Diabetes Diabetes mellitus, commonly referred to as diabetes, is a medical condition associated with abnormally high levels of glucose (or sugar) in the blood (hyperglycaemia). * Glucose is a type of sugar found in certain foods such as honey and some, but not all, fruits. It is also the form of sugar that all sugary and starchy foods are converted to in the body after digestion. Glucose is used by the body to make energy. * Normally, blood glucose levels are tightly controlled by insulin, a chemical signalling substance (hormone) that is produced by a gland near your stomach called the pancreas. * Insulin lowers the blood glucose level because it stimulates the body to make use of glucose. * When the amount of glucose in the blood increases, for example, after eating food, insulin is released from the pancreas to normalise the glucose level. However, in patients with diabetes mellitus, the elevated glucose levels cannot be normalised. This causes abnormally high levels of blood glucose, which ultimately leads to the presence of glucose in the urine (glucosuria). What causes diabetes? Insufficient production of insulin (either absolutely or relative to the body's needs), production of defective insulin (which is uncommon), or the inability of cells to use insulin properly and efficiently leads to hyperglycemia and diabetes. This latter condition affects mostly the cells of muscle and fat tissues, and results in a condition known as "insulin resistance." This is the primary problem in type 2 diabetes. The absolute lack of insulin, usually secondary to a destructive process affecting the insulin producing beta cells in the pancreas, is the main disorder in type 1 diabetes. In type 2 diabetes, there also is a steady decline of beta cells that adds to the process of elevated blood sugars. For more, please read the Insulin Resistance article. Essentially, if someone is resistant to insulin, the body can, to some degree, increase production of insulin and overcome the level of resistance. After time, if production decreases and insulin cannot be released as vigorously, hyperglycemia develops. Glucose is a simple sugar found in food. Glucose is an essential nutrient that provides energy for the proper functioning of the body cells. Carbohydrates are broken down in the small intestine and the glucose in digested food is then absorbed by the intestinal cells into the bloodstream, and is carried by the bloodstream to all the cells in the body where it is utilized. However, glucose cannot enter the cells alone and needs insulin to aid in its transport into the cells. Without insulin, the cells become starved of glucose energy despite the presence of abundant glucose in the bloodstream. In certain types of diabetes, the cells' inability to utilize glucose gives rise to the ironic situation of "starvation in the midst of plenty". The abundant, unutilized glucose is wastefully excreted in the urine.

Diabetes Insulin is a hormone that is produced by specialized cells (beta cells) of the pancreas. (The pancreas is a deep-seated organ in the abdomen located behind the stomach.) In addition to helping glucose enter the cells, insulin is also important in tightly regulating the level of glucose in the blood. After a meal, the blood glucose level rises. In response to the increased glucose level, the pancreas normally releases more insulin into the bloodstream to help glucose enter the cells and lower blood glucose levels after a meal. When the blood glucose levels are lowered, the insulin release from the pancreas is turned down. It is important to note that even in the fasting state there is a low steady release of insulin than fluctuates a bit and helps to maintain a steady blood sugar level during fasting. In normal individuals, such a regulatory system helps to keep blood glucose levels in a tightly controlled range. As outlined above, in patients with diabetes, the insulin is either absent, relatively insufficient for the body's needs, or not used properly by the body. All of these factors cause elevated levels of blood glucose (hyperglycemia). What are diabetes symptoms? The early symptoms of untreated diabetes are related to elevated blood sugar levels, and loss of glucose in the urine. High amounts of glucose in the urine can cause increased urine output and lead to dehydration. Dehydration causes increased thirst and water consumption. The inability of insulin to perform normally has effects on protein, fat and carbohydrate metabolism. Insulin is an anabolic hormone, that is, one that encourages storage of fat and protein. A relative or absolute insulin deficiency eventually leads to weight loss despite an increase in appetite. Some untreated diabetes patients also complain of fatigue, nausea and vomiting. Patients with diabetes are prone to developing infections of the bladder, skin, and vaginal areas. Fluctuations in blood glucose levels can lead to blurred vision. Extremely elevated glucose levels can lead to lethargy and coma. Treatment of Diabetes Self-testing your blood sugar level lets you know how food, exercise, and medications are affecting it. It is a good idea to keep a record of your daily readings and review the results with your health care provider. How do I test my blood sugar level? To test your blood sugar level, a device called a glucose meter is used. There are many different types of glucose meters available, and these can be purchased at your local pharmacy. In general, a drop of blood from a finger stick is placed on a test strip that is then placed in the meter. The meter then reads the amount of glucose (sugar) in your blood. This simple test tells you what your blood sugar level is at the time of the test. The readings you get in this manner help you manage your diabetes on a day-to-day or even an hour-to-hour basis. Glucose meters have generally always revolved around using the finger stick methods, but many other glucose measuring products are available to monitor your blood sugar level. Today there are specialized lancing devices that prick the skin at different levels, a needle free laser device, blood glucose monitors using blood from other parts of the body like the arm instead of fingertips, the GlucoWatch, which is worn like a watch and detects your blood glucose level through your skin, InDuo, which combines a glucose meter and insulin injector pen, and sensors that's placed under your skin. How often should I test my blood sugar level? Self-tests may be done before meals, after meals, or at bedtime. Ask your health care provider how often and when you should test your blood sugar level. Self-tests are important for all individuals with diabetes but especially for patients treated with insulin to monitor for and prevent to prevent hypoglycemia. For most patients with Type 1 diabetes and pregnant women taking insulin, self-tests are recommended three or more times daily. The optimal frequency and timing of self-tests for patients with Type 2 diabetes is not known, but if you have type 2 diabetes and don't use insulin, you may need to test your blood sugar levels only once a day or as little as twice a week (depending on your current level of diabetes control). .When a therapy is added or modified, diabetic patients should test more often than usual.

Diabetes What is considered a good blood sugar reading? Ideal goals recommended for most people: * Before meals: 80-120 mg/dL * After meals: <180 mg/dL * At bedtime: 100 to 140 mg/dL Your blood sugar level goals may vary from these ideal goals. It is important to discuss this with your health care provider. What is a hemoglobin A1C test? The hemoglobin A1C test is a blood test that tells you how well your blood sugar level has been controlled over the past 3 months. The hemoglobin A1C goal for most people with diabetes is less then 7 percent. If your number is less then 7 percent this means that your treatment plan is probably effective and your blood sugar is under good control. This test should be obtained at least twice a year and any other times as indicated by your health care provider. In addition to monitoring my blood sugar levels, what else do I need to do? If you have diabetes, it is recommended that you obtain annual foot, eye, and dental examinations by a health care provider, kidney function tests and cholesterol checks. It is also recommended that you check your feet on a daily basis. Look at your bare feet for cuts, blisters, red spots, and swelling and report anything foot problems to your doctor. If you have trouble seeing your feet, you can use a mirror or ask a friend or family member for help. In type 1 diabetes, the body loses its ability to produce insulin. Insulin therapy is vital to treating type 1 diabetes. The body's lack of insulin can be compensated with various types of insulin that are injected on a daily basis. There are many types of insulin. The differences between insulin are based on the time it takes for the insulin to begin working in the body and how long the insulin will work in your body. To learn more about the various types of insulin, click on the "Insulins" link under "Drug Classes Used to Treat Diabetes." If you have type 1 diabetes, you need to monitor your blood glucose (sugar) levels several times a day and have daily injections of insulin using a syringe, pen or pump, combined with a strict diet, to help maintain constant glucose levels in the blood. You also need to watch the timing of meals and have glucose-rich snacks on hand to treat low blood sugar. Hypoglycemia can be a dangerous complication of insulin treatment, and it must be treated promptly. Hypoglycemia is a condition that occurs when your blood sugar gets too low. Hypoglycemia can develop when you delay or skip a meal, eat too little food at a meal, get more exercise than usual, or if you take too much insulin. Symptoms of hypoglycemia include: * Dizziness * Sweating * Rapid heartbeat * Headache * Blurred vision * Inability to think or concentrate * Drowsiness * Numbness and tingling around lips * Being hungry Usually you can self-treat hypoglycemia relatively quickly. If you experience any of the above symptoms of hypoglycemia seek one of the following glucose sources right away and check your blood sugar level: * a cup of orange juice * 1/3 cup of grape juice * 1 cup (8 oz.) of milk * 5-6 pieces of hard candy * 2 tablespoons of raisins * 1-2 teaspoonfuls of honey When traditional diet and insulin injection measures cannot adequately control your blood sugar levels, you may choose to use an insulin pump. This is a device that delivers a constant supply of insulin through a needle placed in the skin of the abdomen. Symlin (pramlintide acetate) injection has been approved by the FDA for the treatment of type 1 diabetes. It is the pioneer drug in a new class of medications used to treat diabetes called amylin-mimetics. Structurally similar to the human hormone amylin, Symlin is used in addition to insulin to help control blood sugar levels. By slowing down the movement of food through the stomach, sugar absorption into the blood is delayed, thus allowing for better blood glucose control. For type 1 and type 2 diabetes patients, the use of Symlin is only recommended in insulin treated patients who need additional blood sugar control. Symlin is usually injected before each major meal (greater than or equal to 250 calories or 30 grams of carbohydrates) and lasts up to 3 hours after eating. The first treatment for type 2 diabetes is often exercise and meal planning for blood sugar control and weight loss. Sometimes these measures may not be sufficient to bring blood sugar levels back to normal range. The next step is usually taking an oral medication to help decrease your insulin requirements or cause your body to produce more insulin. Obese patients are usually started on medications known as biguanides (for example, metformin), while nonobese patients are started on medications known as sulfonylureas (for example, glyburide or glipizide).. If your blood sugar levels can't be controlled with one medication, your doctor may choose to use a sulfonylurea and biguanide in combination or add other medications such as a thiazolidinedione (for example, Actos or Avandia) or an alpha-glucosidase inhibitor (for example, Precose or Glyset) . Alpha-glucosidase inhibitors and thiazolidinediones require more frequent monitoring from your doctor because of their side effects. Alpha-glucosidase inhibitors may cause gastrointestinal distress (gas, bloating, and diarrhea), and thiazolidinediones have been associated with liver problems. Many individuals with type 2 diabetes will in time require more than one medication to control their blood sugar levels. As mentioned above, a commonly used combination consists of a sulfonylurea and a biguanide. There are products on the market that combine both medications into a single tablet, enabling you to take only one tablet while getting the effects from both medications. These single tablet combinations are available for a sulfonylurea/biguanide and a biguanide/thiazolidineodione If diabetes control cannot be maintained on oral medication, then insulin therapy may be started either alone or in combination with oral therapy. Medication works best when used in combination with appropriate meal planning and exercise. There is no "best" pill to treat type 2 diabetes. You may need to try a combination of medications or medication plus insulin. Recently, two new medications have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of diabetes. Symlin (pramlintide acetate) injection has been approved by the FDA for the treatment of type 2 diabetes. It is the pioneer drug in a new class of medications used to treat diabetes called amylin-mimetics. Structurally similar to the human hormone amylin, Symlin is used in addition to insulin to help control blood sugar levels. By slowing down the movement of food through the stomach, sugar absorption into the blood is delayed, thus allowing for better blood glucose control. For type 1 and type 2 diabetes patients, the use of Symlin is only recommended in insulin treated patients who need additional blood sugar control. Symlin is usually injected before each major meal (greater than or equal to 250 calories or 30 grams of carbohydrates) and lasts up to 3 hours after eating. Byetta (exenatide) injection is a medication used to control blood sugar levels in type 2 diabetics. Recently approved by the FDA in May 2005, Byetta is the first in a new class of drugs called incretin mimetics. When used together with insulin, Byetta enhances glucose dependant insulin secretion from the beta cells in the pancreas, thus mimicking the body�s natural response to glucose. As a result, more insulin is available in the body to help control blood sugar levels, especially after meals. Byetta is usually injected twice a day one hour before the morning and evening meal.