diabeties new

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Diabetes mellitus

Introduction

Diabetes mellitus often simply referred to as diabetesis a condition in which a person has a

high blood sugar (glucose) level as a result of the body either not producing enough insulin, or

because body cells do not properly respond to the insulin that is produced. Insulin is a hormoneproduced in the pancreas which enables body cells to absorb glucose, to turn into energy. If the

body cells do not absorb the glucose, the glucose accumulates in the blood (hyperglycemia),

leading to various potential medical complications.

There are many types of diabetes, the most common of which are:

Type 1 diabetes: results from the body's failure to produce insulin, and presently

requires the person to inject insulin. Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use

insulin properly, sometimes combined with an absolute insulin deficiency.

Gestational diabetes: is when pregnant women, who have never had diabetes before,

have a high blood glucose level during pregnancy. It may precede development of type 2

DM.

Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects ofinsulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of

glucocorticoids, and several forms ofmonogenic diabetes.

All forms of diabetes have been treatable since insulin became medically available in 1921, andtype 2 diabetes can be controlled with tablets, but it is chroniccondition that usually cannot becured. Pancreas transplantshave been tried with limited success in type 1 DM; gastric bypass

surgery has been successful in many with morbid obesity and type 2 DM; and gestational

diabetes usually resolves after delivery. Diabetes without proper treatments can cause manycomplications. Acutecomplications include hypoglycemia, diabetic ketoacidosis, ornonketotic

hyperosmolar coma. Serious long-term complications include cardiovascular disease, chronic

renal failure, retinal damage. Adequate treatment of diabetes is thus important, as well asbloodpressure control and lifestyle factors such as smoking cesation and maintaining a healthybody

weight.

As of 2000 at least 171 million people worldwide suffer from diabetes, or 2.8% of thepopulation. Type 2 diabetes is by far the most common, affecting 90 to 95% of the U.S. diabetespopulation.

Lloyd Institute Of Management &Technology Page 1
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Diabetes mellitus

Classification

Most cases of diabetes mellitus fall into the three broad categories of type 1 ortype 2 and

gestational diabetes. A few other types are described.

The term diabetes, without qualification, usually refers to diabetes mellitus, which roughlytranslates to excessive sweet urine (known as "glycosuria"). Several rare conditions are also

named diabetes. The most common of these is diabetes insipidus in which large amounts of urine

are produced (polyuria), which is not sweet (insipidus meaning "without taste" in Latin).

The term "type 1 diabetes" has replaced several former terms, including childhood-onsetdiabetes, juvenile diabetes, and insulin-dependent diabetes mellitus (IDDM). Likewise, the term

"type 2 diabetes" has replaced several former terms, including adult-onset diabetes, obesity-

related diabetes, and non-insulin-dependent diabetes mellitus (NIDDM). Beyond these twotypes, there is no agreed-upon standard nomenclature. Various sources have defined "type 3

diabetes" as: gestational diabetes, insulin-resistant type 1 diabetes (or "double diabetes"), type 2

diabetes which has progressed to require injected insulin, and latent autoimmune diabetes ofadults (or LADA or "type 1.5" diabetes)

Type 1 diabetes

Diabetes mellitus type 1

Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the isletsof Langerhans in the pancreas leading to insulin deficiency. This type of diabetes can be

further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the

immune-mediated nature, where beta cell loss is a T-cell mediated autoimmune attack. There is

no known preventive measure against type 1 diabetes, which causes approximately 10% ofdiabetes mellitu 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 wastraditionally termed "juvenile diabetes" because it represents a majority of the diabetes cases in

children.

Type 2 diabetes


Type 2 diabetes mellitus is characterized by insulin resistancewhich may be combined withrelatively reduced insulin secretion. The defective responsiveness of body tissues to insulin is

believed to involve the insulin receptor. However, the specific defects are not known. Diabetes

mellitus due to a known defect are classified separately. Type 2 diabetes is the most common

type.

In the early stage of type 2 diabetes, the predominant abnormality is reduced insulin sensitivity.

At this stage hyperglycemia can be reversed by a variety of measures and medications that

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improve insulin sensitivity or reduce glucose production by the liver. As the disease progresses,

the impairment of insulin secretion occurs, and therapeutic replacement of insulin may

sometimes become necessary in certain patients.

Gestational diabetes

Gestational diabetes

Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a

combination of relatively inadequate insulin secretion and responsiveness. It occurs in about

2%5% of all pregnancies and may improve or disappear after delivery. Gestational diabetes isfully treatable but requires careful medical supervision throughout the pregnancy. About 20%

50% of affected women develop type 2 diabetes later in life.

Even though it may be transient, untreated gestational diabetes can damage the health of the fetus

or mother. Risks to the baby include macrosomia (high birth weight), congenital cardiac and

central nervous system anomalies, and skeletal muscle malformations. Increased fetal insulinmay inhibit fetal surfactant production and cause respiratory distress syndrome.

Hyperbilirubinemia may result from red blood cell destruction. In severe cases, perinatal deathmay occur, most commonly as a result of poor placental perfusion due to vascular impairment.

Labor induction may be indicated with decreased placental function. A cesarean section may be

performed if there is marked fetal distress or an increased risk of injury associated withmacrosomia, such as shoulder dystocia.

A 2008 study completed in the U.S. found that more American women are entering pregnancy

with preexisting diabetes. In fact the rate of diabetes in expectant mothers has more than doubled

in the past 6 years. This is particularly problematic as diabetes raises the risk of complications

during pregnancy, as well as increasing the potential that the children of diabetic motherswill also become diabetic in the future.

Other types

Pre-diabetesindicates a condition that occurs when a person's blood glucose levels are higher

than normal but not high enough for a diagnosis of type 2 diabetes. Many people destined to

develop type 2 diabetes spend many years in a state of pre-diabetes which has been termed"America's largest healthcare epidemic.

Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even

when insulin levels are normal, which is what separates it from type 2 diabetes); this form is veryuncommon. Genetic mutations (autosomal ormitochondrial) can lead to defects in beta cellfunction. Abnormal insulin action may also have been genetically determined in some cases.

Any disease that causes extensive damage to the pancreas may lead to diabetes (for example,

chronic pancreatitis andcystic fibrosis). Diseases associated with excessive secretion of insulin-

antagonistic hormones can cause diabetes (which is typically resolved once the hormone excessis removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells.

The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or

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MMDM, ICD-10 code E12), was deprecated by the World Health Organization when the current

taxonomy was introduced in 1999.

Signs and symptoms

Overview of the most significant symptoms of diabetes.

The classical symptoms of DM are:

polyuria (frequent urination),

polydipsia (increased thirst) and

polyphagia(increased hunger).

Symptoms may develop quite rapidly (weeks or months) in type 1 diabetes, particularly in

children. However, in type 2 diabetes symptoms usually develop much more slowly and may besubtle or completely absent. Type 1 diabetes may also cause a rapid yet significant weight loss

(despite normal or even increased eating) and irreduciblemental fatigue. All of these symptoms

except weight loss can also manifest in type 2 diabetes in patients whose diabetes is poorly

controlled, although unexplained weight loss may be experienced at the onset of the disease.Final diagnosis is made by measuring the blood glucose concentration.

When the glucose concentration in the blood is raised beyond its renal threshold (about

10 mmol/L, although this may be altered in certain conditions, such as pregnancy), reabsorptionof glucose in theproximal renal tubuli is incomplete, and part of the glucose remains in the urine

(glycosuria). This increases the osmotic pressure of the urine and inhibits reabsorption of water

by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lostblood volume will be replaced osmotically from water held in body cells and other bodycompartments, causing dehydration and increased thirst.

Prolonged high blood glucose causes glucose absorption, which leads to changes in the shape of

the lenses of the eyes, resulting in vision changes; sustained sensible glucose control usually

returns the lens to its original shape. Blurred vision is a common complaint leading to a diabetesdiagnosis; type 1 should always be suspected in cases of rapid vision change, whereas with

type 2 change is generally more gradual, but should still be suspected.

Patients (usually with type 1 diabetes) may also initially present with diabetic ketoacidosis

(DKA), an extreme state of metabolic dysregulation characterized by the smell ofacetone on thepatient's breath; a rapid, deep breathing known as Kussmaul breathing; polyuria; nausea;

vomiting and abdominal pain; and any of many altered states of consciousness or arousal (such

as hostility and mania or, equally, confusion and lethargy). In severe DKA, coma may follow,progressing to death. Diabetic ketoacidosis is a medical emergency and requires immediate

hospitalization.

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A rarer but equally severe possibility is hyperosmolar nonketotic state, which is more common in

type 2 diabetes and is mainly the result of dehydration due to loss of body water. Often, the

patient has been drinking extreme amounts of sugar-containing drinks, leading to a vicious circlein regard to the water loss.

A number of skin rashes can occur in diabetes that are collectively known as diabeticdermadromes.

Causes

Type 2 diabetes is determined primarily by lifestyle factors and genes.

Lifestyle

A number of lifestyle factors are known to be important to the development of type 2 diabetes. Inone study, those who had high levels of physical activity, a healthy diet, did not smoke, and

consumed alcohol in moderation had an 82% lower rate of diabetes. When a normal weight was

included the rate was 89% lower. In this study a healthy diet was defined as one high in fiber,with a high polyunsaturated to saturated fat ratio, and a lower mean glycemic index.Obesity has

been found to contribute to approximately 55% type 2 diabetes, and decreasing consumption of

saturated fats andtrans fatty acidswhile replacing them with unsaturated fats may decrease therisk The increased rate ofchildhood obesity in between the 1960s and 2000s is believed to have

lead to the increase in type 2 diabetes in children and adolescents.

Environmental toxins may contribute to recent increases in the rate of type 2 diabetes. A positive

correlation has been found between the concentration in the urine ofbisphenol A, a constituentof some plastics, and the incidence of type 2 diabetes.

Medical conditions

Subclinical Cushing's syndrome (cortisol excess) may be associated with DM type 2. The

percentage of subclinical Cushing's syndrome in the diabetic population is about 9%.Diabetic

patients with a pituitary microadenoma can improve insulin sensitivity by removal of thesemicroadenomas.

Hypogonadism is often associated with cortisol excess, and testosterone deficiency is also

associated with diabetes mellitus type 2, even if the exact mechanism by which testosteroneimprove insulin sensitivity is still not known.

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Genetics

Both type 1 and type 2 diabetes are partly inherited. Type 1 diabetes may be triggered by certain

infections, with some evidence pointing at Coxsackie B4 virus. There is a genetic element inindividual susceptibility to some of these triggers which has been traced to particular HLA

genotypes (i.e., the genetic "self" identifiers relied upon by the immune system). However, even

in those who have inherited the susceptibility, type 1 diabetes mellitus seems to require an

environmental trigger.

There is a stronger inheritance pattern for type 2 diabetes. Those with first-degree relatives with

type 2 have a much higher risk of developing type 2, increasing with the number of those

relatives. Concordance among monozygotic twins is close to 100%, and about 25% of those withthe disease have a family history of diabetes. Genes significantly associated with developing

type 2 diabetes, include TCF7L2, PPARG, FTO, KCNJ11, NOTCH2, WFS1, CDKAL1,

IGF2BP2, SLC30A8, JAZF1, and HHEX. KCNJ11 (potassium inwardly rectifying channel,subfamily J, member 11), encodes the islet ATP-sensitive potassium channel Kir6.2, andTCF7L2 (transcription factor 7like 2) regulates proglucagon gene expression and thus the

production ofglucagon-like peptide-1. Moreover, obesity (which is an independent risk factor

for type 2 diabetes) is strongly inherited.

Monogenic forms, e.g., MODY, constitute 15 % of all cases.

Various hereditary conditions may feature diabetes, for example myotonic dystrophy and

Friedreich's ataxia. Wolfram's syndrome is an autosomal recessive neurodegenerative disorder

that first becomes evident in childhood. It consists of diabetes insipidus, diabetes mellitus, optic

atrophy, and deafness, hence the acronym DIDMOAD.

Gene expression promoted by a diet of fat and glucose as well as high levels of inflammation

related cytokines found in the obese results in cells that "produce fewer and smaller

mitochondria than is normal," and are thus prone to insulin resistance.

Pathophysiology

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The fluctuation of blood sugar (red) and the sugar-lowering hormone insulin (blue) in humans

during the course of a day with three meals. One of the effects of a sugar-rich vs a starch-richmeal is highlighted.

Mechanism of insulin release in normal pancreatic beta cells. Insulin production is more or less

constant within the beta cells, irrespective of blood glucose levels. It is stored within vacuolespending release, via exocytosis, which is primarily triggered by food, chiefly food containing

absorbable glucose. The chief trigger is a rise in blood glucose levels after eating

Insulin is the principal hormone that regulates uptake of glucose from the blood into most cells

(primarily muscle and fat cells, but not central nervous system cells). Therefore deficiency ofinsulin or the insensitivity of its receptorsplays a central role in all forms of diabetes mellitus.

Humans are capable of digesting some carbohydrates, in particular those most common in food;

starch, and some disaccharides such as sucrose, are converted within a few hours to simpler

forms most notably themonosaccharideglucose, the principal carbohydrate energy source usedby the body. The most significant exceptions are fructose, most disaccharides (except sucrose

and in some people lactose), and all more complex polysaccharides, with the outstanding

exception of starch. The rest are passed on for processing by gut flora largely in the colon.Insulin is released into the blood by beta cells (-cells), found in the Islets of Langerhans in the

pancreas, in response to rising levels of blood glucose, typically after eating. Insulin is used by

about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, forconversion to other needed molecules, or for storage.

Insulin is also the principal control signal for conversion of glucose to glycogen for internal

storage in liver and muscle cells. Lowered glucose levels result both in the reduced release of

insulin from the beta cells and in the reverse conversion of glycogen to glucose when glucoselevels fall. This is mainly controlled by the hormone glucagonwhich acts in the opposite manner

to insulin. Glucose thus forcibly produced from internal liver cell stores (as glycogen) re-enters

the bloodstream; muscle cells lack the necessary export mechanism. Normally liver cells do thiswhen the level of insulin is low (which normally correlates with low levels of blood glucose).

Higher insulin levels increase some anabolic ("building up") processes such as cell growth and

duplication, protein synthesis, and fat storage. Insulin (or its lack) is the principal signal in

converting many of the bidirectional processes of metabolism from a catabolic to an anabolicdirection, and vice versa. In particular, a low insulin level is the trigger for entering or leaving

ketosis (the fat burning metabolic phase).

http://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Sucrosehttp://en.wikipedia.org/wiki/Starchhttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Receptor_(biochemistry)http://en.wikipedia.org/wiki/Receptor_(biochemistry)http://en.wikipedia.org/wiki/Carbohydrate_metabolismhttp://en.wikipedia.org/wiki/Monosaccharidehttp://en.wikipedia.org/wiki/Monosaccharidehttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Fructosehttp://en.wikipedia.org/wiki/Sucrosehttp://en.wikipedia.org/wiki/Lactosehttp://en.wikipedia.org/wiki/Lactosehttp://en.wikipedia.org/wiki/Starchhttp://en.wikipedia.org/wiki/Glycogenhttp://en.wikipedia.org/wiki/Glucagonhttp://en.wikipedia.org/wiki/Glucagonhttp://en.wikipedia.org/wiki/Anabolismhttp://en.wikipedia.org/wiki/Protein_biosynthesishttp://en.wikipedia.org/wiki/Protein_biosynthesishttp://en.wikipedia.org/wiki/Lipidhttp://en.wikipedia.org/wiki/Catabolismhttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Sucrosehttp://en.wikipedia.org/wiki/Starchhttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Receptor_(biochemistry)http://en.wikipedia.org/wiki/Carbohydrate_metabolismhttp://en.wikipedia.org/wiki/Monosaccharidehttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Fructosehttp://en.wikipedia.org/wiki/Sucrosehttp://en.wikipedia.org/wiki/Lactosehttp://en.wikipedia.org/wiki/Starchhttp://en.wikipedia.org/wiki/Glycogenhttp://en.wikipedia.org/wiki/Glucagonhttp://en.wikipedia.org/wiki/Anabolismhttp://en.wikipedia.org/wiki/Protein_biosynthesishttp://en.wikipedia.org/wiki/Lipidhttp://en.wikipedia.org/wiki/Catabolism


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If the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin

(insulin insensitivity orresistance), or if the insulin itself is defective, then glucose will not have

its usual effect so that glucose will not be absorbed properly by those body cells that require itnor will it be stored appropriately in the liver and muscles. The net effect is persistent high levels

of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis.

Diagnosis

Glycosylated hemoglobinandGlucose tolerance test

1999 WHO Diabetes criteria

Condition 2 hour glucose Fasting glucose

mmol/l(mg/dl) mmol/l(mg/dl)

Normal


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Diabetes mellitus

Fasting plasma glucose level at or above 7.0 mmol/L (126 mg/dL).

Plasma glucose at or above 11.1 mmol/L (200 mg/dL) two hours after a 75 g oral glucose

load as in a glucose tolerance test.

Symptoms of hyperglycemia and casual plasma glucose at or above 11.1 mmol/L

(200 mg/dL).

Glycated hemoglobin (hemoglobin A1C) at or above 6.5. (This criterion wasrecommended by the American Diabetes Associationin 2010; it has yet to be adopted by

the WHO.)

About a quarter of people with new type 1 diabetes have developed some degree of diabetic

ketoacidosis (a type of metabolic acidosis which is caused by high concentrations of ketonebodies, formed by the breakdown of fatty acids and the deamination of amino acids) by the time

the diabetes is recognized. The diagnosis of other types of diabetes is usually made in other

ways. These include ordinary health screening; detection of hyperglycemia during other medicalinvestigations; and secondary symptoms such as vision changes or unexplainable fatigue.

Diabetes is often detected when a person suffers a problem that is frequently caused by diabetes,

such as a heart attack, stroke, neuropathy, poor wound healing or a foot ulcer, certain eyeproblems, certain fungal infections, or delivering a baby with macrosomia or hypoglycemia.

A positive result, in the absence of unequivocal hyperglycemia, should be confirmed by a repeat

of any of the above-listed methods on a different day. Most physicians prefer to measure a

fasting glucose level because of the ease of measurement and the considerable time commitmentof formal glucose tolerance testing, which takes two hours to complete and offers no prognostic

advantage over the fasting test. According to the current definition, two fasting glucose

measurements above 126 mg/dL (7.0 mmol/L) is considered diagnostic for diabetes mellitus.

Patients with fasting glucose levels from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) are considered to

have impaired fasting glucose. Patients with plasma glucose at or above 140 mg/dL(7.8 mmol/L), but not over 200 mg/dL (11.1 mmol/L), two hours after a 75 g oral glucose load

are considered to haveimpaired glucose tolerance. Of these two pre-diabetic states, the latter inparticular is a major risk factor for progression to full-blown diabetes mellitus as well as

cardiovascular disease.

Screening

Diabetes screening is recommended for many people at various stages of life, and for those with

any of several risk factors. The screening test varies according to circumstances and local policy,and may be a random blood glucose test, a fasting blood glucose test, a blood glucose test two

hours after 75 g of glucose, or an even more formal glucose tolerance test. Many healthcareproviders recommend universal screening for adults at age 40 or 50, and often periodicallythereafter. Earlier screening is typically recommended for those with risk factors such as obesity,

family history of diabetes, high-risk ethnicity (Hispanic, Native American, Afro-Caribbean,

Pacific Islander, orMori). Many medical conditions are associated with diabetes and warrantscreening. A partial list includes: subclinical Cushing's syndrome, testosterone deficiency, high

blood pressure, elevated cholesterol levels, coronary artery disease, past gestational diabetes,

polycystic ovary syndrome, chronic pancreatitis, fatty liver, hemochromatosis, cystic fibrosis,

http://en.wikipedia.org/wiki/Plasma_glucosehttp://en.wikipedia.org/wiki/Glucose_tolerance_testhttp://en.wikipedia.org/wiki/Glycated_hemoglobinhttp://en.wikipedia.org/wiki/American_Diabetes_Associationhttp://en.wikipedia.org/wiki/American_Diabetes_Associationhttp://en.wikipedia.org/wiki/WHOhttp://en.wikipedia.org/wiki/WHOhttp://en.wikipedia.org/wiki/Ketoacidosishttp://en.wikipedia.org/wiki/Ketoacidosishttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Strokehttp://en.wikipedia.org/wiki/Neuropathyhttp://en.wikipedia.org/wiki/Neuropathyhttp://en.wikipedia.org/wiki/Fungal_infectionhttp://en.wikipedia.org/wiki/Fungal_infectionhttp://en.wikipedia.org/wiki/Macrosomiahttp://en.wikipedia.org/wiki/Impaired_fasting_glycemiahttp://en.wikipedia.org/wiki/Impaired_glucose_tolerancehttp://en.wikipedia.org/wiki/Impaired_glucose_tolerancehttp://en.wikipedia.org/wiki/Impaired_glucose_tolerancehttp://en.wikipedia.org/wiki/Risk_factorshttp://en.wikipedia.org/wiki/Glucose_tolerance_testhttp://en.wikipedia.org/wiki/Family_history_(medicine)http://en.wikipedia.org/wiki/Ethnicityhttp://en.wikipedia.org/wiki/Hispanichttp://en.wikipedia.org/wiki/Indigenous_peoples_of_the_Americashttp://en.wikipedia.org/wiki/Indigenous_peoples_of_the_Americashttp://en.wikipedia.org/wiki/African_diasporahttp://en.wikipedia.org/wiki/Pacific_Islanderhttp://en.wikipedia.org/wiki/Pacific_Islanderhttp://en.wikipedia.org/wiki/M%C4%81orihttp://en.wikipedia.org/wiki/Testosteronehttp://en.wikipedia.org/wiki/Dyslipidemiahttp://en.wikipedia.org/wiki/Polycystic_ovary_syndromehttp://en.wikipedia.org/wiki/Fatty_liverhttp://en.wikipedia.org/wiki/Fatty_liverhttp://en.wikipedia.org/wiki/Hemochromatosishttp://en.wikipedia.org/wiki/Plasma_glucosehttp://en.wikipedia.org/wiki/Glucose_tolerance_testhttp://en.wikipedia.org/wiki/Glycated_hemoglobinhttp://en.wikipedia.org/wiki/American_Diabetes_Associationhttp://en.wikipedia.org/wiki/WHOhttp://en.wikipedia.org/wiki/Ketoacidosishttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Strokehttp://en.wikipedia.org/wiki/Neuropathyhttp://en.wikipedia.org/wiki/Fungal_infectionhttp://en.wikipedia.org/wiki/Macrosomiahttp://en.wikipedia.org/wiki/Impaired_fasting_glycemiahttp://en.wikipedia.org/wiki/Impaired_glucose_tolerancehttp://en.wikipedia.org/wiki/Risk_factorshttp://en.wikipedia.org/wiki/Glucose_tolerance_testhttp://en.wikipedia.org/wiki/Family_history_(medicine)http://en.wikipedia.org/wiki/Ethnicityhttp://en.wikipedia.org/wiki/Hispanichttp://en.wikipedia.org/wiki/Indigenous_peoples_of_the_Americashttp://en.wikipedia.org/wiki/African_diasporahttp://en.wikipedia.org/wiki/Pacific_Islanderhttp://en.wikipedia.org/wiki/M%C4%81orihttp://en.wikipedia.org/wiki/Testosteronehttp://en.wikipedia.org/wiki/Dyslipidemiahttp://en.wikipedia.org/wiki/Polycystic_ovary_syndromehttp://en.wikipedia.org/wiki/Fatty_liverhttp://en.wikipedia.org/wiki/Hemochromatosis


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several mitochondrial neuropathies and myopathies (such as MIDD), myotonic dystrophy,

Friedreich's ataxia, some of the inherited forms of neonatal hyperinsulinism. The risk of diabetes

is higher with chronic use of several medications, including long term corticosteroids, somechemotherapy agents (especially L-asparaginase), as well as some of the antipsychotics and

mood stabilizers (especiallyphenothiazines and someatypical antipsychotics).

People with a confirmed diagnosis of diabetes are tested routinely for complications. This

includes yearly urine testing formicroalbuminuriaand examination of the retinaof the eye forretinopathy.

Accuracy of tests for early detection

If a 2-hour postload glucose level of at least 11.1 mmol/L ( 200 mg/dL) is used as the reference

standard, the fasting plasma glucose > 7.0 mmol/L (126 mg/dL) diagnoses currentdiabetes with:

sensitivity about 50%

specificity greater than 95%

A random capillary blood glucose > 6.7 mmol/L (120 mg/dL) diagnoses currentdiabetes with

sensitivity = 75%

specificity = 88%

Glycosylated hemoglobin values that are elevated (over 5%), but not in the diabetic range (not

over 7.0%) are predictive ofsubsequentclinical diabetes in US female health professionals. In

this study, 177 of 1061 patients with glycosylated hemoglobin value less than 6% became

diabetic within 5 years compared to 282 of 26281 patients with a glycosylated hemoglobin value

of 6.0% or more. This equates to a glycosylated hemoglobin value of 6.0% or more having:

sensitivity = 16.7%

specificity = 98.9%

Benefit of early detection

Since publication of the USPSTF statement, a randomized controlled trial of prescribing

acarbose to patients with "high-risk population of men and women between the ages of 40 and

70 years with abody mass index (BMI), calculated as weight in kilograms divided by the square

of height in meters, between 25 and 40. They were eligible for the study if they had IGT

according to the World Health Organization criteria, plus impaired fasting glucose (a fastingplasma glucose concentration of between 100 and 140 mg/dL or 5.5 and 7.8 mmol/L) found a

number needed to treatof 44 (over 3.3 years) to prevent a major cardiovascular event.

Other studies have shown that lifestyle changes, xenical and metformin can delay the onset ofdiabetes.

Management

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Main article:Diabetes management

Left untreated, diabetes mellitus type 2 is a chronic, progressive condition, but there are well-

established treatments which can delay or prevent entirely the formerly inevitable consequencesof the condition. Often, the condition is viewed as progressive since poor management of blood

sugar leads to a myriad of steadily worsening complications. However, if blood sugar is properlymaintained, then the condition is, in a limited sense, cured - that is, patients are at no heightened

risk for neuropathy, blindness, or any other high blood sugar complication, though theunderlying isssue, a tendency to hyperglycemia has not been addressed directly. A study at

UCLA in 2005 showed that the Pritikin Program of diet and exercise brought dramatic

improvement to a group of diabetics and pre-diabetics in only three weeks, so that about half nolonger met the criteria for the condition.

There are two main goals of treatment:

1. reduction of mortality and concomitant morbidity (from assorted diabetic complications)

2. preservation of quality of life

The first goal can be achieved through close glycemic control (i.e., to near 'normal' bloodglucose levels); the reduction in severity of diabetic side effects has been very well demonstrated

in several large clinical trials and is established beyond controversy. The second goal is often

addressed (in developed countries) by support and care from teams of diabetic health workers(usually physician, PA, nurse, dietitian or a certified diabetic educator). Endocrinologists, family

practitioners, and general internists are the physician specialties most likely to treat people with

diabetes. Knowledgeable patient participation is vital to clinical success, and so patient educationis a crucial aspect of this effort.

Type 2 is initially treated by adjustments in diet and exercise, and by weight loss, most especiallyin obese patients. The amount of weight loss which improves the clinical picture is sometimes

modest (25 kg or 4.4-11 lb); this is almost certainly due to currently poorly understood aspectsof fat tissue activity, for instance chemical signaling (especially in visceral fat tissue in and

around abdominal organs). In many cases, such initial efforts can substantially restore insulin

sensitivity. In some cases strict diet can adequately control the glycemic levels.

Diabetes education is an integral component of medical care. Among adults with diagnoseddiabetes, 12% take both insulin and oral medications,19% take insulin only, 53% take oral

medications only, and 15% do not take either insulin or oral medications.

Goals

Treatment goals for type 2 diabetic patients are related to effective control ofblood glucose,

blood pressure and lipids to minimize the risk of long-term consequences associated withdiabetes. They are suggested in clinical practice guidelines released by various national and

international diabetes agencies.

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The targets are:

HbA1c of 6% to 7.0%

Preprandialblood glucose: 4.0 to 6.0 mmol/L (72 to 108 mg/dl)

2-hourpostprandialblood glucose: 5.0 to 8.0 mmol/L (90 to 144 mg/dl)

In older patients, clinical practice guidelines by theAmerican Geriatrics Society states "for frail

older adults, persons with life expectancy of less than 5 years, and others in whom the risks of

intensive glycemic control appear to outweigh the benefits, a less stringent target such as HbA1cof 8% is appropriate"

Prevention

Type 1

Type 1 diabetes risk is known to depend upon a genetic predisposition based on HLA types

(particularly types DRs3 and DR4), an unknown environmental trigger (suspected to be aninfection, although none has proven definitive in all cases), and an uncontrolled autoimmune

response that attacks the insulin producing beta cells. Some research has suggested thatbreastfeeding decreased the risk in later life; various other nutritional risk factors are being

studied, but no firm evidence has been found. Giving children 2000 IU ofVitamin D during their

first year of life is associated with reduced risk of type 1 diabetes, though the causal relationship

is obscure.

Children with antibodies to beta cell proteins (i.e. at early stages of an immune reaction to them)

but no overt diabetes, and treated with vitamin B-3 (niacin), had less than half the diabetes onset

incidence in a 7-year time span as did the general population, and an even lower incidence

relative to those with antibodies as above, but who received no vitamin B3.

Type 2

Lifestyle

Type 2 diabetes risk can be reduced in many cases by making changes in diet and increasing

physical activity. The American Diabetes Association(ADA) recommends maintaining a healthy

weight, getting at least 2 hours of exercise per week (several brisk sustained walks appearsufficient), having a modest fat intake, and eating sufficient fiber (e.g., from whole grains). The

ADA does not recommend alcohol consumption as a preventive, but it is interesting to note that

moderate alcohol intake may reduce the risk (though heavy consumption absolutely and clearlyincreases damage to bodily systems significantly); a similarly confused connection between low

dose alcohol consumption and heart disease is termed the French Paradox.

There is inadequate evidence that eating foods of low glycemic index is clinically helpful despite

recommendations and suggested diets emphasizing this approach.

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Diets that are very low in saturated fats reduce the risk of becoming insulin resistant and

diabetic. Study group participants whose "physical activity level and dietary, smoking, and

alcohol habits were all in the low-risk group had an 82% lower incidence of diabetes."

In another study of dietary practice and incidence of diabetes, "foods rich in vegetable oils,

including non-hydrogenated margarines, nuts, and seeds, should replace foods rich in saturatedfats from meats and fat-rich dairy products. Consumption of partially hydrogenated fats should

be minimized."

There are numerous studies which suggest connections between some aspects of Type II diabetes

with ingestion of certain foods or with some drugs. Breastfeeding may also be associated with

the prevention of type 2 of the disease in mothers.

Medications

Some studies have shown delayed progression to diabetes in predisposed patients through

prophylactic use of metformin, rosiglitazone, orvalsartan. In patients on hydroxychloroquine forrheumatoid arthritis, incidence of diabetes was reduced by 77% though causal mechanisms are

unclear. Lifestyle interventions are however more effective than metformin at preventingdiabetes regardless of weightloss.

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Management

Diabetes management

Diabetes mellitus is a chronic disease which is difficult to cure. Management concentrates on

keeping blood sugar levels as close to normal ("euglycemia") as possible without presentingundue patient danger. This can usually be with close dietary management, exercise, and use of

appropriate medications (insulin only in the case of type 1 diabetes mellitus. Oral medications

may be used in the case of type 2 diabetes, as well as insulin).

Lifestyle modifications

Diabetic diet

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Diabetes mellitus

There are roles for patient education, dietetic support, sensible exercise, with the goal of keeping

both short-term and long-term blood glucose levelswithin acceptable bounds. In addition, given

the associated higher risks of cardiovascular disease, lifestyle modifications are recommended tocontrol blood pressure in patients with hypertension, cholesterol in those with dyslipidmia, as

well as exercising more, smoking less or ideally not at all, consuming a recommended diet.

Patients with foot problems are also recommended to wear diabetic socks , and possiblydiabetic shoes

Medications

Oral medications :

Anti-diabetic drug

Insulin

Insulin therapy

Type 1 treatments usually include combinations of regular or NPH insulin, and/or syntheticinsulin analogs.

Support

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, generalpractitioners and specialists share care of a patient in a team approach. Optometrists,

podiatrists/chiropodists, dietitians, physiotherapists, nursing specialists (e.g., DSNs (Diabetic

Specialist Nurse)), nurse practitioners, orCertified Diabetes Educators, may jointly provide

multidisciplinary expertise. In countries where patients must provide for their own health care(e.g. in the US, and in much of the undeveloped world).

Peer support links people living with diabetes. Within peer support, people with a common

illness share knowledge and experience that others, including many health workers, do not have.Peer support is frequent, ongoing, accessible and flexible and can take many formsphone calls,

text messaging, group meetings, home visits, and even grocery shopping. It complements and

enhances other health care services by creating the emotional, social and practical assistancenecessary for managing disease and staying healthy.

.


Diabetes mellitus type 2 ortype 2 diabetes (formerly called non -insulin-dependent diabetesmellitus (NIDDM), oradult-onset diabetes) is a disorder that is characterized by high blood

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glucose in the context of insulin resistance and relative insulin deficiency. Diabetes is often

initially managed by increasing exercise and dietary modification. As the condition progresses,

medications are typically needed.

There are an estimated 23.6 million people in the U.S. (7.8% of the population) with diabetes

with 17.9 million being diagnosed, 90% of whom are type 2. With prevalence rates doublingbetween 1990 and 2005, CDC has characterized the increase as an epidemic. Traditionally

considered a disease of adults, type 2 diabetes is increasingly diagnosed in children in parallel torising obesity rates due to alterations in dietary patterns as well as in life styles during

childhood.

Unlike type 1 diabetes, there is very little tendency toward ketoacidosis in type 2 diabetes,though it is not unknown. One effect that can occur is nonketonic hyperglycemia which also is

quite dangerous, though it must be treated very differently. Complex and multifactorial

metabolic changes very often lead to damage and function impairment of many organs, most

importantly the cardiovascular system in both types. This leads to substantially increased

morbidity and mortality in people with both type 1 and type 2 diabetes, but the two have quitedifferent origins and treatments despite the similarity in complications.

Diabetes Nutrition

Are you tired of taking insulin pills and injections for maintaining your blood sugar levels?

Have you ever thought about the health advantages that can be derived from the

consumption offood supplements? If not, think about it! The transition to the diabetic

lifestyle will be much easier.

Diabetes is one of the most prevalent chronic diseases in the world. It prevents the body

from using glucose in our food for taking care of its energy needs. This glucose gets

accumulated in our blood, thereby risking the well-being of our heart, eyes, kidneys and

nerves.

Nutritional Supplements for Diabetics

Recent researches carried out by food industries and health experts conclude that

herbal supplements such as bitter melon, goats rue, nopal cactus, fenugreek, bilberry,

gurmar, onions and garlic are quite effective in lowering the blood glucose level, therebyhelping the patients to undergo less treatment distress.

Diabetics must be always cautious about the source of their calorie intake. Non starchy

veggies, skimmed milk, lean chicken, high fiber fruits and low glycemic food products

are smart choices for an informed diabetic. Oil low in saturated fats content should be

preferred. It had been proved that a balanced diabetic diet contains some important

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nutrients and useful supplements to help control dancing blood sugar. Lets see few

useful diabetic nutritional supplements we receive from our food, and their action in

controlling diabetes.

Biotin It helps the body in metabolizing carbohydrates, proteins and fats. Vitamin C It prevents sugar from getting attached to proteins. Insulin deficiency

hinders effective metabolism and transport of Vitamin C, making its increasedintake all the more important. Here, ascorbates like EmergenC is more preferredas compared to ascorbic acid.

Chromium It aids the metabolism of glucose. It is most effective if consumedas niacin.

Vitamin E It helps in improving insulin sensitivity. Magnesium It helps in lowering blood pressure and reducing heart-attack risks

by relaxing the muscle tissues. CLA It helps in protecting cells from becoming diabetic or getting damaged by

atherosclerosis, colon cancer and chronic inflammation.

Omega 3 and Alpha Lipoic Acids - They are effective building blocks and anti-oxidants respectively. They reduce the risks associated with nerve damages byaiding balancing of blood sugar.

Vitamin B6 It helps in preventing neuropathy. Vitamin D It helps in reducing insulin resistance and averting the risks of

cataract. Zinc It helps in improving the action of insulin.

Diabetics have greater needs ofnutritional supplements for fulfilling the antioxidant

and metabolic requirements of the body. Design your food intake as per the above

necessities and living the diabetic lifestyle will be a much easier road to travel upon.

Vitamin B1 Biotin

Niacinamide Vitamin B6

Vitamin B12 Deficiency Vitamin D

Vitamin E Coenzyme Q10

L-Carnitine Inositol

Taurine Manganese

Zinc Alpha Lipoic Acid

Nutritional Brewers Yeast Diabetes and Chromium Supplements

Glucomannan Benefits Magnesium Supplementation

Primrose Oil Benefits Dietary Fiber Food

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When diet, exercise and ideal body weight arent enough to maintain normal bloodsugar level, you may need to start medication. Medications used to treat diabetes

include insulin too. Usually, people with Type 1 diabetes don't use oral medications.Diabetes Medications work best in people with Type 2 diabetes who are having highblood sugar for less than ten years with normal weight or obesity. Some people whobegin treatment with oral medications eventually need to take insulin. Unfortunately,insulin cannot be taken in pills form because enzymes in your stomach alter it, whichmakes it ineffective. Hence, insulin is taken with insulin syringe or insulin pump.

Insulin and oral diabetes medications deliberately work to lower your blood sugar. Incertain cases medications taken for other conditions may affect glucose levels. Bloodsugar levels may rise due to corticosteroids. Thiazides medications are used to controlhigh blood pressure and niacin is used to lower high cholesterol. Your doctor has to

change your diabetes treatment, if you need to take certain high blood pressuremedications.

Number of drug options exists in market for treating type 2 diabetes, including:

When diet, exercise and ideal body weight arent enough to maintain normal bloodsugar level, you may need to start medication. Medications used to treat diabetesinclude insulin too. Usually, people with Type 1 diabetes don't use oral medications.Diabetes Medications work best in people with Type 2 diabetes who are having highblood sugar for less than ten years with normal weight or obesity. Some people whobegin treatment with oral medications eventually need to take insulin. Unfortunately,

insulin cannot be taken in pills form because enzymes in your stomach alter it, whichmakes it ineffective. Hence, insulin is taken with insulin syringe or insulin pump.

Insulin and oral diabetes medications deliberately work to lower your blood sugar. Incertain cases medications taken for other conditions may affect glucose levels. Bloodsugar levels may rise due to corticosteroids. Thiazides medications are used to controlhigh blood pressure and niacin is used to lower high cholesterol. Your doctor has tochange your diabetes treatment, if you need to take certain high blood pressure

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medications.


When diet, exercise and ideal body weight arent enough to maintain normal blood

sugar level, you may to start medication. Medications used to treat diabetes includeinsulin too. Usually, people with Type 1 diabetes don't use oral medications. DiabetesMedications work best in people with Type 2 diabetes who are having high blood sugarfor less than ten years with normal weight or obesity. Some people who begin treatmentwith oral medications eventually need to take insulin. Unfortunately, insulin cannot betaken in pills form because enzymes in your stomach alter it, which makes it ineffective.Hence, insulin is taken with insulin syringe or insulin pump.

Insulin and oral diabetes medications deliberately work to lower your blood sugar. Incertain cases medications taken for other conditions may affect glucose levels. Bloodsugar levels may rise due to corticosteroids. Thiazides medications are used to control

high blood pressure and niacin is used to lower high cholesterol. Your doctor has tochange your diabetes treatment, if you need to take certain high blood pressuremedications.


Sulfonylureas

Since 1994, sulfonylureas is the only drug used for diabetes in United States. Itstimulates the pancreas for the production of more insulin to lower down the bloodsugar. It can be effective when the pancreas can release some insulin by its own.Sulfonylureas such as glipizide (Glucotrol, Glucotrol XL), glyburide (DiaBeta, GlynasePresTab, Micronase) and glimepiride (Amaryl) are prescribed more often. If your body issensitive to sulfa drug then you must avoid sulfonylureas.

Side Effects:

Low blood sugar.

Stomach upset. Skin rash and itching. Weight gain.

Biguanides

Metformin (Glucophage, Glucophage XR) is the generic name of this drug. It works byinhibiting the production and release of glucose from your liver. It also lowers down the

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insulin secretion. One good thing about biguanides drug is that it tends to low downweight gain than do others. It can also improve blood cholesterol level, which is enerallyhigh if you are type 2 diabetic.

Side Effects:

If you already have a kidney problem, metformin may build up in your body.Inform your doctor when you are placed on this medication regarding your kidneyproblem.

If you are vomiting, have diarrhea, and can't drink enough fluids, you may needto stop taking this diabetes medication for a few days.

You may feel metallic taste. If you are going for medical test using dye, or planning to opt for any surgery,

then inform your doctor about your metformin intake. He will instruct you to stop

taking metformin for some specific period.

Alpha-glucosidase Inhibitors

Alpha-glucosidase inhibitors are of two types, acarbose and miglitol. They block theenzymes of digestive system which are responsible for the break down of the starchesyou eat. The sugar produced is absorbed slowly and helps prevent the rise of bloodsugar level throughout the day, but usually right after meals. Drugs under this class are

Acarbose (Precose) and Miglitol (Glyset).

Side Effects:

Stomach problems such as gas, bloating and diarrhea etc.- temporary effects. High dosages may cause permanent changes in liver.

Clinical diagnosis of the diabetes require some of the laboratory tests, glycosuria (finding

glucose in the urine) is one of the significant test for detecting frank diabetes. Those who are

non diabetic, for them glycosuria can occur for the short term due to emotional stress, pain,

hyperthyroidism, alimentary hyperglycemia or meningitis. It can also occur when there isinsufficiency of insulin and if a substantial amount of food with high sugar is consumed.

Glycosuria is a condition in which glucose or simple sugar is detected in the urine despite of

normal blood sugar level. The normally functioning kidneys absorb and reabsorb the extra blood

sugar till renal threshold, with the help of millions of micro tubules Nephron (filtering unit of

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kidney). The renal threshold is a concentration level above which all simple sugar is not

absorbed in the blood; hence extra glucose is excreted by the kidneys in the urine. Renal

threshold of normal kidney is around 10mmol/L. In few cases, when drugs are used for a longerspan of time, it may alter the threshold level ofkidney. The amount of glucose not reabsorbed by

the kidneys is usually less than 0.1%. Adults excrete about 65 mg of glucose per day. The

relationship between glycosuria and the renal threshold are explained in the diagram givenbelow.

In renal glycosuria glucose is abnormally eliminated in the urine due to improper action of the

nephron.

The renal glycosuria occurs only when there are abnormally functioning kidneys, due some dent

in the kidneys or as an autosomal recessive trait.

The generic names for these drugs are pioglitazone (Actos) and Troglitazone (Rezulin),

Rosiglitazone (Avandia). Troglitzeone (Rezulin) was banned in March 2000 as it causes liver

failure. Thiazolidinediones drug makes your body tissue more sensitive to insulin. The insulincan then move glucose from your blood into your cells for the production of energy.

Side Effects:

It may affect your liver function and lead to nausea, vomiting, stomach

pain, lack of appetite, tiredness, yellowing of the skin or whiteness in the eyes, or

dark-colored urine.

If you take birth control pills, this drug may decrease its effectiveness in

preventing pregnancy.

Unusual weight gain.

Loss of appetite may develop risk of anemia which will make you feeltired.

Swelling in the legs or ankles.

Meglitinides is available with the generic name Repaglinide (Prandin). It helps the pancreas toproduce more insulin right after meals which lowers blood sugar. Its effect is much similar to

short acting sulfonylureas. Meglitinides works quickly, and the results fade rapidly, so your

doctor might prescribe Repaglinide only or with Metformin.

Side Effects:

weight gain low blood sugar

Juvenile diabetes is an autoimmune disorder which can be due to environmentaltrigger or virus, which hampers the function of beta cell. Once the beta cells are

destroyed the body is unable to produce insulin. It is also believed that Type 1

diabetes results from an infectious or toxic insult to a child, whose immune system ispredisposed to develop an aggressive autoimmune response either against molecules

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of the B cell or against altered pancreatic B antigens, resembling a viral protein. A

child with diabetic siblings is more prone to developjuvenile diabetes than the child

from a totally unaffected family. It is considered to be a more hereditary problem thanexcess eating or being obese.

Pancreas produces the exact amount of insulin, to breakdown the sugar produced inthe body. The juvenile diabetic lack the production of insulin so, sugar builds up

high in the blood, overflows into the urine and passes from the body unused.

It is estimated that about 10-15% in United States are suffering with juvenilediabetes. Approximately 35 American children are diagnosed with juvenile diabetes

every day.

To keep your blood glucose in control through out the day you need diet modifications,regular exercise, medicine (tablets/insulin injections).

Insulin injection is not needed immediately after the diagnosis of diabetes is made

(unless your doctor feels this is an emergency).

If you are obese you need to reduce your weight through diet control and give up

sedentary habits so that your insulin works better. Your treatment should be started andsupervised by an expert, who should review every 3-6 months to help you keep your

blood glucose in control. You should register in a diabetic clinic for regular blood

pressure check ups, ECG and advice for care.

Treatment is aimed at maintaining the blood glucose in the normal range and HbA1c less

than 7%, by balancing food intake with oral medication or insulin and physical activity

year after year, to prevent complications ofdiabetes.

An emotional stress (a death in family, displeasure at work or at home) may increase and

disturb the control ofdiabetes. You need to discuss the problem with your doctor forsuitable adjustment in dosage ofmedication and stress control exercises.

By keeping a good control of diabetes at all times, you will be able to prevent thecomplications ofdiabetes affecting the nerves, eyes, kidneys, heart and blood vessels.

Tips for diabetics before and during pregnancy

Coordinate with the health care team to achieve blood sugar levelclose to the normal range.

Consult with a doctor, who has experience in handling diabetesmellitus during pregnancy.

Put some extra care to the eyes and kidneys and check it frequently,because pregnancy may make it worst.

Stop smoking, drinking alcohol, or use of harmful drugs.

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Consult and coordinate with an experienced dietician and plan yourmeal and follow it strictly and make sure the mother and the unbornbaby have a healthy diet.

If already pregnant, then consult the doctor right away. Its not too late to bring the blood sugar

close to normal so that the mother and the baby stay healthy during the rest of the pregnancy.

Diabetes pregnancy management

Diabetes mellitus may be effectively managed by appropriate meal planning, increased physical

activity and properly-instituted insulin treatment. Some tips for controlling diabetes in pregnancyinclude:

Meals cut down sweets, eats three small meals and one to three snacks aday, maintain proper mealtimes, and include balanced fiber intake in theform of fruits, vegetables and whole-grains.

Increased physical activity - walking, swimming/aquaerobics, etc. Monitor blood sugar level frequently, doctors may asked to check the blood

glucose more often than usual. The blood sugar level should be below 95 mg/dl (5.3 mmol/l) on awakening,

below 140 mg/dl (7.8 mmol/l) after one hour of meal and below 120 mg/dl(6.7 mmol/l) after two hours of a meal.

Each time when checking the blood sugar level, keep a proper record of theresults and present to the health care team for evaluation and modification ofthe treatment. If blood sugar levels are above targets, a perinatal diabetes

management team may suggest ways to achieve targets. Many may need extra insulin during pregnancy to reach their blood sugar

target. Insulin is not harmful for the baby.

Breast feeding

Breast feeding is good for the child even with a mother with diabetes mellitus. Some women

wonder whether breast feeding is recommended after they have been diagnosed with diabetes

mellitus. Breast feeding is recommended for most babies, including when mothers may be

diabetic. In fact, the childs risk for developing type 2 diabetes mellitus later in life may be lowerif the baby was breast-fed. It also helps the child to maintain a healthy body weight in infancy.

Classification

The White classification, named after Priscilla White who pioneered research on the effect of

diabetes types on perinatal outcome, is widely used to assess maternal and fetal risk. Itdistinguishes between gestational diabetes (type A) and diabetes that existed before pregnancy

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(pregestational diabetes). These two groups are further subdivided according to their associated

risks and management.

There are 2 classes of gestational diabetes (diabetes which began during pregnancy):

Class A1: gestational diabetes; diet controlled Class A2: gestational diabetes; insulin controlled

The second group of diabetes which existed before pregnancy can be split up into these classes:

Class B: onset at age 20 or older or with duration of less than 10 years Class C: onset at age 10-19 or duration of 1019 years Class D: onset before age 10 or duration greater than 20 years Class F:

diabeties new

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