Diabetic Neuropathy

Diabetic neuropathy is a heterogeneous disorder that encompasses a wide range of abnormalities affecting proximal and distal peripheral sensory and motor nerves as well as the autonomic nervous system. The exact prevalence of diabetic neuropathy is unknown, partly because of difficulties with definition. Reported prevalence rates vary from 10 to 90 in diabetic patients. It is known, however, that the risk of developing neuropathy is directly linked to the duration of diabetes after 20 years of...

Classification Of Diabetes

The diagnostic label 'diabetes mellitus' refers not to a unique disease but rather to multiple disorders of different causation. Increasing knowledge has allowed us to identify discrete conditions caused by specific genetic abnormalities, while other types of diabetes remain difficult to classify on an etiologic basis. The ADA has published a new etiologic classification of diabetes, an adapted version of which is presented in Figure 6. Type 1 diabetes (previously insulin-dependent diabetes...

Drug And Insulin Treatment For Type Diabetes Mellitus

The treatment of type 2 DM continues to be a major therapeutic challenge. Our knowledge of the efficacy of treatment strategies was informed by the landmark intervention study, the United Kingdom Prospective Diabetes Study (UKPDS). In this study, an intensive glucose control policy, which was able to maintain a HbA1c value 0.9 lower than conventional treatment, was associated with significant reductions in the risk of microvascular endpoints. The UKPDS has demonstrated the progressive nature of...

Type Diabetes Mellitus

Type 2 DM is one of the most commonly seen genetic disorders, yet its exact mode of inheritance has remained elusive and is likely to be polygenic. The rate of concordance is high in identical twins, but is much lower in non-identical dizygotic twins. Patients with type 2 DM show an increased frequency of diabetes in other family members compared with the non-diabetic population. Only a small proportion of patients (< 3 ) with type 2 DM have a monogenic disorder. No unequivocal, reproducible...

Index

Acanthosis nigricans 77, 104 acromegaly 2, 18 acute complications of DM 63-7 Addison's disease 18 adenovirus 12 adhesive capsulitis, shoulder 78 alcohol 33, 63 alprostadil (prostaglandin Ej) 76, 90, 91 American Diabetes Association (ADA) diagnostic criteria 1-2, 14 etiologic classification 6 exercise guidelines 34 GDM criteria 112,113 HbAjc target 38 hyperlipidemia screening recommendations 110 Working Group on the Prevention of Diabetes recommendations 14 amputation, lower-limb 73, 74 amylin...

Treatment of children and adolescents with diabetes

The importance of effective strategies for the treatment of diabetes in children and adolescents is accentuated by the knowledge that time-trend data, for countries where it is available, have demonstrated a clear increase in incidence of type 1 diabetes mellitus DM in these age groups. Such an increase suggests changes in environmental factors with the larger increase in children lt 5 years of age suggestive of factors operative in early life. As alluded to elsewhere, cases of type 2 DM...

Info

Figure 57 Insulin injection technique the modern practice is to insert the needle vertically into the subcutaneous tissue. Needles of 8 mm in length are used with a pinch-up technique except in obese patients, in whom the standard 12-mm needle should be used. When insulin is being injected without pinch-up into the arms, 6-mm needles are recommended. It is no longer considered necessary to swab the skin with alcohol or to withdraw the skin plunger to check for blood. Care must be taken in thin...

The Skin In Diabetes

A variety of disorders of the skin occur in patients with DM. Some of these conditions are associated with endocrine or metabolic disorders that may themselves cause diabetes. This skin manifestation is often missed on examination, but is, nevertheless, fairly frequently encountered in patients with DM especially in those with genetic syndromes of insulin resistance and the metabolic syndrome. It is characterized by a velvety, papillomatous, usually pigmented, overgrowth of the epidermis and...

Diabetic dyslipidemia

Lipid disorders assume a position of utmost importance in patients with diabetes because of the high risk of macrovascular disease in this condition. Patients with well controlled type 1 diabetes mellitus DM have lipoprotein concentrations similar to the background non-diabetic population. With poor control, increased concentrations of triglyceride-rich lipopro-teins are seen giving rise to hypertriglyceridemia. The most common lipoprotein abnormality in type 2 diabetes is an elevation in...

Other Types Of Diabetes

Maturity-onset diabetes of the young MODY is inherited as an autosomal dominant and, to date, abnormalities at six genetic loci on different chromosomes have been identified. The most common form of MODY is associated with mutations on chromosome 12 in hepatic nuclear factor HNF -la and hence this is referred to as transcription-factor MODY. Other mutations affect such transcription factors as HNF-ip, HNF-4a, insulin promoter factor-1 and NEUROD 1. Transcription factor mutations alter insulin...

Introduction

Diabetes mellitus DM is set to become one of the world's biggest health problems owing to the projected increase in new cases. The word diabetes means 'to run through' or 'a siphon' in Greek and the condition has been recognized since the time of the ancient Egyptians. Mellitus from the Latin and Greek roots for 'honey' was later added to the name of this disorder when it became appreciated that diabetic urine tasted sweet. The incidence of type 1 diabetes differs enormously between populations...

Insulin Treatment Of Type Diabetes Mellitus

The Diabetes Control and Complications Trial DCCT published in the USA in 1993 established beyond all reasonable doubt that intensive insulin therapy delays the onset and slows the progression of diabetic microvascular complications. The achievement of good blood glucose control while avoiding hypoglycemia is therefore the therapeutic goal for most patients with type 1 DM. For the majority of patients this proves to be a major challenge despite considerable input from the diabetic team....

Bibliography

Gestational diabetes. Diabetes Care 2000 23 Suppl 1 S77-9 Crowther CA, Hiller JE, Moss JR, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005 352 2477-86 Drury IM, Greene AT, Stronge JM. Pregnancy complicated by clinical diabetes mellitus. A study of 600 pregnancies. Obstet Gynecol 1977 49 519-22 Greene MF, Solomon CG. Gestational diabetes mellitus -time to treat. N Engl J Med 2005 352 2544-6 HAPO Study Cooperative...

Patients On Insulin Therapy

Patients on insulin therapy having anything other than a minor surgical procedure should, optimally, be admitted prior to the day of planned surgery to allow stabilization of the blood glucose levels. On the day of surgery, which, as stated above, should always be in the morning, an intravenous infusion of insulin and glucose should be set up with potassium supplementation. Most centers utilize a continuous intravenous infusion of insulin via a pump driving a syringe containing 50 units of...

Frederick Banting

James Collip

Preventing insulin dependent diabetes mel-litus. Promising strategies but formidable hurdles still to clear. Br Med J 1993 307 1435-6 Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part I diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998 15 539-53 American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 2000 23 381-9 Diabetes care...

Preface

The world is witnessing an increase in new cases of diabetes, in both the developed and the developing nations, of near epidemic proportion. This ubiquitous condition will have an ever-increasing impact on all aspects of medicine and public health. It follows that all practicing physicians must seek to gain at least a basic knowledge and understanding of this important global health problem that is so closely linked to the increasing prevalence of obesity. Diabetes is the paradigm of a...

Hypochlorhydria

Normal Pancreas Electron Microscope

Figure 22 Insulin deficiency results in increased hepatic glucose production and, hence, hyperglycemia by increased gluconeogenesis and glycogenolysis. Insulin deficiency also results in increased proteolysis releasing both glucogenic and ketogenic amino acids. Lipolysis is increased, elevating both glycerol and non-esterified fatty acid levels which further contribute to gluconeogenesis and ketogenesis, respectively. The end result is hyperglycemia, dehydration, breakdown of body fat and...

Insulin Hypertrophy

Insulin Atrophy

Figure 60 Effect of adding twice-daily soluble insulin injections to a regimen based on twice-daily intermediate-acting isophane insulin. Many newly presenting type 1 diabetes mellitus patients who have residual endogenous insulin secretion can be controlled with twice-daily isophane, two-thirds in the morning and one-third in the evening. However, if postprandial hyperglycemia is pronounced, soluble insulin can be added to one or both injections. Alternatively, fixed mixtures of soluble...

Bibliography Of The Diabetes Mellitus

Cerebral Edema Dka

Hypoglycemia. Diabetes Care 1994 17 734-55 Frier BM, Fisher BM, eds. Hypoglycemia and Diabetes. London Edward Arnold, 1993 Kitabchi AE, Umpierrez GE, Murphy MB, et al. Management of hyperglycaemic crises in patients with diabetes. Diabetes Care 2GG1 24 131-53 Schade DS, Eaton RP, Alberti KGGM, Johnston DG. Diabetic Coma, Ketoacidotic and Hyperosmolar. Albuquerque University of New Mexico Press, 1981 Small M, Alzaid A, MacCuish AC. Diabetic hyperosmolar...

Future developments in diabetes

Research activity in the field of diabetes has increased greatly in recent years. People with diabetes would want this to translate into more effective treatment of diabetes and its complications. Patients with type 1 diabetes would like to be freed from the need to self-inject with insulin. Pancreatic and islet-cell transplantation can achieve this however, it is unlikely that these techniques will find widespread application in the immediate future. It may prove possible to generate mature...

Diabetic Dermopathy

Antifungal Creams Penis

Fall in visual acuity 2 lines or more on Snellen chart Established maculopathy edema of macula, hard exudates on macula New vessels at periphery or disc Rubeosis iridis Advanced diabetic retinopathy e.g. retinal detachment Immediate referral to an ophthalmologist Fall in visual acuity 2 lines or more on Snellen chart Established maculopathy edema of macula, hard exudates on macula New vessels at periphery or disc Rubeosis iridis Advanced diabetic retinopathy e.g. retinal detachment Urgent...

Hypoglycemia

Hypoglycemia is the greatest fear of patients treated with insulin. Hypoglycemia in patients with type 1 diabetes is a major source of disruption to their lives. It also occurs in patients treated with sulfonylureas, although to a lesser extent. Over 30 of insulin-treated diabetic patients experience hypoglycemic coma at least once in their lives, and approximately 3 experience frequent and severe episodes. In the Diabetes Control and Complications Trial, the incidence of severe hypoglycemia...

Insulin Crystals

Cnbr Cleavage Proinsulin

Management of non-insulin dependent diabetes in Europe a consensus view. Diabetic Med 1988 5 275-81 American Diabetes Association. Nutritional recommendations and principles for people with diabetes mellitus. Diabetes Care 2000 23 Suppl I s43-6 American Diabetes Association. Nutritional principles and recommendations in diabetes. Diabetes Care 2004 27 Suppl 1 s36-s46 DeVries JH, Snoek FJ, Heine RJ. Persistent poor glycaemic control in adult type 1 diabetes. A closer look...

Intraretinal Microvascular Abnormalities

Intraretinal Microvascular Abnormalities

Aiello LP, Gardner TW, King GL, et al. Diabetic retinopathy. Diabetes Care 1998 21 143-56 Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002 346 1221-31 Archer AG, Watkins PJ, Thomas PK, Sharma AK, Payan J. The natural history of acute painful diabetic neuropathy. J Neurol Neurosurg Psychiatr 1983 46 491-9 Arkkila PE, Kantola IM, Viikari JS, et al. Dupuytren's disease in type 1 diabetic patients a five-year prospective study. Clin Exp Rheumatol 1996 14 59-65 Barnett AH, Dodson PM....

Human Monotard Humulin Lente Hypurin Bovine Lente

Long Acting Insulin

Figure 50 Over 300 insulin preparations are available worldwide. They may be classified according to their duration of action short-acting soluble, neutral or regular , intermediate-acting isophane , long-acting insulin-zinc suspensions , and fixed mixtures of short- and intermediate-acting biphasic insulins . Some of the most commonly used insulins are summarized in this figure. It is preferable for the non-specialist to become familiar with a small number of appropriate insulins and insulin...

Xxy Klinefelter Child

Years Old Klinefelter Sindrome

Andersen RE, Crespo CJ, Bartlett SJ, et al. Relationship of physical activity and television watching with body weight and level of fatness among children results from the Third National Health and Nutrition Examination Survey. JAMA 1998 279 938-42 Atkinson MA, Eisenbarth GS. Type I diabetes new perspectives on disease pathogenesis and treatment. Lancet 2001 358 221-9 Bottazzo GF. Death of a beta cell homicide or suicide Diabetic Med 1986 3 119-30 Chiasson JL, Gomis R, Hanefeld M, et al. The...

Amyloid Diabetes Pancreas

Hemosiderin Staining Urinary Deposits

Figure 30 The same pancreas as in Figure 29 has been immunostained to show P-cells note the destruction of the P-cells in this islet owing to inflammation compare with Figure 24 Figure 31 This histologic section of pancreas was obtained at autopsy from a patient 5 years after the onset of type 1 diabetes. It shows persistence of an infiltrate of lymphocytes insulitis some of which have been indicated by arrows, affecting this islet, immunostained for insulin. This shows that P-cell destruction...

Nonalcoholic Steatohepatosis

Non-alcoholic fatty liver disease, has recently become increasingly recognized and may progress to end-stage liver disease. It is histologically indistinguishable from the liver damage that is secondary to alcohol abuse, but occurs in people with no history of alcohol excess. Non-alcoholic fatty liver disease has a wide spectrum of liver damage ranging from simple steatosis to steatohepatitis, advanced fibrosis and cirrhosis. The combination of steatosis, infiltration by mononuclear or...