Today medications have become a common form of treatment for diabetes with a wide variety of medicines available all over the world [1]. It is still important to remember that medications are only part of the entire treatment program and a healthy diet with a lot of active exercise is essential for successfully controlling the symptoms of the diabetes. Nevertheless, medications can prove to be great in helping lower the blood sugar levels and to provide relief to diabetics.

Medications for diabetes include both oral tablets as well as injectable insulin for better and faster cure [2]. The purposes of diabetic medications include:

• To increase the production of insulin in the body of a patient
• To reduce the blood glucose levels in the body
• To decrease the absorption of carbohydrates from the alimentary canal
• To increase or to correct the response of the body cells to insulin
• To facilitate slower emptying of the stomach and the delayed absorption of carbohydrates

 

Medications for Type I Diabetes

Since Type I Diabetes is also known as insulin-dependent diabetes, the insulin is the major requisite in such patients. Since the body cells are unable to produce insulin internally, thus external insulin is administered which may be in form synthetic insulin or insulin analogues. These analogues are of two kinds:

• Rapid acting insulin analogues: Insulin Lispro, insulin Aspart and insulin Glulisine are some common rapid acting insulin analogues that are administered within 5-10 minutes of food intake and have rapid but short term effect. These are given in cases of high blood sugars to avoid any immediate increase in blood glucose level at the time of meals. The peak period of action is 60-120 minutes and the action lasts for not more than 4 hours.
• Long acting insulin analogue: Insulin Glargin and insulin Determir are long acting insulin analogues that do not have any peak action period and lasts for long once the drug is administered inside the body. The onset of action occurs 60-90 minutes after injecting and lasts for 12-24 hours. However, even for gestational diabetes, these insulin analogues are an effective cure.

Intermediate insulin administration options are also available for the administration of insulin to Type I Diabetes patients. This insulin may be injected intravenously into the blood stream or an insulin pump may also be used to administer insulin.

Some of the common insulin brands include Humulin, Novolin, Apidra, Levemir, Lantus, Humalog and Novalog [3].

Some other medications that are commonly used in Type I Diabetes cases include the following:

• An injection of symlin or pramlintide may be used to slow down the digestion of food to reduce blood sugar levels
• Medications to control high blood pressure may be often prescribed to reduce the risk of diseases
• Aspirin may be recommended in order to protect the heart
• Many cholesterol lowering drugs may be used in order to keep levels in check

Some emerging options for the treatment of Type I Diabetes include:

• Artificial pancreas: This process links a glucose monitor to an insulin pump which is in turn delivered to the body when there is a need to. The first step towards this procedure was approved in 2013 and the process has been receiving a lot of interest and active research is continually being carried out.
• Pancreas transplant: This process is not usually recommended as it involves high chances of risk of infection and many other side effects as well. This process is only carried out if any other organ of the body has failed and requires a transplant as well.
• Islet Cells transplant: The islet cells are the beta cells which are directly responsible for the production of insulin and these exhibit dysfunction in Type I Diabetes sufferers. Transplantation of the cells in order to infuse healthy cells that not only provide insulin, but also grow and multiply is used. However, this method is not widespread and has received little recognition due to the lack of healthy islet cells to be transplanted in comparison to the large number of diabetic individuals.
• Stem cell transplant: This is another newly sought after and emerging method of transplantation which might help Type I Diabetes sufferers. Stem cell transplants from a patient’s own blood can help the immune system to shut down and restart to function normally.

Other lifestyle changes and methods that can help in the treatment of Type I Diabetes includes following procedures including:

• Monitoring of the levels of blood sugars on a frequent basis
• Counting the carbohydrates consumption in the diet
• Maintaining a healthy and a well-balanced diet
• Maintaining a healthy weight
• Getting lots of exercise

 

Medications for Type II Diabetes

There are several oral medications available for Type II Diabetes or non-insulin dependent diabetes to increase body’s response to insulin and regulate the blood sugar levels [4]. There are more than 18 types of drugs available in the market nowadays. These oral hypoglycemic drugs include:

• Alpha glucosidase inhibitors (AGIs) – These drugs help in slowing down the digestion of carbohydrates. An example of this class of drugs is Glucobay which is also known as Acarbose and greatly slows down the carbohydrate digestion process.
• Amylin agonists – Examples of this type of medication include Symlin or pramlintide that assist insulin in controlling post-meal glucose levels.
• Biguanidecs – These drugs prevents glucose production by the liver. Metformin is a common drug which can also help in increasing the sensitivity of the tissues of the body to insulin. Examples of biguanides include Glumetza and Glucophage. Some of the possible side effects that may be caused by this class of drugs include diarrhea, nausea and vomiting.
• Gliptins or DPP-4 inhibitors – These medications prevent the destruction of Incretin hormones but have very small effect on reducing the levels of blood sugar. Examples of this class of medication include Tradjenta, Januvia, Onglyza, Sitagliptin, Vildagliptin and Saxagliptin.
• Megalintides – Similar to Sulphonylureas, these drugs help the body to produce more insulin but prove to be much faster acting and have a shorter lasting effect on the body. Possible side effects of megalintides include extremely low blood sugar levels and excessive gain of weight. Examples of megalintide drugs include Starlix and Prandin.
• GLP-1 Receptor Agonists or Incretin mimetic – These medications tend to mimic the actions of body’s Incretin hormone, but have very humble effect in reducing the blood sugar levels. Examples of this class of drugs include Victoza and Byetta.
• Thiazolidinedione or glitazones – These medications reduces the resistance of the body to insulin. However, this class of drugs is known to be associated with a number of side effects, including a higher risk of developing fractures and also failure of the heart. Examples of this class of medication include Actos and Avandia.
• Sulphonylureas – These drugs stimulate the insulin production by the pancreas. Common examples of Sulphonylureas include Glynase, DiaBeta, Glucotrol and Amaryl. However, possible side effects of Sulphonylureas include gaining of weight and very low blood sugar levels.
• SGL T2 inhibitors or gliflozins – These drugs lowers the blood glucose levels by acting on the kidneys and preventing them from reabsorbing the sugar back into the blood stream. The excess sugar is excreted out through the urine. Examples of this class of drugs include Farxiga and Invokana.
• Glinides or prandial glucose regulators – Prandin, also known as Repaglinide stimulates beta cells in pancreas to produce insulin and may be used to help Type II Diabetes sufferers.

Insulin therapy may also be administered to Type II Diabetes patients in case of requirements. Insulin always needs to be administered externally and not orally as the enzymes present in the human stomach prove to interfere with the hormone. Insulin drugs may be administered either using an insulin pump or an insulin injection.

The common types of insulin therapy include the following types of options:

• Insulin Glulisine or Insulin Apidra
• Insulin Lispro or Insulin Humalog
• Insulin Glargine or Insulin Lantus
• Insulin Aspart or Insulin Novalog
• Insulin Isophane or Insulin Humulin and Insulin Novolin
• Insulin Determir or Insulin Levemir

Besides treating Type II Diabetes, these drugs are also used in the treatment of two other types of diabetes, namely Gestational Diabetes and prediabetes. However, the use of medications is rarer in these cases and very often; only healthy lifestyle changes, active physical exercise and a diabetic diet can prove to be enough to help control prediabetes and Gestational Diabetes.

There are a few precautions needed before going for these drugs and analogues for treatment of diabetes:

• The type of diabetes: While the symptoms and the conditions of Type I and Type II diabetes may appear to be the same, care must be taken to correctly identify the type of diabetes before beginning taking medication. The two types of diabetes are known to have very different causes and as such, their treatment procedures and medications are quite different.
• The cause and magnitude of diabetes: While the chronic conditions may exhibit extremely high blood sugar levels, lower levels can be controlled by following a healthy diet and maintaining an active lifestyle with adequate amounts of exercise. This more often than not proves to help control the symptoms in less severe cases and also in prediabetes and Gestational Diabetes.
• The adverse effects and drug reactions: Most of the drugs that are used in the treatment of different types of diabetes are known to have different types of side effects on the body and in case medications are being taken, then these side effects will have to be managed.
• Other medical conditions: Conditions like hypertension, thyroid etc. which may co-exist with diabetes can cause interference with the medications for diabetes. This can cause a lot of complications and can be potentially hazardous. Other associated diseases and any underlying and latent diseases will need to be thoroughly sought for before the medication for diabetes can be prescribed to full effect.
• Compliance factors: There may be a host of compliance factors associated with different types of drugs as per the location of a user. Care must be taken that if a person is required to travel or relocate, the medication is available to be used in all locations visited. This can be a hassle as different countries have different agencies that approve the drugs to be sold and used.
• Contradictions to therapy: While different drugs have proven to be effective in their own ways, there have also been a number of cases involving contradictions to the type of therapy used. As such, any medication should always be resorted to only after the recommendation of a licensed medical professional.
• Cost effectiveness of the treatment procedure: Different treatment procedures have different costs and it is up to the patient to determine which process is financially feasible. Fortunately, many healthcare providers and diabetic clinics offer consultation to help suffers avail the right kind of treatment as per their lifestyle and budget.

It must be remembered that there is no treatment or cure for diabetes and any condition of diabetes should be considered serious. While the symptoms of the disorder can be controlled to some extent with the help of regular exercise, physical activity and by following a diabetic diet, sometimes the use of medication cannot be avoided. Even in such cases, the physical activity and the diet must continue throughout the life of the diabetic.

It is critical that diabetics always seek proper medical counseling and advice from licensed medical practitioners or healthcare providers before deciding to take up any type of medication [5]. All types of medication are known to be associated with their own sets of hassles and side effects and diabetics will need to effectively manage living with these mild side effects and also will need to mentally prepare themselves to battle the disorder throughout the entirety of their lives. There is a lot of active scientific as well as medical research being carried out in order to find a permanent cure for diabetes. Till then, all types of diabetic sufferers including those suffering from prediabetes and Gestational Diabetes will have to be hopeful and continue following a strict diet and a healthy lifestyle.

 

References

[1] Glycemic Control From 1988 to 2000 Among U.S. Adults Diagnosed With Type 2 Diabetes, Carol E. Koro, PHD12, Steven J. Bowlin, DO, PHD1, Nancy Bourgeois, BS1 and Donald O. Fedder, DPH2.; vol. 27 no. 1 17-20 – January 2004 – DOI: 10.2337/diacare.27.1.17Diabetes Care, http://care.diabetesjournals.org/content/27/1/17.short

[2] Trends in Prevalence, Awareness, Treatment, and Control of Hypertension in the United States, Ihab Hajjar, MD, MS; Theodore A. Kotchen, MD.;;290(2):199-206 – May, 2003 – DOI: 11001/jama.290.2.199, http://jama.jamanetwork.com/article.aspx?articleid=196894

[3] REDUCTION IN THE INCIDENCE OF TYPE 2 DIABETES WITH LIFESTYLE INTERVENTION OR METFORMIN, N Engl J Med.; 346(6): 393–403 – 2002 Feb 7 – DOI: 1056/NEJMoa012512, http://www.nejm.org/doi/full/10.1056/NEJMoa012512

[4] Predictors of medication nonadherence among patients with diabetes in Medicare Part D programs: A retrospective cohort study, Noel E. Wilkin, RPh, PhD, William B. Lobb, RPh, PhD.; Volume 31, Issue 10 Pages 2178–2188 – October 2009 – DOI: 10.1016/j.clinthera.2009.10.002, http://www.ncbi.nlm.nih.gov/pubmed/19922889

Bedienungsanleitung.
[5] Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus, The ACCORD Study Group,; 362(17): 1575–1585 – Apr 29, 2010 – DOI: 11056/NEJMoa1001286 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123215/

Diagnosing diabetes enables the doctors and lab workers to detect and treat diabetes well before complications begin to occur [1]. It also helps to detect and cure prediabetes, which indicates greater risk of developing diabetes in future. Following tests are used nowadays to diagnose or detect diabetes:

• Oral glucose tolerance test (OGTT)
• A1C or the hemoglobin A1c or the glycohemoglobin test
• Fasting blood sugar test

Oral Glucose Tolerance Test (OGTT)

The OGTT can be used to diagnose diabetes, prediabetes as well as gestational diabetes. OGTT measures blood sugar after 8 hours of fasting and 2 hours after the intake of a liquid containing 75 grams of glucose dissolved in water.

If the blood sugar level is 140 to 199 mg/dL, the person has prediabetes or impaired glucose tolerance (IGT). On confirmation by another test if,the glucose level is 200 mg/dL or above means that a person has diabetes.

 

A1C Test

The A1C test is used for detection of prediabetes and type 2 diabetes but does not diagnose type 1 or gestational diabetes. It is a blood test that determines the average blood glucose levels of a person over past 3 months but does not detect daily fluctuations. The A1C test can be performed at any time of the day and doesn’t require fasting which makes it convenient for patients.

The A1C test result is obtained in percentage with 5.7% or lesser as normal value. A value of 5.7- 6.4% indicates prediabetes. A1C level above 6.0% is considered as very high risk of developing diabetes. A1C level of 6.5% or above indicates that a person has diabetes.

Fasting Plasma Glucose Test (FPG)

The Fasting blood glucose test detects both diabetes and prediabetes. It is the most common test used for the diagnosis of diabetes as it is more convenient than other tests like OGTT besides being less expensive. This test requires measurement of blood glucose in a person after fasting for a minimum of 8 hours. This test is performed most commonly in the morning.

A fasting blood sugar level of 100 to 125 mg/dL is considered as prediabetes. The fasting blood sugar level of 126 mg/dL or more after repeating the test on another day confirms that a person is a victim of diabetes.

Treatment of Diabetes

Diabetes, even though a common disorder which has been fairly widespread throughout the world, is a chronic condition with no definitive cure. Even the non-chronic types of diabetes, namely prediabetes and Gestational Diabetes leave individuals at a risk of developing Type II Diabetes in the future. As such, the signs and symptoms of any type of diabetes must be taken seriously and the only possible methods of treatment include controlling these signs and symptoms and trying to make the bodily functions return to normal.

The main aim in treating diabetes is to lower the blood sugar level without causing hypoglycemia or a condition characterized by abnormally low levels of blood sugar. Whatever the type of diabetes may be and whatever treatment plan is being adhered to, care must be taken that the blood sugar levels are monitored on a frequent and consistent basis. Monitoring is the first step in determining the severity of diabetes and it is then followed up with deciding on the appropriate measures to be taken in order to control the condition.

Prediabetes is the stage where one can control the blood sugar level from rising and prevent diabetes from occurring [2]. This can be treated with adequate amounts of exercise followed in conjunction with a diabetic diet. In some rare cases, oral medication may also be prescribed, especially if there has been a history of preeclampsia or Gestational Diabetes in the past.

Type I Diabetes is treated with exercise, diabetic diet and external insulin administration. Insulin may be injected intravenously or an insulin pump may be used to administer the dose. Active medical and scientific research is being done in order to come up with newer and more convenient methods of externally administering insulin to diabetics. Insulin cannot be administered orally as the enzymes present in the human stomach interfere with the functioning of insulin.

There are some extremely rare cases in which a transplantation of the pancreas is used in order to treat Type I Diabetes. This is only carried out if some other organ of the body has also failed and requires transplantation such as the kidneys. However, this process may yield dangerous effects on the body and also results in higher chances of infections to internal organs.

Type II Diabetes is first treated with exercise, weight reduction and a diabetic diet. In case these measures prove to fail in controlling the disease, oral hypoglycemic drugs such as metformin, prandin, glimepiride and pioglitazone are used. If oral medications are still insufficient, treatment with insulin or insulin analogues like insulin Lispro, insulin Glargin and insulin Aspart are considered useful.

Bariatic surgery is a lesser used method to treat Type II Diabetes. People who have a BMI greater than 35 may see improvements in conditions by undergoing this type of surgery.

Gestational Diabetes can be treated by exercise and diet modification. Only 15% of women with gestational diabetes need medications like oral hypoglycemics or sometimes insulin analogues. However, any female who has experienced an episode of Gestational Diabetes stands a risk of developing the condition again in subsequent pregnancies and may also develop prediabetes and Type II Diabetes in the future. As such, care and treatment procedures will need to be continued throughout the life of the diabetic.

Weight reduction and exercise are important treatments for diabetes. Weight reduction and exercise increase the body’s sensitivity to insulin, thus helping to control blood sugar elevations. A diabetic diet is also an important measure to prevent as well as control diabetes. It is recommended that diabetics have more of fruits, vegetables and whole grains in the diet. Fatty foods and sugary foods should be avoided as far as possible. A diabetic diet often involves a calorie count which is supposed to be strictly adhered to.

Signs of Danger in Diabetics

While there may be many methods to help control the symptoms of diabetes, care must be taken not to lower the blood sugar levels abnormally and also to prevent other potential hazards [3]. Some of the signs of danger that must be taken heed of at the earliest include:

• An increased presence of ketones in the urine. Ketones are toxic produces of the body when it breaks down fat for energy rather than using glucose. This condition is known as Diabetic Ketoacidosis and is accompanied with an extreme loss of appetite, a general feeling of weakness and fatigue, nausea and vomiting, stomach pains and also fever. This condition is more frequently associated with Type I Diabetes.
• Hypoglycemia or a low blood sugar level is also a complication associated with improper treatment of diabetes. This is likely to happen if, during the course of treatment, a meal is skipped or higher than normal physical activity is undergone. This condition is characterized by a feeling of dizziness, sweating, jitters, extreme hunger, blurring of the vision and palpitation of the heart, confusion, faintness and even seizures. The condition can be quickly remedied by having glucose tablets or a fruit juice.
• Extremely high blood sugar levels can lead to a condition known as hyperglycemia and this can adversely affect the condition of a diabetic. The signs and symptoms of the condition include the frequent need to urinate, dehydration and dryness, fatigue and blurred vision and the condition requires adjustments made to both the dietary plan as well as the medications used for treating diabetes.
• A life threatening complication involves an extremely high blood sugar level, typically around 600mg/dL. This condition is extremely serious and is known as hyperglycemic hyperosmolar non-ketotic syndrome and is characterized by the sugar present in the blood to turn thick and syrupy. It causes hallucinations, loss of vision, confusion and seizures and can also lead to death. This condition is more commonly associated with Type II Diabetes.

If any complications and symptoms are experienced by individuals, immediate medical attention needs to be provided at the earliest. These conditions can potentially be life-threatening and must be controlled at the earliest before too much damage has been inducted.

Alternative Remedies for Diabetes

There are some alternative medication procedures and therapies which may prove to help in controlling the symptoms of diabetes. While there are some such therapies, none of them are clinically proven and there is no established or agreed benefit upon resorting to these therapies. If individuals are keen on seeking alternative medications and therapies, they should do so only after proper medical consultation.

Diabetes does not have any treatment and it is a potentially life-threatening condition. Diabetics must take care to adhere to a strict treatment plan which is recommended and also approved.

Home Remedies and Lifestyle Tips for Diabetes

Since diabetes does not have a definitive cure, patients must learn to cope up with the disease and bring about healthy changes to diet and lifestyle in order to lead a close to normal life. This means that the diabetic individual will require to actively take measures through all aspects of life and to also seek proper medical treatment.

A strong mental commitment to fight the disease is the first and foremost step that must be taken in order to beat the symptoms. Diabetic individuals are urged to find out as much about the disease as possible, its methods of containment and also the various complications that may be associated with diabetes.

Any excess weight should be shed off and regular physical activity is highly recommended to diabetics. This highly increases the sensitivity of the body to insulin and also makes sure that the cells of the body can absorb sugar more effectively. Regular exercise should always be combined with a diabetic diet after taking consultation from healthcare providers or dieticians.

Diabetics are also advised to always carry along with them a tag which mentions that they are diabetics who may require assistance in cases of emergencies [4]. A glucagon kit should also be carried along at all times and the close friends and family of a diabetic should learn how to properly administer insulin in cases of emergencies.

Medical checkups, which involve not just the monitoring of the blood sugar levels, but also the checking of sensitive regions for any potential damage caused to the blood vessels and the nerve tissues, should be carried out on a frequent basis. Eye checkups are also recommended to be had frequently.

Vaccinations against different types of infections should always be taken on time. Diabetics are more prone to develop infections and the healing process is also slow in diabetics. It is a must that they ensure to keep themselves vaccinated and always up to date.

Blood pressure levels and cholesterol levels must always be kept in check. In some cases, medications may also be used to keep these in check.

Special attention should be given to the gums, the teeth, the feet and also the genital areas when diagnosed with diabetes. These regions of the body are much more prone to infections than other parts and medical attention needs to be provided at the earliest in case of any problems.

Alcohol should always be had after careful consideration. Not only may the alcohol and the associated mixing drinks upset the diabetic diet, but excess of alcohol can prove to cause complications in diabetics. The recommended amount of alcohol to be consumed is not more than one drink for a woman and not more than two for a man.

In case a person diagnosed with diabetes mellitus is a smoker, cessation of smoking must be done at the earliest [5]. Use of tobacco greatly increases the risks of complications and may also lead to the development of cardiovascular diseases in diabetics. Cessation of smoking is not easy and often, special alternatives and other nicotine products are the starting point to quitting smoking.

Diabetics may be prone to be hypertensive and stressful. This stress will always need to be effectively managed as there is already enough abnormal pressure on the delicate blood vessels and the nerves of a diabetic. Plenty of sleep, meditation and relaxation are recommended to diabetics in order to keep stress levels in check.

 

References

[1] Changing the Way Diabetes is Treated With Information and Resources, James R. Gavin III, MD, PhD; 24 no. 1 14-16 – January 2006 – DOI: 10.2337/diaclin.24.1.14Clinical Diabetes, http://clinical.diabetesjournals.org/content/24/1/14.short

[2] Continuous glucose monitoring and intensive treatment of type 1 diabetes, Tamborlane WV,Beck RW, Bode BW, Buckingham B, Chase HP, Clemons R, Fiallo-Scharer R, Fox LA, Gilliam LK, Hirsch IB, Huang ES, Kollman C, Kowalski AJ, Laffel L, Lawrence JM, Lee J, Mauras N, O’Grady M, Ruedy KJ, Tansey M,Tsalikian E, Weinzimer S, Wilson DM, Wolpert H, Wysocki T, Xing D,; 359(14):1464-1476 – September, 2008 – DOI: 1056/NEJMoa0805017, http://europepmc.org/abstract/med/18779236,,

[3] A Randomized Trial of Therapies for Type 2 Diabetes and Coronary Artery Disease, The BARI 2D Study Group,; 360(24): 2503–2515 – Jun 7, 2009 – DOI: 10.1056/NEJMoa0805796, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2863990/

[4] Diabetes Mellitus:  Pathogenesis and Treatment Strategies, Jay S. Skyler,; 47 (17), pp 4113–4117 – July 20, 2004 – DOI: 10.1021/jm0306273, http://pubs.acs.org/doi/abs/10.1021/jm0306273?journalCode=jmcmar

[5] The Burden of Treatment Failure in Type 2 Diabetes, Jonathan B. Brown, PHD, MPP1, Gregory A. Nichols, PHD1and Andrew Perry, MA HONS, MSC2.; 27no. 7 1535-1540 – July 2004 – DOI: 10.2337/diacare.27.7.1535, http://care.diabetesjournals.org/content/27/7/1535.short

Diabetes is a fairly common condition and it affects people across all ages across different parts of the world [1]. While the symptoms associated with diabetes vary quite a lot across the different types of the disorder, there are a few symptoms which are common across all the types of diabetes and equally in men, women and children. These symptoms include the following:

• Excessive urination – Also known as polyuria, this is one of the most common symptoms of diabetes where the person feels an urge to urinate several times in a day being more than 2.5 liters per day. This is because the body tries to eliminate the excess glucose through urine.
• Increased thirst – Polydipsia or excessive thirst is another common symptom of diabetes mellitus which is induced due to loss of fluids from the body and it may even lead to dehydration if not fulfilled.
• Increased hunger – Also known as polyphagia is found in diabetic patients as the body cells do not get sufficient calories for routine activities due to accumulation of glucose in blood and inability of glucose to enter these.
• Fatigue or increased tiredness due to insufficient calorie production and the body cells being unable to effectively absorb sugar from the blood stream even though there is enough present.
• Slow healing of wounds is another important feature that is seen exclusively in diabetic patients. This happens because the cells are unable to actively use energy in order to help the skin tissues to heal.
• Numbness or a tingling sensation in limbs – When a person feels loss of sensation in his/her hands or feet as the blood circulation are reduced due to accumulation of high level of glucose in bloodstream. This can be mild to pretty severe.
• Unexplained Weight Loss – Any unexpected weight loss, even when eating quite a lot of food is a common symptom of the body not being effectively able to absorb sugar and is a symptom of some type of diabetes.
• Higher risk to infections – A diabetic person is more prone to an infectious disease as compared to a normal person due to lower blood circulation and immunity. An example of this is yeast infection and also infections happening in the feet and the gums.
• Miscellaneous – Some of the other symptoms of diabetes includes blurring of vision, itchiness of the skin, weight loss, irritability and a lack of interest, fruity odor in breath and a loss of concentration while working or studying.

Besides these symptoms, there are also certain age and sex specific symptoms associated with the different types of diabetes.

Diabetes in Men

Type I Diabetes symptoms in men include [3]:

• Erectile dysfunction might be found in males with Type I Diabetes
• Fatigue and weakness that may be accompanied with nausea, persistent headaches, and vomiting

Type II Diabetes symptoms in men include:

• Impotency
• The skin may show velvety patches or dark spots
• There may be itchy feeling around genitals
• Weight gain that could be sudden

Some of the symptoms that are common to any type of diabetes in men include the following:

• Erectile dysfunction is often associated with any type of undiagnosed diabetes mellitus in men. This is usually caused by damage being done to the blood vessels which carry blood to the penis due to the presence of excess sugar in the blood stream. Erectile dysfunction refers to a condition in which men are not able to achieve or to sustain an erection.
• Sudden loss of muscle mass which also leads to reduced strength in males is associated with diabetes mellitus. This happens when the body is unable to effectively use the sugar in the blood for energy and resorts to breaking down of fatty tissues and muscle mass for obtaining energy. While this is more commonly associated with Type I Diabetes, unexplained and sudden loss of muscle mass in men also occurs during Type II Diabetes.
• Appearance of thrush in and around the genitals which occurs on a recurring basis. This is caused due to infection by yeast and also involves a lot of blood sugar being excreted alongside urine. This condition is also characterized by redness, itching and swelling of the head of the penis, an unpleasant odor emanating from the penis, the appearance of curd-like white substance on the skin surface and extreme soreness of the skin on the penis during sexual intercourse. Itching of the skin, especially around and on the surface of the penis is also common when there is an appearance of genital thrush.

Diabetes in Women

Type I Diabetes symptoms in women include:

• Sudden weight loss even despite of increased appetite
• Nausea
• Vomiting
• Vaginal yeast infection

Type II Diabetes symptoms in women include:

• A condition known as Acanthosis Nigricans or the appearance of dark patches on the skin
• Dry and scaly skin which may also exhibit itching
• Fungal infection especially in the vaginal region
• Certain psychological effects such as irritability, agitation, nervousness
• Sexual dysfunction or discomfort as well as pain during sexual intercourse
• Urinary tract infection

Some of the symptoms of diabetes which are common to women across different types of the disorder include the following [5]:

• Vaginal thrush and yeast infections are common across different types of diabetes. This is also associated with an excess of glucose being discharged with the urine. Vaginal thrush and yeast infections are characterized by soreness, reddening and a white appearance on the surface of the vaginal skin and also involve itching around the vaginal area. Sometimes, a white fluid may be discharged from the vagina and intense pain is felt during intercourse. The high concentration of sugar in the blood also decreases the lubrication of the vaginal canal. Sometimes, yeast infections may also be oral.
• Sexual dysfunction in females is also typically associated with different forms of diabetes. This can include a general lack of libido, a difficulty in feeling aroused and inability to reach an orgasm. The high blood sugar levels can cause nerve damage to the genital area and this is often the cause of sexual dysfunction in females.

Gestational diabetes during pregnancy

In women who become pregnant after 35 years of age, there might be various pregnancy related complications where the increased glucose levels in blood may enter the fetus through placenta and may cause large size of baby that may lead to complications during delivery, including the need of a C-Section surgery.

 

The symptoms of Gestational Diabetes cannot be easily determined and as such, screening methods are used to check whether the blood sugar levels are in the normal range. Pregnant women will need to have frequent medical check-ups, especially during the third trimester of pregnancy. Women will need to avail the services of an endocrinologist, an educator for diabetes and also a dietician in order to understand the symptoms of the disorder and also all of its associated complications.

Some of the known risk factors of Gestational Diabetes include:

• Women who are overweight or obese during the onset of pregnancy, especially those with a BMI greater than 30
• Women who have had a history of Gestational Diabetes in the family or in the past
• Women who are Hispanic, Black, Native American or Asian American are more prone to developing Gestational Diabetes although the cause for this is unclear

Diabetes in Children

Type I Diabetes symptoms in children include:

• Irritability and other psychological effects such as being moody and hypertensive
• Lack of concentration and blurring of the vision
• Bedwetting on an irregular basis
• Unexplained fatigue
• Extreme hunger, increased thirst and the frequent need to urinate
• Female children may exhibit yeast infections around the genital area and female infants may also develop rashes caused by the diapers

The risk factors which may lead children to develop Type I Diabetes include the following:

• Viral infections by some specific pathogens which destroy the functioning of the beta cells of the pancreas.
• A low level of Vitamin D being available to a child after childbirth increases the chances of developing Type I Diabetes.
• Dietary factors such as the early introduction of cow’s milk and also cereal to a baby’s diet make the child much more prone to developing Type I Diabetes.

Type II Diabetes symptoms in children include:

• Dry mouth also known as Xerostomia
• Darkening of skin and the formation of patches
• Itching and redness on the skin surface
• An unexplained loss in mass and weight
• Extreme thirst and hunger felt even right after eating and drinking
• Difficulty in breathing and heaviness of the breath
• Extremely slow healing of cuts and sores

The risk factors of Type II Diabetes in children include the following:

• A BMI above 85% can lead to children developing Type II Diabetes.
• Any sibling, parent or relative having Type II Diabetes.
• Children of particular races including Native American, Hispanic, Asian American and also Pacific Islander are at a higher risk of developing the condition.
• Children who exhibit signs of resistance to insulin such as the appearance of darkened skin around the armpits and the neck is considered to be e risk factor to Type II Diabetes in children.

Diabetes Complications

If the symptoms of diabetes mellitus are not taken care of, they might exaggerate and lead to following complications [4]:

• Damage to the body: High blood glucose levels may damage the small blood vessels and nerves of the body leading to atherosclerosis, or hardening of the arteries that can further lead to heart attack and stroke. There is a greater risk to becoming more susceptible to various infections, skin ulcerations and gangrene in limbs due to poor blood circulation. This may also result in the need for amputation of limbs.
• There is an increased chance of encountering cardiovascular diseases if the signs and symptoms of diabetes are left uncontrolled. These include various coronary artery diseases, heart diseases, heart attacks, stroke and also excessive pain in the chest or angina.
• The increased level of sugar in the blood results in an increase in urinating frequency, causing dehydration of the body. It leads to a dryness and foul odor originating in the mouth.
• Diabetic coma: If a person with Type II Diabetes is severely dehydrated and is not able to make up for the fluid losses may lead to a reversible form of coma which is of three types; diabetic hypoglycemia, diabetic ketoacidosis ( a combination of hyperglycemia, dehydration and shock) and hyperosmolar non-ketotic diabetic coma.
• Retinopathy: Increased blood sugar levels may damage the nerves and blood vessels of eyes leading to retinopathy. Thus it is important to control blood sugar level as well as blood pressure and cholesterol to prevent eye diseases. Severe diabetes may also lead to loss of eyesight.
• Complications in diabetes also lead to diseases being developed in the foot. This occurs due to nerve damage and is typically characterized by infections, cuts and blisters being developed on the feet, which, if ignored can lead to serious conditions even requiring amputation.
• Diabetic people are also more prone to damage their hearing as the nerve and blood vessels may tend to get damaged.
• Type II Diabetes is also associated with a higher risk of developing Alzheimer’s disease.
• Bacterial and fungal infections of the skin are extremely common if diabetes is left untreated.
• Complications involved with Gestational Diabetes can lead to both the mother and the child developing prediabetes or Type II Diabetes later in the future. Unattended Gestational Diabetes can also lead to serious conditions such as preeclampsia and may cause death of both the mother and the child. A mother who has suffered an episode of Gestational Diabetes is also more prone to developing the condition again with subsequent pregnancies.

Diabetes mellitus is a chronic and common disorder which affects many people all over the world. If the signs and symptoms of the disease are ignored and the warning signs are left unattended, diabetes can result in a range of other associated complications which can even lead to death in severe cases.

 

References

[1] Diabetic Peripheral Neuropathic Pain: Clinical and Quality-of-Life Issues, Charles E. Argoff, MD^a, B. Eliot Cole, MD, MPA^{b, ,} , David A. Fishbain, MD, FAPA (Distinguished)^c, Gordon A. Irving, MBBS, FFA (SA), MMed, MSc^d; Volume 81, Issue 4, Supplement, Pages S3-S11 – April 2006 – DOI: 10.1016/S0025-6196(11)61474-2, http://www.sciencedirect.com/science/article/pii/S0025619611614742

[2] Role of diabetes in congestive heart failure: The Framingham study, William B. Kannel, MD, FACC^{,1, 2}, Marthana Hjortland, PhD^{1, 2, ∗}, William P. Castelli, MD^{1, 2},; Volume 34, Issue 1, Pages 29-34, – July 1974 – DOI: 1016/0002-9149(74)90089-7 ,http://www.sciencedirect.com/science/article/pii/0002914974900897

[3] Diet and risk of clinical diabetes in women, G A Colditz, J E Manson, M J Stampfer, B Rosner, W C Willett, and F E Speizer; 55no. 5 1018-1023 – May 1992, http://ajcn.nutrition.org/content/55/5/1018.short

[4] Pregnancy complications and outcomes among overweight and obese nulliparous women, Mark B. Landon, M.D., Catherine Y. Spong, M.D., Elizabeth Thom, Ph.D., Marshall W. Carpenter,; v.91(3); 436–440 – Mar 2001, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446581/

[5] A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes, M.D., Susan M. Ramin, M.D., Brian Casey, M.D., Ronald J. Wapner, M.D., Michael W. Varner, M.D., Dwight J. Rouse, M.D; Vol. 94, No. 9, pp. 1549-1554 – September 2004 – DOI: 10.2105/AJPH.94.9.1549, http://www.nejm.org/doi/full/10.1056/NEJMoa0902430

Diabetes is a metabolic disorder that can occur in any age. It is characterized by an increase in the blood glucose levels which may be either due to insufficient production of insulin, the inability of body cells to use insulin properly or due to production of defective insulin depending upon the type of diabetes.

While the exact causes of diabetes are still not known, the conditions that characterize diabetes are pretty well agreed upon and symptoms are largely the same. While researches still debate on the exact causes of the disorder, many argue that genetic factors, including the presence of some form of the disease in the history of the family, combined with some special triggers such as some specific environmental factors can lead to individuals developing the condition.

The Role of Glucose

Glucose is the primary fuel of the body. It is the substance which is carried to all parts of the body via the blood and is absorbed by the cells of the body. Glucose is obtained by the body through the process of digestion and is carried out by the liver. When the food is being digested, excess amounts of glucose are also stored by the liver in the form of glycogen. When the body requires more glucose, the liver breaks up the glycogen into glucose and then releases it into the blood stream.

Any physical activity requires more energy and the body cells actively take up more sugar from the blood stream. As the level of glucose in the blood stream decreases, the regulation of the hormone insulin helps to keep the levels in check in order to provide the necessary energy to different parts of the body.

The Effect of Insulin

In order to try and understand the causes of diabetes, first the action of insulin on the body must be understood. Insulin is a hormone that is secreted by the beta cells present in the pancreas. Insulin is responsible for regulating the way in which the cells of the body absorb glucose from the blood stream. In cases of diabetes, the sensitivity of the body to insulin is greatly hindered and the cells of the body are unable to effectively absorb sugar from the blood stream. This is turn, results in a buildup of the concentration of glucose in the blood. When the glucose levels are abnormally high, it leads to the diagnosis of some type of diabetes or prediabetes.

Causes of Type I Diabetes

Type I Diabetes is caused due to insulin deficiency which occurs due to destruction of insulin producing beta cells in the pancreas. It is an autoimmune disease caused due to self-destruction of beta cells by the body’s own defense cells. Latent auto-immune diabetes (LADA) is also found in adults and is often mistaken as Type II diabetes.

Genetic susceptibility and heredity are also causes of Type I Diabetes and some individuals are more prone to developing the condition than others [5]. These genes, which are passed down in a family through generations can determine whether a member will develop the condition in the future. Type I Diabetes occurs more commonly in children and young adults. Heredity gas a major role to play in Type 1 diabetes as it is passed on from one generation to other through genes. HLA or Human Leukocyte Antigens also play an important role in determining the chances of occurrence of diabetes in an individual since these cells help in recognizing the body’s own cells as foreign cells leading to their auto-destruction.

People who are genetically susceptible to developing Type I Diabetes may become diabetic when triggered by environmental factors like diet, viruses, and toxins. However, the exact mechanism or the nature by which this process is triggered is still not known. While some theories suggest that these factors aid in the destruction of the beta cells, some other theories seem to suggest that these factors play a longer and ongoing role in the condition.

While a virus or an infection cannot trigger Type I Diabetes on their own, there has often been a link which suggests that certain factors can trigger the condition in individuals who are already at the risk of developing the disease [4]. Some of the commonly associated pathogens include:

• Cytomegalovirus
• Rubella
• Adenovirus
• Coxsackievirus
• Mumps

There is active research being carried out in order to develop a vaccine which can help individuals fight these pathogens.

Infants, who face improper feeding practices, such as the early or late introduction of cereal to the diet, or an early exposure to cow’s milk rather than mother’s milk are at a higher risk of developing Type I Diabetes.

Type I Diabetes mellitus can also be controlled or corrected by intake of insulin as a curative measure.

Causes of Type 2 Diabetes

Type II Diabetes is caused due to a number of factors like insulin resistance, where the body’s muscle, fat, and liver cells become ineffective to use up all the insulin. Type II Diabetes occurs when the body is no longer able to produce enough insulin as a compensatory mechanism.

Type II Diabetes is more prevalent than Type I Diabetes as it is found in almost 90% of the total diabetic cases whereas less than 10% of diabetics suffer from Type I Diabetes. Type II Diabetes develops commonly in middle-aged and old people and more often in overweight or obese individuals. Triggers of Type II Diabetes include genetic susceptibility, lifestyle or dietary factors. Various studies have been done all over the world to prove that Type II Diabetes is caused due to obesity and physical inactivity in the youth today.

Genetic studies reveal that some specific variants of genes can cause individuals to be at a higher risk of developing Type II Diabetes. However, only a few of these gene variants have been identified and the majority of these are still to be discovered.

Genes may also influence how much a person weighs and obesity is also thought to be caused by genes. Obesity can also greatly increase a person’s susceptibility to developing Type II Diabetes.

A sedentary lifestyle, especially among the elderly, is also associated with Type II diabetes. Such people, if they are also genetically susceptible to the disease are much more vulnerable to the condition.

In some special cases, the liver of individuals proves to produce excess amounts of glucose, even when the body does not require sugar. In such conditions, the sugar rapidly builds up in the blood stream and the effect of insulin is no enough to counter these levels. In such cases, metformin is often prescribed to control the high concentrations of sugar in the blood.

When the body of an individual develops a resistance to the effects of insulin, the condition is known as insulin resistance syndrome or metabolic syndrome which is characterized by the following:

• A glucose level in the blood stream which is much higher than normal
• An excess of fatty tissues, especially in the abdominal area leading to an increase in the waist size
• An increase in the blood pressure levels
• An abnormally high concentration of triglycerides and cholesterol in the blood stream

Type II Diabetes can also be caused because of a dysfunction of the beta cells of the pancreas [3]. Any impairment of these cells causes abnormal amounts of insulin to be released into the blood stream and this process results in a higher concentrations of blood sugar.

Sometimes, the process in which cells regulate their communication and signaling is also affected and there is an improper channel of communication. In such cases, the some proteins and other specific substances affect the sensitivity of insulin to the body. This can also prove to cause Type II Diabetes. Research is actively being conducted in this area in order to determine how exactly this process is associated with the development of Type II Diabetes in an individual.

Type II Diabetes can be reversed by medications that may either reduce the glucose production by liver or by increasing the sensitivity to insulin. It can also be controlled or prevented in susceptible individuals by modifying the lifestyles such as by taking up physical exercises, by diet modification (by replacing saturated fats and trans fatty acids with polyunsaturated or monounsaturated fatty acids) to control obesity.

Some of the known risk factors which can leave individuals susceptible to Type II Diabetes include:

• People who are above the age of 45
• Individuals who are overweight
• Individuals who lead a sedentary lifestyle
• People who have a family history of any type diabetes having occurred
• People of some particular races are at a higher risk than others
• Any history of prediabetes or Gestational Diabetes can lead to Type II Diabetes
• High blood pressure conditions can also increase the risk of developing the condition
• Any abnormally low level of good cholesterol or an excess of triglycerides is associated with the condition
• Any history of a cardiovascular disorder also increases the risk of an individual encountering the disease

Causes of Gestational Diabetes

Gestational diabetes is exclusively associated with pregnant females especially in their third trimester who had never suffered from diabetes previously [2]. About 2-10% of all pregnant women suffer from gestational diabetes. Just like Type II Diabetes, even Gestational Diabetes occurs due to inadequate insulin secretion as well as decreased responsiveness to insulin. In most of the cases of gestational diabetes, it is corrected after the delivery but in some cases it may continue to occur. Gestational Diabetes is harmful to both mother and fetus and may result in few complications if not controlled.

Gestational Diabetes can occur in women due to dysfunction of the beta cells of the pancreas or a resistance being developed by the body in response to insulin. As with Type II Diabetes and prediabetes, Gestational Diabetes is also more frequently associated with obese people and people who are overweight. Uživatelské příručky.

Women who have a family history of any kind of diabetes are also at a higher risk of encountering the disease. This again, suggests that heredity and genes play a major role in determining diabetes in an individual. Gene variants, as also a combination of gene variants can prove to cause Gestational Diabetes in some women.

Pregnant women who are diagnosed with Gestational Diabetes are also at a higher risk of contracting both prediabetes and Type II Diabetes in the future. While Gestational Diabetes is a non-chronic condition and the blood sugar levels in the mother’s body return to normal shortly after child birth, care will always need to be taken throughout the life of the individual in order to prevent the onset of the chronic disease.

Causes of Prediabetes

The causes of prediabetes are generally considered to be the same as the causes of Type II Diabetes [1]. In this condition, the cells of the body become resistant to the action of insulin on the body, and this leads to a buildup of the sugar levels in the blood stream. While the concentration of glucose in the blood is high, it is still not high enough to be diagnosed as Type II Diabetes and in such cases, prediabetes is said to be diagnosed.

Others causes

There are other conditions that may lead to diabetes at some stage of life. For instance gene mutations, Malnutrition Related Diabetes Mellitus (MRDM) or injuries and defects in pancreas can lead to any form of chronic and non-chronic diabetes being diagnosed in an individual. Endocrine diseases which affect the release of hormones might cause improper amounts of insulin being released into the blood stream.

Genetic mutations may cause the beta cells of the pancreas to dysfunction and more often than not, such mutations occur spontaneously. Some known genetic diseases such as Turner Syndrome, Klinefelter Syndrome and also Down syndrome are also associated with cases of diabetes and active research is being carried out in order to determine a definitive genetic link between all of these disorders.

In some cases, damage done to the pancreas, including damage caused by any surgery to organs around the pancreas can also trigger the onset of some types of diabetes.

 

References

[1] The Economic Burden of Diabetes and the Benefits of Improved Glycemic Control: The Potential Role of a Continuous Glucose Monitoring System, Jay S. Skyler.; 2(supplement 1): 7-12 – July 5, 2004 – DOI: 10.1089/15209150050214069, http://online.liebertpub.com/doi/abs/10.1089/15209150050214069?journalCode=dia

[2] Role of AMP-activated protein kinase in mechanism of metformin action, Gaochao Zhou, Robert Myers, Ying Li, Yuli Chen, 108(8): 1167–1174 – Oct 15, 2001 – DOI: 1172/JCI13505, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC209533/

[3] Effects of Once-Weekly Dosing of a Long-Acting Release Formulation of Exenatide on Glucose Control and Body Weight in Subjects With Type 2 Diabetes, Dennis Kim, MD1, Leigh MacConell, PHD1, Dongliang Zhuang, PHD1, Prajakti A. Kothare, PHD2, Michael Trautmann, MD3, Mark Fineman, MS1and Kristin Taylor, PHD1; 30no. 61487-1493 – June 2007 – DOI: 10.2337/dc06-2375, http://care.diabetesjournals.org/content/30/6/1487.short

[4] Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus, N Engl J Med. 2010 Apr 29; 362(17): 1563–1574.; Mar 14, 2010 – DOI: 1056/NEJMoa1001282, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879499/

[5] Adiponectin and adiponectin receptors in insulin resistance, diabetes, and the metabolic syndrome, Takashi Kadowaki,^1,2Toshimasa Yamauchi,^1,3 Naoto Kubota,^1,2,3 Kazuo Hara,^1,2 Kohjiro Ueki,¹ and Kazuyuki Tobe¹ ; 116(7): 1784–1792 – Jul 3, 2006 – DOI: 1172/JCI29126, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1483172/

Prediabetes is a condition in which all the symptoms required to label any person ‘diabetic’ are not met but still blood sugar levels are high enough which cannot be considered normal [5]. While diabetes is the condition in which all the diagnostic tests show high blood sugar levels in the results, Prediabetes is the condition in which diagnostic tests show the level of blood sugar in the body which is neither that high that it is considered as diabetic and not even normal. This condition is basically a very alarming sign signaling the upcoming metabolic disease.

The patients who are suffering from prediabetes are at high risk of developing Type II Diabetes more or less in 10 years. They should get alarmed if they are diagnosed with prediabetes and should change their lifestyle and follow the healthy regime and should also start involving themselves in more physical activity.

If left unattended, prediabetes can easily develop into full blown Type II Diabetes and may have adverse effects on the circulatory system as also the heart and other essential organs in the body. However, following a proper treatment procedure can easily help the blood sugar levels to drop down to normal and as such prediabetes is not classified as a chronic disorder. Maintaining a healthy diet and lifestyle while keeping the weight in check can greatly help in reducing the sugar levels in an individual’s blood stream.

Blood sugar levels in Prediabetes

There are basically two criteria for considering the patient in prediabetes. And different physician follow different criteria. These two criteria for setting upper limit of fasting blood sugar level, a medical terminology, that is prediabetes are:

• WHO criteria upper limit of fasting blood sugar is 110 mg/dl
• ADA criteria upper limit of fasting blood sugar is 100 mg/dl

So, the patients showing this upper limit level or high are considered to be suffering from prediabetes.

Causes of Prediabetes

While the exact cause of prediabetes being developed in individuals is not known, it is generally agreed to be a condition which is caused by a combination of factors, primarily of which are genetics and the medical history of the family. Inactivity and the presence of excess fatty tissue in the body are also commonly linked to the condition.

As with proper diabetes, in prediabetes, the cells of the body are unable to effectively take up glucose from the blood stream and this subsequently leads to a build-up of the sugar levels in the blood stream. While this condition still is not threatening, it is definitely a wake-up call to individuals to change their lifestyle and to properly manage the condition.

Causes of prediabetes can include both the pancreas of the body producing insufficient insulin or the body failing to react to the effects of insulin effectively.

Prediabetes should always be taken seriously as it means that an individual is exposed to the risk of developing Type II Diabetes later on in the future. While the condition is not chronic by itself, it can very easily develop into a chronic condition if left unattended to or if improperly treated.

Risk factors in Prediabetes

One should aware of the risk factors which lead to development of this condition. Following are various factors:

• Overweight: Being overweight, is not only a risk factor for this disease, in fact it invites a number of many other metabolic diseases with it. The fat cells in the body increase in resistance against insulin and thus make a favorable environment for the development of Type II Diabetes.
• Sedentary lifestyle: A sedentary lifestyle is highly associated with prediabetes. Physical activity greatly helps the cells of the body to effectively react to insulin and to absorb as much glucose from the blood stream as possible. Lack of activity can cause the fat cells to not absorb any glucose at all.
• Genetics: Genetics play a major role in the development of prediabetes along with other factors influenced by the external environment. If an individual has a family history of diabetes, then they are more likely to develop this condition unless a healthy lifestyle is being followed.
• Ovarian syndrome: The women suffering from polycystic ovarian disease, a condition characterized by presence of cysts in ovaries and irregular menstrual period, are more likely to develop this condition sometime in their life.
• Improper sleep: Individuals who are not getting proper sleep or adequate time of sleep are at the risk of prediabetes. This has been proven by some recent studies. Lack of sleep as well as excess of sleep, both lead to increase the body’s resistance against insulin.
• Age: While prediabetes can affect individuals at any age, the condition is more commonly associated with elderly people.
• Waist size: A large waist size, typically caused by the deposition of excess fatty tissue around the abdominal region also increases the risk of an individual developing prediabetes.
• Gestational Diabetes: Women who have had Gestational Diabetes in the past are also at a higher risk of developing both prediabetes and Type II Diabetes.

Some of the common medical conditions that are also associated with prediabetes include:

• An abnormally high blood pressure level
• A very low level of HDL (good) type of cholesterol
• An excess of triglycerides, a type of fat in the blood stream
• Obesity

Prediabetes, if left unattended to, can result in some complications. These may include:

• Progression of the disease to full blown Type II Diabetes
• Diseases associated with high blood pressure and high cholesterol levels
• Stroke
• Heart and other cardiovascular diseases
• Kidney diseases
• Amputations in extremely severe cases
• Blindness in some extreme cases

Tests for Diagnosing Prediabetes

The testing of prediabetes can be done using any of the following [2]:

• A glycated hemoglobin test, also known as an A1C test is used to measure the amount of blood sugar or glucose that is attached to the red blood cells of the body. A normal A1C test result lies below 5.7%. A test result in between 5.7% and 6.4% determines prediabetes. In case the result is above 6.5%, full blown diabetes is suspected and additional tests are required to be carried out. This test, however, is not very accurate for pregnant women and also people who have a variant of hemoglobin in their body.
• A blood sugar test after fasting is also used in order to determine prediabetes. Under normal circumstances, the test results indicate a blood sugar concentration level of less than 100mg/dL or 5.6mmol/L. If this level rises up to 125mg/dL or up to 6.9mmol/L, it indicates prediabetes in an individual. Levels even higher than this determines full blown diabetes mellitus.
• An oral glucose tolerance test may also be used to determine prediabetes. After the oral sample has been consumed, the blood sugar levels are checked after a period of 8 hours in order to determine the condition. A blood sugar concentration level between 140mg/dL to 199mg/dL indicates prediabetes.
• If the blood sugar levels are within check, but the individual is at a risk of developing prediabetes, the doctor may advise on frequent and regular screening tests and checkups to be conducted from time to time. The levels of blood pressure and also the cholesterol levels should be kept in check alongside the monitoring of blood sugar levels.

Your health is your treasure. To keep your body healthy and free from disease, you should first start losing your weight, if you are overweight and in your diet, the following things you need to take care of:Treatment and Prevention of Prediabetes

• Eat boiled food only and stop eating fried foods.
• Cut the amount of butter and oil you use in your cooking.
• Eat more green vegetables and go for more protein diet like fish and chicken and cut down on your carbohydrates.

Individuals suffering from, or at a risk to developing the condition should also get as much physical activity as they can. Typically, it is recommended that individuals get a least an hour of moderate to rigorous physical activity every day.

Often, people who are overweight are at a higher risk of developing the condition. Excess weight should be shed off as soon as possible as obesity and a higher weight greatly increases the chances of developing Type II Diabetes in the future.

In some special cases, sufferers of prediabetes may need to resort to oral medications in order to control the symptoms. In such cases, metformin is a commonly prescribed drug. Typically, this is only prescribed if the individual is over 60, or has a history of gestational diabetes or has a body mass index greater than 35. In addition to medications aimed directly at controlling the symptoms of prediabetes, indirect medications may also be used which can help regulate the blood pressure levels and can also help keep the cholesterol levels in check.

Alternative Therapies for Prediabetes

There are a range of alternative therapies that are used across the world [3]. While none of these are clinically proven, these remedies may prove to be quite effective in helping alleviate symptoms of prediabetes. Despite the lack of definitive evidence, the following alternative medications and remedies are quite popular:

• Chromium
• Cassia cinnamon
• Coenzyme Q10
• Ginseng
• Glucomannan
• Guar gum
• Gymnema
• Magnesium
• Soy
• Prickly pear cactus
• Stevia

There are many other dietary supplements and alternative therapies available. However, it is recommended that these therapies are only sought in conjunction with the traditional methods of treatment of the condition and also after the recommendation of a licensed medical professional or healthcare provider.

Some Tips for Prediabetes Appointment

Individuals who have been diagnosed with prediabetes or those who stand a risk of developing the disease will need to visit a licensed medical practitioner in order to successfully control the symptoms of the disorder [4]. Thankfully, this is a relatively simple procedure. Individuals should not fear this and must avail of medical attention at the earliest before any complications arise.

Sufferers must always adhere to the prerequisites of the diagnostic tests conducted on them. Some such tests require fasting before the collection of blood samples and care must be taken that each test meets the required prerequisites. Improperly conducted tests can lead to a vastly incorrect diagnosis of the condition.

All the symptoms experienced by a sufferer, should be disclosed to the medical examiner. Any other medications that the individual may be taking should also be mentioned to the doctor and recommendation should be taken before deciding on continuing with the medications.

In case there have been any unexpected physiological changes in the body, such as an unexplained change in weight, it may indicate rapidly rising blood sugar levels. Immediate attention should be given to such changes and they must also be always mentioned to the medical examiner in order to quickly determine if there are any chances of complications or other associated risks with the condition.

Dieticians and physiotherapists can also prove to be of great help to prediabetes sufferers. These people have the required knowledge, knowhow and expertise to effectively help in controlling the levels of sugar in the blood and subsequently keep both prediabetes and Type II Diabetes at bay. They can also offer specialized advice and consultation as per the individual’s physiological requirements as each sufferer of prediabetes will have a unique body and chemical composition and may also be suffering from other medical conditions as well.

Other health conditions will need special care, alongside the treatment and management of prediabetes [5]. The condition is a difficult one as it means that lifelong dedication and support will be required in order to combat the disease and to prevent the onset of Type II Diabetes. However, by only maintaining a healthy lifestyle, following a healthy diet and by getting adequate amounts of physical activity, the symptoms of prediabetes can easily be kept in check. Many people have uses the condition as an opportunity to successfully turn around their lifestyle into being much more active and healthy and this should be done by everyone who faces a risk of this disease.

 

References

[1] Idiopathic neuropathy, prediabetes and the metabolic syndrome, A. Gordon Smith^,, J. Robinson Singleton; Volume 242, Issues 1-2, Pages 9-14 – March 15, 2006 – DOI: 10.1016/j.jns.2005.11.020, http://www.sciencedirect.com/science/article/pii/S0022510X05004223

[2] Screening for Diabetes and Pre-Diabetes With Proposed A1C-Based Diagnostic Criteria, Darin E. Olson, Mary K. Rhee, Kirsten Herrick, David C. Ziemer, Jennifer G. Twombly, and Lawrence S. Phillips,; 33no. 10 2184-2189 – October 2010, DOI: 10.2337/dc10-0433Diabetes Care, http://care.diabetesjournals.org/content/33/10/2184.short

[3] Effect of regression from prediabetes to normal glucose regulation on long-term reduction in diabetes risk, Leigh Perreault, Qing Pan, Kieren J Mather, Karol E Watson, Richard F Hamman, Steven E Kahn,; Volume 379, Issue 9833, Pages 2243–2251, June 2012, http://www.sciencedirect.com/science/article/pii/S014067361260525X

[4] Pre-Type I Diabetes: Linear Loss of Beta Cell Response to Intravenous Glucose, S Srikanta, O P Ganda, R E Gleason, R A Jackson, J S Soeldnerand G S Eisenbarth,; 33 no. 8 717-720 – August 1984 – DOI: 10.2337/diab.33.8.717Diabetes , http://diabetes.diabetesjournals.org/content/33/8/717.short

[5] What Is the Metabolic Syndrome?: Prediabetes and Cardiovascular Risk, Borgman, Marilyn RN, BSN; McErlean, Ellen MSN, RN, FAHA,, Volume 21 – Issue 4 – July/August 2006 – http://journals.lww.com/jcnjournal/Abstract/2006/07000/What_Is_the_Metabolic_Syndrome___Prediabetes_and.9.aspx

Apart from the known and recognized forms of diabetes, there is also a much rarer type of Diabetes Mellitus which affects infants and new born children and is known as Congenital Diabetes. This disorder is also referred to as Neonatal Pseudodiabetes Mellitus as it exhibits slight differences in clinical nature from the more common forms of diabetes. In most cases, Congenital Diabetes proves to be fatal and is considered to be a serious condition.Manuels d’utilisation.

This condition is extremely rare and there are only very few reported cases of Congenital Diabetes [1]. As such, not much is known about the pathogenesis of the disease, and the cause of the condition is completely unknown. In fact, Congenital Diabetes is considered to be a controversial subject, with many medical experts dismissing the condition as a form of diabetes given the significantly lower occurrence rates and some others considering the disease to be related in some way to Diabetes Mellitus as some of the aspects of the condition completely comply with those of diabetes.

Conditions of Congenital Diabetes can only be found in infants between six months to twelve months of age. If undiagnosed, the disease may prove to kill the infant. However, in some cases, the infant may survive and this may lead to many other complications later in life.

When diabetes in diagnosed in an infant, it is a must to be able to correctly determine whether it is a case of Type I Diabetes or a case of Congenital Diabetes. Often misdiagnosed as Type I Diabetes, the treatment is commenced in infants and this helps control the blood glucose levels. However in such cases, there are development delays exhibited by such sufferers in various aspects of life.

If diagnosed properly, all of the complications as well as the conditions of Congenital Diabetes can be controlled. This may be done either with the help of external administration of insulin, or through the use of some specific medications. Early diagnosis can also help distinguish between the different types of Congenital Diabetes and this in turn can help with offering a prognosis and in defining the future lifestyle choices, diet conditions and medication to be followed in order to prevent recurrences or in order to successfully manage conditions of recurrence of the disorder.

Congenital Diabetes can affect infants even before they reach six months of age in some special cases and as such, any infant below one year of age, who is exhibiting signs and symptoms of diabetes such as that of hyperglycemia, can be suspected to be affected by Congenital Diabetes.

Any form of diabetes in which the sugar levels of the blood are higher than normal should be considered seriously. There can be a number of nasty and serious complications associated with diabetes and with conditions of hyperglycemia and these must be avoided at all costs and measures.

Neonatal Pseudodiabetes Mellitus

This form of diabetes is very rare and is often not even included under the different categories of diabetes as it exhibits certain differences from the other clinical signs and symptoms of diabetes. Typically, the disorder is found in infants and new born children below six months of age.

Congenital Diabetes is considered to be different from Type I Diabetes as it does not involve any destruction of the insulin producing cells of the body present in the beta cells of the pancreas and is not considered to be an autoimmune disorder. Type I Diabetes is also diagnosed in children who are above six months of age and this is also one of the major differences between Type I Diabetes and Congenital Diabetes.

Congenital Diabetes is considered to be caused due to changes having occurred to the genes of the infant, which in turn produce a decrease in the production rate of the insulin hormone in the body. Consequently, the sugar level in the blood rises much higher than normal and this is why some medical experts argue that Congenital Diabetes should be classified under Diabetes Mellitus, even though it may be a much rarer and significantly less reported condition.

As per the reported conditions, it is believed that a change caused to the either the KCNJ11 or the ABCC8 genes can lead to a development of Neonatal Pseudodiabetes Mellitus. The condition is also considered to be associated with the maternal pedigree and many have reported unexplained cases of infant deaths on the maternal side, which are largely suspected to have been caused due to complications resulting from Congenital Diabetes. However, the occurrence of the disease in very rare and there are only a handful of reported cases all over the world and this makes it extremely difficult to be able to determine the exact cause of the disease.

Signs and Symptoms of Congenital Diabetes

The most important and vital sign of Congenital Diabetes is a high concentration of serum antibodies of insulin and glutamic acid decarboxylase in the blood stream. This results in a lower concentration of insulin as well as the C-Peptide serum in the body. Even through the external administration of either glucose or glucagon the C-peptide serum levels remain close to indiscernible.

This reduction results in a steady buildup in the concentration of the blood sugar levels and many of the vital organs of the body such as the heart, the lungs, as well as the pancreas are targeted by lymphocytic infiltration conditions.

Lymphocytic infiltration results in a larger than normal concentration of T Lymphocytes in the blood, most of which are activated T-Cells. A consequence of this high concentration of T-Cells results in a higher concentration of the serums IgA and IgE in the blood stream.

There are no other reported abnormalities of the functioning of the immunologic system. It is however believed that genetic features, primarily from the maternal side are somehow related to development of this extremely rare condition.

Sufferers of Congenital Diabetes may also exhibit various other symptoms including episodes of vomiting and nausea, diarrhea and problems with digestion and sudden and drastic loss in body weight.

There may also be some delays in the normal development of an infant as a result of Congenital Diabetes. Some of the observed developmental delays exhibited by such infants include the following;

• Clumsy walking or being very slow in walking
• Talking slowly and finding difficulty in learning how to talk
• Difficulty with concentration
• Epileptic episodes may also be experienced in the first year of life of the infant
• Difficulty in social situations
• Difficulty in understanding numeracy or math

Diagnosis of Congenital Diabetes

Typically, there is no complication associated with pregnancy in cases of Neonatal Pseudodiabetes mellitus [4]. In fact, Congenital Diabetes can be diagnosed in infants through the process of genetic testing for any infants around six months of age. A blood sample is used for this diagnostic procedure and is examined in a medical laboratory to check for abnormalities in the blood serum IgA and IgE concentrations, insulin levels and a high concentration of T-lymphocytes. Glucose concentration in the blood stream is much higher than normal levels and ketoacidosis is also occasionally observed.

Genetic testing of a blood sample can help in improving the clinical management as also in predicting the prognosis of the condition. Mutation of genes in the K-ATP channels of the pancreas is usually tested for in the blood sample. In some cases, these genetic mutations occur on their own in an individual. The individual may also prove to have a diabetic relative, with a pattern of autosomal dominant inheritance and the transmission of the defected gene from generation to generation.

Some medical centers offer free testing for the condition. However, a diagnosis of the condition is confirmed only after proper molecular genetic testing has been carried out on the blood sample of the infant.

In case you suspect that your infant may be suffering from Congenital Diabetes conditions and is under the age of six months, genetic testing should be carried out at the earliest in order to diagnose the condition and also to be able to effectively control the disorder.

Complications associated with Congenital Diabetes

Congenital Diabetes can prove to be a serious and life threatening condition if it is not diagnosed and provided with proper treatment at the right time [3]. While conditions of hypoglycemia, fatigue, weakness and less resistance to infection are commonly exhibited, the loss of weight and an inability to show proper development can all lead to serious conditions, often leading to a death of the child below even twelve months of age.

There have been many cases of deaths of infants due to unknown causes and it is suspected that the genetic susceptibility of individuals to encounter the disorder are higher if there have been such cases in the family, typically on the maternal side.

Even after having been successfully treated in infancy, symptoms of Congenital Diabetes may re-manifest during the teenage years of an individual. At such a stage, the complications associated with the condition can prove to be just as severe as that of other types of diabetes and may cause damage to many of the vital organs of the body due to excessive hyperglycemic conditions. If somehow the sufferer is unaware of having the condition, administration of glucagon or other measures may not prove to be effective immediately and may further cause delays in providing treatment processes.

Treatment of Congenital Diabetes

It is estimated that about half the cases of individuals diagnosed with Congenital Diabetes need not be given insulin administration as a necessity [2]. The insulin producing cells are still active in the body and what needs to be controlled is the presence of the insulin antibody serum in high concentration in the blood stream.

Sulphonylurea drugs are also used in cases of Permanent Congenital Diabetes and also Type II Diabetes. One of the most popular forms of this type of medication known as Glibenclamide can be given to the suffering infants in order to control both of the conditions. The medication is also often administered to Type II Diabetes sufferers; however the dosage is typically much higher in the case of Congenital Diabetes. When administered at higher dosages, the medication can prove to stimulate the pancreas to produce and release insulin directly into the blood stream whenever food is consumed by an individual.

Sulphonylurea drugs can help in both controlling the glucose levels in the blood and in improving other associated symptoms of development delay in infants. In many cases, sufferers of Congenital Diabetes are shifted from insulin administration therapy to completely sulphonylurea drug supported medication. Typically, the development delays can be avoided with higher dosages of sulphonylureas

In some of the other cases, both insulin administration and Glibenclamide are prescribed as medication procedures in order to control the condition of Congenital Diabetes. However, such cases are rarer and insulin administration is more often associated with Type I Diabetes treatment.

It is always recommended to obtain recommendation from a licensed medical professional post the diagnosis of Neonatal Pseudodiabetes Mellitus before the administration of any type of medication or resorting to any alternative remedies for treatment.

Plenty of fluids are also recommended to be given to infants suffering from the condition often to be boosted with electrolytes. This can help with dehydration and in controlling other symptoms that are associated with Neonatal Pseudodiabetes Mellitus.

Prognosis of Congenital Diabetes

Congenital Diabetes can be considered to be of two types:

• Transient Congenital Diabetes: This condition, as the name suggests, is only a temporary condition and is usually resolved after the infant reaches 12 months of age. However, symptoms of the disease may recur later on during the teenage years of the individual. It is more common than Permanent Congenital Diabetes.
• Permanent Congenital Diabetes: This condition is a permanent condition and suffers exhibit the signs and symptoms of the disease throughout the course of their lives.

Both of these types of Congenital Diabetes can be controlled with medication. However, as with other forms of diabetes, any individual who has been diagnosed with the condition will have to maintain utmost care in terms of diet and lifestyle in order to prevent any complications that diabetes may have to offer.

 

References

[1] Risks For All-Cause Mortality, Cardiovascular Disease, And Diabetes Associated With The Metabolic Syndrome, Earl S. Ford, MD, MPH; 28no. 7 1769-1778 – July 2005 – DOI: 10.2337/Diacare.28.7.1769, http://Care.Diabetesjournals.Org/Content/28/7/1769.Short

[2] The Effectiveness Of Disease And Case Management For People With Diabetes, Susan L Norris, Phyllis J Nichols, Carl J Caspersen, Russell E Glasgow, Michael M Engelgau, Leonard Jack Jr, George Isham, Susan R Snyder, Vilma G Carande-Kulis, Sanford Garfield, Peter Briss, David Mcculloch,; Volume 22, Issue 4, Supplement1 Pages 15-38 – May 2002 – DOI: 1016/S0749-3797(02)00423-3, http://www.sciencedirect.com/science/article/pii/S0749379702004233

[3] Vascular Complications Of Diabetes, Richard Donnelly,Alistair M Emslie-Smith, Iain D Gardner, And Andrew D Morris; 320(7241): 1062–1066 – April 2000 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117946/

[4] Neonatal–Onset Multisystem Inflammatory Disease Responsive To Interleukin-1β Inhibition, Raphaela Goldbach-Mansky, M.D., Natalie J. Dailey, M.D., Scott W. Canna,; 355:581-592 – August 10, 2006 – DOI: 10.1056/Nejmoa055137, http://www.nejm.org/doi/full/10.1056/nejmoa055137

[5] Projection Of Diabetes Burden Through 2050, James P. Boyle, Amanda A. Honeycutt, K.M. Venkat Narayan, Thomas J. Hoerger, Linda S. Geiss, 24 No. 11 1936-1940 – November 2001 – DOI: 10.2337/Diacare.24.11.1936Diabetes, http://care.diabetesjournals.org/content/24/11/1936.short

Also known as non-insulin-dependent diabetes, Type II Diabetes is the common form of diabetes, affecting about 90% of people [1]. In this disorder, the beta cells in the pancreas produce insulin, but either the amount of insulin produced is insufficient, or the body develops insulin resistance. This inhibits the body cells from being able to actively use up glucose and this ultimately leads to an increased concentration of sugar in the blood stream. Since the body cells are unable to produce energy from glucose, diabetes may cause weakness and muscle wasting.

While this type of diabetes is more often seen in adults, it is becoming increasingly common in children as well as cases of child obesity are on the rise. While there is still no complete cure for Type II Diabetes available yet, there are a number of methods for treatment and control of the symptoms and these can greatly help sufferers lead a better and closer to normal lifestyle.

A condition called prediabetes is often considered to be a precursor to Type II Diabetes. Prediabetes is typically characterized by a higher than normal level of sugar present in the blood stream, but this level is not high enough for the condition to be classified as full blown diabetes. While prediabetes is a reversible condition, if left untreated, there is a good chance of individuals developing Type II Diabetes.

Causes of Type II Diabetes

Even though it is the most prevalent form of diabetes, the actual causes of Type II Diabetes are yet to be known. It is most commonly observed to occur in elderly and obese people. Various factors that may trigger Type II Diabetes include the diet, the lifestyle and the genetic susceptibility of an individual.

Some of the risk factors have been identified, which may lead to individuals contracting the disorder. People are more likely to get Type II Diabetes at some point of time in their life if they face some specific risk factors including:

• Presence of an excess amount of fatty tissue in the body
• An uneven distribution of fat in the body, concentrated in the hips and the thighs
• A lesser amount of physical activity
• Elderly people who are over 45 years of age
• Obese or overweight individuals including children
• Females who had episode of gestational diabetes during pregnancy
• Persons having family members with Type II Diabetes
• People suffering from pre-diabetes conditions
• Those who consume low HDL cholesterol or high triglycerides with less amounts of physical activity
• Hypertensive patients
• Members of specific racial or ethnic groups
• Women who suffer from polycystic ovary syndrome

Signs and symptoms of Type II Diabetes

Some of the common symptoms of Type II Diabetes include:

• Increased hunger due to a depletion of energy in the body cells
• Increased thirst due to excessive loss of fluids by urination
• Dryness of the mouth
• A feeling of nausea and occasional vomiting
• Frequent urination, amounting to over 2.5 liters excreted each day
• Fatigue and a general feeling of weakness
• Blurring of vision
• Numbness or tingling sensation in hands or feet
• Infections of the skin, urinary tract, the gums and the vagina
• Slow healing of wounds
• Appearance of patches of darkened skin

Complications associated with Type II Diabetes

If left uncontrolled, Type II Diabetes may lead to certain life threatening complications like [2]:

• The increased level of sugar in blood results in an increase in urinating frequency, causing dehydration.
• High blood glucose levels may damage blood vessels and nerves of the kidneys, eyes, and heart leading to atherosclerosis, or hardening of the arteries that can further lead to heart attack or stroke. There is a greater risk to becoming more susceptible to various infections, skin ulcerations and gangrene in limbs due to poor blood circulation. This may also result in the need for amputation of limbs.
• Retinopathy: Increased blood sugar levels may damage the nerves and blood vessels of eyes leading to retinopathy. Thus it is important to control blood sugar as well as blood pressure and cholesterol to prevent eye diseases. Severe diabetes may also lead to loss of eyesight.
• Hyperosmolar non-ketone diabetic coma or Diabetic coma: It is a situation where a person with type II diabetes is severely dehydrated and is not able to make up for the fluid losses.
• Other complications that can be associated with Type II Diabetes include a susceptibility of Alzheimer’s disease, development of skin conditions and also hearing impairment.

Diagnosis of Type II Diabetes

In order to diagnose Type II Diabetes, blood is examined for abnormalities in blood glucose level through a random fasting blood test or through a 2-hour glucose tolerance test [1]. A hemoglobin A1C test may also be done to show average blood sugar for the past 2 to 3 months. One may even look for glucose or ketones in urine.

Some other alternatives to the A1C test may be resorted to under some certain conditions such as pregnant women and individuals with hemoglobin variants in the blood. In such cases, the tests for diagnosing Type II Diabetes include:

• A blood sugar test taken at a random point in time
• A blood sugar test taken specifically after fasting
• A tolerance test for glucose which is administered orally

Another test named zinc transporter 8 autoantibody (ZnT8Ab) test is another blood test that helps to determine the type of diabetes. The advantage of the ZnT8Ab test is that it gives a prompt and an accurate diagnosis of diabetes which can lead to timely treatment.

Screening tests for people who are suspected to be at a risk of diabetes should also be carried out. In case of prediabetes, a screening test can greatly help in determining the presence of the condition and necessary measure can be taken before the condition develops fully into Type II Diabetes.

After the presence of diabetes is confirmed in an individual, additional tests need to be carried out in order to distinguish Type I diabetes from Type II. This is required as the treatment procedures for the disorders are quite different from each other.

Along with the normal diagnostic measures, blood samples and urine samples are also analyzed to check for other complications which are related to diabetes. These analyses check for the levels of cholesterol, the functioning of the thyroid gland and also the functioning of other major organs such as the kidneys and the liver. Blood pressure, eye check-ups and checking of the foot through physical examinations are also common diagnostic procedures that are included in the diagnosis of Type II Diabetes.

Treatment of Type II Diabetes

Type II Diabetes can be controlled with exercise, weight reduction and by following a diabetic diet [3] [4]. Weight reduction and exercise are important treatments for diabetes. Weight reduction and exercise increase the body’s sensitivity to insulin, thus helping to control blood sugar elevations.

When these measures fail, oral hypoglycemic drugs may be prescribed to sufferers. These may include:

• Metformin drugs including Glumetza and Glucophage
• Megalitinide drugs including Prandin and Starlix
• Sulfonylurea drugs including Amaryl, Glucotrol and Glynase
• Thiazolidinedione drugs including Avandia and pioglitazone
• DPP4 inhibitor drugs including Januvia, Onglyza and Tradjenta
• GLP1 receptor agnostic drugs including Victoza and Byetta
• SGLT2 inhibitor drugs including Invokana and Farxiga

If oral medications for diabetes are still insufficient, treatment with insulin or insulin is considered to be useful. Insulin therapy may include injecting the patient with various forms of insulin such as:

• Insulin Glulisine
• Insulin Lispro
• Insulin Aspart
• Insulin Glargin
• Insulin Detemir
• Insulin Isophane

Sufferers must also ensure to monitor the levels of sugar present in the blood on a periodic basis. Not only will this help in setting and achieving target, but it is also a wonderful indicator of whether medication or treatment therapy is proving to be effective.

While Type II Diabetes is a chronic condition and there is not much that individuals can do to prevent onset of the disease, especially if there is a history of the disease in the family. However, there are a few accepted measures which need to be followed by people who consider themselves at risk to the disease. These include:

• People should always eat healthy foods which are lower in calories and fats and higher in fiber
• Individuals should resort to an active physical lifestyle involving at least half an hour of rigorous exercise each day
• People should always maintain a healthy weight and keep checking the weight regularly to notice unexplained irregularities at the earliest
• Individuals who suspect themselves at risk should always undergo screening tests for diabetes
• Individuals should also make sure to monitor the glucose levels in the blood on a frequent basis

In some specific cases, medication such as Metformin and other orally administered diabetic medications may help in reducing the risk of contracting the disorder. However, the most essential thing in order to prevent Type II Diabetes is maintaining an active and healthy lifestyle. Cessation of smoking must be done at the earliest and people are also advised to drink alcohol more responsibly as drink mixers and alcohols can dramatically affect the blood sugar levels.

Some of the vital things that diabetics should always remember are to regularly conduct health checkups and to follow as healthy and as active a lifestyle as possible. While it may not be entirely possible for a diabetic to lead a completely normal life, careful measures can help sufferers lead a somewhat closer to normal life.

 

References

[1] Diagnosis and Classification of Diabetes Mellitus, Silvio Inzucchi, MD; Richard Bergenstal, MD; Vivian Fonseca, MD; Edward Gregg, PhD; Beth Mayer-Davis, MSPH, PhD, RD; Geralyn Spollett, MSN, CDE, ANP, Richard Wender, MD; 33(Suppl 1): S62–S69 – Jan 2010 – DOI: 10.2337/dc10-S062, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797383/

[2] Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes, William Duckworth, M.D., Carlos Abraira, M.D., Thomas Moritz, M.S., Domenic Reda, Ph.D., Nicholas Emanuele, M.D., Peter D. Reaven, M.D., Franklin J. Zieve, M.D., Ph.D., Jennifer Marks, M.D., Stephen N. Davis, M.D., Rodney Hayward, M.D., Stuart R. Warren, J.D., Pharm.D., Steven Goldman, M.D., Madeline McCarren, Ph.D., M.P.H., Mary Ellen Vitek, William G. Henderson, Ph.D., and Grant D. Huang, M.P.H., Ph.D.; 360:129-139 – January 8, 2009 – DOI: 10.1056/NEJMoa0808431, http://www.nejm.org/doi/full/10.1056/nejmoa0808431

[3] Epidemiology of Diabetes and Diabetes-Related Complications, Anjali D Deshpande, Marcie Harris-Hayes, Mario Schootman; vol. 88 no. 11 1254-1264 – September 18, 2008 – DOI: 10.2522/​ptj.20080020, http://ptjournal.apta.org/content/88/11/1254.short

[4] REDUCTION IN THE INCIDENCE OF TYPE 2 DIABETES WITH LIFESTYLE INTERVENTION OR METFORMIN, I.W. Culbert, D.A. Ehrmann, P.G. Watson, H. Miettinen, R.F. Hamman,; 346(6): 393–403 – Feb 7, 2002 – DOI: 10.1056/NEJMoa012512, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1370926/

[5] The Cost-Effectiveness of Lifestyle Modification or Metformin in Preventing Type 2 Diabetes in Adults with Impaired Glucose Tolerance, William H. Herman, MD, MPH; Thomas J. Hoerger, PhD; Michael Brandle, MD, MS; Katherine Hicks, MS; Stephen Sorensen, PhD; Ping Zhang, PhD; Richard F. Hamman, MD, DrPH; Ronald T. Ackermann, MD, MPH; Michael M. Engelgau, MD, MS; Robert E. Ratner, MD; 142(5):323-332 – March 1, 2005 – DOI: 10.7326/0003-4819-142-5-200503010-00007, http://annals.org/article.aspx?articleid=718240

Typically found in children, only less than 10% of the people with diabetes suffer from Type I Diabetes [5]. This condition occurs in individuals, where the body is not able to produce enough insulin. Insulin is a hormone which is produced by beta cells of the islet of Langerhans situated on top of the pancreas. Insulin is used by the body to regulate the amount of sugar that is absorbed by the cells of the body. A lack of adequate amounts of insulin in the body lead to an excess concentration of sugar or glucose in the blood stream and it is the primary cause of Type I Diabetes. The condition is believed to be a cause of the immune system of the body destroying the islet cells in the pancreas [4]. Despite all the amount of active research being conducted, there is still no complete cure for Type I Diabetes and managing the symptoms with treatment is the only option available to sufferers.

Juvenile Diabetes

Since Type I Diabetes is usually found in children and young adults, it was earlier known as Juvenile Diabetes. It also goes by the name insulin dependent diabetes.

Type I Diabetes is classified as an autoimmune disorder and this is also the primary distinction from Type II Diabetes. The process of auto antibody testing can be used to verify if a particular case of diabetes is a Type I case or a Type II case.

While Type I Diabetes is typically observed in younger people, it can affect people at any age, though the chances of encountering Type II diabetes are far more likely with an individual aging.

Causes of Type I Diabetes

While the exact causes of Type I Diabetes are unknown, it is believed that in this condition, the immune system of the body of a sufferer destroys the insulin-producing beta cells of the pancreas. The result of this process leads to a complete deficiency of insulin in the blood stream.

• HLA or Human Leukocyte Antigens also play an important role in determining the chances of occurrence of diabetes in an individual since these cells help in recognizing the body’s own cells as foreign cells leading to their auto-destruction.
• The pancreas normally regulates the amount of insulin production based on the changing blood sugar levels but in diabetes, insulin is absent to control blood sugar levels. Thus high blood sugar levels may prevail.
• Heredity also has a major role to play in Type I Diabetes, as it is passed on from one generation to other through genes.
• People who are genetically susceptible to diabetes may become diabetic when triggered by environmental factors like diet, viruses, and toxins
• Sometimes, other factors like cystic fibrosis may destroy beta cells that may lead to diabetes resembling type I diabetes and this is called secondary diabetes.

There are some known risk factors which increase the chance of an individual contracting Type I Diabetes. These include:

• A history of the disease having occurred in the family
• The presence of certain genes in the body
• The disease is more prone to affect younger individuals
• People living away from the equator are also believed to be at a higher risk of developing the condition, especially people in Sardinia, Finland and other neighboring regions.
• Other possible risk factors to the disease include an early exposure of infants to cow’s milk, a low level of Vitamin D in the body, exposure to some specific pathogens and virus, consumption of water rich in nitrates, either early or late introduction of Gluten in an infant’s diet and the risk of contracting the disease is also much higher in babies who are born with jaundice.

Signs and Symptoms of Type I Diabetes

Due to deficient insulin production, glucose is not moved into the cells and glucose accumulates in the blood instead of going into cells, the body’s cells are not able to get energy for many important bodily functions and may cause the following:

• Increased urination even more noticeable at night
• Increased thirst due to excessive urination
• Increased hunger because of insufficient energy production.
• Blurring of vision excess sugar accumulation in the lens of eyes suck extra water into your eye. This leads to change in the shape of the lens and blurs the vision.
• Fatigue and weakness as the body isn’t using the calories is not getting the required amount of energy.
• Damage to the body: High blood glucose levels may damage the small blood vessels and nerves of the kidneys, eyes, and heart leading to atherosclerosis, or hardening of the arteries that can further lead to heart attack and stroke. There is a greater risk to becoming more susceptible to various infections, skin ulceration and gangrene in limbs due to poor blood circulation. This may also result in the need for amputation of limbs.
• The accumulation of glucose in the blood may lead to increase in urination as a measure to remove excess glucose. This may result in loss of a big quantity of water, causing dehydration.
• Diabetic ketoacidosis. Without insulin, the body cells become starved of energy for which the body has to break down fat cells producing acidic chemicals called ketones as end products to be used for energy. Increased levels of ketones in the blood, causes an increased acidity. This phenomenon of excess sugars along with dehydration and acid accumulation is known as diabetic ketoacidosis that can be life-threatening if not immediately treated.
• Weight loss. Due to loss of sugar in the urine, loss of energy providing calories takes place. This loss of energy along with dehydration contributes to weight loss.
• Symptoms of depression are also very common in sufferers of Type I Diabetes.

If left untreated, Type I Diabetes can also present some serious complications. These may include:

• Diseases of the blood vessels and the heart
• Damage caused to the nerves or neuropathy
• Damage caused to the kidneys or nephropathy
• Damage caused to the foot and the limbs
• Conditions of the mouth and the skin
• Complications related to pregnancies
• Infection in the urinary tract
• Sexual dysfunction in both males and females.

Treatment of Type I Diabetes

Type 1 diabetes is treated with exercise, diabetic diet and insulin. Treatment with insulin includes use of synthetic insulin or insulin analogues that are classified as:

• Rapid acting insulin analogue: Insulin Lispro, Insulin Aspart and Insulin Glulisine are some common rapid acting insulin analogues that are administered within 5-10 minutes of food intake and have rapid but short term effect.
• Long acting insulin analogue: Insulin Glargin and Insulin Determir are long acting insulin analogues that do not have any peak action period and lasts for long once the drug is administered inside the body.
• Other intermediate options: There are a number of other medications which may be prescribed for sufferers of Type I Diabetes such as
  • Pramlintide or Symlin injections which helps slow down the digestion of food and in turn limits the release of sugar into the blood stream.
  • Medications for high blood pressure which can help prevent the kidneys from damage.
  • Cholesterol reducing medications, also known as statins, which can help keep the levels of bad cholesterol and fatty acids in check.
  • Aspirin and other drugs which can prove to help protect the heart from damage.

There are also many investigational treatment methods available for Type I Diabetes, which are increasingly growing in popularity [1] [3]. While these methods have not yet been conclusively adopted by people, they may prove to be of great help in treatment of some specific cases. Such investigational treatment methods include:

• A transplant of the pancreas: While such a transplant surgery can be potentially risky and not all surgeries are successful, a transplant of the pancreas can allow individuals to successfully lead a normal life without requiring constant insulin medication. This method is usually only used in severe cases of Type I diabetes or when the sufferer requires a kidney transplant as well.
• Transplantation of the islet cells: This is a relatively new method which is being actively researched. While this method has had to face a number of problems in the past, newer drugs and better medical techniques have greatly improved this method. In this method, the available healthy islet cells are protected from the immune system of the body and are also encouraged to expand.
• Transplant of the stem cells: There is active research being done in stem cell research. In studies and clinical trials, it has been demonstrated that patients suffering from Type I Diabetes could refrain from using insulin and lead a healthy and normal life for up to five years after the transplant. While this technique can seem to be appealing, stem cell transplant is still in its nascence and it is a risky procedure.
• Research is also being carried out in order to create a vaccine containing the auto antigen, GAD65. Sufferers who had received this vaccine demonstrated an increased protection of the beta cells. However, this method is not fully approved yet and clinical trials are being conducted in the US and in Europe.

If you suspect that you are at a risk of Type I Diabetes, you need to get a screening and an evaluation done at the earliest. On diagnosis of the disease, proper medical attention will need to be provided with a complete healthcare team consisting of a certified educator on diabetes, a dietician, a social worker, an ophthalmologist or eye specialist and a podiatrist or a foot specialist.

You will also need to understand all of the risks and the complications that Type I Diabetes has to offer. Since the disease has no definite cure, sufferers must ensure that they keep complications in check and manage the symptoms as best as possible.

 

References

[1] Diabetes Treatment — Bridging the Divide, Kristina I. Rother, M.D.; 356(15): 1499–1501 – Apr 12, 2007 – DOI: 10.1056/NEJMp078030, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4152979/

[2] The past, present, and future of genetic associations in type 1 diabetes, The Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO 80045-6511, USA; 11(5):445-53 – October 2011 – DOI: 10.1007/s11892-011-0212-0, http://www.ncbi.nlm.nih.gov/pubmed/21792535?dopt=Abstract

[3] Type 1 diabetes: etiology, immunology, and therapeutic strategies, van Belle TL, Coppieters KT, von Herrath MG; 91(1):79-118 – Jan 2011 – DOI: 0.1152/physrev.00003.2010, http://www.ncbi.nlm.nih.gov/pubmed/21248163?dopt=Abstract

[4] Virus infections in type 1 diabetes, Coppieters KT, Boettler T, von Herrath M; 2(1):a007682 – Jan 2012 – DOI: 10.1101/cshperspect.a007682, http://www.ncbi.nlm.nih.gov/pubmed/22315719

[5] Type 1 diabetes: recent developments, Devasenan Devendra; 2004;328:750 – March 25, 2004 – DOI: 10.1136/bmj.328.7442.750, http://www.bmj.com/content/328/7442/750?variant=full