Diabetes mellitus

Diabetes mellitus is a disease characterized by persistent hyperglycemia (high blood sugar levels), resulting either from inadequate secretion of the insulin, an inadequate response of target cells to insulin, or a combination of these factors. Diabetes is a metabolic disease that requires medical diagnosis, treatment and lifestyle changes.

There are many causes and forms of diabetes known. The three most common patterns of diabetes have been recognized over the last thirty years as type 1, type 2 and gestational diabetes. There are some patients whose diabetes cannot be easily fit into one of these types, and some who display characteristics of more than one type at the same time.

Medications for Diabetes

Many people with type 2 diabetes, especially those in the early stages, manage their blood sugar effectively through diet, weight loss, and physical activity. If this does not provide effective control for you, however, there are many medications that can help manage your condition.

If your weight is normal and your blood glucose is not manageable by diet and exercise alone, your doctor may prescribe oral diabetes medications to lower your blood glucose levels. There are five classes of medications available. Each works a bit differently and has its own side effects. If one medication is not enough, your doctor may suggest combining two of these diabetes treatment medications.

Sulfonylureas
Sulfonylureas, such as Glucotrol® and Micronase®, are commonly prescribed medications for diabetes treatment. Sulfonylureas work by helping your body make insulin. They can be used alone or with other medications. They have few side effects, but cannot be used by people allergic to sulfa medications.

Biguanides
Biguanides, such as Metformin (Glucophage®), help the body use insulin more effectively. It is often used by people who are overweight, since it also helps with weight control. It can be taken alone or with another medication, but it may cause side effects, which include nausea or diarrhea.

Alpha-glucosidase inhibitors
Alpha-glucosidase inhibitors, such as Precose® and Glyset®, work by slowing down the absorption of sugar in your digestive tract. They are often used in combination with another diabetes treatment medication, such as a sulfonylurea. This type of medication can cause stomach or bowel problems in some people.

Meglitinides
Repaglinide (Prandin®) works by controlling blood sugar after meals. It is taken with meals and adjusted according to the number of meals you eat. It can be taken alone or with other medications, and has few side effects.

Thiazolidinediones
The overall action of thiozolidinediones (TZDs) is to make cells more sensitive to insulin. Medications include Avandia® and Actos®. Rezulin® was the first thiazolidinedione, but it was recently withdrawn from the market after it was determined it causes liver toxicity. The other medications in this class are considered safe and effective.

*Note: If you still use Rezulin®, contact your primary healthcare professional immediately to get it replaced with an equally effective diabetes treatment medication that does not have Rezulin®'s side effects. Rezulin® was withdrawn from the market in March 2000, after recent test data showed that the drug was more toxic to the liver than two other similar drugs, Avandia® and Actos®.

Insulin
If oral medications do not control your blood sugar levels, insulin may be used for diabetes treatment. A person with type 2 diabetes needs insulin injections if his or her pancreas has stopped producing insulin altogether.

How to delay or prevent type 2 diabetes?

A major research study, the Diabetes Prevention Program, confirmed that the following approaches can greatly reduced the chances of developing diabetes:

1. Keep a low-fat, low-calorie diet.
2. Lost a modest amount of weight.
3. Engaging in regular physical activity (walking briskly for 30 minutes, five times a week, for example).

These strategies worked well for both men and women and were especially effective for participants aged 60 and older.

Insulin

Insulin is a polypeptide hormone that regulates carbohydrate. It is produced by the pancreas. Apart from being the primary factor in carbohydrate homeostasis, it has effects on fat metabolism. It can change the liver's ability to release fat stores. Insulin's concentration has extremely widespread effects throughout the body.

After eat, the food is broken down into glucose, the simple sugar that is the main source of energy for the body's cells. But your cells cannot use glucose directly without insulin. Insulin helps the cells take in glucose and convert it to energy. When the pancreas does not make enough insulin or the body is unable to use the insulin that is present, the cells cannot use glucose. Excess glucose builds up in the bloodstream, setting the stage for diabetes.

Being obese or overweight affects the way insulin works in your body. Extra fat tissue can make your body resistant to the action of insulin, but exercise helps insulin work well.

Insulin is used medically in some forms of diabetes mellitus. Patients with type 1 diabetes mellitus depend on exogenous insulin (commonly injected subcutaneously) for their survival because of an absolute deficiency of the hormone; patients with type 2 diabetes mellitus have either relatively low insulin production or insulin resistance or both, and a non-trivial fraction of type 2 diabetics eventually require insulin administration when other medications become inadequate in controlling blood glucose levels.

Diabetes symptoms

Diabetes often goes undiagnosed because many of its symptoms seem so harmless. It may begin gradually and can be hard to identify at first.

Recent studies indicate that the early detection of diabetes symptoms and treatment can decrease the chance of developing the complications of diabetes.

Some diabetes symptoms include:

1. Frequent urination
2. Excessive thirst
3. Extreme hunger
4. Unusual weight loss
5. Increased fatigue
6. Irritability
7. Blurry vision
8. Slow healing of skin
9. Gum and urinary tract infections
10. Women may notice genital itching

If you have one or more of these diabetes symptoms, see your doctor right away.

Hypoglycemia

The term hypoglycemia literally means "low blood sugar". It occurs when your blood glucose (blood sugar) level drops too low to provide enough energy for your body's activities.

Hypoglycemia can produce a variety of symptoms and effects but the principal problems arise from an inadequate supply of glucose as fuel to the brain, resulting in impairment of function. Derangements of function can range from vaguely "feeling bad" to coma, and (rarely) permanent brain damage or death.

In adults or children older than 10 years, hypoglycemia is uncommon except as a side effect of diabetes treatment, but it can result from other medications or diseases, hormone or enzyme deficiencies, or tumors.

In general, plasma glucose levels below 70 mg/dl or 3.9 mmol/L are considered hypoglycemic.

Hyperglycemia

Hyperglycemia means “high blood glucose”. It means you don’t have enough insulin in your body. If your blood glucose stays over 180, it may be too high.

High blood glucose can happen if you miss taking your diabetes medicine, eat too much, or don’t get enough exercise. Sometimes, the medicines you take for other problems cause high blood glucose. Be sure to tell your doctor about other medicines you take.

Having an infection, being sick, or under stress can also make your blood glucose too high. That's why it's very important to check your blood glucose and keep taking your insulin or diabetes pills when you're sick.

If you're very thirsty and tired, have blurry vision, and have to go to the bathroom often, your blood glucose may be too high. Very high blood glucose may also make you feel sick to your stomach.

If your blood glucose is high much of the time, or if you have symptoms of high blood glucose, call your doctor. You may need a change in your insulin or diabetes pills, or a change in your diet.