Download Word Count: 2214 DIABETES MELLITUS In the United States, about

Word Count: 2214
DIABETES MELLITUS
In the United States, about 16 million people suffer from diabetes mellitus, although only
half of these individuals are diagnosed. Every year, about 650,000 people learn they
have the disease. Diabetes mellitus is the seventh leading cause of all deaths and the
sixth leading cause of all deaths caused by disease.
Diabetes is the most common in adults over 45 years of age; in people who are
overweight or physically inactive; in individuals who have an immediate family member
with diabetes; and in minority populations including African Americans, Hispanics, and
Native Americans. The highest rate of diabetes in the world occurs in Native Americans.
More women than men have been diagnosed with the disease.
Diabetes can develop gradually, often without symptoms, over many years. It
may reveal itself too late to prevent damage. In fact, you may first learn you have
diabetes when you develop one of its common complications – cardiovascular disease,
kidney disease, or vision problems.
Diabetes is a condition that occurs because of a lack of insulin or because of the
presence of factors opposing the actions of insulin. The result of insufficient action of
insulin is an increase in blood glucose concentration (hyperglycemia). Hyperglycemia is
the unused glucose that builds up in your blood. Many other metabolic abnormalities
occur, notably an increase in ketone bodies in the blood when there is a severe lack of
insulin.
The condition may also develop if muscle and fat cells responds poorly to insulin.
In people with diabetes, glucose levels build up in the blood and urine, causing excessive
urination, thirst, hunger, and problems with fat and protein metabolism. Diabetes
mellitus differs from the less common diabetes insipidus, which is cause by the lack of
the hormone vasopressin that controls the amount of urine secreted.
The earliest known record of diabetes on third dynasty Egyptian papyrus by
physician Hesy-ra; mentions polyuria (frequent urination) as a symptom in 1552 B.C. In
the 16th century, Paracelsus identifies diabetes as a serious general disorder. In the Early
19th century, the first chemical tests developed to indicate and measure the presence of
sugar in the urine. In 1919-20, Allen establishes the first treatment clinic in the USA, the
Physiatric Institute in New Jersey, to treat patients with diabetes, high blood pressure, and
Bright’s disease; wealthy and desperate patients flock to it. On January 23,1922, one of
Dr. Collip’s insulin extracts are first tested on a human being, a 14-year-old boy named
Leonard Thompson, in Toronto; the treatment was considered a success by the end of the
following February. In 1955, oral drugs are introduced to help lower blood glucose
levels, and in 1960, the purity of insulin is improved. Home testing for sugar levels in the
urine increases level of control for people with diabetes. The 75th anniversary of the
discovery of insulin was celebrated worldwide in 1996.
Diabetes is classified into two types. In Type I, or insulin-dependent diabetes
mellitus (IDDM), formerly called juvenile-onset diabetes, the body does not produce
insulin or produces it only in very small quantities. Symptoms usually appear suddenly
and in individuals under 20 years of age. Most cases occur before or around puberty. In
the United States, about 5 to 10 percent of all diagnosed cases of diabetes, up to 800,000
persons, suffer from Type I diabetes. About 30,000 new cases are diagnosed every year.
Type I
diabetes is considered an autoimmune disease because the immune system (system of
organs, tissues, and cells that rid the body of disease-causing organisms or substances)
attacks and destroys cells in the pancreas, known as beta cells, that produce insulin.
Scientists believe that genetic and environmental factors, such as viruses or food proteins,
may somehow trigger the immune system to destroy these cells.
Untreated Type I diabetes affects the
metabolism of fat. Because the body cannot convert glucose into energy, it begins to
break down stored fat for fuel. This produces increasing amounts of acidic compounds
called ketone bodies in the blood, which interfere with respiration.
In Type II, or non-insulin-dependent diabetes mellitus
(NIDDM), formerly called adult-onset diabetes, the body either makes insufficient
amounts of insulin or is unable to use it. Symptoms characteristic of Type II diabetes
include repeated infections or skin sores that heal slowly or not at all, generalized
tiredness, tingling or numbness in the hands or feet, and itching.
The most common form of diabetes, Type II accounts for 90 to 95
percent of all cases of diagnosed diabetes in the United States. Each year 595,000 new
cases are diagnosed. The onset of Type II diabetes usually occurs after the age of 40, and
often after the age of 55. Because symptoms develop slowly, individuals with the disease
may not immediately recognize that they are sick. Scientists believe that in some persons
weight gain or obesity triggers diabetes—about 80 percent of diabetics with this form of
the disease are overweight.
Diabetes is detected
by measuring the amount of glucose in the blood after the individual has fasted (abstained
from food) for several hours, either overnight or several hours after breakfast. In some
cases, physicians diagnose diabetes by administering an oral glucose tolerance test, the
measurement of glucose levels before and after a specific amount of sugar is ingested.
Another test being developed for Type I diabetes looks for specific antibodies (proteins
of the immune system that attack foreign substances called antigens) present only in
persons with diabetes. This test may detect Type I diabetes at an early stage, reducing the
risk for complications from the disease.
Once diabetes is diagnosed, treatment
consists of controlling the amount of glucose in the blood and preventing complications.
Depending on the type of diabetes, this can be accomplished through regular physical
exercise, a carefully controlled diet, and medication.
Individuals with Type I diabetes require insulin injections, often
two to four times a day, to provide the body with the insulin it does not produce. The
amount of insulin needed varies from person to person. Typically, several times a day,
individuals with Type I diabetes measure the level of glucose in a drop of their blood
obtained by pricking a fingertip. They can then adjust the amount of insulin injected,
physical exercise, or food intake to maintain the blood sugar at a normal level. People
with Type I diabetes must carefully control their diets by distributing meals and snacks
throughout the day so the insulin supply is not overwhelmed and by eating foods that
contain complex sugars, which break down slowly and cause a slower rise in blood sugar
levels.
Although most persons with Type I diabetes strive to lower the amount of glucose in their
blood, levels are too low can also cause health problems. For example, low blood sugar
levels can cause hypoglycemia, a condition characterized by shakiness, confusion, and
anxiety. The treatment for hypoglycemia is to eat or drink something that contains sugar.
One
third of type 2 diabetics can control their condition with diet and exercise alone, which
benefits both glucose levels and blood pressure. The remainders of diabetics, however,
need oral medications that stimulate residual insulin secretion or increase sensitivity to it.
Such as the sulfonylurea drugs or metformin. Eventually, natural insulin fails and insulin
replacement is needed. Studies are now indicating that, as in type 1 patients, rigorous
control of blood glucose levels can help reduce the risk for complications of diabetes,
particularly retinopathy, but also kidney and nerve damage. Controlling glucose levels is
not enough. Intensive insulin producing or sensitizing treatments needed for strict
control put patients at increased risk for weight gain and arteriosclerosis and offer no
protection against heart problems and stroke.
For type 2 diabetes, many lifestyle
measures can be used to treat and prevent the disease. For most diet is the key to
managing this complicated disease. It is also extremely difficult to do so. All people
with diabetes should aim for healthy lipid (cholesterol and triglyceride) levels and control
of blood pressure. For overweight type 2 diabetics, both weight loss and blood glucose
control are important. Health benefits are highest with the first pounds lost, and losing
only 10% body weight can control progression of diabetes. For obese patients who
cannot control weight using dietary measures, medication may be needed. A new drug
orlistat (Xenical) appears not only to reduce weight but also to have benefits on glucose
control and cholesterol and lipid levels has proven to work in one study. Long-term side
effects are unknown at this time. People taking oral medications should focus on
coordinating calorie intake with insulin administration, exercise, and other variables.
Adequate calories must be maintained for normal growth in children, for increased needs
during pregnancy, and after illness. For overweight type2 diabetics who are not taking
medication, both weight loss and blood sugar control are important. A reasonable weight
is usually defined as what is achievable and sustainable, rather than one that is culturally
defined as desirable or ideal. Some general rules for healthy eating apply to everyone;
limit fats (particularly saturated fats) and consume plenty of fiber and vegetables.
Some general guidelines for treating type 2 diabetes. Exercise helps to lower the
blood glucose level and increase insulin sensitivity; it also helps to lower blood pressure,
improve cholesterol levels, decrease body fat, and reduce the risk of cardiovascular
disease. Aerobic exercise is best. Regular exercise, even moderate intensity, improves
insulin sensitivity.
Unlike type 1 diabetes, in
type 2 diabetes some insulin is still produced, although not in the amounts necessary to
overcome insulin resistance. Patients, then, who need medications usually, start out with
drugs that enhance residual insulin production or the sensitivity rather than replacing the
insulin by the standard treatment for type 1 diabetics.
Metformin (Glucophage) is a biguanide drug, which appears to work by reducing glucose
production in the liver and by making tissues more sensitive to insulin. Combinations
with other insulin-secreting or insulin-sensitizing drugs, such as repaglinide and acarbose,
are proving to be particularly effective. Sulfonylureas are oral drugs that stimulate that
pancreas to release insulin. A number of brands are available, including chlorpropamide
(diabinese), tolazamide (tolinase), glimepiride (amaryl), and glyburide (diabeta,
micronase). Other new drugs include glibenclamide and gliclazide. Gliclazide may have
specific benefits for the heart. For adequate control of blood glucose levels, the drugs
should only be taken 20 to 30 minutes before a meal. Eventually oral drugs usually fail,
and patients need insulin injections.
In patients being treated with insulin or
insulin-producing or sensitizing drugs, it is important to monitor blood glucose levels
carefully to avoid hypoglycemia. Patients should aim for premeal glucose levels of
between 80 and 120 and bedtime levels of between 100 and 140. Blood glucose levels
are generally more stable in type 2 diabetes than in type 1, so experts usually recommend
measuring blood levels only once or twice a day. Usually, a drop of blood obtained by
pricking the finger is applied to a chemically treated strip. The glucose level is read on a
standard meter or a small, portable digital display device. New methods for accurately
measuring blood glucose levels may improve the quality of life for many individuals with
diabetes. Techniques being developed include the use of laser beams and infrared
technology.
At present, no cure exists for diabetes and scientists are
unsure of the exact cause. Researchers in England have identified up to 18 genes
involved in Type I diabetes and are working to determine each gene’s role in causing the
disease. Other scientists hope to identify the environmental factors that trigger Type I
diabetes. If they can determine what causes the immune system to attack the cells that
produce insulin, they may discover how to prevent the condition from developing.
In 1996, researchers discovered the first genetic link to Type II diabetes.
The gene, which controls storage of sugar in muscle tissue, has been found in one-third of
people with Type II diabetes and may indicate susceptibility to adult-onset diabetes.
Recent findings indicate that a pair of genes causes a variation of Type II diabetes called
maturity onset diabetes of the young (MODY), which develops in persons under the age
of 25. While scientists do not yet understand how these genes cause the disease, the
genes are known to be active in the liver, intestine, kidney, and pancreas.
Today, improved methods of diabetes control, new medications, and easier ways to take
insulin enable most people who develop type 1 or 2 diabetes to live a long and healthy
life. A diagnosis of diabetes is not a sentence of premature death, as it often used to be
“Diabetes mellitus,” Diabetes Timeline, http://www.diabetes.ca/atoz/diatime.htm,
“Diabetes,” Treatment, http://members.aol.com/m4ynk/treatment.html,
Metabolic control and prevalent cardiovascular disease in non-insulin dependant diabetes
mellitus (NIDDDM); The American Journal of Medicine, January 1997
Don’t let diabetes go undetected, Consumer Reports on Health, February 1997.
Milchovich, Dunn-long, Diabetes Mellitus, A Practical Handbook, Palo Alto, California:
Bull Publishing Company, 1995.
Krall, Beaser, Joslin Diabetes Manual, Pennsylvania: Lea & Febiger, 1988.
Keywords:
word count diabetes mellitus united states about million people suffer from diabetes
mellitus although only half these individuals diagnosed every year about people learn
they have disease diabetes mellitus seventh leading cause deaths sixth leading cause
deaths caused disease most common adults over years people overweight physically
inactive individuals have immediate family member with minority populations including
african americans hispanics native americans highest rate world occurs native americans
more women than have been diagnosed with disease develop gradually often without
symptoms over many years reveal itself late prevent damage fact first learn when develop
common complications cardiovascular kidney vision problems condition that occurs
because lack insulin because presence factors opposing actions insulin result insufficient
action insulin increase blood glucose concentration hyperglycemia hyperglycemia unused
glucose that builds your blood many other metabolic abnormalities occur notably
increase ketone bodies blood when there severe lack condition also develop muscle cells
responds poorly with glucose levels build urine causing excessive urination thirst hunger
problems protein metabolism differs from less common insipidus which cause lack
hormone vasopressin that controls amount urine secreted earliest known record third
dynasty egyptian papyrus physician hesy mentions polyuria frequent urination symptom
century paracelsus identifies serious general disorder early century first chemical tests
developed indicate measure presence sugar urine allen establishes first treatment clinic
physiatric institute jersey treat patients high pressure bright wealthy desperate patients
flock january collip extracts tested human being year named leonard thompson toronto
treatment considered success following february oral drugs introduced help lower levels
purity improved home testing sugar levels increases level control anniversary discovery
celebrated worldwide classified into types type dependent iddm formerly called juvenile
onset body does produce produces only very small quantities symptoms usually appear
suddenly individuals under years most cases occur before around puberty united states
about percent diagnosed cases persons suffer from type cases every year type considered
autoimmune because immune system system organs tissues cells body causing organisms
substances attacks destroys cells pancreas known beta produce scientists believe genetic
environmental factors such viruses food proteins somehow trigger immune system
destroy these untreated affects metabolism body cannot convert into energy begins break
down stored fuel this produces increasing amounts acidic compounds called ketone
bodies which interfere respiration dependent niddm formerly called adult onset either
makes insufficient amounts unable symptoms characteristic include repeated infections
skin sores heal slowly generalized tiredness tingling numbness hands feet itching most
form accounts percent united states each onset usually occurs after often after slowly
immediately recognize they sick scientists believe some persons weight gain obesity
triggers percent diabetics this form overweight detected measuring amount after
individual fasted abstained food several hours either overnight several hours breakfast
some physicians diagnose administering oral tolerance test measurement before specific
amount sugar ingested another test being developed looks specific antibodies proteins
immune attack foreign substances antigens present only persons this test detect early
stage reducing risk complications once treatment consists controlling preventing
complications depending accomplished through regular physical exercise carefully
controlled diet medication require injections often four times provide does produce
needed varies person person typically several times measure level drop their obtained
pricking fingertip they then adjust injected physical exercise food intake maintain normal
level must carefully control their diets distributing meals snacks throughout supply
overwhelmed eating foods contain complex sugars which break down slowly slower rise
although strive lower their also health problems example hypoglycemia condition
characterized shakiness confusion anxiety hypoglycemia drink something contains third
diabetics control diet exercise alone benefits both pressure remainders diabetics however
need oral medications stimulate residual secretion increase sensitivity such sulfonylurea
drugs metformin eventually natural fails replacement needed studies indicating patients
rigorous help reduce risk particularly retinopathy also kidney nerve damage controlling
enough intensive producing sensitizing treatments needed strict increased risk weight
gain arteriosclerosis offer protection against heart stroke many lifestyle measures used
treat prevent diet managing complicated extremely difficult should healthy lipid
cholesterol triglyceride pressure overweight both weight loss important health benefits
highest pounds lost losing progression obese cannot using dietary measures medication
drug orlistat xenical appears reduce benefits cholesterol lipid proven work study long
term side effects unknown time taking medications should focus coordinating calorie
intake administration other variables adequate calories must maintained normal growth
children increased needs during pregnancy illness taking medication both loss important
reasonable usually defined what achievable sustainable rather than culturally defined
desirable ideal some general rules healthy eating apply everyone limit fats particularly
saturated fats consume plenty fiber vegetables general guidelines treating helps lower
sensitivity helps improve cholesterol decrease reduce cardiovascular aerobic best regular
even moderate intensity improves sensitivity unlike still produced although amounts
necessary overcome resistance then need medications start drugs enhance residual
production rather than replacing standard metformin glucophage biguanide drug appears
work reducing production liver making tissues more sensitive combinations other
secreting sensitizing such repaglinide acarbose proving particularly effective
sulfonylureas stimulate pancreas release number brands available including
chlorpropamide diabinese tolazamide tolinase glimepiride amaryl glyburide diabeta
micronase include glibenclamide gliclazide gliclazide specific heart adequate should
taken minutes before meal eventually fail need injections being treated producing
sensitizing important monitor carefully avoid hypoglycemia premeal between bedtime
between generally more stable experts recommend measuring once twice drop obtained
pricking finger applied chemically treated strip read standard meter small portable digital
display device methods accurately measuring improve quality life techniques developed
include laser beams infrared technology present cure exists scientists unsure exact
researchers england identified genes involved working determine each gene role causing
hope identify environmental factors trigger determine what causes attack discover
prevent developing researchers discovered genetic link gene controls storage muscle
tissue been found third indicate susceptibility adult recent findings indicate pair genes
causes variation maturity young mody develops under while understand these genes
known active liver intestine kidney pancreas today improved methods easier ways take
enable live long healthy life diagnosis sentence premature death used timeline http atoz
diatime http members html metabolic prevalent cardiovascular dependant nidddm
american journal medicine january undetected consumer reports health february
milchovich dunn long practical handbook palo alto california bull publishing company
krall beaser joslin manual pennsylvania febiger
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