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Additional health information from my cousin:

DIABETES MELLITUS

WHAT IS DIABETES?

>Diabetes is a disease in which blood glucose levels are above
normal.
>Most of the food we eat is turned into glucose, or sugar, for our
bodies to use for energy.
>The pancreas, an organ that lies near the stomach, makes a hormone
called insulin to help glucose get into the cells of our bodies.
When you have diabetes, your body either doesn't make enough insulin
or can't use its own insulin as well as it should. This causes sugar
to build up in your blood.
>Diabetes can cause serious health complications including heart
disease, blindness, kidney failure, and lower-extremity amputations.

HOW WILL YOU KNOW IF YOU ARE DIABETIC?
1.Frequent urination
2.Excessive thirst
3.Unexplained weight loss
4.Extreme hunger
5.Sudden vision changes
6.Tingling or numbness in hands or feet
7.Feeling very tired much of the time
8.Very dry skin
9.Sores that are slow to heal
10.More infections than usual.
11.Blood sugar of >200 mg/dl
12.Fasting Blood Sugar (FBS) of more than 126 mg/dl in at leat 3
different occassions

TYPES OF DIABETES

1. Type I/insulin dependent diabetes mellitus/juvenile diabetes
mellitus- accounts for 5-10% of all diagnosed cases of diabetes.
- the pacreas failed to produced enough insulin
-the cause is unknown, but autoimmunity is one of the possibility

autoimmunity: your body produce an antibody against itself
antibody: is a substance produce by lymphocytes to kill/remove an
invading antigen
antigen: any foreign to your body including pathogenic
microorganisms
lymphocytes: a white blood cells that can produce
immunoglobulin/ antibodies to kill an antigen
pathogens: anything that can cause diseases.

2. Type II/non-insulin dependent diabetes mellitus/adult onset
diabetes mellitus - account for almost 90-95% of all diagnosed cases
of diabetes
-It happens when the body connot properly use insulin (insulin
resistance)

Insulin: hormone necessary for the proper utilization of sugar by
muscles, fat and liver.

3. Gestational diabetes is a type of diabetes that only pregnant
women get. If not treated, it can cause problems for mothers and
babies.
-Gestational diabetes develops in 2% to 5% of all pregnancies but
usually disappears when a pregnancy is over.

4. Other specific types of diabetes resulting from specific genetic
syndromes, surgery, drugs, malnutrition, infections, and other
illnesses may account for 1% to 2% of all diagnosed cases of
diabetes.

RISK FACTORS:

Type I diabetes mellitus

1. autoimmunity
2. genetics
3. environmental factors

Type II diabetes mellitus

1. advance age
2. obesity
3. family history
4. prior history of gestational diabetes
5. impaired glucose tolerance
6. physical inactivity
7. hypertension
8. high cholesterol levels

Gestational diabetes mellitus

1. family history
2. obesity
3. age >35 years old

Women who have had gestational diabetes are at increased risk for
later developing type 2 diabetes. In some studies, nearly 40% of
women with a history of gestational diabetes developed diabetes in
the future.

WHAT CAN YOU DO TO CONTROL YOUR BLOOD SUGAR?

1. Diet Therapy

* Avoid simple sugars like cakes and chocolates. Instead have
complex carbohydrated like rice, pasta, cereals and fresh fruits.
* Do not skip or delay meals. It causes fluctuations in blood sugar
levels.
* Eat more fiber-rich foods like vegetables.
* Cut down on salt.
* Avoid alcohol. Dietary guidelines recommend no more than two
drinks for men and no more than one drink per day for women.

2. Exercise

Regular exercise is an important part of diabetes control.

Daily exercise . . .

* Improves cardiovascular fitness
* Helps insulin to work better and lower blood sugar
* Lowers blood pressure and cholesterol levels
* Reduces body fat and controls body weight

Exercise at least 3 timeS a week for at least 30 minutes each
session. Always carry quick sugar sources like candy or softdrink to
avoid hypoglycemia (low blood sugar) during and after exercise.

3. Control your weight

If you are overweight or obese, start weight reduction by diet and
exercise. This improves your cardiovascular risk profile.

* It lowers your blood sugar
* It improves your lipid profile
* It improves your blood pressure control

4. Quit smoking.

Smoking is harmful to your health.

5. Maintain a normal blood pressure.

Since having hypertension puts a person at high risk of
cardiovascular disease, especially if it is associated with
diabetes, reliable BP monitoring and control is recommended. See
your doctor for advice and management.

If there is no improvement in blood sugar what advice can I expect
my doctor to give?

There are drug therapies using oral hypoglycemic agents. Your doctor
can prescribe one or two agent, depending on which is appropriate
for you.

1. Sulfonylurea – Glibenclamide, Gliclazide, Glipizide, Glimepiride,
Repaglinide

2. Biguanide – Metformin

3. Alpha-glucosidase Inhibitors – Acarbose

4. Thiazolidindione – Troglitazone, Rosiglitazone, Proglitazone.

Remember

If you have the classic symptoms of diabetes:

* See your doctor for blood sugar testing
* Start dieting
o eat plenty of vegetables
o avoid sweets such as chocolates and cakes
o cut down on fatty foods
* Exercise regularly
* If you are obese, try to lose some weight
* Avoid alcohol drinking and stop smoking
* If you are hypertensive, consult your doctor for advice and
management

Note: Insulin is the main stay of therapy in uncontrolled diabetes

LBORATORY DIAGNOSIS:

screening test
1. Fasting Blood sugar
2. 2 hour postprandial test

confirmatory
Oral glucose Tolerance Test (OGTT)

monitoring
Glycosylated hemoglobin (HbA1c)

COMPLICATIONS:

1.Blindness (retinopathy)
2.Kidney failure (nephropathy)
3.Stroke (Cerbrovascular accident)
4.Heart attack (myocadial infarction)
5.Wounds that would not heal
6.Impotence
7.numbness (neuropathy)
8.gastrointestinal discomfort (gastroenteropathy)
9.Diabetic ketoacidois (DKA) - is a life-threatening complication in
patients with diabetes mellitus.
-Near complete deficiency of insulin and elevated levels of certain
stress hormones increase the chance of a DKA episode. DKA is more
common among Type I diabetics, but may also occur in Type II
diabetics
-DKA was a major cause of death in Type I diabetics before insulin
injections were available; untreated DKA has a high mortality rate.

ketone body productions:

Under low-insulin conditions, regardless of circulating plasma
glucose concentration, the liver acts as though the body is starving
and produces another form of fuel, known as ketone bodies. This is
an aspect of fat metabolism (beginning with lipolysis) that makes
ketone bodies as intermediate products in the fatty acid-processing
metabolic sequence. Two of the ketone bodies beta-hydroxybutyrat e
and acetoacetate enter the blood and can be used as fuel by some
organs such as the brain, though the brain still requires a large
amount of glucose to function. If large amounts of ketone bodies are
produced, the metabolism is in the state termed ketosis; this
condition is itself not necessarily harmful, and is normal during
times of relatively low carbohydrate availablility (as, for
instance, between meals). However, if produced in very large
quantities, unprocessed ketone bodies will cause the blood pH to
drop, leading to ketoacidosis.

signs and symptoms of diabetic ketoacidosis:

1.Sluggishness, extreme tiredness.
2.Extreme thirst, despite large fluid intake.
3.Constant urination
4.Fruity smell to breath, similar to nail polish remover.
5.Hyperventilation, at first rapid and shallow, then progressively
6.deeper and less rapid.
7.Extreme weight loss.
8.Oral Thrush and/or persistent vaginal yeast infections may be
present; this is because the normal fungal flora present in the oral
cavity and cervix is disrupted
9.Muscle wasting.
10.Agitation / Irritation / Aggression / Confusion
11.Emesis (vomiting)
12.Confusion.
13.Abdominal pain.
14.Loss of appetite.
15.Flu-like symptoms.
16.Lethargy and apathy.
17.Extreme weakness.
18.Kussmaul breathing ("air hunger"). A type of hyperventilation
where patients breathe very deeply at a normal or increased rate.
This is a sign of severe acidosis.
19.Unconsciousness (a variety of diabetic coma) after prolonged DKA.
At this stage, speedy medical attention is imperative

10. Non Ketotic hyperosmolar coma - is a type of diabetic coma
associated with a high mortality seen in diabetes mellitus type 2.

Nonketotic coma is usually precipitated by an infection, myocardial
infarction, stroke or another acute illness. A relative insulin
deficiency leads to a serum glucose that is usually higher than 33
mmol/l (600 mg/dl), and a resulting serum osmolarity that is greater
than 350 mOsm. This leads to polyuria (increase urination), which,
in turn, leads to volume depletion and hemoconcentration (increased
concentration of red blood cells) that causes a further increase in
blood glucose level.

Clinical presentation
The increasing hemoconcentration and volume depletion may result in:

1.Hyperviscosity and increased risk of thrombosis (clot formation)
2.Disordered mental functioning,
3.Neurologic signs including focal signs such as sensory or motor
4.impairments or focal seizures or motor abnormalities, including
flacidity, depressed reflexes, tremors or fasciculations,
5.Ultimately, if untreated, will lead to death.