Diabetes mellitus ( DM ), commonly referred to as diabetes , is a group of metabolic disorders where there is a high blood sugar level in a long period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can cause many complications. Acute complications may include diabetic ketoacidosis, hyperglycemic hyperglycemic, or death. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, leg ulcers, and eye damage.
Diabetes is because the pancreas does not produce enough insulin or the body's cells do not respond correctly to the insulin produced. There are three main types of diabetes mellitus:
- The result of type 1 DM from pancreatic failure produces sufficient insulin. This form was previously referred to as "insulin dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The cause is unknown.
- Type 2 diabetes begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As disease develops, a lack of insulin can also develop. This form was previously referred to as "non-dependent insulin diabetes mellitus" (NIDDM) or "adult onset diabetes". The most common causes are excessive weight and inadequate exercise.
- Gestational diabetes is the third major form, and occurs when pregnant women without previous diabetes history develop high blood sugar levels.
Prevention and care include maintaining a healthy diet, regular physical exercise, normal weight, and avoiding tobacco use. Controlling blood pressure and maintaining proper foot care is important for people with this disease. Type 1 DM should be administered with insulin injections. Type 2 diabetes can be treated with drugs with or without insulin. Insulin and some oral medications can cause low blood sugar. Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 diabetes. Gestational diabetes usually disappears after the birth of a baby.
By 2015, an estimated 415 million people suffer from diabetes worldwide, with type 2 DM which makes up about 90% of cases. It represents 8.3% of adult population, with the same rate in women and men. By 2014, the trend shows the rate will continue to rise. Diabetes at least doubles a person's risk of premature death. From 2012 to 2015, about 1.5 to 5.0 million deaths each year are due to diabetes. The global economic cost of diabetes by 2014 is estimated to be US $ 612 billion. In the United States, diabetes costs $ 245 billion in 2012.
Video Diabetes mellitus
Signs and symptoms
The classic symptoms of untreated diabetes are weight loss, polyuria (increased urination), polydipsia (increased thirst), and polifagia (increased hunger). Symptoms can develop rapidly (weeks or months) in type 1 DM, while symptoms usually develop more slowly and may be smooth or absent in type 2 DM.
Some other signs and symptoms may signal the onset of diabetes even if they are not specific to the disease. In addition to the above known, they include blurred vision, headache, fatigue, slow wound healing, and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which causes a change in shape, resulting in vision changes. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadrome.
Diabetic emergency
Low blood sugar is common in people with type 1 and type 2 DM. Most cases are mild and are not considered medical emergencies. Effects can range from discomfort, sweating, trembling, and increased appetite in mild cases to more serious problems such as confusion, behavioral changes such as aggressiveness, seizures, unconsciousness and (rarely) permanent brain damage or death in severe cases. Moderate hypoglycemia can be easily misinterpreted as intoxicated; rapid breathing and sweating, cold skin, pallor is a characteristic of hypoglycemia but not definitive. Mild to moderate cases are self-treated by eating or drinking something high in sugar. Severe cases can cause unconsciousness and should be treated with intravenous glucose or injections with glucagon.
People (usually with type 1 DM) may also experience diabetic ketoacidosis episodes, metabolic disorders characterized by nausea, vomiting and abdominal pain, acetone odor on the breath, deep breathing known as Kussmaul respiration, and in severe cases of decreased rates awareness.
A rare but equally severe possibility is hyperglycemic hyperglycemic, which is more common in type 2 DM and is primarily caused by dehydration.
Complications
All forms of diabetes increase the risk of long-term complications. This usually develops after years (10-20) but may be the first symptom in those who otherwise did not receive a diagnosis before that time.
Major long-term complications are associated with damage to blood vessels. Diabetes doubles the risk of cardiovascular disease and about 75% of deaths in diabetics are due to coronary artery disease. Other "makrovascular" diseases are stroke, and peripheral arterial disease.
The major complications of diabetes due to damage in small blood vessels include damage to the eyes, kidneys, and nerves. Eye damage, known as diabetic retinopathy, is caused by damage to blood vessels in the retina of the eye, and can result in gradual loss of vision and blindness. Diabetes also increases the risk of glaucoma, cataracts, and other eye problems. It is recommended that diabetics visit an ophthalmologist once a year. Damage to the kidneys, known as diabetic nephropathy, can cause scarring, loss of urine protein, and eventually chronic kidney disease, sometimes requiring dialysis or kidney transplantation. Damage to the body's nerves, known as diabetic neuropathy, is the most common complication of diabetes. The symptoms can be numbness, tingling, pain, and the constant sensation of pain, which can cause damage to the skin. Diabetic foot problems (such as diabetic foot ulcers) can occur, and can be difficult to treat, sometimes requiring amputation. In addition, proximal diabetic neuropathy causes painful atrophy and muscle weakness.
There is a relationship between cognitive deficits and diabetes. Compared with those who did not have diabetes, those who suffered from this disease had a cognitive impairment rate of 1.2 to 1.5 times greater. Being diabetic, especially when using insulin, increases the risk of falling on older people.
Maps Diabetes mellitus
Cause
Diabetes mellitus is classified into four broad categories: type 1, type 2, gestational diabetes, and "other specific types". "Another specific type" is a collection of several dozen individual causes. Diabetes is a disease that is more varied than ever thought and people may have a combination of forms. The term "diabetes", without qualification, usually refers to diabetes mellitus.
Type 1
Type 1 diabetes mellitus is characterized by the loss of insulin-producing beta cells from the pancreatic islets, leading to insulin deficiency. This type can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is an immune-mediated trait, in which T cell-mediated autoimmune attacks lead to loss of beta cells and thus insulin. This accounts for about 10% of cases of diabetes mellitus in North America and Europe. Most affected people are otherwise healthy and have a healthy weight when the onset occurs. Sensitivity and response to insulin are usually normal, especially in the early stages. Type 1 diabetes can affect children or adults, but it is traditionally called "juvenile diabetes" because the majority of cases of this diabetes in children.
"Fragile" diabetes, also known as unstable diabetes or unstable diabetes, is a term traditionally used to describe dramatic and repetitive changes in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. This term, however, has no biological basis and should not be used. However, type 1 diabetes may be accompanied by irregular and unpredictable blood sugar levels, often with ketosis, and sometimes with serious low blood sugar levels. Other complications include poorly controlled counter-regulatory responses to low blood sugar, infections, gastroparesis (which leads to erratic carbohydrate eradication of food), and endocrineopathy (eg, Addison's disease). This phenomenon is believed to occur no more often than in 1% to 2% of people with type 1 diabetes.
Type 1 diabetes is partially inherited, with many genes, including certain HLA genotypes, known to affect the risk of diabetes. In genetically susceptible people, the onset of diabetes can be triggered by one or more environmental factors, such as viral or dietary infection. Some viruses have been involved, but to date there is no solid evidence to support this hypothesis in humans. Among dietary factors, the data suggest that gliadin (a protein present in gluten) may play a role in the development of type 1 diabetes, but the mechanism is not fully understood.
Type 2
Type 2 diabetes is characterized by insulin resistance, which can be combined with relatively reduced insulin secretion. The damaged responsiveness of body tissues to insulin is believed to involve insulin receptors. However, specific defects are unknown. The case of diabetes mellitus due to a defect known to be classified separately. Type 2 diabetes is the most common type of diabetes mellitus.
In the early stages of type 2, the main disorder is reduced insulin sensitivity. At this stage, high blood sugar can be reversed by various measures and drugs that increase insulin sensitivity or reduce liver glucose production.
Type 2 DM is mainly caused by lifestyle and genetic factors. A number of lifestyle factors are known to be important for the development of type 2 DM, including obesity (defined by body mass index greater than 30), lack of physical activity, poor diet, stress, and urbanization. Excess body fat is associated with 30% of cases in Chinese and Japanese descent, 60-80% of cases in European and African descent, and 100% Pima Indians and Pacific Islanders. Even those who are not overweight often have a high waist-hip ratio.
Food factors also affect the risk of developing type 2 DM. Excessive consumption of sweet drinks is associated with increased risk. This type of fat in the diet is also important, with saturated fats and trans fats raising risks and polyunsaturated and monounsaturated fats lowers risk. Eating lots of white rice can also increase the risk of diabetes. Lack of physical activity is believed to cause 7% of cases.
Gestational diabetes
Gestational diabetes mellitus (GDM) resembles type 2 DM in some ways, involving a combination of insulin secretion that is relatively inadequate and responsive. It occurs in about 2-10% of all pregnancies and may improve or disappear after childbirth. However, after pregnancy about 5-10% of women with gestational diabetes are found to have diabetes mellitus, most often type 2. Gestational diabetes is completely treatable, but requires careful medical supervision during pregnancy. Management may include dietary changes, blood glucose monitoring, and in some cases, insulin may be necessary.
Although granular and untreated gestational diabetes may be harmful to fetal or maternal health. Infant risks include macrosomia (high birth weight), congenital heart abnormalities and central nervous system, and skeletal muscle malformations. Increased insulin levels in fetal blood may inhibit the production of fetal surfactants and cause respiratory distress syndrome. High blood bilirubin levels can occur due to damage to red blood cells. In severe cases, perinatal death may occur, most often as a result of poor placental perfusion due to vascular disorders. Induction of labor may be indicated by decreased placental function. Cesareans may be performed if there is real fetal pressure or an increased risk of injury associated with macrosomia, such as shoulder dystocia.
Maturity onset of young diabetes
Maturity of onset of young diabetes (MODY) is an autosomal dominant inheritance form, because it is one of several single gene mutations that cause defects in insulin production. This is significantly less common than the three main types. The name of this disease refers to the initial hypothesis of its nature. Because of the damaged gene, the disease varies in age at presentation and in severity according to the specific gene defect; so there are at least 13 MODY subtypes. People with MODY can often control it without using insulin.
Other types
Prediabetes shows a condition that occurs when a person's blood glucose level is higher than normal but not high enough for the diagnosis of type 2 DM. Many people are destined to develop type 2 DM spending years in prediabetes.
Adult latent autoimmune diabetes (LADA) is a condition in which Type 1 DM develops in adults. Adults with LADA are often initially misdiagnosed to have type 2 diabetes, based on age rather than cause.
Some cases of diabetes are caused by tissue receptors that do not respond to insulin (even when normal insulin levels, which distinguish them from type 2 diabetes); this form is very rare. Genetic mutations (autosomal or mitochondrial) can cause damage to beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes severe damage to the pancreas can cause diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of the insulin-antagonist hormone can cause diabetes (which usually resolves after excess hormone is removed). Many drugs damage the secretion of insulin and some toxins damage the pancreatic beta cells. The ICD-10 (1992) diagnostic entity, diabetes mellitus associated with malnutrition (MRDM or MMDM, ICD-10 code E12), has been abandoned by the World Health Organization when the taxonomy is currently introduced in 1999.
Other forms of diabetes mellitus include congenital diabetes, caused by genetic defects of insulin secretion, diabetes associated with cystic fibrosis, steroid diabetes induced by high-dose glucocorticoids, and some forms of monogenic diabetes.
"Type 3 diabetes" has been suggested as a term for Alzheimer's disease because the underlying process may involve insulin resistance by the brain.
The following is a complete list of other causes of diabetes:
A 2018 study suggested that three types should be abandoned because they are too simple. It classified diabetes into five subgroups, with what is usually described as type 1 and advanced autoimmune onset diabetes categorized as one group, while type 2 includes four categories. This is expected to improve the treatment of diabetes by adjusting it more specifically to subgroups.
Pathophysiology
Insulin is the main hormone that regulates the taking of glucose from the blood into most of the body's cells, especially the liver, adipose tissue and muscle, except the smooth muscle, where insulin works through IGF-1. Therefore, insulin deficiency or its receptor's insensitivity plays a central role in all forms of diabetes mellitus.
The body obtains glucose from three main sources: absorption of food by the gut; breakdown of glycogen, a form of glucose storage found in the liver; and gluconeogenesis, the generation of glucose from a non-carbohydrate substrate in the body. Insulin plays an important role in balancing glucose levels in the body. Insulin can inhibit the breakdown of glycogen or the process of gluconeogenesis, insulin can stimulate the transport of glucose into fat and muscle cells, and can stimulate the storage of glucose in the form of glycogen.
Insulin is released into the blood by beta cells (? -cells), which are found on the island of Langerhans in the pancreas, in response to elevated blood glucose levels, usually after meals. Insulin is used by about two thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other required molecules, or for storage. Lower glucose levels result in decreased insulin release from beta cells and in the breakdown of glycogen into glucose. This process is mainly controlled by the glucagon hormone, which acts counter to insulin.
If the amount of insulin available is insufficient, or if the cell responds poorly to the effects of insulin (insulin insensitivity or insulin resistance), or if insulin itself is damaged, glucose will not be properly absorbed by the body cells that need it, and it will not stored properly in the liver and muscles. Its net effect is high blood glucose levels, poor protein synthesis, and other metabolic disorders, such as acidosis.
When the concentration of glucose in the blood remains high over time, the kidneys will reach the reabsorption threshold, and glucose will be excreted in the urine (glycosuria). This increases the osmotic pressure of the urine and inhibits the reabsorption of water by the kidneys, resulting in increased urine production (polyuria) and increased fluid loss. Loss of blood volume will be replaced osmotically from water stored in body cells and other body compartments, leading to dehydration and increased thirst (polydipsia).
Diagnosis
Diabetes mellitus is characterized by recurrent or persistent high blood sugar, and is diagnosed by showing one of the following:
- Fasting plasma glucose levels> = Ã, 7.0Ã, mmol/l (126Ã, mg/dl)
- Plasma glucose> = Ã, 11.1 mmol/l (200 Âμg/dl) two hours after oral glucose load of 75 g on glucose tolerance test
- Symptoms of high blood sugar and casual plasma glucose> = Ã, 11.1 mmol/l (200 mg/dl)
- Glycated hemoglobin (HbA 1C )> = Ã, 48Ã, mmol/mol (> = Ã, 6.5 DCCTÃ,%).
Positive results, in the absence of high blood sugar, should be confirmed by repeating one of the above methods on different days. It is better to measure fasting glucose levels because of the ease of measurement and a considerable time commitment of a formal glucose tolerance test, which takes two hours to complete and does not offer prognostic benefits during fasting tests. According to the current definition, two fasting glucose measurements above 126 mg/dl (7.0 mmol/l) are considered diagnostic for diabetes mellitus.
Per World Health Organization people with fasting glucose levels of 6.1-6.9 mmol/l (110-125 mg/dl) are considered to have impaired fasting glucose. people with plasma glucose at or above 7.8 mmol/l (140 mg/dl), but not more than 11.1 mmol/l (200 mg/dl), two hours after oral glucose load of 75 g were considered to have impaired tolerance glucose. Of these two prediabetic conditions, the latter is specifically a major risk factor for the development of full diabetes mellitus, as well as cardiovascular disease. The American Diabetes Association since 2003 used a slightly different range for fasting glucose disorder 5.6-6.9 mmol/l (100-125 mg/dl).
Hemoglobin is better than fasting glucose to determine the risk of cardiovascular disease and death from any cause.
Prevention
There are no known preventive measures for type 1 diabetes. Type 2 diabetes - which accounts for 85-90% of all cases - can often be prevented or delayed by maintaining normal weight, engaging in physical activity, and consuming healthy foods. A higher level of physical activity (more than 90 minutes per day) reduced the risk of diabetes by 28%. Dietary changes that are known to be effective in helping prevent diabetes include maintaining a diet rich in whole grains and fiber, and choosing good fats, such as polyunsaturated fats found in nuts, vegetable oils, and fish. Restricting sugary drinks and eating less red meat and other saturated fat sources may also help prevent diabetes. Tobacco smoking is also associated with an increased risk of diabetes and its complications, so quitting smoking can also be an important preventative measure.
The association between type 2 diabetes and modifiable primary risk factors (overweight, unhealthy diet, physical activity and tobacco use) is similar in all regions of the world. There is growing evidence that the underlying factors of diabetes are a reflection of the major forces that drive social, economic and cultural change: globalization, urbanization, population aging, and the general health policy environment.
Management
Diabetes mellitus is a chronic disease, in which no drug is known except in very specific situations. Management concentrates on keeping blood sugar levels close to normal, without causing low blood sugar. This can usually be achieved with a healthy diet, exercise, weight loss, and appropriate drug use (insulin in case of type 1 diabetes, oral medication, and possibly insulin, in type 2 diabetes).
Learning about disease and actively participating in care is important, because complications are much less frequent and less severe in people who have well managed blood sugar levels. The goal of treatment is HbA 1C 6.5%, but should not be lower than that, and can be set higher. Caution is also given to other health problems that can accelerate the negative effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise. Specific footwear is widely used to reduce the risk of ulceration, or ulceration in diabetic foot at risk. The evidence for this efficacy remains vague, however.
Lifestyle
People with diabetes can benefit from education about illness and treatment, good nutrition for normal weight gain, and exercise, with the aim of keeping blood glucose levels short and long term within acceptable limits. In addition, given the higher risk of cardiovascular disease, lifestyle modification is recommended for controlling blood pressure.
There is no single best diet for all diabetics. For people who are overweight with type 2 diabetes, any diet that people will adhere to and achieve weight loss is effective.
Drugs
Drugs used to treat diabetes do so by lowering blood sugar levels. There are a number of different classes of anti-diabetic drugs. Some are available by mouth, such as metformin, while others are only available with injections such as GLP-1 agonists. Type 1 diabetes can only be treated with insulin, usually with a combination of regular insulin and NPH, or synthetic insulin analogues.
Metformin is generally recommended as first-line treatment for type 2 diabetes, as there is good evidence that it lowers mortality. It works by reducing the production of liver glucose. Some other drug groups, mostly given by mouth, may also lower blood sugar in type II DM. These include agents that promote insulin release, agents that decrease the absorption of sugar from the intestine, and agents that make the body more sensitive to insulin. When insulin is used in type 2 diabetes, long-acting formulations are usually added initially, while continuing oral treatment. The insulin dosage is then enhanced for the effects.
Since cardiovascular disease is a serious complication associated with diabetes, some people have recommended blood pressure levels below 130/80 mmHg. However, the supporting evidence is less than or equal to somewhere between 140/90 mmHg to 160/100 mmHg; the only additional benefit found to target blood pressure below this range is the decreased risk of isolated stroke, and this is accompanied by an increased risk of other serious adverse events. A 2016 review found a potential danger to treat lower than 140 mmHg. Among the drugs that lower blood pressure, the angiotensin converting enzyme inhibitor (ACEI) increases the yield in those with DM while angiotensin receptor blocker (ARB) -like drugs do not. Aspirin is also recommended for people with cardiovascular problems, but regular use of aspirin has not been found to improve outcomes in uncomplicated diabetes.
Surgery
Weight loss surgery in those with obesity and type 2 diabetes is often an effective step. Many are able to maintain normal blood sugar levels with little or no drugs after surgery and long-term mortality decreases. However, there is a short-term mortality risk of less than 1% of surgery. Body mass index cuts for when the surgery is correct are not yet clear. It is recommended that this option be considered in those who can not lose their weight and blood sugar.
Pancreatic transplantation is sometimes considered for people with type 1 diabetes who have severe complications of their disease, including end-stage renal disease requiring kidney transplantation.
Support
In countries that use general practitioner systems, such as the UK, treatment can be performed primarily outside the hospital, with special hospital-based care used only in cases of complications, difficult blood sugar control, or research projects. In other circumstances, general practitioners and specialists share treatments in a team approach. Home telehealth support can be an effective management technique.
Epidemiology
By 2016, 422 million people have diabetes worldwide, up from about 382 million people in 2013 and from 108 million in 1980. Accounting for the age-changing structure of the global population, the prevalence of diabetes is 8.5% among adults , almost doubled. a 4.7% rate in 1980. Type 2 makes up about 90% of cases. Some data show about the same level in women and men, but male overload in diabetes has been found in many populations with higher type 2 incidence, possibly due to sex-related differences in insulin sensitivity, the consequences of obesity and regional body fat deposition, and other contributing factors such as high blood pressure, tobacco smoking, and alcohol intake.
The World Health Organization (WHO) estimates that diabetes mellitus generates 1.5 million deaths by 2012, making it the 8th cause of death. However, 2.2 million deaths worldwide are caused by high blood glucose and an increased risk of cardiovascular disease and other related complications (eg renal failure), which often lead to premature death and are often listed as the underlying cause of death certificates than diabetes. For example, by 2014, the International Diabetes Federation (IDF) estimates that diabetes causes 4.9 million deaths worldwide, using modeling to estimate the total number of deaths that can be directly or indirectly associated with diabetes.
Diabetes mellitus occurs worldwide but is more common (especially type 2) in more advanced countries. However, the largest increase in figures has been seen in low- and middle-income countries, where over 80% of diabetic deaths occur. The fastest prevalence increases are expected in Asia and Africa, where most people with diabetes may live in 2030. The rate increases in developing countries follow the trend of urbanization and lifestyle changes, including sedentary lifestyles, less physically demanding jobs and the transition of global nutrients, characterized by increased intake of high energy-dense, but poor nutrients (often high in sugars and saturated fats, sometimes referred to as "Western-style" diets).
History
Diabetes is one of the first illnesses described, with Egyptian manuscripts of c. 1500 BC which mentions "urinating too much". The Ebers papyrus includes recommendations for drinking to be taken in such cases. The first case described is believed to be type 1 diabetes. Indian doctors around the same time identify the disease and classify it as madhumeha or honey urine, noting the urine will attract the ants.
The term "diabetes" or "passing through" was first used in 230 BC by Apollonius of Memphis Greece. The disease was considered rare during the Roman empire, with Galen commenting he only saw two cases during his career. This may be due to the diet and lifestyle of the ancients, or because of the clinical symptoms observed during the advanced stages of the disease. Galen named the disease "urine diarrhea" (urinary diarrhea).
The earliest survival work with detailed references to diabetes is that of Aretaeus from Cappadocia (2 or early 3rd century ). He describes the symptoms and course of the disease, which is associated with moisture and coldness, reflecting the belief of "Pneumatic School". He hypothesized the correlation of diabetes with other diseases, and he discussed the differential diagnosis of snakebite which also induced excessive thirst. His work remained unknown in the West until 1552, when the first Latin edition was published in Venice.
Type 1 and type 2 diabetes were identified as a separate condition for the first time by Indian physicians Sushruta and Charaka in 400-500Ã, CE with type 1 associated with youth and type 2 with overweight. The term "mellitus" or "from honey" was added by British rider John Rolle in the late 1700s to separate the condition of diabetes insipidus, which was also associated with frequent urination. Effective treatment was not developed until the early 20th century, when the Canadians Frederick Banting and Charles Herbert Best isolated and purified insulin in 1921 and 1922. This was followed by the development of long-acting insulin NPH in the 1940s.
Etymology
The word diabetes ( or ) comes from the Latin diab? T? S , which in turn comes from the Ancient Greek ???????? ( diab? T? S ), which literally means "a passer through the siphon". Ancient Greek physician Aretaeus of Cappadocian (Fl 1 century ) used the word, with the meaning meant "excessive urine drain", as the name for the disease. In the end, the word comes from the Greek word ?????????? ( diabainein ), meaning "bypass," which consists of ??? - ( he -), which means "through" and ??????? ( bainein ), meaning "to go". The word "diabetes" was first recorded in English, in the form of diabete , in a medical text written about 1425.
The word mellitus ( or ) comes from the classic Latin word mell? Tus , which means "mellite" (ie sweetened with honey, sweet honey). The Latin word comes from mell -, which comes from mel , which means "honey"; sweetness; fun stuff, and suffix - ? tus , which means the same as the English "-ite" suffix. It was Thomas Willis who in 1675 added "mellitus" to the word "diabetes" as the term for the disease, when he noticed the urine of a diabetic has a sweet taste (glikosuria). This sweet taste has been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians and Persians.
Society and culture
The "St. Vincent Declaration" of 1989 is the result of an international effort to improve the care given to those who have diabetes. Doing so is important not only in terms of quality of life and life expectancy but also economically - diabetes expenditure has proven to be a major source of health - and productivity-related resources for the health care system and government.
Some countries have established more and less successful national diabetes programs to improve the treatment of diseases.
People with diabetes who have neuropathic symptoms such as numbness or tingling in the legs or hands are twice as likely to be unemployed as those without symptoms.
In 2010, the visit to emergency room-related diabetes in the United States was higher among people of the lowest income (526 per 10,000 population) than among the highest income (236 per 10,000 population). Approximately 9.4% of diabetes-related ER visits are for the uninsured.
Naming
The term "Type 1 diabetes" has replaced some of the previous terms, including childhood onset diabetes, juvenile diabetes, and insulin dependent diabetes mellitus (IDDM). Likewise, the term "type 2 diabetes" has replaced some of the previous terms, including adult-onset diabetes, obesity-related diabetes, and non-insulin-dependent diabetes (NIDDM). Beyond these two types, there is no agreed standard nomenclature.
Diabetes mellitus is also sometimes known as "diabetes sugar" to distinguish it from diabetes insipidus.
Other animals
In animals, diabetes is most common in dogs and cats. Middle aged animals are most often affected. Female dogs are twice as likely to be exposed to males, while according to some sources, male cats are also more vulnerable than females. In both species, all breeds may be affected, but some small dog breeds are very likely to develop diabetes, such as Miniature Poodles.
Feline diabetes mellitus is very similar to human type 2 diabetes. Burmese cattle, along with Russian Blue, Abyssinia, and Norwegian races, show an increased risk of DM, while some breeds exhibit lower risk. There is a relationship between being overweight and an increased risk of diabetes in cats.
The symptoms may be related to fluid loss and polyuria, but of course it can also be harmful. Diabetic animals are more susceptible to infection. Long-term complications known to humans are less common in animals. The principles of treatment (weight loss, oral antidiabetics, subcutaneous insulin) and emergency management (eg ketoacidosis) are similar to those in humans.
Research
Inhaled insulin has been developed. The original product was withdrawn because of side effects. Afrezza, which is being developed by the pharmaceutical company MannKind Corporation, has been approved by the FDA for general sales in June 2014. The advantage to inhaling insulin is that it may be more convenient and easy to use.
Transdermal insulin in the form of cream has been developed and trials are being performed on people with type Ã, 2 diabetes.
References
Further reading
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Polonsky KS (October 2012). "The last 200 years in diabetes". The Journal of New England Medicine . 367 (14): 1332-40. doi: 10.1056/NEJMra1110560. PMID 23034021.
External links
- Diabetes mellitus at Curlie (based on DMOZ)
- IDF Diabetes Atlas
- National Diabetes Education Program
Source of the article : Wikipedia
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