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What is Diabetes?

By Dr Ananya Mandal, MD

 

Diabetes is a condition where the body fails to utilize the ingested glucose properly. This could be due to lack of the hormone insulin or because the insulin that is available is not working effectively.


How many Americans have diabetes and prediabetes?


  • 25.8 million Americans have diabetes — 8.3 percent of the U.S. population. Of these, 7 million do not know they have the disease.
  • In 2010, about 1.9 million people ages 20 or older were diagnosed with diabetes.
  • The number of people diagnosed with diabetes has risen from 1.5 million in 1958 to 18.8 million in 2010, an increase of epidemic proportions.
  • It is estimated that 79 million adults aged 20 and older have prediabetes. Prediabetes is a condition where blood glucose levels are higher than normal but not high enough to be called diabetes. Studies have shown that by losing weight and increasing physical activity people can prevent or delay prediabetes from progressing to diabetes.

Diabetes mellitus

 

The term diabetes is the shortened version of the full name diabetes mellitus. Diabetes mellitus is derived from:


  The Greek word diabetes meaning siphon - to pass through

  The Latin word mellitus meaning honeyed or sweet


This is because in diabetes excess sugar is found in blood as well as the urine. It was known in the 17th century as the “pissing evil”.

 

Diabetes epidemiology

 

Diabetes is the fastest growing long term disease that affects millions of people worldwide. According to the charity Diabetes UK, more than two million people in the UK have the condition and up to 750,000 more are unaware of having the condition. In the United States 25.8 million people or 8.3% of the population have diabetes. Of these, 7.0 million have undiagnosed diabetes. In 2010, about 1.9 million new cases of diabetes were diagnosed in population over 20 years. It is said that if this trend continues, 1 in 3 Americans would be diabetic by 2050.

 

 Learn About Diabetes


Diabetes means that your blood glucose (blood sugar) is too high. There are two main types of diabetes.

Type 1 diabetes - the body does not make insulin. Insulin helps the body use glucose from food for energy. People with type 1 need to take insulin every day.

Type 2 diabetes - the body does not make or use insulin well. People with type 2 often need to take pills or insulin. Type 2 is the most common form of diabetes.

Gestational diabetes - may occur when a woman is pregnant. Gestational diabetes raises her risk of getting another type of diabetes, mostly type 2, for the rest of her life. It also raises her child’s risk of being overweight and getting diabetes.


Diabetes is serious.


You may have heard people say they have “a touch of diabetes” or “your sugar is a little high.” These words suggest that diabetes is not a serious disease. That is not correct. Diabetes is serious, but you can learn to manage it!

All people with diabetes need to make healthy food choices, stay at a healthy weight, and be physically active every day.


Taking good care of yourself and your diabetes can help you feel better. It may help you avoid health problems caused by diabetes such as:


When your blood glucose (blood sugar) is close to normal you are likely to:


  • have more energy.
  • be less tired and thirsty and urinate less often.
  • heal better and have fewer skin, or bladder infections.
  • have fewer problems with your eyesight, feet, and gums.


Actions you could take:


  • Ask your health care team what type of diabetes you have.

  • Learn why diabetes is serious.

  • Learn how caring for your diabetes helps you feel better today and in the future.


Types of diabetes


There are two types of diabetes – Type 1 and type 2. Type 1 diabetes is called insulin-dependent diabetes mellitus and occurs at a younger age or childhood. In these patients there is complete lack of the hormone insulin that mandates external administration of the hormone regularly as treatment.


Around 75% of people with diabetes have type 2 diabetes mellitus. This was earlier termed non-insulin dependent diabetes mellitus (NIDDM) or maturity-onset diabetes mellitus. The number of people with type 2 diabetes is rapidly increasing. In type 2 diabetes, not enough insulin is produced or the insulin that is made by the body is insufficient to meet the needs of the body. Obesity or being overweight predisposes to type 2 diabetes.

 

Gestational diabetes

 

Gestational diabetes occurs in pregnant women who have never had diabetes before but who have high blood sugar levels during pregnancy. Gestational diabetes affects about 4% of all pregnant women. After childbirth the mother may go on to develop type 2 diabetes.

 

How is blood sugar regulated normally?

 

When food is taken, it is broken down to smaller components. Sugars and carbohydratesare thus broken down into glucose for the body to utilize them as energy source. The liver is also able to manufacture glucose. In normal persons the hormone insulin, which is made by the beta cells of the pancreas, regulates how much glucose is in the blood. 


When there is excess glucose in the blood, insulin stimulates cells to absorb enough glucose from the blood for the energy that they need. Insulin also stimulates the liver to absorb and store any glucose that is excess in blood. Insulin release is triggered after a meal when there is rise in blood glucose. When blood glucose levels fall, during exercise for example, insulin levels fall too.


A second hormone manufactured by the pancreas is called glucagon. It has the opposite function of stimulating the liver to release glucose when necessary.

 

Symptoms of diabetes

 

The main symptoms of diabetes are three – polydipsia, polyphagia and polyuria. These mean increased thirst, increased hunger and increased frequency of urination. In addition patients complain of feeling very tired and weight loss and loss of muscle bulk. Type 1 diabetes can develop quickly, over weeks or even days whereas type 2 diabetesmay develop gradually.

 

What happens in diabetes?

 

Due to lack or insufficiency of insulin there is high blood glucose in diabetes. Excess glucose in the blood can damage the blood vessels. This leads to several complications like heart disease, kidney damage, nerve damage, eye damage and blindness, impotenceand stroke.


Diabetes, when not controlled, may raise the propensity for infections. Infections andgangrene of the lower limbs is common in uncontrolled diabetes. This may necessitate an amputation if severe. People with diabetes are also 15 per cent more likely to have an amputation than people without the condition.

 

Prevention, treatment and care

 

The risk of complications with diabetes can be reduced by adhering to medical advice and keeping diabetes under control. Blood sugar should be regularly monitored so that any problems can be detected and treated early.

 

Treatment involves both healthy diet and exercise as well as oral medications to regulate blood sugar. In all type 1 diabetics and in severe uncontrolled type 2 diabetics one or more injections of insulin a day may be needed.

 

Blood sugar or blood glucose level is the amount of glucose present in the blood of a human or animal. Blood glucose is a tightly regulated biochemical parameter in blood. It is important for metabolic homeostasis.

 

By Dr Ananya Mandal, MD

 

Diabetes is a condition where the body fails to utilize the ingested glucose properly. This could be due to lack of the hormone insulin or because the insulin that is available is not working effectively.

 

Diabetes mellitus

 

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PHILADELPHIA -- A popular class of diabetes drugs increases patients’ risk of bladder cancer, according to a new study published online this month in the Journal of the National Cancer Institute. Researchers from the Perelman School of Medicine at the University of Pennsylvania  found that patients taking thiazolidinedione (TZDs) drugs – which account for up to 20 percent of the drugs prescribed to diabetics in the United States -- are two to three times more likely to develop bladder cancer than those who took a sulfonylurea drug, another common class of medications for diabetes.

 

The authors say the findings are especially important since diabetic patients are known to already be at a slightly increased risk of this type of cancer as compared to the general population, in which about 30 in 100,000 people develop bladder cancer. Among diabetes patients overall, the incidence of this cancer is typically about 40 out of 100,000.

 

The authors of the new study analyzed 60,000 Type 2 diabetes patients from the Health Improvement Network (THIN) database in the United Kingdom. They found that patients treated with the TZD drugs pioglitazone (Actos) or rosiglitzaone (Avandia) for five or more years had a two-to-three-fold increase in risk of developing bladder cancer when compared to those who took sulfonylurea drugs. Among patients taking TZDs for that length of time, the team’s analysis indicates that 170 patients per 100,000 would be expected to develop the disease. About 60 in 100,000 of those who take sulfonylurea drugs – such as glipizide (Glucotrol) -- would be expected to develop bladder cancer.

 

“Diabetes is one the most common chronic diseases worldwide, affecting 285 million people. There are many factors clinicians must weigh in deciding which drug to use to control a patient’s diabetes, and these new data provide important information to include in that decision-making process,” said the study’s lead author, Ronac Mamtani, MD, an instructor in the division of Hematology-Oncology in Penn’s Abramson Cancer Center. “Our study shows that doctors who care for patients with diabetes should be very aware of any bladder-related symptoms patients might be having, like blood in the urine, and take steps to further evaluate those issues.”

 

Though most patients in the United States no longer take Avandia since it was linked to severe cardiovascular problems, Actos is the ninth most commonly prescribed drug in the nation, accounting for some 15 million prescriptions each year. The drug is a common choice when Type 2 diabetes patients’ illnesses can no longer be controlled with the first-line diabetes drug Metformin.

 

Based on previous data examining safety risks among patients taking Actos, the FDA has already warned that it may be associated with a risk of bladder cancer, and France and Germany have removed the drug from their markets. The new findings add to mounting evidence against the entire class of TZDs, as one of the first studies examining this type of risk among people taking both types of TZDs and among those taking sulfonylurea drugs.

 

“The risk does seem to be common among both drugs in the TZD class, and the fact that we have compared bladder cancer risk among patients taking each of those drugs provides essential information, because a safety warning on a drug is only useful to a doctor when they have knowledge of the same risks for an alternative drug,” Mamtani says. “We believe our study will help doctors and their patients weigh the potential benefits and risks when selecting between different diabetes medication.”

 

The study was funded by the National Institutes of Health (T32-CA009679-20, UL1-RR024134, and K24-DK078228).

The Facts about Diabetes Prevention
How Diabetes effect the Body
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