Diabetes Mellitus - Summary

1. DiabetesMellitus - Summary

2. Diabetes Mellitus , or simply, diabetes, is a group of diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin. • Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin. • Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Only 5% of people with diabetes have this form of the disease.

3. Type 2 diabetes is the most common form of diabetes. Millions of Americans have been diagnosed with type 2 diabetes, and many more are unaware they are at high risk. • In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose for energy. • When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can lead to diabetes complications.

4. Diabetes often goes undiagnosed because many of its symptoms seem so harmless. • Recent studies indicate that the early detection of diabetes symptoms and treatment can decrease the chance of developing the complications of diabetes. • The main symptoms across the two main types of diabetes are increased urination (polyuria), thirst (polydipsia) and tiredness

5. Symptoms of Type 1 Diabetes • Frequent urination • Unusual thirst • Extreme hunger • Unusual weight loss • Extreme fatigue and Irritability

6. Symptoms of Type 2 Diabetes • Any of the type 1 symptoms • Frequent infections • Blurred vision • Cuts/bruises that are slow to heal • Tingling/numbness in the hands/feet • Recurring skin, gum, or bladder infections

8. Microvascular Complications of Diabetes • Diabetic retinopathy • Diabetic nephropathy • Diabetic neuropathy

9. Macrovascular Complications of Diabetes • Ischemic heart disease • Cerebrovascular disease • Peripheral vascular disease

10. Diabetes is a common disease, yet every individual needs unique care. We encourage people with diabetes and their families to learn as much as possible about the latest medical therapies and approaches, as well as healthy lifestyle choices. Good communication with a team of experts can help you feel in control and respond to changing needs. • Diabetes can affect every part of the body, fortunately, there are many activities you can incorporate into your daily routine to head off problems before they turn into serious complications.

11. Skin Care • Diabetes can affect every part of the body, including the skin. As many as one third of people with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. In fact, such problems are sometimes the first sign that a person has diabetes. Luckily, most skin conditions can be prevented or easily treated if caught early. • Keep your diabetes well managed. People with high glucose levels tend to have dry skin and less ability to fend off harmful bacteria. Both conditions increase the risk of infection.

12. Foot Care • Inspect your feet every day, and seek care early if you do get a foot injury. Make sure your health care provider checks your feet at least once a year - more often if you have foot problems. Your health care provider should also give you a list and explain the do's and don'ts of foot care. • Most people can prevent any serious foot problem by following some simple steps. So let's begin taking care of your feet today

13. Eye Care There are steps you can take to avoid eye problems. • First and most important, keep your blood sugar levels under tight control.  • Second, bring high blood pressure under control. High blood pressure can make eye problems worse. • Third, quit smoking. • Fourth, see your eye care professional at least once a year for a dilated eye exam.  • Fifth, see your eye care professional if you have problems in your eye

14. Mouth Care Daily Dental Care • The three main steps in fighting gum disease are brushing, flossing, and seeing your dentist regularly. • Brush at least twice a day and floss at least once a day. Ask your dentist or hygienist to show you the correct way to brush and floss. • Reducing Mental Stress

15. Treatment of DM Insulin • There are different types of insulin depending on how quickly they work, when they peak, and how long they last. • Insulin is available in different strengths; the most common is U-100. Types of Insulin • Rapid-acting insulin, such as insulin lispro (Eli Lilly), insulin aspart (Novo Nordisk), or insulin glulisine (sanofi-aventis). • Regular or Short-acting insulin (human) • Intermediate-acting insulin • Long-acting insulin (ultralente). There are also two long-acting insulin analogues: glargine and detemir.

16. Insulin Routines • Insulin is required for people with type 1 diabetes and sometimes necessary for people with type 2 diabetes. • Syringe is the most common form of insulin delivery, but there are other options, including insulin pens and pumps. • Insulin should be injected in the same general area of the body for consistency, but not the exact same place. • Insulin delivery should be timed with meals to effectively process the glucose entering your system.

17. Type 1 DM • People diagnosed with type 1 diabetes usually start with two injections of insulin per day of two different types of insulin and generally progress to three or four injections per day of insulin of different types. The types of insulin used depend on their blood glucose levels. • Studies have shown that three or four injections of insulin a day give the best blood glucose control and can prevent or delay the eye, kidney, and nerve damage caused by diabetes.

18. Type 2 DM • Most people with type 2 diabetes may need one injection per day without any diabetes pills. Some may need a single injection of insulin in the evening (at supper or bedtime) along with diabetes pills. • Sometimes diabetes pills stop working, and people with type 2 diabetes will start with two injections per day of two different types of insulin. They may progress to three or four injections of insulin per day.

19. Other Injectable Medications • Pramlintide • Exenatide Oral Medication • The first treatment for type 2 diabetes blood glucose (sugar) control is often meal planning, weight loss, and exercising. Sometimes these measures are not enough to bring blood glucose levels down near the normal range. The next step is taking a medicine that lowers blood glucose levels.

20. Can Diabetes Pills Help Me? • Only people with type 2 diabetes can use pills to manage their diabetes. These pills work best when used with meal planning and exercise. This way you have three therapies working together to lower your blood glucose levels. • Diabetes pills don't work for everyone. Although most people find that their blood glucose levels go down when they begin taking pills, their blood glucose levels may not go near the normal range.

21. What are the chances that diabetes pills will work for you? Your chances are low if you have had diabetes for more than 10 years or already take more than 20 units of insulin each day. On the other hand, your chances are good if you developed diabetes recently or have needed little or no insulin to keep your blood glucose levels near normal. • Diabetes pills sometimes stop working after a few months or years. The cause is often unknown. This doesn't mean your diabetes is worse. When this happens, oral combination therapy can help.

22. Even if diabetes pills do bring your blood glucose levels near the normal range, you may still need to take insulin if you have a severe infection or need surgery. Pills may not be able to control blood glucose levels during these stressful times when blood glucose levels shoot up. • Also, if you plan to become pregnant, you will need to control your diabetes with diet and exercise or with insulin. It is not safe for pregnant women to take oral diabetes medications.

23. All diabetes pills sold today in the United States are members of six classes of drugs that work in different ways to lower blood glucose levels: • Sulfonylureas like glipizide • Meglitinides like Repaglinide • Biguanides like Metformin • Thiazolidinediones like Rosiglitazone • Alpha-glucosidase inhibitors like Acarbose • Inhibitors of dipeptidyl peptidase 4 (DPP-4 inhibitors) like Sitagliptin

24. Oral combination therapy • Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together. For example, a biguanide and a sulfonylurea may be used together. • Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood glucose control when taking only a single pill does not have the desired effects. • Switching from one single pill to another is not as effective as adding another type of diabetes medicine.

25. Aspirin • Studies have shown that taking a low-dose aspirin every day significantly lowers the risk of heart attacks. • Aspirin can benefit people at high risk of a heart attack, such as those with diabetes and other risk factors such as high blood pressure. It can also help people with diabetes who have had a heart attack or a stroke, or who have heart disease

26. MEDICATIONS FOR INITIAL THERAPY • Our approach — The metabolic abnormalities that characterize type 2 diabetes worsen with age. Early institution of treatment for diabetes, at a time when the A1C is not significantly elevated, is associated with improved glycemic control over time and decreased long-term complications. • Pharmacologic therapy is often not initiated soon enough, resulting in poor glycemic control. In the absence of specific contraindications, we suggest metformin as initial therapy in most patients. We suggest initiating metformin at the time of diabetes diagnosis, along with consultation for lifestyle intervention .

27. For highly motivated patients with A1C near target (ie, <7.5 percent), a three to six month trial of lifestyle modification before initiating metformin is reasonable. • Metformin was chosen for initial therapy because of glycemic efficacy, absence of weight gain and hypoglycemia, general tolerability, and favorable cost. The majority of guidelines recommend metformin as first-line therapy . .

28. Other options for initial therapy in those with contraindications to metformin are available. In the absence of many high-quality head-to-head comparison trials, our suggestions are based upon clinical trial evidence and clinical experience in achieving glycemic targets. • The long-term benefits and risks of using one approach over another are unknown. In patients with contraindications to metformin, we suggest a shorter acting sulfonylurea, such as glipizide. Insulin is also a reasonable option for initial therapy in patients who present with symptomatic or poorly controlled diabetes or in patients in whom it is difficult to distinguish type 1 from type 2 diabetes.

29. In patients who are intolerant of or are not candidates for metformin or sulfonylureas, repaglinide is a reasonable alternative, particularly in a patient with chronic kidney disease at risk for hypoglycemia. • Pioglitazone may also be considered in patients with specific contraindications to metformin and sulfonylureas. However, the risk of heart failure, fractures, and the potential increased risk of bladder cancer raises the concern that the overall risks and cost of pioglitazone may exceed its benefits.

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