycemic agent, from the too frequently administered insulin, from unaccustomed exercise, or from a delayed or skimpy meal. In other words, there is...

The diabetes care team

Whether an individual with diabetes is cared for principally by a general practice team or by a hospital diabetes specialist team, it is now widely recognised that care is best provided by groups of health-care professionals with their own particular skills, working closely together. The teams include a consultant physician, diabetes specialist nurse, dietitian, chiropodist, general practitioner and practice nurse. They can also call upon the skills of a psychologist, ophthalmologist, nephrologist, neurologist, vascular and orthopaedic surgeons, obstetricians, midwifes and other specialists as necessary. The consultant physician responsible for diabetes services has a special interest in diabetes. Such specialists are often referred to as diabetologists. In some districts, however, a general physician runs the clinic. One paediatrician in each district should have a specialist interest and knowledge of diabetes in children, and be part of a named and experienced paediatric diabetes...

Postprandial Blood Sugar PPBS Two Hour Postprandial Blood Sugar 2hour PPBS

While many practitioners use the fasting blood sugar test results as a primary screen for diabetes mellitus, the postprandial blood sugar test (PPBS) is often used to confirm the diagnosis. Prior to the test the client fasts overnight and then consumes a meal that contains approximately 100 grams of carbohydrates, or drinks a special 100-gram carbohydrate drink. Two hours after eating, a venous blood sample is drawn and analyzed. The purpose of the PPBS test is to assess the body's response to the ingestion of carbohydrates in a meal. Like the fasting blood sugar test, the postprandial blood sugar test measures the plasma level of glucose. The value of the postprandial test is its ability to identify diabetic conditions that may not be clearly revealed by the fasting blood sugar test.

Functional Relationship of Glucagon and Insulin

Insulin, associated with well-fed, absorptive metabolism, and glucagon, associated with fasting and post absorptive metabolism, usually oppose each other with respect to pathways of energy metabolism. Glucagon works through the cAMP system to activate protein kinase A favoring phosphorylation of rate-limiting enzymes, whereas insulin often activates protein phosphatases that dephosphorylate many of the same enzymes. An example of this opposition in glycogen metabolism is shown in Figure 1-9-5. Glucagon promotes phosphorylation of both rate-limiting enzymes (glycogen phosphorylase for glycogenosis and glycogen synthase for glycogen synthesis). The result is twofold in that synthesis slows and degradation increases, but both effects contribute to the same physiologic outcome, release of glucose from the liver during hypoglycemia. Insulin reverses this pattern, promoting glucose storage after a meal. Figure 1-9-5. Opposing Activities of Insulin and Glucagon Figure 1-9-5. Opposing...

Insulin Sensitizing Agents

Drugs developed initially to treat type 2 diabetes have also been utilized to treat PCOS. None of these agents are currently FDA-approved for the treatment of PCOS or for related symptoms such as anovulation, hirsutism, or acne. These include metformin (117-119), thiazolidinediones, and an experimental insulin sensitizer drug, d-chiro-inositol (120). Metformin was approved for the treatment of type 2 diabetes by the FDA in 1994, but was used clinically for almost 20 yr before that in other parts of the world. The effects of the drug are therefore well known. Metformin is a biguanide that works primarily by suppressing hepatic gluconeogenesis, and in muscle and fat cells it enhanced glucose uptake and utilization, therefore improving insulin sensitivity in the periphery. This effectively lowers glucose and insulin levels. Its most serious, but rare, side effect is lactic acidosis, which has been reported in individuals with renal deficiency, liver disease, and heart and respiratory...

Insulinomimetic Agents

The need to inject insulin to bypass digestion of the peptide by gastrointestinal enzymes and increase its bioavailability is a major drawback to its acceptability. The insulin receptor is a cell surface protein, so it is theoretically possible that compounds will be discovered that are absorbed orally and can bind and activate the insulin receptor.71 This might be by binding to the insulin-binding sites on the extracellular domain of the insulin receptor or by activating its intracellular domain tyrosine kinase activity by another mechanism. Alternatively, given the large number of protein kinases involved in insulin signaling to metabolic endpoints of insulin action, small molecules may potentially activate downstream intracellular second messengers of insulin action. Fasting hyperglycemia in type 2 diabetes is mainly determined by unrestrained hepatic glucose output (HGO) thus, any treatments that reduce HGO will lower glucose levels. This is one major mechanism whereby metformin...

How does diabetes affect your kidneys

One-third of people with type 1 diabetes and 10-20 per cent of people with type 2 diabetes develop kidney disease after living with diabetes for 15 years or more. To understand how this complication develops, you need to know a little bit about the structure and function of the kidneys. The kidneys maintain the body's internal environment by controlling its fluid and electrolyte levels, and by removing its waste products. Each kidney contains approximately one million microscopic units called nephrons, which filter out waste products from the blood. Over long periods of time, high blood sugar levels damage the tiny blood vessels in the kidneys, making them thicker and clogged, and impairing the filtering ability of the nephrons. As a result, they are less able to filter wastes and impurities from the blood properly. Waste products in the bloodstream then build up to harmful levels. At the same time, some of the nutrients and proteins that should remain in the blood leak out of the...

Genetic or Spontaneous Diabetes Mellitus Models

Diabetes mellitus develops in many, if not all, species of mammals. Just as with people, there are those animals that have a predisposition for diabetes. These genetically or spontaneously induced models have been used extensively for all kinds of research, including studies of tissue repair. The genetic models can be divided into insulin-dependent models and insulin-resistant models. Frequently, the models are divided into nonobese or obese models, since most insulin-resistant models occur in animals that have a tendency for obesity. Each type of diabetes has at least some but not all characteristics of the corresponding human form of diabetes. There are several animals that spontaneously develop IDDM (15-23). These animals develop diabetes that results from autodestruction of the islet cells to produce an abnormally low amount of insulin. These animals include the nonobese (NOD) mouse, BB Wister rat, Chinese hamster, South African hamster, many guinea pigs, Yucatan miniature pig,...

History Of Concept Of Insulin Resistance

If it can be argued that there is ambiguity concerning whether substrate competition is always adverse for metabolism or whether it is glucose or FFA that causes problems, then this note of ambiguity might also be extended to a consideration of IR itself. Insulin resistance has been an enigma since it was initially described 75 yr ago (1). It is customary that a pathophysiological process like IR is regarded as a mechanism of disease. But there is another perspective. There is an emerging body of evidence that IR is a highly regulated adaptation that protects, or at least partially protects, the very organ systems (muscle, adipocytes, and liver) that are pivotal in generating IR. This latter perspective has relevance to the discussion of both substrate competition and ectopic fat. Even at the inception of the concept of IR, it was recognized to be a process that did not fit into established paradigms for categorizing endocrine disorders. Endocrine disorders, then as now, can nearly...

Diabetes

Diabetes mellitus magnifies the risk of cardiovascular morbidity and mortality. Diabetics have a two- to fourfold increase in the risk of CAD. Diabetics, particularly those with non-insulin-dependent diabetes mellitus (NIDDM) are at high risk of vascular disease because of high levels of triglycerides, LDL, and very low-density lipoprotein (VLDL) particles. Patients with NIDDM tend to produce small, dense LDL particles that are more vulnerable to oxidation. Other mechanisms for the adverse effects of diabetes that promote vascular disease include glycation of arterial wall proteins, enhancement of LDL oxidation, microvascular disease of the vasa vasorum, change in cellular function, promotion of thrombogenesis, and the development of renal disease and hypertension (Beckman et al., 2002).

What is diabetes

Diabetes is a permanent change in your internal chemistry, which results in your blood containing too much glucose. The cause is a deficiency of the hormone 'insulin'. One of the most difficult things I found that I had to come to terms with when you are newly diagnosed is that diabetes is for life.' Diabetes is one ofthe oldest known humandiseases. Its full name, 'diabetes mellitus', comes from the Greek words for 'siphon' and 'sugar' and describes the most obvious symptom of uncontrolled diabetes the passing of large amounts of urine, which is sweet because it contains sugar. A proper understanding of the condition has only developed over the last hundred years or so.Inl921, two Canadian scientists, Frederick Banting and Charles Best, discovered that a mysterious substance was produced in small groups of cells, known as the islets of Langerhans, within the pancreas. They named this substance 'insulin' (after the Latin name for 'islet' which is insula), and it was probably the most...

Insulin

Insulin, a hormone secreted by pancreatic beta cells, regulates metabolism of carbohydrates and is responsible for maintaining a constant blood glucose level. Insulin lowers blood glucose levels by promoting the transport of glucose from the bloodstream into the cells. Insulin levels can be measured by radioimmunoassay, a technique that uses radioactive substances to determine the concentration of specific blood constituents. Insulin levels are reported as microunits per milliliter ( xU mL). Variations from Normal. Diseases such as acromegaly, Cushing's syndrome, and insulinoma (a benign tumor of the insulin secreting cells of the pancreas) are associated with an increased level of insulin. Decreased insulin levels are seen primarily in diabetes. Interfering Circumstances. Food intake and obesity may cause false increases in insulin levels. Recent administration of radioisotopes may affect test results, as will use of oral contraceptives. Other drugs that may cause increased insulin...

Secondary diabetes

There are a small number of people who develop diabetes as a result of other diseases of the pancreas. For example, pancreatitis (or inflammation of the pancreas) can bring on the condition by destroying large parts of the gland. Some people suffering from hormonal diseases, such as Cushing's syndrome (the body makes too much steroid hormone) or acromegaly (the body makes too much growth hormone), may also have diabetes as a side-effect of their main illness. It can also be a result of damage to the pancreas caused by chronic over-indulgence in alcohol.

Diabetes Mellitus

Depression in patients with diabetes is common, with prevalence rates ranging from 8.5 to 27.3 in controlled studies. The mechanisms (serum glucose levels, cerebrovascular conglucation or psychological stress related to the chronicity of the condition) which account for the high comorbidity rates have to be determined 111 .

Diagnosing Diabetes

The criteria for diagnosing diabetes in the clinical setting can been seen in Table 2. The criteria for impaired fasting glucose (IFG) include a fasting glucose concentration on two occasions equal to or greater than 100 mg dL and less than 126 mg dL (5.66.9 mmol). IGT is not defined by clinical signs and symptoms but strictly by plasma glucose levels alone. This state has also been referred to as chemical diabetes, borderline diabetes, or prediabetes. Although these patients do not yet have the microvascular complications of diabetes mellitus they are at risk for, and begin to develop, macrovascular complications caused by arteriosclerotic deposition secondary to the hyperglycemic state and are at significant risk for developing diabetes, especially when associated with concomitant risk factors of hypertension, body mass index (BMI) greater than 25 kg m2, sedentary lifestyle, dyslipidemia (especially increased small, dense low-density lipo-proteins LDL and increased triglycerides),...

Gestational Diabetes

Gestational diabetes most often develops between the 24th and 28th week of pregnancy, occurs in 2-5 of pregnancies, and usually disappears after birth. Gestational diabetes is more common in older, obese, or diabetes-prone ethnic groups, and in those with a positive family history. Most (80-94 ) women with gestational diabetes will return to normal after delivery. Hispanic females and Native Americans are especially prone to developing diabetes after an episode of gestational hyperglycemia, with the occurrence rate being as high as 50 within 5 years of pregnancy termination. The other gestational diabetics will have a 30-40 chance of developing diabetes in 10-20 years. A diagnosis of gestational diabetes is established with a 50-g oral glucose tolerance load followed by a 1-hour glucose determination. If the plasma glucose is greater than 139 mg dL, a 100-g, 3-hour glucose tolerance test in the fasting state is required. Normal results for the 100-g test are as follows If any two of...

Insulin Replacement

Insulin deficiency is logically treated by replacing the absent insulin peptide. This is the mainstay of treatment for patients with the absolute insulin deficiency found in type 1 diabetes and is frequently necessary for many patients with type 2 diabetes when they fail to respond to oral drug therapy. Exogenous insulin therapy, given by subcutaneous injection, does not closely match physiological release of insulin. Hypoglycemia may occur when a mismatch occurs between carbohydrate intake and circulating insulin concentrations. Insulin-treated patients have the highest risk of severe hypoglycemia and the risk increases when lower glucose levels are pursued. Fear of hypoglycemia and dislike of injections are major obstacles to uptake of insulin therapy. Insulin analogues with different pharmacokinetic profiles that are less likely to cause hypoglycemia when used appropriately have been developed however, cost currently restricts their use in developing countries.68 At the present...

Insulin Hypothesis

The discovery of hyperinsulinemia (13) and insulin resistance in women with PCOS (14) led to a de-emphasis on the ovary as a diagnostic criterion, and resulted in the insulin hypothesis. In insulin resistance there is a defect of insulin receptor at the postbinding level, leading to abnormality of postreceptor insulin signaling and glucose transport (15). This leads to overproduction of insulin to compensate for the perceived lack of effect, and over time to P-cell exhaustion and ultimately type 2 diabetes. There is now a relatively substantial body of literature confirming P-cell dysfunction in PCOS, although as in diabetes, there is still considerable debate as to the primacy of the defects and their worsening over time (16). Women with PCOS may have hyperinsulinemia, insulin resistance, impaired glucose tolerance, or diabetes mellitus (13,17,18). The increase in insulin resistance in women with PCOS compared with appropriate controls ( 5-40 ), is of a similar magnitude to that seen...

Insulin Analogs

By switching amino acids in the primary structure of the insulin molecule, insulin analogs have been produced that are characterized by a more favorable insulin-replacement pattern, a lower variability of effect, better absorption profiles, and the same onset and duration of action despite increasing doses. The two rapid-acting insulin analogs, lispro (Humalog) and aspart (NovoLog), have absorption profiles that more closely mimic physiological replacement patterns of meal time insulin secretion. They each possess fast absorption patterns, which reduce their tendency to dissociate into hexamers or dimers and they exhibit increased absorption rates. The increased absorption rates allow the insulin analogs to be given closer to mealtime and even, on occasion, shortly after eating. This makes these insulins very popular and desirable from the patient's point of view because of the relative proximity of meal consumption to use. Indeed, in head-to-head studies with human insulin, the...

Mixed Insulins

Premixed insulins include various percentages of short-acting and intermediate-acting preparations. The human insulin, NPH, and the analog insulin, NPL, have virtually identical onsets of action and duration of activity. Most mixed insulins are ideally used in twice-daily regimens, consisting of a morning and an evening dose. The bolus insulin has its major effects postprandially, whereas the intermediate-acting effects of the NPH or NPL moieties extend until dinnertime. When administered with the evening meal, the second mixed-dose regimen provides insulin coverage between dinner and bedtime, usually eliminating the need for supplemental overnight coverage. The dosage of these various insulins depends on the patients' needs some patients respond better to a 75 25 or 70 30 mix preparation and others may respond optimally to a 50 50 mix preparation. The major difference between the premixed human insulins and the premixed analog insulins is that there is less of an incidence of...

Premixed Insulins

Mixtures of short-acting and intermediate-acting insulins are a convenient method for primary care physicians to manage the basal bolus problem with one vial or pen. The following various mixtures currently exist 1. Humulin or Novolin 70 30 (70 insulin isophane suspension-NPH and 30 regular insulin). 3. Humulin 50 50 (50 insulin isophane suspension-NPH and 50 regular insulin). Of these premixed insulins, the 70 30 and 75 25 preparations seem to be the most popular. Patients with A1-C levels greater than 9.5 may benefit from premixed preparations. All of the intermediate moieties in these mixtures have similar onsets and durations of action. The major differences between the preparations lie in the short-acting portions, which will provide quicker onsets and shorter durations of action and will not have a prolongation of duration of action with increased doses. One of the criticisms of fixed-dose combinations is that inconsistent blood glucose readings increase the risk of hypoglycemia...

Longacting Insulins

Glargine (Lantus) is an analog insulin with significant advantages over the Ultralente preparation. Glargine has an onset of action of 1-2 hours, is virtually peakless, and has a duration of action of 24 hours. Glargine is produced by recombinant DNA technology using a nonpathogenic strain of E. coli as the principal organism. Glargine differs from human insulin in that the amino acid asparagine at position A21 on the a-chain is replaced by glycine, with two arginine molecules added to the C-terminus of the P-chain (27). Insulin glargine is dissolved in a clear aqueous fluid with a pH of approximately 4 when adjusted by aqueous solutions of hydrochloric acid and sodium hydroxide. After glargine is injected into the subcutaneous tissue, neutralization of the acidic solution is achieved. This causes the formation of microprecipitates from the small amounts of glargine that are slowly released and result in a consistent concentration time profile over 24 hours with essentially no peak,...

Diabetes Mellitus Dm

DM results from a deficiency in insulin, or a defect in its action, or both. This results in abnormal metabolism of carbohydrate, protein, and fat. The two major classifications of diabetes are type I diabetes, also known as insulin-dependent DM (IDDM), in which there is a severe lack of insulin. This is more common in children and is also known as juvenile DM. Type II diabetes, also known as adult-onset, maturity-onset, or non-insulin-dependent DM (NIDDM), is characterized by insulin resistance. Diagnostic Tests. Diabetic ketoacidosis (DKA) occurs when the glucose is > 300 mg dl and there is ketonemia, acidosis (pH < 7.30 bicarbonate, 15 mEq L), glucosuria, and ketonuria. DM can also be diagnosed in patients with milder symptoms. The new criteria are symptoms of diabetes with a random plasma glucose > 200 mg dl, or fasting glucose > 126 mg dl, or 2-h glucose tolerance > 200 mg dl. In all cases, hyperglycemia and glucosuria are necessary. Treatment. Treatment of...

Insulin Resistance

Plasma glucose levels in transgenic mice overexpressing GH are normal, or only slightly elevated in spite of chronic elevations of both GH and corticosterone (33,34). However, plasma insulin levels are markedly elevated (33,34). Hyperinsulinemia and normoglycemia imply insulin resistance (33,34). In PEPCK-bGH-transgenic mice, this is associated with significant reduction of the content of insulin receptors (IR) in both the particulate fraction and the solubilized membranes of the liver, corresponding to the expressed (functional) and nonexpressed (cryptic) receptors (34). There were no significant changes in IR affinity, but the activity of insulin-dependent tyrosine kinase in partially purified IR preparations was markedly increased (35). Subsequent studies provided evidence that both the decrease in the number of IR and the increase in their autophosphorylation activity are directly related to increased insulin levels in transgenic animals, rather than to their abnormally elevated...

Living with diabetes

As you learn to live with diabetes you will gradually realise that you can lead a normal life, and provided that you understand the condition you can probably do almost anything you wish The thing about living with diabetes is it makes you focus on yourself all the time, you need to think about where you are and what you are doing in terms of food, medicines, etc. - it can make you very self-orientated. ' Coming to terms with living with diabetes takes time, and no one can tell you how long it will be before you overcome all those initial feelings of anger, guilt, 'why me'. It would be impossible to focus on every aspect ofdaily living with diabetes. Instead, this chapter will discuss a broad range of issues from taking part in sports, issues related to work, managing other illnesses, driving, alcohol and smoking.

Diabetes and sports

People with diabetes have reached the top in many sports and the vast majority of sports are perfectly safe for people with diabetes. The problem lies in those sports where loss of control due to a hypo (i.e. hypoglycaemic reaction) could be dangerous, not only to you but also to your fellow participants or to spectators. Swimming is an example of a potentially dangerous sport but by taking certain precautions, such as never swimming alone and keeping your glucose tablets on the side of the pool, it is safe to swim. However, in other sports, for example motor racing, the risks of serious injury in the case of a hypo are even greater. For this reason the governing bodies of these high-risk sports discourage people with diabetes from taking part. Discouragement does not necessarily mean a total ban the restrictions may vary depending on whether your treatment is diet, diet and tablets, or insulin. You can always contact the governing bodies of the particular sport that interests you and...

Diabetes and work

It is especially important to tell people at work about your diabetes, particularly if you are on insulin or the type of tablets that might make you have a hypo. Most people combine work with diabetes without any problems but shift work or working irregular hours may need a little extra adjustment with your medications as most insulin regimens, for example, are designed around a 24-hour clock. Shift workers usually complain that they are just settling into one routine when everything changes and they have to start again. It is difficult to generalise about shift work or irregular working hours as there are so many different patterns, but you should get help with this from your diabetes team, and employers are generally much more sympathetic if they know that you are doing your best to remedy the problem. You should definitely warn fellow employees that you might be subject to a hypo. Tell your workmates that if they find you acting in a peculiar way they must get you to take some...

Type 1 diabetes

Many people think that if they are not eating they should not take their insulin, otherwise they will have a hypo. In fact, the opposite is the case. Your blood glucose level is much more likely to be too high than too low in these circumstances. Even if you have a stomach bug such as gastro-enteritis and are being sick constantly, you will still need some insulin to keep your glucose under control. If you cannot keep any fluids down, you must call your doctor immediately. You may have to go into hospital until you are again able to eat and drink.

History Of Insulin

The existence of insulin has been known for many years. As early as 1889, scientists were aware of the fact that the surgical removal of an animal's pancreas resulted in that animal's having signs similar to those associated with human diabetes mellitus. In 1922, a human suffering from diabetes mellitus was successfully treated with a hormonal product known as insulin. Since that time, insulin has been obtained from the pancreases of slaughtered animals. Such insulin has allowed the millions of persons who use insulin to continue living. Today, breakthroughs in genetic engineering have resulted in an insulin exactly like that of humans. This new insulin is called Humulin .

Actions Of Insulin

That is, it is a chemical catalyst that enhances the processes by which the tissues of the body use glucose. Insulin impacts both the use of glucose as fuel for the tissues and the storage of glucose (with as glycogen or as fat). Therefore, the key word is energy. Specifically, insulin affects metabolism by increasing the use and decreasing the production of glucose, increasing the storage and decreasing the production and oxidation of fatty acids, and increasing the formation of protein. a. Insulin is produced and stored in the beta cells of the Islets of Langerhans of the pancreas. Insulin is released from storage in the pancreas into the bloodstream. b. The level of glucose in the blood is the primary regulator of the secretion of insulin into the bloodstream. When an individual has not eaten in a long while, the level of insulin in the blood is at a minimum. Also, some gastrointestinal hormones (i.e., cholecystokinin, gastrin, and secretin) and amino acids...

Diabetes and driving

Anyone whose diabetes is treated by diet alone does not require to inform the DVLA (Driving and Vehicle Licensing Agency). If your diabetes is treated by tablets or insulin, then you must declare this when applying for a driving licence. If you already hold a driving licence, then you must declare your diabetes to the DVLA as soon as you have been diagnosed. When you have notified the DVLA, they will send you a form asking for details about your diabetes and the names of any doctors you see regularly. They will also ask you to sign a declaration allowing your doctors to disclose medical details about your condition. There is usually no difficulty over someone with diabetes obtaining a licence to drive. Ifyou are treated with tablets, you will be able to obtain an unrestricted licence, providing you undertake to inform the DVLA of any change in your treatment or if you develop any complications of diabetes. Ifyou are treated by insulin, the licence will be valid for only three years...

Diabetes and smoking

One of the most positive things you can do if you have diabetes is stop smoking Smoking is a danger not only to the lungs because it causes cancer, but it also leads to hardening of the arteries, affecting chiefly the heart, brain and legs. Having diabetes means that you already run a higher than usual risk of damaged blood vessels, which can lead to certain conditions including heart attacks, kidney damage, strokes and problems with the blood supply to your legs. The risks for people with diabetes who smoke are therefore multiplied. The benefits of giving up smoking are immediate. Only 20 minutes after you quit, your blood pressure and pulse rate return to normal. After 24 hours, carbon monoxide has left your body and the lungs start to clear themselves. Traces of nicotine begin to vanish within 48 hours of your last cigarette. You will soon notice a greatly improved sense of taste and smell and should feel more energetic. Breathing will become easier and your circulation will...

Sources Of Insulin

Insulin is primarily obtained from the pancreases of slaughtered beef cattle and pigs. Hence, it is labeled beef or pork depending on the source of the pancreases. Insulin you have in the pharmacy consists of either a mixture of pork or beef insulin or single-source products (i.e., insulin prepared either from beef or pork pancreases). The information specific to the source of the insulin is contained on the product label. The mixture products are usually dispensed. However, when a patient has been taking either pork or beef insulin, the source should not be switched. b. A new type of insulin, Humulin , has begun being used by some diabetics. This new product is made by bacteria and by chemical alteration of pork insulin. Interestingly, this type of insulin is very similar to human insulin.

Types Of Insulin

The various types of insulin you will encounter in your pharmacy are listed and discussed below a. Insulin Injection (Regular Insulin, Crystalline Zinc Insulin). Insulin injections may be given subcutaneously in the treatment of diabetic hyperglycemia and intravenously in the treatment of diabetic ketoacidosis. This product is available in the 40 and 100 unit strengths in a mixture of beef and pork insulin. The 100 unit strength is available as either beef or pork source. The onset of action of this product is from 30 minutes to one hour. The time required to reach the peak effect is from two to four hours. The duration of action of this product ranges from five to seven hours. b. Protamine Zinc Insulin Suspension (PZI Insulin). This product is administered subcutaneously only. It is typically administered once a day, from 30 to 60 minutes before breakfast. The onset of action of this product is from four to six hours. The peak effect of PZI insulin is reached within four to six hours...

Diabetes clinics

The long-term care required by people with diabetes is organised in different ways from district to district. Traditional means of providing care are based upon attendance at a hospital diabetes clinic. Increasingly, however, the concept of 'shared care' - that is, care shared between the hospital and the general practice team - is being employed, and GPs are paid a fee for providing a programme ofcare, often in the form of a 'mini-clinic', approved by the local Family Health Services Authority. With this system many people with diabetes can be cared for principally by the primary health care team. Certain groups, such as children, adolescents or pregnant women with diabetes and those with specific complications or difficulties in management, will often require the specialised care of the hospital clinic or diabetes centre. Though often based in or near the district general hospital, the diabetes centres are devoted to the provision of diabetes care throughout the district, and are a...

Diabetes UK

Diabetes UK, the new name ofthe British Diabetic Association, is the leading charity working for people with diabetes. It is dedicated to helping people with diabetes, their carers, families and friends. The main aim of this organisation is to improve the lives of people with diabetes and to work towards a future without diabetes. Diabetes UK has produced a booklet setting out the standards of care you should expect from the National Health Service (NHS) and your role in managing your own diabetes, which includes the following

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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