There are many people who are inflicted with the diabetes disease. Unfortunately, there is no cure-all miracle drug for those that have to live with diabetes, but there are several things that can help a person keep his or her diabetes under control. These tools, also known as diabetes testing supplies, will help an individual monitor the progress of the diabetes and keep a watch on his or her glucose levels.

There are several important diabetes testing supplies that a person usually uses in order to help him or her get a handle on their diabetes. A few of them are the blood sugar monitors, testing strips, as well as lancets that are included with diabetes testing supply packages. The blood sugar monitors are not at all expensive, but the testing strips are very expensive compared to the blood sugar monitor. One can think about the price difference compared with the cost of razors and razor blades. Likewise, the blood sugar monitor is relatively inexpensive compared Diabetes Test Strips with the testing strips. However, testing strips for people with diabetes are a crucial part and tool in helping an individual keep up to date on his or her diabetes situation. In a normal month span, a person may go through as many as one hundred testing strips, depending on the type and severity of the diabetes. The testing strips are included in testing supplies because a person will normally use 2 or 3 testing strips per day. The checks are normally done in the morning, at noontime, and sometime in the evening.

One thing to know about diabetes testing strips is that they must be compatible with the blood glucose meter. Purchasing off-brand strips may not even be the best idea simply because they may give you a skewed reading of your glucose level, thereby skewing the results on the testing strip. If you are on Medicare, however, the testing strips should be provided free of charge at the prescription of the doctor. If you need more testing strips than what is normally provided, the doctor will usually write a letter to Medicare explaining the situation. The doctor is the official authority when it comes to dealing with Medicare.

However, if you use a lancet for diabetes testing alone, that is a whole other situation that must be considered. There are several different kinds of lancets- you can purchase one that is an automated lancet, as well as those that require you to puncture your finger yourself to check your blood glucose level.

For all of these supplies, the best thing to do would be to check with your doctor about how to go about getting these diabetes testing supplies. They may suggest ordering them direct through your health insurance provider or you may even be able to get them through a pharmacy, clinic, or hospital completely free of charge! Whatever the scenario, be careful and cautious about where you go to get your diabetes testing supplies, as not everywhere you go to check them out may be the same!

There are two types of diabetes, which consists of Type I and Type II. It is important to understand the distinction between the two and how both are treated.

Type 1 diabetes is commonly found in children and/or adolescents, but may also occur in adults. With type 1 diabetes, there is almost always a complete deficiency of insulin. As a result, the most common treatment is insulin injections, a lifestyle that consists of both diet and exercise and regular monitoring of blood glucose levels with the use of blood testing monitors. Patients who have been diagnosed with type 1 diabetes can continue to enjoy a normal life providing they continue with their treatment and take special care to follow their doctor’s instructions and/or recommendation.

With type 2 diabetes, an individual’s insulin level is usually either normal or sometimes even elevated, but is not deficient. This form of diabetes is believed to Type II diabetes in children and adolescents be more complicated than type 1, but ironically is thought to be easier to treat. Because insulin is still being produced inside the body, type 2 diabetes often goes undetected for years. Symptoms are milder and may even be sporadic, which often reduces the level of concern. The main problem with type 2 diabetes going unnoticed is the potential for serious complications, including renal failure and coronary artery disease. The initial treatment phase of type 2 diabetes will likely include a lifestyle adjustment to feature increased physical activity and a diet that is geared toward weight loss. The next step, if necessary, will be medication and possibly insulin therapy if needed.

Both types of diabetes require that the patient maintain normal blood glucose levels in an effort to reduce the possibility of organ damage, including eyesight, kidney, blood circulation, etc. In order for this to occur, patients must carefully monitor their food intake and make sure to participate in regular exercise, all the while continuing to monitor their blood glucose level.

As of 2006, there is no known cure for diabetes. A chronic disease that effects many, diabetes is best treated through patient education, nutrition, self awareness and long-term care. In addition, patients are often urged to be aware of other symptoms that may indicate complications arising from diabetes.

The contents of this article are to be used for informational purposes only. It should not be used in conjunction with, or in place of, professional medical advice relating to diabetes. This article must not be used as a basis for diagnosing or treating diabetes, but rather an informational source designed to explain the difference between the two types. For further information, a diagnosis or recommended treatment method for diabetes, individuals should consult a licensed physician.

DIABETES



Definition as stated by Dr Miriam Stoppard

Types of diabetes
1- Type 1
2- Type 2



Causes
1- Lifestyle
2- Disorders
3- Gestational diabetes

DIABETES MELLITUS

Long term complication
1-Heart problem
2-Eye

Treatment
1-Insulin Prevention
2- Good lifestyle 1-healthy diet
3- Monitoring blood glucose 2-blood pressure measurement
3- healthy lifestyle

Symptoms
1-excessive urination
2- weakness
3- weight loss

Notes from readings

- pancreas either produces insufficient amounts of insulin or body cells become resistant to the hormone’s effects.

- Type 1 diabetes and type 2 diabetes.

- Although dietary measures are also important, it must be treated with insulin injections. About 60,000 people in the UK have this type of diabetes.

- The pancreas continues to secrete insulin but cells in the body become resistant to its effects.

- Diabetes mainly affects people over the age of 40 and is more common in overweight people.

- Condition may be treated with dietary measures only.

- Diabetes mellitus can sometimes develop during pregnancy. This is called gestational diabetes and is usually treated with insulin to maintain the health of the mother and baby.

- Type 1 diabetes is usually caused by an abnormal reaction in which the immune system destroys insulin-secreting cells in the pancreas.

- Type 2 diabetes are less well understood, but the genetics and obesity are important factors.

- The symptoms of type 2 may not be obvious or may go unnoticed until a routine medical check-up. The main symptoms of both forms may include:

- Excessive urination

- Thirst and a dry mouth

- Insufficient sleep because of the need to urinate at night.
- Lack of energy

- Blurry vision

- Weight loss

Symptoms of type 2 may go unnoticed until routine medical check up.

The main symptoms of both forms may include:
- excessive urination
- thirst and a dry mouth
- insufficient sleep because of the need to urinate at night.
- Lack of energy
- Blurry vision
- Weight loss

The main symptoms of ketoacidosis include:
- nausea and vomiting, sometimes with abdominal pain.
- Deep breathing.
- Acetone smell to the breath (like pear drops or nail polish remover)
- Confusion.

Living with diabetes:
- A healthy diet
- Drinking and smoking
- Special care for your feet.
- Exercise and sports.
- Strenuous exercise
- Moderate exercise
- Medical check up
- Eye examination
- Blood pressure measurement.

Treatment for:
Type 1
Insulin can be injected into any fatty area, such as upper arm.

Source: Dr Miriam Stoppard , Doling Kindersley Ltd 2002 ‘Family Health Guide’, pages 504 to 507.

“Department of Diabetes, University of Newcastle upon Tyne, UK.
Address correspondence and reprint requests to:
P Home. Department of Diabetes, The Medical School, University of Newcastle
upon Tyne, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
philip.home@newcastle.ac.uk
Received: ; revised: December 10, 2002
Diabetes Metab 2003,29,101-9 • © 2003 Masson, all rights reserved 101”

- Diabetes is a growing healthcare challenge worldwide.

-A considerable proportion
of people either have impaired glucose tolerance with a significant
risk of development of diabetes, or have undiagnosed Type 2
diabetes.

-Pivotal to reducing the risk of morbidity and the development
of complications and mortality is the normalisation of both fasting
and postprandial blood glucose levels.

-diabetes is reaching epidemic proportions
worldwide, with between 5 and 10% of the world population
affected.

- People with diabetes have approximately twice
the prevalence of hypertension compared with non-diabetic
patients

-40% of subjects were defined as hypertensive on entry
(receiving antihypertensive treatment or with a mean systolic
blood pressure ? 160 mmHg and/or a mean diastolic blood
pressure ? 90 mmHg)

-People with diabetes are 17 times more prone to kidney disease,
with diabetic nephropathy being the most common
complication [11]. Diabetic nephropathy may eventually
lead to end-stage renal disease and thus significant mortality.

-Approximately 30-40% of people with diabetes develop
retinopathy, and diabetes is the most common cause of blindness
in the working years of life in developed countries

-According to a 1997 estimate [12], 120 million people
have Type 2 diabetes (approximately 2% of the world population)
and an additional 4 million have Type 1 diabetes.
Type 2 diabetes accounts for more than 85% of all cases of
diabetes in developed countries and almost all cases in developing
countries. It appears to be epidemic (affecting a high
and increasing proportion of the population) in many parts
of the world, and represents a serious and growing global
health challenge primarily as a result of increased obesity,
ageing populations, increasing urbanisation and a more sedentary
lifestyle [34, 35]. However, data from many parts of
the world with high and increasing prevalence (Asia, Latin
America, China) are not broadly based, and so this estimate
is likely to be markedly low.

-Type 1 diabetes
is one of the most common childhood diseases in developed
European countries and the incidence has increased dramatically
in some newly prosperous countries

-The incidence of Type 2 diabetes in particular is expected
to increase considerably as developing countries become
more Westernised in terms of availability of healthcare and
modernisation of existing resources, as well as a result of
substantial improvements in diabetes surveillance and
screening. Growth is projected to be greatest in Asia and
Africa, where diabetes could become 2-3 times more common
than it is today [12]. By 2025, more than 75% of people
with diabetes will be from developing countries, compared
with 62% in 1995

-Type 2 diabetes suggests a need for continuing
attention to control of blood glucose, blood pressure
and blood lipids through medication, diet and exercise.
People with Type 1 diabetes, and increasingly those with
Type 2 diabetes, have the additional burden of subcutaneous
insulin injections, self-monitoring and care of their insulin
supplies and equipment.





Direct Quote
Dr Miriam’s definition of diabetes is:
“the inability of the body to use glucose for energy due to inadequate amounts of or loss of sensitivity to, the hormone insulin.”

Dr Miriam Stoppard. 2002, Family Health Guide, Dorling Kindersley Ltd, England, Page 504

Paraphrase
The body uses glucose as energy in order to perform work and if it fails because of insufficient amount of insulin (which is essential for the absorption of glucose) or because the body cells become more resistant to the hormone’s effect then we end up with the non-healthy state called diabetes.

Summary
Dr Stoppard states that “Glucose from the blood stream is the main source of energy for the body’s cells. Its absorption is enabled by the pancreas, which produces insulin. Among people suffering from diabetes mellitus, a build up of toxic by- products, like acetone with a pear drop smell, in the body occurs. This is caused by the use of other sources of energy than glucose. Hence the unused glucose accumulates in the blood and urine, causing high blood sugar levels. 1 in 10 diabetes depends on self administered injections of insulin and the rest take oral drug and are careful about their diet. These treatments are vital in preventing the symptoms of high blood sugar level like frequent passing of urine, thirst and loss of weight as well as complications leading to peripheral nerve disorders which may affect the eyes, kidneys, the cardiovascular system. The weakening of the immune system may also cause infections like cystitis.”

Dr Miriam Stoppard. 2002, Family Health Guide, Dorling Kindersley Ltd, England, Page 504









Plan

1- Introduction
a- Definition
b- Types of diabetes
c- Brief description of each diabetes
2- Causes
a- Causes of Type 1 diabetes more frequent in children
b- Causes of Type 2 diabetes more frequent in adults
3- Symptoms
a- Both short term and long term consequences in case of non treatment for both Type 1 and Type 2 diabetes.
4- Treatment
a- The use of insulin to control diabetes in both Type 1 and Type 2
5- Short Term and Long Term complications.
a- Short term and long term effect in Type 1 diabetes
b- Short term and long term effect in Type 2 diabetes
6- Conclusion
a-healthy diet
b- healthy lifestyle
7- Bibliography


Introduction
Diabetes mellitus is developing in epidemic proportions in today’s world with 5 to 10% of the worldwide population affected. This disease is defined by Dr Stoppard, “as the inability of the body to use glucose for energy due to inadequate amounts of or loss of sensitivity to, the hormone insulin”. Which means that the body uses glucose in order to perform work and if it fails because of insufficient amount of insulin or because the body cells become more resistant to the hormone’s effect then we end up with the non-healthy state called diabetes.

There are two types of diabetes:
1- Type 1 which is caused by the abnormal reaction in which the immune system destroys insulin secreting cells in the pancreas. It is more common in childhood.
2- Type 2 which causes are less understood. However, genetics and overweight are important factors.

Causes
Diabetes of Type 1 is usually caused by some viral diseases which affect the immune system of the child, though the genetic factor of one parent suffering from type 1 diabetes may have some effect, however most children who develop type 1 diabetes do not have parents with diabetes. As for Type 2 diabetes it is the increase in food intake which leads to overweight and obesity as well as the living of a sedentary lifestyle and it mostly affects adults.

Symptoms
Both types of diabetes have the same symptoms where there is excessive urination which account for the thirst and dry mouth but also for the insufficient sleep at night because of the need to go to the toilet. This state is paralleled by the lack of energy; blur vision and quick weight loss, abdominal pain, deep breathing and acetone smell breath may also consist of symptoms of diabetes.

Treatment
While the Type 1 diabetes have to submit themselves to the burden of insulin injection, self monitoring and the care of their insulin supplies and equipments, though the Type 2 diabetes have the need to control their blood glucose, their blood pressure and their blood lipids these may be done through medication, diet and exercise but sometimes in addition the Type 2 diabetes have to make insulin injections as the Type 1’s diabetes with all the inconvenience attached to it. As for treatment by insulin Dr Stoppard states that “Glucose from the blood stream is the main source of energy for the body’s cells. Its absorption is enabled by the pancreas, which produces insulin. Among people suffering from diabetes mellitus, a build up of toxic by-products, like acetone with a pear drop smell, in the body occurs. This is caused by the use of other sources of energy than glucose. Hence the unused glucose accumulates in the blood and urine, causing high blood sugar levels. 1 in 10 diabetes depends on self administered injections of insulin and the rest take oral drug and are careful about their diet. These treatments are vital in preventing the symptoms of high blood sugar level like frequent passing of urine, thirst and loss of weight as well as complications leading to peripheral nerve disorders which may affect the eyes, kidneys, the cardiovascular system. The weakening of the immune system may also cause infections like cystitis.”

Hence, no complete cure of diabetes exist, for it is a chronic disease but it can be controlled so as not to cause more severe damage to the body which is affected by it. For that a healthy diet with special attention to avoid excessive drinking of alcoholic beverages and smoking. Special care should also be taken with the feet and the eyes. Medical check up as well as blood pressure measurement should be regular. While sports should be practiced excessive strenuous exercise should be avoided.

Short Term and Long Term effect
If left unattended the diabetes mellitus may give rise to both short-term and long term complications. In case of Type 1 neglect of treatment may lead to nausea and vomiting accompanied by abdominal pain and deep breathing, while an acetone smell breath is noted. If left untreated the subject quickly enter in a confusion state where dehydration may lead to coma and death. As for the Type 2 diabetes if left untreated as is often the cause long term diseases like cardiovascular diseases occurs which may end up in a stroke. These are consequences of high blood pressure and elevated cholesterol in the blood. There is an increase risk of cataracts in the eyes and symptoms of dizziness upon standing and poor circulation because of nerve damage may lead to ulcers and gangrene.

Conclusion
In conclusion it can be said that the Diabetes mellitus is a disease that compel the one suffering from it to adopt a healthier lifestyle so as to control the devastation that the disease may cause to the body and to avoid the shortening of one’s life.
(810 words)





BIBLIOGRAPHY

1- http://www.e2med.com/dm

“Department of Diabetes, University of Newcastle upon Tyne, UK.
Address correspondence and reprint requests to:
P Home. Department of Diabetes, The Medical School, University of Newcastle
upon Tyne, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
philip.home@newcastle.ac.uk
Received: ; revised: December 10, 2002
Diabetes Metab 2003,29,101-9 • © 2003 Masson, all rights reserved 101”

2- Dr Miriam Stoppard, 2002, Family Health Guide, Doling Kindersley Ltd, England

Cardiovascular diseases have become the biggest killers of human beings on the planet. Heart attacks and strokes are major killers in all parts of the world.

An estimated 17.5 million people died from cardiovascular disease in 2005, representing 30 % of all global deaths. Of these deaths, 7.6 million were due to heart attacks and 5.7 million were due to stroke.

The biggest problem is that we just keep on trending upwards. Experts fear that if a global lifestyle modification is not implemented the death toll of cardiovascular diseases will reach 20 million people by 2015. That is right around the corner.

What you can do to stop cardiovascular diseases
First and foremost, if you smoke, stop today. If someone in your family smokes get as much literature on cardiovascular disease as you can and make them read it, for you kids if no one else.

Your chance of stroke or heart attack decreases Diabetes and cardiovascular disease the minute you stop smoking.

Second, start your new exercise regimen immediately. Daily exercise is available to everyone; you just have to make yourself do it.

Stretching, cardiovascular training (walking is great), and weight bearing exercises are the cornerstone to getting all aspects of your body, especially your heart, in shape.

Third is diet. Do your research and find a diet that you can make into a lifestyle. You need to find a meal plan that you can adopt for the rest of your life.
Once you learn how to eat properly, the occasional cheat meal is not nearly as detrimental.

Believe me I know what I am talking about; I lost 150 pounds 10 years ago. I have been able to keep it off because I developed a new eating lifestyle, I do not go on diets.

Fourth, if you have any other diseases you have to try doubly hard to gain control.

Diabetes, Cancer, Kidney, Liver, and Bacterial Diseases all work together to subdue your organs abilities to work properly. These make diet and exercise even more important to preventing or at least controlling cardiovascular diseases.

Fifth, see your doctor often if you have a history of cardiovascular disease in your family.

There is seldom an outward indication that you have high blood pressure. The same goes for an impending heart attack or stroke.

Lastly, if you are having a heart attack or stroke find help immediately.

You ability to survive any attack of cardiovascular disease goes up exponentially if you get help within the first 10 minutes.

If you have a history of cardiovascular disease, be sure to get a bracelet or necklace that lets the first responder know your history in the event that you are unconscious or ca not speak.

Control the disease, do not let it control you!

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One of the most dreaded diseases is diabetes. It is a killer disease and it is really very difficult to control. Going by the official US stats, diabetes is the third biggest giant killer among the deadly diseases in the United States of America. The global statistics is also mind-boggling!

First things first, Living with Diabetes how does a person become diabetic? When your body is unable to produce insulin that is necessary for its normal functioning, it becomes unable to absorb glucose (sugar). When the levels of glucose take a course to the blood stream, you become a diabetic patient.

Once you become diabetic, you have a problem for life. You live hour by hour, during the day. Medication becomes part of your life, which is likely to demand a good portion of your pension! Your lifestyle will be changed. You will suddenly become a thinking man now—thinking about diabetes. You might find your self pronouncing the term diabetes, diabetes, and diabetes hundreds of times a day!!

When it has finally seized you, it is not only diabetes alone! Many other dreaded diseases live in waiting to take hold of you. Some of them are kidney failure, heart diseases, nervous breakdown, blindness, blurred vision, limb amputation and the ultimate for the human body—death!

The prescriptive medicines complete the remaining process of the damage. Many toxic side effects are reported- skin rashes, weight gain and respiratory ailments, are few to quote. Notwithstanding the claims of many over-the-counter drugs that promise cure, the one thing that can really help you is your diet control and perfect discipline as regards to time management.

For example, your morning walks. Now, all the medical practitioners agree that morning walks do great service to tame the intensity of diabetics. So, you need to take a complete brief about the articles of food that is suitable for you, vegetables included! If anything will have the exacting affects to take you out of the influence of this disease, it is nature! So, have a perfect dietary discipline. It has taken many to the path of complete recovery! Some of the local treatments have the intrinsic capacity to tame your high blood sugar and such cases are the only hope for the diabetic patients!

So, do not think that everything is lost for you! From the dark ashes, sprouts a seedling!

Buying A Used Car

When we go to buy things, we generally have a word ‘bargain’ on our mind especially in case of used things. There are more chances to get bargain on used items. Buying a car can be a difficult process if one knows nothing about the deal. You much search for a place where you can get yourself a less costly used car in good condition. It depends on the factor that which car you want to go for, whether you want to buy it from a franchised dealer or from the private market. You need to go into the background of the desired car.


Buying from a franchised dealer

Franchised dealers prove to be a great help. There is availability of choices to the franchised dealer. You may call it a safest place to buy a used car. One of the benefits that you can have at their shops is they will tell you about entire background of the car in addition to warranty. So they serve your purpose and interest.

Buying from a used car dealer

You have to take an extra care while dealing with them. Many dealers may influence you with their good reputation. They have mastered themselves in the history and finance of cars. You should go for your own research for the car that you wish to buy. Used car dealers generally provides 3 months warranty period. Ensure what all is included in the warranty because many dealers do not include service items like tyres, exhausts and brake pads.

Buying from Private market

It may be the best place but the most risky place to buy a car too. You may call it a best place in terms of bargain. The cars that are sold here could have been associated with any accident and theft. You need Handbook of diabetes medical nutrition therapy to properly interrogate the seller first of all. You may ask questions related to the true identity of the seller. If you suspect the car’s condition, then you may ask the seller Whether the car has ever been involved in any accident or not?. Always ask for the signed receipt. You may go ask for the counterfeit parts, car ringing, clocks etc.

You may find many fraud dealers ready to pounce on you, taking advantage of your generosity. These dealers are well acquainted with tactics to be employed to be-fool the buyer. They just want to dig out money out of buyers selling them a wrong car by using their oily tongue. They never lose anything but ultimately loss has to be bore by innocent buyer. These deals leave drivers with illegal cars.

You can not rely on such dealers. After rendering a new look to an accidental car, they befool the buyer. There are many strategies employ by such dealers such as:


‘Cut and shut’

This is termed to a situation when two cars are welded together after taken up from a scrap yard. It is very difficult to judge originality of the car. But you may search for mismatched panels and upholstery, traces of paint on door handles and on window seals. There will be some sign of serious repair work that may ensure you about its fake appearance. A close inspection of a used car is utmost necessary to ensure a safe deal.


Counterfeit parts

What these fraud dealers show you is deceptive copies of genuine branded components. They are makers of deceptive appearance of the car. They are not at all anxious about the safety of the user. Moreover their deals offer more threats to a motorist. What they care about is their money. Now days, they have begun manufacturing fake brake pads, steering linkages and discs that could result into serious accidents. But again it will be a foolishness to think that they worry about all these effects. They will not give you a chance to check that what they have fitted into your new car. But an alert buyer can easily escape and can catch these fake dealers.

Car ringing

Fake dealers always change identification number of the car in case it is a stolen car. They take vehicle identification number from vehicles that have been written off in accidents. With the help of these fake details, thieves easily escape grip of buyers. If you have paid cost price, then you may never catch them again. Insecurity always goes side by side with these vehicles. In case the car you buy turned out to be a forged one, it will get return to its real owner. Nobody will pay you back and the entire responsibility of legal matters would be yours. Therefore, you need to be very cautious while dealing. Ensure that you have checked all legal formalities and documents associated with the car.

Car locking

In this strategy, car dealers make changes in the car’s odometer. They set the odometer in such a way that it gives a fake reading and the car appears to travel less miles than originally it had. It increases the value of the car. There are other tale signs like wear and tear to the pedal rubbers and seats that you can search to ensure the originality of the car.

Before buying a car, you may get an independent vehicle inspector to check it. It will certainly help you to escape the possibility of buying a fraudulent vehicle.

To compare the role of glibenclamide and pioglitazone drugs in type 11 non- insulin dependent diabetes mellitus patients.

Diabetes comes from the greek word for ‘SIPHON" which one is the first term and implies for a lot of urine is made .The trm "mellitus" comes from a laton word, "met" which means "honey" and was used because the urine was sweet (Wheeler,2004)

Diabetic ketaocidosis is one of life threatening condition requiring some data hospitalization and treatment. Recognition of this condition is of almost importance, because even small delays can have an impact on survival (Nattrass, 2006). Hypoglycaemia are involved in insulin induced episodes in individuals with diabetes. Probably the major factor prescribing, insulin treated patient from achieving the glucose targets needed to prevent diabetic complications. The incidence of hypoglycaemia reflects the inadequancy of current mathods of insulin delievery which lead ot inappropriately high insulin concentration, particularly some persons after eating more foods at night onset of blindness and also a major risk factor heart disease and stroke

(Heller, 2003).

TYPES OF DIABETE MELLITUS

Type II diabetes is a complex metabolic disorder associated with, b -cells dysfunction and with varying degree of insulin resistance primary pathogenic factors leading insulin resistance leading to type 2 diabetes and decreased insulin, secretion which arise from abnormalities with in liver, skeletal muscle and pancreatic b -cells (charles & clark, 1996).

GESTATIONAL DIABETUS MELLITUS

SECONDARY DIABETUS MELLITUS:

Secondary diabetes is due to disease of the pancreatic and endocrime system, genetic disorders, or exposure to chemical agents.

Type – I diabetes formerly known as insluin dependent diabetes mellitus (IDDM), is characterized by the destruction of the pancreatic beta cells that produces inslulin

Type – I diabetes formerly known as insulin dependent diabetes(IDDM),is characterized by the destruction of pancreatic beta cells that produces insulin.Type-1 diabetes occures most often in children and young adults but it can occures at any age.(Anderson et al 2007).

Type-11 diabetes is not straight uprward. A pancreas that does not produce enough insulin. Liver that release too much glucose,muscle cells that do not readily take in glucose.(Carren 2008)

Many genetic factors are involved in the development of diabetes.Because of new genetic methodology researchers are closers to identifying all of the cadidate gene for both non –insulin dependent and insulin dependent diabetes(Bernhard,1995).

Woman who had gestation diabetes are more likely to develop Type-11diabetes themselves.Pergnant women with diabetes are another disadvantaged group.They need much more intensive antenatal care and close monitoring of blood sugar,blood pressure and weight.(jawed2006)

Over weight children the progression of child obesity into adulthood is associated with early develop of complications, including IgpG2 diabetes and cardiovascular disease.Type diabetes is the most common clinical form of diabetes accountingforabout 90% of all cases,it is currently undergoing world wide epidemic. Type 11diabetes mellitus is caused by body’s infective use of insulin, it is often results from excess body weight and physical inactivity(WHO 2007).

PREVALACES& IINCIDENCE

Diabetes mellitus increases with aging, in 200 the prevalance of diabetes,it was estimated to be 0.19% people<20 years old and 8.6% in people>20 years old.There is considered geographic variation in the incidence of both type-1 and type-11 diabetes mellitus.Scavandinvian has the highest incidence of type-1 diabetes mellitus e.g in Finland, the incidence is 35/100,000 per year the pacific rim has a much lower rate in japan and china the incidence is 1 to 3/100,00 per year of type-1 diabetes mellitus, Northern Europe and the United States share an intermediate rate (8to17/100,000 per year).The prevalence of type 11 diabeties mellitus is highest in certain pacific island, intermediate in countries such as India and the United States, and relatively low in Russia and China.This variability is likely due to genetic, beharioral and enviromental factors(Power 2005).Diabettes mellitus prevalance also arises among different ethic population within a given countries it is common inall ethnic groups its prevalance increased with age and more than 5% of individuals of more than 65 years of age have diabetes mellitus (David Owerback 1988).The World wide prevalence of diabetes mellitus has risen dramatically over past two decades.The prevalence of type11 diabettes mellitus is expected, type 11 diabetes mellitus is more prevalent among Hispanies Native Americas,African,American,and Asians, pacific Islanders than in non- Hispanic whites,the incidence is essentially equal in woman and men in all populations. Type 11 diabetes is becoming increasingly common because people are living longer,and the prevalence of diabetes increases with age it is also seen more frequently now than before in young people, in association with the rising prevalenceof childhood obesity although type11 diabetes still countries with the estimated nubers of cases of diabetes in 2000and 2030.

Rank Country

2000 Individuals country with diabetes (milloins)

Country

2030 Individuals with diabtes (Million)

India

31.7

India

79.47

China

20.8

China

42.3

USA

17.7

USA

30.3

Indonesia

8.4

Indonesia

21.3

Japan

6.8

Pakistan

13.9

Pakistan

5.2

Brazil

11.3

Russian federation

4.6

Bangladesh

11.1

Brazil

4.6

Japan

8.9

Italy

4.3

Philippines

7.8

Bangladesh

3.2

Egypt

6.7

(Wareham& FOROUHI 2OO6)

DRUG TREATMENT OF DIABETIES MELLITUS

Biguanides lower blood glucose, they increase glucose uptake and utilize in skeletal muscle there by reducing insulin resistance, and reduce hepatic glucose production (gluconeogenesis).Lower blood glucose, addionally reduces low denisity and very low denisity lipoproteins (LDL and VLDL) respectively. Metformin Therapy for diabetes mellitus and related disorders has a half life of about 3 hours and is excreted unchanged in the urine.Clinically metformin used in type 2 diabetic who are obese and who fail treatment with diet alone.Adverse effects are produced dose related gastrointestinal disturbances e.g anorexia,diarrhoea,nausea,lactic acidosis rare but potentially fatal toxic effect.(Dale,2003).

Improving insulin sensitivity by activating certain genes involved in fat synthesis and carbohydrate metabolism Rosigilitazone and Piogiltazone are currently approved.Thiazolidinediones. Thiazolidinediones do not cause hypoglycemia when used alone,although they are usually taken in combination with sulfonylurease.

In some incouraging studies, thaiazolidiniones have produced very favorable effects on the heart, including reducing blood pressure and improving triglycerides and cholestrol levels including increasing HDL level,the good cholestrol. They may also block a molecule called 11 Best HSK that may play a significant role in metabolic syndrome,as well as diabetes type11. One study also sugessted that Rosiglitazone may even improve beta cells functions and so help prevent progression of diabetes.Anemia, weight gain, increased risk of fluid buildup, may worson heart failure.Troglitazone,was withdrawn after a few reports of heart failure.Liver failure abd death.Current Thiazoldinediones don not appear to pose the same effects on the liver although there have been a few reports of liver injury.

In patients with dietry failur the choice of a sulfonylurea agent or insulin therapy has been controversial and empric in favour of insulin therapy are the studies, who reported marked improvement post receptor diagnostic after intensive short term therapy in untreated type 2 diabetes mellitus (Scarlett et al,1984) Sulfonylureas further classified into two groups or generations based on their potency,duration,drug interaction,side effects profiles. Sulfonylureas enhance insulin action in cells in culture and stimulate the synthesis of glucose transporters (Jacobes et al 1998).A sulfonylurea drug should normally be the insulin secretagogue of choice, NICE (National Institute for Clinical Excellence) also recommends that a generic ,drug should be perscribed (Scsade et al1998).

RESEARCH DESIGN AND MATERIAL AND METHODS:

This study was conducted in the deprtment of Pharmacololgy and Therapeutics,Basic Medical Science Institute,Jinnah,Postgraduate Medical Centre,karachi under kind supervision od DRr:GhulamRsool Mashori,Associate Professoer and Head OF Department Of Pharmacology and Therapeutics in colloboration with Medical Outpatient Department Unit111 and Filter Clinic, Medical Department, JPMC,Karachi.

Seventy NIDDM (type-II)diabetic patients were initially enrolled in the study from the filter clinic/ out patient department Medical Unit III ,and diabetic clinic.Out of this 60 diabetic patients were associated in whole period of study, remaining 10 patients were dropped due to poor comlpiance or change in residential place.All the patients were divided in two main groups,groupI and in group II these patients were selected in this study according of inclusion and exclusion criteria.

INCLUSION CRITERIA

• Newly diagnose patients of non Insulin Dependent Diabtes Mellitus.




• Diagnsed patients of diabetes also including having no any history medication.




• Having either sex of age between 30 to 60 years.




• Diagnosed patients who were Non Insulin Depedent Diabetes Mellitus who were treated with Pioglitazone.




• Diagnosed patients who were Non Imsulin Depedent Mellitus, who were treated with drug Glibenclamide.

EXCLUSION CRIRERIA

• Patients suffering from blood pressure.




• Patients suffering from liver disease.




• Patients suffering from cardiac disease.




• Pregnancies and lactating women.




• Patient suffering from renal disorders.




• Patients having serious complications.

MATERIAL:

1. Lacets.




2. Lancet Hlder(Abbots easy touch TM2 lot 03 Asee).




3. Glucometer(Medisense) optilim one touch(Abbotts).




4. Blood glucose nest trpis (IVD for Invitro diagnostic use (Abbott Labortries,Medisense UK Ltd,Abigngdon,Ox14ITR,Masde in UK). Stored between minimum 30?, (4°-30° C) and Maximum 40°C (39°-86°F).




5. Weight Machine Model No 1101 Lot No.312. TANTIATA.

DRUGS

Tab:Daonil 5 mg (Aventis Pharma)

Drug category:Sulphonylurea.

Generic Name: Glibenclamide.

MFGLIC:No.000007 RegistrationNO.000220

MFG Date:0-06

EXP Date:7-10

Lot NO:B230

Tab:piozer (Hilton Pharm) PvtLTd.

Tab:Poizer 15mg

Drug category:Thaiazolinedione.

Generic Name:Pioglitazone Hydrochloride.

MFG LIC: O.000136 Registration No.03270

MFG Date:3-06

EXP Date:3-o9

Lot No:6287

Tab: Poizer (Hilton Pharma)pvt ltd.

PARAMETERS:

Fasting Blood Sugar (FBS).

Random Blood Sugar (RBS).

Weight.

Key words:Diabetes mellitus,Non-insulin diabetes mellitus,Insulin depedent diabetes mellitus, Daonil,poizer,Insulin.

RESULTS:

Table 1

Weight and Blood Sugar level observed on baseline day 0

In group1 and group11

Group 1

Group 11

Pioglitazone n=27

Glibenclamide n=33

Weight

63.37

+ 2.25

¯

62.7

+ 15.56

¯

Fasting Blood Sugar

172.7

+ 13.32

¯

188.42

+ 12.o5

¯

Random Blood Sugar

285.11

+ 15 .532

¯

284.18

+ 17.07

¯

All Values are expressed in Means± SEM.

FIGURE-1 weight and blood sugar levels observed on baseline (day-o)

In table No shpwing the weight (KG’S) and blood sugar (msg/dl0 levels which is observed on baseline (day-0) in both groups 9group: 1 & group11)

Group: 1 Weight in (Kg’s) mean + SEM) IS 63.37±2.25 Fasting blood sugar 172.7±13.32,and Random

blood sugar 285.11±15.32

Group:11

Figure 2: showing the weight and blood sugar levels observed in base line (day-0) in group: 1 and group 11 weight in 9kg’s) its mean values are 63.37,62.7, Fasting blood sugar in (mg/dl) is 172.71, 188.42 Random blood sugar (mg/dl) is 285.11 &284.18.

TABLE: 2

Peroidic Observation In All Parameters Group1

Goup1(Pioglitazon) n=27

P-value

Day-0

Day-45

Day-90

Day-0to45

Day-45-90

Weight

63.37

±2.25

63.63

±2.26

63.63

±2.23

>0.05

(NS)

>0.05

(NS)

Fasting blood sugar

172.7

±13.32

165.04

±8.98

153.37

±7.59

>0.05

(NS)

0.05

(NS)

Randomblood sugar

285.11

±15.32

279.78

±13.63

255.56

±12.65

>0.05

(NS)

>0.05

(NS)

All values are expressed in Mean±SEM .(NS) Non significant.

Showing the periodic observations in all parameters in group 1 (piogiltazone) (n+27) weight P.value (day 0 to day 45)>0.05 (NS). Fasting blood sugar >0.05 (NS) Random blood sugar >0.05 (NS) P.values day 90 weight >0.05 (N.S), FBS>0.05 (N.S) 7RBS >0.05(N.S) NON SIGNIFICANT

FIGURE:2 Showing the periodic observation in all parameters in group 1 on day0 day 45& day-90.Mean values in weight (Kg) is 63.37,63.26,63.63, fbs (mg/dl) 172.7,165.04,153.37,RBS(mg/dl) 285.11,279.78,255.56.

TABLE NO3

Peroidic Observation in All Parameters Group11

Group 11 (Glibenclamide)

N=33

P-value

Day-0

Day-45

Day-90

Day-0 to 45

Day-45 to 90

Weight

62.7

±1.56

65.64

±2.10

64.55

±1.92

>0.05(NS)

0.05(NS0

Fasting blood sugar

188.42

±12.05

168.45

±10.99

140.06

±5.68

>0.05(NS)

>0.05(S)

Random blood sugar

284.18

±17.03

220.12

±13.39

170.94

±5.80

<0.005 (MS)

0.002(MS0

(s) significant, (MS) moderate significant

All values are expressed in Mean±SEM.

Table No3:

Showing the periodic observation in all parameter in goup:11, Group:11 containing drug (Glibenclamide),no of patients (n=33).It’s P-value on day 0 to day 45 on weight >0.05(NS),FBS>0.05(N.S) RBS<0.005 (MS) <0.01- AND DAY 45 TO DAY 90 WEIGHT >0.05 (NS) FBS (0.05) RBS <0.002(M.S0 moderately significant.

Figure 3:Shwing the periodic observations in all parameters in Group 11 weight 62.7,65.64,64.55,FBS (MG/DL) 188.42,168.45 140.06,RBS(mg/dl) 284.18 220.12, 170.94 (on day-0-day 45 to 90).

DISCUSSION:

In Denmark Beck-Nielsenet al,skillman TG (1981) published studies demonstation that glyburide increased he number of receptors on the monocytes of patients with type 11 diabetes mellitus. Some patients were treated with diet and in cobination of second generation sulfonyureas agents Wie. The numbers of insulin receptors all patients were measured before and after the treatment.Intrvenous glucose test shows the persistent impairent of insulin secretion afterthe starting of drug therapy.However those patient who were on drug Pioglitazone some results were obtained of insulin secretion in the impairment in early drug drug therapy.Clinical observations have suggested that the second generation sulfonylureas may exert their effects by potentiating insulin released by other primary stimulators Insulin secreting drug.

According to the study of WilliamC Dukworth et al(1972), aftr the chronic treatment with sulfonylureas it is well documented that plasma insulin levels were decreased in response to oral glucose load. This apparently occures even though glucose tolerance is improved over pre-treatment, levels,present study clearly support that study.

The result og group 11 correlates with the research conducted by Bonnie &Kimmel (2005) produces the same results as FBS reduces from baseline, and at the end of study,with an overall 23.44%,reduction,while with the results showed at the end of study peroid p-value were (p<0,001).

Similarly Michael Alvarsson et al (2003) conducted a similar type of study and the found and overall changes of change of 22.11% in Fbs and 40.88% in Rbs at the end of trial p-value were (p<0.001).

However a study conducted by (Stone &Brown in (2003) didnot match to our results in the parameter of FBS and observer a reduction of 26.22%.

CONCLUSION:

In the light of study discussion it is obiovus the glibenclamide was more effective,tolerable and safer than pioglitzone in a short duration.Diabetes Mellitus is chronic prolong disease for whole life.Poor community can afford it easily,on base of marketing of this drug in pakistan diabetes patients easily go and purchase economically,in fact ,mostly people buy it from pharmacy without dr’s perscription,because pharmacist and patient both of know about this disease.Just like dispirin as analgesic,it is famous anti-diabetic drug in our states as compared of other anti-diabetic drugs.

REFERNCES:

1. Anderson J,Kendall,Perryman.S etal,"Diet and Diabettes" Diabetes 2006,16(3):17-19-




2. Bui H- Type 1 diabetes in childhood-Medicine 2006,3 ,1-3




3. Bernhard –Diabetes-type 11 diabetes mellitus Diabetes care 1995,19(100:12-17-




4. Clark CM-Oral therapyin type11 diabetes-pharmacological properties and clinical use of current use of currently available agents-Diabetes spectrum 1998,11(4):211-221.




5. Carren M.Types of Diabetes mellitus-Diabettes 2006 10 (3),07-




6. David Owerback NJ-Prevalence in diabetes population-Diabetes 1988,02(6):31-32




7. Dale MM,-Treatment of Diabetes mellitus –pharmacology 20035th edition:287-391.




8. Heller SR –Hypoglycemic in diabetes Ketoacidosis and hypoglycemic-Medicine 2006:34(03):102-110.




9. Jawad F Untraveling the mystry of Diabetes’Diabetes 2006;15(3):13-15.




10. Jacobes D-Insulin-Diabetes 1998;6(3);1160126.




11. Lambert and Bingliy-basic facts-medicine 2006,34(6):3-7.




12. Natters M-Ketoacdosis and hyperglycemia-Medicine 2006;34(3):104-106.




13. Power AC-Epidemiology of type11 diabetes Basic facts of diabetes –Diabetes 2005;1(1)7-9




14. Scarlet Oral therapy in type 11 diabetes sulfonylureas 1984;16(10);3-9.




15. Schade DS et al A placebo controlled randomized study of glimepiride in patients of Diabetes mellitus- Diabetes 19998, 38(7);636-641.




16. Warchman and Forouhi-Epidimology of Diabetes- Diabetes basic facts- Medicine 2006 ;34(2);57-60




17. Wheeler Gd- Aaccident dicovery led to the noble prize for canadian reseachers,2005,01-02.




18. WHO Report-Health-Diabetes Mellitus-Defiition and types of Diabetes 2007;1:1-4.