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Diabetes - diabetes mellitus

Diabetes - is a group of diseases that affect the way your body uses blood sugar (glucose). This sugar is vital to your health because it's your body's main source of fuel.

• Exercise Can Help in Treating Diabetes
• Why Supplement Helpful for Diabetics (07/27/2005, Reuters Health)
   

Normally, glucose is able to enter your cells because of the action of insulin - a hormone secreted by your pancreas. Insulin acts like a key to unlock microscopic doors that allow glucose into your cells. But in diabetes mellitus, this process goes awry. Instead of being transported into your cells, glucose accumulates in your bloodstream and eventually is excreted in your urine. This usually occurs either because your body doesn't produce enough insulin or because the cells don't respond to insulin properly.

Diabetes mainly occurs in two forms:

• Type 1 diabetes. This type develops when your pancreas makes little or no insulin. It affects between 5 percent and 10 percent of people with the disease.
• Type 2 diabetes. This type is far more common than type 1, affecting between 90 percent and 95 percent of people with diabetes over age 20. It occurs when your body is resistant to the effects of insulin or your pancreas produces some, but not enough, insulin to maintain a normal glucose level.

No one has yet found a cure for diabetes mellitus. But the good news is that eating right, maintaining a healthy weight and getting plenty of exercise can help prevent the disease. And if you have diabetes, diet and exercise along with medications that control blood sugar can help you continue to live a healthy and active life.

Diabetes progress

Either the pancreas produce insufficient amounts of insulin or body cells become resistant to the hormone's effects. The cells use other sources of energy, which leads to a buildup of toxic by-products in the body. Unused glucose also accumulates in the blood and urine.

Types of Diabetes

The types of diabetes are
 
A) Type I (IDDM)- occurs when the pancreas produces far too little insulin or produces none at all.                        
 
 
B) Type II Diabetes (NIDDM)- cells in the body become resistant to its effects                                                             
 
 
C) Gestational diabetes develops during pregnancy and usually disappears after childbirth.

Type I (IDDM)- occurs when the pancreas produces far too little insulin or produces none at all.  

IDDM affect the most

It usually develops suddenly during childhood or adolescence in both sexes.

causes of IDDM

The causes are

• An abnormal immunologically mediated bodily reaction, against the insulin-secreting cells in the pancreas. 

• Trigger Factors may be:

  • a viral infection. 

  • inflammation of the pancreas 

• Genetics.

Symptoms of IDDM

The symptoms are

• Polyuria (frequent urination)

• Polydipsia (frequent thirst)

• Polyphagia (frequent hunger)

• Weight loss

• Blurred vision

• Foot paresthesias ( tingling numbness)

• Pruritus (itching)

• Abdominal pain

Investigations

The tests conducted are

• Physical examination may be entirely normal.

• Orthostatic hypotension and / or tachycardia, 

• Decreased skin turgor, and flat neck veins (in supine position) reflect dehydration.

• Loose skin folds and poorly fitting clothing may suggest recent weight loss.

• Decreased visual acuity, 

• Decreased peripheral nerve vibratory / position threshold,

• Eruptive xanthomas 

Treatment methods

The Key Tests are

• Plasma glucose :

  • Fasting

  • Random

  • Post-lunch.

• Urinalysis for Glucose, ketones, Proteins.

• Serum islet cell antibodies (ICAs). 

• Serum C-peptide.

• Treatment         

• Insulin is used

• Diet:

  • Total fat less than 30 percent and saturated fat less than 10 per cent of total calories.

  • Cholesterol less than 300 mg/day.

  • Distribution of calories: 

  • 20 percent breakfast, 

  • 20 per cent lunch, 

  • 30 per cent supper, 

  • 10 per cent midmorning snack,

  • 10 per cent mid-afternoon snack, 

  • 10 per cent bedtime snack.

  • slowly absorbed carbohydrates such as pasta, lentils, and beans can be consumed.

• Activity:

  • Regular moderate exercise 

  • Avoid exercising within 4 hours after administration of regular insulin.

• Avoid exercise if FPG is very high/low.

Important things one should know about IDDM

 The important things are

• Basic skills and knowledge:

  • Insulin injection technique

  • Finger stick capillary glucose testing technique

  • Factors that raise and lower glucose.

• Hypoglycemia:

  • Warning symptoms, such as sweating, apprehension, tremulousness, hunger, and confusion.

• "Sick day" management:

  • Insulin requirement increases 

  • Consult physician if nausea/vomiting prevent oral food intake.

• Foot care:

  • Inspect feet daily

  • Use moisturizer cream daily after bath, if skin dry.

  • Avoid going barefoot.

  • Wear professionally fitted shoes.

• Do not smoke.

• Nausea
• vomiting

Follow-up of IDDM

 Regular follow-up is essential for

• Assessment of control of blood glucose levels.

• Assessment of compliance

• Assessment of / screening for complications

  • Retinopathy: Performance of regular fundoscopic examination 

  • Peripheral neuropathy and peripheral vascular disease.

  • Nephropathy

  • Measurement of blood pressure regularly

• Measurement of triglycerides, HDL, and LDL cholesterol regularly.

Type II Diabetes (NIDDM)- cells in the body become resistant to its effects  - non-insulin dependent DM

It comprises of a heterogeneous group of disorders in adults, and it accounts for the vast majority of cases of diabetes mellitus.

Non-insulin dependent DM affect the most

It is usually found in people over the age of 40,  especially among females.

Causes of non-insulin dependent DM

The causes are

• A degree of insulin resistance in peripheral tissues

• Abnormality in insulin secretion. 

• Heredity is a risk factor.

Symptoms of non-insulin dependent DM

The symptoms are

• Polyuria (frequent urination)

• Polydipsia (frequent thirst)

• Fatigue

• Chronic skin infections

• Blurred vision

• Paresthesias (pins and needles sensation)

• fatigue

Signs of non-insulin dependent DM

The signs are

• Obesity

• Family history of adult-onset diabetes mellitus.

• Proteinuria, 

• Retinopathy, 

• Vitreous hemorrhage

• Glaucoma, 

• Neuropathic lower extremity lesions,

• Coronary artery disease 

• Peripheral vascular disease

• Delivery of large infants

Treatment methods

Treatment methods are

Laboratory Tests

• Urine for 

  • Glucose

  • Ketones

  • Proteins

  • Creatinine Clearance

• Oral glucose tolerance test

• Glycosylated hemoglobin

• Glycosylated serum proteins 

• Fasting plasma glucose (FPG) level on two separate occasions.

Diet

• Caloric restriction 

• Limit refined sugars, alcohol, and saturated fats.

• High fiber diet.

Medication: Generally used drugs are

• Sulfonylureas

• Insulin

• Acarbose 

• Biguanides

• insulin sensiters like pioglitazone,rosiglitazone

Exercise: Moderate exercise.

Important things one should know about NIDDM

The important things are

• Self-monitoring of glucose: patients must be instructed on the use of a glucometer 

• Foot and skin care

• Infections and sick days: 

  • Insulin requirements may increase 

  • Adequate fluid intake

  • Frequent blood sugar monitoring.

• Diet and exercise:

• The benefits of dietary compliance, exercise, and weight loss must be explained.

Follow-up of NIDDM

Patients should seek a follow-up at least every 6 months.

• Annually, a complete physical examination is recommended

• Regular laboratory testing of:

  • Glycosylated hemoglobin 

  • Urine protein excretion

  • Fasting lipoid levels

• Assessment of blood pressure

• Retinal examination by an eye-specialist at least every year. 

Prognosis

Diabetics with blood glucose maintained at or near normal levels have a good prognosis.

Diabetes Prevention

Diabetes can be prevented through

• Regular exercise.

• Healthy diet to maintain ideal weight

Related Sites:

• Gestational diabetes
• Diabetes Links
• Type I (IDDM)
• Type II Diabetes (NIDDM)

Exercise Can Help in Treating Diabetes

Exercise is often recommended in treating type 1 (insulin- dependent) and type 2 (noninsulin- dependent) diabetes ~ both as a stand-alone activity and in combination with diet and drug therapy. For people who are heavily dependent on medicines, exercise cannot replace drugs but it does contribute to normalizing the glucose metabolism. The positive effects of exercise on diabetes sufferers are many. First, exercise helps to keep weight controlled. Second, exercise helps to lower the blood sugar level, which is definitely a major advantage for diabetes sufferers. Third, exercise reduces the risk of another risk factor - heart disease, which often goes together with diabetes. In the long-term, exercise helps in minimizing the complications from diabetes by improving one~s general condition. What is more, it is believed that for people for whom there is a risk to develop diabetes, diabetes can be prevented by exercise. Despite the numerous advantages of exercise, do not underestimate the risks. Let your doctor decide if taking exercise is recommendable for you and if yes ~ what kind of exercise will be less risky. One of the dangers for diabetes sufferers are that exercise might change your reaction to insulin or might lead to an abrupt drop in blood sugar level, which is another risk for you. Besides the standard recommendations for exercising, there are some special ones, which are vital for diabetes sufferers. It is always true that one needs comfortable clothes and shoes for exercising, but besides the discomfort, for diabetes sufferers there is one more risk, if the shoes are not comfortable ~ blisters. Blisters can be easily infected and in your case a serious infection might need a very serious treatment. Special attention should be paid to drinking enough water and any kinds of liquid in order to avoid dehydration. Dehydration during exercising occurs because the body evaporates liquid in order to keep cool and if you do not drink water while exercising, you will get dehydrated, which is bad for your blood sugar level. Your physical condition is the factor that determines what the recommendable activities are. Exercise for diabetes sufferers can include diverse activities - cleaning the house, going up the stairs, even strength training. Usually household chores are risk free because they do not require much effort and are no longer than 20-30 minutes a day. Also, doctors often recommend various aerobic exercise ~ walking, aerobics, jogging, bicycling, etc. Bicycling, swimming, or chair exercises are recommended especially if one has problems with the nerves in his or her legs or feet, because unlike jogging and walking, bicycling, swimming, and chair exercise do not put stress on the lower limbs. Even strength training can be allowed, if you are younger and do not have diabetes-related complications. Strength training is good because by burning more calories, it helps to reduce body fat and weight in general. Additionally, more active muscles are more effective in glucose consumption, which in turn is positive for regulating the glucose metabolism. But in any case, consult a doctor whether strength training is appropriate for you and even better ~ consider taking a personal coach to train you. Denny Santi is the Staff Writer of DiabetesSERV This site has a great collection of information on diabetes, including a free newsletter, resources and interesting articles. For great information, go to: diabetesserv.com

Reuters Health

Wednesday, July 27, 2005

NEW YORK (Reuters Health) - For people with type 2 diabetes, adding whey to high-carbohydrate meals stimulates insulin release and reduces spikes in blood glucose levels after meals, according to new findings.

Writing in the American Journal of Clinical Nutrition, Dr. Mikael Nilsson, of Lund University, Sweden, and colleagues say the reason whey proteins have this effect is not known, but it may have something to do with particular amino acids and hormones found in the mild product.

The researchers examined the effect of supplementing high glycemic index (GI) meals -- that is, readily digested carbs that cause a rapid rise in blood sugar levels -- with whey proteins.

A total of 14 individuals with type 2 diabetes were served a high-GI breakfast (white bread) and subsequent high-GI lunch (mashed potatoes with meatballs). Whey supplementation was provided with both meals on one day, and whey was exchanged for lean ham and lactose on another day.

The investigators took blood samples before and during a 4-hour period after breakfast and 3 hours after lunch in order to measure blood glucose, insulin, and other factors.

Insulin secretion was higher after both breakfast and lunch when the meals were supplemented with whey compared to when whey was not included, although the effect was less pronounced after breakfast. The rise in blood glucose was significantly reduced after the lunch meal was supplemented with whey.

The lesser effect on insulin of whey after breakfast, "in combination with the fact that the insulin resistance may be higher in the morning after the overnight fast, may explain the inability of whey to reduce the blood glucose increment after breakfast," Nilsson's team explains.

SOURCE: American Journal of Clinical Nutrition, July 2005.

Copyright 2005 Reuters. Reuters content is the intellectual property of Reuters. Any copying, republication or redistribution of Reuters content, including by caching, framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in content, or for any actions taken in reliance thereon. Reuters, the Reuters Dotted Logo and the Sphere Logo are registered trademarks of the Reuters group of companies around the world.

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