Diabetes: Difference between revisions

Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas, leading to insulin deficiency. This type can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, in which beta cell loss is a T-cell-mediated autoimmune attack.<cite>6</cite>There is no known preventive measure against Type 1 diabetes, which causes approximately 10% of diabetes mellitus cases in North America and Europe. Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type 1 diabetes can affect children or adults, but was traditionally termed ''juvenile diabetes'' because a majority of these diabetes cases were in children.

''Brittle'' diabetes, also known as unstable diabetes or labile diabetes, is a term that was traditionally used to describe to dramatic and recurrent swings in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. This term, however, has no biologic basis and should not be used.<cite>7</cite> There are many reasons for Type 1 diabetes to be accompanied by irregular and unpredictable hyperglycemias, frequently with ketosis, and sometimes serious hypoglycemias, including an impaired counterregulatory response to hypoglycemia, occult infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison's disease).<cite>7</cite> These phenomena are believed to occur no more frequently than in 1% to 2% of persons with Type 1 diabetes.<cite>8</cite>

Patient education, understanding, and participation is vital, since the complications of diabetes are far less common and less severe in people who have well-managed blood sugar levels.<ref>{{cite journal | author = Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, Raskin P, Zinman B; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group | title = Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes | journal = The New England Journal of Medicine | volume = 353 | issue = 25 | pages = 2643–53 | year = 2005 | month = December | pmid = 16371630 | pmc = 2637991 | doi = 10.1056/NEJMoa052187 }}</ref><ref>{{cite journal | author = <Please add first missing authors to populate metadata.> | title = The effect of intensive diabetes therapy on the development and progression of neuropathy. The Diabetes Control and Complications Trial Research Group | journal = Annals of Internal Medicine | volume = 122 | issue = 8 | pages = 561–8 | year = 1995 | month = April | pmid = 7887548 | doi = 10.1059/0003-4819-122-8-199504150-00001 }}</ref> The goal of treatment is an HbA1C level of 6.5%, but should not be lower than that, and may be set higher.<ref name=NICE66/> Attention is also paid to other health problems that may accelerate the deleterious effects of diabetes. These include tobacco smoking|smoking, hypercholesterolemia|elevated cholesterol levels, obesity, hypertension|high blood pressure, and lack of regular exercise.<ref name=NICE66>{{NICE|66|Type 2 diabetes|2008}}</ref>

There are roles for patient education, dietetic support, sensible exercise, with the goal of keeping both short-term and long-term blood glucose levels Diabetes management#Glycemic control|within acceptable bounds.  In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.<ref>{{cite journal | author = Adler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA, Wright AD, Turner RC, Holman RR | title = Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study | journal = BMJ | volume = 321 | issue = 7258 | pages = 412–9 | year = 2000 | month = August | pmid = 10938049 | pmc = 27455 | doi = 10.1136/bmj.321.7258.412 }}</ref>

{{Main|Anti-diabetic medication}}

Metformin is generally recommended as a first line treatment for Type 2 diabetes, as there is good evidence that it decreases mortality.<ref name=AFP09>{{cite journal | author = Ripsin CM, Kang, H, Urban, RJ | title = Management of blood glucose in type 2 diabetes mellitus | journal = American family physician | volume = 79 | issue = 1 | pages = 29–36 | year = 2009 | pmid = 19145963 | doi =  | url = http://www.aafp.org/afp/2009/0101/p29.pdf }}</ref> Routine use of aspirin, however, has not been found to improve outcomes in uncomplicated diabetes.<ref>{{cite journal | author = Pignone M, Alberts MJ, Colwell JA, Cushman M, Inzucchi SE, Mukherjee D, Rosenson RS, Williams CD, Wilson PW, Kirkman MS; American Diabetes Association; American Heart Association; American College of Cardiology Foundation | title = Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation | journal = Diabetes Care | volume = 33 | issue = 6 | pages = 1395–402 | year = 2010 | month = June | pmid = 20508233 | pmc = 2875463 | doi = 10.2337/dc10-0555 }}</ref>

;Insulin

{{Main|Insulin therapy}}

Type 1 diabetes is typically treated with a combinations of regular and NPH insulin, or synthetic insulin analogs. When insulin is used in Type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications.<ref name=AFP09/> Doses of insulin are then increased to effect.<ref name=AFP09/>

In countries using a general practitioner system, such as the United Kingdom, care may take place mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or research projects. In other circumstances, general practitioners and specialists share care of a patient in a team approach. Optometry|Optometrists, podiatry|podiatrists/chiropodists, dietitians, Physical therapy|physiotherapists, nursing specialists (e.g., diabetic specialist nurses), nurse practitioners, or certified diabetes educators, may jointly provide multidisciplinary expertise.{{Citation needed|date=June 2011}} Home telehealth support can be an effective management technique.<ref name=''Polisena''>{{cite journal | author = Polisena J, Tran K, Cimon K, Hutton B, McGill S, Palmer K | title = Home telehealth for diabetes management: a systematic review and meta-analysis | journal = Diabetes Obes Metab | volume = 11 | issue = 10 | pages = 913–30 | year = 2009 | pmid = 19531058 | doi = 10.1111/j.1463-1326.2009.01057.x }}</ref>

#1 ''Diabetes Blue Circle Symbol''. International Diabetes Federation. 17 March 2006.

#2 Shoback, edited by David G. Gardner, Dolores (2011). Greenspan's basic & clinical endocrinology (9th ed.). New York: McGraw-Hill Medical. pp. Chapter 17. ISBN 0-07-162243-8.

#3 [http://www.npr.org/blogs/health/2012/06/21/155505445/how-to-spot-a-neglected-tropical-disease How to spot a neglected tropical disease]

#4 Williams textbook of endocrinology (12th ed.). Philadelphia: Elsevier/Saunders. pp. 1371–1435. ISBN 978-1-4377-0324-5.

#5 Lambert, P.; Bingley, P. J. (2002). ''What is Type 1 Diabetes?''. Medicine 30: 1–5. doi:10.1383/medc.30.1.1.28264. Diabetes Symptoms edit

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