Diabetes Mellitus
  International awareness day November 14



Overview
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    Diabetes is a disorder of metabolism the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body. For glucose to get into cells, insulin must be present.
    When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body in the urine.

    Types of Diabetes

    There are 4 main types:

    1 - Type 1 Diabetes
    In Type 1 Diabetes, the pancreas produces little or no insulin.
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    2 - Type 2 Diabetes
    When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases.
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    3 - Gestational Diabetes
    Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin.
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    4 - Pre-diabetes
    In pre-diabetes, blood glucose levels are higher than normal but not high enough to be characterized as diabetes.
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    Source: Diabetes Overview (diabetes.niddk.nih.gov)

Causes
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    Type 1 Diabetes
    Type 1 diabetes is believed to be an autoimmune disease. The body's immune system attacks the cells in the pancreas that produce insulin.
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    Type 2 diabetes
    Type 2 diabetes is believed to have a strong genetic link, meaning that it tends to run in families.
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    Source: Diabetes Risks, Symptoms, Causes, Diagnosis, and Treatment Information on eMedicineHealth.com (emedicinehealth.com)

Epidemiology
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    The worldwide prevalence of Diabetes was 171,000,000 in the year 2000 and has been estimated to reach 366,000,000 by year 2030.
    Source: (who.int)

Prevention
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Symptoms
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    Type 1 Diabetes:
    The symptoms often begin abruptly and dramatically.
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    Type 2 Diabetes:
    People with type 2 diabetes may not have any symptoms for years or decades before they are diagnosed. Symptoms may be subtle.
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    Source: Diabetes Mellitus (DM): Hormonal Disorders: Merck Manual Home Edition (merck.com)

    Complications of Diabetes
    Diabetic complications can be classified broadly as microvascular (complications arising from small vessel damage) or macrovascular disease (complications arising from large vessel damage).
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    Source: Complications of Diabetes (healthinsite.gov.au)

Diagnosis
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    The following tests are used for diagnosis:

    Fasting Plasma Glucose (FPG) Test
    A fasting plasma glucose test measures your blood glucose after you have gone at least 8 hours without eating. This test is used to detect diabetes or pre-diabetes.
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    Oral Glucose Tolerance Test (OGTT)
    An oral glucose tolerance test measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a glucose-containing beverage. This test can be used to diagnose diabetes or pre-diabetes.
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    Gestational diabetes is also diagnosed based on plasma glucose values measured during the OGTT.
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    Random Plasma Glucose Test
    In a random plasma glucose test, your doctor checks your blood glucose without regard to when you ate your last meal.
    This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes.
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    Source: Diagnosis of Diabetes (diabetes.niddk.nih.gov)

Treatment
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    People with type 1 diabetes who are able to maintain a healthy weight may be able to avoid the need for large doses of insulin.
    People with type 2 diabetes may be able to avoid the need for all drugs by achieving and maintaining a healthy weight.
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    Insulin Replacement Therapy
    People with type 1 diabetes almost always require insulin therapy, and many people with type 2 diabetes require it as well.
    Insulin is usually injected; it currently cannot be taken by mouth because insulin is destroyed in the stomach.
    Source: Diabetes Mellitus (DM): Hormonal Disorders: Merck Manual Home Edition (merck.com)

    Oral Antihyperglycemic drugs
    Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth.
    There are several types of medicines used to lower blood glucose in type 2 diabetes.
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    Gestational diabetes is treated with insulin and changes in diet.
    Source: MedlinePlus Medical Encyclopedia: Diabetes (nlm.nih.gov)

Illustrations
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Source: MedlinePlus Medical Encyclopedia: Type I diabetes (nlm.nih.gov)



In response to high levels of glucose in the blood, the insulin-producing cells in the pancreas secrete the hormone insulin.
Type I diabetes occurs when these cells are destroyed by the body's own immune system.

News
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Scientific Articles (a selection for health professionals)
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    Early infant feeding and risk of type 1 diabetes mellitus-a nationwide population-based case-control study in pre-school children.
    Rosenbauer J, Herzig P, Giani G.
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    Source: PubMed (ncbi.nlm.nih.gov)

    Aldose reductase inhibitors for the treatment of diabetic polyneuropathy
    Chalk C, Benstead TJ, Moore F
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    Source: The Cochrane Collaboration (cochrane.org)

    Protein restriction for diabetic renal disease
    Robertson L, Waugh N, Robertson
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    Source: The Cochrane Collaboration (cochrane.org)