Erectile Dysfunction in Diabetes and Its Treatment

Dipartimento di Medicina Interna, Universita degli Studi di Torino, Ospedale Molinette, Torino, Italy The existence of sexual disorders in diabetes mellitus has long been recognized. In the pre-insulin era, impotence was considered one of the commonest symptoms of diabetes, being present in both severe and milder forms of the disease. However, only now are sexual function problems receiving their rightful attention, as the medical professional has moved from a mere 'survivalist' approach to...

Clinical Emergencies in Diabetes Diabetic Ketoacidosis and Hyperosmolar Nonketotic Syndrome

Institute of Internal Medicine, University of Catania, Ospedale Garibaldi, Catania, Italy Diabetic ketoacidosis DKA is the classical acute metabolic complication of type 1 diabetes, although it may also occur much less commonly in type 2 diabetes, being primarily due to severe insulin deficiency. The hormonal pattern favoring DKA is represented by severe insulin deficiency and or excess of counterregulatory hormones or stress hormones which include glucagon, catecholamines, cortisol and GH....

Insulin Treatment in Type and Type Diabetes Practical Goals and Algorithms

Institute of Internal Medicine, University of Catania, Ospedale Garibaldi, Catania, Italy In type 1 diabetes, insulin therapy is focused on the replacement of insulin secretion, even if lifestyle changes are required to optimize insulin treatment. In type 2 diabetes, insulin treatment may be required when diet and oral therapy do not suffice. A variety of highly purified preparations of human insulin the only form of insulin today sold in industrialized countries are commercially available,...

Introduction

Diabetes mellitus and its complications are clinical conditions of growing importance both from the clinical as well as epidemiological standpoint. The relevance of diabetes at clinical and individual level is given by its life-threatening acute complications and, especially, by its chronic complications affecting several organs and systems, with increased risk for ocular, renal, cardiac, cerebral, nervous and peripheral vascular diseases. The high prevalence of diabetes in many developed...

Foot Problems in Diabetes

Boulton Department of Medicine, Manchester Royal Infirmary, Manchester, UK The diabetic foot can present with a variety of problems, but the most important clinically are ulceration, amputation and Charcot neuroarthropathy. These will be the focus of this chapter. Many diabetic complications have a great impact on the foot and it is therefore not surprising that diabetic foot problems account for more hospital inpatient days than any other diabetic problems....

Insulin Secretion and Its Pharmacological Stimulation

Glucagon Epinephrine Camp Glut2

Institute of Internal Medicine, University of Catania, Ospedale Garibaldi, Catania, Italy Pancreatic P-cells synthesize a large polypeptide chain, the proinsulin, which is then cleaved into the so-called connecting peptide C-peptide and the insulin molecule, composed of two peptide chains containing 51 amino acid residues. Both insulin and C-peptide are packaged in the secretory granules. During the secretory process, the granule content is discharged outside the P-cell through a process of...

Cardiovascular Disease and Diabetes

Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italia and Adis International, Auckland, New Zealand Epidemiological Evidence for Increased Risk of Cardiovascular Disease in Diabetic Patients It has been known for many years that diabetes mellitus is a potent independent risk factor for cardiovascular disease CVD . In the Framingham Study the risk of CVD for diabetic subjects at baseline was higher by about 2 times for men and 3 times for women after adjustment for other risk factors...

Diabetic Retinopathy

Proliferative Diabetic Retinopathy

Department of Ophthalmology, Arhus University Hospital, Arhus, Denmark Diabetes mellitus is a systemic disease that affects all parts of the eye. The majority of these changes have a mild course with no permanent influence on visual function. Transitory changes in the refraction of the lens occur secondary to changes in the blood sugar, and can be prevented by optimizing the metabolic control. Diabetic cataract can nowadays be operated with few complications and with a good visual result, and...

Insulin Resistance and Its Relevance to Treatment

Catecholamines And Insulin Resistance

Institute of Internal Medicine, University of Catania, Ospedale Garibaldi, Catania, Italy Insulin exerts its metabolic effects on the insulin-sensitive tissues, i.e. on liver, muscle and adipose tissue. In these tissues, insulin action is the result of complex mechanisms. We can distinguish 1 insulin binding to specific receptors and the following sequence of events along the insulin signalling pathway, which ultimately lead to 2 the insulin metabolic effects at postreceptor level. The insulin...

Info

Titrate to diastolic BP Optimal BP Suboptimal BP ABM Ambulatory blood pressure monitoring. 1 In those with high cardiovascular risk and initial BP 140-159 90-99 mm Hg there could be a case for adopting the targets for diabetic patients British Hypertension Society 1999 . ABM Ambulatory blood pressure monitoring. 1 In those with high cardiovascular risk and initial BP 140-159 90-99 mm Hg there could be a case for adopting the targets for diabetic patients British Hypertension Society 1999 ....

Nephropathy and Hypertension in Diabetic Patients

Medical Department M Diabetes and Endocrinology , Kommunehospitalet, Arhus University Hospital, Arhus, Denmark Strict and steady near normoglycemia over many years is of paramount importance for the prevention and postponement of renal disease, as well as other complications in most patients with type 1 and type 2 diabetes. Later, several other factors appear to affect progression in renal disease of which blood pressure BP elevation seems most important. This seems also to be the case for...

Lipid Abnormalities and Lipid Lowering in Diabetes

Secretory Pathway Lipoprotein

Institute of Internal Medicine, University of Catania, Ospedale Garibaldi, Catania, Italy The metabolism and function of the various lipoproteins VLDL, LDL and HDL is quite complex. Here a brief summary will be given, referring to the various steps illustrated in figure 1. Metabolism of Lipoproteins in the Normal State VLDL are produced by the liver and secreted into circulation step 1 in figure 1 . In the liver they are formed by assembling TG, formed through the esterification of FFA coming...