All Types Of Diabetes!!
January 15, 2008 by Greg
Filed under Diabetes Information
Though most people know only type 1 and type 2 diabetes, there are other minor variants of diabetes.
Type 1 diabetes :
* It’s genetic inheritance – Risk increases 20 – 50% if an identical twin is affected. More common with certain class II HLAs.
* Complete dependency on insulin treatment – Most of the patients need insulin in their daily life. The dose should be adjusted according to their demands, exercise and other stress factors.
* Young age onset – Around puberty.
* Autoimmune destruction of beta cells in pancreas (Body defense cells called lymphocytes destroy own body cells) – Lymphocytes of the patient are sensitized to his/her own beta cells destroying them.
* Development of ketoacidosis – Most serious complication of type 1 diabetes. As most patients depend on exogenous insulin for their blood sugar control, there should be fine balance between the demand and the supply. If there is more demand for insulin (like surgeries,exercise, pregnancy) and less supply (like missing insulin injections), they easily prone to high glucose levels and ketosis.
Type 2 diabetes :
* It’s genetic inheritance – 50 – 90% of risk if an identical twin is involved.
* Insulin resistance – Main pathology behind this type of diabetes. There are many genetic defects in insulin receptors that causes insulin resistance.
* Partial insulin deficiency – Still some insulin secretion will be preserved, atleast in most of the patients. Beta cell mass is reduced to 50% of normal at the time of diagnosis.
* Age over 40 years
* No autoimmunity – No role for autoimmunity as in type 1 diabetes.
* Development of Hyperosmolar nonketotic coma instead of ketoacidosis – This complication is common in type 2 than type 1. Due to hyperglycemia and impaired water intake in elderly diabetics.
* Insulin treatment sometimes – Usually oral antidiabetic drugs are given to control blood glucose. Some of these drugs enhances the insulin secretion from beta cells. Insulin is last resort if diet, exercise, oral drugs fail.
* Often obese – Central obesity appears to trigger the disease in persons who are genetically susceptible.
Maturity onset diabetes of the Young (MODY) :
* Primary defect is impaired glucose induced secretion of insulin.
* Age is usually less than 25 years.
* This is inherited by a mechanism called autosomal dominance.
* No autoimmunity (as in type 1)
* No insulin resistance (as in type 2)
* No obesity (as in type 2)
MODY is different category. It won’t lead to type 2 diabetes in old age.
Gestational diabetes :
Placenta in preganancy produces anti-insulin hormones that counteract the actions of insulin. So pregnant woman can not maintain normal glucose levels in blood exhibiting glucose tolerance. Fortunately, the condition disappears once the baby was delivered.
Risk factors are obesity, happens when more than 30 years of age, positive family history, unexplained still birth, polyhydromnios (excess amniotic fluid)
Other types of diabetes (secondary causes):
* Diabetes associated with insulin gene or insulin receptor genes.
* Pancreatic diseases like chronic pancreatitis, cystic fibrosis,hemochromatosis.
* Endocrine disorders like acromegaly, cushing’s syndrome, hyperthyroidsm.
* Exogenous administration of glucocorticoids.
[tags]gestational diabetes, mody, type 1 diabetes, type 2 diabetes, diabetes, diabetic[/tags]
Type 2 Diabetes – Insulin Resistance and Beta Cell Dysfunction
January 8, 2008 by Greg
Filed under Diabetes Information
What is Type 2 diabetes?
* Its genetic inheritance (infact genetic factors are more important than type 1 diabetes)
* Insulin resistance
* Partial insulin deficiency
* Age over 40 years
* No autoimmunity
* Development of Hyperosmolar nonketotic coma instead of ketoacidosis
* Insulin treatment sometimes
* Often obese
What causes Type 2 diabetes?
The main factor in type 2 diabetes is insulin resistance. This is caused by genetic predisposition, lifestyle factors, obesity etc. Once there will be insulin resistance (cells are not responsive to insulin actions), beta cells produce more insulin to maintain normal glucose levels and to overcome insulin resistance. This leads to beta cell hyperplasia (number of beta cells are increased).
This will go on for a while and at one time beta cells are unable to produce enough insulin leading to ‘Glucose intolerance’. Further down the road, beta cells will fail to cope up with insulin resistance and insulin secretion will fall. This produces frank diabetes status.
Factors that causes type 2 diabetes?
Insulin resistance :
Insulin resistance is defined as the resistance to the effects of the insulin on glucose uptake, metabolism and storage. Decreased uptake of glucose in to muscle and adipose tissue is seen and liver glucose production is not suppressed. End result is increased glucose levels in blood.
There are many genetic defects of insulin receptors in the type 2 diabetics which are responsible for the development of insulin resistance.
Obesity and Insulin resistance :
Abdominal obesity (central obesity) is implicated in insulin resistance than peripheral obesity. Free fatty acids are more in blood in obese people and these levels are inversely related to the insulin sensitivity. The more FFAs in plasma, less is insulin sensitivity and more will be the insulin resistance.
Fat stores releases some hormone like substances called adipokines. Examples are leptin, adiponectin, resistin etc. Their altered secretions (either decrease or increase) implicated in insulin resistance. For example, leptin acts on brain to reduce food intake and induce satiety. Leptin deficient animals exhibits insulin resistance and reversed by administration of leptin.
Beta cell dysfunction :
As described above, beta cells slowly exhausted because of chronic hyperglycemia and insulin resistance though they produce more insulin in initial stages. Several mechanisms are proposed for these beta cell dysfunction like – toxicity of free fatty acids in plasma or chronic hyperglycemia. There will be decrease in beta cell mass, islet cell degeneration and deposition of pink color protein called amyloid.
Genetic factors :
Genetic factors are important than type 1 diabetes with 50 – 90% of concordance rate between identical twins. First degree relatives with type 2 diabetes, risk of developing disease is 20 – 40%. Though the genetic factors plays much role, there is no role for autoimmunity like type 1 diabetes.
[tags]diabetes, diabetic, beta cell dysfunction, insulin resistance, type 2 diabetes[/tags]
General Approach for Treatment of Type 2 Diabetes.
December 30, 2007 by Greg
Filed under Diabetes Information
Main aim of treatment should be:
* Good glycemic control
* Prevent acute complications
* Prevent long term complications
STEP ONE : DIET, EXERCISE, WEIGHT CONTROL, HEALTH EDUCATION :
Diet:
* Fats – 30% of total energy intake
* Protein – 15%
* Carbohydrate – 50 – 55% of total intake
* Limit simple sugars like table sugar, fruits
* Eat complex carbohydrates like pasta, potato
* Multiple feeds of small quantities
Weight reduction:
Reduced adipose stores restores tissue sensitivity to insulin. But weight reduction is difficult to achieve with current therapies.
STEP TWO : ORAL AGENTS :
First mono therapy is tried. In obese patients metformin and sulphonylureas for lean people is recommended. Later oral agent combination therapy is recommended. In this combination therapy two different classes of drugs are used.
STEP THREE : INSULIN :
Soluble insulins, rapid acting insulins and prolonged acting insulins are used based on clinical situation.
STEP FOUR : INSULIN PLUS AN ORAL AGENT :
Here insulin is given along with oral hypoglycemic agent.
Brief description of drugs:
Sulphonylureas: They promote insulin secretion. Glibenclamide, Tolbutamide are popular drugs. Side effect is hypoglycemia which may be prolonged. These are not drugs for obese patients as they increase patients weight.
Biguanides: Metformin is popular drug. It reduces glucose production by the liver and sensitizes target tissue to insulin. Can be used in obese diabetics as it doesn’t increase weight. Main side effect is lactic acidosis in patients with liver or renal disease.
Alpha-glucosidase inhibitors: Acarbose slows glucose absorption and postprandial glucose peaks are reduced.
Thiazolidinediones: Exampleas are Rosiglitazone and Pioglitazone. They are contraindicated in patients with liver impairment or cardiac failure.
Insulin:
Soluble insulins start working within 30 – 60 minutes and lasts for 4 – 6 hours. Used in emergency situations like ketoacidosis and for surgical procedures.
Rapid-acting insulin start working quicker like in 15 minutes with shorter duration of action like 2 – 4 hours.
Prolonged-acting insulin acts between 12 – 24 hours. Protamine insulins and lente insulins are examples of these type of insulins.
DISCLAIMER: All the content is for information purpose only. This does not replace your doctors advice.
[tags]diabetes, diabetic, type 2 diabetes[/tags]
