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Diabetes Mellitus – At a Glance with Infographics

The incidence of diabetes is growing rapidly both in the United States and worldwide. For example, it is estimated that more than 250 million people worldwide are afflicted with diabetes, and the prevalence is expected to exceed 350 million by the year 2030.

Diabetes mellitus is not one disease, but rather is a heterogeneous group of multifactorial, polygenic syndromes characterized by an elevation of fasting blood glucose that is caused by a relative or absolute deficiency in insulin. Diabetes is the leading cause of adult blindness and amputation, and a major cause of renal failure, nerve damage, heart attacks, and stroke.

Adverse effects observed with insulin
Adverse effects observed with insulin

The American Diabetes Association (ADA) recognizes four clinical classifications of diabetes: type 1 diabetes (formerly, insulin dependent diabetes mellitus), type 2 diabetes (formerly, non-insulin dependent diabetes mellitus), gestational diabetes, and diabetes due to other causes (for example, genetic defects or medications).

Type 1 Diabetes

Type 1 diabetics constitute approximately 10% of diabetics in the United States. The disease is characterized by an absolute deficiency of insulin caused by an autoimmune attack on the β cells of the pancreas. This destruction requires a stimulus from the environment (such as a viral infection) and a genetic determinant that allows the β cell to be recognized as ‘nonself’. The metabolic abnormalities of type 1 diabetes mellitus include hyperglycemia, ketoacidosis, and hyper triacylglycerolemia. They result from a deficiency of insulin and a relative excess of glucagon.

Treatment of Type 1 Diabetes

Type 1 diabetics must rely on exogenous insulin injected subcutaneously to control hyperglycemia and ketoacidosis. The goal in administering insulin to Type 1 diabetics is to maintain blood glucose concentrations as close to normal as possible and to avoid wide swings in glucose levels that may contribute to long-term complications. Insulin may also be delivered by a pump, which allows continuous subcutaneous infusion of insulin 24 hours a day at preset levels and the ability to program doses (a bolus) of insulin as needed at meal times.

Type 2 diabetes

Most  diabetic  patients  have  type  2  disease.  Type  2  diabetes  is  influenced  by  genetic  factors,  aging,  obesity,  and  peripheral insulin resistance, rather than by autoimmune processes or viruses. It results from a combination of insulin resistance and dysfunctional β cells. Insulin resistance is the decreased ability of target tissues, such as liver, adipose tissue, and muscle, to respond properly to normal (or elevated) circulating concentrations of insulin.

Obesity is the most common cause of insulin resistance. However, most people with obesity and insulin resistance do not become diabetic. In the absence of a defect in β-cell function, non -diabetic, obese individuals can compensate for insulin resistance with elevated levels of insulin. Insulin resistance alone will not lead to type 2 diabetes. Rather, type 2 diabetes develops in insulin-resistant individuals who also show impaired β-cell function. The metabolic alterations observed in type 2 diabetes are milder than those described for the insulin-dependent form of the disease, in part, because insulin secretion in type 2 diabetes- although not adequate- does restrain ketogenesis and blunts the development of diabetic ketoacidosis. Available treatments for diabetes moderate the hyperglycemia, but fail to completely normalize metabolism. The long standing elevation of blood glucose is associated with the chronic complications of diabetes- premature atherosclerosis, retinopathy, nephropathy, and neuropathy.

Treatment of type 2 diabetes

The goal in treating type 2 diabetes is to maintain blood glucose concentrations within normal limits, and to prevent the development of long-term complications. Weight reduction, exercise, and medical nutrition therapy (dietary modifications) often correct the hyperglycemia of newly diagnosed type 2 diabetes. Hypoglycemic agents or insulin therapy may be required to achieve satisfactory plasma glucose levels.

Some adverse effects observed with oral hypoglycemic agents
Some adverse effects observed with oral hypoglycemic agents.

Gestational Diabetes/ Diabetes in Pregnancy

Gestational diabetes is defined as carbohydrate intolerance with onset or first recognition during pregnancy. It is important to maintain adequate glycemic control during pregnancy, because uncontrolled gestational diabetes can lead to fetal macrosomia (abnormally large body) and shoulder dystocia (difficult delivery), as well as neonatal hypoglycemia. Diet, exercise, and/or insulin administration are effective in this condition. Glyburide and metformin may be reasonably safe alternatives to insulin therapy for gestational diabetes. However, larger randomized studies are needed to fully assess neonatal outcomes and optimal dosing regimens.

 

Diabetes management infographics

How To Avoid Diabetes

Comparison between type 1 and type 2 diabetes
Comparison between type 1 and type 2 diabetes

There are precautions you can take to avoid getting diabetes

Exercise Exercise helps keep a healthy blood sugar level, maintain a healthy weight, manage stress, and Improve steep

Eat Healthy Eat a balanced diet tow in saturated fats and sugars in order to maintain healthy weight and blood sugar level

Manage Weight Make sure you are at a healthy weight for your body type and take special notice to any weight you gain around your midsection

Manage Your Diabetes

Don’t Skip Medication Follow your doctor’s recommendations and do not skip a dose even if you feel happy

Don’t Stress Stress can complicate diabetes so speak to someone if you ever need support

Don’t Smoke In addition to its many other dangers smoking can harm your circulatory system

Keep Teeth Healthy Higher blood sugar levels lead to an increased risk of tooth decay and gum disease

Check Blood Glucose Keep track of your blood sugar levels to stay in control of your diabetes

Check Your Feet Check your feet daily for cuts, sores, and swelling and call your doctor if they don’t go away

Reference

International Diabetes Federation, Lippincott Illustrated Reviews Pharmacology & Biochemistry, American Diabetes Association, National Diabetes Education Program USA, Mayo Clinic.

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